Even on a good day, service jobs are pretty hard. Your schedule is constantly changing, you’re on your feet, you’re at the mercy of the general public, and the pace of your shifts swings between crushing boredom and frenetic activity. You’re probably not guaranteed any particular number of hours in a given week, and you can be cut from the schedule or called in to work at the last second. For all that, you’re paid too little to cover the basic needs of an American adult: a median of $12 to $14 an hour, according to data from the Bureau of Labor Statistics. So far, Omicron has not provided service workers with any good days. As the highly transmissible, immunity-evading coronavirus variant surges across the country, it has filled hospitals, infected record numbers of people, and made everyday life a nightmare for workers in stores, restaurants, gyms, schools, health-care facilities, and so many other workplaces. Many workers are currently sick or have been exposed to the virus, and changing isolation and quarantine guidelines make it unclear how long they should stay home, or whether their employer will even allow that. Tests to confirm infection are expensive and scarce. In workplaces with Omicron outbreaks, there may not be enough available workers to continue operating the business for days or weeks at a time, which means everyone loses their shifts—and their paychecks—in “soft lockdowns” that workers must navigate with little institutional or governmental support. For businesses that remain open, understaffing and supply shortages make workers’ interactions with customers even more tense and dangerous. Before the new variant reared its head, people were already leaving the service sector in droves. Now the Omicron surge is laying bare how few protections workers have retained from the scant services given to them earlier in the pandemic, and just how little safety and stability this kind of work provides to the people who do it. Omicron is making many of America’s bad jobs even worse. Some elements of this current crisis were put in place and allowed to fester over the past two years, but many of them spring from the fundamentally precarious nature of service jobs. Understaffing and low pay, for example, have been chronic issues across shift-work occupations for years, according to Daniel Schneider, a sociologist at Harvard and a co-founder of the Shift Project, which surveys tens of thousands of hourly workers at large employers, including Dollar General, Starbucks, and Macy’s. Lowering labor costs makes these businesses more profitable, Schneider told me, but it also makes them brittle, even under the best circumstances. There may be a “kind of tipping-point dynamic here,” he said, “where, yeah, these jobs have always been precarious, they’ve always been bad, but the confluence of those conditions—more difficult customer management and even fewer people on the job—is almost a multiplier on the hazard of this work.” One of the most obvious issues is service workers’ widespread lack of access to paid sick leave, according to Schneider. Before the pandemic, more than half of the workers surveyed by the Shift Project lacked paid sick leave completely. As of November, that number had barely moved. This is the case even though in March 2020, the federal government passed the Families First Coronavirus Response Act (FFCRA), which mandated two weeks of paid sick leave for workers previously not given it by their employer. Even at its best, this patchwork of policies had enormous deficiencies, Schneider said: The FFCRA excluded anyone who worked for a company employing more than 500 people, which disqualified workers at big-box stores, supermarkets, chain pharmacies, department stores, fast-food restaurants, and large e-commerce companies. It also left out many of the people who do poorly paid and largely invisible work in workplaces that put them at particularly extreme risk, such as hospitals and care homes, including many janitorial, laundry, and cafeteria workers. [Read: The real reason Americans aren’t isolating] Some of the big companies not affected by the FFCRA chose to implement leave policies and other pandemic-specific benefits of their own, such as hazard pay and testing programs, thanks at least in part to public pressure to protect workers. Walmart, Amazon, and CVS, for instance, made headlines by extending 10 days of paid leave to anyone who tested positive for COVID-19. But Schneider said this was only ever a tiny minority of employers, and for every large company that made these changes, many more didn’t provide any additional benefits at all. “What we’re seeing is large companies really try their best to do the least possible,” Schneider said. “There is really an effort by firms to avoid requirements to do things and instead to just be asked to voluntarily do things.” That effort clearly has contributed to the tipping-point dynamic: Cases have surged at the exact same time that many protections for workers, including the FFCRA, have expired, and the relatively small number of employers who voluntarily granted extra sick leave and other benefits have largely rolled back those programs. Amazon, for example, requires employees to submit test results in order to qualify for any COVID-19 sick leave, but a number of the company’s workers told NBC News that they’re now on their own to secure testing, after the company closed down employee testing facilities that provided that service free of charge earlier in the pandemic. (In response to NBC, an Amazon spokesperson said that the company is looking into the reported issues and focusing on getting workers vaccinated.) Many companies have similar testing requirements for service workers to access leave. Without results, taking time off for illness is unpaid for many workers. And making $12 to $14 an hour, vanishingly few service workers have the financial stability necessary to take any amount of unpaid leave, if their employer would even allow it. The federal public-health apparatus has effectively endorsed these rollbacks. In late December, the CDC reduced isolation guidelines for infected Americans who aren’t severely ill from 10 days to five. Anthony Fauci hailed the move for helping Americans “get back to the workplace, doing things that are important to keep society running smoothly,” but many experts have criticized the agency over a lack of strong evidence that it’s safe for workers to return to in-person jobs so quickly. Requiring a negative test after infection would make these guidelines safer, but the revised rules don’t require that. In the weeks since the announcement was made, Delta, Amazon, Walmart, CVS, and Walgreens have all cut their paid-leave policies for COVID-19 infections down to the equivalent of five workdays. And they’ve been slow to add any testing requirement to their own guidelines. The story has largely been the same for any other benefits or protections extended to service workers during the pandemic, Schneider said. Enhanced federal unemployment benefits expired months ago; companies that provided hazard-pay wage bumps have almost all rolled those back; and even many simple precautions to protect people who work with the general public, such as local mask mandates, have been repealed. Just this week, the Supreme Court blocked the Biden administration’s vaccine-or-test mandate, which would have required large employers to verify that all of their employees are either vaccinated or regularly tested in order to ensure the safety of their workplaces. As protections and support wash away, many service jobs themselves have become more difficult. Supply and staffing shortages at stores and restaurants mean that service and selection may not be exactly the same for customers as they were before the pandemic—tiny disappointments that spark episodes of verbal abuse or violent rage toward workers. A swirl of infections, winter storms, and supply-chain disruptions have left America’s grocery stores, for instance, scrounging for goods in recent weeks. “We’re essentially asking this least well compensated and most precariously employed workforce to take on the everyday management of a polarized and angry and dangerous public,” Schneider said. This was the case before Omicron, and even if the variant’s wave is as short as many hope it will be, its interruptions will have effects visible in additional shortages (and their attendant frustrations) for months, at least. Schneider said no one has a totally satisfying answer as to why retail stores and restaurants have had such a hard time staffing up in the past six months. After all, he pointed out, many of the people who would usually fill those jobs had no safety net before the pandemic either. But a few theories add up to explain much of the problem. Long-term downward trends in immigration to the United States, and especially low immigration levels in the past two years, might have choked off an important source of low-wage workers. Increased difficulty in finding adequate and affordable child care is another reason, especially for the many families that may have relied on older relatives who have been lost to the pandemic. And some people have simply left the retail and food-service industries altogether, switching to other kinds of work. “A better way to think about the labor-shortage problem is that we have a pay-shortage problem,” Ben Zipperer, an economist at the Economic Policy Institute, a left-leaning think tank, told me. Workers who take less-than-ideal jobs after mass layoffs might be more likely to stick with them instead of looking for a better role if the circumstances of many of those jobs weren’t so bad. There is little reason to believe that the Omicron wave won’t make these jobs even harder to fill. “We haven’t solved any of the kind of fundamental problems of the labor market that make things worse during a pandemic,” Zipperer said. Incredibly popular policies, such as increasing the federal minimum wage, have largely stalled out, even though Zipperer thinks that the pandemic is an ideal time to rally the political will to make something like that happen. Schneider didn’t feel much more optimistic about what Omicron might do to the lives of service workers, or about the signals those in power have been sending about how they intend to handle the situation. “It doesn’t feel like there is any real appetite by anybody to return to substantial policy that might protect workers,” he told me. Instead, we’ve committed to riding out this wave, no matter how bad it gets. The hope, Schneider said, is that it’s fast. from https://ift.tt/3fneyXJ Check out http://natthash.tumblr.com
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Just weeks into its staggering ascent in the United States, Omicron appears to maybe, maybe, be taking its leave of a few big urban centers up and down the East Coast. Documented coronavirus infections seem to be leveling off, even falling, in cities such as Boston, New York, and Washington, D.C.