The world was slow to recognize long COVID as one of the most serious consequences of the coronavirus. Six months into the pathogen’s tear across the globe, SARS-CoV-2 was still considered an acute airway infection that would spark a weeks-long illness at most; anyone who experienced symptoms for longer could be expected to be dismissed by droves of doctors. Now long COVID is written into CDC and WHO documents; it makes a cameo in the newest version of President Joe Biden’s National COVID-19 Preparedness Plan. But for all we know now about long COVID, it is still not enough. Researchers still don’t know who’s most at risk, or how long the condition might last; whether certain variants might cause it more frequently, or the extent to which vaccines might sweep it away. We do not have a way to fully prevent it. We do not have a way to cure it. We don’t even have a way to really quantify it: There still isn’t consensus on how common long COVID actually is. Its danger feels both amorphous and unavoidable. People already struggle to deal with well-known risks, let alone fuzzy, slippery ones. “You can be too afraid of what you don’t understand or just say, ‘It’s not well defined; I’m not going to think about it,’” says Erin Sanders, a nurse practitioner and clinical scientist at MIT. Concern, when we let it, can act like a gas. It expands to fill the space we give it. [Read: How did this many deaths become normal?] This is a precarious position for long COVID to be in, with enthusiasm for pandemic precautions crumbling. The Biden administration recently reinforced its stance on which COVID-19 outcomes matter most: Since we can’t stave off all infections, we’re shifting our focus to hospitalizations and deaths, a well-defined pair of metrics that we know we can prevent. Where does long COVID—a condition that can spin out of infections of all severities—fit in? “It doesn’t,” says Hannah Davis, of the Patient-Led Research Collaborative, who has long COVID. But even if long COVID’s prevalence turns out to be a single-digit percentage of SARS-CoV-2 infections—proportionally much smaller than most experts estimate—in absolute terms “that is not small,” says Ziyad Al-Aly, the director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System. Millions of people have already developed long COVID; many of them, an untold fraction, have not recovered. This is the challenge of chronic illness: When people join its ranks, they do not always exit. With each new case of long COVID, the virus’s burden balloons. “I worry, now that everyone is moving to the post-pandemic world, we’re going to sweep all these patients under the rug,” Al-Aly told me. Long COVID struggled to gain a toehold in the national consciousness; now it threatens to be one of the first major COVID impacts to slip back into the margins. Researchers have known for many months that long COVID is more a category than a monolith. Al-Aly very roughly likens it to the way we talk about cancer—an umbrella term for diseases that are related but that require distinct diagnoses and treatments. Long COVID has hundreds of possible symptoms. It can batter the brain, the heart, the lungs, the gut, all of the above, or none of the above. The condition can start from a silent infection, an ICU-caliber case, or anything in between. It can begin days, weeks, or months after the virus first infects someone, and its severity can fluctuate over time. “We lump all of that into one broad thing,” Al-Aly said. “It is not.” The condition’s root causes, accordingly, are also diverse. In some cases, long COVID may be collateral damage from the war waged between virus and immune system; in others, it might sprout out of a chronic SARS-CoV-2 infection or, conversely, a quick viral encounter that sets bodily systems on the fritz. These hypotheses aren’t comprehensive or mutually exclusive: There are only so many ways for bodies to run smoothly, and infinite ways to throw those processes out of whack. All of this means that even diagnosing long COVID—an essential step toward understanding it—is still a battle. We don’t have a clear-cut, consensus clinical definition, a single name for the condition, or a standardized set of tests to catch it. Even the CDC and the WHO can’t agree on how long a person must be sick before they meet the condition’s criteria. Some researchers and health-care providers favor one agency’s definition; others, dissatisfied with both, come up with their own. And “there are still doctors out there that do not think long COVID exists,” says Alexandra Yonts, a pediatric-infectious-disease specialist at Children’s National Hospital, in Washington, D.C. That makes researching the condition fraught, and studies less uniform. Davis, of the Patient-Led Research Collaborative, says many efforts are peppered with problems that misrepresent long COVID’s burden. Some studies miss cases because they omit many of the condition’s most common symptoms, for instance, or because they exclude the many long-haulers whose illness comes and goes. Others can botch the numbers when they neglect to include information about long-haulers’ baseline health before infection, or when they fail to establish good control groups of uninfected and infected people who don’t go on to develop long COVID’s chronic symptoms. Too many studies, Davis told me, have “inadvertently included COVID-infected people in their negative control groups” because they rely on fallible tests that can’t adequately determine who’s actually caught the virus. [Read: Long haulers are fighting for their future] In an ideal experimental world, to understand long COVID’s risks, researchers would systematically survey large swaths of the population over long periods of time, watching to see who gets infected, who goes on to develop the condition, what form it takes, and how it impacts people’s health, says