Uniquely Nelson

It's time for the supporting cast to bask in the spotlight. The deputies will have their day in charge. The number-two figures are stepping out of the shadows. This promises to be a vice-presidential debate like no other. Mike Pence and Kamala Harris Photo: AFP Some have even called it the most important in history, since it comes as the US president is ill with Covid-19 - a virus that has claimed the lives of 210,000 Americans - and amid a Supreme Court fight and racial unrest. In one corner you have Kamala Harris, the woman who aspires to be the first female vice-president in history. The California senator, 55, is one of the toughest interrogators in Congress, a hardened former lawyer who has left congressional witnesses bloodied after tearing into them in Senate hearings. In her sights she has an unflappable Republican vice-president who rarely puts a foot wrong under intense media questioning. He won't just be playing defence, either. He'll be looking to exploit his obvious advantage in one area - he's done it before. Vice President Mike Pence is a 61-year-old, softly-spoken, deeply religious man, a Christian from Indiana. Despite their obvious differences, Pence has been a pillar of loyalty to his boss for four years and they've walked in lock-step on nearly every issue and through every controversy. See RNZ's live updates and reaction to the debate from 2pm Members of the stage crew set up the debate hall ahead of the vice presidential debate at University of Utah in Salt Lake City. Photo: AFP / Getty Images Isn't it usually a non-event? Who actually cares? Vice-presidential debates don't usually trouble presidential historians too much, but this year the drama of the election campaign could heighten interest in how the pair fare against each other. The fact that the president has been seriously ill has reminded the public they have the two oldest presidential candidates in history. Being first in the line of succession has never been more significant, and both debaters will be aware they have to present themselves as ready to step into the world's biggest job. The first debate between Trump and Democratic presidential contender Jo Biden was also so bereft of serious policy that some have said they're hoping for a proper discussion about the vision for America being offered by each ticket. It could even also be the final debate of the campaign, depending on whether the president recovers in time. No wonder the Brookings Institution called it the most important vice-presidential debate ever. The two remaining presidential debates are scheduled for 15 October in Miami, Florida, and 22 October in Nashville, Tennessee. Has Trump's infection forced any changes? Debate organisers are aware that President Trump could have been contagious during the first debate, and potentially infected Joe Biden and moderator Chris Wallace (though both have tested negative so far), so they want to make no mistakes with this one. The Commission on Presidential Debates has agreed to seat Kamala Harris and Mike Pence 12ft apart - up from 7ft at the presidential debate. There will also be a glass shield between each candidate's side of the stage to diminish infections. And no more than 200 people on site at the University of Utah's Kingsbury Hall. A Pence official told the BBC's partner in the US, CBS News, the vice-president is opposed to his side of the stage having any glass. Will it be as chaotic as the presidential debate? Unlikely. Pence and Harris are tough but always civil so the chances of it being as nasty and disruptive as Cleveland are close to zero. In 2016, Pence was very effective in defending Trump and attacking Hillary Clinton. He was widely credited with coming out of his battle with Democrat VP candidate Tim Kaine with the advantage. It's his trademark to be forceful without ever raising his voice. Harris debates like the lawyer she once was - she's always controlled. She demolished Biden in a debate when she was running against him for the presidential nomination by focusing laser-like on a vulnerability she identified in his past record on civil rights. That should make the moderator's job a bit easier. Definitely. In charge this time is USA Today newspaper Washington bureau chief Susan Page. Page is a seasoned operator with 10 presidential campaigns under her belt, and she won't be intimidated by the occasion - she's interviewed nine presidents. So what will they politely debate? Covid-19, and the Trump administration's handling of it, will clearly be the dominant topic of discussion. Mike Pence is in charge of the presidential task force on the pandemic, and he will be pressed to defend the administration's response. Kamala Harris will probably be asked about her record on criminal justice as attorney general of California, as well as her shifting positions on healthcare reform. She ran to the left of Joe Biden during the race for the presidential nomination, so Pence's debate success may hinge on how well he is able to pin her more liberal views to Biden. Finally, four years from now, Pence and Harris could be leading their party's tickets in the general election, so consider this debate a possible sneak preview of political battles to come. - BBC

