Monkeypox ‘unlikely’ to become pandemic but experts advise caution

August 10, 2022 | 12:05 am

By Brontë H. Lacsamana, Reporter

BECAUSE monkeypox is not airborne and isn’t infectious before symptoms appear, it’s unlikely that it will become a global pandemic like coronavirus disease 2019 (COVID-19). Still, everyone must remain cautious and observe minimum public health standards, according to infectious disease specialists.

“Patients with skin lesions can be isolated more effectively,” said Dr. Franco A. Felizarta, a US-based infectious disease expert, at a virtual talk organized by the University of the Philippines (UP) on Aug. 5. “Monkeypox’s infectious nature is from the time of symptoms until the scabs fall off.”

Transmission occurs via close or direct skin contact, respiratory droplets from prolonged face-to-face interactions, and contaminated fomites. These are all avoidable with hand washing, mask wearing, distancing, and regular sanitization of surfaces, he added.

Meanwhile, the Philippine Society for Microbiology and Infectious Disease released a monkeypox screening and detection briefer for healthcare providers.

“It’s very important for our responses to be on an institutional, individual, and collective level because we don’t want to lose our patients. We want them to come to us and be diagnosed as efficiently as possible,” said Dr. Regina P. Berba, chair of the infection control unit at UP-Philippine General Hospital.

The briefer details that a monkeypox isolation area has to be its own isolation space with health workers wearing personal protective equipment when handling suspected cases, similar to COVID-19.

Suspected cases typically present with fever or headaches along with the characteristic rashes and lesions.

While the Philippine Food and Drug Administration hasn’t approved treatments specifically for monkeypox, Dr. Felizarta said that there are available options, including the drug tecovirimat, which is traditionally used for smallpox.

On Aug. 5, the Philippines’ first monkeypox case was deemed officially recovered after spending 21 days in isolation, according to a report by the Department of Health on Monday. However, the patient’s 10 close contacts are still in quarantine.

Dr. Berba shared basic tips to take care of oneself in case of a monkeypox infection, which is usually mild: take care of the rashes, take care of your mental health, and avoid being in the same room as someone else.

The specialists also warned the public not to attach any social stigma to the disease. “Infectious pathogens don’t care about race, gender, or sexual orientation,” Dr. Felizarta said. “Don’t underestimate monkeypox. Everybody can be infected with this virus.”

Prosecutor clears Okada of false documents charges

August 10, 2022 | 12:04 am

THE Office of the City Prosecutor of Makati has dismissed falsification of public documents, use of falsified documents, and other deceit charges against Japanese billionaire Kazuo Okada filed by Tiger Resort Leisure and Entertainment, Inc. (TRLEI) board member Hajime Tokuda.

In a 12-page resolution, Assistant Makati City Prosecutor Kristina Carmela G. So-Reyes said the evidence submitted by Mr. Tokuda did not show probable cause to charge Mr. Okada, who was removed from TRLEI as a shareholder and company chairman due to alleged mismanagement.

“Based on the evidence on record, this Office finds no probable cause to charge the respondents (Mr. Okada’s group) with the crime of falsification of public document under Article 172 of the Revised Penal Code,” she added.

TRLEI is the company that operates the casino resort Okada Manila.

Mr. Tokuda alleged in his complaint that Mr. Okada and his group were deceitful when they informed BDO Unibank, Inc. that there were newly appointed signatories to the TRLEI bank accounts.

BDO then froze all bank accounts owned and maintained by TRLEI due to the controversy.

The camp of Mr. Okada issued a statement last month citing a Philippine Supreme Court ruling ordering a status quo ante order (SQAO) identifying him as the lone representative of Tiger Resort Asia Ltd. (TRAL), TRLEI’s parent company, which is registered in Hong Kong.

The group argued that the SQAO allowed Mr. Okada to fill vacancies on the board, and his actions were done in good faith to ensure that the casino resort was effectively managed.

In a statement, Okada Manila said the resolution issued by the Makati City prosecutor “is a testament that the Okada Group has done nothing illegal with respect to its recovery of Okada Manila.”

In the same statement, Mr. Okada said the decision showed that “the Justice system in the Philippines works and that justice will be served to those who always work within the bounds of the country’s legal system.”

