Mark Sklansky, a pediatric cardiologist at UCLA, has not shaken a hand in several years. The last time he did so, it was only “because I knew I was going to go to the bathroom right afterwards,” he told me. “I think it’s a really bad practice.” From where he’s standing, probably a safe distance away, our palms and fingers are just not sanitary. “They’re wet; they’re warm; they’re what we use to touch everything we touch,” he said. “It’s not rocket science: The hand is a very good medium to transmit disease.” It’s a message that Sklansky has been proselytizing for the better part of a decade—via word of mouth among his patients, impassioned calls to action in medical journals, even DIY music videos that warn against puttin’ ’er there. But for a long time, his calls to action were met with scoffs and skepticism. So when the coronavirus started its sweep across the United States three years ago, Sklansky couldn’t help but feel a smidgen of hope. He watched as corporate America pocketed its dealmaking palms, as sports teams traded end-of-game grasps for air-fives, and as The New Yorker eulogized the gesture’s untimely end. My colleague Megan Garber celebrated the handshake’s demise, as did Anthony Fauci. The coronavirus was a horror, but perhaps it could also be a wake-up call. Maybe, just maybe, the handshake was at last dead. “I was optimistic that it was going to be it,” Sklansky told me. [Read: Good riddance to the handshake] But the death knell rang too soon. “Handshakes are back,” says Diane Gottsman, an etiquette expert and the founder of the Protocol School of Texas. The gesture is too ingrained, too beloved, too irreplaceable for even a global crisis to send it to an early grave. “The handshake is the vampire that didn’t die,” says Ken Carter, a psychologist at Emory University. “I can tell you that it lives: I shook a stranger’s hand yesterday.” The base science of the matter hasn’t changed. Hands are humans’ primary tools of touch, and people (especially men) don’t devote much time to washing them. “If you actually sample hands, the grossness is something quite exceptional,” says Ella Al-Shamahi, an anthropologist and the author of the book The Handshake: A Gripping History. And shakes, with their characteristic palm-to-palm squeezes, are a whole lot more prone to spread microbes than alternatives such as fist bumps. Not all of that is necessarily bad: Many of the microscopic passengers on our skin are harmless, or even beneficial. “The vast majority of handshakes are completely safe,” says David Whitworth, a microbiologist at Aberystwyth University, in Wales, who’s studied the griminess of human hands. But not all manual microbes are benign. Norovirus, a nasty diarrheal disease infamous for sparking outbreaks on cruise ships, can spread easily via skin; so can certain respiratory viruses such as RSV. The irony of the recent handshake hiatus is that SARS-CoV-2, the microbe that inspired it, isn’t much of a touchable danger. “The risk is just not very high,” says Jessica Malaty Rivera, an infectious-disease epidemiologist at the Johns Hopkins Center for Health Security. Despite early pandemic worries, this particular coronavirus is more likely to use breath as a conduit than contaminated surfaces. That’s not to say that the virus couldn’t hop from hand to hand after, say, an ill-timed sneeze or cough right before a shake. But Emily Landon, an infectious-disease physician and hand-hygiene expert at the University of Chicago, thinks it would take a hefty dose of snot or phlegm, followed by some unwashed snacking or nose-picking by the recipient, to really pose a threat. So maybe it’s no shock that as 2020’s frantic sanitizing ebbed, handshakes started creeping back. [Read: The great pandemic hand-washing blooper] Frankly, that doesn’t have to be the end of the world. Even when considering more shake-spreadable pathogens, it’s a lot easier to break hand-based chains of transmission than airborne ones. “As long as you have good hygiene habits and you keep your hands away from your face,” Landon told me, “it doesn’t really matter if you shake other people’s hands.” (Similar rules apply to doorknobs, light switches, subway handrails, phones, and other germy perils.) Then again, that requires actually cleaning your hands, which, as Sklansky will glady point out, most people—even health-care workers—are still pretty terrible about. For now, shakes don’t seem to be back to 2019 levels—at least, not the last time researchers checked, in the summer of 2022. But Gottsman thinks their full resurgence may be only a matter of time. Among her clients in the corporate world, where grips and grasps are currency, handshakes once again abound. No other gesture, she told me, hits the same tactile sweet spot: just enough touch to feel personal connection, but sans the extra intimacy of a kiss or hug. Fist bumps, waves, and elbow touches just don’t measure up. At the pandemic’s worst, when no one was willing to go palm-to-palm, “it felt like something was missing,” Carter told me. The lack of handshakes wasn’t merely a reminder that COVID was here; it signaled that the comforts of routine interaction were not. If handshakes survive the COVID era—as they seem almost certain to do—this won’t be the only disease outbreak they outlive, Al-Shamahi told me. When yellow fever pummeled Philadelphia in the late 18th century, locals began to shrink “back with affright at even the offer of a hand,” as the economist Matthew Carey wrote at the time. Fears of cholera in the 1890s prompted a small cadre of Russians to establish an anti-handshake society, whose members were fined three rubles for every verboten grasp. During the flu pandemic that began in 1918, the town of Prescott, Arizona, went so far as to ban the practice. Each time, the handshake bounced back. Al-Shamahi remembers rolling her eyes a bit in 2020, when she saw outlets forecasting the handshake’s untimely end. “I was like, ‘I can’t believe you guys are writing the obituary,’” she told me. “That is clearly not what is happening here.” Handshakes do seem to have a knack for enduring through the ages. A commonly cited origin story for the handshake points to the ancient Greeks, who may have deployed the behavior as a way to prove that they weren’t concealing a weapon. But Al-Shamahi thinks the roots of handshaking go way further back. Chimpanzees—from whom humans split some 7 million years ago—appear to engage in a similar behavior in the aftermath of fights. Across species, handshakes probably exchange all sorts of sensory information, Al-Shamahi said. They may even leave chemical residues on our palm that we can later subconsciously smell. [Read: What a handshake smells like] Handshakes aren’t a matter of survival: Plenty of communities around the world get by just fine without them, opting instead for, say, the namaste or a hand over the heart. But palm pumping seems to have stuck around in several societies for good reason, outlasting other customs such as curtsies and bows. Handshakes are mutual, usually consensual; they’re imbued with an egalitarian feel. “I don’t think it’s a coincidence that you see the rise of the handshake amongst all the greetings at a time when democracy was on the rise,” Al-Shamahi told me. The handshake is even, to some extent, built into the foundation of the United States: Thomas Jefferson persuaded many of his contemporaries to adopt the practice, which he felt was more befitting of democracy than the snobbish flourishes of British court. American attitudes toward handshakes still might have undergone lasting, COVID-inspired change. Gottsman is optimistic that people will continue to be more considerate of those who are less eager to shake hands. There are plenty of good reasons for abstaining, she points out: having a vulnerable family member at home, or simply wanting to avoid any extra risk of getting sick. And these days, it doesn’t feel so strange to skip the shake. “I think it’s less a part of our cultural vernacular now,” Landon told me. Sklansky, once again in the minority, is disappointed by the recent turn of events. “I used to say, ‘Wow, it took a pandemic to end the handshake,’” he told me. “Now I realize, even a pandemic has failed to rid us of the handshake.” But he’s not ready to give up. In 2015, he and a team of his colleagues cordoned off part of his hospital as a “handshake-free zone”—an initiative that, he told me, was largely a success among health-care workers and patients alike. The designation faded after a year or two, but Sklansky hopes that something similar could soon return. In the meantime, he’ll settle for declining every proffered palm that comes his way—although, if you go for something else, he’d rather you not choose the fist bump: “Sometimes,” he told me, “they just go too hard.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic. from https://ift.tt/YDsqfNB Check out http://natthash.tumblr.com