US President Donald Trump has entered the White House Oval Office for the first time since returning earlier this week from a military hospital where he was being treated for Covid-19, a White House spokesman said. Donald Trump is anxious to resume a normal working schedule after being diagnosed with Covid-19. (file pic) Photo: AFP "Was just briefed on Hurricane Delta, and spoke with @GovAbbott of Texas and @LouisianaGov John Bel Edwards," Trump said in a tweet a short while later. Hurricane Delta is expected to gather strength and hit the Gulf of Mexico later in the day. Trump's doctor said the president has had no Covid-19 symptoms for the past 24 hours, as the Republican seeks ways to get back to a normal working schedule and revive his struggling re-election bid with four weeks left until US Election Day. White House physician Sean Conley said in a statement that Trump has been fever-free for more than four days and has not needed or received any supplemental oxygen since his initial hospitalisation, which began on Saturday (NZ time). Conley said Trump's physical exam and vital signs "all remain stable and in normal range". Donald Trump's vital signs are stable and normal, according to Dr Sean Conley. Photo: AFP Tests from Tuesday showed Trump had evidence of coronavirus antibodies, which are protective against the infection, the doctor said. A spokeswoman for Regeneron, which makes an experimental antibody treatment given to Trump last week, said the detected antibodies are likely from that treatment. Trump has been in a defiant mood since returning from hospital, angling to work in the Oval Office rather than in the Residence, as well as pushing for an address to the nation and a resumption of campaign activity. Since he returned to the White House in a dramatic display before cameras on Tuesday, Trump has not been seen in public or on video, although his Twitter account has been busy sending messages attacking opponents and downplaying the coronavirus pandemic. Despite his illness, Trump has been looking for ways to get his election message out and cut into Democrat Joe Biden's lead in battleground states where the 3 November election will be decided, advisers said. Vice President Mike Pence's debate with Democratic vice presidential nominee Kamala Harris in Salt Lake City will take centre stage of the campaign later today. The debate is one of the most eagerly anticipated in years. Mike Pence and Kamala Harris Photo: AFP Aides say Trump is impatient to get back on the campaign trail and insistent on going ahead with the next debate on 15 October in Miami, but Biden said yesterday he will not participate if Trump is not virus-free. The White House's chief of staff, Mark Meadows, said that Trump was eager to get back to work in the Oval Office. He has been working from a makeshift space in his residence in the White House since returning from hospital. Meadows told reporters there would be adequate personal protective equipment and ventilation for other staff. Any political boost Trump could get from a fresh injection of stimulus money into Americans' pockets appears to be out of reach after he abruptly ended negotiations with Democrats yesterday, with both sides far apart on how much money to devote to a deal. Both Biden and the top Democrat in the US Congress, House Speaker Nancy Pelosi, accused Trump of abandoning needy Americans. Republican Senator Susan Collins, facing a tough re-election bid in her home state of Maine, called Trump's move a "huge mistake". "The president turned his back on you," Biden said in a Twitter post. With layoffs in key industries mounting by the day and threatening the fragile recovery, Trump has urged Congress to quickly pass $US25 billion ($NZ38b) in funding for passenger airlines, $135b for small businesses and provide $1200 stimulus checks for Americans. But White House officials have downplayed the likelihood of any kind of stimulus being passed before the election. Trump's drive to get Judge Amy Coney Barrett confirmed to the vacant seat on the Supreme Court by the Republican-controlled Senate before the election also may be in doubt, since three Republican senators have been infected with the coronavirus and may not be able to vote. Drive for political advantage A wave of infections at the White House among Trump's top lieutenants and press office aides has left the West Wing struggling to find its footing. ABC News said its count of cases related to the White House was now 23, including Trump and his wife, Melania. Trump has attempted to use his coronavirus infection to his political advantage, making a prime-time exit from Walter Reed military hospital on Monday and whipping off his face mask before the cameras on his return to the White House. He depicted himself as a man who vanquished the disease and emerged stronger, telling Americans: "Don't be afraid of Covid. Don't let it dominate your life." But Trump's handling of the pandemic, which has killed more than 210,000 people in the United States, has been met with scepticism from many Americans. The latest Reuters/Ipsos poll, conducted 2-6 October, found that 38 percent of adults approved of Trump's handling of the coronavirus, while 56 percent said they disapproved. The poll found that 79 percent of US adults, including 94 percent of registered Democrats and 70 percent of registered Republicans, said they are "very" or "somewhat" concerned personally about the spread of the virus. Advisers say Trump wanted to be talking about other issues instead of the virus by this stage of the campaign, to put pressure on Biden. Opinion polls show Trump down double digits, and Biden with sizeable leads in many swing states. People wait for Covid-19 tests in Brooklyn, New York. Photo: AFP Trump had been expected to go on tour this week through Western states to raise millions of dollars for a campaign facing a deficit to Biden's well-funded effort. One adviser noted that almost exactly four years ago in 2016, Trump's campaign was knocked off the rails by release of an "Access Hollywood" tape in which he boasted about groping women. He went on to beat the odds and win the election. "He's the real comeback kid and if anybody can come back from something it's him," the adviser said. - Reuters

