Conflict and war are ingrained in human history. Historically, groups have always fought against groups, cities against cities, and nations against nations. Most independent countries have had their fair share of war. In the first and second world wars, Canada was a crucial part of the western alliance, and was involved in the long Military Intervention against the Islamic State of Iraq and the Levant. Conflict and war arise for various reasons including money, power, territorial control, ideologies, and a combination of these reasons. Similar to several social factors, armed conflict is a pervasive man-made public health problem.
Regarding the current Russia-Ukraine war, it is important to give a brief background and back story. In February 2014, Russia’s annexation Crimea was followed by war in Donbas and subsequently, the declaration of Independence of separatist states (Luhansk, Donetsk). The fear of Russia losing control of countries formerly part of the Soviet Union, to the western alliance, combined with Ukraine’s desire for autonomy from Russia, made Russia place a ban on Ukraine from joining NATO. This deteriorated into a full blown war on 24th February, 2022 in an attempt to demilitarize Ukraine.
Modern warfare differs significantly from those of the past. A combination of multiple treaties, alliances and highly destructive nuclear weapons create horrific possibilities of another world war, and in extreme cases, an end to current civilization. Due to much more advanced weapons in modern warfare, damages can be terrible and unfathomable. The statistics for the Russo-Ukrainian war- in just a month are already alarming. The Office of the United Nations High Commissioner for Human Rights (OHCHR) has confirmed over a thousand deaths, and much more injured. It is challenging to precisely quantify the impact of this war, or any other war for that matter, because the long term destructive effects go way beyond bullets and bombs. The current war is especially worse considering that the world is still recovering from the Covid-19 pandemic.
An already existing public health challenge from this conflict was the removal of opioid substitution therapy on May 2014, after Russia annexed Crimea. This resulted in increased breakout of infections related to intravenous drug use. These infections, often called syndemics- as a result of common association with each other, include HIV and Tuberculosis. Concerns around the potential of biological warfare has led the World Health Organization (WHO) to advise Ukraine to destroy high-threat pathogens housed in the country’s public health laboratories. This would prevent any potential spills that may spread disease among the population. Anxiety, PTSD and other mental health problems are also expected to increase due to this war. If not for anything, the thought of escalation to nuclear warfare is enough to cause mental health anguish- just like the the nuclear attack on Hiroshima/Nagasaki which lasted for decades after the Second World War. Armed conflict like this leads to increased incidence of traumatic injuries- not just among soldiers but also among civilians; men, women and children. News reports in the past weeks have captured gruesome scenes of the destruction of essential health facilities such as Mariupol Maternity hospital, and a psychiatric hospital in Izyuum. In a desperate effort to force the Ukrainian leaders to submission, these destructions by the Russian military have resulted in massive civilian casualties. Russia has inflicted significant damage on Ukraine since the war is fought on Ukrainian soil. Overwhelmed by the pressure from the Russian military, Ukrainian citizens continue to feel unsafe and anxious, this has led to increase in the number of refugees in neighbouring countries. The number of refugees are now as high as 3.16 million- mostly moving to Poland, creating a major public health crisis.
Citizens of other countries like Ghana, India, Zimbabwe,Nigeria have been trapped In Ukraine due to difficulties leaving the country. Since the onset of the war, Russia has received multiple sanctions from western allied countries, international organizations like EU, council of Europe ,UN and many others. This has caused significant economic consequences for the country, in addition to the usual economic decline that come from war. Notable economic outcomes of war include: • Ban on Russia oil, gas and coal on March 8 by the US president • Freezing of foreign exchange reserves worth over $1 trillion • Suspension of Visa and MasterCard in Russia • Inflation rates of about 9.15 percent • Sanctioning of important Russian oligarchs
Other countries have also seen economic decline due to the nature of global economics today. Interest rates in US are now as high as 25%. In Canada,Inflation rates have risen to a 30 year high of around 6% leading to sharp increase in the prices of oil and other commodities. Ukraine has attracted massive support from international organizations, national governments all over the world and NGOs. Canada, amongst other nations, continue to provide financial and humanitarian support, armed support and standby UNIFIER troops. Whether the Russo-Ukrainian conflict is resolved by the ongoing war is left for the future to decide. What is known, however, is that the public health effects and resulting social change will be felt for many years to come.