—a possible preview of what the country’s been waiting on tenterhooks for: the beginning of the end of the Omicron wave. The pattern fits with what recent models predict. National case counts will hit a maximum this month, maybe a touch later. (Some think that the peak is already behind us.) It’s all a bit squishy still, but epidemiologists such as Justin Lessler of the University of North Carolina at Chapel Hill are “pretty confident” that the American apex is nigh. Peak could then give way to plunge, as it did in South Africa. It’s tempting, then, to imagine Omicron loosening its vice grip on the United States just as quickly as it latched on. February will be better; March, rosier still. Americans will get something like a Hot Post-Omi Spring. A symmetrical, V-shaped rise and fall is a very nice and neat story. It is also probably wrong. Before I stuff my foot completely inside my own mouth, let me be clear: This is not a Full-Blown Pandemic Prediction™. I personally do not know exactly what is on the other side of the Omicron peak. Neither do the experts. Actually, no one does. The back ends of curves can mirror the fronts, but they don’t have to—it depends on us and our immunity, on the virus and its hijinks, and on the frequency and intensity at which host and pathogen continue to collide. The decline could be sharp and fast, or sputtering and slow. It could start off steep, then lose steam. It could plateau—or even reverse course and tick back up. [Read: We’re not at endemicity yet] What we can say is that the higher a wave crests, the longer and more confusing the path to the bottom will be. We need to prepare for the possibility that this wave could have an uncomfortably long tail—or at least a crooked one. “I do think the decline is unlikely to be as steep as the rise,” Saad Omer, an epidemiologist at Yale, told me. During outbreaks, the only truly certain things are those “in hindsight,” Shweta Bansal, an infectious-disease modeler at Georgetown University, told me. And even the recent past is cloudy right now. We’ve lacked the test-and-trace infrastructure to fully track Omicron’s spread, which has seriously messed with our ability to forecast what the virus might do next. Most scientists are not even all that certain about where we stand in relation to the peak. And “the further into the future we want to project, the more uncertainty there is,” Lauren Ancel Meyers, the director of the University of Texas at Austin’s COVID-19 Modeling Consortium, told me. When this tide turns hinges on when Omicron starts to run out of new people to infect—either because it has burned through everyone it can or because we, through our behaviors, starve it of hosts. Cases crater; the curve, in turn, crashes. A version of this seems to have unfolded in South Africa, where recorded cases peaked around mid-December, then fell, and fell, and fell. (The United Kingdom, whose wave is a couple of weeks behind South Africa’s, seems poised to turn a corner too.) How those foreign free falls play out is instructive, “but we also need to recognize that the U.S. is not South Africa,” Maia Majumder, a computational epidemiologist at Harvard, told me. Even subtle differences in host populations can massage a wave into a different shape—a rounder pinnacle, a more leisurely wane. Yes, the United States’ population is more vaccinated than South Africa’s, but it’s also older. (And lots of Americans over 65 aren’t boosted.) The two countries’ health profiles, medical infrastructures, and approaches to controlling SARS-CoV-2 differ; so do the behaviors of their residents. Omicron also caught South Africa as it was heading into summer; the United States may have a tougher time unsticking itself from the virus during colder months. And Delta, which was already driving surges of its own before Omicron arrived, hasn’t yet disappeared here. [Read: Calling Omicron “mild” is wishful thinking] The United States is also an especially sprawling and diverse place, as Samuel Scarpino of the Rockefeller Foundation’s Pandemic Prevention Institute pointed out on Twitter. Viruses thrive on human interconnectedness, and an early surge in big cities can front-load cases so much that the national narrative booms, then starts to bust. After we pass the summit, “I think at least the initial downslope will be precipitous,” Yonatan Grad, an infectious-disease expert at Harvard, told me. But as the virus continues to trickle into more rural, sparsely populated parts of the country, that story gets more complicated: a smattering of regional peaks could slow and lengthen the overall decline. We tend to talk about “the peak” as if it’s one monolithic thing, but it’s an aggregate of asynchronous outbreaks; each community will experience its own, unique Omicron spike, Grad said. The national trajectory depends heavily on “how long it takes to percolate into different parts of the country,” Natalie Dean, a biostatistician at Emory University, told me. A cliff-like drop might give way to a series of rolling hills. (Scarpino thinks that South Africa’s decline, which has recently slowed, may now be exhibiting this geographical flattening effect.) How we react to the curve could also stretch it out, and that’s the biggest wild card of all. When people hear that we’ve skittered past the top of a peak, “psychologically, they loosen up,” UNC’s Lessler told me. (This is something that many epidemic models don’t account for.) Masks come off. Schools, workplaces, and leisure venues reopen. People rejoin social circles, or kick-start new ones. Smaller shifts such as these, multiplied by millions, can turn a waterfall decline into molasses. “So much of susceptibility is tied up in behavior,” Majumder said. And as people get further out from their most recent vaccination or infection, their risk of catching the virus goes back up. A lethargic decline is a costly one. Already, health-care systems around the country are being pummeled by record-breaking cases. In many states, hospitals are hitting capacity; people are struggling to access care for all sorts of sicknesses. Hospitalization and death waves are smaller in magnitude than infection waves, and lag behind them, but they’re “much more protracted,” UT’s Meyers said. The sheer height of our infection peak is already poised to haunt us. There have been so many infections that cases, hospitalizations, and deaths won’t return to November’s pre-Omicron levels—let alone the numbers of last year’s early-summer lull—for a long time. “It’s going to get much worse before it gets better,” Meyers said. Even if the United States’ curve turns out to be symmetrical, half of this wave’s infections, and more than half of its hospitalizations and deaths, are still ahead, past the peak of cases. Adding any more weight to the curve’s far side just makes that picture uglier. [Read: Hospitals are in serious trouble] On the more optimistic flip side, behavior can also curb transmission—enough to keep the overall number of infections lower than it might otherwise be. We heard this lesson early on in the pandemic, when cases were first rising at alarming rates: mask up, hunker down, flatten the curve. It’s still true now. The hope is that the lower the peak, the fewer unnecessary infections can occur after it, Lessler said. A horizontal squish does delay the peak and stretch out the wave. But it also buys us time to vaccinate more people and roll out treatments, and reduces the burden on the health-care system at any single point. We missed our chance for an early pancaking effect in many big cities, but smaller, rural parts of the country can still take heed, and it’s probably especially important that they do so. Those regions tend to have lower vaccination rates and lack “the capacity for a fast-running surge,” Anne Sosin, a public-health researcher at Dartmouth College, told me. If they’re not buffered from their own Omicron waves, the variant could concentrate in the parts of the country that can least afford to absorb it. What lies beyond the peak isn’t out of our control either. The decline can be sped up by the same mitigation behaviors that temper the rise, Majumder said. Curves can get flatter. They can also get shorter. And minimizing cases on the wave’s far side will still blunt the impact on the health-care system, and lessen the variant’s social toll. The key here, then, is to avoid seeing “past the peak” as a cue to relapse into riskier behavior. “The start of a decline is not sufficient to think we’re out of the woods,” Georgetown’s Bansal said. Every step we take now will determine how long we stay high up on this curve and, eventually, where we land—as well as what condition we’ll be in when we arrive at the bottom. from https://ift.tt/3nqCyO1 Check out http://natthash.tumblr.com On top of everything else, the pandemic has been a terrible time for overdoses. From June 2020 to June 2021, nearly 100,000 Americans died of a drug-related overdose, by far the most in a single year since the opioid crisis began ravaging the United States more than a decade ago. And yet things could have been far worse. When someone ingests too many opioids and stops breathing, we know what to do: Give them naloxone. The drug, sometimes known by one of its brand names, Narcan, is an extraordinary medicine that serves as a crucial tool in the fight against overdoses. Whether taken through a shot or a nasal spray, it blocks opioid receptors in the brain, preventing opioids such as oxycodone and heroin from binding to them. What that functionally means is that when someone is unconscious and on the verge of death, administering naloxone can fully revive them in just a few minutes. Naturally, police departments and emergency responders across the country carry the drug, and so do many opioid users and their loved ones. (Naloxone is available with a prescription.) That’s especially true now that the opioid epidemic has taken a turn for the worse and even stronger forms, such as fentanyl, are circulating in the U.S. Fentanyl and other synthetic opioids accounted for 60 percent of overdose deaths in 2020, up from 18 percent in 2015. In recent months, the pharmaceutical industry has pushed to make sure that naloxone can keep up with fentanyl, engaging in an “opioid-antagonist arms race” to bring stronger forms of naloxone to market, says Lucas Hill, a pharmacy professor at the University of Texas at Austin who studies opioids. First, in April, the FDA approved a higher dose of a nasal spray marketed as Kloxxado, and then in October, the agency green-lit a higher dosage of Zimhi, an injection. These dosages represent significant increases in strength compared with previous forms of naloxone: Kloxxado is twice as strong as Narcan and Zimhi is 12 times as strong as the standard injection—the equivalent of using a power drill instead of a screwdriver. And yet when it comes to naloxone, more isn’t always better. Experts I talked with suggested that a more potent form of the drug could backfire, compounding naloxone’s harmful side effects with no significant benefit over the lower dosages. The pharmaceutical industry certainly has a role to play in alleviating the opioid crisis, but the impulse to strengthen naloxone reduces the problem to a battle between more potent forms of opioids and more potent forms of the antidotes that neutralize them. If only the way out of this crisis were that simple. [Read: Narcan has made overdosing less terrifying] Revved-up naloxone didn’t come out of nowhere. Around 2013, anecdotal reports started appearing of emergency responders needing to use more than one dose of naloxone to revive someone who had overdosed. A few years later, researchers documented the same trend. One study, which tracked naloxone usage in emergency departments from 2012 to 2015, noted a bump from 15 to 18 percent in how often multiple doses of the drug were administered. Another study (which has been cited by the makers of Kloxxado) looked at data from 2013 to 2016 and saw a similar increase. But Hill points out that these studies were conducted when standard naloxone doses were much smaller than they are now. As more products have come onto the market in recent years, their oomph has increased. And how naloxone is administered matters too. Nasal sprays may not be as effective as injections when delivering the same dose. All of this can create the impression that we need stronger doses of naloxone when we really don’t. “Higher doses are rarely needed and usually indicate some other issue besides pure opioid overdose,” says Ryan Marino, a medical toxicologist and emergency-room physician in Cleveland who administers naloxone on a regular basis. I reached out to the companies behind Kloxxado and Zimhi, and they disputed the idea that more potent forms of naloxone may not be necessary. “Our models predict that with the use of more potent opioids such as fentanyl, higher doses of naloxone are required,” said Ron Moss, the chief medical officer for Adamis, which manufactures Zimhi. Meanwhile, David Belian, a spokesperson for Hikma Pharmaceuticals, the company behind Kloxxado, said in an email that “the FDA, American Medical Association and CDC have cited the need for higher doses of naloxone to reverse the deadly effects of opioid overdoses, and we are providing another important treatment option.” Indeed, the American Medical Association praised the FDA for approving Kloxxado in an April statement, citing “increasingly lethal” forms of opioids, but it didn’t point to any evidence suggesting that the new drug would better handle these opioids. In his email, Belian linked to a 2015 CDC report that very briefly mentions the need for health-care providers to administer multiple doses of naloxone in certain instances, and Gery Guy, a health scientist at the agency’s Injury Center, said in an email that the CDC still believes this is the case. Strong formulations of naloxone may have unintended consequences, says Sheila Vakharia, the deputy director of research and academic engagement at the Drug Policy Alliance, a nonprofit group. When someone takes naloxone and is brought out of their overdose, the experience is not always pleasant. The drug induces the same type of withdrawal that occurs when a person stops taking an opioid, leading to symptoms such as headaches, nausea, vomiting, and sweating. And higher doses of naloxone have been shown to make these symptoms worse (but they are quicker at pulling people out of an overdose). “With some very high doses of naloxone, you can actually be in withdrawal for more than 24 hours and need to seek out additional drugs to