By James Clayton, BBC North America technology reporter The US elections could affect the global social media and technology landscape. We now have two huge clues for what Big Tech can expect in the years to come. Photo: 123RF In the US, both the Democrats and the Republicans now have a fixed position on regulating tech. They are both totally different. First off Trump. After the US President shared a piece of disinformation on Facebook and Twitter about the relative dangers of Covid, the two companies reacted: Twitter hid his post and Facebook removed it altogether. Trump responded by tweeting "Repeal Section 230!!!". This is a key piece of legislation that stops companies like Facebook and Twitter from being liable for the things people post. It essentially gives them "platform" rather than "publisher" status. Impossible task Just imagine for a second if all of the posts on Facebook - all of the accusations, all of the libellous content, all of it - was the responsibility of Mark Zuckerberg. It doesn't work. Without Section 230 companies like Facebook, Twitter, TikTok etc couldn't function as they do now. They'd potentially have to moderate your content in real time. Even for the most powerful artificial intelligence systems, that is not possible. You might think: "Trump says he'll repeal Section 230, but will he actually?" Photo: AFP My response would be: "Look at TikTok." Trump has well and truly followed up on his actions - without a judge's last minute intervention it would be illegal for Apple and Google's app stores to offer TikTok for download in the US now. It's perfectly conceivable that a Trump presidency would follow through with his campaign threats. Plenty of Republicans believe that much of social media has an anti-conservative bias. Trump would certainly find support from his own party to act. Competition clash The other big tech news earlier this week was the release of The House Judiciary Committee's report into "antitrust". This is the idea that Big Tech has got so big it is now flouts anti-competition rules. This is a Democrat-led committee - the report was written by Democrats. The report concludes: "To put it simply, companies that once were scrappy, underdog start-ups that challenged the status quo have become the kinds of monopolies we last saw in the era of oil barons and railroad tycoons." Photo: 123RF The share price of all four companies dived as soon as the report was released. Literally, the first recommendation is to prohibit "dominant platforms from operating in adjacent lines of business". That would be massive. It could potentially stop companies like Google owning YouTube. Or Facebook owning Instagram. The word "monopoly" is used 120 times in the report. These weren't bi-partisan recommendations though - Republicans didn't support all the findings. However, there is some common ground between the parties. For example, Republican Ken Buck has said he agrees with much of the report. And in terms of Section 230, Biden has also indicated he could support getting rid of it - albeit for different reasons to Trump. Big Tech election And so we have two Presidential candidates, each with his own stick to bash Big Tech. The company that perhaps is least hedged against these two approaches is Facebook. It's hard to know which option would be worse for the social network. If Joe Biden becomes the US President, calls to break up Big Tech could grow. Photo: AFP For others, well there's now a reasonable argument that can be made that Trump would be better. Republican focus on social media bias would pretty much leave Apple and perhaps Amazon untouched. The election issues in this campaign have been centred around Covid, Black Lives Matter, the economy and law enforcement. But make no mistake, this US election is a huge event for Big Tech too. - BBC

Two scientists have been awarded the 2020 Nobel Prize in Chemistry for developing the tools to edit DNA. Emmanuelle Charpentier, left, and Jennifer Doudna are the first women to win the Nobel chemistry prize without a man also being on the ticket. Photo: AFP Emmanuelle Charpentier and Jennifer Doudna are the first two women to share the prize, which honours their work on the technology of genome editing. Their discovery, known as Crispr-Cas9 "genetic scissors", is a way of making specific and precise changes to the DNA contained in living cells. They will split the prize money of £861,200 ($NZ1.7 million). This year is the first time any of the science prizes has been awarded to two women without a male collaborator also listed on the award. Biological chemist Pernilla Wittung-Stafshede, commented: "The ability to cut DNA where you want has revolutionised the life sciences." Not only has the women's technology been transformative for basic research, it could also be used to treat inherited illnesses. Prof Charpentier, from the Max Planck Unit for the Science of Pathogens in Berlin, said it was an emotional moment when she learned about the award. "When it happens, you're very surprised, and you think it's not real. But obviously it's real," she said. On being one of the first two women to share the prize, Prof Charpentier said: "I wish that this will provide a positive message specifically for young girls who would like to follow the path of science... and to show them that women in science can also have an impact with the research they are performing." She continued: "This is not just for women, but we see a clear lack of interest in following a scientific path, which is very worrying." Emmanuelle Charpentier, left, and Jennifer Doudna are shown in a park