“Patients taking fluvoxamine reported steadily improving fatigue and quality-of-life scores over 60 to 90 days, with fewer side effects than those on placebo, they said.

The findings were published on March 30,2026 in Annals of Internal Medicine.

The investigators enrolled 399 adults with fatigue persisting 90 or more days following a confirmed SARS-CoV-2 infection.

The trial was conducted in 22 outpatient medical sites in Brazil between October 2023 and February 2025.

The subjects were randomized to 60-day treatment with fluvoxamine (100 mg twice daily), metformin (750 mg twice daily) or matching placebo.

The study excluded people with diabetes, stroke, Lyme disease or other COVID-19 complications. It also excluded people identified as substance abusers, those with uncontrolled psychiatric conditions and those already being treated with fluvoxamine or metformin.

The primary outcome was the change between baseline and 60-day scores on the Fatigue Severity Scale (FSS), a 9-item self-reported measure of fatigue severity, with higher scores indicating worse fatigue.

The investigators reported that, at day 60, fluvoxamine subjects had achieved a significant reduction in fatigue compared with placebo subjects. And the effect was sustained at day 90.

Fluvoxamine treatment also improved quality-of-life scores, while metformin treatment showed no such benefit.

They reported that adverse events were less frequent with fluvoxamine (20.0%) than with metformin (28.8%) or placebo (29.7%).

The authors concluded, “This study supports the potential benefit of fluvoxamine in people with long COVID and fatigue lasting at least 90 days after acute COVID-19.”

In a large, randomized trial, researchers at Mass General Brigham have found that high-dose vitamin D3 did not reduce COVID-19 infection severity, but may impact long COVID outcomes. Results of the study are published in The Journal of Nutrition.

“There’s been tremendous interest in whether vitamin D supplements can be of benefit in COVID, and this is one of the largest and most rigorous randomized trials on the subject,” said senior author JoAnn Manson, MD, DrPH, of the Mass General Brigham Department of Medicine. “While we didn’t find that high-dose vitamin D reduced COVID severity or hospitalizations, we observed a promising signal for long COVID that merits additional research.”

Vitamin D has been hypothesized to boost immune health, but clinical evidence in the context of COVID-19 has been mixed. The Vitamin D for COVID-19 (VIVID) Trial aimed to provide clarity by rigorously evaluating high-dose vitamin D3 supplementation among newly diagnosed COVID-19 patients and their household contacts. Across the United States and Mongolia, 1,747 adults who had recently tested positive for COVID-19 and 277 household contacts were randomized to receive either daily vitamin D3 (9,600 IU/day for two days followed by 3,200 IU/day) or daily placebo for four weeks. The U.S. trial was conducted from December 2020 to September 2022 while the Mongolia trial ran from September 2021 to April 2022. The median time between the participants’ positive COVID-19 tests and the initiation of vitamin D supplementation or placebo was three days.

Alongside Manson, lead authors Davaasambuu Ganmaa, Kaitlyn Cook and team used stratified randomization and statistical weighting to ensure factors that can affect COVID-19 outcomes (including age, sex, body mass index, race/ethnicity and COVID-19 vaccination status) were balanced between the two groups.

The rate of healthcare utilization (including hospitalizations, in-person or virtual clinic visits, and emergency visits) or death did not differ between the vitamin D and placebo groups over a four-week period. Similarly, no significant differences were found in symptom severity. Taking high-dose vitamin D also didn’t reduce the rate at which household contacts contracted COVID-19.

However, an analysis of the participants who adhered to the vitamin D regimen demonstrated a signal that they were less likely to experience long COVID symptoms at eight weeks than those who took placebo pills. In the vitamin D group, 21% reported at least one persistent symptom, compared to 25% in the placebo group, a difference of borderline statistical significance.

“Long COVID, which can include symptoms of fatigue, shortness of breath, brain fog, other cognitive challenges and more, continues to significantly impact people’s lives,” said Manson. “We hope to conduct further research in larger populations on whether long-term vitamin D supplementation reduces the risks and severity of long COVID.”