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Somehow, in a few short days, gas stoves have gone from a thing that some people cook with to, depending on your politics, either a child-poisoning death machine or a treasured piece of national patrimony. Suddenly, everyone has an opinion. Gas stoves! Who could have predicted it? The roots of the present controversy can be traced back to late December, when scientists published a paper arguing that gas stoves are to blame for nearly 13 percent of childhood asthma cases in the U.S. This finding was striking but not really new: The scientific literature establishing the dangers of gas stoves—and the connection to childhood asthma in particular—goes back decades. Then, on Monday, the fracas got well and truly under way, when Richard Trumka Jr., a member of the Consumer Product Safety Commission, said in an interview with Bloomberg News that the commission would consider a full prohibition on gas stoves. “This is a hidden hazard,” he said. “Any option is on the table. Products that can’t be made safe can be banned.” Just like that, gas stoves became the newest front in America’s ever expanding culture wars. Politicians proceeded to completely lose their minds. Florida Governor Ron DeSantis tweeted a cartoon of two autographed—yes autographed—gas stoves. Representative Jim Jordan of Ohio declared simply: “God. Guns. Gas stoves.” Naturally, Tucker Carlson got involved. “I would counsel mass disobedience in the face of tyranny in this case,” he told a guest on his Fox News show. No matter that Democrats are more likely to have gas stoves than Republicans, and in fact the only states in which a majority of households use gas stoves—California, Nevada, Illinois, New York, New Jersey—are states that went blue in 2020. Why let a few pesky facts spoil a perfectly good opportunity to own the libs? The Biden administration, for its part, clarified yesterday that it has no intention of banning gas stoves. In the long run, though, this may prove to have been more a stay of execution than a pardon. [Read: The gas-stove debate exemplifies the silliest tendencies of American politics] Beyond the knee-jerk partisanship, the science of gas stoves is not entirely straightforward. Emily Oster, an economist at Brown University, suggested in her newsletter that the underlying data establishing the connection between gas-stove use and childhood asthma may not be as clear-cut as the new study makes it out to be. And because those data are merely correlational, we can’t draw any straightforward causal conclusions. This doesn’t mean gas stoves are safe, Oster told me, but it complicates the picture. Switching from gas to electric right this minute probably isn’t necessary, she said, but she would make the change if she happened to be redesigning her kitchen. Whatever the shortcomings of the available data, it’s clear that gas stoves are worse for the climate and fill our homes with pollutants we’re better off not inhaling. Brady Seals, a manager at the Rocky Mountain Institute and a lead author of the new paper, told me that even assuming the maximum amount of uncertainty, her work still suggests that more than 6 percent of childhood asthma cases in the U.S. are associated with gas stoves. Regardless of the exact science, gas stoves might be in trouble anyway. Statistically, they’re not all that deeply entrenched to begin with: Only about 40 percent of American households have one. Plus, induction stoves—a hyper-efficient option that generates heat using electromagnetism—are on the rise. “We’re not asking people to go back to janky coils,” said Leah Stokes, a political scientist at UC Santa Barbara who has provided testimony on the subject of gas stoves before the U.S. Senate, and who is currently in the process of installing an induction stove in her home. Rachelle Boucher, a chef who has worked in restaurants, in appliance showrooms, and as a private cook for such celebrity clients as George Lucas and Metallica, swears by induction. She started using it about 15 years ago and has since become a full-time evangelist. (In the past, Boucher has done promotions for electric-stove companies, though she doesn’t anymore.) Induction, she told me, tops gas in just about every way. For one thing, “the speed is remarkable.” An induction stovetop can boil a pot of water in just two minutes, twice as quickly as a gas burner. For another, it allows for far greater precision. When you adjust the heat, the change is nearly instantaneous. “Once you use that speed,” Boucher said, “it’s weird to go back and have everything be so much harder to control.” Induction stoves also emit virtually no excess heat, reducing air-conditioning costs and making it harder to burn yourself. And they’re also easier to clean. Induction stoves do have minor drawbacks. Because they are flat and use electromagnetism, they aren’t compatible with all cookware, meaning that if you make the switch, you may also have to buy yourself a new wok or kettle. Flambéing and charring will also take a little longer, Boucher told me, but few home cooks are deploying those techniques on a regular basis. In recent years, induction has received the endorsement of some of the world’s top chefs, who have tended to be ardent gas-stove users. Eric Ripert, whose restaurant Le Bernardin has three Michelin stars, switched his home kitchens from gas to induction. “After two days, I was in love,” he told The New York Times last year. At his San Francisco restaurant, Claude Le Tohic, a James Beard Award–winning chef, has made the switch to induction. The celebrity chef and food writer Alison Roman is also a convert: “I have an induction stove by choice AMA,” she tweeted yesterday. If it’s good enough for them, it’s probably good enough for us. At the moment, induction stoves are more expensive than the alternatives, although their efficiency and the fact that they don’t heat up the kitchen help offset the disparity. So, too, do the rebates included in last year’s Inflation Reduction Act, which should kick in later this year and can amount to as much as $840. The price has been falling in recent years, and as it continues to come down, Stokes told me, she expects induction to overtake gas. A 2022 Consumer Reports survey found that while 3 percent of Americans have induction stoves, nearly 70 might consider going induction the next time they buy new appliances. “I think the same thing’s going to happen for induction stoves” as happened with electric vehicles, Stokes told me. In the end, culture-war considerations will lose out to questions of cost and quality. The better product will win the day, plain and simple. Still, gas stoves’ foray into the culture wars likely means that at least some Republicans will probably scorn electric stoves now in the same way they have masks over the past few years. And this whole episode does have a distinctly post-pandemic feel to it: the concern about the air we’re breathing, the discussion of what precautions we ought to take, the panic and outrage in response. The new gas-stove controversy feels as though it has been jammed into a partisan framework established—or at least refined—during the pandemic. “I don’t know if this discourse that we’re seeing now could have happened five years ago,” Brady Seals told me. Whatever happens to gas stoves, the public-health culture wars don’t seem to be going anywhere. from https://ift.tt/MQIAev5 Check out http://natthash.tumblr.com A new subvariant of SARS-CoV-2 is rapidly taking over in the U.S.—the most transmissible that has ever been detected. It’s called XBB.1.5, in reference to its status as a hybrid of two prior strains of Omicron, BA.2.10.1 and BA.2.75. It’s also called “Kraken.” Not by everyone, though. The nickname Kraken was ginned up by an informal group of scientists on Twitter and has caught on at some—but only some--major news outlets. As one evolutionary virologist told The Atlantic earlier this week, the name—at first glance, a reference to a folkloric sea monster—“seems obviously intended to scare the shit out of people” and serves no substantive purpose for communicating science. Yes, Kraken is klickbait. It’s arbitrary, unofficial, and untethered to specific facts of evolution or epidemiology—a desperate play to get attention. And mazel tov for that. We should all rejoice at this stupid name’s arrival. Long live the Kraken! May XBB.1.5 sink into the sea. Since Omicron spread around the world in the fall of 2021, we’ve been subject to a stultifying slew of jargon from the health authorities: Miniature waves of new infections keep lapping at our shores, while the names of the Omicron subvariants that produce them slop together in a cryptic muck: XBB.1.5 has overtaken BA.5 in recent weeks, and also BF.7, as well as BQ.1 and BQ.1.1; in China, BA.5.2 is quickly spreading too. One might ask, without a shred of undue panic, how worried we should be—but the naming scheme itself precludes an