TRLEI’s Legal Counsel Estrella C. Elamparo did not immediately respond when sought for comment. — John Victor D. Ordoñez

Cinemalaya competition films on view at SM and Ayala Malls cinemas

August 10, 2022 | 12:04 am

THE CULTURAL Center of the Philippines (CCP) and Cinemalaya Foundation have partnered with Ayala Malls Cinemas and SM Cinema to present special screenings of the Cinemalaya 18 competition films from Aug. 10 to 16.

The participating Ayala Malls Cinemas are those in Glorietta, TriNoma, Manila Bay, Capitol Central Bacolod, and CDO Centrio. The theater chain under SM Cinema includes SM Megamall, SM City Baguio, SM City Clark, SM City Dasmariñas, and SM City Legazpi.

With this year’s theme “Breaking Through The Noise,” the 2022 Cinemalaya offers a diverse lineup in both the full-length and short film categories.

The 11 full-length films are: Angkas (The Backride) by Rainerio C. Yamson II; Bakit ‘Di Mo Sabihin? (Tell Her) by Real S. Florido; Batsoy by Ronald Espinosa Batallones; Blue Room by Ma-an L. Asuncion-Dagñalan; Bula sa Langit (Trigger) by Sheenly Gener; Ginhawa (Solace) by Christian Paolo Lat; Kaluskos (Rustles) by Roman S. Perez, Jr.; Kargo (Cargo) by TM Malones; Retirada (The Retiree) by Milo Alto Paz and Cynthia Cruz-Paz; The Baseball Player by Carlo Obispo; and 12 Weeks by Anna Isabelle Matutina.

Meanwhile, the 12 short films are split into two sets. Shorts A consists of six films: Roundtrip to Happiness by Claudia Fernando; Mata Kang Busay (Vision of The Falls) by Niño B. Maldecir, Ampangabagat Nin Talakba Ha Likol (It’s Raining Frogs Outside) by Maria Estela Paiso, Kwits (Quits) by Raz de la Torre, Mga Handum Nga Nasulat sa Baras (The Dreams That Are Written On The Sand) by Arlie Sweet Sumagsay and Richard Jeroui Salvadico, and City of Flowers by Xeph Suarez.

Shorts B, on the other hand, is composed of: Si Oddie by Maria Kydlee Torato, Duwa-Duwa (The Play) by Nena Jane Achacoso, Distance by Dexter Paul De Jesus, Dikit by Gabriela Serrano, See You, George! by Mark Moneda, and Black Rainbow by Zig Dulay.

Screenings on Aug. 10 will be followed by talkbacks for the films Ginhawa and Kargo at SM Megamall and Glorietta, respectively. The talkback for Retirada is set to take place at TriNoma on Aug. 11. The Cinemalaya Talkback Sessions are designed for audience members to interact with the filmmakers, cast, creative and production teams face-to-face by giving their feedback on the film or asking questions about it.

For more information, visit the CCP (www.culturalcenter.gov.ph) and Cinemalaya (https://cinemalaya.org/) websites. For ticket inquiries, call the CCP Box Office at 8832-3704 or SM tickets 8470-2222.

AstraZeneca nixes variant-specific COVID vaccines, eyes annual shots

August 10, 2022 | 12:04 am

There is little value in developing vaccines that target specific coronavirus variants, according to Bruce Mungall, Asia area medical director of vaccines and infectious diseases at AstraZeneca, a multinational pharmaceutical company.

“In terms of whether there’s value in chasing a new updated vaccine for a specific variant, I think there’s very limited incremental value in doing that,” he said. “I’m relatively confident that the current vaccines will continue to provide very high levels of protection against serious outcomes.”

Unlike Pfizer and BioNTech, which announced this June that they were evaluating Omicron-adapted COVID-19 vaccine candidates, AstraZeneca hopes to move to “more sustainable approaches” such as annual shots, Mr. Mungall said at a roundtable discussion on Aug. 5.

He pointed out that on the logistics side, manufacturing millions of variant-specific doses is a “very difficult and time-consuming process,” in light of how quickly the Omicron coronavirus subvariant spreads.