Authorship: In addition to Manson and Ganmaa, Mass General Brigham authors include Allison Clar, Michael Rueschman, Aditi Hazra, Howard D. Sesso, Valerie E. Stone, Patricia Copeland and Georgina Friedenberg. Additional authors include Cook, Polyna Khudyakov, Dorjbal Enkhjargal, Tsolmon Bilegtsaikhan, Kenneth H. Mayer, Raji Balasubramanian, Douglas C. Smith, Quanhong Lei, Todd Lee, Emily G. McDonald, Tserenkhuu Enkhtsetseg, Erdenebaatar Sumiya, Yansanjav Narankhuu, Myagmarsuren Erdenetuya, Dalkh Tserendagva, Rikard Landberg, Niclas Roxhed and Susanne Rautiainen.

Disclosures: Roxhed is a founder and shareholder of Capitainer AB, a company commercializing the blood collection devices used in this study. All other authors declare no conflicts of interests.

Funding: The study received anonymous foundation support and philanthropic support from Jon Sabes of Minneapolis, Minn. The authors also acknowledge support from the Tishcon Corporation, which donated the vitamin D and placebo study capsules; Takeda; and Capitainer cards. The authors have not declared a specific grant for this research from any funding agency in the public, commercial or nonprofit sectors.

Paper cited: Ganmaa, D., et al. “A Randomized Trial of Vitamin D Supplementation and COVID-19 Clinical Outcomes and Long COVID: The VIVID Trial.” The Journal of Nutrition. DOI: 10.1016/j.tjnut.2026.101398

The findings were published on March 9, 2026 in the CMAJ/Canadian Medical Association Journal.

“Our findings may reflect improved recognition and treatment of ADHD in adulthood; however, the speed and scale of this growth also raises important questions about how diagnoses are being made, and if this prescribing is always appropriate,” said Dr. Tara Gomes, program director of the Ontario Drug Policy Research Network at St. Michael’s Hospital, Unity Health Toronto and an ICES scientist, Toronto, Ontario.

As background, the researchers noted that, historically, stimulants have been prescribed mainly for pediatric cases of ADHD and some other conditions. But in the past 20 years, ADHD diagnoses and stimulant prescriptions have increased among adults, and data shows that this change accelerated after the start of the pandemic.

“We sought to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and during the pandemic,” the authors said.

The investigators used a regional database to identify monthly rates of new stimulant dispensations among adults in Ontario between January 2016 and June 2024

They found that among 327,053 adults who initiated stimulant therapy, the median age was 31 years and 55.4% were female.

When compared with stimulant prescribing before the COVID-19 pandemic, new adult users during the pandemic were more likely to be aged 25 to 34 years (26.5% v. 32.8%) and female (48.0% v. 59.0%). And the drugs were less likely to be prescribed by psychiatrists (25.5% v. 18.0%).

The rate of new stimulant dispensations rose from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024.

“Many of these findings are consistent with trends in stimulant prescribing observed globally in the post-pandemic era and are likely influenced by greater awareness of adult ADHD and improved access to care following a historical pattern of underdiagnosis of ADHD in adulthood — particularly among women,” said coauthor Dr. Mina Tadrous, associate professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “However, the rising impact of social media influencers on ADHD awareness in young adults, as well as the rapid evolution of virtual health services that support online assessments and treatment, may also be contributing to misdiagnoses and potential harm.”

The authors concluded, “In Ontario, rates of new prescriptions for stimulants dispensed to adults accelerated rapidly during the COVID-19 pandemic. Monitoring and evaluation are needed to ensure appropriateness of use and safeguard against potential harms.”

Vaccination against COVID-19 and influenza are recommended during pregnancy by the World Health Organization (WHO) and Norway, as pregnant women and their newborns have an increased risk of severe outcomes from these diseases. For at-risk groups, the WHO recommends a vaccination target of 75% for both infections.

These findings emphasise the need for more targeted strategies and better integration of vaccinations into routine pre-natal care for pregnant women in Norway, along with comprehensive surveillance of maternal vaccination.

In Norway, the influenza vaccine is provided during the influenza season, while the COVID-19 vaccine is available year-round. Generally, both vaccines are recommended to pregnant women during the second and third trimester. Pregnant women in Norway access these vaccines through self-initiated appointments with healthcare professionals; the influenza vaccine is provided at a cost, while the COVID-19 vaccine is free.