try to counteract that effect,” Hill told me. [Read: A radical way to stop heroin overdoses] Since the stronger antidotes have been on the market for only a few months, it’s too soon to know how these effects of withdrawal are playing out in practice. At the moment, it appears as though local governments are still largely purchasing and using existing supplies of Narcan instead of the newer, more potent drugs. Moss acknowledged withdrawal as a side effect of Zimhi, but characterized it as “rarely life-threatening, while untreated opioid overdose is frequently fatal.” But withdrawal cannot be brushed off as merely unpleasant and inconsequential. Withdrawal sickness can up the urgency to inject drugs to keep symptoms at bay, increasing the risk of an overdose in the short term. In these cases, people may not have time to get new needles and might resort to sharing them instead, which in turn can cause HIV and hepatitis B. “Withdrawal could be life-threatening, especially if it’s prolonged, because [it] can lead to severe dehydration,” Hill said. “And if a person has any underlying medical conditions, like a heart or kidney condition, there could be a serious risk there if they’re not receiving fluids or if they’re not being medically supervised.” Knowing that emergency responders are carrying even stronger naloxone doses might further discourage people from seeking medical attention or calling 911, both Hill and Vakharia told me, which drug users are already hesitant to do because of fear of arrest. [Read: The true cause of the opioid epidemic] Some people really may need multiple doses, and in the moment, withdrawal is clearly preferable to death. But naloxone is an intervention of last resort, and should be treated as such. At the point when someone needs the drug, they’ve “already been failed by the system and [are] on the brink of death,” Vakharia said. Pharmaceutical solutions are of course still necessary. But as a society we need to address this crisis with a much wider range of solutions. Strengthening naloxone does nothing to address some of the biggest risk factors behind an overdose, including homelessness and having been incarcerated. And harm-reduction programs such as safe-consumption sites, where people can use drugs under supervision and receive referrals to treatment, help make opioid use safer. New York City opened such a site in early December, and after three weeks it had reversed 59 overdoses, according to the city. The irony of the trend toward stronger forms of naloxone is that the pharmaceutical industry helped get us into this crisis in the first place. Purdue Pharma and some other pharmaceutical companies spent much of the ’90s and 2000s using deceptive marketing techniques to get doctors to overprescribe certain opioids, leading some patients to become addicted. Things are different this time around—naloxone is a lifesaving drug, and a new set of companies is pushing to make it more powerful. But the premise is similarly flawed: Stronger chemicals weren’t the cure-all then, and they aren’t the cure-all now. from https://ift.tt/3KmhdPI Check out http://natthash.tumblr.com For weeks, the watchword on Omicron in much of America has been some form of phew. A flurry of reports has encouraged a relatively rosy view of the variant, compared with some of its predecessors. Omicron appears to somewhat spare the lungs. Infected laboratory mice and hamsters seem to handily fight it off. Proportionally, fewer of the people who catch it wind up hospitalized or dead. All of this has allowed a deceptively reassuring narrative to take root and grow: Omicron is mild. The variant is docile, harmless, the cause of an #Omicold that’s no worse than a fleeting flu. It is so trivial, some have argued, that the world should simply “allow this mild infection to circulate,” and avoid slowing the spread. Omicron, as Senator Rand Paul of Kentucky would have you believe, is “basically nature’s vaccine.” These dismissals of the variant as trifling—desirable, even—represent “a very dangerous attitude,” Akiko Iwasaki, an immunologist at Yale, told me. At the core of the problem sits the word mild itself, a slippery and pernicious term that “doesn’t mean what people think it means,” Neil Lewis, a behavioral scientist at Cornell, told me. Less severe forms of COVID-19 can certainly be experienced by individual people, especially if they’re vaccinated. And there are true reasons to think that Omicron, particle for particle, might be less toothsome than Delta. But Omicron’s unfettered spread has sowed a situation that is not mild at all. And right now, the notion of mildness is making the pandemic worse for everyone. Much of our Omicron problem can be traced back to a false binary: That the variant is less of a danger too often gets misconstrued as the variant is not a danger at all. Severity works in degrees, which is indeed what we’re seeing. Per capita, Omicron seems less likely than Delta to hospitalize or kill the people it infects. In South Africa, one of the first countries to be hit by the variant, cases have already crested at a record-shattering peak, but hospitalizations, admissions to intensive-care units, and deaths remain far below the heights of prior waves; infections also appear to be decoupling from severe disease in parts of continental Europe. Even in the United States, where the pandemic is as bad as it’s ever been, early data are pointing to a blunting in the propensity of Omicron cases to turn severe. [Read: COVID-hospitalization numbers are as bad as they look] It’s tempting to attribute all of this to the virus, but doing so would be overly simplistic. Disease always manifests as an interaction between pathogen and host, which means there are two main reasons that Omicron cases can present with softer symptoms: a more resilient human, or a more docile microbe. In this current surge, we’re likely seeing both effects collide. The first part of the equation is entirely about us. Two years into a pandemic that’s left hundreds of millions with known infections and prompted billions to sign up for shots, Omicron is knocking up against populations that are better defended than ever. In the United Kingdom, where more than 80 percent of people over 12 are at least doubly vaccinated, the shots are clearly lowering the risk of hospitalization among those infected with Omicron, especially among the boosted. A high number of prior infections from past COVID surges may have had a similarly mollifying effect in South Africa, where the average age of the population is also very young, and thus better steeled against severe COVID-19. The second part of the equation—the inherent potency of the virus itself—unfortunately gets harder to parse when the world is more immune. Still, even unvaccinated people with Omicron seem less likely to end up hospitalized, in the ICU, or on ventilators. Laboratory rodents infected with Omicron don’t seem to be getting all that sick either, perhaps because the new variant is less adept than Delta at colonizing the lungs, where the wildfire-like inflammation of serious respiratory disease often ignites. Similarly, researchers are finding that Omicron isn’t keen on infecting human tissue extracted from the lung, and may prefer to cloister itself in loftier sites like the throat, Ravindra Gupta, a virologist at the University of Cambridge, told me. What happens in a rodent or a plastic dish can’t recapitulate what happens in a human body. But Iwasaki still thinks “there is something intrinsically less virulent about Omicron.” It’s fair, then, to say that the average Omicron case is indeed “less severe.” And there are plenty of people for whom the math will work out well. They’re hosts who are young, healthy, and up to date on their vaccines, squaring off with a pathogen that packs an oh-so-slightly weaker punch, at least compared with Delta. Keep in mind, though, that Delta is probably nastier than its already-awful ancestors, so to simply call the virus “mild” massively undersells the danger it still poses, especially when it finds its way into unvaccinated or vaccinated-but-still-vulnerable hosts. Even people who are thrice-vaccinated can’t exempt themselves from Omicron’s risk, especially not while cases are rising at such high rates, and exposures are so frequent and heavy. [Read: Hospitals are in serious trouble] The variant offers a harsh lesson in multiplication: So many people have been infected that a relatively small percentage of medically severe cases has still erupted into an absolutely staggering number. In the United States, where most of the population has at least one risk factor for severe COVID-19 and a quarter of people have yet to receive a single dose of a vaccine, the untethering of severe disease from cases is shaping up to be a substantially muted echo of what’s been seen abroad. Hospitalizations have already hit a new pandemic peak. Among them are huge numbers of kids, many of whom are still too young to be vaccinated. When Omicron finds vulnerable hosts, it can still exact SARS-CoV-2’s worst. And Omicron is finding them. COVID-19 doesn’t have to be medically severe to take a toll. Lekshmi Santhosh, a critical-care physician at UCSF, has seen Omicron exacerbate chronic health issues to the point where they turn fatal. “You could say they didn’t die of COVID,” she told me. “But if they didn’t have COVID, they wouldn’t have had this issue.” Iwasaki, of Yale, also worries about the storm of long-COVID cases, which can sprout out of infections that are initially almost symptom-free, that may soon be on the way. “Some of these people are bedridden, unable to return to work for months,” she told me. “There is nothing mild about it.” In high-enough numbers, any Omicron infection can wreak havoc. Across the country, people are entering isolation in droves, closing schools and businesses, and hamstringing hospitals that can already ill-afford a staffing shortage. In many parts of the country, hospital capacities are already being reached and exceeded, making it difficult for people to seek care for any kind of illness. An overstretched system could also, ironically, mask the extent of Omicron’s tear: When hospitals are full, they cannot accept more patients, artificially deflating recorded rates of severe disease, even as total cases continue to rise. “Omicron may be more mild at the individual symptom level,” Duana Fullwiley, a medical anthropologist at Stanford who has studied how the term mild has affected people’s experience of sickle-cell anemia in Senegal, told me. “But we’re not talking about the severity of Omicron as it’s impacting the system.” Omicron also still harbors dangerous unknowns. The variant may snub the lungs, but it still accumulates quickly in the throat and mouth—real estate that positions it to spill easily out of infected people. That, compounded with Omicron’s ability to dodge certain immune defenses, makes it a threat to more of us at once. Subdued symptoms, too, can come with a catch if infected people ignore them and continue to mingle. (And the variant seems to be tougher to detect early in infection with certain rapid antigen tests.) Researchers also don’t yet have a good handle on just how much immunity Omicron infections—especially the gentlest ones—may leave behind. [Read: Should I just get Omicron over with?] Stephen Goldstein, an evolutionary virologist at the University of Utah, told me that Omicron might turn out to be about as severe as the original SARS-CoV-2 variant, the version of the virus that kick-started all this misery. If that’s the case, it would be ironic. Two years ago is also when mild and COVID-19 first insidiously intertwined: Roughly 80 percent of cases could be described as such, reports noted at the time, inviting dismissive and misleading comparisons to the flu, and jeering calls to push Americans back to work and school. Mild became shorthand for piddling; that soothing framing took hold, then lingered, “diminishing the sense of urgency in prevention,” as the medical anthropologist Martha Lincoln has written, even through the billions of infections, and the many millions of hospitalizations and deaths, that followed. Today, news reports are using mild to describe COVID-19 more than ever before, Elena Semino, a linguist at Lancaster University, in the United Kingdom, told me. Medically, the term mild originated as an academic catchall for all SARS-CoV-2 infections not severe enough to get someone admitted to a hospital—everything from asymptomatic cases all the way up to people just short of going into respiratory failure. But most of that range squares poorly with mild’s colloquial connotations regarding “temperate, pleasant, generally benign” food, weather, even people, Semino said. Mild, to most of us, is whatever, something