As the COVID-19 pandemic in the USA has eased, the extent of devastation caused during this period by the opioid epidemic is no longer obscured. Data released by the National Center for Health Statistics on July 14 show a steep rise in overdose deaths. Between December, 2019, and December, 2020—the peak of the pandemic in the USA—more than 93 000 Americans died from drug overdoses, up 29·4% over the previous 12 months. This figure equates to roughly 255 overdose deaths per day; national daily COVID-19 deaths currently hover at around the same number.

Riots and looting have prevented medical care and cut supply chains of food, medicines, and COVID-19 vaccines. Munyaradzi Makoni reports from Cape Town.

An inquest has begun into the deaths of 144 patients deinstitutionalised from Life Esidimeni psychiatric care facilities. Marion Scher reports from Johannesburg.

Many prescriptions are unfilled, driven by shortages of drugs in Mexico. President López Obrador has blamed corruption, but analysts say otherwise. David Agren reports.

When we meet on Zoom, Cheryl Moyer joins from her new office—the home gym above her garage in Ann Arbor, MI, USA. She is used to being on the road for much of the year for global health research, and she misses her African friends and colleagues. But she says that while the COVID-19 pandemic stopped her regular field trips to Ghana, it has empowered her local partners to “grab the ball and run with it. They may not need us high-income country partners after all”, she laughs. “That's how it should be and I feel good about that.”

Brigid Edwards is a leading botanical artist. She creates exquisite paintings on vellum, using watercolours and tiny brushes to create portraits of plants and insects. Her work also includes a series of postage stamps of creatures in danger of extinction. As well as the beauty of these images, her paintings are precise scientific records. One of her biggest challenges is to capture the nuances of colour, the precise green of a leaf, or the speckles on a beetle's back. Edwards combines a naturalist's observation with an artist's sensitivity and a craftsman's precision.

COVID-19 has propelled a number of scientific breakthroughs that have only been possible because of unprecedented global research collaborations. These remarkable achievements will have profound implications for the future. Women have been front and centre in many of these developments, notably in the area of COVID-19 vaccines and sequencing of SARS-CoV-2. Yet in this pandemic women's position in biomedicine has not been helped by the fact that many women have been disproportionately affected by increased caring responsibilities during lockdowns, reducing the amount of time they have been able to devote to research and publication—with implications for career advancement.

Chemist and co-inventor of dip-and-read diagnostic testing. She was born on Feb 20, 1923, in Pittsburgh, PA, USA, and died following a stroke in Elkhart, IN, USA, on May 1, 2021, aged 98 years.

The randomised controlled RECOVERY trial1 has met its primary endpoint of reduced 28-day mortality. We congratulate the RECOVERY Collaborative Group for this excellent study. However, the mortality at day 28 was up to 31% in the tocilizumab group and was higher than the results of other published randomised controlled trials.2 The pathophysiology underlying COVID-19 is characterised by SARS-CoV-2 viral infection-induced inflammatory response, cell death, and microvascular thrombosis. Thrombosis appears to be common in patients with COVID-19 pneumonia and could also be responsible for multiorgan failure in patients who are critically ill.

The RECOVERY Collaborative Group reported statistically significant improvement in survival of patients with COVID-19 who were receiving tocilizumab interleukin (IL)-6 inhibitor, albeit with very modest reduction of mortality (31% vs 35% with usual care, p=0·0028).1 This result adds to a number of studies with tocilizumab and other IL-6 antagonists, such as sarilumab, which showed only minor, or no, reduction in mortality.2 Given that IL-6 is associated with COVID-19 severity and mortality,3 the question arises as to why IL-6 antagonist therapy does not substantially improve survival.

We thank Chengliang Yang and Hedi Zhao for their interest in the thrombotic event rate in the RECOVERY trial of tocilizumab in patients hospitalised with COVID-19.1 Data on thrombotic events were only collected on follow-up forms from Nov 1, 2020, so these data are only available for about 60% of participants. Nevertheless, we observed no difference in the thrombotic event rate between patients allocated to tocilizumab or usual care alone (appendix).

The Lancet's Series on progress in maternal and child undernutrition reminds us that malnutrition and stunting, and the double burden of obesity and malnutrition, remain important priorities for achieving Sustainable Development Goal 3 and other goals for child health. However, although recognising the importance of the environment and commercial determinants of food availability, the nutrition agenda continues to ignore the importance of tobacco control in achieving nutritional goals.

We thank Jonathan Klein for raising the issue of the direct and indirect effects of tobacco smoking on maternal and child undernutrition. Although our Series paper1 did not address the effects of specific risk factors such as tobacco on gestational weight gain and low birthweight, we recognise that smoking is an important determinant of fetal growth. The indirect effects relate to the trade-offs between purchasing nutritious foods and spending the limited family budget on tobacco, alcohol, and non-nutritious foods (eg, sugar-sweetened beverages).

The results from CheckMate 7431 are a relevant advance for the systemic treatment of patients with malignant pleural mesothelioma. However, we have concerns about the presentation and interpretation of subgroup analyses. Some further clarity would be helpful for the applicability of the study results in clinical practice, beyond the unequivocal clinically relevant effect observed in the whole population.

We thank Massimo Di Maio and Marco Tagliamento for their Correspondence regarding CheckMate 743, a global, open-label, randomised, phase 3 study of first-line nivolumab plus ipilimumab versus chemotherapy in unresectable malignant pleural mesothelioma (MPM).1 We appreciate their remarks on the interaction test to investigate heterogeneity across histological subtypes.

An 87-year-old woman presented to our hospital with a 3-day history of dyspnoea on exertion. She had a history of chronic kidney disease, pulmonary embolism, and recent right-sided ischaemic stroke causing aphasia and hemiparesis. She was taking aspirin, clopidogrel, and atorvastatin.

Many countries in Africa face a serious third wave of COVID-19 that is both larger and more burdensome on health systems than previous waves. This predictable turn of events has been driven by a morally reprehensible lack of vaccine equity (<1% of the population are fully vaccinated), leaving the continent vulnerable to new and more transmissible variants of the virus, behavioural and economic pandemic fatigue, and complacency. A lack of diagnostic capacity in some countries means the epidemiology of this current wave is uncertain, but South Africa, Namibia, and Zambia are reporting the highest numbers of new cases.

As the COVID-19 pandemic persists globally,1 an emerging challenge is the shift from acute infection to the burden of long-term consequences resulting from the disease. Although a consensus terminology has not yet been reached, the post-acute stage of COVID-19 is mostly defined as 3 or 4 weeks after symptom onset, and long or chronic COVID-19 is defined as symptoms and abnormalities persisting or presenting beyond 12 weeks.2,3 Most studies have focused on acute and subacute COVID-19, although evidence-based guidance for the management of long COVID-19 is limited.

Diabetes is a growing public health problem in all countries, but this increase has been much faster in low-income and middle-income countries (LMICs)1,2 than in high income countries (HICs)3 over the past three decades.4 Concomitantly, the paucity of robust and representative data has prevented improved characterisation of the risk factors underlying this sharp increase in the burden in LMICs, which is needed to build more efficient diabetes screening and prevention policies than the current standard.

Experts warn of the health costs of falling donor support and a risk of increased conflict as US and NATO troops withdraw from Afghanistan. Sophie Cousins reports.