Social change explains how the world changes overtime with respect to human behavior, interactions and relationships as well as social and cultural norms. Social change is a force that drives institutions, world views, opinions, standards and laws which ultimately transform the society. These changes can be positive or negative, they may take years, or even decades to become evident since they are usually subtle and observable only after long periods of time. Here, we focus specifically on positive social change- particularly how education and health determinants create social change. Significant outcomes of positive social change over the years include:
• Abolition of slave trade
• Civil rights and democracy
• Feminist movement- women being able to vote, attend university and gain employment
• The LGBTQ+ rights movement
The Social determinants of health are social factors that directly or indirectly impact health. These factors, such as education, income, housing and employment, are agents of social change. This is because they are able to significantly influence our lives, ways of thinking and reasoning. These internal changes in our thoughts and attitudes, in turn, influence our external actions that contribute to social change in societies. All forms of change usually begin when human beings are open minded, interactive and engage on ideological, political, and social levels. This also involves listening to other peoples opinions and potentially engaging in difficult conversations or dialogues. Open-mindedness means listening to other people’s views and perspectives on diverse issues, as well as agreeing to disagree.
Social change can be influenced by:
• Social order
• Technology
• Environment
• Social institutions
• Population
• War and conquest
• Diffusion
• Values and beliefs
As a social determinant of health, an agent of change and a major method of distributing information, education is an essential tool that drives positive social change. Parents and teachers impact wards with social, moral, and cultural values and skills needed to become agents of social change. These are done through activities, games and storytelling. Education gives us information about government, history, and our rights as citizens, as well as teaches us the roles and responsibilities of citizens. In fact, most forms of interaction, including dealing with disagreements, forming opinions, problem solving, exercising self control, relations with various personality types, are learned in school. Although these may not be true for all, another form of education called edutainment, is usually one we can all relate to. Edutainment uses entertainment to teach and inspire social change- this may be by role plays, fictions, revealing what’s happening in other parts of the world and learning about society in general.
Social change is an ongoing, inevitable and ever-present phenomenon that is often used as a marker of development. Most times, social change follows predictable patterns that can either be continuous or cyclic. Continuous forms of social change include changes that happen constantly , but on a smaller scale. These changes are always happening in our societies but may not be immediately observable. They become evident after a long period of time, particularly when we look back in time, historically. Patterns of social change are regarded as cyclic when everything follows a distinct cycle. This is similar to the annual cycle of seasons that come and go, as well as economic booms and dooms that are continuously experienced in the world. Other examples include fashion trends and social expectations. Some cycles are more predictable than others, while others can take decades to recur. Due to the natural ability of human beings to learn, adapt and grow, it is necessary to constantly change with the changing environment around us. We are able to continuously inspire social change, both personally and socially.
For many decades, the world had not witnessed or experienced anything like the COVID-19 outbreak. This pandemic is the first of its kind; a global health crisis resulting in significant human suffering and loss of lives. All aspects of human life were affected by the pandemic, particularly health, social and economic aspects. More so, every section of the population- especially the most vulnerable groups, continue to feel the highest impact of the pandemic. This is because these groups, which include people living in poverty, seniors, displaced persons, people living in homelessness or with addictions as well as persons with disability, may have decreased immunity, fewer opportunities, lack of access to vaccines and appropriate health services.
The impacts of COVID-19 on health and healthcare are numerous. According to Canadian Institute for Health information (CIHI), healthcare in Canada has seen unprecedented evolution and adaptation in response to the COVID-19 pandemic. Healthcare sectors such as emergency services, hospital services including intensive care units, longterm care and physician services suffer the most interruption as several appointments and surgeries were either postponed or cancelled due to limited hospital and human resources. Long-term health effects of COVID-19 are predicted to follow in forms of depression, anxiety, decreased energy and economic downturn due to the extended lockdown.
Socially, COVID-19 pandemic is impacting the world in significant ways. More specifically, the effects of measures to control the pandemic- including lockdowns and closure of essential offices, such as schools and businesses, have been felt by all and sundry. Additionally, social distrusts and crisis created by tightening restrictions, physical distancing and wearing of masks may potentially increase inequality, exclusion, discrimination and global unemployment in the long term. At such, extensive and protective recovery systems are needed to play essential roles in rebuilding trust, stabilizing the economy, managing social expectations, preventing discrimination, alleviating poverty and improving people’s ability to manage and overcome shocks.