that blows almost imperceptibly by. That’s the trap of mildness: the underlying sense of fatalism it engenders. “People say, it’s inevitable; it’s mild; I hope I can catch it and move on,” Santhosh, of UCSF, told me. Calling Omicron “mild” implies that the virus is spontaneously domesticating itself; it punts the responsibility of harm reduction to the pathogen, and away from us. But Omicron is not our deus ex microbe. As Goldstein, of the University of Utah, points out, a virus’s imperative is only to spread—not, necessarily, to treat its hosts more genially. (Omicron is not even descended from Delta, so we can’t frame their severities as a stepwise evolutionary drop.) The attitude that Omicron is hardly anything to worry about is compounding the disaster we’ve found ourselves in: The more opportunities the virus has to enter new hosts, the more variants will arise. And there’s no telling what harm the next SARS-CoV-2 iteration will bring. It’s worth remembering, then, that severity, or lack thereof, is not up to the virus alone. We, as hosts, dictate its damage at least as much—and that’s the side of the equation we can control. SARS-CoV-2 can’t be counted on to pull its punches, but we have the vaccines to pummel it right back. If mildness is what we’re after, that future is largely up to us. from https://ift.tt/3ra4vL7 Check out http://natthash.tumblr.com More Americans are now hospitalized with COVID-19 than at any previous point in the pandemic. The current count—147,062—has doubled since Christmas, and is set to rise even more steeply, all while Omicron takes record numbers of health-care workers off the front lines with breakthrough infections. For hospitals, the math of this surge is simple: Fewer staff and more patients mean worse care. Around the United States, people with all kinds of medical emergencies are now waiting hours, if not days, for help. Some reporters and pundits have claimed that this picture is overly pessimistic because the hospitalization numbers include people who are simply hospitalized with COVID, rather than for COVID—“incidental” patients who just happen to test positive while being treated for something else. In some places, the proportion of such cases seems high. UC San Francisco recently said a third of its COVID patients “are admitted for other reasons,” while the Jackson Health System in Florida put that proportion at half. In New York State, COVID “was not included as one of the reasons for admission” for 43 percent of the hospitalized people who have tested positive. But the “with COVID” hospitalization numbers are more complicated than they first seem. Many people on that side of the ledger are still in the hospital because of the coronavirus, which has both caused and exacerbated chronic conditions. And more important, these nuances don’t alter the real, urgent, and enormous crisis unfolding in American hospitals. Whether patients are admitted with or for COVID, they’re still being admitted in record volumes that hospitals are struggling to care for. “The truth is, we’re still in the emergency phase of the pandemic, and everyone who is downplaying that should probably take a tour of a hospital before they do,” Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, in Massachusetts, told me. Some COVID-positive patients are unquestionably hospitalized for COVID: They are mostly unvaccinated, have classic respiratory problems, and require supplemental oxygen. Omicron might be less severe than Delta, but that doesn’t make it mild. “If a virus that causes less severe lung disease affects an extraordinarily large proportion of the population, you’ll still get a lot of them in the hospital with severe lung disease,” Sara Murray, a hospitalist at UC San Francisco, told me. The proportion of such patients varies around the country: In areas where Omicron has taken off, it’s lower than in previous surges, but it remains high in communities that still have a lot of Delta infections or low vaccination rates, as The Washington Post has reported. At the University of Nebraska Medical Center, “the vast majority of our COVID-positive cases are at the hospital for reasons related to their COVID infection,” James Lawler, an infectious-disease physician, told me. At the other extreme, there are patients whose COVID infection is truly incidental. They might have gone to an emergency room with a broken limb or a ruptured appendix, only to realize when they got tested that they also have asymptomatic COVID. Many health-care workers told me that they’ve treated such patients—but rarely. “It happens, but it’s not a big proportion,” Craig Spencer, an emergency physician at Columbia University Medical Center, told me. The problem with splitting people into these two rough categories is that a lot of patients, including those with chronic illnesses, don’t fit neatly into either. COVID isn’t just a respiratory disease; it also affects other organ systems. It can make a weak heart beat erratically, turn a manageable case of diabetes into a severe one, or weaken a frail person to the point where they fall and break something. “If you’re on the margin of coming into the hospital, COVID tips you over,” Vineet Arora, a hospitalist at the University of Chicago Medicine, told me. In such cases, COVID might not be listed as a reason for admission, but the patient wouldn’t have been admitted were it not for COVID. (Some people might have chronic conditions only because of an earlier COVID infection, which can increase the risk of diabetes, heart problems, and other long-term complications.) “These incidental infections are not so incidental for people with chronic conditions,” Faust said. “Whether they live to see the age of 60 or 90 depends on things just like this.” Colds and other viral infections can also land people in the hospital by pushing their chronic diseases over the edge. “But we don’t generally see such infections happening to such massive swaths of the population at once,” Murray said. Omicron (helped along by Delta) is doing what other respiratory viruses do, but with enough speed and ferocity to overwhelm the health-care system. As Arora put it to me recently, “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time.” These patients whose problems were exacerbated by COVID are often misleadingly bundled together with the smaller group whose medical problems are truly unrelated to COVID. In fairness, there’s no easy way to tell, for example, whether a COVID-positive person’s heart attack was triggered by their infection or whether it would have happened anyway. But health problems don’t line up to afflict patients one at a time. They intersect, overlap, and feed off one another. The entire for-COVID-or-with-COVID debate hinges on a false binary. “The health-care system is in crisis and on the verge of collapse,” Spencer said. “It doesn’t matter whether it’s with or for. It’s a pure deluge of numbers.” Even the truly incidental cases increase the strain. COVID-positive people must be kept apart from other patients, which complicates hospitals’ ability to use the beds they have. These patients need to be monitored in case their infection progresses into something more severe. If they start dying for unrelated reasons, their family won’t be allowed into their room. The health-care workers who treat them need to wear full personal protective equipment. If they need follow-up care, they can’t be discharged to a nursing home or similar facility. They’re taking up space and attention when hospitals are short on both. “If you’re 90 percent full and you suddenly have 10 percent more patients, I don’t care if it’s half COVID, all COVID, incidental COVID—it just matters that you’re full,” Faust said. In the short time since Omicron was discovered, the popular narrative about the variant has calcified around the idea that it is milder. That is true for individuals, and in comparison with Delta, but the variant certainly isn’t mild for unvaccinated people, for those who could develop long COVID from a supposedly “mild” infection, and especially not for the health-care system as a whole. The hospitalization debate illustrates how wishful thinking about the new variant, and America’s continued failure to consider the pandemic at both the personal and societal scales, is obscuring the danger of the current surge. Instead of overselling our plight, official hospitalization data might actually be underestimating it. The number of staffed hospital beds, as tracked by the Department of Health and Human Services, is subject to the whims of individual hospitals, which can choose how to count the number of beds that their staff could reasonably oversee. Many health-care workers have told me that over the course of the pandemic, they have been pushed to care for more patients than they can safely handle, and that the pressure is getting worse as more of them are falling sick with COVID themselves. Capacity data also tend to be out-of-date by at least a week. Take Maryland as an example: As Faust recently wrote, HHS currently estimates that only 87 percent of the state’s hospital beds are occupied. But a model that he co-created, which projects that number forward based on the previous week’s cases, suggests that's not right—and that every county in the state is now above capacity. The experiences of Maryland’s health-care workers support Faust’s conclusions. Last week, a Maryland nurse told me that her emergency department regularly has 10 patients on ventilators waiting for a bed in the overcrowded ICU. A critical-care physician said that patients with heart attacks and other emergencies might wait 24 to 36 hours before seeing a doctor. It is difficult to reconcile these firsthand accounts with the notion that 13 percent of the state’s beds are still free. COVID data have always been mushy, lagging, and incomplete. No single metric can account for the number of patients, how sick they are, what their care demands, how many health-care workers are around to help them, or how close those workers are to their breaking point. We have no straightforward way to measure exactly how stressed the health-care system is. But we can ask health-care workers what they’re experiencing. I’ve asked dozens over the past three months, and heard from hundreds more. And what they’ve said, almost unanimously, is that they’re exhausted, demoralized, overwhelmed, and working in a system that cannot handle the strain it is being asked to shoulder. Debating how many patients are in the hospital with COVID or for COVID distracts from the most important question of the moment: As Anne Sosin, a public-health practitioner at Dartmouth College, wrote to me on Twitter, “What is or will be too much for our health systems and workforce to bear?” The U.S. is about to learn the answer the hard way. from https://ift.tt/3K7zqjG Check out http://natthash.tumblr.com Last week in the United States, more than 1 million COVID-19 cases were reported in a single day, schools resorted to virtual instruction, and COVID outbreaks among staff left hospitals struggling to attend to their ever-growing number of COVID patients. Also, the CDC endorsed Pfizer booster shots for teenagers, saying not only that every American 12 and up can get one, but that they should. The latest recommendation on boosters feels like a natural response to the Omicron variant’s lightning-fast spread: With so many Americans getting exposed to the coronavirus, vaccination is more important than ever. Yet the risk-benefit calculus around third shots—particularly for teenage boys and young men—may be even more complicated than it was before the present surge in cases. The new variant’s knack for sneaking past immune protection, combined with its mildness relative to Delta, makes its actual value, in terms of harm averted, that much harder to assess. And whatever protection it does afford must still be weighed against the incremental (but very small) risk of heart inflammation that comes with each mRNA-vaccine injection. Simply put, Omicron has added substantial new uncertainty to what was already a difficult equation. [Read: Our relationship with COVID vaccines is just getting started] Inflammation of the heart muscle, called myocarditis, typically arises in children and young adults after they recover from a viral infection such as Coxsackievirus or adenovirus. It can cause chest pain, heart palpitations, and arrhythmias, and in the worst cases, fatal shock or heart failure. Patients with mild myocarditis might not get sick enough to need medical attention, but in some extremely unusual cases they may develop arrhythmias that lead to sudden death. Patrick Flynn, a pediatric cardiologist at Weill Cornell Medicine, told me that specialists haven’t figured out any risk factors for myocarditis besides sex—boys