“To do that fast enough to react to a new variant is very challenging and expensive,” he said. “Every time a company gives you a new vaccine, I can guarantee you: it’s not going to be cheaper than the previous [one]. You’re going to pay an incremental cost every time there’s a new vaccine.”

Mr. Mungall said that current vaccines are effective in preventing hospitalization and death.

On Monday, the Department of Health (DoH) reported that there were 27,331 additional COVID-19 cases from Aug. 1 to Aug. 7, a 13% increase from a week before.

A 2022 study in Thailand that assessed the effectiveness of a mixed (heterologous) four-dose COVID-19 vaccine schedule found that a fourth dose of any of the COVID-19 vaccines studied, including AstraZeneca’s, were 75% effective in preventing Omicron infection.

The vaccine effectiveness of the AstraZeneca vaccine (73%) was similar to that of mRNA vaccines (71%).

“In Thailand, they use different vaccines for their third and fourth doses,” Mr. Mungall said. “The broader message is that any vaccine you have available for boosters is good for you.”

Across the age groups studied, data showed that a three-dose mixed schedule provided 98% protection against severe infection or COVID-19-related death.

A single death in a person with comorbidities was observed following a fourth dose booster, according to a preprint published June 28 in Research Square.

Meanwhile, researchers at Airfinity, a London-based predictive health analytics firm, took the Imperial College London’s research on deaths averted per country, and examined which vaccines were administered in each of these countries.

Using this methodology, it reported in July that AstraZeneca and Pfizer/BioNTech saved 6.3 million and 5.9 million lives, respectively. Sinovac, furthermore, saved 2 million lives; Moderna, 1.7 million lives.

More than 71 million individuals, or 92.06% of the target population in the Philippines, have been vaccinated against COVID-19 as of Aug. 7. Over 16 million individuals have had their booster shots.

In an Omicron world, a third dose is probably necessary, Mr. Mungall said.

“A booster dose will probably be necessary — either a third or a fourth — depending on your risk status,” he said. “There is a very similar effectiveness of all vaccines as booster doses.” — Patricia B. Mirasol

Director Lars von Trier diagnosed with Parkinson’s disease

August 10, 2022 | 12:03 am

COPENHAGEN — Danish director Lars von Trier, 66, has been diagnosed with Parkinson’s disease and will do limited promotion for his upcoming supernatural TV series Kingdom Exodus, his production company said on Monday.

Mr. Von Trier, often referred to as the “enfant terrible” of contemporary cinema, was in “good spirits” and is being treated for his symptoms, Zentropa said in a statement.

The Kingdom Exodus is the third and final installment in Mr. Von Trier’s 1990s cult TV show The Kingdom. The series premieres at the Venice Film Festival later this month as a five-hour film. It will be launched in five episodes on Viaplay’s platform and Danish broadcaster DR later this year.

“The illness means that Lars will only take part in interviews to a limited extent until the premiere later this year,” Zentropa said.

In 2011, Mr. Von Trier was banned from the Cannes Film Festival after he joked he was a Nazi at a news conference to promote his film Melancholia, an unusual disaster movie starring Kirsten Dunst and Charlotte Gainsbourg.

His other works include sexually graphic films such as Antichrist and Nymphomaniac, and the harrowing melodrama Dancer in the Dark, starring Icelandic singer Bjork and Catherine Deneuve, for which he won the Golden Palm for best movie at Cannes in 2000. — Reuters

Monde Nissin signs up for EDC ‘green’ power

August 10, 2022 | 12:03 am

CONSUMER goods maker Monde Nissin Corp. and other companies in the group have signed up for nearly 16 megawatts (MW) of renewable energy from Energy Development Corp. (EDC).

The group, composed of Monde Nissin, Monde M.Y. San Corp., and Sarimonde Foods Corp., started last month its power supply agreement with the First Gen Corp. subsidiary.

In a press release, EDC said the deal will power the food brands’ nine facilities in the Philippines, a move that is expected to cut their operations’ carbon footprint as part of their sustainability commitment.

Five facilities started running on ‘green’ power last month, while two others will start getting their supply in December this year and two more next year.