The effects of COVID-19 pandemic on economic and financial sectors of the world are staggering. In most countries, economic growth declined suddenly and significantly in 2020. Global trade was estimated to decline by about 5.3% in the same year. Thankfully, these declines and setbacks were temporary, as most of the affected economies rebounded rather quickly, and have remained positive since. The continued lockdowns have not only disrupted social activities but have also halted some economic advancements. According to Organization for Economic Co-operation and Development (OECD), global economic recovery has advanced better than predicted when COVID-19 first began. However, lower-income countries which have lower vaccination rates find it difficult to recover, especially in GDP and the labor market.
Furthermore, limited supplies and increased demands of products as well as high energy prices and fuel shortages remain significant economic challenges which invariably raise the cost of food. These factors affect low-income households particularly, especially in countries without necessary regulations.
As a continuous measure to reduce the long term effects of COVID-19, governments need to lift current restrictions, invest in sustainable recovery practices aimed at effectively restoring the economy, and alleviating poverty.
The World Health Organization (WHO) designated variant B.1.1.52, a variant of concern on November 26, 2021. The virus was named Omicron, on the advice of WHO’s Technical Advisory Group on Virus Evolution (TAG-VE). Factors that determine whether a variant is medically important include, the method or ease of spread, number of mutations, and severity of the disease caused. Scientists report that the Omicron variant spreads more easily than the original SARS-CoV-2 virus and infected persons can spread the virus to others, irrespective of their vaccination status or level of symptoms.
All COVID-19 variants, including Omicron, can be detected through current laboratory tests-
nucleic acid amplification tests (NAATs) and antigen tests. These tests only indicate the presence of an infection but does not specify the type of variant one is infected with. Additional and more complex tests are needed to determine which variant of concern is responsible for an infection. There are also self tests which are easy to do at home and produce rapid results. Evidence from studies suggest that there is an increased risk of reinfection with Omicron compared to the other variants of concern. Polymerase Chain Reaction (PCR) is a widely used tests which is effective in detecting COVID-19 infection, including infection with Omicron.
To protect against severe forms of illness, hospitalizations, and deaths due to Omicron infection, Centres for Disease Control and Prevention (CDC) recommends up to date vaccination. CDC also recommends that people aged 16 years and above get a booster shot about 6 months after the completion of their primary vaccination series. Vaccines have been the best public health approach and solution that protect people from COVID-19. Vaccines function by preventing or delaying viral transmission and potentially reducing the likelihood of the emergence of new variants. As with the previous variants, vaccines remain critical to reducing severe disease and death from Omicron and are still the most effective approach against life threatening complications. CDC’s recommendation is based on the fact that vaccines have remained effective for the previous variants, which are similar to Omicron in genetic make-up. Although the virus-specific genetic make-up of Omicron makes it non-responsive to some of the current treatments used for the previous variants, Corticosteroids and IL6 Receptor Blockers continue to be effective in the management managing patients with severe COVID-19.
It is important to note that all variants of COVID-19 are capable of causing severe disease or death, particularly for the most vulnerable people, and thus prevention is always the best option.
In addition to vaccines and boosters, masks- especially surgical masks, continue to provide a physical barrier against all variants. The wearing of masks in public spaces is a necessary protective strategy, irrespective of one’s vaccination status. Other effective ways to reduce the spread of the COVID-19 virus are: physical distance, avoiding poorly ventilated or crowded spaces, frequent hand washing and covering the mouth properly when coughing or sneezing.
It has been a long and rough ride with the CoVID-19 pandemic spanning over two years. As of January 2022, there have been over 364,191,494 confirmed cases of COVID-19 globally, including 5,631,457 deaths. A total of 9,854,237,363 vaccine doses have been administered.
For about two years now, COVID-19 has plagued the entire world, causing significant changes in the way we live and relate to one another. So far, several medically important strains of the virus, also called variants of concern, have been isolated and identified. Most recently on November 26 2021, the World Health Organization (WHO) designated a new variant of concern, the B.1.1.529. On the advice of WHO’s Technical Advisory Group on Virus Evolution (TAG-VE),, this variant was isolated and subsequently named Omicron,. Decisions on whether a variant should be of concern is based on the evidence presented to TAG-VE about the unique behaviour and characteristics of the virus such as transmissibility, mutative tendencies and severity of disease caused.
