The number of cardiac deaths exceeded expectations during the years of the COVID pandemic, according to data from a single state.
A sharp increase was reported for deaths at home in particular.
The observed excess mortality is thought to be related to the lower cardiovascular procedural volumes previously reported.
Cardiovascular mortality has been higher than usual since the COVID-19 pandemic, data from Massachusetts suggested.
Records from the state showed that the observed number of cardiac deaths in 2020 was 16% higher than expected, 17% higher than expected in 2021 and 2022, and 6% higher than expected in 2023, reported Jason Wasfy, MD, MPhil, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.
"In this population-based cohort study of Massachusetts decedents, we found cardiac deaths increased substantially starting in 2020, with exaggerated seasonal patterns and increases in deaths at home," the authors wrote in JAMA Network Openopens in a new tab or window. "The U.S. increase has persisted well past the early pandemic; as of mid-2024, some monthly rates remain elevated."
Wasfy and colleagues cited the changes in where and when deaths take place to reconcile their findings with other studies showing reduced admissions for cardiac emergencies in various countries in the aftermath of COVID-19.
Notably, a report from March 2020 -- arguably the first month of the pandemic in the U.S. -- had shown major disruptions to cardiovascular care, with cath lab activations for ST-segment elevation myocardial infarction down around 40%opens in a new tab or window in high-volume centers.
The present study suggests that these changes did not reflect real shifts in cardiac event rates, but rather the use of healthcare that can be captured by acute hospital data.
"Lots of reports have shown that there have been fewer heart attacks in hospitals since 2020 -- but something seems to be missing from that data. We now show that if you account for deaths at home, cardiac deaths are going up and have stayed up for years," said Wasfy in a press release.
While the study was unable to explain the excess cardiac deaths, the authors suggested hospital and outpatient facility limitations and hospital avoidance as potential causes.
Of note, 2021 was the year that COVID-19 vaccines were made available to most Americans. Thereafter came a period of recoveryopens in a new tab or window across cardiac services, before the huge spike in cases from the Omicron variant threw another wrench in the system starting at the end of that year.
For the present study, Wasfy and colleagues used Massachusetts state death certificate records from January 2014 to July 2024. U.S. Census data were used to estimate age- and sex-adjusted expected monthly cardiac death rates. They included 127,746 people (mean age 77 years, 47.9% women).
Wasfy's group reported that from 2020 to 2022, cardiac mortality rates were higher than expected for deaths at home; deaths in hospitals were more than expected from 2020 to 2023.
The nature of the death records used left room for possible misclassification of cause of death, the investigators acknowledged.
"Further work is needed to improve the resilience of cardiac care during future pandemics," Wasfy and colleagues wrote.
Disclosures
The study was supported by an NIH grant.
Wasfy had no disclosures. A co-author reported receiving consulting fees from Cambridge Health Alliance, Brandeis University, and Alta Med, and giving keynote speeches for Invitx and the University of South Carolina.
The CDC now advises shared clinical decision-making when it comes to COVID-19 shots for kids, a narrowing of its previous broad recommendation.
The change follows an announcementopens in a new tab or window by HHS Secretary Robert F. Kennedy Jr. earlier this week that the CDC would no longer recommend COVID shots for kids and pregnant women.
Late Thursday, the CDC updated its childhood immunization scheduleopens in a new tab or window to reflect that for kids ages 6 months to 17 years who aren't moderately or severely immunocompromised, the decision to vaccinate should be made via a discussion between parents and healthcare providers.
"Where the parent presents with a desire for their child to be vaccinated, children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a healthcare provider and personal preference and circumstances," the recommendationopens in a new tab or window now states.
Previouslyopens in a new tab or window, language about shared decision-making was not included and it was recommended that all children 6 months and older should receive the vaccine. The rest of the updated recommendations, stratified by age, remain largely the same. However, recommendations for children who are immunocompromised were moved up from a "special situations" section, into the main recommendation section.
The changes appear to maintain the same primary series for the youngest kids ages 6 months to 4 years -- two doses of the Moderna vaccine or three doses of the Pfizer vaccine.
The move also appears to ensure that health insurers will still be required to cover COVID shots for kids.