“The message is clear and consistent. We should embrace sustainability and look into more ways of incorporating sustainable practices in our businesses. What Monde Nissin and First Gen made possible is just a fraction of what the world needs. Let us hope that more companies move in this direction for the sake of the planet and future generations,” said Monde Nissin Chief Sustainability Officer Marivic N. Cajucom-Uy.

Monde Nissin’s five-year power supply comes from EDC’s Unified Leyte geothermal power plant complex, one of the company’s largest facilities.

EDC said geothermal energy is considered the “Holy Grail” of renewable energy (RE) technologies as it can provide uninterrupted, year-round baseload power, rain or shine — or what it calls Geo 24/7.

Carlos Lorenzo L. Vega, vice-president at First Gen and head of its power marketing, trading and economics, described the partnership as “heartening” for the commitment to addressing society’s present needs “without harming the ability of future generations to meet theirs.”

“And our new partners do this by making a conscious decision of creating a more positive impact on its consumers and on the environment through shifting to RE,” he added.

EDC has more than 1,480-MW installed energy capacity, which it said accounts for 20% of the country’s total installed RE capacity. It added that its 1,185.40-MW geothermal portfolio accounts for 62% of the country’s total installed geothermal capacity.

More than half of human infectious diseases can be worsened by climate change

August 10, 2022 | 12:03 am

typhoon-flood — PHILIPPINE STAR/ MICHAEL VARCAS

By Tristan McKenzie, Camilo Mora,
and Hannah von Hammerstein

Climate change can exacerbate a full 58% of the infectious diseases that humans come in contact with worldwide, from common waterborne viruses to deadly diseases like plague, our new research shows.

Our team of environment and health scientists reviewed decades of scientific papers on all known pathogenic disease pathogens to create a map of the human risks aggravated by climate-related hazards.

The numbers were jarring. Of 375 human diseases, we found that 218 of them, well over half, can be affected by climate change.

Flooding, for example, can spread hepatitis. Rising temperatures can expand the life of mosquitoes carrying malaria. Droughts can bring rodents infected with hantavirus into communities as they search for food.

With climate change influencing more than 1,000 transmission pathways like those and climate hazards increasingly globally, we concluded that expecting societies to successfully adapt to all of them isn’t a realistic option. The world will need to reduce the greenhouse gas emissions that are driving climate change to reduce these risks.

To be able to prevent global health crises, humanity needs a comprehensive understanding of the pathways and the magnitude with which climate change might affect pathogenic diseases.

We focused on 10 climate-related hazards linked to rising greenhouse gas emissions: atmospheric warming, heat waves, drought, wildfires, heavy precipitation, flooding, storms, sea-level rise, ocean warming and land cover change. Then we looked for studies discussing specific and quantifiable observations of human disease occurrences linked to those hazards.

In total, we reviewed over 77,000 scientific papers. Of those, 830 papers had a climatic hazard affecting a specific disease in an explicit place and/or time, allowing us to create a database of climatic hazards, transmission pathways, pathogens and diseases. An interactive map of every pathway between hazard and pathogen is available online.

The largest number of diseases aggravated by climate change involved vector-borne transmission, such as those spread by mosquitoes, bats or rodents. Looking at the type of climate hazard, the majority were associated with atmospheric warming (160 diseases), heavy precipitation (122) and flooding (121).

We found four key ways climatic hazards interact with pathogens and humans:

1) Climate-related hazards bring pathogens closer to people.

In some cases, climate-related hazards are shifting the ranges of animals and organisms that can act as vectors for dangerous pathogenic diseases.

For example, warming or changes in precipitation patterns can alter the distribution of mosquitoes, which are vectors of numerous human pathogenic diseases. In recent decades, geographic changes in outbreaks of mosquito-borne diseases such as malaria and dengue have been linked to these climatic hazards.

2) Climate-related hazards bring people closer to pathogens.

Climate disasters can also alter human behavior patterns in ways that increase their chances of being exposed to pathogens. For example, during heat waves, people often spend more time in water, which can lead to an increase in waterborne disease outbreaks.

Notably, Vibrio-associated infections increased substantially in Sweden and Finland following a heat wave in northern Scandinavia in 2014.

3) Climate-related hazards enhance pathogens.

In some cases, climate-related hazards have led to either environmental conditions that can increase opportunities for pathogens to interact with vectors or increase the ability of pathogens to cause severe illness in humans.