are more susceptible than girls—nor can they predict who will get very sick from the condition, or who might die from it without warning. “It’s really largely random,” he said. Myocarditis associated with COVID-19 vaccines is rare, and tends to affect a very specific group: boys and men in their teens and early 20s who have received mRNA-based shots. It is overwhelmingly mild. As of last month, 265 reports that met the definition of myocarditis in kids ages 12 to 15 were filed to the Vaccine Adverse Event Reporting System, and 92 percent of the patients had recovered. Only a handful of fatal cases have been reported worldwide. Second shots have produced far more reports of myocarditis than first shots, at about 70 cases for every million 12-to-17-year-olds who finish their vaccine series. And early data from Israel, where teens have been eligible for boosters since last August, indicate that myocarditis rates might be lower after third doses than second doses. All of these numbers are likely undercounts, Walid Gellad, a professor at the University of Pittsburgh School of Medicine, told me; one study from Oregon that has not yet been peer-reviewed looked for myocarditis cases that might have been missed by the standard surveillance system, and estimated the incidence among 12-to-39-year-old boys and men to be 195 cases per million second doses administered (and higher for men ages 18 to 24). But the study was working with small margins—just a handful of cases, in the population it examined, that might have been missed—and the exact degree of underestimation is difficult to pin down, Flynn said. Even allowing for this bias in the stats, for the overwhelming majority of people—including boys and young men—the risks of developing myocarditis after a booster shot are minimal. Flynn said that the only patients he would consider advising not to take the shot would be those who had developed myocarditis after their second dose. But not all the experts I spoke with agreed. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told me that getting boosted would not be worth the risk for the average healthy 17-year-old boy. Offit advised his own son, who is in his 20s, not to get a third dose. Even with Omicron’s ability to sidestep some of the protection vaccines provide, Offit said, he believes that his son is well protected against serious illness with two shots, so a third just isn’t necessary. Young people are generally at much lower risk of severe COVID than older people, which is one of the reasons that boosting them was controversial to begin with. And if Omicron causes less severe disease than Delta, the benefit of boosters might be smaller still. But the United States is positively drowning in coronavirus right now. “It’s not a theoretical risk,” Gigi Gronvall, an immunologist at the Johns Hopkins Center for Health Security, told me. “You are going to get exposed to the actual virus.” Each individual teen’s risk of bad outcomes if they do get infected might be small, but each individual teen is also now much, much more likely to get infected in the first place, thanks in large part to Omicron. (Gronvall’s 14-year-old son has a booster appointment for this week.) All those infections don’t have to be severe to be harmful. Missing school and work has real consequences for families. And MIS-C, a dangerous post-infection syndrome that can affect the heart (among other organs), has shown up in kids who had even mild bouts of COVID. Compared with MIS-C, Flynn said, the sort of myocarditis that vaccines have tended to cause is a walk in the park. “I think every pediatric cardiologist I’ve talked to would rather be seeing cases of vaccine myocarditis than ever seeing a case of MIS-C again,” he said. The latest CDC data indicate that two doses of the Pfizer vaccine were 91 percent effective at preventing MIS-C in 12-to-18-year-olds when Delta was king; it’s too early to tell what that number is in the Omicron era, or by how much a third dose might increase that protection. Gellad said that if MIS-C turns out to be much more common with Omicron, he might be convinced that every teen boy needs a booster. But for now, he thinks the benefits vary patient by patient. A teen who lives with an organ-transplant recipient, for example, might have more to gain from a booster than one whose household is otherwise made up of vaccinated-and-boosted adults with healthy immune systems. [Read: The alternative to closing schools] In the long term, boosting could end up being more effective for teenagers, shot for shot, than it is for adults. Younger people have more robust immune systems, says Sallie Permar, the chair of pediatrics and a viral-infections specialist at Weill Cornell, so they may develop stronger post-vaccine protection as a result. In other viral diseases such as hepatitis C, HPV, and HIV, she told me, a vaccination or bout of infection in early childhood has been shown to confer longer-lasting immunity against more variants of the pathogen than an encounter later in life. The same could be true of SARS-CoV-2 and the COVID-19 vaccines, Permar said: You might be better off getting three doses before you’re all grown up. For millions of young people in the U.S., this entire discussion is irrelevant: As of last Friday, 46 percent of 12-to-17-year olds, and 41 percent of 18-to-24-year-olds, are yet to be fully vaccinated. The benefits of getting those first two doses are beyond question. For the teen boys and young men who are staring down the possibility of a booster, setting up a dichotomy—avoiding Omicron versus avoiding myocarditis—amounts to a “false choice,” Gellad said. Men 18 and older can mitigate their myocarditis risk by choosing Pfizer’s shot over Moderna’s, given that the latter has been linked to higher myocarditis rates. And boys under 18, who are eligible for only the Pfizer jab, may eventually have an option to get a smaller booster dose, which should carry a smaller risk of side effects. Omicron adds one more important wrinkle to decision making about boosters: It’s a reminder that our current best practices could change at any moment. Until the overwhelming majority of the world is vaccinated, new variants are likely to emerge from one season to the next. “If this is the last wave, then that’s great. And a lot of the questions that we’re asking and a lot of the answers that we’re struggling with become moot,” Flynn said. But if it’s not, then a third dose could provide essential protection against the next variant—and Americans who avoid a booster now could find themselves regretting their complacency. from https://ift.tt/31MMWba Check out http://natthash.tumblr.com When Delta swept across the United States last year, the extremely transmissible and deadlier variant threw us into pandemic limbo. The virus remained a danger mostly to unvaccinated people, but they largely wanted to move on. Vaccinated people also largely wanted to move on. The virus did not want to move on. So we got stuck in a deadly rut, and more Americans died of COVID-19 in 2021 than in 2020. Now Omicron is sweeping across state after state—even highly vaccinated ones—and new cases are shooting up and up. The virus is still deadliest to the unvaccinated, but the sheer number of mostly mild infections in the vaccinated is shocking us out of that post-Delta stasis. To deal with this extremely transmissible but now milder variant, we are in the middle of a COVID reset. Already, the CDC has shortened the isolation period for vaccinated people. Breakthrough infections are becoming routine. And Anthony Fauci is pointing to hospitalizations, rather than cases, as a measure of Omicron’s true impact because many infections are now mild breakthroughs. By infecting so many people so quickly, Omicron is also speeding us toward an endemic future where everyone left has some immunity, so the coronavirus is eventually less deadly. But in the short term, Omicron as an accelerant is dangerous. The fastest path to endemicity is not the best path. The U.S. still has too many unvaccinated and undervaccinated people, and cases that might have been spread out over months are now being compressed into weeks. Even if a smaller percentage of patients ends up in the hospital than before, that small percentage multiplied by a simply huge number of cases will overwhelm hospitals that are already stretched too thin. The coming weeks will be a bad time to have COVID, or appendicitis, or a broken leg. Compressing all those mild cases into weeks has its own toll: Too many health-care workers are falling sick at the same time, exacerbating hospitals’ ongoing staffing shortages. Schools, airlines, subways, and businesses are finding their workers out sick with Omicron too. There may be no preemptive shutdowns, but there will be unpredictable cancellations. “It’s going to be a messy few weeks. I don’t think there’s any way around it,” says Joseph Allen, a professor of public health at Harvard. The fact that we’ll eventually end up with endemic COVID has not changed. And the fact that people cannot expect to avoid the virus forever in an endemic scenario has not changed. Omicron is now forcing us to look squarely at the reality that people can get and spread COVID even when vaccinated. The problem is, we’re doing it in crisis mode. With so many people getting COVID, our mindset toward the virus is changing. Breakthrough infections are the new normal. For a while, in certain highly vaccinated bubbles at least, people who got breakthrough infections racked their brains about what they did “wrong.” But now—excuse the hyperbole—everyone has COVID. And if you don’t, you probably know someone who does. Even the most careful people are getting sick. “I think the silver lining, to the extent there is any silver lining, is that the shame [of getting COVID] is quickly melting away. And thank goodness,” Lindsey Leininger, a public-health-policy expert at Dartmouth College, told me. Breakthrough infections will be the norm when COVID eventually becomes endemic too. [Read: We’re not at endemicity yet] Vaccinated people also see, correctly, that their individual risk of a bad COVID case is much, much lower than it was in March 2020. (Omicron also appears to inherently be a little less virulent than Delta, but because Delta was more virulent than the original coronavirus, Omicron is in the same ballpark as the original.) The transition to endemicity was always going to be in part a psychological one, in which people slowly let go of the idea that COVID must or can be avoided forever. Omicron has simply made that clear very quickly. Even if COVID can’t be avoided forever, there are good reasons to try to avoid getting or passing it on over the next several weeks. Better treatments for Omicron are on the horizon, Syra Madad, an infectious-disease epidemiologist at Harvard, told me. Pfizer’s very effective pill has just been authorized by the FDA, but supplies are short. Only one monoclonal antibody, sotrovimab, currently works against Omicron, and supplies are also short. “It’s a terrible time to unfortunately be hospitalized and not have these types of therapies available,” Madad said. In a few months, the outlook will get better for individual people at serious risk from COVID. For society at large, too, a huge number of cases right now is a risk to our hospitals and our essential services. Consider everything that someone who is vulnerable to COVID needs, Leininger said. “We need water in her faucet, and we need food in her fridge. And we need the visiting nurse to be able to fly in because our hospitals are under siege,” she told me. That means water plants and grocery stores and airlines need employees to stay healthy and continue working. This is where things get messier. Our Omicron strategy is also constrained, at this point, by the willingness of a wearier public. With so much virus out there, we are once again needing to flatten the curve. But back in March 2020, we understood social distancing to “flatten the curve” as a temporary measure to get us through the next weeks or months. “Well now it’s been two years. Do we have to do this for five years? It’s just not sustainable,” says Julie Downs, who studies risk perception at Carnegie Mellon University. If the most drastic COVID restrictions—stay-at-home orders and preemptive closures—are off the table, then we cannot avoid a staggering number of Omicron cases. The CDC cutting isolation periods from 10 to five days for sick people is an attempt to balance these realities. The agency managed to roll out the new recommendations in the most confusing way possible—by first not requiring a test for people with no symptoms and downplaying the utility of tests before adding an optional test. But the CDC is fundamentally dealing with a hard set of trade-offs: We don’t have enough rapid tests for every sick person right now, and isolating people for too long or too short of a time both have consequences. Keep teachers and students in isolation for too long and schools can’t stay open; make them go back too soon, they spread the virus, and schools also can’t stay open. [Read: America’s COVID rules are a dumpster fire] Omicron is forcing us to reconsider how we deal with mild cases of COVID, which will never completely go away. It is doing so, unfortunately, in a chaotic and dangerous moment. For the next variant and for next winter, we need to plan in advance. The challenges ahead are already clear. Hospitals, which are stressed even in bad flu seasons, will have to deal with combined COVID and flu every winter. The coronavirus will also keep evolving, and new variants that keep eroding our immunity will emerge. In a series of three papers last week, a group of former Biden advisers laid out a long-term strategy to monitor all respiratory infections—including COVID, flu, and respiratory syncytial virus—and keep their collective burden below that of a bad flu season through more robust testing, surveillance, mitigation, and vaccine and therapy development. We’ve spent the past year lurching in reaction to new variants, but what the U.S. needs now is a big-picture goal for COVID, even if the coronavirus surprises us again. from https://ift.tt/3n9a5fC Check out http://natthash.tumblr.com If you’re trapped in COVID isolation right now, you’re making muffins. If that’s literally true, good for you, and I can recommend these. But I’m talking metaphorically. Right now, the infection you’re nursing, and the contagious risk it carries, is—hear me out--raw batter in an oven. You really, really don’t want to remove it too soon. Yes, we are in crisis right now. The pandemic’s been raging for two years, and I am talking about muffins. But just bear with me a second. Muffins are warranted at this bizarre pandemic juncture because the CDC has starved us of proper guidance. This week, the agency debuted new guidelines that told people who have been infected by the coronavirus that they can spring from isolation as little as five days after their symptoms start, or their first positive test result, rather than the typical 10—regardless of vaccination status, and without confirming they’re not still contagious by taking a coronavirus test. The agency did this despite evidence that it cites on its own website suggesting that some 30 percent of people may remain contagious after their fifth day in solitude. (And these data largely predate Omicron, which might rejigger the transmission math.) [Read: America’s COVID rules are a dumpster fire] The CDC says that people can take tests if they want to, and that anyone who continues to test positive or still feels pretty sick should remain in isolation. You’re also still supposed to mask until after day 10. But a slew of experts I spoke with earlier this week called this tepid guidance reckless, unscientific, and punishingly complex—the ifs and thens of the recommendations run nearly 2,000 words long—and they worry that the rest of us have essentially been left to navigate the rules of infection prevention for ourselves. This brings us back to the muffins, and the solace they can offer in times of despair. Here, muffins aren’t just tasty. They can provide actual clarity on how to exit isolation. Muffins, like infected people, need to incubate for a set period of time before they’re ready for a public debut. There’s pressure to get them out of the oven somewhat speedily: People are hungry; muffins are delicious; overcooked muffins are not. But removing them too soon is even worse. You risk a lot of people … well, getting sick. [Read: A very radical, very delicious take on risk management] I apologize if I’m ruining muffins for you. But like infections, all muffins are unique. The ideal time to bake them may vary by ingredients, by oven, even by the color of the pan the batter’s baked in—a whole slew of factors that actually track decently well with how infection also works. With SARS-CoV-2, people who are very sick or immunocompromised might carry and transmit it for longer; people who are young, healthy, vaccinated, and didn’t snarf up too much of the virus might be only briefly contagious. Any decent muffin recipe will account for that degree of variation. Most will give a range of cooking times: 20 to 30 minutes, say, in a 350-degree oven. They’ll also ask you to look for visual cues, and test the batch when it seems to nearly be done. Our public-health guidelines would benefit from such flexibility. You can think of the virus, crudely, as the rawness of the batter; a proper tenure in a hot oven should burn the contagion out. External appearance, or symptoms, can be a clue. Intense illnesses are like visibly runny, shiny, snot-like (again, sorry) batter—a sign that something’s undercooked. (Fast-resolving symptoms? Golden-brown muffin tops that feel lightly springy to the touch? That’s more encouraging.) Vaccines can play a big role here too, because they’re known to curb contagiousness. Like a hotter oven or a darker-colored pan, they can speed the cooking process along. [Read: Why are we still isolating vaccinated people for 10 days?] Stay with me now. This is for your health, and your batter’s still cooking! Given that outsides can sometimes be deceptive, it’s nice to also test what’s going on inside. For SARS-CoV-2, many experts (though not the CDC) advise using a test around the five-day mark, and to not exit isolation until you’ve received one or two negative results. It’s the COVID equivalent of the toothpick trick: Stick one into a muffin when it’s looking crisp; if just a couple soft crumbs cling, it’s done. Neither method is perfect. The toothpick test can deceive, and coronavirus tests can ping back false negatives, especially if they’re the rapid, at-home kind that look for antigens. (Omicron, which appears to prefer the throat early in infection, may be eroding antigen tests’ performance further.) To make matters worse, the current at-home test shortage has made it as though every grocery store in America has suddenly run out of toothpicks. But when possible, gathering this kind of evidence is far better than fumbling in the dark. In any case, a positive result—a blazing line on an antigen test, or a toothpick coated with goop—should be incentive enough to shut the door again. I’ll level with you here: This comparison is silly. But we need these sorts of communication tactics because we’re not finding many of them elsewhere, especially from the agencies that are supposed to be shepherding us through this mess. In a way, the fact that I needed to reach for muffins at all is more proof that, two years into this pandemic, we’re still very bad at talking about it. As Omicron cases shatter records and pricey tests remain in woefully short supply, we don’t have the equipment we need to do shortened isolations justice. But that is little reason to shrug and say that five untested days is enough. By now, we know how to avoid infecting one another. And yet, we’re still depriving ourselves of the opportunity to whip up the perfect batch. from https://ift.tt/3JPJwFV Check out http://natthash.tumblr.com When I was a kid, my dad did something on family vacations that perplexes me to this day: He ran. Every day, at least four or five miles, rising before the sun and before anyone else was awake. He wasn’t training for anything. He wasn’t trying to lose weight. There was no specific goal, no endpoint, no particular reason he couldn’t take the week off while in the greater Disney World metropolitan area, which, in July, is hotter than the surface of the sun. He was just running, like he had basically every day since time immemorial. My dad will turn 75 next week, and whenever you’re reading this, he has probably already been out for a run today. My dad didn’t always run. He started a few years before I was born. One day he wasn’t a jogger, and the next day he was, even if he didn’t know at the time that the change was indeed permanent. When I asked him why he started all those years ago, there was no great motivator, no epiphany. “It was the cool thing to do at the time for people like me,” he said of the 1980s fitness boom. Now, when my dad doesn’t run, “I feel like I’ve lost something,” he told me. For a lot of people, this is, without exaggeration, the dream: You decide you’d like to start doing something, you get past the initial phase of this new activity being hard and bad and a huge bummer, and then you do that thing for 40 years. It’s a deceptively simple fantasy—and, so often, an impossible one. Right now, I work out once or twice a week, which is less than I’d like to. I’ve tried to form various exercise habits over the years—I bought the equipment, I made a plan, I got out there and did it—and never quite reached the automatic stage, even though I observed it at close range for my entire childhood. My experience is extremely common among people who want to change how they do all kinds of things: to waste less money, to floss, to quit smoking, to drink less, to learn a new language. And it’s a salient dynamic at the beginning of a new year, resolution or not. New beginnings are seductive, and so is our own capacity for change. You tell yourself that, this time, you’re really going to do God-knows-what differently, but all too soon you’re reminded that forever is a pretty long time to keep it up. Stories like my dad’s often serve as pop-psychological proof that you, too, could become a runner, if you really wanted to. But we all want things—human longing knows no bounds—and plenty of people do genuinely throw themselves into trying something new, without much success at converting those behaviors into lasting habits. If some people can just get up one day and decide to behave differently for the rest of their life, why do most people fail at it again and again? The conventional wisdom on changing habits goes something like this: You can change if you really want to. Americans especially tend to see ourselves and one another as individuals with identical reservoirs of willpower, which some people choose to use and others do not. If you can’t figure out how to get up at 4:30 in the morning to make sure you get five miles in before commuting to work every day, which my dad somehow did for 30 years, you’re not trying hard enough, or you don’t want it badly enough, or you’re not motivated enough. Try harder. [Read: The false promise of morning routines] Now, as anyone who has ever tried anything might suspect, it sure seems like that idea might be bullshit. Or at least, many researchers have concluded that it does not account for an enormous amount of observed human behavior, according to the psychologist Wendy Wood. In her book Good Habit, Bad Habit, she explains that for the latter half of the 20th century, psychological scholarship more or less affirmed its righteousness. Attitude leads behavior, the theory went, and the circumstances in which you exist aren’t that important to the choices you make. Individuals do certain things and not others mostly because of their own conscious decisions; your fate is largely in your own hands. You can see how this logic permeated culture: The self-help and diet industries boomed, government slashed the social safety net’s tires, the 1970s became the Me Decade. In the past 20 years, the field’s tune has begun to change. According to Michael Inzlicht, a social psychologist at the University of Toronto, the most recent research suggests that conscious decision making plays a much more minor role in people’s actions than previously thought, and long-term behavior patterns largely aren’t created by stringing together a series of conscious choices. How people use the phrase self-control, he told me, tends to conflate two different things: a largely immutable element of someone’s personality (a trait) and a way that someone chooses to behave at a particular time (a state). Trait self-control varies from person to person, he said, and the amount you get is probably determined by some combination of heredity, culture, and environment. A person who has high trait self-control might be preternaturally punctual, whereas the timeliness track record of an average person—even one constantly trying hard to make it to things on time—might be more subject to the whims of circumstance. The key distinction here, Inzlicht told me, is that a person who appears highly self-controlled to others—who is displaying a high level of trait self-control—probably isn’t exercising their behavioral self-control as much as you do. “People who have high trait self-control, they don't actually engage in more restraint of their behavior and thoughts and