It was initially unclear whether Omicron is more transmissible than previously identified variants, including the Delta variant. Although South African researchers reported an increase in the number of people testing positive in parts of the country where the Omicron variant was dominant, epidemiological studies were needed to decipher if the increase was attributable to the new variant or as a result of other factors. In addition, the severity of the disease caused by Omicron was not fully understood, even though some data suggested an increase in the rate of hospitalization. The observed increase may not necessarily be due to infection with Omicron, hence, more research has been conducted in different parts of the world, as researchers continue to better understand the unique characteristics of the Omicron variant.
It is important to note that all identified variants of concern are capable of causing severe disease or death, especially in vulnerable people. It is therefore essential to take all the necessary precautions even before more research is available. This may be the reason why the United Kingdom and Canada initiated restrictive travel guidelines and banned several African countries in early December as a measure to curtail the spread of the new variant. However, following some international backlash and in light of more information about the Omicron variant, the ban was lifted and travel regulations relaxed barely a week afterwards. This is because there is currently no evidence to show that symptoms associated with Omicron are more severe compared to those from other variants according to WHO and other international/governmental organizations.
Irrespective of the variant identified, vaccines remain indispensable in reducing severe disease and death. More so, PCR tests continue to be reliable in detecting infection, including infection with Omicron. WHO consistently coordinates with a large number of researchers on various topics around the any variant of concern including viral transmissibility, severity of infection, vaccine effectiveness, diagnostic testing and disease management. WHO encourages countries and hospitals to collect and report patients data as well as to enhance surveillance methods. Additionally, countries must continue implementing effective public health measures to reduce the spread of COVID-19.
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The Centre for Disease Control and Prevention (CDC) has recommended a booster shot for Covid-19, following the first and second doses. In the past, vaccine programs required years of post-marketing surveillance to determine the best time interval between vaccine doses and the number of doses necessary to sustain long-term protection. However, in the case of Covid-19 pandemic, there is no luxury of time or years for such long-term protocols to observed or followed. The virus, which causes serious health complications requires immediate and proactive approaches and decisions to be contained… hence, the recommendation for booster shots..
So, what is a booster shot? By definition, a booster shot is simply an extra or additional dose of a vaccine given to people following an observed decrease in the effectiveness and efficacy of an original dose(s). A decline in the strength of protection conferred by a vaccine is often expected, especially when the causative agent mutates and has various strains or variants as in the case of Covid-19. The aim of a booster shot is to restore protection that may have waned or decreased over a period of time to a level that is deemed insufficient to protect individuals who initially responded satisfactorily to the original vaccine doses. A booster shot is distinct from a third dose in that it is not considered a part of the standard primary vaccine doses. It is usually recommended on the side, when there is need to enhance immune response and establish adequate levels of protection for individuals who have developed no or sub-optimal immune response to an original dose(s).
A booster, in general, is designed to help the population retain the highest level of immunity and for the longest possible time. Typically, individuals are encouraged to get a booster after the immunity from the initial dose(s) have naturally begun to to diminish.
The CDC recommends a COVID-19 boosters for individuals who are 18 years or older, and have received the first and second doses. Boosters are readily available in many vaccine outlets across the world including retail pharmacies, mobile vaccination clinics and state or local vaccination sites. As with most vaccines, temporary side effects and symptoms similar to those of a flu shot are expected for a few days. These may include sore or swollen arm, fever, body aches, headaches, cold, general malaise and swollen lymph nodes. All Covid-19 booster shots are mRNA vaccines and can be interchangeable- either the same brand as the original doses or a different brand- the Moderna or Pfizer (mRNA) vaccine are readily available in the United States and Canada.
An additional dose- also known as a third dose, is given to people whose immune systems are moderately or severely compromised in order to improve their response to the initial doses. This is different from a booster dose in that the booster is given when a person has completed their vaccine doses, and protection against the virus has reduced over time. A third dose is especially recommended for Individuals who have cancer, underwent organ or stem cell transplant in the last two years, are taking immunosuppressive drugs, are diagnosed with HIV and have a high viral load or low CD4 count.