answer. You don’t even need to ask, it says. You’ll never fully understand. This isn’t subtext; it’s explicit. A spokesperson for the World Health Organization told my colleague Jacob Stern that people should be grateful for the arcane pronouncements of our leading international consortia. “The public doesn’t need to distinguish between these Omicron subvariants in order to better understand their risk or the measures they need to take to protect themselves,” he said. “If there is a new variant that requires public communication and discourse, it would be designated a new variant of concern and assigned a new label.” In other words: None of what we’re seeing now is bad enough to merit much attention. You don’t need to make any brand-new precautions, so we don’t need to talk about it. The public may not need to draw distinctions. But do those distinctions really need to be obscured? A different set of names, one that isn’t precision-engineered to harpoon people’s interest, wouldn’t have to fool us into feeling false alarm. It’s not as though our habit of assigning common names to storms leads to widespread panic starting every summer. When Hurricane Earl appeared last September, no one rushed into a bunker just because they knew what it was called. Then Ian came a few weeks later, and millions evacuated. Granted, Kraken sounds a bit more ominous than Earl. (Of all the labels that could be given to the latest version of a deadly virus, it’s not the best.) But the name is more befuddling than terrifying: a nitwitted reference, somehow, to ferocity, absurdity, and conspiratorial delusion all at once. Even so, a silly name still has the virtue of being a name, while a string of numbers and letters is just an entry in a database. Kraken doesn’t care if you’re afraid of COVID, and it doesn’t mind if you’re indifferent. It only wishes to be understood. Isn’t that important? A proper name eases conversation (wherever that might lead), and makes it possible to talk about what matters (and what doesn’t). Just try telling the public that Hurricane Earl will be no big deal but Ian is a mortal threat, if instead of “Earl” and “Ian” you had to say “BA.2.12.1” and “B.1.1.529.” The committee that names our storms is chasing clouds instead of clout; it knows that branding efforts make it easier for everyone to stay informed. We might have done the same for SARS-CoV-2, and handed out simple, easy-to-remember names for all the leading Omicron subvariants. (Through 2021, we used Greek letters to describe each major variant.) If Kraken seems alarmist now, that’s because we’re living in a different, dumber timeline, where public legibility has been forbidden. Why give this subvariant a name, the global health officials ask, when it isn’t really that much worse than any other? But that’s a problem of their own creation. If Kraken seems too gaudy, that’s because every other recent name has been too drab. Having useful, catchy names doesn’t mean avoiding all abstraction. Florida residents were glad to know, last fall, which hurricanes were Category 2 and which were Category 5; and it may be just as useful to remind yourself that Kraken is not now, of its own accord, a “variant of concern,” let alone a “variant of high consequence.” Our trust in those distinctions is a product of their formality: A special group of experts has decided which public threats are the most important. The Kraken name, if it continues to spread, could undermine this useful sense of deference—and leave us in an awkward free-for-all where anyone could give a name to any variant at any time. For the moment, though, our only recourse is to the numbing nomenclature that is now in place, and to the creaking bureaucracy that delivers it. Any other name for XBB.1.5—any better one than Kraken—would have to come from the WHO, an organization that recently spent five months rebranding monkeypox as “mpox” and that has warned that disease names like “paralytic shellfish poisoning” are unduly stigmatizing to shellfish. Kraken has the crucial benefit of being right in front of us. It’s a stupid name, but it’s a name—and names are good. from https://ift.tt/AW0DgkU Check out http://natthash.tumblr.com In the two-plus years that COVID vaccines have been available in America, the basic recipe has changed just once. The virus, meanwhile, has belched out five variants concerning enough to earn their own Greek-letter names, followed by a menagerie of weirdly monikered Omicron subvariants, each seeming to spread faster than the last. Vaccines, which take months to reformulate, just can’t keep up with a virus that seems to reinvent itself by the week. But SARS-CoV-2’s evolutionary sprint might not be the only reason that immunity can get bogged down in the past. The body seems to fixate on the first version of the virus that it encountered, either through injection or infection—a preoccupation with the past that researchers call “original antigenic sin,” and that may leave us with defenses that are poorly tailored to circulating variants. In recent months, some experts have begun to worry that this “sin” might now be undermining updated vaccines. At an extreme, the thinking goes, people may not get much protection from a COVID shot that is a perfect match for the viral variant du jour. Recent data hint at this possibility. Past brushes with the virus or the original vaccine seem to mold, or even muffle, people’s reactions to bivalent shots—“I have no doubt about that,” Jenna Guthmiller, an immunologist at the University of Colorado School of Medicine, told me. The immune system just doesn’t make Omicron-focused antibodies in the quantity or quality it probably would have had it seen the updated jabs first. But there’s also an upside to this stubbornness that we could not live without, says Katelyn Gostic, an immunologist and infectious-disease modeler who has studied the phenomenon with flu. Original antigenic sin is the reason repeat infections, on average, get milder over time, and the oomph that enables vaccines to work as well as they do. “It’s a fundamental part,” Gostic told me, “of being able to create immunological memory.” This is not just basic biology. The body’s powerful first impressions of this coronavirus can and should influence how, when, and how often we revaccinate against it, and with what. Better understanding of the degree to which these impressions linger could also help scientists figure out why people are (or are not) fighting off the latest variants—and how their defenses will fare against the virus as it continues to change. The worst thing about “original antigenic sin” is its name. The blame for that technically lies with Thomas Francis Jr., the immunologist who coined the phrase more than six decades ago after noticing that the initial flu infections people weathered in childhood could bias how they fared against subsequent strains. “Basically, the flu you get first in life is the one you respond to most avidly for the long term,” says Gabriel Victora, an immunologist at Rockefeller University. That can become somewhat of an issue when a very different-looking strain comes knocking. In scenarios like these, original antigenic sin may sound like the molecular equivalent of a lovesick teen pining over an ex, or a student who never graduates out of immunological grade school. But from the immune system’s point of view, never forgetting your first is logically sound. New encounters with a pathogen catch the body off guard—and tend to be the most severe. A deep-rooted defensive reaction, then, is practical: It ups the chances that the next time the same invader shows up, it will be swiftly identified and dispatched. “Having good memory and being able to boost it very quickly is sometimes a very good thing,” Victora told me. It’s the body’s way of ensuring that it won’t get fooled twice. [Read: Annual COVID shots mean we can stop counting] These old grudges come with clear advantages even when microbes morph into new forms, as flu viruses and coronaviruses often do. Pathogens don’t remake themselves all at once, so immune cells that home in on familiar snippets of a virus can still in many cases snuff out enough invaders to prevent an infection’s worst effects. That’s why even flu shots that aren’t perfectly matched to the season’s most prominent strains are usually still quite good at keeping people out of hospitals and morgues. “There’s a lot of leniency in how much the virus can change before we really lose protection,” Guthmiller told me. The wiggle room should be even bigger, she said, with SARS-CoV-2, whose subvariants tend to be far more similar to one another than, say, different flu strains are. With all the positives that immune memory can offer, many immunologists tend to roll their eyes at the negative and bizarrely moralizing implications of the phrase original antigenic sin. “I really, really hate that term,” says Deepta Bhattacharya, an immunologist at the