Significant variation in coverage depending on month of delivery and timing during pregnancy

Stecher et al. looked at how many pregnant women received the influenza and COVID-19 vaccines during the 2023/24 influenza season, at what stage of pregnancy they received the vaccine, and whether uptake differed by age group or region.

A total of 53,161 women were included in the study. Researchers drew data from two Norwegian national registries, with the study population comprising all women who delivered in Norway between 1 October 2023 and 30 September 2024, as identified in the Medical Birth Registry Norway (MBRN). The records and birth data from MBRN were then linked to data from the Norwegian Immunisation Registry (SYSVAK).

Despite universal recommendations for vaccination during pregnancy, coverage in the influenza season 2023/24 was low at 29.9% and 12.1% for influenza and COVID-19, respectively, while only 11.4% of pregnant women received both vaccines.

For the influenza vaccine, 22.3% of women were vaccinated in the second or third trimester. Coverage increased from 16.4% in October to 26.4% in November, and levelled off thereafter. It was highest among women delivering in February at 50.8%, declining afterwards. Coverage for the COVID-19 vaccine followed a similar pattern to influenza, with 10.1% of women receiving the vaccine in the second or third trimester.

Low vaccination rates despite high trust in health authorities

There were considerable differences across regions and age groups, despite the population’s high level of trust in health authorities and recommendations, and the authors point to practical and psychological barriers to vaccination. The lowest uptake was among women aged 25 years or younger. Regionally, the Oslo and Vestland counties had the highest vaccination coverage, while the lowest coverage was found in Northern Norway.

Stecher et al. suggest removing financial barriers, improving accessibility, and exploring information sources on vaccines trusted by women to address hesitancy. The authors also cite international evidence supporting the integration of free vaccination into routine pre-natal care, with vaccination coverage for whooping cough among pregnant women improving when the vaccine was introduced into Norway’s maternal immunisation programme.

Similar challenges globally, including limited surveillance systems and inconsistent integration, highlight the importance of coordinated efforts to promote maternal immunisation in Europe and worldwide.

Depression is the most severely impacted, with almost a third fewer diagnoses than expected compared with pre-pandemic trends.

The King’s College London study is the first to evaluate whether diagnosis rates have recovered after emerging from the pandemic. Published today in the British Medical Journal (BMJ), it uses anonymised data from over 29 million people in England.

The pandemic had an unprecedented impact on healthcare systems around the world, leading to abrupt decreases in diagnosis rates for a wide range of diseases.

Of the 19 major conditions analysed, diagnoses of depression were 27.7% lower than expected compared with pre-pandemic trends. Diagnoses were also lower than expected for asthma (16.4%), chronic obstructive pulmonary disease (COPD, 15.8%) and osteoporosis (11.5%).

The study also identified differences in how diagnosis rates recovered across ethnic and socioeconomic groups. While dementia diagnoses recovered to pre-pandemic levels for individuals of white ethnicity and those living in less deprived areas, they remained lower than expected among other ethnic groups and in more deprived communities.

Co-author Professor Sam Norton, Professor of Medical Statistics at King’s College London, said: “The deficits in depression diagnoses were particularly striking and somewhat puzzling. After an initial decrease during the early pandemic, diagnosis rates partially recovered by late 2021, but have declined markedly since 2022. This pattern was most evident among younger adults aged 20 to 39 years, and among individuals of white or mixed ethnicity.

“This is difficult to reconcile with other indicators of mental health need. Disability benefit claims for mental health conditions have increased substantially over the same period, suggesting these declining diagnosis rates may not reflect improving mental health.”

Diagnosis rates may be influenced by increasing pressures on the NHS, meaning it is taking longer for people to be formally diagnosed. It is also possible that more people are accessing mental health support without receiving a formal diagnosis of depression. Following a national drive to expand access to psychological therapies, referrals to NHS Talking Therapies services increased by nearly two-thirds between 2013 and 2024, with self-referrals accounting for almost 70% of all referrals.

The team also suggest that pandemic-related disruption could be behind the fall in diagnoses for asthma, COPD and osteoporosis. Backlogs in diagnostic testing for these conditions during the pandemic is likely to be a key factor, and the NHS has identified this as a priority area for improvement.