Nonetheless, COVID shots have not been popular among young patients. COVID vaccination coverage for kids remains low, at 13% for this past season among those ages 6 months to 17 years, according to CDC dataopens in a new tab or window. When looking at the youngest kids (6 months to 4 years), the percentage falls even lower, to just 5.6%.
As of Friday morning, there were no changes to the adult immunization scheduleopens in a new tab or window pertaining to the COVID vaccine. Last week, FDA Commissioner Marty Makary, MD, MPH, and Center for Biologics Evaluation and Research Director Vinay Prasad, MD, MPH, announced changesopens in a new tab or window to the way COVID shots would be approved by the agency -- allowing immunogenicity endpoints for high-risk groups, while calling for randomized controlled trials for those at lower risk.
As for pregnancy, a "medical conditions" table now shows "no recommendationopens in a new tab or window" for pregnancy, whereas it was previously recommended. However, as of Friday morning, a CDC websiteopens in a new tab or window pertaining to shots for pregnant women continued to state that "everyone ages 6 months and older is recommended to get the updated COVID-19 vaccine, including if you are pregnant, breastfeeding a baby, trying to get pregnant now, or might become pregnant in the future."
It's not known if the CDC's Advisory Committee on Immunization Practices (ACIP), which is tasked with evaluating vaccination data and making recommendations to the agency, weighed in on recent changes. It is set to meetopens in a new tab or window at the end of June, and at its last meeting in April, members considered switchingopens in a new tab or window to a risk-based strategy for COVID vaccination.
Susan Kressly, MD, president of the American Academy of Pediatrics, said in a statement that the organization is "relieved" to see that CDC "updated its schedules for child and adolescent immunizations to allow families to maintain the choice to immunize their children against COVID in consultation with their doctor."
Kressly acknowledged that including the vaccine on the schedule means it will be covered by insurance. "However," she said, "the deeply flawed process to reach the recommendation raises serious concerns about the stability of the nation's immunization infrastructure and commitment by federal leaders to make sure families can access critical immunizations, whether for COVID or other infectious diseases."
The results of a chromosome test on Olympic gold medalist Imane Khelif at the World Boxing Championships in March 2023 confirm the Algerian boxer is, as many have suspected, a biological male.
In 2023, Khelif was disqualified by the International Boxing Association (IBA) for “failing gender eligibility tests.”
The leaked medical report, first published by 3 Wire Sports on Sunday, showed Khelif’s DNA showed “markers with male karyotypes.”
A separate medical report in June 2023 found that Khelif was born with a deficiency in his sexual organs known as “5-alpha reductase type-2,” showing XY chromosomes, internal testes and a “micropenis.”
The results of a hormone test showed that Khelif had a “male-type testosterone level of 14.7.” In females, testosterone does not exceed the level of 3.
According to the National Library of Medicine, many people with 5-alpha reductase are “assigned female at birth,” but are in fact, “genetically male.”
Despite this, Khelif was deemed eligible to compete at the Paris 2024 Summer Olympics, where he “won” the women’s boxing gold medal representing Algeria.
World Boxing on Friday declared that in the future, Khelif will need to undergo sex screening to be eligible for any further boxing matches against women.
Khelief had previously expressed interest in competing at the 2028 Los Angeles Olympics.
World Boxing, which is set to run testing for the Los Angeles Games, requires any person over 18 required to undergo PCR testing to determine their sex. The tests will reportedly be “conducted by nasal/mouth swab, saliva or blood.”
In a letter to the Algerian Boxing Federation, World Boxing stated that Khelif will not be able “to compete in the female category at the Eindhoven Box Cup or any World Boxing event” until he undergoes the sex testing.
“Imane Khelif may not participate in the female category at the Eindhoven Box Cup, 5-10 June 2025 and any World Boxing event until Imane Khelif undergoes genetic sex screening in accordance with World Boxing’s rules and testing procedures,” the letter read.
“To all the people that insisted Imane Khelif was a woman because his passport said so, you were wrong. We were right. Sincerely, People with functioning eyes and a shred of honesty,” wrote women’s sports advocate Riley Gaines on X.
Author JK Rowling posted on X that Khelif’s ban from boxing is “a win for women because they won’t be battered to death in the ring by men.”