in San Francisco beside a children's painting that reflects their work on DNA. Photo: AFP During Prof Charpentier's studies of the bacterium Streptococcus pyogenes, she discovered a previously unknown molecule called tracrRNA. Her work showed that tracrRNA is part of the organism's system of immune defence. This system, known as Crispr-Cas, disarms viruses by cleaving their DNA - like genetic scissors. In 2011, the same year she published this work, Prof Charpentier began a collaboration with Prof Doudna, from the University of California, Berkeley. The two had been introduced by a colleague of Doudna's at a cafe in Puerto Rico, where the scientists were attending a conference. And it was on the following day, during a walk through the streets of the island's capital, San Juan, that Prof Charpentier proposed the idea of joining forces. Together, they recreated the bacterium's genetic scissors in a test tube. They also simplified the scissors' molecular components so they were easier to use. In their natural form, the bacterial scissors recognise DNA from viruses. But Charpentier and Doudna showed that they could be reprogrammed to cut any DNA molecule at a predetermined site, publishing their findings in a landmark 2012 paper. The breakthrough DNA snipping technology allowed the "code of life" to be rewritten. Since the two scientists discovered the Crispr-Cas9 genetic scissors, their use has exploded. The tool has contributed to many important discoveries in basic research; and, in medicine, clinical trials of new cancer therapies are under way. The technology also holds the promise of being able to treat or even cure inherited diseases. It is currently being investigated for its potential to treat sickle cell anaemia, a blood disorder that affects millions of people worldwide. 'Designer babies' fears But without regulation, some fear Crispr could equally be used to create "designer babies", opening up an ethical minefield. If genome-edited children grow up and have children, any alterations to their genomes could be passed down through the generations - introducing lasting changes to the human population. Last year, Chinese scientist He Jiankui was jailed for three years after creating the world's first gene-edited human babies. He was convicted of violating a government ban by carrying out his own experiments on human embryos, to try to give them protection against HIV. It had been thought a Nobel for this revolutionary science would not be awarded for many years because the technique is also the subject of a long-running patent battle in the US. The dispute involves Charpentier and Doudna's group at the University of California, Berkeley, and a team at MIT and Harvard's Broad Institute in Cambridge, Massachusetts. The disagreement centres on the use of the Crispr technique in eukaryotic cells - those cells that bundle their DNA in a nucleus. It is in such cells, which are found in higher animals, that the most profitable future applications will exist. The competing institutions claim their scientists made the crucial, most relevant advances. Charpentier was born in 1968 in Juvisy-sur-Orge, France. She obtained her PhD while at the Institut Pasteur in Paris and subsequently worked at scientific institutes in the US, Austria, Sweden and Germany - in addition to her native France. Doudna was born in 1964 in Washington DC but spent much of her childhood in Hilo, Hawaii. She was awarded her PhD by Harvard Medical School. Swedish industrialist and chemist Alfred Nobel founded the prizes in his will, written in 1895 - a year before his death. - BBC

Alexanda Kotey and El Shafee Elsheikh are accused of belonging to an IS cell dubbed "The Beatles" involved in kidnappings in Iraq and Syria. El Shafee Elsheikh, left, and Alexanda Kotey Photo: AFP / Syrian Democratic Forces (SDF) The pair are being held in FBI custody and will appear in a US federal court in Virginia. The men, who had been in US custody in Iraq, previously denied the charges. US Assistant Attorney General John Demers told a press conference the charges were "the result of many years of hard work in pursuit of justice" for the four Americans who died - James Foley, Steven Sotloff, Kayla Mueller and Peter Kassig. Addressing the families of the victims, he said: "Although we cannot bring back your children, we will do all that we can do: obtain justice for them, for you, and for all Americans." He added: "These men will now be brought before a United States court to face justice for the depraved acts alleged against them in the indictment." The charges carry a maximum penalty of life in prison. The pair are alleged to have been members of an IS gang - nicknamed by hostages after the 1960s pop group due to their British accents - which was responsible for the death of hostages in Iraq and Syria in 2014. Some of the victims - who included American journalists and UK and US aid workers - were beheaded and their deaths filmed and broadcast on social media. Kotey and Elsheikh, originally from west London, were previously stripped of their UK nationality. They face charges including hostage-taking resulting in death, conspiracy to murder US citizens outside of the United States and conspiracy to provide material support to terrorists resulting in death. The IS group's alleged ringleader, Mohammed Emwazi, known as "Jihadi John" died in a drone strike in 2016. Referring to his death, Mr Demers said he had "faced a different kind of American resolve - the mighty reach of our military, which successfully targeted him in an air strike several years ago". 