From all indications, COVID-19 does not seem to be backing down anytime soon; in fact, a new variant-omicron, has just been identified. Despite all precautions by individuals, organizations and governments, the pandemic has persisted. However, we must not lose hope- we must continue to follow appropriate guidelines and recommendations by governments and health authorities. As always, BlessWorld Foundation continues to provide information to keep the community updated about COVID-19 through her online blogs.
Malaria vaccine is a long awaited, ground breaking invention and breakthrough in medical science.. Since time immemorial, malaria has persisted in sub-Saharan Africa, causing significant health challenges, personal suffering, loss of life and economic drawbacks. The continent, and world at large, has long hoped and looked forward to the birth of an effective malaria vaccine. Now, for the first time ever, the dreams of many have come true- a malaria vaccine recommended for widespread use has been approved by World Health Organization (WHO). This great progress increases the hope that someday, the menace and misfortune caused by malaria, mostly in Africa- the continent with the heaviest burden of malaria, and other continents, will be history.
Based on the results of an ongoing pilot program from 2019 in Ghana, Kenya and Malawi, WHO has recommended a widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine- schedule of 4 doses in children from 5 months of age, in sub-Saharan Africa and in other regions. These regions are considered to have moderate to high Plasmodium falciparum malaria transmission.. The program has currently reached over 800,000 children since it’s onset in 2019. It is projected that the vaccine, in addition to other existing malaria prevention tools, could save tens of thousands of lives annually.
Clearly, the benefits of inventing and administering the malaria vaccine are extensive given that malaria is the primary cause of childhood illness and death in sub-Saharan Africa. Approximately, two hundred and sixty thousand (260,000) African children below five years of age die yearly from malaria. Findings from the pilot program mentioned above have continued to inform WHO’s decisions regarding the malaria vaccine. Established facts and benefits of the vaccine include:
Feasibility: The malaria vaccine administration is very feasible as it follows four scheduled doses
Accessibility: Vaccines are funded by international organizations and are available in countries where malaria cases and incidents are high
Positive and strong safety profile: The vaccine has not been associated with any side effect and is considered safe.
Cost effectiveness: Given the economic impact of malaria, vaccination which reduces the incident of malaria is a cost-effective practice
Significant reduction in number of cases: Up to 30% reduction in the number of malaria cases have been recorded in some countries and regions where the vaccine has been introduced
According to CDC, malaria is a critical, potentially fatal disease caused by the parasite, Plasmodium falciparum- which feeds on human blood. Symptoms of malaria are typically similar to the flu with high fevers, chills, and headache. Although there are other plasmodium species that cause malaria, P. falciparum causes symptoms that may most likely result in severe cases and possibly death, if not promptly treated. Generally, illness and death from malaria can usually be prevented.
About 2,000 malaria cases are diagnosed in the United States annually, majority which are travellers and immigrants returning from parts of the world where malaria transmission occurs, particularly sub-Saharan Africa and South Asia. Worldwide, millions of malaria cases occur clinically causing hundreds of thousands of deaths. Malaria transmission occurs when people are bitten by infective female Anopheles mosquitoes- the only mosquitoes that transmit malaria, and they must have been infected by a P. falciparum through a previous blood meal from an infected person. Malaria can also be transmitted through blood transfusion, organ transplant or the shared use of needles or syringes contaminated with blood because the malaria parasite is found in red blood cells of an infected person. Malaria may also be transmitted from a mother to her unborn infant before or during delivery, known as congenital malaria. Malaria is not spread from person to person, and it cannot be sexually transmitted.
Scientists have been working hard to find a vaccine for malaria, however, a completely effective vaccine is not yet available. Currently, there are several vaccines under development- these vaccine candidates target the blood-stage of the parasite’s life cycle but that has not been sufficient. Consequently, several potential vaccines targeting the pre-erythrocytic stage are being developed.
So far, R21/Matrix-M, with 77% efficacy shown in clinical trials is the most effective malaria vaccine. It meets the World Health Organization’s goal of a malaria vaccine with a requirement of at least 75% efficacy. The vaccine was developed following a collaboration of various institutions including Oxford University, Kenya Medical Research Institute, London Hygiene and Tropical Medicine, Serum Institute of India amongst others. Further clinical trials are needed to approve the vaccine, which has an expected annual production of 200million doses.