Further analysis revealed that chronic kidney disease (CKD) diagnoses have increased by 34.8% compared to expected levels.

Lead author Dr Mark Russell, consultant rheumatologist and epidemiologist at King’s College London, said: “The rise in CKD diagnoses may reflect increased testing and greater awareness following guideline changes and the introduction of new treatments.

“It is also possible that the pandemic itself has contributed to an increase in CKD, either through the direct effects of Covid-19 infection or through delays in diagnosing related conditions such as diabetes.”

The research team used OpenSAFELY, a highly secure and anonymised NHS data platform, to analyse disease trends for 29 million people between April 2016 and November 2024.

Dr Russell added: “This study highlights the incredible health data resources available within the NHS and demonstrates how real-time, anonymised data could be used safely and securely, without any individual patient data ever leaving the NHS system, to transform disease monitoring, enabling earlier identification of inequities and informing how care is delivered.”

Notes to Editors

The OpenSAFELY platform is principally funded by grants from NHS England, the Wellcome Trust, and the Medical Research Council.

The study, led by researchers from Imperial College London, found that of the participants initially hesitant about getting a COVID-19 vaccine, 65% went on to get vaccinated at least once.

The findings offer a novel perspective on the main types of vaccine hesitancy during the COVID-19 pandemic. Their potential to be reversed may help inform the targeting and messaging for future roll-outs of novel vaccines.

While vaccine hesitancy is not a new phenomenon, with WHO naming vaccine hesitancy as one of the top 10 global health threats in 2019 [1], reduced uptake of various vaccines including childhood vaccinations against measles and pertussis (whooping cough), remains a major public health concern.

COVID-19 vaccination roll-out began in the UK on 8^th December 2020, with a phased strategy that prioritised vaccines on the basis of age and clinical need. “We wanted to look at COVID-19 vaccine hesitancy in more depth to identify groups with more persistent forms of hesitancy and their main concerns. Understanding these drivers is critical to address vaccine uptake and better control disease spreads,” explained lead author Professor Marc Chadeau-Hyam from Imperial College London, UK.

Researchers analysed longitudinal survey data from 1.1 million adults (aged 18 and older, 57% female) from the Real-time Assessment of Community Transmission (REACT) Study (at the time of the initial COVID-19 vaccine roll-out between January 2021 and March 2022). They compared vaccine attitudes at enrolment with subsequent vaccination uptake from National Health Service (NHS) vaccination records up to May 7, 2024, to identify categories and drivers of vaccine hesitancy.

During the pandemic, participants were asked whether they had been or intended to get vaccinated. Those who refused the vaccine, or were sceptical about vaccination, were asked about their reasons for hesitancy from a checklist of 23 options as well as a free text option [2].

Vaccine effectiveness and health effects key reasons for hesitancy

Overall, 3.3% (37,982 of 1.1 million) of participants reported some degree of COVID-19 vaccine hesitancy and subsequent vaccination data was available through NHS records linkage for 24,229 (64%) of them. Hesitancy rates declined over time from an initial high of 8% of those surveyed in January 2021, to a low of 1.1% at the start of 2022. There was a small uptick in hesitancy to over 2.2% in February and March 2022 during the Omicron wave (see figure 1 in paper).

The researchers identified eight categories of vaccine hesitancy including concerns about effectiveness and side-effects, perception of low risk from COVID-19 and mistrust of vaccine developers, and fear of vaccines and reactions [3]. Among the hesitant who provided a reason for hesitancy, 41% (12,498 of 30,701) reported concerns around long-term health effects, 39% (11,953) that they wanted to wait to see whether the vaccine worked, and 37% (11,287) that they had concerns about side effects.

Reasons for hesitancy varied across demographic groups with, for example, men more likely than women to report not feeling COVID-19 was a personal risk (18% vs 10%); women more likely to be worried about fertility-related consequences (21% vs 8%), while those aged 74 years or older were more likely to be against vaccines in general compared with 18-24 year olds (12% vs 2.5%).

The analysis of subsequent vaccination behaviour found that the likelihood of remaining unvaccinated was higher for older people, women, people of Black ethnicity, people who were unemployed or living in deprived areas, those with a history of COVID-19, and people with a lower level of education.