University of Arizona. Instead, Bhattacharya and others prefer to use more neutral words such as imprinting, evocative of a duckling latching onto the first maternal figure it spots. “This is not some strange immunological phenomenon,” says Rafi Ahmed, an immunologist at Emory University. It’s more a textbook example of what an adaptable, high-functioning immune system does, and one that can have positive or negative effects, depending on context. Recent flu outbreaks have showcased a little bit of each: During the 2009 H1N1 pandemic, many elderly people, normally more susceptible to flu viruses, fared better than expected against the late-aughts strain, because they’d banked exposures to a similar-looking H1N1—a derivative of the culprit behind the 1918 pandemic—in their youth. But in some seasons that followed, H1N1 disproportionately sickened middle-aged adults whose early-life flu indoctrinations may have tilted them away from a protective response. [Read: COVID science is moving backwards] The backward-gazing immune systems of those adults may have done more than preferentially amplify defensive responses to a less relevant viral strain. They might have also actively suppressed the formation of a response to the new one. Part of that is sheer kinetics: Veteran immune cells, trained up on past variants and strains, tend to be quicker on the draw than fresh recruits, says Scott Hensley, an immunologist at the Perelman School of Medicine at the University of Pennsylvania. And the greater the number of experienced soldiers, the more likely they are to crowd out rookie fighters—depriving them of battlefield experience they might otherwise accrue. Should the newer viral strain eventually return for a repeat infection, those less experienced immune cells may not be adequately prepared—leaving people more vulnerable, perhaps, than they might otherwise have been. Some researchers think that form of imprinting might now be playing out with the bivalent COVID vaccines. Several studies have found that the BA.5-focused shots are, at best, moderately more effective at producing an Omicron-targeted antibody response than the original-recipe jab—not the knockout results that some might have hoped for. Recent work in mice from Victora’s lab backs up that idea: B cells, the manufacturers of antibodies, do seem to have trouble moving past the impressions of SARS-CoV-2’s spike protein that they got from first exposure. But the findings don’t really trouble Victora, who gladly received his own bivalent COVID shot. (He’ll take the next update, too, whenever it’s ready.) A blunted response to a new vaccine, he told me, is not a nonexistent one—and the more foreign a second shot recipe is compared with the first, the more novice fighters should be expected to participate in the fight. “You’re still adding new responses,” he said, that will rev back up when they become relevant. The coronavirus is a fast evolver. But the immune system also adapts. Which means that people who receive the bivalent shot can still expect to be better protected against Omicron variants than those who don’t. Historical flu data support this idea. Many of the middle-aged adults slammed by recent H1N1 infections may not have mounted perfect attacks on the unfamiliar virus, but as immune cells continued to tussle with the pathogen, the body “pretty quickly filled in the gaps,” Gostic told me. Although it’s tempting to view imprinting as a form of destiny, “that’s just not how the immune system works,” Guthmiller told me. Preferences can be overwritten; biases can be undone. Original antigenic sin might not be a crisis, but its existence does suggest ways to optimize our vaccination strategies with past biases in mind. Sometimes, those preferences might need to be avoided; in other instances, they should be actively embraced. For that to happen, though, immunologists would need to fill in some holes in their knowledge of imprinting: how often it occurs, the rules by which it operates, what can entrench or alleviate it. Even among flu viruses, where the pattern has been best-studied, plenty of murkiness remains. It’s not clear whether imprinting is stronger, for instance, when the first exposure comes via infection or vaccination. Scientists can’t yet say whether children, with their fiery yet impressionable immune systems, might be more or less prone to getting stuck on their very first flu strain. Researchers don’t even know for certain whether repetition of a first exposure—say, through multiple doses of the same vaccine, or reinfections with the same variant—will more deeply embed a particular imprint. It does seem intuitive that multiple doses of a vaccine could exacerbate an early bias, Ahmed told me. But if that’s the case, then the same principle might also work the other way: Maybe multiple exposures to a new version of the virus could help break an old habit, and nudge the immune system to move on. Recent evidence has hinted that people previously infected with an early Omicron subvariant responded more enthusiastically to a bivalent BA.1-focused vaccine—available in the United Kingdom—than those who’d never encountered the lineage before. Hensley, at the University of Pennsylvania, is now trying to figure out if the same is true for Americans who got the BA.5-based bivalent shot after getting sick with one of the many Omicron subvariants. Ahmed thinks that giving people two updated shots—a safer approach, he points out, than adding an infection to the mix—could untether the body from old imprints too. A few years ago, he and his colleagues showed that a second dose of a particular flu vaccine could help shift the ratio of people’s immune responses. A second dose of the fall’s bivalent vaccine might not be practical or palatable for most people, especially now that BA.5 is on its way out. But if next autumn’s recipe overlaps with BA.5 in ways that it doesn’t with the original variant—as it likely will to at least some degree, given the Omicron lineage’s continuing reign—a later, slightly different shot could still be a boon. Keeping vaccine doses relatively spaced out—on an annual basis, say, à la flu shots—will likely help too, Bhattacharya said. His recent studies, not yet published, hint that the body might “forget” old variants, as it were, if it’s simply given more time: As antibodies raised against prior infections and injections fall away, vaccine ingredients could linger in the body rather than be destroyed by prior immunity on sight. That slightly extended stay might offer the junior members of the immune system—lesser in number, and slower on the uptake—more of an opportunity to cook up an Omicron-specific response. In an ideal world, researchers might someday know enough about imprinting to account for its finickiness whenever they select and roll out new shots. Flu shots, for instance, could be personalized to account for which strains babies were first exposed to, based on birth year; combinations of COVID vaccine doses and infections could dictate the timing and composition of a next jab. But the world is not yet living that reality, Gostic told me. And after three years of an ever-changing coronavirus and a fluctuating approach to public health, it’s clear that there won’t be a single vaccine recipe that’s ideal for everyone at once. Even Thomas Francis Jr. did not consider original antigenic sin to be a total negative, Hensley told me. According to Francis, the true issue with the “sin” was that humans were missing out on the chance to imprint on multiple strains at once in childhood, when the immune system is still a blank slate—something that modern researchers could soon accomplish with the development of universal vaccines. Our reliance on first impressions can be a drawback. But the same phenomenon can be an opportunity to acquaint the body with diversity early on—to give it a richer narrative, and memories of many threats to come. from https://ift.tt/p5kmWCd Check out http://natthash.tumblr.com These days, it’s a real headache to keep tabs on the coronavirus’s ever-shifting subvariants. BA.2, BA.4, and BA.5, three Omicron permutations that rose to prominence last year, were confusing enough. Now, in addition to those, we have to deal with BQ.1.1, BF.7, B.5.2.6, and XBB.1.5, the version of Omicron currently featuring in concerned headlines. Recently, things have also gotten considerably stranger. Alongside the strings of letters and numbers, several nicknames for these subvariants have started to gain traction online. Where once we had Alpha and Delta and Omicron, we now have Basilisk, Minotaur, and Hippogryph. Some people have been referring to XBB.1.5. simply as “the Kraken.” A list compiled on Twitter reads less like an inventory of variants than like the directory of a mythological zoo. The nicknames are not official. They were coined not by the World Health Organization but by an informal group of scientists on Twitter who believe Omicron’s many rotating varieties deserve more widespread conversation. The names have, to an extent, caught on: Kraken has already made its way from Twitter to a number of major news sites, including Bloomberg and The New York Times. Unofficial epithets have come and gone throughout the pandemic—remember “stealth Omicron” and the “Frankenstein variant”?