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Authorities assured of reaching vaccine goal

Government confident of reaching vaccine target

The Indian government is confident that the country will be able to meet an ambitious target of having more than 2 billion coronavirus vaccine doses by the end of the year, Civil Aviation Minister Hardeep Singh Puri said.

Last month, Health Minister Harsh Vardhan said in a statement that India will have 516 million vaccine doses by July, including shots already administered, and that the number will rise to 2.16 billion doses between August and December.

“We have paid the two existing domestic manufacturers, Serum Institute (of India) and Bharat Biotech, advance money to produce vaccines for the whole of May, June, and July. We are only past May,” Puri told CNBC’s Tanvir Gill in an interview. He explained that the government is also in advanced stages of talks with other vaccine manufacturers.

The government is “absolutely confident of being able to meet this target by December,” Puri added.

In its forecast, the Indian government expects about 750 million doses of the AstraZeneca vaccine that is being locally produced by the Serum Institute of India and is known as Covishield. Another 550 million doses of Covaxin, which is developed and produced by Indian company Bharat Biotech, are also expected.

People walking past a wall mural depicting medical staff hitting the coronavirus with vaccine needle at Santacruz on March 29, 2021 in Mumbai, India.

Pratik Chorge | Hindustan Times | Getty Images

Both vaccines are being currently used in India’s inoculation campaign where more than 222 million doses have been administered as of Thursday — but a majority of them are first of the two doses required for immunity.

Russia’s Sputnik vaccine — the third shot to get approved — will contribute about 156 million to the predicted tally. Reuters reported that six Indian companies have already signed deals to produce around 1 billion doses of the vaccine annually and that Serum Institute is also seeking approval to make it.

The government also expects:

In addition, India has also authorized foreign-made vaccines that have been granted emergency approval by the U.S., U.K., European Union, Japan and World Health Organization-listed agencies.

Vaccines, the way forward

Experts agree that vaccination is the way forward for India — both to bring the economy out of the Covid crisis and to mitigate the effects of a third wave. But vaccine hesitancy, in part due to misinformation being spread about the shots, has been an issue both in India and globally.

Vaccines are also in short supply and that has slowed down domestic inoculation efforts and forced India to halt exports to other countries.

For his part, Puri said that proper dissemination of information and education around vaccination is needed and that the government is doing its part.

India is battling a devastating second wave of outbreak that started in February and accelerated in April and early May, which overwhelmed the country’s health-care infrastructure. The sector has struggled with shortages of beds, oxygen and medication as many doctors and other health-care workers succumbed to Covid-19.

A doctor walks past the banner announcing a Covid-19 vaccination drive in Hyderabad, India on May 28, 2021.

Noah Seelam | AFP | Getty Images

Some of that pressure eased once the central government and states stepped up their efforts to manage the outbreak while international aid poured in, providing some of the much-needed medical supplies.

Daily reported cases in India have declined from a peak of more than 414,000 in early May. So far, the South Asian nation reported more than 28.5 million cases and over 340,000 deaths.

Puri said the government has now mapped out ways to deal with challenges like oxygen shortages, where hard-hit areas ran out of stock and logistical difficulties made it harder for new supplies to reach them.

Initially, the government diverted oxygen meant for industrial use to medical facilities. Last month, it stepped up efforts to streamline the supply by allocating funds to install 500 medical oxygen plants across India within three months.

“If a third wave comes, and when it comes, depending on the requirements, our capacity to again repurpose and again to convert back to dealing with it, I think that infrastructure capacity is there,” Puri said.

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Digital Actuality Remedy Plunges Sufferers Again Into Trauma. Right here Is Why Some Swear by It.

Virtual Reality Therapy Plunges Patients Back Into Trauma. Here Is Why Some Swear by It.

“V.R. is not going to be the solution,” said Jonathan Rogers, a researcher at University College London who has studied rates of anxiety disorders during the pandemic. “It may be part of the solution, but it’s not going to make medications and formal therapies obsolete.”

Virtual reality treatments aren’t necessarily more effective than traditional prolonged exposure therapy, said Dr. Sherrill. But for some patients, V.R. offers convenience and can immerse a patient in scenes that would be hard to replicate in real life. For some people, the treatment can mimic video game systems they’re already familiar with. There’s also a dual awareness in patients who use virtual reality — the images on the screen are almost lifelike, but the headset itself functions as proof that they’re not real.