Majority of vaccine hesitant individuals got vaccinated

People who reported the most common reasons for hesitancy (i.e., those related to vaccine efficacy or health concerns), were most likely to change their mind and subsequently get vaccinated against COVID-19 (see figure 6 in paper).

In contrast, people expressing hesitancy relating to lack of trust, perception of low personal risk, and general anti-vaccine sentiment were two to three-times less likely to get vaccinated compared to those who did not report these reasons.

“We show that certain types of vaccine hesitancy are more readily addressed than others, for example concerns relating to pregnancy or breastfeeding,” said co-author Professor Helen Ward from Imperial College London and the National Institute for Health and Care Research Imperial Biomedical Research Centre, UK. “Our study suggests that as the vaccine was rolled out, public confidence increased and the original vaccine scepticism was largely overcome.”

According to co-author Professor Paul Elliott from Imperial College London, “What we learned from the COVID-19 experience is the importance of ensuring that people have access to reliable and trusted information so they can make well-informed decisions about their personal health choices. Reliable, easy-to-understand information, for example, on vaccine effectiveness and potential risks, is of particular importance in the case of a public health emergency such as COVID-19, which involved the rapid deployment at-scale of new vaccine technologies.”

The authors acknowledge some limitations of the study, including that NHS vaccine records and self-reported vaccine status showed some inconsistencies, likely reflecting both imperfect recall and imperfect coverage in the NHS data. Additionally, vaccine hesitant respondents were less likely to consent to NHS record linkage, potentially introducing selection bias, which may limit the generalisability of the findings.

Writing in a linked Comment, Professor Silvio Tafuri from the University of Bari Aldo Moro, Bari, Italy (who was not involved with the study) underscored the “valuable contribution” of the study and concluded, “whereas these data reflect the extraordinary setting of SARS-CoV-2 vaccination, it is crucial to ascertain whether similar drivers of hesitancy affect ordinary (ie, routine or seasonal) vaccinations, in order to guide context-specific public health interventions at the micro, meso, and macro levels.”

Postural orthostatic tachycardia syndrome, or POTS, is a condition where the heart beats abnormally fast when changing position from lying down to standing up. Standing up is a challenge for those affected who feel dizzy and would rather sit or lie down, so called orthostatic intolerance. Their hearts may also beat faster than normal at rest and during exertion. Patients experience fatigue and difficulties concentrating, symptoms that are common in long COVID.

Now, researchers at Karolinska Institutet show that POTS occurs in almost a third of patients with severe long COVID. By comparison, less than one per cent of the Swedish population was affected by POTS before the pandemic.

“Previous, smaller studies have shown that there is a connection, but now we can say with certainty that POTS is a very common condition in patients with long COVID. This is valuable knowledge for both healthcare professionals and patients,” says Mikael Björnson, doctoral student at the Department of Medicine, Solna, Karolinska Institutet.

Women in their early middle age

According to the researchers, this study is the largest and most detailed to date on the link between POTS and long COVID. A total of 467 patients with severe long COVID who had not been hospitalised for COVID-19 were examined. Ninety-one per cent were middle-aged women who were essentially healthy and physically active before they developed long COVID. At an average of twelve months after falling ill, they underwent physical tests and completed forms about their health. Those who showed signs of possible POTS also received an assessment from a cardiologist after further, targeted tests.

Thirty-one per cent of participants received a POTS diagnosis, while 27 per cent had symptoms but did not meet the criteria for diagnosis. The remaining 42 per cent had no symptoms of POTS. Patients with a diagnosis had significantly higher heart rates during walking tests and reported lower health-related quality of life.

POTS can be treated

“It is important to know that POTS can be detected with inexpensive, simple tests that are available at all levels of healthcare. For those who receive a diagnosis, there are treatments that can alleviate symptoms and improve quality of life,” says Judith Bruchfeld, associate professor at Karolinska Institutet, senior consultant in infectious diseases at Karolinska University Hospital and head of the study.

The researchers now recommend that patients with long COVID who experience a significant increase in heart rate when changing position from lying down to standing, as well as during exertion, and who experience symptoms such as dizziness, brain fog and pronounced fatigue, are investigated for POTS.

The next step in the research is a four- and five-year follow-up of the patient group, and in addition, patients with COVID-19 who have been treated in hospital. The researchers will investigate recovery and functional level over time.