—but these new ones are on another level of weirdness. And not everyone’s a fan. The names associated with the coronavirus have been a fraught conversation since the pandemic’s earliest days, as scientists and public-health figures have tried to use terms that are comprehensible and hold people’s attention but that also avoid pitfalls of inaccuracy, fear-mongering, or xenophobia and racism (see: Donald Trump referring to the coronavirus as “the Chinese virus” and “kung flu”). The official names for variants and subvariants—names such as SARS-CoV-2 B.1.1.7—come from the Pango naming system, which was fashioned by evolutionary biologists in the early months of the pandemic to standardize variant-naming practices. As baffling as they can seem, they follow a clear logic: Under the system, B refers to a particular COVID lineage, B.1 refers to the sublineage of B lineage, B.1.1 refers to the first sublineage of the B.1 sublineage, and so on. When the names get too long, a letter replaces a string of numbers--B.1.1.529.1, for example, becomes BA.1. These official names do not exactly roll off the tongue or stick in the memory, which became a problem when new variants of concern started to arise and the world began groping for ways to talk about them. In May 2021, the WHO instituted its now-familiar Greek-letter naming system to stamp out the geographic associations that were gaining prominence at the time. B.1.1.7, B.1.351, and B.1.617—which were being referred to respectively as the U.K. variant, the South African variant, and the Indian variant—became Alpha, Beta, and Delta. But then, alas, came Omicron. Rather than giving way to yet another new Greek-letter variant, Omicron has spent more than a year branching into sublineages, and sublineages of sublineages. As a result, the nomenclature has devolved back into alphanumeric incomprehensibility. Seven different Omicron sublineages now account for at least 2 percent of all infections, and none accounts for more than about 40 percent (though XBB.1.5 is threatening to overwhelm its competitors). It’s great news that the ways in which the coronavirus has been mutating recently haven’t been significant enough to produce a whole new, widespread, and possibly far more worrisome version of itself that the world has to contend with. But it also makes talking about the virus much more annoying. Enter T. Ryan Gregory, an evolutionary biologist at Canada’s University of Guelph who is one of the leaders of a small, informal group of scientists that have taken it upon themselves to name the many subvariants that the WHO does not deem worthy of a new Greek letter. The names—Hydra, Cerberus, Centaurus—originated on Twitter, where Gregory compiled them into a list. Their value, Gregory told me, is that they fill the space in between the Greek and Pango systems, allowing people to discuss the many current Omicron variants that do not justify a new Greek letter but are still, perhaps, of interest. You can think of it in the same way we do animal taxonomy, he said. Calling a variant Omicron, like calling an animal a mammal, is not particularly descriptive. Calling a variant by its Pango name, like calling an animal by its Latinate species designation, is highly descriptive but a bit unwieldy in common parlance. When we speak of farm animals that moo and produce milk, we speak not of mammals or of Bos taurus but of cows. And so BA.2.3.20 became Basilisk. To decide whether a new lineage deserves its own name, Gregory told me, he and his colleagues consider both evolutionary factors (how different is this lineage from its predecessors, and how concerning are its mutations?) and epidemiological factors (how much havoc is this lineage wreaking in the population?). They’re trying to make the process more formal, but Gregory would prefer that the WHO take over and standardize the process. That, however, is unlikely to happen. When I asked about this, Tarik Jasarevic, a WHO spokesperson, told me that the organization is aware of the unofficial names but that, for the moment, they’re not necessary. “Virologists and other scientists are monitoring these variants, but the public doesn’t need to distinguish between these Omicron subvariants in order to better understand their risk or the measures they need to take to protect themselves,” he said. The WHO’s position, in other words, is that the differences between one Omicron subvariant and another simply haven’t mattered much in any practical sense, because they shouldn’t have any effect on our behavior. No matter the sublineage, vaccines and boosters still offer the best protection available. Masks still work. Guidance on testing and isolation too is the same across the board. “If there is a new variant that requires public communication and discourse,” Jasarevic told me, “it would be designated a new variant of concern and assigned a new label.” The WHO isn’t alone in objecting. For Stephen Goldstein, an evolutionary virologist at the University of Utah, the new names are not just unnecessary but potentially harmful. “It’s absolutely crazy that we’re having random people on Twitter name variants,” he told me. For Goldstein, dressing up each new subvariant with an ominous monster name overplays the differences between the mutations and feeds into the panic that comes every time the coronavirus shifts form. In this view, distinguishing one Omicron sublineage from another is less like distinguishing a wolf from a cow and more like distinguishing a white-footed mouse from a deer mouse: important to a rodentologist but not really to anyone else. To go as far as naming lineages after terrifying mythical beasts, he said, “seems obviously intended to scare the shit out of people … It's hard to understand what broader goal there is here other than this very self-serving clout chasing.” Gregory told me that fear and attention are not his group’s aim. He also said, though, that his group is thinking of switching from mythological creatures to something more neutral, such as constellations, in part to address concerns of whipping up unnecessary panic. When it comes to XBB.1.5, some of that panic certainly already exists, whipped up by less-than-nuanced headlines and Twitter personalities who feast on moments like these. Whether or not the name Kraken has contributed, the fear is that XBB.1.5 might be a variant so immune-evasive that it infects everyone all over again or so virulent that it amps up the risk of any given infection. So far, that does not seem to be the case. As my colleague Katherine Wu reported in November, we are likely (though by no means definitely) stuck for the foreseeable future in this Omicron purgatory, with its more gradual, more piecemeal pattern of viral evolution. This is certainly preferable to the sudden and unexpected emergence of a dangerous, drastically different variant. But it does mean that we’re likely going to be arguing about whether and how and with what names to discuss Omicron subvariants for some time to come. Whichever side you come down on, the state of variant-naming pretty well encapsulates the state of the pandemic as a whole. Hardly anything about the pandemic has been a matter of universal agreement, but the present nomenclatural free-for-all seems to have taken us somewhere even more splintered, even more anarchic. We’re not just arguing about the pandemic; we’re arguing about how to argue about the pandemic. And there’s no end in sight. from https://ift.tt/IoVRgn1 Check out http://natthash.tumblr.com This article was originally published by Kaiser Health News. Amanda Shelley was sitting in her dentist’s waiting room when she received a call from the police. A local teenage girl had been sexually assaulted and needed an exam. Shelley, a nurse in rural Eagle County, Colorado, went to her car and called a telehealth company to arrange an appointment with a sexual-assault nurse examiner, or SANE. The nurse examiners have extensive training in how to care for assault survivors and collect evidence for possible criminal prosecution. About an hour later, Shelley met the patient at the Colorado Mountain Medical urgent-care clinic in the small town of Avon. She used a tablet to connect by video with a SANE about 2,000 miles away, in New Hampshire. The remote nurse used the video technology to speak with the patient and guide Shelley through each step of a two-hour exam. One of those steps was a colposcopy, in which Shelley used a magnifying device to closely examine the vagina and cervix. The remote nurse saw, in real time, what Shelley could see, with the help of a video camera