For example, standing water left by heavy precipitation and flooding can provide breeding grounds for mosquitoes, leading to increased transmission of diseases such as yellow fever, dengue, malaria, West Nile fever and leishmaniasis.

Studies have shown that rising temperatures may also help viruses become more resistant to heat, resulting in increased disease severity as pathogens become better able to adapt to fever in the human body.

For instance, studies have suggested that rising global temperatures are leading to increased heat tolerance of fungal pathogens. The sudden appearance on multiple continents of treatment-resistant human infections of Candida auris, a fungus that was previously nonpathogenic to humans, has been associated with increasing global temperatures. Similarly, fungi in urban environments have been shown to be more heat tolerant than those in rural areas, which tend to be cooler.

4) Climate-related hazards weaken the body’s ability to cope with pathogens.

Climate-related hazards can affect the human body’s ability to cope with pathogens in two key ways. They can force people into hazardous conditions, such as when disaster damage leads to people living in crowded conditions that might lack good sanitation or increase their exposure to pathogens.

Hazards can also reduce the body’s capacity to fight off pathogens, through malnutrition, for example. Living through climatic hazards may also induce increased cortisol production from stress, leading to a reduction in the human body’s immune response.

Climate change presents a significant threat to human lives, health and socioeconomic well-being. Our map shows just how extensive that threat can be. In our view, to dial back the risk, humanity will have to put the brakes on the human-caused greenhouse gas emissions fueling global warming.

Tristan McKenzie is a postdoctoral researcher in Marine Science at the University of Gothenburg.

Camilo Mora is an associate professor of biology at the University of Hawaii.

Hannah von Hammerstein is a Ph.D. candidate in geography and environmental science at the University of Hawaii.

This article is republished from The Conversation under a Creative Commons license.

Treasury fully awards reissued bonds

August 10, 2022 | 12:03 am

THE GOVERNMENT fully awarded the reissued 10-year Treasury bonds (T-bonds) it auctioned off on Tuesday at a lower average rate amid robust demand, which led it to open its tap facility.

The Bureau of the Treasury (BTr) raised P35 billion as planned from its offer of reissued 10-year securities that have a remaining life of six years and five months on Tuesday. Total bids reached P105.72 billion or more than thrice the amount on the auction block.

Rates awarded on Tuesday ranged from 5.7% to 5.874%, bringing the average yield for the bonds on offer to 5.791%, lower by 108.4 basis points (bps) than the 6.875% coupon fetched for the series when it was first offered on Jan. 8, 2019.

The average rate was also 6.2 bps below the 5.853% yield on the seven-year bonds, the closest tenor to the remaining life of the papers on offer, but 1.3 bps above the 5.778% quoted for the issue at the secondary market before Tuesday’s auction, based on PHP Bloomberg Valuation Reference Rates data provided by the BTr.

To accommodate the strong demand seen for Tuesday’s offering, the Treasury opened its tap facility to raise P10 billion more via the bonds for a yield-to-maturity of 5.791%.

National Treasurer Rosalia V. de Leon said in a Viber message to reporters that it was “another well received auction” as bids reached over thrice as much as the offering and with rates seen lower than secondary market levels.

The first trader said that it was “another strong auction, possibly supported by weaker-than-expected GDP (gross domestic product) numbers.”

“The demand was quite similar to the three prior auctions, which also shows that end-users are still extending duration for yield pickup,” the first trader added.

The second trader said the auction result was in line with expectations.

“We know it’s going to be a robust auction given the market’s preference for belly to long-end bonds due to their relatively attractive yields offered,” the second trader said.

Preliminary data released by the Philippine Statistics Authority on Tuesday showed GDP grew by 7.4% year on year in the April to June period, easing from the downward-revised 8.2% reading for the first quarter and the 12.1% expansion in the same period in 2021.

This brought the first semester average to 7.8%, faster than the 3.9% growth seen in the same period last year and well above the government’s 6.5-7.5% target for the year.

Meanwhile, investors have shown strong demand for longer tenors, with the Treasury making full awards of all its T-bond offerings since last month as the market is looking for higher yields amid expectations of higher interest rates due to sustained inflationary pressures.