“I never said and never believed Khelif was trans. I knew* he was a man. The gender activists who created a political climate in which sex testing was seen as ‘bigoted’ are as culpable as the IOC for the travesty that ensued. *via a highly credible source who saw his test results,” Rowling wrote.
Broadcaster Piers Morgan also weighed in on X: “The biology-denying woke brigade abused and shamed me for saying it was outrageous and dangerous for Khelif to be beating up women at the Olympics. I’m ready for their apology, but won’t hold my breath.”
Doctors and residents across China continue to report more infections and deaths as the latest wave of COVID-19 continues, portraying a far more severe situation than the Chinese regime is letting on.
Schools in various provinces are reportedly suspending classes and placing students in quarantine, leading to growing concerns among the public of a return of lockdowns, according to information provided to the Chinese language version of The Epoch Times and on social media.
A “home quarantine notice”—issued by a primary school in Guangzhou and circulated by Chinese netizens on China’s TikTok equivalent, Douyin, before it was posted to social media platform X on May 26 before CCP censors could delete it—has attracted widespread attention.
The notice said that a third grade student was ordered to undergo quarantine for seven days after being diagnosed with COVID-19. After the quarantine period, health certificates from a clinic and community health service agency were required for the student to return to school.
Schools in Shaanxi and Jiangsu also suspended classes after some students exhibited fevers, which were suspected to be COVID-19 infections.
The Chinese communist regime’s official data show that the COVID-19 infection rate doubled in April, with 168,507 cases, including 340 severe cases and nine deaths. The Chinese Center for Disease Control and Prevention (China CDC) said that infection rates in China’s southern provinces were higher than those in the north.
Chinese state media Xinhua reported on May 28 that, according to health officials, the upward trend of COVID-19 infections has slowed, and in most provinces the epidemic has reached a peak or is on a downward trend.
However, residents across the country told The Epoch Times that the situation is far worse and that official data continue to not match their lived experience.
Because of the CCP’s history of covering up information and publishing unreliable data, including the underreporting of COVID-19 infections and related deaths since early 2020, accounts from local medical doctors and residents can offer valuable information for understanding the situation on the ground in the totalitarian country.
Kang Hong, a doctor at a clinic in Guangzhou city in China’s south who used a pseudonym for safety concerns, told The Epoch Times on May 29 that most of those infected with COVID-19 in this wave have been adults, although it has also affected children.
“Their symptoms are far more severe than the common cold,” including the white-lung symptom often seen in COVID-19 patients, he said.
Kang said that most patients came to the clinic for cold symptoms and fevers. They are not being tested for COVID-19 “because hospitals in China had not conducted large-scale nucleic acid testing for a long time because it was worried about causing social panic,” he said.
Many patients are also unwilling to take a COVID-19 test, Kang said, “because they know they are infected with the COVID-19 [based on their symptoms] and were unwilling to spend more than 100 yuan [about $13.90] for testing.”
He said that a doctor in a tertiary hospital in Guangzhou, where his daughter works, has died from COVID-19 in recent days. “It’s a senior doctor who only got tested when his symptoms became serious, and the result was COVID-19,” Kang said.
Although COVID-19 infections have increased, the local health bureau has told doctors that they do not need to report confirmed cases, he said.
Mr. Li, a resident of Guangzhou city who gave only his last name out of safety concerns, told The Epoch Times that there are many people around him who have had cold-like symptoms recently, including his whole family. Li said these people were diagnosed with COVID-19 several times before, and they believe that their symptoms are another round of COVID-19.
Mr. Guo, a resident in the adjacent Shenzhen city, told The Epoch Times that during the May Day holiday (May 1 to May 4), many people traveled and started to show cold symptoms that were likely those of COVID-19.
Meanwhile, residents in northern China also reported a spike in COVID-19 infections.
Liu Kun, owner of a private clinic in Hohhot city in Inner Mongolia who gave a pseudonym for safety concerns, told The Epoch Times on May 30 that COVID-19 infections are ongoing, “with many experiencing symptoms of coughing, sputum, vomiting, and diarrhea.”