attached to the machine. The service, known as “teleSANE,” is new at Shelley’s hospital. Before, sexual-assault patients faced mountains of obstacles—literally—when they had to travel to a hospital in another county for care. [Read: What a doctor learns from watching you on video chat] “We’re asking them to drive maybe over snowy passes and then [be there] three to four hours for this exam and then drive back home—it’s disheartening for them,” Shelley says. “They want to start the healing process and go home and shower.” To avoid this scenario, teleSANE services are expanding across the country in rural, sparsely populated areas. Research shows that SANE programs encourage psychological healing, provide comprehensive health care, allow for professional evidence collection, and improve the chance of a successful prosecution. Jennifer Pierce-Weeks is the CEO of the International Association of Forensic Nurses, which created the national standards and certification programs for sexual-assault nurse examiners. She says every sexual-assault survivor faces health consequences. Assaults can cause physical injuries, sexually transmitted infections, unwanted pregnancies, and mental-health conditions that can lead to suicide attempts and drug and alcohol misuse. “If they are cared for on the front end, all of the risks of those things can be reduced dramatically with the right intervention,” Pierce-Weeks says. Pierce-Weeks says there are no comprehensive national data on the number and location of health-care professionals with SANE training. But she says studies show that there’s a nationwide shortage, especially in rural areas. Some rural hospitals struggle to create or maintain in-person SANE programs because of staffing and funding shortfalls, Pierce-Weeks says. Training costs money and takes time. If rural hospitals train nurses, they still might not have enough to provide round-the-clock coverage. And nurses in rural areas can’t practice their skills as often as those who work in busy urban hospitals. Some hospitals without SANE programs refer sexual-assault survivors elsewhere because they don’t feel qualified to help and aren’t always legally required to provide comprehensive treatment and evidence collection. Avel eCare, based in Sioux Falls, South Dakota, has been providing telehealth services since 1993. It recently added teleSANE to its offerings. Avel provides this service to 43 mostly rural and small-town hospitals across five states and is expanding to Indian Health Service hospitals in the Great Plains. Native Americans face high rates of sexual assault and might have to travel hours for care if they live in one of the region’s large, rural reservations. Jen Canton, who oversees Avel’s teleSANE program, says arriving at a local hospital and being referred elsewhere can be devastating for sexual-assault survivors. “You just went through what is potentially the worst moment of your life, and then you have to travel two, three hours away to another facility,” Canton says. “It takes a lot of courage to even come into the first hospital and say what happened to you and ask for help.” Patients who receive care at hospitals without SANE programs might not receive trauma-informed care, which focuses on identifying sources of trauma, determining how those experiences may affect people’s health, and preventing the retraumatizing of patients. Emergency-department staffers may not have experience with internal exams or evidence collection. They also might not know about patients’ options for involving police. Patients who travel to a second hospital might struggle to arrange for and afford transportation or child care. Other patients don’t have the emotional bandwidth to make the trip and retell their story. That’s why some survivors, such as Ada Sapp, don’t get an exam. Sapp, a health-care executive at Colorado Mountain Medical, was assaulted before the hospital system began its SANE program. She was shocked to learn that she would need to drive 45 minutes to another county for an exam. “I didn’t feel comfortable doing that by myself,” Sapp says. “So my husband would have had to come with me, or a friend. The logistics made it feel insurmountable.” [Read: A new system to ensure sexual-assault cases aren’t forgotten] Sapp’s experience inspired her to help bring SANE services to Colorado Mountain Medical. Shelley and several other of the hospital system’s nurses have SANE training but appreciate having telehealth support from the remote nurses with more experience. “We are a rural community, and we’re not doing these every single day,” Shelley says. “A lot of my nurses would get really anxious before an exam because maybe they haven’t done one in a couple months.” A remote “second set of eyes” increases the confidence of the in-person nurse and is reassuring to patients, she says. Avera St. Mary’s Hospital in Pierre, South Dakota, recently began using teleSANE. Rural towns, farms, and ranches surround this capital city, home to about 14,000 people. The nearest metropolitan area is more than a two-and-a-half-hour drive. Taking a break from a recent busy morning in the emergency department, the nurse Lindee Miller rolled out the mobile teleSANE cart and colposcope device from Avel eCare. She pulled out a thick binder of instructions and forms and opened drawers filled with swabs, evidence tags, measuring devices, and other forensic materials. “You’re never doing the same exam twice,” Miller said. “It’s all driven by what the patient wants to do.” She said some patients might want only medicines to prevent pregnancy and sexually transmitted infections. Other patients opt for a head-to-toe physical exam. And some might want her to collect forensic evidence. Federal laws provide funding to pay for these sexual-assault exams, but some survivors are billed because of legal gaps and a lack of awareness of the rules. A proposed federal law, the No Surprises for Survivors Act, would close some of those gaps. SANE programs, including telehealth versions aimed at rural communities, are expected to continue expanding across the country. President Joe Biden signed a bill last year that provides $30 million annually through 2027 to expand SANE services, especially those that use telehealth and help rural, tribal, and other underserved communities. The law also requires the Justice Department to create a website listing the locations of the programs and grant opportunities for starting them. from https://ift.tt/HAbe2xa Check out http://natthash.tumblr.com Cases have surged in China since it dropped its zero-COVID policy in December, and the latest models now suggest that at least 1 million people may die as a result. Many countries have responded by policing their borders: Last week, the CDC announced that anyone entering the United States from China would be required to test negative within two days of departure; the U.K., Canada, and Australia quickly followed suit; and the European Union has urged its member states to do the same. (Taking a more extreme tack, Morocco has said it will ban travelers from China from entering altogether.) At a media briefing on Wednesday, World Health Organization Director-General Tedros Adhanom Ghebreyesus said, “It is understandable that some countries are taking steps they believe will protect their own citizens.” On Tuesday, a Chinese official denounced some of the new restrictions as having “no scientific basis.” She wasn’t wrong. If the goal is to “slow the spread of COVID” from overseas, as the CDC has stated, there is little evidence to suggest that the restrictions will be effective. More important, it wouldn’t matter if they were: COVID is already spreading unchecked in the U.S. and many of the other countries that have new rules in place, so imported cases wouldn’t make much of a difference. The risk is particularly low given the fact that 95 percent of China’s locally acquired cases are being caused by two Omicron lineages—BA.5.2 and BF.7—that are old news elsewhere. “The most dangerous new variant at the moment is from New York—XBB.1.5—which the U.S. is now busy exporting to the rest of the world,” Christina Pagel, a mathematician who studies health care at University College London, told me. “I’m sorry, but this is fucking ridiculous.” By now, it’s well known that travel restrictions can’t stop COVID from crossing borders. At best, they slow its entry. When Omicron was first detected, in South Africa in late November 2021, America blocked travel from southern-African countries in an attempt to prevent the variant from spreading; by mid-December, Omicron dominated the United States. Restrictions can delay the spread of a variant only if they are implemented while cases are low and before travelers have had a chance to spread it. Such policies were more effective early in the pandemic: A BMJ Global Health review concluded that the initial ban on all travel into or out of Wuhan, China, in January 2020 