'Strongest case possible' The assistant attorney general was asked by reporters whether the death penalty was not being sought solely because the UK government had made it a requirement in return for its co-operation. "The attorney general decided that we should provide the death penalty assurance in order to get the British evidence and see that justice could be done more expeditiously than if we had to continue to litigate this issue in the courts in the United Kingdom," Mr Demers said. "The decision was to try to keep the option (of seeking the death penalty) open at first but ultimately that didn't work." Last month the UK sent evidence to the US following assurances the two men would not face the death penalty. Mr Demers added: "We decided that if we were going to do this case, we were going to tell the fullest story we could of what these defendants did and we were going to put on the strongest case possible. And with the British evidence I think we can do that very well." FBI director Christopher Wray told the press conference: "We mourn not only our American victims but also the British victims David Haines and Alan Henning, and victims of all nations who suffered unimaginable cruelty at the hands of Isis." Mike Haines, whose aid worker brother David was killed by the IS cell in 2014, said he was relieved "the fate of these two men is closer to being decided but this is just the beginning". "The pain we experienced as families was excruciating when we lost our loved ones and the last three years have been a long, horrible waiting game," he said. "It was a big win for us knowing that the US courts would be taking this forward because we have been waiting years since they were first detained." It has taken nearly eight years to reach this moment - from the day that James Foley and John Cantlie were taken hostage in Syria to the reading out of the indictment against two of the alleged perpetrators, both now in US custody. The eight charges against them are so serious that each one carries a maximum sentence of life in prison. Over the course of the coming trial the court is likely to hear some harrowing testimony from those who survived IS captivity - men whose freedom was ransomed in exchange for millions of Euros while their fellow prisoners from the US and Britain suffered horrific deaths at the hands of their captors. IS once controlled 88,000 sq km of territory stretching from western Syria to eastern Iraq and imposed its brutal rule on almost eight million people. The liberation of that territory exposed the magnitude of the abuses inflicted by the jihadist group, including summary killings, torture, amputations, ethno-sectarian attacks, rape and sexual slavery imposed on women and girls. Hundreds of mass graves containing the remains of thousands of people have been discovered. UN investigators have concluded that IS militants committed acts that may amount to war crimes, crimes against humanity and genocide. - BBC

Photo: Getty Images American reggae and pop singer-songwriter Johnny Nash, best known for the 1972 hit 'I Can See Clearly Now', has died aged 80, his family has said. Nash, whose health had been in decline, died at his home of natural causes on Tuesday, his son told US media. The musician began singing as a child and made his major label debut with the 1957 song 'A Teenager Sings the Blues'. Nash, born in Houston, was one of the first non-Jamaican singers to record reggae music in Kingston, Jamaica. His single 'I Can See Clearly Now' sold more than a million copies and reached the top of the Billboard Hot 100 chart in 1972, where it remained for four weeks. He also had a number one hit in the UK in 1975 with Tears on My Pillow. According to his official website, Nash helped reggae legend Bob Marley sign a recording contract. Nash's covers of songs like Stir It Up helped bring Marley's music to a broader audience, and the pair later collaborated on a track called You Poured Sugar On Me. 'Music is for the ears and not the age' In an interview with Zoo World magazine in 1973, Nash told journalist Cameron Crowe he hoped his music had wide appeal. "I feel that music is universal. Music is for the ears and not the age. Everybody likes music… from eight to 80. "There are some people who say that they hate music," he added. "I've run into a few, but I'm not sure I believe them. Maybe they have never been without music. Know what I mean?" Reacting to the news of his death, singer Boy George credited Nash, with his "voice like silk", as one of the artists who "made me fall in love" with reggae. British ska band The Beat described it as "a sad day for music". US actor John Cusack also paid tribute to the late singer online, thanking him for allowing them to use his most famous track in the 1997 movie Grosse Pointe Blank. Actress and singer Holly Robinson Peete offered: "Rest in peace Johnny Nash", while fellow musician Rex Chapman added: "2020 is the worst… Rest, Sir." Besides his son John, Nash is survived by his wife, Carli. - BBC