Headline inflation quickened to 6.4% year on year in July, its fastest pace since October 2018, mainly due to soaring prices of food and higher transport costs.

For the first seven months, inflation averaged 4.7%, faster than the 4% seen in the same period a year ago and the central bank’s 5% inflation forecast, but higher than its 2-4% target for the year.

BSP Governor Felipe M. Medalla last week said the central bank may hike rates by 50 bps at the Monetary Board’s Aug. 18 meeting after headline inflation accelerated further in July.

The Monetary Board last month raised the benchmark interest rates by 75 bps in an off-cycle move, as it sought to contain inflationary pressures. It has raised rates by 125 bps so far since May.

The BTr wants to raise P215 billion from the domestic market this month, or P75 billion through Treasury bills and P140 billion via T-bonds.

The government borrows from local and external sources to help fund a budget deficit capped at 7.6% of GDP this year. — Diego Gabriel C. Robles

Pulitzer Prize-winning author David McCullough, 89

August 10, 2022 | 12:02 am

DAVID McCullough, best-selling author and renowned historian who won Pulitzer Prizes for his biographies of presidents John Adams and Harry Truman, has died at the age of 89, his publisher said on Monday.

Mr. McCullough died on Sunday at his home in Hingham, Massachusetts, surrounded by his five children, according to a Facebook page maintained by his publisher, Simon and Schuster.

Mr. McCullough was known for writing several deeply researched and popular works about important American figures and points in history such as the building of the Brooklyn Bridge and the first flight by the Wright Brothers.

“As an historian, he paints with words, giving us pictures of the American people that live, breathe, and above all, confront the fundamental issues of courage, achievement, and moral character,” the citation for his honorary degree from Yale University read, according to his biography on the Simon and Schuster website.

Mr. McCullough won a Pulitzer Prize in 1993 for Truman, a biography about the 33^rd president of the United States and another Prize in 2002 for John Adams, a biography about the 2^nd US president.

Mr. McCullough also earned National Book Awards for The Path Between the Seas: The Creation of the Panama Canal and Mornings on Horseback.

In 2016, Mr. McCullough was awarded the Presidential Medal of Freedom, the nation’s highest civilian award.

Mr. McCullough was born in Pittsburgh in 1933. He attended Yale University where he earned an English literature degree. After school, he moved to New York City and got a job with Sports Illustrated.

He married Rosalee Barnes in 1954 and the couple had five children. Rosalee Barnes McCullough died in June at the age of 89. — Reuters

SPNEC board clears name change

August 10, 2022 | 12:02 am

SOLAR Philippines Nueva Ecija Corp. (SPNEC) announced on Tuesday that its board of directors approved to change its corporate name to SP New Energy Corp. subject to stockholder and regulatory approval.

“SPNEC signaled that it would be reintroducing its business to the market over the coming weeks, including sharing new details on its portfolio, as well as advancing the assumption of certain projects ahead of the share swap,” SPNEC said in a media release.

It said the move to rename the company is meant to reflect its expansion from a single project in Nueva Ecija to a portfolio that includes other projects and developments.

The company aims to complete the development of 10 gigawatts (GW) by 2025.

SPNEC also said that its asset-for-share swap with Solar Philippines Power Project Holdings, Inc. is moving forward, as its public float is to be increased from its stock rights offering, with an offer period scheduled from Aug. 30 to Sept. 5.

After the completion of the swap deal, SPNEC would gain a portfolio of projects, including 400 megawatts of operating projects or under construction; the 3.5-GW solar and 4.5-GW-hours battery project of Terra Solar Philippines, Inc., which plans to supply mid-merit power to Manila Electric Co. for around 12 hours per day; and 1.8 GW of projects contracted under the Department of Energy’s Green Energy Auction.

On Tuesday, shares in the company inched up by 1.16% or P0.20 to finish at P1.74 apiece on the stock exchange. — Ashley Erika O. Jose

Gross domestic product (GDP) quarterly performance

August 10, 2022 | 12:02 am

THE Philippine economy expanded by 7.4% in the second quarter — slower than expected — as rising inflation weighed on consumer spending. Read the full story.

Why am I so tired and when is it time to see the doctor about it?