The study is a collaboration with Karolinska University Hospital and has been funded by the Swedish Research Council and the Swedish Heart-Lung Foundation.

Publication: “Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID”. Björnson M, Wijnbladh K, Törnberg A, Svensson-Raskh A, Svensson A, Ståhlberg M, Runold M, Fedorowski A, Nygren Bonnier M, Bruchfeld J. Circulation: Arrhythmia and Electrophysiology, online 30 September 2025, doi: 10.1161/CIRCEP.124.013629.

The study analysed data from almost 500 patients hospitalised with COVID-19 across six countries. Patients who inhaled heparin were half as likely to require ventilation and had a significantly lower risk of dying compared with those receiving standard care.

Heparin, a drug traditionally injected to treat blood clots, was tested in this study in an inhaled form, targeting the lungs directly. As well as acting as an anticoagulant, heparin has anti-inflammatory and pan-antiviral properties. Earlier research results showed breathing and oxygen levels improved in COVID-19 patients after they inhaled a course of heparin.

The researchers believe the drug could also be useful in fighting other serious respiratory infections such as pneumonia.

Professor Clive Page, Emeritus Professor of Pharmacology at King’s who co-led the international study with ANU’s Professor van Haren, said: “Inhaled heparin is anti-viral, anti-inflammatory and anti-coagulant. There’s no other drug that has that unique combination. We know it’s only a matter of time until the next pandemic, and there are still COVID-19 patients who get very sick. This is a great weapon to have up our sleeve.”

While the findings highlight the potential of inhaled heparin, further development is required before the treatment can be routinely adopted. The researchers believe the drug could also be useful in fighting other serious respiratory infections such as pneumonia, which can be caused by a range of viruses and bacteria.

According to Professor van Haren, the drug would also be helpful for those with a compromised immune system, such as cancer patients, when they experience a respiratory infection.

Professor Frank van Haren, lead author, ANU and Director of the Intensive Care Unit at the St George Hospital in Sydney, said: “It doesn’t matter what kind of respiratory infection the patient is dealing with, the drug – when inhaled – will stop it from infecting the patient and from damaging the lungs. We’re aiming to conduct another trial in Europe to confirm its effectiveness in fighting other common respiratory infections such as influenza and RSV. And because it’s inexpensive, it’s much more accessible for those from low-income countries”

The researchers are now also developing an improved formulation of heparin, specifically designed to be given by inhalation.

The research is published in eClinicalMedicine and simultaneously presented of at the European Respiratory Society (ERS) International Congress in Amsterdam on Sunday 28 September, the leading annual gathering for respiratory research.

Alcohol-induced deaths have been increasing over the past two decades. Particularly concering are increases between 2019 and 2021, when the population was under significant stress from isolation due to the COVID-19 pandemic, and people with alcohol-use disorders were less able to access treatment. Quantifying mortality trends and determining whether alcohol-induced deaths have returned to pre-pandemic levels is essential for understanding long-term temporal patterns and dynamics. To examine these trends, the authors of this study analyzed data from the Centers for Disease Control and Prevention’s National Vital Statistics System, focusing on 14 specific alcohol-induced causes of death.

Wong et al. found that rates of alcohol-induced deaths in the United States nearly doubled between 1999 and 2024, reaching their highest level in 2021. Most deaths are due to alcoholic liver disease and, to a lesser degree, alcohol-related mental and behavioral disorders. The largest overall increase in alcohol-induced mortality across all race, sex, age groups occurred in 2021 when fatalities peaked at 54,258 deaths overall. By 2024, fatalities had declined, but the average alcohol-induced mortality rate across U.S. counties remained approximately 25% higher than in 2019.

American Indian/Alaska Native populations (AIAN) remain the most affected, with male AIAN rates of alcohol-induced mortality three times higher than that of white males, and female AIAN mortality rates four times higher than that of white females, over the entire period of investigation.

The largest increase by demographic was among females aged 25-34, which rose from 0.9 deaths per 100,000 in 1999 to 3.2 per 100,000 in 2024 — a 255 percent increase. The second largest increase was in males aged 25-34, from 2.3 fatalities per 100,000 in 1999 to 6.5 in 2024 — a 188 percent increase. As deaths from chronic diseases related to alcohol use, such as certain cancers or cardiovascular events, were not included in this study, the overall fatality counts may be underestimated. These findings underscore the critical need for targeted policies to reduce excessive alcohol consumption and improve access to treatment for those who need it most.