He said there are many patients whose “symptoms last for a long time—some even for months.” He predicted that based on the characteristics of this infectious disease, “there may be an explosive growth in infections in June and July.”
Mr. Xu, a resident in Benxi city in Liaoning Province who gave only his surname out of safety concerns, told The Epoch Times that some of his friends and relatives have recently caught colds.
“We have already realized that it may be COVID-19 caused by a mutated virus,“ he said. ”The symptoms have been dragging on and not getting better. It cannot be cured by medicine at all.”
Xu said there have been sudden deaths, especially concentrated in people in their 40s and 50s.
The infections have also been rapidly spreading in Shanxi Province, Mr. Luo, a resident of Changzhi city who gave only his surname, told The Epoch Times. “My family members—including my wife, daughter, son-in-law, and granddaughter—have all been infected,” he said.
Fear of Zero-COVID Restrictions
The school suspensions and quarantines have heightened public concern that the regime’s draconian zero-COVID restrictions employed from 2020 to the end of 2022—during which communities were locked down, mass testing was mandatory, travel was restricted, and residents were forcefully sent to quarantine centers—could make a comeback.
Dr. Jonathan Liu, director of Liu’s Wisdom Healing Centre and a professor at Canada Public College, told The Epoch Times on May 30 that although mainland China is experiencing another wave of COVID-19 infections, the official data haven’t indicated a serious spread that requires the lockdown of cities.
“Following the continuing strategy of concealment, the Chinese regime does not want to shut down the cities or implement the zero-COVID policy at the moment because that will seriously affect its economic development. Now, stimulating economic development is the regime’s top priority,” Liu said.
Sean Lin, assistant professor in the Biomedical Science Department at Feitian College and a former U.S. army microbiologist, shared a similar assessment.
“The authorities won’t immediately adopt the lockdown measure because they also know that if they implement the strict zero-COVID policy, it will cause a huge backlash from the public,” Lin told The Epoch Times on May 30.
“So the government is now building mobile cabin hospitals or temporary isolation facilities in various regions to quietly take people away. There may not be major changes in policy announced to the public.”
The Chinese language edition of The Epoch Times reported earlier this year that, according to insiders in some parts of China, local governments were building large-scale mobile cabin hospitals to quarantine patients with respiratory infections, including COVID-19, such as in Urumqi in the Xinjiang region and in several provinces.
Lin said that some places may have adopted measures to let people stay at home for quarantine, “but it will not turn into a large-scale policy unless the regime is unstable and the authorities have to take such measures.”
The China CDC has yet to release its COVID-19 data for May, but it did update its weekly influenza report, in which the number of infections had increased significantly in the week.
According to the weekly influenza report for epidemiological week 21 (May 19 to May 25), released on May 29, a total of eight influenza-like outbreaks have been reported nationwide. In comparison, only one influenza-like outbreak was reported nationwide in week 20, and no influenza-like outbreaks were reported in week 19.
Lin said that the authorities continue to cover up real COVID-19 data in China.
“The people do not know the real situation and the severity of the wave of outbreak, especially the severity rate and mortality rate. The authorities don’t tell the people,” he said.
Lin said that China’s situation is more complicated and severe, because “it involves multiple respiratory pathogens co-circulating and co-infections, with three or four respiratory pathogens infecting at the same time, not just this NB.1.8.1 strain.”
“But the officials have not revealed the real situation, so I think it is difficult for the international community to understand,” he said.
NB.1.8.1
Chinese health authorities announced on May 23 that Omicron variant NB.1.8.1 is currently the primary variant spreading across China, as detection of the variant increased in the international community.
NB.1.8.1 is a sixth-generation sub-branch of the XDV variant.
“The current data does not show that the NB1.8.1 variant has a significant breakthrough in pathogenicity, but it has an almost 1.8-fold improvement in immune escape capability. If it replaces the previous dominant variant that caused COVID-19, it’s because its transmission ability is enhanced,” Lin told The Epoch Times.
He pointed out that new COVID-19 variants have frequently emerged in the past three years.
“Often new strains quickly replace old ones to be the dominant one,“ Lin said. ”This has become routine.”
The World Health Organization (WHO) has classified NB1.8.1 as a “variant under monitoring,” which means that it’s on “a watchlist,” Lin said.
