Ginsenosides alleviate the progression of hepatic fibrosis by targeting the liver circadian clock gene CLOCK.

Coronavirus disease (COVID) 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020 . It caused an enormous number of deaths and a 2.2-year decrease in life expectancy worldwide in the first 3 years . Since then, COVID-19 mortality has decreased owing to the widespread use of vaccines and the dominance of the Omicron variant. However, the pandemic is not over, and COVID-19 continues to affect mortality rates . In addition, the post-viral syndrome, long COVID, has become a major public health problem . There have been many attempts to grasp the causes of death in patients with COVID-19. However, accurate outcomes are difficult to clarify in the Omicron-variant era. There are several reasons for this. First, excess mortality was previously considered an important means of estimating mortality rates directly and indirectly attributable to COVID-19 . However, this had already begun to decrease by 2023 in many countries . Excess mortality has also been found inconsistent between diseases and countries , and the underlying mortality data usually underestimate the number of deaths compared with data from death certificates, health care billing records, or medical chart reviews . Second, it is unclear whether the risk factor for mortality in cases of the Omicron variant is the same as that in cases of the other variants. Moreover, the clinical course of COVID-19 has been altered by widespread vaccination and new antivirals . Recently, frailty was reported as one of the greatest factors associated with clinical outcomes in older patients with COVID-19 even in an era when coronavirus vaccines were widespread and the Omicron variant was dominant . However, causes of death were not strictly evaluated in those studies. Third, long COVID makes it difficult to pinpoint the origin of symptoms . Suboptimal recognition and responses to long COVID have been reported among physicians . Although long COVID may be a mortality risk, the situation is not fully understood . As a result, the true causes of death in patients with COVID-19 are not always clear. Cause-of-death statistics are indispensable for health care policymaking, and ensuring their accuracy is imperative. In Japan, COVID-19 was described as “the Novel Influenza etc.” by the Infectious Diseases Control Law on February 13, 2020, and legal notifiable surveillance for COVID-19 cases was initiated . The Omicron variant emerged in December 2021, and COVID-19 mortality began to decrease in early 2022 . However, these mortality rates were not derived from the national surveillance system (Health Center Real-Time Information-Sharing System on COVID-19 [HER-SYS]) , and no strict definition of COVID-19-related death (CRD) was applied . It has also been reported that the HER-SYS does not collect all COVID-19 outcome data . Moreover, CRD adopted by the Japanese Ministry of Health, Labour, and Welfare (MHLW) is not identical to the “definition for deaths due to COVID-19” according to WHO . After the epidemic was brought under control, COVID-19 was reclassified as a category V infectious disease on May 8, 2023, and notifiable surveillance transitioned to sentinel surveillance . Consequently, national surveillance has failed to provide accurate data on COVID-19 mortality, and real-time monitoring is no longer possible. Under these circumstances, it is worth noting that CRDs during the Omicron epidemic were concentrated among older adults .