More so, RTS,S- developed by PATH Malaria Vaccine Initiative (MVP) and GlaxoSmithKline (GSK), and supported by Bill and Melinda Gates Foundation is a recent recombinant vaccine which comprises of the P. falciparum circumsporozoite protein (CSP) from the pre-erythrocytic stage. The CSP antigen stimulates the production of antibodies capable of preventing the infection of blood cells as well as destroying already infected cells. The vaccine is commercially traded as Mosquirix, and requires four injections.
In July of 2015, Mosquirix was positively appraised by the European Medicines Agency (EMA) on the proposal for the vaccine to be used in children aged 6 weeks to 17 months outside the European Union. Subsequently, a pilot project for vaccination was launched in 2019 for children in Malawi, Ghana and Kenya. The vaccine was then endorsed by the World Health Organization in October 2021.
The major question on everyone’s lips remains “Can COVID-19 be treated?”
Well, governments, scientists and drug companies have been working very hard to find a cure. So far, Remdesivir, an antiviral agent, was the first drug to gain full FDA approval for the treatment of COVID-19 in October 2020. While many investigational treatments exist, only Remdesivir and Dexamethasone (a steroid medication) have been approved to lower death rate in hospitalized covid 19 patients.
Research has established that hospitals, although vital to health systems, have never been the solution to public health problems. Consequently, vaccination is regarded as the means to the end of COVID 19, through achieving herd immunity. This is why vaccination and the hope to attain herd immunity remains the cul de grace- a final trump card to bring an end to COVID-19. The vaccine rollout started as early as late December 2020 in countries like Israel but became very popular in other countries by April 2021, especially in countries that took big hits in terms of death rates like France, Italy, Portugal, Spain and the United Kingdom.
Different types of COVID vaccine include:
Protein Subunit: Novavax is working on a protein subunit COVID-19 vaccine
Viral Vector: The Janssen/Johnson & Johnson COVID-19 vaccine is a vector vaccine. AstraZeneca and the University of Oxford also have a vector COVID-19 vaccine
Nucleic Acid (RNA AND DNA): ThePfizer-BioNTech and the Moderna COVID-19 vaccines use mRNA.
Despite success with vaccine availability, reaching herd-immunity thresholds has been impossible because of factors such as vaccine hesitancy, emergence of new variants and the delayed arrival of vaccinations for children. In most countries, vaccine distribution is stratified by age, with priority given to older people, who are at the highest risk of dying from COVID-19. Therefore, some vulnerable groups are left out; for example, children (who have less developed active immunity) or adults that have medical conditions or are undergoing specific cancer treatment that cause them to produce few or no antibodies in response to a vaccine. With herd immunity, the spread of the virus in communities are reduced and most people are protected by default.
Currently, Pfizer–BioNTech and Moderna have now enrolled teens in clinical trials of their vaccines, and the Oxford–AstraZeneca and Sinovac Biotech vaccines are being tested in children as young as three. Vaccination rates have also been highly variable across regions in countries. In Canada for example, Yukon, Prince Edward Island and Nova Scotia have total fully vaccinated above 70% while Nunavut has only 52%. The situation in the United States is even more variable with Vermont at 68% and Alabama at 39%.
As of October 2021, 62.2% of the U.S. population have had at least one vaccine dose and 52.8% are fully vaccinated. Worldwide, only about 36.5% are fully vaccinated. These percentages are constantly changing.
Estimates from the United Kingdom show that two doses of the Pfizer vaccine are between 85% and 95% effective against symptomatic disease with the Alpha variant, while two doses of AstraZeneca are 70% to 85% effective. Overall, vaccine effectiveness appears to drop about 10% with the Delta variant. With the increase in variants, which may be more infectious and could potentially impact the effectiveness of vaccines, that percentage is now estimated to be higher—some say up to 85%.
Thankfully,, there has been massive support from international organizations like the WHO, UN and Gavi COVAX initiatives and even from non-profit organizations. In Canada, some bodies like the Canadian Red Cross society have increased funding to nonprofit organizations involved in COVID 19 relief in any way. A couple of Canadian nonprofit and charity organizations have been pooling resources together to help different communities manage the crisis. Bless world foundation international has also been engaging communities during this pandemic; specifically, the cradle2fame program aims to support and help with talent development.
Finally, there has been a truly gruesome journey but the world is adapting to this whole change.With up and downs to things returning back to status quo, the post covid era is taking longer than we thought