Months after the Sept. 11 terrorist attacks, Dr. Difede and Dr. Hunter Hoffman, who is the director of the Virtual Reality Research Center at the University of Washington, tested virtual reality treatments in one survivor with acute PTSD, one of the first reported applications of the therapy. Dr. Difede said that the first time the patient put on the headset, she started crying. “I never thought I’d see the World Trade Center again,” she told Dr. Difede. After six hourlong sessions, the patient experienced a 90 percent decrease in PTSD symptoms. Dr. Difede later tested V.R. exposure therapy in Iraq War veterans; 16 out of the first 20 patients no longer met the diagnostic criteria for PTSD after completing treatment.

At the University of Central Florida, a team called U.C.F. Restores has been building trauma therapies using V.R. that allows clinicians to control the level of detail in a simulation, down to the color of a bedspread or a TV that can be clicked on or off, in order to more easily trigger traumatic memories. The program offers free trauma therapy, often using V.R., to Florida residents and focuses on treating PTSD.

Dr. Deborah Beidel, a professor of psychology and executive director of U.C.F. Restores, has broadened the treatments beyond visuals, customizing sounds and even smells to create an augmented reality for patients.

Jonathan Tissue, 35, a former Marine, sought treatment at U.C.F. Restores in early 2020 after talk therapy and medication failed to alleviate his PTSD symptoms, which included flashbacks, anxiety and mood swings. In the end, it was the smells pumped into the room while he described his military service to a clinician that helped unlock his memories. There was the stench of burning tires, diesel fumes, the smell of decaying bodies. He heard the sounds of munitions firing. His chair rumbled, thanks to the center’s simulated vibrations.

“It unlocked certain doors that I could start speaking about,” he said. He talked through his newly uncovered memories with a therapist and a support group, processing the terror that had built in his body for years.

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NIH scientists say they could have discovered a promising new oral antiviral drug

NIH scientists say they may have found a promising new oral antiviral drug

Alex Raths | Getty Images

Scientists may have found promising new treatment for Covid-19 after an experimental oral antiviral drug demonstrated the ability to prevent the coronavirus from replicating, the National Institutes of Health said Thursday, citing a new study.

The drug called TEMPOL can reduce Covid-19 infections by interfering with an enzyme that the virus needs to make copies of itself once it’s in human cells, which could potentially limit the severity of the disease, des researchers said NIH. The drug was tested in a live virus cell culture experiment.

“We urgently need additional effective, accessible treatments for COVID-19,” wrote Dr. Diana W. Bianchi, director of the National Institute of Child Health and Human Development at the NIH, in a statement. “An oral drug that prevents SARS-CoV-2 from replicating would be an important tool in reducing the severity of the disease.”

The results were published in the journal Science.

While vaccines have been incredibly useful in containing Covid-19 cases in the United States and other parts of the world, scientists say treatments are still badly needed for those who contract the virus.

According to the Johns Hopkins University, the US reported an average of around 16,300 infections per day on Wednesday. Gilead Sciences’ remdesivir is the only drug that has received full US approval from the Food and Drug Administration for the treatment of Covid and that must be administered intravenously in a hospital.

Pfizer, who worked with German drug maker BioNTech to develop the first approved Covid-19 vaccine in the United States, is also developing an oral drug against Covid that can be taken at home at the first signs of illness. The researchers hope the drug will prevent the disease from getting worse and prevent hospital stays. It started with an early trial in March.

The NIH researchers said they intend to conduct additional preliminary studies and look for ways to evaluate the drug in a clinical study on Covid.

The results of the study are “hopeful,” said Dr. Tracey Rouault, another NIH officer who led the study.

“However, clinical trials are needed to determine whether the drug will be effective in patients, especially early on in the disease process when the virus begins to replicate.”

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First U.S. Vaccine Donations Will Go to ‘Vast Vary’ of Nations in Want

First U.S. Vaccine Donations Will Go to ‘Wide Range’ of Nations in Need

And the president has pledged to donate up to 60 million doses of AstraZeneca’s vaccine. However, these cans, which are also manufactured in the Emergent facility, are not approved for domestic use and may not be released in other countries until the regulatory authorities deem them safe. If they weren’t cleared for release, Mr. Biden would have to agree to donate more of the three vaccines used here in order to fulfill his 80 million pledge.