Senior author Maria R D’Orsogna adds: “The rapid rise of alcohol-induced deaths among women is particularly concerning. Although men still die at higher rates, the gender gap appears to be closing. Notably, for the population aged 25-34, the male-to-female mortality ratio has decreased from three-to-one in 1999 to two-to-one in 2024.”

The authors conclude: “The rise in alcohol-induced mortality is widespread and affects the entire country, with particularly large surges arising during the COVID-19 pandemic. In the early months of the pandemic, alcohol-induced deaths among AIAN males increased by as much as 40% in a single month and remained unusually high for nearly four years. Similar trends were observed among AIAN and Black females, whose alcohol-induced death rates rose by over 30% in one month.”

PLOS Global Public Health: https://plos.io/4nra5UI

Citation: Wong T, Böttcher L, Chou T, D’Orsogna MR (2025) Alcohol-induced deaths in the United States across age, race, gender, geography, and the COVID-19 pandemic. PLOS Glob Public Health 5(9): e0004623. https://doi.org/10.1371/journal.pgph.0004623

Author Countries: United States

Funding: This work was supported by the ARO through a grant [W911NF-23-1-0129 to LB and MRD], and by the U.S. National Science Foundation through a grant [OAC-2320846 to MRD]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The international research team used an electronic health database in the United States, TriNetX, to investigate the link between COVID-19 and so-called type-2 inflammatory diseases, a group of chronic conditions in which the immune system overreacts to allergens or infections.

The researchers compared 973,794 people who had had COVID-19 with 691,270 people who had been vaccinated against the SARS-CoV-2 virus and 4,388,409 healthy controls with no documented infection or vaccination.

Inflammation in the airways

The results are presented in The Journal of Allergy and Clinical Immunology. People who had had COVID-19 had a 66 per cent higher risk of developing asthma, a 74 per cent higher risk of chronic sinusitis and a 27 per cent higher risk of hay fever compared with healthy controls. However, no increased risk was seen for the skin disease atopic eczema or for eosinophilic oesophagitis, an inflammation of the oesophagus.

“Our results suggest that COVID-19 can trigger type-2 inflammation in the airways, but not in other organs,” says Philip Curman, a physician and researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, Sweden, who led the research.

Vaccination against the virus had the opposite effect. The risk of asthma was 32 per cent lower among vaccinated individuals compared with healthy unvaccinated individuals. The risk of sinusitis and hay fever was also slightly lower.

More than twice the risk

When people who had had COVID-19 were compared with vaccinated individuals, an even clearer effect was seen. Infected individuals had more than twice the risk of developing asthma or chronic sinusitis and a 40 per cent higher risk of developing hay fever compared with those who had been vaccinated.

“It is interesting to see that vaccination not only protects against the infection itself, but also appears to provide good protection against certain respiratory complications,” says Philip Curman.

The study is retrospective, i.e. based on data that has already been collected. This means that the researchers cannot draw any firm conclusions about causal links. Another limitation is that some infections may have gone undiagnosed, especially if they were detected through self-testing.

The research was conducted in close collaboration with the University of Lübeck and the Lübeck Institute of Experimental Dermatology in Germany, the Technical University of Madrid in Spain and Bar-Ilan University in Israel. It was mainly funded by the German Research Foundation (Deutsche Forschungsgemeinschaft), Region Stockholm and Karolinska Institutet. Two researchers received travel grants from TriNetX, which provides the database used in the study, and one of the authors is employed by the company.

Publication: “COVID-19 infection raises respiratory type-2 inflammatory disease risk, whereas vaccination is protective”, Henning Olbrich, Sophie L Preuß, Khalaf Kridin, Gema Hernandez, Diamant Thaçi, Ralf J Ludwig, Philip Curman, The Journal of Allergy and Clinical Immunology, online 12 August 2025, doi: 10.1016/j.jaci.2025.07.030.