A Greek court has declared far-right party Golden Dawn a criminal group, effectively banning a radical organisation that was once the third-largest political force in the country. Thousands outside the Athens appeal court cheered as the leadership of the far-right Golden Dawn party was found guilty of running a crime group Photo: AFP / Anadolu Agency The courtroom cheered as the high-profile trial reached its end after five years of hearings, as did thousands who gathered outside the Athens appeals court. But the mood on the streets turned sour when isolated groups of hooded youths threw petrol bombs at police, who responded with tear gas and water cannon. Golden Dawn was catapulted from obscurity to infamy in the space of a few years, attracting supporters with a xenophobic rhetoric at the height of Greece's debilitating debt crisis. In 2012 it had 18 MPs in parliament. But it started to unravel in September 2013, when a party supporter was arrested for the killing of Pavlos Fyssas, a musician and rapper aligned to the political left. "With today's decision, a traumatic cycle in the country's public life comes to an end," said Prime Minister Kyriakos Mitsotakis. "As in the ballot, this Nazi group was also convicted by the court." Golden Dawn members, including its leader Nikos Mihaloliakos, were rounded up and authorities launched an inquiry into whether the group was a criminal organisation in parallel to the probe into Fyssas's death. Before the court ruled that the party leadership was running a criminal group, the court found Golden Dawn supporter Yiorgos Roupakias guilty of Fyssas's murder. Magda Fyssa, the mother of murdered singer Pavlos Fyssas, holds a bunch of red roses as she arrives in court for the announcement of the verdict. Photo: AFP Fyssas's black-clad mother Magda, who has not missed a day since the trial started, burst into tears when the verdict went against Golden Dawn. "Pavlos you did it," she said. "We won a battle but are continuing the fight." The Golden Dawn members were not in court on Wednesday. They were arrested in 2013, the first time that elected politicians had been detained in Greece since a military coup in 1967, and released after their pre-trial detention period expired. Golden Dawn failed to win a single seat in last year's parliamentary election. Prosecutors had charged 65 people, including 18 former Golden Dawn lawmakers, with being members of a criminal group. The party said it was the victim of a political witch-hunt. Dozens of others on trial, party members and alleged associates, face convictions on charges that range from murder to perjury, linked to violent attacks on immigrants and left-wing activists. Wednesday's verdict sets the stage for the high-profile case to proceed with the court looking into sentencing for the murder of Fyssas and other violent attacks. Tens of thousands rallied outside the court, holding banners reading "Fascism, Never Again" and "Freedom for the People, Death to Fascism". "We must send a message to the younger generations, a message against fascism," said 69-year-old Sophia. "It's our duty to democracy to be here today, to show we are standing up against such criminal actions." Amnesty International said Wednesday's verdict would boost efforts to fight hate crimes. "This verdict sends a clear message to political groups with aggressive anti-migrant and anti-human rights agendas in Greece and across Europe that violent and racist criminal activity will not go unpunished," said Nils Muiznieks, Amnesty's Europe director. - Reuters

For most people, Covid-19 is a brief and mild disease but some are left struggling with symptoms including lasting fatigue, persistent pain and breathlessness for months. Photo: AFP The condition known as "long Covid" is having a debilitating effect on people's lives, and stories of being left exhausted after even a short walk are now common. So far, the focus has been on saving lives during the pandemic, but there is now a growing recognition that people are facing long-term consequences from a Covid infection. Yet even basic questions - such as why people get long Covid or whether everyone will fully recover - are riddled with uncertainty. What is long Covid? There is no medical definition or list of symptoms shared by all patients - two people with long Covid can have very different experiences. However, the most common feature is crippling fatigue. Others symptoms include: breathlessness, a cough that won't go away, joint pain, muscle aches, hearing and eyesight problems, headaches, loss of smell and taste as well as damage to the heart, lungs, kidneys and gut. Mental health problems have been reported including depression, anxiety and struggling to think clearly. It can utterly destroy people's quality of life. "My fatigue was like nothing I've experienced before," said one sufferer Jade Gray-Christie. See all RNZ coverage of Covid-19 Long Covid is not just people taking time to recover from a stay in intensive care. Even people with relatively mild infections can be left with lasting and severe health problems. "We've got no doubt long Covid exists," said Prof David Strain, from the University of Exeter, who is already seeing long-Covid patients at his Chronic Fatigue Syndrome clinic. How many people are getting it? A study of 143 people in Rome's biggest hospital, published in the Journal of the American Medical Association, followed hospital patients after they were discharged. It showed 87 percent had at least one symptom nearly two months later and more than half still had fatigue. However, such studies focus only on the minority of people who end up needing hospital treatment. The Covid Symptom Tracker App - used by around four million people in the UK - found 12 percent of people still had symptoms after 30 days. Its latest, unpublished data, suggests as many as 1 in 50 (2 percent) of all people infected have long-Covid symptoms after 90 days. Do you need severe Covid to get long Covid? It appears not. Half of people in a study in Dublin still had fatigue 10 weeks after being infected with coronavirus. A third were physically unable to return to work. Crucially, doctors found no link between the severity of the infection and fatigue. However, extreme exhaustion is only one symptom of long Covid. Prof Chris Brightling, from the University of Leicester and the chief investigator in the PHOSP-Covid project which is tracking people's recovery, believes people who developed pneumonia may have more problems because of