The president has described vaccine donations as part of an “entirely new effort” to increase vaccine supply and significantly expand manufacturing capacity, most of it in the United States. To further expand the offering, Mr. Biden recently announced that he would support the waiver of intellectual property protection for coronavirus vaccines. He also made Mr. Zients responsible for developing a global vaccine strategy.

But activists say it’s not enough to simply donate overdoses and support renunciation. They argue that Mr Biden needs to create the conditions for pharmaceutical companies to transfer their intellectual property to vaccine manufacturers abroad so that other countries can set up their own vaccine manufacturing operations.

Peter Maybarduk, director of the Public Citizen’s Access to Medicines program, on Thursday called on the government to invest $ 25 billion in “urgent public vaccine manufacturing in locations around the world” to achieve eight billion doses of mRNA in one year. Technology and “share these vaccine recipes with the world.”

When asked recently whether the United States would be ready, Andrew Slavitt, a senior health advisor to the President, sidestepped the question, saying only that the United States would “play a leadership role” but still “global partners across the board.” World ”. ”

On Thursday, Mr Zients said the United States would repeal the Defense Production Act “priority assessment” for three vaccine manufacturers – AstraZeneca, Novavax and Sanofi – that do not make coronavirus vaccines for use in the United States. The shift means companies in the United States supplying vaccine manufacturers “can make their own decisions about which orders to fill first,” Zients said.

This could free up supplies for foreign vaccine manufacturers and allow other countries to ramp up their own programs.

Abdi Latif Dahir contributed to the coverage.

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White Home lays out plan to share tens of millions of doses with poorer nations

White House lays out plan to share millions of doses with poorer nations

The Oxford-AstraZeneca covid vaccine.

Karwai Tang | Getty Images

The U.S. government will share the majority of its donated Covid-19 vaccine doses through COVAX, the World Health Organization-led program that provides shots to countries in need, the White House announced Thursday.

The Biden administration has committed to donating at least 20 million doses of Covid vaccines produced by Pfizer-BioNTech, Moderna and Johnson & Johnson as well as 60 million doses of AstraZeneca’s vaccines, which has not yet been authorized for use in the United States.

The U.S. plans to allocate 75% of the vaccines through the COVAX global vaccine sharing program, the White House in an email. Of the first 25 million doses, about 6 million will go to countries in South and Central America, 7 million to Asia and 5 million to Africa, the White House said. About 6 million will go to neighboring countries and U.S. allies.

At least 25% of shots will be kept for immediate U.S. needs and for “countries in need, those experiencing surges, immediate neighbors, and other countries that have requested immediate U.S. assistance,” according to the plan.

The administration is donating the shots to “save lives” and thwart the emergence of new variants,  national security advisor Jake Sullivan said Thursday.

“The United States is not doing this as some kind of back-and-forth deal where we are getting something in return,” Sullivan said at a White House briefing. “We are giving these for a single purpose. It is the purpose of ending this pandemic.”

The announcement comes as world leaders urge wealthy nations such as the U.S. to donate Covid shots to other countries. While the U.S. has returned to some form of normality as more Americans get vaccinated and new cases fall, other countries, like India, have experienced huge outbreaks.

Just last week, the WHO said Africa needed at least 20 million doses of AstraZeneca’s vaccine within six weeks to get the second round of shots to people who have received the first.

The head of the Coalition for Epidemic Preparedness Innovations told Reuters that leaders of the Group of 7 rich nations must donate shots urgently to avoid an outcome akin to the 1918 flu pandemic, which killed 50 million people.

“It’s a moral imperative if we want to avoid situations like Peru, if we want to avoid impacts that could rival those of the 1918 flu, we must send vaccine to countries to protect their health-care workers and protect the vulnerable populations now,” Richard Hatchett, chief executive of CEPI which co-runs the COVAX vaccine sharing facility, told Reuters.

In addition to donating the doses, the White House also announced it is lifting restrictions as part of the Defense Production Act that gave the U.S. priority for vaccines developed by AstraZeneca, Sanofi and Novavax.

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When a Surgeon Grew to become a Covid-19 Affected person: ‘I Had By no means Confronted the Actuality of Demise’

When a Surgeon Became a Covid-19 Patient: ‘I Had Never Faced the Reality of Death’

“He brought his culture of innovation,” Dr. Emond said. “And his personal capability, his ability to work for long hours, never quitting, never giving up, no matter how difficult the situation, carrying out operations that many would deem impossible.”