The National Institute on Aging-funded study offers valuable insights into the role of telehealth in home healthcare, a rapidly expanding sector. As the population ages and seeks alternatives to nursing homes, this field is expected to grow by 10 percent annually.

The survey’s findings spotlight the urgent need for policy considerations from the Centers for Medicare & Medicaid Services, which has not reimbursed home healthcare agencies for telehealth services, even during the pandemic.

Conducted from October 2023 to November 2024, the study queried 791 home healthcare agencies, with a response rate of 37 percent. It focused on businesses that served a significant portion of dementia patients, averaging 33 percent of their clientele. The results revealed that only 23 percent of home healthcare agencies had adopted telehealth by 2019. However, that number surged to 65 percent by 2021, primarily driven by the implementation of virtual visits to mitigate disease transmission and address staffing and equipment shortages during the COVID-19 pandemic. Nevertheless, 19 percent of adopting agencies had discontinued telehealth by 2024. The reasons cited for this included a lack of Medicare reimbursement and concerns about the suitability of telehealth for the home healthcare of older, less tech-savvy patients.

“This study is the first to provide a comprehensive national picture of telehealth’s trajectory in home healthcare,” said corresponding author Dana B. Mukamel, UC Irvine Distinguished Professor of medicine. “Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets.”

The survey revealed that 33 percent of home healthcare agencies never adopted telehealth, even during the pandemic, often believing it inappropriate for the sector’s hands-on model. Virtual visits saw the largest adoption spike in 2020 (21.1 percent), but 22 percent of users had discontinued them by about 2022. Among this group, 60 percent echoed concerns about patient suitability, while 55 percent highlighted costs and lack of reimbursement. Remote patient monitoring and client surveys saw smaller adoption increases and similar discontinuation trends.

These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic, with 23 percent adoption by 2019. The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.

As the Centers for Medicare & Medicaid Services considers telehealth reimbursement policies, the study calls for rigorous evaluations of telehealth’s cost-effectiveness and patient outcomes. With home healthcare expenditures projected to grow significantly, policies supporting telehealth could enhance care delivery and manage costs. The results also underscore the need for future research to assess whether these trends hold across all home healthcare agencies, given the study’s focus on dementia-serving businesses.

The study, co-authored by experts from UC Irvine, UCLA, Brown University, the University of Minnesota and other institutions, is a critical resource for policymakers navigating the future of home healthcare. As the nation grapples with an aging population and rising care demands, understanding telehealth’s role could shape effective, sustainable solutions.

About the University of California, Irvine: Founded in 1965, UC Irvine is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UC Irvine has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UC Irvine, visit www.uci.edu.

“We anticipated some level of association between excess weight and post-COVID-19 symptoms based on prior evidence linking obesity with worse COVID-19 long-term outcomes.

“What stood out was the consistency of findings across a wide range of neurological and neuropsychiatric symptoms — including memory problems, depression, sleep disturbances, and sensory impairments. While we did not perform subgroup analyses by ethnicity, the inclusion of studies from 23 different countries suggests the global relevance of our findings,” Ms Ronca said.

Excess weight has been associated with the development of long COVID or Post-COVID-19 condition, as proposed by the World Health Organization.

While the mechanics behind the negative association between excess weight and long COVID is yet to be confirmed, Ms Ronca noted that it could be linked to an exaggerated inflammatory response predisposed by excess fatty tissue in the body. Moreover, fat tissue helps the SARS-CoV-2 virus enter the body and may store the virus, allowing it to spread.

Some studies have shown that long COVID symptoms could persist for 12 months or longer, necessitating the need for long-term medical interventions.

“These symptoms of long COVID can significantly impact quality of life and may linger for months. As we face overlapping public health challenges in the post-pandemic era, such as long COVID, mental health issues, and rising rates of obesity, it’s essential to develop personalised and multidisciplinary care strategies to better support affected individuals,” Ms Ronca said.

“Physicians and healthcare professionals should be aware that individuals with excess weight may be at higher risk of experiencing long-term neurological and mental health symptoms following COVID-19. This population may require closer monitoring and multidisciplinary care approaches. Integrating concomitant weight management, mental health support, and rehabilitation into post-COVID care plans could improve patient outcomes.”

Ms Ronca initiated the study at the University of Brasília, with analysis carried out and completed at ECU.