damage to the lungs. How is the virus causing long Covid? There are lots of ideas, but no definitive answers. The virus may have been cleared from most of the body, but continues to linger in some small pockets. "If there's long-term diarrhoea then you find the virus in the gut, if there's loss of smell it is in the nerves - so that could be what's causing the problem," says Prof Tim Spector, from King's College London. The coronavirus can directly infect a wide variety of cells in the body and trigger an overactive immune response, which also causes damage throughout the body. One thought is the immune system does not return to normal after Covid, and this causes ill-health. The infection may also alter how people's organs function. This is most obvious with the lungs if they become scarred - long-term problems have been seen after infection with Sars or Mers, which are both types of coronavirus. A CT scan of lungs showing the affects of Covid-19. Photo: AFP But Covid may also alter people's metabolism. There have been cases of people struggling to control their blood sugar levels after developing diabetes as a result of Covid, and Sars led to changes in the way the body processed fats for at least 12 years. There are early signs of changes to brain structure, but these are still being investigated. And Covid-19 also does strange things to the blood, including abnormal clotting, and damaging the network of tubes that carry blood around the body. Prof Strain told the BBC: "The theory I'm working on is a premature ageing of the small blood vessels that deliver oxygen and nutrients to the tissues." But he warned that until we figure out what is causing long Covid "it is difficult to figure out treatments." Is this unusual? Post-viral fatigue or a post-viral cough are well documented and common - we've probably all had an infection that has taken ages to fully recover from. Around 1 in 10 people with glandular fever has fatigue which lasts for months. And there have even been suggestions that flu, particularly after the 1918 pandemic, may be linked to Parkinson's-like symptoms. "With Covid there seem to be more far-reaching symptoms, and the number of people seems to be much greater," says Prof Brightling. The emphasis though is on the word "seems" as until we have a true picture of how many people have been infected we won't know exactly how common these symptoms are, he says. "The uniqueness of the way the virus attacks the host, and the different ways it then alters the way cells behave, seem to be both giving people more severe infection than other viruses and persistent symptoms," he says. Will people fully recover? The number of people with long-Covid appears to be falling with time. However, the virus emerged only at the end of 2019, before going global earlier this year, so there is a lack of long-term data. "We've asked, deliberately, to follow people for 25 years. I certainly hope only a very small number will have problems going beyond a year, but I could be wrong," said Prof Brightling. However, there are concerns that even if people appear to recover now, they could face lifelong risks. People who have had chronic fatigue syndrome are more likely to have it again, and the concern is that future infections may cause more flare-ups. "If long-Covid follows the same pattern I'd expect some recovery, but if it takes just another coronavirus infection to react then this could be every winter," said Prof Strain. It is still possible more problems could emerge in the future. The World Health Organisation has warned that widespread inflammation caused by coronavirus could lead to people having heart problems at a much younger age. What should I do if I think I have long-Covid? In the UK the National Health Service has published information: "Your Covid Recovery Plan", which has advice, particularly for those who needed hospital treatment. It recommends the "three Ps" in order to conserve energy: Pace yourself so you don't push yourself too hard, and make sure you have plenty of rest Plan your days so your most tiring activities are spread out across the week Prioritise - think about what you need to do and what can be put off The service advises those who are slow to recover from Covid to speak to either their GP or hospital team if they do not recover as quickly as they might expect. Some have raised concerns that there's not enough support for people with long-Covid. - BBC

Drugmakers and research centres around the world are working on Covid-19 vaccines, with large global trials of several of the candidates involving tens of thousands of participants well underway. File photo. Photo: AFP As some companies close in on unveiling their initial findings - with Canadian and European regulators already reviewing early data on some vaccines - the following is what we know about the race to deliver vaccines to help end the coronavirus pandemic that has claimed over a million lives: Who is furthest along? US drugmaker Pfizer Inc with German partner BioNTech SE, US biotech Moderna Inc and Britain-based AstraZeneca Plc in conjunction with University of Oxford researchers could provide early analyses of data from their various large trials over the next two months. Johnson & Johnson is not far behind. What happens in these trials? The companies are testing their vaccines against a placebo - typically saline solution - in healthy volunteers to see if the rate of Covid-19 infection among those who got the vaccine is significantly lower than in those who received the dummy shot. Neither trial participants nor researchers know who has received the vaccine or placebo until the data is ready for review, or unblinded. The studies rely