In his first year at Columbia, Dr. Kato and his team operated successfully on a 7-year-old girl, Heather McNamara, whose family had been told by several other hospitals that her abdominal cancer was inoperable. The surgery, which involved removing six organs and then putting them back in, took 23 hours.

More and more patients from around the country, and around the world, began seeking out Dr. Kato for operations that other hospitals could not or would not perform. He had also begun making trips to Venezuela to perform liver transplants for children and teach the procedure to local surgeons, and he created a foundation to help support the work there as well as in other Latin American countries.

As Dr. Kato’s colleagues struggled to save him, a waiting list of surgical patients clung to hopes that he would soon be able to save them.

Gradually, Dr. Pereira said, there were signs of recovery.

“You come in early in the morning to see him,” he said. “The hospital hallways are empty and everybody’s looking at each other, scared and anxious. You go into the intensive care unit dreading bad news, and the team is giving you a sort of hopeful thumbs-up that maybe he’s looking better.”

Dr. Kato spent about a month on a ventilator, and a week on ECMO. Like many people with severe Covid, he was tormented by frightening and vivid hallucinations and delusions. In one, he was arrested at the Battle of Waterloo. In another, he had been deliberately infected with anthrax; only a hospital in Antwerp could save him, but he could not get there. He saw the white light that some people describe after near-death experiences. “I felt like I died,” he said.

He had spent much of his adult life in hospitals, but never as a patient.

“I never got sick,” he said. “I had never faced the reality of death.”

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5 issues to know earlier than the inventory market opens Thursday, June 3

5 things to know before the stock market opens Thursday, June 3

Here are the most important news, trends and analysis that investors need to start their trading day:

1. AMC mania captivates Wall Street, company to sell more shares

Traders at the New York Stock Exchange, June 2, 2021.

Source: NYSE

U.S. stock futures fell Thursday after another muted day in the broader market belied the incredible trading in meme stock AMC Entertainment. In premarket trading, AMC initially jumped 20%, before going back and forth between much smaller gains and losses, after the movie theater chain filed to sell 11.55 million shares “from time to time.” AMC shares skyrocketed 95% on Wednesday, bringing their year-to-date gains to more than 2,800%.

Focusing on the link between inflationary pressures and the reopening of U.S. businesses after Covid, the Dow Jones Industrial Average, S&P 500 and Nasdaq posted modest gains Wednesday. The Dow and S&P 500 were within 1% of their May record closes, while the Nasdaq was 2.7% away from its late April record close. However, on Thursday, Dow futures dropped about 200 points, or 0.6%. S&P futures saw similar declines. Nasdaq futures fell 1%.

2. Short sellers of AMC shares lost $2.8 billion in one day

Movie poster of current offerings are displayed on the front of an AMC theater on June 01, 2021 in Chicago, Illinois. Mudrick Capital has agreed to purchase 8.5 million share of the theater chain for $230.5 million.

Scott Olson | Getty Images

The Reddit-fueled retail trader war on those betting against AMC, similar to January’s GameStop mania, cost short sellers $2.8 billion on Wednesday alone, according to S3 Partners. About 18% of the AMC shares available for trading were still sold short through Wednesday. Most Wall Street analysts still believe AMC shares will plummet eventually. The average 12-month target price was $5.11, according to FactSet. AMC closed out 2020 at $2.12 per share.

3. Bond yields inch higher after two jobs reports

A sign advertising job openings is seen outside of a Starbucks in Manhattan, New York City, New York, U.S., May 26, 2021.

Andrew Kelly | Reuters

4. Largest meat producer getting back online after cyberattack

The JBS meat placing plant is viewed in Plainwell, Michigan on June 2, 2021.

Jeff Kowalsky | AFP | Getty Images

Brazil’s JBS, the world’s largest meat processor, has resumed most production after a weekend cyberattack. However, experts warned that the vulnerabilities exposed by this breach and others are far from resolved. JBS blames hackers with ties to Russia. Last month, Colonial Pipeline, the largest U.S. fuel pipeline, paid ransomware demands after its operations were closed for nearly a week. Hackers with ties to Russia are also suspected in that attack. Following media reports Wednesday, New York City’s Metropolitan Transportation Authority acknowledged a cyberattack in late April with suspected ties to China.