“At present, the international community does not regard this variant as worthy of special attention,” he said.
As the wave of infections in China continues, neighboring Asian countries and the United States have reported COVID-19 cases caused by NB1.8.1, including in international travelers at airports.
However, Lin said there is no sign of a ban of travelers or flights from China by other countries “because the WHO does not have accurate data from China.”
“According to the current monitoring of countries around the world, there has not been a rapid, large-scale increase in infections like in the one in 2020,” he said.
Lin said that because the Chinese regime does not reveal true data, “it’s not possible to track virus spreading routes.”
“This also brings about a greater danger,” he said. “China often covers up many things until they can no longer be covered up. When they come out, the situation is already quite serious and may be out of control. This is actually the biggest concern.”
Merck has held talks to buy Swiss biotech MoonLake Immunotherapeutics for more than $3 billion, the Financial Times reported on Monday, citing three people familiar with the matter.
MoonLake's shares rose 19% in extended trading.
Merck submitted a nonbinding offer for MoonLake earlier this year, according to the report, which added that the initial approach was rejected but talks could be revived.
Merck's approach for MoonLake ahead of late-stage clinical data for its flagship drug puts the biotech on a strong footing to get sold, the report said.
There was no guarantee a deal would happen and there was a possibility that other buyers would emerge, the FT reported.
Merck and MoonLake did not immediately respond to Reuters requests for comment.
Merck has relied on its best-seller Keytruda to fuel its growth for years, but the drug's patents will begin to expire in 2028. It has also been seeing declining revenue in China from its Gardasil vaccine.
The FDA on June 2launcheda generative artificial intelligence tool agencywide to improve internal workflows and staff efficiency.
Four things to know.
1. The AI tool, Elsa, is currently being used to speed up the review of clinical trial protocols, reduce the time needed to analyze scientific data and identify the agency’s most urgent inspection priorities.
2. Elsa can quickly summarize adverse events to help assess product safety, perform quick label comparisons and generate code for creating internal FDA databases.
“As we learn how employees are using the tool, our development team will be able to add capabilities and grow with the needs of employees and the agency,” FDA Chief AI Officer Jeremy Walsh said in a June 2 news release.
3. The tool operates within GovCloud, a secure Cloud platform used by federal agencies to manage sensitive data. It is powered by a large language model but does not train on any data submitted by drug manufacturers, device makers or other regulated industry entities.
4. The rollout comes after a successful pilot and precedes a June 30 deadline set by FDA Commissioner Martin Makary, MD, to implement the tool agencywide.
Civilization is fragile. Countless social and commercial interactions build civilization. In one of his most essential essays,“Individualism: True and False,”F. A. Hayek warns, “While it may not be difficult to destroy the spontaneous formations which are the indispensable bases of a free civilization, it may be beyond our power deliberately to reconstruct such a civilization once these foundations are destroyed.”
Today, an alarming number of people see a collapse as a good thing. Some deeply pessimistic brokenists view our institutions as beyond repair, making a restart preferable. Some radical activists desire the collapse of Western civilization.
Hayek might say, be careful what you wish for; few will escape the carnage that a collapse in civilization would bring.
If you are concerned about Hayek’s warning, then Alexandra Hudson’s superb book The Soul of Civility is part of the educational corrective.
I write educational corrective because Hudson would argue that if our institutions are failing, it’s because we are making bad moral choices. We can and must do better, not only for ourselves but for the sake of humanity. Hudson writes, “We can’t change society, but we can change ourselves and how we operate in the world around us. And if enough of us decide to change ourselves, we might be able to change the world we live in, too.” This is not a call to elect better leaders or align with a tribal identity.
Civility, Hudson informs us, “is the basic respect we are owed by virtue of our shared dignity and equal moral worth as human beings.” She continues, “We owe this to others regardless of who they are, what they look like, where they are from, whether or not we like them, and whether or not they can do anything for us.”
Drawing on the work of philosopher Martin Buber, Hudson argues, “We must consciously battle the perennial temptation to see the world and others exclusively through the lens of our own experiences and advancement. We instrumentalize people when it suits us — and are quick to (appear to) be kind and generous when we have something to gain.”