emotions in the moment,” he said. Instead, they just aren’t tempted or distracted or diverted from their purpose as often or as effectively as the rest of us. For the small number of people at the far end of the trait spectrum, the things that others have to exercise self-control to resist every single time—sleeping in, skipping the gym, making impulsive purchases, having a cigarette even though they’re trying to quit—often just don’t get recognized as viable options in the same way that they do by the rest of us. This doesn’t mean it’s always easy for these people to sit down to study or to get out the door to exercise, but broadly speaking, they’re less readily pulled away from their plans by the siren song of novelty or opportunity, so they don’t have to rely on their active sense of restraint, with its far less reliable results, as frequently. My father, I suspect, is one of the people at the far end of this personality continuum. It’s not just the running: He smoked for more than 20 years—back when everyone smoked, he would want me to stipulate—but he quit on his first try and never looked back. After he decided he liked running every morning, he added on an evening strength-training routine several days a week, and has stuck to the two-a-days for decades. He always eats breakfast, and the meal—a big bowl of Raisin Bran and a buttered, toasted bagel for much of my childhood—goes unchanged for years at a time. He is always reading a book, often about history, and has probably consumed hundreds of thousands of pages of dry descriptions of obscure military battles in my lifetime, for fun. He is what happens if you make the whole plane out of New Year’s resolutions. Inzlicht described the evidence that any given person can increase their level of trait self-control to be more like my dad as “extremely weak,” but said that researchers should nonetheless still keep looking for ways it might be possible. Having the inherent ability to more easily form good habits and jettison harmful ones is enormously beneficial—people who can do that tend to be healthier, happier, and more financially stable. My dad is an easygoing, curious, nonjudgmental guy, and a very good dad. He’s not constantly working against himself to do the “right” thing, or to do anything at all. This is just how he is. “I don't get out in that lane, I don't get out in this lane, I stay in my lane,” he said, when I asked him about his routines. “These are the things that I like to do.” [Read: The problem with being perfect] According to Wood, the Good Habit, Bad Habit author, forming new long-term behavioral patterns is possible to some extent for most people, and it’s largely a function of learning to do something so automatically that you perform the task without having to consciously decide to do it, like brushing your teeth before you go to bed. She runs the University of Southern California’s Habit Lab, where she studies how and why people learn to change their behavior. She says that people who go to the gym a lot, for instance, don’t have to decide to go every time—they just sort of find themselves headed in that direction at the appropriate moment. For those to whom habit-formation doesn’t come so naturally, the circumstances you’re in can make a big difference. Stability, for instance, is an enormous boon: Many people who leave work at the same time every day are able to rely on their routine as a cue to tell themselves that it’s time to go to the gym. If only half your workdays end when the gym is open, converting that choice to a habit can be much harder. Having money to buy the tools that make a new behavior easier or more rewarding is also enormously helpful, as is consistent access to the environs in which new tasks can best be performed. My dad started running on safe, low-traffic streets, which gave him the opportunity to realize that he really, really liked the rush of endorphins that is often called a runner’s high, which reinforced the creation of his new habit in ways that Wood has found to be crucial. One study Wood described found that people who lived within four miles of a gym went much more frequently than people who lived further away, even when the difference between the two groups was only a mile or two. Another study found that adding farm stands outside of schools and community centers in a low-income area of Austin, Texas, meant local residents ate more vegetables, even if nothing else was done to encourage people to change their dietary habits, or even to tell them the farm stands were there. “That's part of the health advantage of higher-income folks,” Wood told me. “They live in environments that are more conducive to exercise; they're less likely to live in food deserts; they have access to restaurants beyond just fast food.” For many people who make something out of their good intentions and healthy tendencies, those successes have been supported by policy choices that they had nothing to do with. To Wood, the implication is clear: If you want people to behave differently en masse, you’re going to have to change—to improve—the circumstances in which a lot of them live. I do not mean to sound fatalistic here. It’s not that personal change or self-improvement is impossible—most people can change their habits and create new ones, according to Wood, if they set realistic goals and they’re able to create cues and rewards that effectively encourage repetition. Much of that involves tinkering with the circumstances of your existence that you can affect. For instance, I became a more frequent flosser by taking the package of floss out of my medicine cabinet and sitting it next to my toothbrush, where I could always see it. I used to procrastinate on washing dishes, but now I do them every day like clockwork, thanks to a Bluetooth speaker that I use to listen to podcasts while I stand at the sink. Having a clean kitchen, in turn, means I cook more—an activity I really enjoy—and resort to expensive takeout orders less frequently. I figured out what was stopping me from doing some of the things I knew I could do, and I tried to eliminate the obstacles I could control, to reasonable success. Figuring out how to do something a little less or a little more is likely to yield the best results for most people, even if it’s not going to turn you into a different human. Before you do any of this, though, or before you decide you’ve failed, it’s probably worth making peace with who you are as a person. My irregular exercise habits don’t really bother me anymore, mostly because I do not take myself as seriously as I used to. I figure that I am who I am, give or take a reasonable capacity for marginal change. I have exercise equipment in my apartment that I could use more often, but I simply do not feel like it. I have never once felt like it, even if I have often wanted to be a person who does. What I can actually do for myself over the next year to make my life better probably will not include a spontaneous dedication to daily exercise. It may include more careful attention to, say, reading or cooking—things that I already love, and that are good for me. Before I left my parents’ house over the holidays, Dad made sure to pass on a few books he thought I’d enjoy. None of them are about war. from https://ift.tt/3EZC9YM Check out http://natthash.tumblr.com When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me. In this surge, COVID-19 hospitalizations rose slowly at first, from about 40,000 nationally in early November to 65,000 on Christmas. But with the super-transmissible Delta variant joined by the even-more-transmissible Omicron, the hospitalization count has shot up to 110,000 in the two weeks since then. “The volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before,” Kit Delgado, an emergency physician in Pennsylvania, told me. Health-care workers in 11 different states echoed what he said: Already, this surge is pushing their hospitals to the edge. And this is just the beginning. Hospitalizations always lag behind cases by about two weeks, so we’re only starting to see the effects of daily case counts that have tripled in the past 14 days (and are almost certainly underestimates). By the end of the month, according to the CDC’s forecasts, COVID will be sending at least 24,700 and up to 53,700 Americans to the hospital every single day. This surge is, in many ways, distinct from the ones before. About 62 percent of Americans are fully vaccinated, and are still mostly protected against the coronavirus’s worst effects. When people do become severely ill, health-care workers have a better sense of what to expect and what to do. Omicron itself seems to be less severe than previous variants, and many of the people now testing positive don’t require hospitalization. But such cases threaten to obscure this surge’s true cost. Omicron is so contagious that it is still flooding hospitals with sick people. And America’s continued inability to control the coronavirus has deflated its health-care system, which can no longer offer the same number of patients the same level of care. Health-care workers have quit their jobs in droves; of those who have stayed, many now can’t work, because they have Omicron breakthrough infections. “In the last two years, I’ve never known as many colleagues who have COVID as I do now,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. “The staffing crisis is the worst it has been through the pandemic.” This is why any comparisons between past and present hospitalization numbers are misleading: January 2021’s numbers would crush January 2022’s system because the workforce has been so diminished. Some institutions are now being overwhelmed by a fraction of their earlier patient loads. “I hope no one you know or love gets COVID or needs an emergency room right now, because there’s no room,” Janelle Thomas, an ICU nurse in Maryland, told me. Here, then, is the most important difference about this surge: It comes on the back of all the prior ones. COVID’s burden is additive. It isn’t reflected just in the number of occupied hospital beds, but also in the faltering resolve and thinning ranks of the people who attend those beds. “This just feels like one wave too many,” Ranney said. The health-care system will continue to pay these costs long after COVID hospitalizations fall. Health-care workers will know, but most other people will be oblivious—until they need medical care and can’t get it. The PatientsThe patients now entering American hospitals are a little different from those who were hospitalized in prior surges. Studies from South Africa and the United Kingdom have confirmed what many had hoped: Omicron causes less severe disease than Delta, and it is less likely to send its hosts to the hospital. British trends support those conclusions: As the Financial Times’ John Burn-Murdoch has reported, the number of hospitalized COVID patients has risen in step with new cases, but the number needing a ventilator has barely moved. And with vaccines blunting the severity of COVID even further, we should expect the average COVID patient in 2022 to be less sick than the average patient in 2021. In the U.S., many health-care workers told me that they’re already seeing that effect: COVID patients are being discharged more easily. Fewer are critically ill, and even those who are seem to be doing better. “It’s anecdotal, but we’re getting patients who I don’t think would have survived the original virus or Delta, and now we’re getting them through,” Milad Pooran, a critical-care physician in Maryland, told me. But others said that their experiences haven’t changed, perhaps because they serve communities that are highly unvaccinated or because they’re still dealing with a lot of Delta cases. Milder illness “is not what we’re seeing,” said Howard Jarvis, an emergency physician in Missouri. “We’re still seeing a lot of people sick enough to be in the ICU.” Thomas told me that her hospital had just seven COVID patients a month ago, and is now up to 129, who are taking up almost half of its beds. Every day, about 10 patients are waiting in the ER already hooked up to a ventilator but unable to enter the ICU, which is full. During this surge, record numbers of children are also being hospitalized with COVID. Sarah Combs, a pediatric emergency physician in Washington, D.C., told me that during the height of Delta’s first surge, her hospital cared for 23 children with COVID; on Tuesday, it had 53. “Many of the patients I’m operating on are COVID-positive, and some days all of them are,” Chethan Sathya, a pediatric surgeon in New York, told me. “That never happened at any point in the pandemic in the past.” Children fare much better against the coronavirus than adults, and even severely ill ones have a good chance of recovery. But the number