5. Activist firm Engine No. 1 claims third Exxon board seat

A view of the Exxon Mobil refinery in Baytown, Texas.

Jessica Rinaldi | Reuters

Engine No. 1 has won a third board seat at Exxon. The upstart activist firm has been targeting the oil giant since December, pushing the company to shift its focus away from fossil fuels. Engine No. 1, which has a miniscule 0.02% stake in Exxon, nominated four directors ahead of the firms’ annual shareholder meeting at the end of May, a move that garnered support from major state pension funds. Last week’s vote followed months of back-and-forth between Engine No. 1 and Exxon.

— The Associated Press contributed to this report. Follow all the market action like a pro on CNBC Pro. Get the latest on the pandemic with CNBC’s coronavirus coverage.

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The Illness Detective – The New York Occasions

The Disease Detective - The New York Times

Meningitis itself is not a disease, just a description that means that the tissues around the brain and spinal cord have become inflamed. In the United States, bacterial infections can cause meningitis, as can enteroviruses, mumps, and herpes simplex. But a high percentage of cases, as doctors say, have no known etiology: Nobody knows why the patient’s brain and spinal cord swell.

This was the case with the Dhaka eruption. CHRF is one of the leading microbiology laboratories in Southeast Asia and is responsible for tracking meningitis in the country for the World Health Organization. “Every case of meningitis that comes in, we cultivate,” Saha told me. “We do antigen tests for pneumococci, Neisseria meningitidis, Haemophilus influenzae and GBS” or group B streptococci – the four infections most likely to cause meningitis. “Then we do a much more sensitive and specific test for Streptococcus pneumoniae bacteria as this causes the highest percentage of cases. And then we also do real-time PCR to look for DNA fragments from one of these pathogens. ”

When the outbreak began, the cause was thought to be bacterial again, but none of the tests could locate a pathogen. Over the next year, Saha worked to solve the puzzle, sometimes in collaboration with other laboratories. A partnership with an organization in China broke up when the group was unwilling to share their techniques. Another group of researchers in Canada did their own tests on the meningitis samples, but couldn’t figure out the cause either. Not long after, Saha was attending a conference at the British Museum where she gave a presentation entitled “The Dark Side of Meningitis”. “It was a negative conversation,” recalls Saha. “How: Why does everyone only talk about the successful cases? We have to talk about thousands of cases each year where we have no idea what is causing the disease. ”

Before meeting DeRisi, Saha was skeptical about further collaboration. But the two hit it off right away. Although DeRisi could be impatient, Saha liked that he was direct and appreciated that his “ethics are very strong. In his head he says: That’s right; that is wrong; I’ll do that. ”Still, she proceeded cautiously. “Because IDseq was new and I’m very meticulous, I built in a lot of controls,” she told me. Of the 97 cerebrospinal fluid samples, only 25 were from actual mystery meningitis cases. The remainder were either from cases for which Saha’s lab had already identified the cause or were not meningitis at all. Several were just water. “The idea was that all of this would be tested and the process dazzled,” says Saha. “Because I had to see whether the platform worked or not.”

However, when Saha and her team performed the mysterious meningitis testing through IDseq, the result was surprising. Rather than uncovering a bacterial cause as expected, a third of the samples showed signs of the Chikungunya virus – particularly a neuroinvasive strain that was thought to be extremely rare. “At first we thought: That can’t be true!” Saha remembers. “But when Joe and I realized it was Chikungunya, I went back and looked at the other 200 samples we had collected around the same time. And we also found the virus in some of these samples. ”

Until recently, chikungunya was a comparatively rare disease that occurs mainly in parts of central and east Africa. “Then it just exploded across the Caribbean and Africa and across Southeast Asia to India and Bangladesh,” DeRisi told me. No cases of chikungunya were reported in Latin America in 2011. In 2014 there were a million.

Common chikungunya can cause permanent neurological damage and lifelong joint pain. DeRisi called the disease “enormously devastating” and stated that chikungunya means “to be distorted” in the Kimakonde language spoken in Tanzania. But one neuroinvasive version that caused brain damage, particularly affecting children and infants, was particularly alarming.