significantly reduced the number of cases exported to other countries and delayed outbreaks elsewhere by “up to a few weeks.” Later on, such restrictions lost value. The COVID Border Accountability Project, which tracks travel restrictions around the world, has found that border closures did not reduce COVID spread, at least through April 2021, Mary Shiraef, the project’s principal investigator and a political scientist at Notre Dame University, told me. (According to the study, domestic lockdowns did slow transmission.) At this stage of the pandemic, restrictions make sense only under two conditions, Pagel said: The country deploying them must have low levels of spread and good control policies, and the restrictions must be applied to all other nations, as opposed to just one. Neither of these conditions is being met right now by any country deploying travel measures against China. Even if a single-point ban did serve some useful purpose, the rules in place for China don’t add up. Predeparture testing likely won’t catch most infected travelers from China, Adam Kucharski, a professor of infectious-disease epidemiology at the London School of Hygiene and Tropical Medicine, told me. A person could test negative one day and then positive a few days later. If the point of restrictions is to slow local transmission, Kucharski said, calculations based on his research suggest that travelers should be tested twice: once before they arrive, then about three or four days afterward. Doing so would catch infected travelers who initially tested negative while limiting their window for spreading disease. [Read: Why America scrapped its travel bans] The best possible outcome of a travel restriction like the one the U.S. now has in place would be a very small delay before the arrival of a catastrophic new variant that has just emerged in China. In that scenario, any extra time might be used to intensify mitigation strategies and assess the degree to which current vaccines are expected to hold up. Historically, though, the time saved by travel bans has been wasted. After countries restricted travel from South Africa to keep Omicron at bay, governments responded by “not really doing much at all domestically,” Kucharski said. In any case, as my colleague Katherine J. Wu has pointed out, the virus is able to spread easily in China right now without any further changes to its genome. Population immunity there is modest, owing to the country’s low natural-infection rate and less effective vaccines, so the virus can infect people perfectly well as is. The travel restrictions on China will have little impact on the spread of COVID, but they do send a forceful political message. The U.S. measures are meant to pressure China, by slowing its economic rebound, into being transparent about its COVID situation, Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies, a Washington, D.C.-based think tank, told me. China’s alleged official death count, for example--5,259 as of January 4—seems way too low to be believable, especially amid reports of overflowing Chinese hospitals and funeral homes. So long as the country isn’t more forthcoming, Morrison said, then Chinese tourists, who have only recently been allowed to travel internationally, will continue to be unwelcome. Expressing this message through a largely pointless public-health measure comes with a price. When that measure fails to keep COVID spread at bay, faith in public-health institutions could decline, which Pagel said is the “biggest danger” for the next pandemic. It also stokes the long-standing fear that Chinese people are more likely to carry disease than anyone else, whether foreign or American. “We are watching this policy so carefully to see if it will once again invite a racial backlash,” Manjusha Kulkarni, a co-founder of Stop AAPI Hate, told me. If a rise in anti-Asian hate and violence comes along with more transparency from China about its COVID situation, the cost of these restrictions hardly seems worth their benefits. from https://ift.tt/GrsDqMy Check out http://natthash.tumblr.com After months and months of SARS-CoV-2 subvariant soup, one ingredient has emerged in the United States with a flavor pungent enough to overwhelm the rest: XBB.1.5, an Omicron offshoot that now accounts for an estimated 75 percent of cases in the Northeast. A crafty dodger of antibodies that is able to grip extra tightly onto the surface of our cells, XBB.1.5 is now officially the country’s fastest-spreading coronavirus subvariant. In the last week of December alone, it zoomed from 20 percent of estimated infections nationwide to 40 percent; soon, it’s expected to be all that’s left, or at least very close. “That’s the big thing everybody looks for—how quickly it takes over from existing variants,” says Shaun Truelove, an infectious-disease modeler at Johns Hopkins University. “And that’s a really quick rise.” All of this raises familiar worries: more illness, more long COVID, more hospitalizations, more health-care system strain. With holiday cheer and chilly temperatures crowding people indoors, and the uptake of bivalent vaccines at an abysmal low, a winter wave was already brewing in the U.S. The impending dominance of an especially speedy, immune-evasive variant, Truelove told me, could ratchet up that swell. But the American public has heard that warning many, many, many times before—and by and large, the situation has not changed. The world has come a long way since early 2020, when it lacked vaccines and drugs to combat the coronavirus; now, with immunity from shots and past infections slathered across the planet—porous and uneven though that layer may be—the population is no longer nearly so vulnerable to COVID’s worst effects. Nor is XBB.1.5 a doomsday-caliber threat. So far, no evidence suggests that the subvariant is inherently more severe than its predecessors. When its close sibling, XBB, swamped Singapore a few months ago, pushing case counts up, hospitalizations didn’t undergo a disproportionately massive spike (though XBB.1.5 is more transmissible, and the U.S. is less well vaccinated). Compared with the original Omicron surge that pummeled the nation this time last year, “I think there’s less to be worried about,” especially for people who are up to date on their vaccines, says Mehul Suthar, a viral immunologist at Emory University who’s been studying how the immune system reacts to new variants. “My previous exposures are probably going to help against any XBB infection I have.” SARS-CoV-2’s evolution is still worth tracking closely through genomic surveillance—which is only getting harder as testing efforts continue to be pared back. But “variants mean something a little different now for most of the world than they did earlier in the pandemic,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, who’s been tracking the proportions of SARS-Cov-2 variants around the world. Versions of the virus that can elude a subset of our immune defenses are, after all, going to keep on coming, for as long as SARS-CoV-2 is with us—likely forever, as my colleague Sarah Zhang has written. It’s the classic host-pathogen arms race: Viruses infect us; our bodies, hoping to avoid a similarly severe reinfection, build up defenses, goading the invader into modifying its features so it can infiltrate us anew. [Read: How long can the coronavirus keep infecting us?] But the virus is not evolving toward the point where it’s unstoppable; it’s only switching up its fencing stance to sidestep our latest parries as we do the same for it. A version of the virus that succeeds in one place may flop in another, depending on the context: local vaccination and infection histories, for instance, or how many elderly and immunocompromised individuals are around, and the degree to which everyone avoids trading public air. With the world’s immune landscape now so uneven, “it’s getting harder for the virus to do that synchronized wave that Omicron did this time last year,” says Verity Hill, an evolutionary virologist at Yale. It will keep trying to creep around our defenses, says Pavitra Roychoudhury, who’s monitoring SARS-CoV-2 variants at the University of Washington, but “I don’t think we need to have alarm-bell emojis for every variant that comes out.” [Read: The coronavirus’s next move] Some particularly worrying variants and subvariants will continue to arise, with telltale signs, Roychoudhury told me: a steep increase in wastewater surveillance, followed by a catastrophic climb in hospitalizations; a superfast takeover that kicks other coronavirus strains off the stage in a matter of days or weeks. Omens such as these hint at a variant that’s probably so good at circumventing existing immune defenses that it will easily sicken just about everyone again—and cause enough illness overall that a large number of cases turn severe. Also possible is a future variant that is inherently more virulent, adding risk to every