Hudson provides a simple guideline: “Moral habits that promote human flourishing are virtues. Moral habits that divide us — within ourselves and between us and others — are vices.”
Hudson explains that civility is not the same as politeness, and a cultivated personality is not the same as character. She encourages us to stand for timeless principles even when others strongly disagree.
She argues that virtue cannot be legislated. As we become more virtuous, enlivened in us is the moral sentiment that, by birthright, every human being is equal to others.
Hudson’s mission is to inspire virtue to save liberty. Many thinkers influenced her, including Ben Franklin, who warned, “Only a virtuous people are capable of freedom. As nations become corrupt and vicious, they have more need of masters.”
She quotes Edmund Burke, who wrote, “Men are qualified for civil liberty in the exact proportion to their disposition to put moral chains upon their own appetites.” Like Franklin, Burke saw that if the “controlling power” is not found within individuals, it will be found without in the hands of authoritarians.
Hudson shares what the American jurist Learned Hand wrote in the twentieth century: “Liberty lies in the hearts of men and women; when it dies there, no constitution, no law, no court can save it; no constitution, no law, no court can even do much to help it.”
Perfect Days, a hauntingly beautiful film by Wim Wenders, depicts the life of a Tokyo street toilet cleaner. The baseline high level of cleanliness in Japanese public restrooms and streets is unimaginable in US cities. Law does not mandate this individual attention to cleanliness; it’s a demonstration of respect for others.
Recently, in a Philadelphia bar, some young people danced and took selfies to a sign saying “F##k the Jews.” One of the students involved claimed it was just an “edgy joke.”
“Government can’t legislate thought,” said Congressman Thomas Massie when he voted against a bill condemning antisemitism a few years ago. Massie is right, but he is making Hudson’s point.
If you want to live in a society where antisemitism has been normalized, don’t expect to escape the consequences.
“Obedience to the unenforceable” is a concept introduced by John Fletcher Moulton, a nineteenth-century English mathematician and judge. Moulton and Hudson agree this obedience is where “the real greatness of a nation, its true civilization” lies. Hudson adds, “The more society relies on self-regulation — and the less it relies on law, coercion, conflict, and litigation — the freer it is.”
She makes the case that “a free society depends on its citizens deciding to do the honorable and virtuous actions even when they have the opportunity not to do so.” Hudson wants us to consider our willingness to be obedient to unenforceable virtues.
On a good day, if you stay off social media and the news, you may never have cause to think about the ideas in Hudson’s book. On a good day, your life works pretty well. You have electricity at your fingertips, food on the table, and people who love and care for you. It’s unlikely you’ll ever visit that Philadelphia bar.
Our character is tested not by our good days — the calm seas of economic prosperity and social cohesion — but by challenging economic times and times when the bonds of civil society are frayed. Hudson’s book is preventive medicine.
Recently, during a fitting for my wife’s dental crown, the dentist and her assistant worked well into their lunch hour to get the fit precise. Some dentists might have cut corners. Instead, the dentist placed my wife’s needs first. Hudson advises we need more of such transactions in everyday life. She writes, “Our everyday interactions can either elevate or degrade our experience of living in society together. Our considerateness toward others promotes mutual trust, and in turn, our freedom and flourishing.”
Building on Hayek, Hudson points out that there is a difference between the thick trust we have with families and friends and the thin trust we may build with strangers.
Thin trust makes commercial society possible. Hudson writes that thin trust “is generalizable trust, or the trust we place in the countless strangers we interact with every day. Thin trust lowers the transaction costs in our anonymous society, and is built by our small acts of kindness and generosity toward strangers.”
The “tranquility of mind which is so necessary to happiness… is best promoted by the…passions of gratitude and love,” wrote Adam Smith in TheTheory of Moral Sentiments.
Hudson writes, “No earthly battle is worth compromising the health and life of our soul. At the end of the day, we cannot control the civility or incivility of others. We can only control ourselves.”
Each of us will fail to control ourselves many times today. What matters is not that, as flawed humans, we make errors, but that we are willing to have those errors corrected by the bonds of affection that help us all flourish.
Barry Brownstein is professor emeritus of economics and leadership at the University of Baltimore.