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Day by day U.S. information on June 2

Daily U.S. data on June 2

Medical assistant Odilest Guerrier administers a Moderna COVID-19 vaccine to Pasqual Cruz at a clinic established by Healthcare Network in Immokalee, Florida on May 20, 2021.

Joe Raedle | Getty Images

Twelve US states now have 70% of adult residents who have received at least one Covid shot, according to data from the Centers for Disease Control and Prevention, released on Tuesday.

California and Maryland most recently reported crossing the milestone, joining Vermont, Hawaii, Massachusetts, Connecticut, Maine, New Jersey, Rhode Island, New Mexico, Pennsylvania and New Hampshire.

President Joe Biden’s goal is to have one or more vaccinations to 70% of those over 18 years of age by July 4th. On Wednesday he will talk about the status of the vaccination campaign and declare June the national month of action more people vaccinated.

The seven-day average of daily U.S. infections stayed below 20,000 for the second straight day on Tuesday, although many states did not release data and may be catching up with reporting during the Memorial Day holiday.

US percentage of vaccinated population population

CDC data shows that about 51% of Americans have received at least one dose and about 41% are fully vaccinated.

Of those over the age of 18, around 63% have received one dose or more.

US vaccine shots given

The US reports an average of 1.2 million vaccinations per day over the past week, according to the CDC.

White House Covid-19 data director Cyrus Shahpar wrote in a tweet on Tuesday that data coverage over the holiday weekend will be limited and will be supplemented in the coming days.

Covid cases in the USA

The most recent seven-day average of U.S. Covid cases is 17,289, data from Johns Hopkins University shows. Many states have not reported Memorial Day data, and cases could rise in the coming days to reflect residue depletions.

Before the bank holiday weekend, the number of cases had been falling for weeks.

Covid deaths in the US

Also affected by the slowdown in reporting over the holiday weekend, the current seven-day average of Covid deaths in the US is 589.

The latest trend in the daily death toll in the US is made even more complicated by data reviews by state health officials. In these scenarios, a batch of previously unreported cases or death dates are assigned to a single day, even if they occurred before the assigned date. Oklahoma and Maryland each added hundreds of deaths to their pandemic totals last week.

Kentucky Governor Andy Beshear announced Tuesday that an audit found 260 new Covid deaths, all currently attributed to June 1 in the Hopkins data, according to the Associated Press.

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For Sleep Apnea, a Mouth Guard Could also be a Good Different to CPAP

For Sleep Apnea, a Mouth Guard May be a Good Alternative to CPAP

But many patients find sleeping with a face mask less awkward or uncomfortable than using a CPAP machine. The technical term for these devices is mandibular advancement device, so named because it pushes the mandible forward, which in most people helps keep the airway open. There are many variations of these devices in drug stores, but a dentist can design a more effective personalized device and modify or customize it if necessary. The patients in the laryngoscope study were all reexamined after the initial adjustment and most adjustments needed over a period of two to four weeks.

“We recommend a custom device made by a dentist,” said Dr. Benjamin. “And you should be retested to see how well it works. There are subjective and objective improvements that should be pursued. “

But there are people for whom neither CPAP nor dental devices work, either because they cannot use them consistently and correctly, or because the devices themselves do not solve the problem if they are used correctly. Various effective surgical procedures exist for these patients.

The most common is soft tissue surgery, which involves modifying or removing tissue from the back of the mouth. Depending on the structures and muscles of the mouth, the surgeon can trim the soft palate and uvula, remove the tonsils, shrink tissue with a heated instrument, straighten a crooked septum or change the position of the tongue muscles – all with the aim of improving airflow.

There are also bone surgeries that move the jaw forward to increase the total breathing space, a procedure that can involve a lengthy recovery period.

In 2014, the Food and Drug Administration approved a device called the Inspire Upper Airway Stimulation. This is a small device that is implanted under the skin like a pacemaker. Using two electrical wires, it detects the breathing pattern and stimulates the nerve that controls the tongue to move it out of the way and allow the air to flow freely. Implantation is a daily surgical procedure that takes about two hours.

“It doesn’t change the anatomy, and recovery is easier than with other surgeries,” said Dr. Maria V. Suurna, Associate Professor of Otorhinolaryngology at Weill Cornell Medicine, who specializes in sleep apnea surgery. “It’s effective. It has the lowest complication rate of any surgery.