new case. In extreme versions of these scenarios, tests, treatments, and masks might need to come back into mass use; researchers may need to concoct a new vaccine recipe at an accelerated pace. But that’s a threshold that most variations of SARS-CoV-2 will not clear—including, it seems so far, XBB.1.5. Right now, Hodcroft told me, “it’s hard to imagine that anything we’ve been seeing in the last few months would really cause a rush to do a vaccine update,” or anything else similarly extreme. “We don’t make a new flu vaccine every time we see a new variant, and we see those all through the year.” Our current crop of BA.5-focused shots is not a great match for XBB.1.5, as Suthar and his colleagues have found, at least on the antibody front. But antibodies aren't the only defenses at play—and Suthar told me it’s still far better to have the new vaccine than not. In the U.S., wastewater counts and hospitalizations are ticking upward, and XBB.1.5 is quickly elbowing out its peers. But the estimated infection rise doesn’t seem nearly as steep as the ascension of the original Omicron variant, BA.1 (though our tracking is now poorer). XBB.1.5 also isn’t dominating equally in different parts of the country—and Truelove points out that it doesn’t yet seem tightly linked to hospitalizations in the places where it’s gained traction so far. As tempting as it may be to blame any rise in cases and hospitalizations on the latest subvariant, our own behaviors are at least as important. Drop-offs in vaccine uptake or big jumps in mitigation-free mingling can drive spikes in illness on their own. “We were expecting a wave already, this time of year,” Hill told me. Travel is up, masking is down. And just 15 percent of Americans over the age of 5 have received a bivalent shot. The pace at which new SARS-CoV-2 variants and subvariants take over could eventually slow, but the experts I spoke with weren’t sure this would happen. Immunity across the globe remains patchy; only a subset of countries have access to updated bivalent vaccines, while some countries are still struggling to get first doses into millions of arms. And with nearly all COVID-dampening mitigations “pretty much gone” on a global scale, Hodcroft told me, it’s gotten awfully easy for the coronavirus to keep experimenting with new ways to stump our immune defenses. XBB.1.5 is both the product and the catalyst of unfettered spread—and should that continue, the virus will take advantage again. from https://ift.tt/0txskKh Check out http://natthash.tumblr.com During this week’s Monday Night Football game, the 24-year-old Buffalo Bills safety Damar Hamlin collapsed moments after making a routine defensive play. Hamlin seemed to have suffered a blow to his chest shortly before losing consciousness from cardiac arrest, and his condition is grave. The source of his illness remains unclear. A study of sudden cardiac events in U.S. athletes from 2014 to 2016 found that structural abnormalities of the heart muscle or arteries and faulty electric rhythms were the most common causes; traumatic chest injuries have also been linked to such incidents, in a rare condition called commotio cordis. Still, the availability of these hypotheses did not stop online activists from blaming Hamlin’s health crisis on vaccines. Anti-vaccine influencers have been fomenting fear about a supposed rise in COVID-shot-induced athletic deaths for a while. Fact-checkers have repeatedly assessed these claims and found them to be without merit. Jonathan Drezner, a sports-medicine physician who studies sudden deaths in athletes, told media outlets last year that he was “not aware of any COVID-19 vaccine-related athletic death.” The National Center for Catastrophic Sport Injury Research, which systematically tracks sports-related fatalities, identified 13 medical deaths during football-related activities in 2021 among players participating at all levels of competition, eight of which were caused by cardiac arrest. The same researchers had found 14 medical deaths two years earlier, 10 of which were heart-related. These incidents remain tragic and scarce. The mRNA shots by Pfizer and Moderna are associated with a very small risk of heart inflammation, called myocarditis, which can lead to cardiac arrest. This risk is most pronounced in teenage boys receiving a second dose of the vaccine, but even in that scenario only about one in 10,000 recipients is affected. (Most professional athletes are in their 20s, not teens, so the risk to them is lower.) Myocarditis is a potentially fatal condition, but the version that occurs after vaccination is much less deadly than the heart inflammation induced by many viruses, including SARS-CoV-2. A recent analysis identified only a single death in 104 cases of vaccine-induced myocarditis. In comparison, for every 100 people who get myocarditis from a virus, about 11 will die. [Read: The selfishness of Novak Djokovic] The mere fact that mRNA shots can lead to heart problems has been exploited by conservative commentators and politicians to exaggerate the risks to young people. Last month, per a news release, Florida Governor Ron DeSantis promised to look into “sudden deaths of individuals that received the COVID-19 vaccine,” and called for a grand jury to investigate alleged wrongdoing by the vaccine manufacturers. His petition to the Florida Supreme Court justified the investigation by pointing out that “excess mortality from heart attacks rose significantly during the COVID-19 pandemic, especially among individuals ages 25 to 44.” Yet the rise in youth heart attacks actually began in 2020, before vaccines were available. That’s because increased cardiac fatalities during the pandemic have mostly been due to the coronavirus itself. Heart-disease deaths in the United States have been observed to rise and fall in near lockstep with waves of COVID deaths, suggesting that most of these cases—97 percent, according to one estimate—are the result of undocumented SARS-CoV-2 infection. DeSantis’s crusade against vaccines is backed by his surgeon general, Joseph Ladapo, who is a staunch opponent of inoculating young people against COVID. (He has encouraged the use of ineffective therapies such as hydroxychloroquine and ivermectin, though.) In October, Ladapo’s department produced an anonymous, non-peer-reviewed analysis suggesting that COVID shots were causing an increase in cardiac fatalities in young men. This report was modeled on a study by the U.K. government, which came to the opposite conclusion about vaccines but did find that COVID infection was associated with a sixfold increase in youth cardiac death. Given the lack of detail provided in the Florida study, it’s hard to know how to reconcile its contradictory result. This week, a group of University of Florida physicians and scientists released a report that strongly criticized the work’s methodology. The COVID vaccines are among the most widely used medical interventions. More than 13 billion doses have been administered, at least 1 billion of which relied on mRNA technology. In analyzing this trove of real-world data, researchers have occasionally identified potential safety issues. A lack of perfect consistency across their studies is expected, and only confirms that the scientific dialogue about this new technology has been transparent. Scientists know that findings made outside a clinical trial are prone to spurious associations, so they examine how well each analysis has been performed and interpret it in the context of prior research. [Read: The core lesson of the COVID-19 heart debate] Vaccine skeptics prefer to cherry-pick supportive studies while ignoring others that contradict them. Ladapo, for example, has cited a Scandinavian report showing a potential increase in post-vaccine blood clots and heart attacks. Yet the study authors themselves cautioned readers against relying too heavily on their results, because the finding was observed in only some age groups and time periods but not others. Ladapo also failed to mention that similar studies out of the U.K., France, Scotland, and elsewhere had not found a meaningful increase in blood clots or heart attacks with mRNA shots. A careful recitation of facts can take one only so far in combatting anti-vaccine claims. Activists use ambiguous anecdotes such as Hamlin’s cardiac arrest and the sudden death of the soccer journalist Grant Wahl during last month’s World Cup to make the alleged risks of the shots more visceral. Sports are much less dangerous than SARS-CoV-2, but when unexpected tragedies do occur, they lead to an outpouring of mourning and reflection. Collective trauma can easily give way to collective speculation, and partisans on all sides will be happy to tell us what really happened. Yet convenient scapegoats will not be enough to mend our grief. from https://ift.tt/rENjlD1 Check out http://natthash.tumblr.com |
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