on subjects becoming naturally infected with Covid-19, so how long it takes to generate results largely depends on how pervasive the virus is where the trials are being conducted. In areas with large outbreaks and community spread, infections will pile up faster. How will we know if the vaccine works? The United States, the European Union, the United Kingdom and the World Health Organization have all set similar minimum standards for effectiveness. Vaccines must demonstrate at least 50 percent efficacy - meaning at least twice as many infections among volunteers who got a placebo than in the vaccine group. Independent panels oversee the trials to monitor for safety and effectiveness since the data is hidden from companies and researchers. These data safety monitoring boards take a peek at the interim results at pre-determined milestones, such as after a certain number of people have become infected. It the vaccine is looking significantly better than the placebo, the companies can apply for emergency use, and the study may be halted or continue to its intended conclusion. A trial also can be halted if the panel determines the vaccine to be unsafe. Will regulators ensure a vaccine is safe before making it available to the public? The US Food and Drug Administration has said it will not approve a vaccine unless it is both effective and safe. On Tuesday, it added more stringent safety guidelines for US vaccines. The FDA wants developers to follow trial subjects for at least two months after they receive their final vaccine dose to check for any side effects that may crop up. The agency will consider an emergency use authorisation (EUA) once that data is collected from at least half of the trial's participants. The UK Medicines and Healthcare products Regulatory Agency will review the vaccines for the UK and the European Medicines Agency will review vaccines for European Union use. When will regulators decide? Regulators will review the vaccines after the companies have enough data to submit applications seeking an EUA or formal approval. Pfizer/BioNtech will likely know how well its vaccine works as soon as this month, while Moderna's first look at data is more likely to come next month. AstraZeneca could provide a look at late-stage data in the next two months. Regulators for Europe and Canada are considering data on a rolling basis, as it becomes available. The UK and the US both expect speedy reviews of initial data for possible emergency use before more traditional lengthy reviews for formal commercial approvals. Could these be the first approved coronavirus vaccines? Yes, although China and Russia are on a similar timeline. China launched an emergency use program in July aimed at essential workers and others at high risk of infection that has vaccinated hundreds of thousands of people. At least four vaccines are far along including from China National Biotec Group (CNBG), CanSino Biologics and Sinovac. Sinovac and CNBG have said to expect early trial data as soon as November. Russia's Gamaleya Institute has begun a 40,000-person late-stage trial and is expected to have early data at the end of October or early November. Russia has also given the vaccine to at least hundreds of 'high risk' members of the general population. Is US authorisation up to President Trump? The FDA must make sure that the benefits of a vaccine outweigh the risks before authorisation since they are intended to be given to hundreds of millions of healthy people. However, the US Department of Health and Human Services (HHS) has the authority to override the FDA's recommendation. US President Donald Trump has complained about the new safety guidelines that would likely delay any vaccine availability until after the 3 November presidential election. The Trump administration can hire and fire HHS officials, opening the possibility of political pressure to approve a vaccine. - Reuters

Billionaire wealth reached record high levels amid the Covid-19 pandemic, a report by UBS and PwC found, as a rally in stock prices and gains in technology and healthcare helped the wealth of the world's richest break the $10 trillion mark ($NZ15 trillion). File photo. Photo: 123rf The report, covering over 2000 billionaires representing some 98 percent of the cohort's total wealth, found billionaire wealth grew by more than a quarter during the early months of the pandemic to reach $US10.2 trillion in July, breaking the previous record of $US8.9 trillion ($NZ13.5 trillion) at the end of 2019. The figure represents a five- to ten-fold rise over the past 25 years, the span covered by the UBS and PwC database, when billionaire wealth stood at just over $US1 trillion ($NZ1.5 trillion). Between 7 April and 31 July this year, billionaires across every industry covered by the study saw their wealth rise by double digits, with billionaires in the technology, healthcare and industrial sectors leading the pack with 36 percent - 44 percent gains. The pandemic accelerated a trend of technology and healthcare entrepreneurs, and other business innovators, pulling ahead of their ultra-rich peers. From 2018 through July 2020, tech billionaires saw their wealth rise 42.5 percent to $US1.8 trillion ($NZ 2.7 trillion), the report found, while billionaires deriving their fortune from healthcare similarly saw their wealth rise 50.3 percent during the period to $658.6 billion (NZ$999.4 billion). Just over 200 of those billionaires publicly committed some $US7.2 billion ($NZ10.9 billion) to help tackle the Covid-19 pandemic, the study found, noting that billionaire donations to combat the medical crisis as well as the societal and economic turmoil it caused were likely actually higher. - Reuters