August 10, 2022 | 12:02 am

By Natasha Yates

Everyone feels tired sometimes. But how do you know whether your tiredness is a problem worth seeing a doctor about? And with all the mental and emotional strain we have been under from the pandemic, isn’t it just normal to feel tired?

Tiredness is subjective; what’s normal for one person won’t be for the next. Many people see their general practitioners (GPs) reporting tiredness (a recent study in Ireland found that it was present in 25% of patients).

As a GP, my first question to someone who feels tired is: “how well can you function?”

If tiredness is interfering with your everyday life and your ability to do what you like to do, it should be explored further.

Poor sleep is an obvious and very common cause of tiredness. Often patients tell me “Oh, lack of sleep is not the cause, I sleep fine, possibly too much!” But on questioning they admit they don’t wake up feeling refreshed.

That’s a bit of a giveaway because it means their sleep quality is poor, even if the quantity seems enough. They could be suffering from sleep apnea, where breathing stops and starts while a person is asleep. Apnea can lead to serious long-term health problems, so it’s worth investigating.

Alcohol can also wreak havoc on a person’s sleep quality and they wake feeling unrefreshed.

Another common cause of tiredness is depression — and don’t forget, someone can be depressed without feeling they have low mood. For example, they may feel irritable or frustrated, or struggle to concentrate. This is concerning, because such patients may fly under the radar and not realize this is actually depression. Unexplained tiredness may be the predominant symptom of depression, with other symptoms only coming to light with careful questioning.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious long-term illness that, among other symptoms, causes people to feel extreme fatigue — well beyond the range of “normal” tiredness. It can begin with patients noticing a degree or type of tiredness different from their past experience, and can be difficult to diagnose in the early stages.

There are other potential causes of tiredness — problems such as low iron, thyroid disease, diabetes, kidney disease, heart disease and many more. Treatment for these can alleviate the tiredness too.

Tiredness also accompanies many illnesses, but should not persist after recovery.

The take-home message is this: if tiredness is interfering with your life, there are many possible causes and it’s worth speaking to a GP about it.

Screening tools for a concerning level of tiredness include the Epworth Sleepiness Scale and the STOP-BANG score. You can do both tests at home and take the results to your GP.

But even if you have normal scores, your tiredness is worth investigating if you:

feel too tired to exercise (this can be a vicious cycle because regular exercise can actually give you more energy — however, it can be risky for people with ME/CFS to exercise, so caution is required for these patients)
feel too tired to go out, see friends or do activities you once enjoyed
hit the alarm snooze button a lot because you don’t wake feeling refreshed
doze off in front of the TV regularly
spend the whole day wishing you could go back to bed.

If, along with tiredness, you also have any of the following “red flags,” it is vital you see a GP sooner rather than later: unexplained weight loss, shortness of breath, recurrent fevers, bleeding from your bowels or gums, swollen and sore joints, or other new symptoms concerning you.

I sometimes get asked if wanting an afternoon nap is a red flag. That’s a tricky one; a late afternoon energy slump is pretty normal physiologically (we have whole cultures built around the idea of a siesta, and I often wish Australia was more open to the idea!).

And, of course, many of us lead busy lives and are subject to crushing expectations around work, study and parenting. Tiredness may not always be a sign of a physical health problem, but rather that the balance between work and rest is not right.

Talk to your doctor. What happens next depends on the individual and unique factors at play.

Some people need investigating immediately if possible serious underlying causes are suspected.

However, there are often obvious ways to address lifestyle factors, and we’d start there. Is alcohol or caffeine interfering with your sleep? Do you have good sleep hygiene habits? Is your exercise level appropriate and your diet not too high in sugar?

After we’ve tackled lifestyle factors, we can look at whether to investigate for health conditions that might be contributing to the tiredness.

As I have written before, fatigue is about more than feeling just tired: Tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.

If you’re especially concerned about fatigue after recovering from coronavirus disease 2019 (COVID-19) and are worried about long COVID, definitely talk to a doctor.

The factors at play are complex and unique to the individual, so a good doctor can help you work out when tiredness has crossed over into true fatigue.

Natasha Yates is an assistant professor of general practice at Bond University in Australia.

This article is republished from The Conversation under a Creative Commons license.