of such patients is high, and Combs and Sathya both said they worry about long COVID and other long-term complications. “I have two daughters myself, and it’s very hard to take,” Sathya said. These numbers reflect the wild spread of COVID right now. The youngest patients are not necessarily being hospitalized for the disease—Sathya said that most of the kids he sees come to the hospital for other problems—but many of them are: Combs told me that 94 percent of her patients are hospitalized for respiratory symptoms. Among adults, the picture is even clearer: Every nurse and doctor I asked said that the majority of their COVID patients were admitted because of COVID, not simply with COVID. Many have classic advanced symptoms, such as pneumonia and blood clots. Others, including some vaccinated people, are there because milder COVID symptoms exacerbated their chronic health conditions to a dangerous degree. “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time,” said Vineet Arora, a hospitalist in Illinois. “Some of it is for COVID, and some is with COVID, but it’s all COVID. At the end of the day, it doesn’t really matter.” (COVID patients also need to be isolated, which increases the burden on hospitals regardless of the severity of patients’ symptoms.) Omicron’s main threat is its extreme contagiousness. It is infecting so many people that even if a smaller proportion need hospital care, the absolute numbers are still enough to saturate the system. It might be less of a threat to individual people, but it’s disastrous for the health-care system that those individuals will ultimately need. Other countries have had easier experiences with Omicron. But with America’s population being older than South Africa’s, and less vaccinated or boosted than the U.K.’s or Denmark’s, “it’s a mistake to think that we’ll see the same degree of decoupling between cases and hospitalizations that they did,” James Lawler, an infectious-disease physician in Nebraska, told me. “I’d have thought we’d have learned that lesson with Delta,” which sent hospitalizations through the roof in the U.S. but not in the U.K. Now, as then, hospitalizations are already spiking, and they will likely continue to do so as Omicron moves from the younger people it first infected into older groups, and from heavily vaccinated coastal cities into poorly vaccinated rural, southern, and midwestern regions. “We have plenty of vulnerable people who will fill up hospital beds pretty quickly,” Lawler said. And just as demand for the health-care system is rising, supply is plummeting. The WorkersThe health-care workforce, which was short-staffed before the pandemic, has been decimated over the past two years. As I reported in November, waves of health-care workers have quit their jobs (or their entire profession) because of moral distress, exhaustion, poor treatment by their hospitals or patients, or some combination of those. These losses leave the remaining health-care workers with fewer trusted colleagues who speak in the same shorthand, less expertise to draw from, and more work. “Before, the sickest ICU patient would get two nurses, and now there’s four patients for every nurse,” Megan Brunson, an ICU nurse in Texas, told me. “It makes it impossible to do everything you need to do.” Omicron has turned this bad situation into a dire one. Its ability to infect even vaccinated people means that “the numbers of staff who are sick are astronomical compared to previous surges,” Joseph Falise, a nurse manager in Miami, told me. Even though vaccinated health-care workers are mostly protected from severe symptoms, they still can’t work lest they pass the virus to more vulnerable patients. “There are evenings where we have whole sections of beds that are closed because we don’t have staff,” said Ranney, the Rhode Island emergency physician. Every part of the health-care system has been affected, diminishing the quality of care for all patients. A lack of pharmacists and outpatient clinicians makes it harder for people to get tests, vaccines, and even medications; as a result, more patients are ending up in the hospital with chronic-disease flare-ups. There aren’t enough ambulance drivers, making it more difficult for people to get to the hospital at all. Lab technicians are falling ill, which means that COVID-test results (and medical-test results in general) are taking longer to come back. Respiratory therapists are in short supply, making it harder to ventilate patients who need oxygen. Facilities that provide post-acute care are being hammered, which means that many groups of patients—those who need long-term care, dialysis, or care for addiction or mental-health problems—cannot be discharged from hospitals, because there’s nowhere to send them. These conditions are deepening the already profound exhaustion that health-care workers are feeling. “We’re still speaking of surges, but for me it’s been a constant riptide, pulling us under,” Brunson said. “Our reserves aren’t there. We feel like we’re tapped out, and that person who is going to come in to help you isn’t going to, because they’re also tapped out … or they’ve tested positive.” Public support is also faltering. “We once had parades and people hanging up signs; professional sports teams used to do Zooms with us and send us lunches,” Falise told me. “The pandemic hasn’t really become any different, but those things are gone.” Health-care workers now experience indifference at best or antagonism at worst. And more than ever, they are struggling with the jarring disconnect between their jobs and their communities. At work, they see the inescapable reality of the pandemic. Everywhere else—on TV and social media, during commutes and grocery runs—they see people living the fantasy that it is over. The rest of the country seems hell-bent on returning to normal, but their choices mean that health-care workers cannot. As a result, “there’s an enormous loss of empathy among health-care workers,” Swaminathan said. “People have hit a tipping point,” and the number of colleagues who’ve talked about retiring or switching careers “has grown dramatically in the last couple of months.” Medicine runs on an unspoken social contract in which medical professionals expect themselves to sacrifice their own well-being for their patients. But the pandemic has exposed how fragile that contract is, said Arora, the Illinois hospitalist. “Society has decided to move on with their lives, and it’s hard to blame health-care workers for doing the same,” she said. The SystemIn the coming weeks, these problems will show up acutely, as the health-care system scrambles to accommodate a wave of people sick with COVID. But the ensuing stress and strain will linger long after. The danger of COVID, to individual Americans, has gone far past the risk that any one infection might pose, because the coronavirus has now plunged the entire health-care system into a state of chronic decay. In Maryland, Milad Pooran runs a center that helps small community hospitals find beds for critically ill patients. Normally, it gets a few calls a night, but “now we’re getting two an hour,” he told me. In Swaminathan’s emergency room, “we routinely have 60 to 70 people who are waiting for six to 12 hours to be seen,” he said. Other health-care workers noted that even when they can get people into beds, offering the usual standard of care is simply impossible. “Yes, sure, if you’re the patient who puts us at 130 percent capacity, you still technically get a bed, but the level of care that everyone gets is significantly diminished,” Lawler said. Some doctors are discharging patients who would have been admitted six months ago, because there’s nowhere to put them and they seem temporarily stable enough. To be clear, these problems are not affecting just COVID patients, but all patients. When Swaminathan’s friends asked what they should be doing about Omicron, he advised them about boosters and masks, but also about wearing a seat belt and avoiding ladders. “You don’t want to be injured now,” he told me. “Any need to go to the emergency department is going to be a problem.” This is the bind that Americans, including vaccinated ones, now face. Even if they’re unconcerned about COVID or at low personal risk from it, they can still spread a variant that could ultimately affect them should they need medical care for anything. These conditions are contributing to the moral distress that health-care workers feel. “This pandemic is making it almost impossible to provide our best care to patients, and that can become too much for some folks to bear,” Ranney said. A friend recently told her, after seeing a patient who had waited six hours with a life-threatening emergency, “How can I go back tomorrow knowing that there might be another patient in the waiting room who might be about to die and who I don’t know about?” From outside the system, it can be hard to see these problems. “I don’t think people will realize what’s happening until we fall off that cliff—until you call 911 and no one comes, or you need that emergency surgery and we can’t do it,” Swaminathan said. The system hasn’t yet careened over: “When the trauma patients, the cardiac arrests, or the strokes come in, it’s a mad shuffle, but we still find a way to see them,” said Kit Delgado, the Pennsylvania emergency physician. “I don’t know how sustainable that’s going to be if cases keep rising everywhere.” Measures that worked to relieve strain in earlier surges are now harder to pull off. Understaffed hospitals can hire travel nurses, but Omicron has spread so quickly that too many facilities “are pulling from the same labor pool—and if that pool is sick, where are the reinforcements?” Syra Madad, an infectious-disease epidemiologist in New York, told me. Hospitals often canceled nonemergency surgeries during past surges, but many of those patients are now even sicker, and their care can’t be deferred any longer. This makes it harder for COVID teams to pull in staff from other parts of a hospital, which are themselves heaving with patients. Brunson works in a cardiac ICU, not a COVID-focused one, but her team is still inundated with people who got COVID in a prior surge and “are now coming in with heart failure” because of their earlier infection, she said. “COVID isn’t done for them, even though they’re testing negative.” Hospitals aren’t facing just Omicron, but also the cumulative consequences of every previous variant in every previous surge. Newer solutions are limited, too. Joe Biden has promised to bolster hard-hit hospitals with 1,000 more military personnel—a tiny number for the demand. New antiviral drugs such as Pfizer’s Paxlovid could significantly reduce the odds of hospitalization, but supplies are low; the pills must also be taken early on in the disease’s course, which depends on obtaining rapid diagnostic tests, which are also in short supply. For people who get the drugs, “they’ll be great, but at a population scale they’re not going to prevent the system from being overwhelmed,” Lawler said. So, almost unbelievably, the near-term fate of the health-care system once again hinges on flattening the curve—on slowing the spread of the most transmissible variant yet, in a matter of days rather than weeks. Some experts are hopeful that Omicron will peak quickly, which would help alleviate the pressure on hospitals. But what then? Ranney fears that once hospitalizations start falling, policy makers and the public will assume that the health-care system is safe, and do nothing to address the staffing shortages, burnout, exploitative working conditions, and just-in-time supply chains that pushed said system to the brink. And even if the flood of COVID patients slows, health-care workers will still have to deal with the fallout--cases of long COVID, or people who sat on severe illnesses and didn’t go to hospital during the surge. They’ll do so with even less support than before, without the colleagues who are quitting their jobs right now, or who will do so once the need and the adrenaline subside. “Right now, there’s a sense of purpose, which lets you mask the trauma that everyone is experiencing,” Pooran said. “My fear is that when COVID is done with and everything does quiet down, that sense of purpose will go away and a lot of good people will leave.” There’s a plausible future in which most of the U.S. enjoys a carefree spring, oblivious to the frayed state of the system they rely on to protect their health, and only realizing what has happened when they knock on its door and get no answer. This is the cost of two years spent prematurely pushing for a return to normal—the lack of a normal to return to. from https://ift.tt/3HIGx05 Check out http://natthash.tumblr.com |
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