Shruti Mehta, an infectious-disease epidemiologist at Johns Hopkins University who is studying long COVID. But few institutions have the resources for such an undertaking, which could span many months or years. So many researchers have to make do with the limited data sets that are already available to them. As a result, some studies end up biased toward patients who were hospitalized, while others wind up favoring people who have the time, means, and trust in the health-care system to sign up for long-term studies. Neither group fully captures long COVID’s wide-ranging toll. The situation’s especially tough for pediatric patients, who might be too young to articulate the severity of their symptoms and are often excluded from long-COVID studies. Long COVID certainly exists in kids, but it may not perfectly mirror what goes on in adults: Children’s susceptibility to the virus is different, and their bodies are so rapidly changing, says Yonts, who runs a pediatric-long-COVID clinic in D.C. All told, the study of long COVID has become, as Sanders of MIT puts it, “a data disaster.” Some researchers estimate that a single-digit percentage of SARS-CoV-2 infections bloom into long COVID; Al-Aly is one of them. Others, meanwhile, favor larger numbers, with a few even insisting that the rates are actually more than half. Most of the experts I spoke with said they feel comfortable working in the 10 to 30 percent range, which is where many studies seem to be starting to converge. Finding one answer is tricky, without knowing how many forms long COVID can take—some could be more common than others. Formally splitting the disease into subdivisions could help address some of these ambiguities. But we don’t know nearly enough to start slicing and dicing, says Bryan Lau, an infectious-disease epidemiologist working with Mehta and Priya Duggal. [Read: Even healthcare workers with long COVID are being dismissed] If researchers aren’t comprehensively capturing who currently has long COVID, they can’t say for certain who’s most likely to get it either. Many researchers have found that women contract long COVID more frequently than men. Others have uncovered evidence that people who end up infected with gobs of the coronavirus, or who produce antibodies that attack the body’s own tissues, also seem to tilt toward long COVID. Chronic health issues, including diabetes, could up a person’s chances of getting sick and staying sick as well. So might a lingering Epstein-Barr infection. But some of these trends are still being confirmed, experts told me, and the extent to which they toggle risk up or down isn’t known. And it’s definitely too early to pinpoint any of these factors as long-COVID causes. “For acute COVID, we know what the risk factors are,” Akiko Iwasaki, an immunologist studying long COVID at Yale, told me. “For long COVID, it’s much less clear.” Still, a couple of other variables feel a bit more nailed down. “The risk is high in people who need hospitalization or ICU care,” Al-Aly said. Deepti Gurdasani, an epidemiologist at Queen Mary University of London, says she’s fairly confident that the nature of a person’s exposure to SARS-CoV-2 plays a role as well: Heavier and more frequent viral encounters seem to tip the scales toward symptoms that last and last. That’s a concern for people in essential occupations, who “aren’t able to shield themselves,” she told me. If these last few factors directly affect how and whether long COVID unspools, vaccination—which reliably staves off hospitalization and, to a lesser degree, infection—could be a partial preventive. Several studies have shown that shots do seem to muzzle long-COVID rates. (Other interventions that lower exposure also help: masks, distancing, ventilation.) They don’t, however, eliminate long COVID’s odds. To date, experts have yet to find any demographic that has been spared from the condition, despite persistent myths that certain groups, particularly kids, are somehow immune. “We’ve seen it in children of all ages,” says Laura Malone, a pediatric neurologist at the Kennedy Krieger Institute, in Baltimore. Some of her patients are toddlers. The virus isn’t pulling any punches either. Every iteration we’ve encountered so far, Omicron included, seems capable of causing long COVID. “No one is not at risk,” Al-Aly said. To this day, most countries do not keep a running tally of long-COVID cases. But ballparks of the burden are staggering. Some 2 percent of all U.K. residents—not just those with documented infections—might currently have long COVID, according to the Office for National Statistics. Another analysis estimates that up to 23 million Americans have developed the condition since the pandemic’s start. More will join them. But Davis worries that those numbers will continue to be left off of national dashboards, and thus out of the public eye. Now that the federal government has tightened the boundaries of its concern to hospitalizations and deaths, the public does not even really have to look away from the national perspective on long COVID: There is next to nothing to see. As people rack up different combinations of shots and infections with different variants, what worsens or soothes long COVID is also getting harder to understand. Many of the experts I’ve spoken with over the past two years have told me that while they think long COVID is essential to study, it’s too complex for them to want to tackle themselves. Meanwhile, long COVID remains the pandemic’s looming specter. We are told there is risk, but not exactly how much; we are told that avoiding long COVID would be ideal, but lack the practical guidance to do so—the virus is so widespread that eventual infection, for many people, feels almost inevitable. At the same time, as researchers look deeper and deeper into the bodies of infected people, they’re only seeing more damage. With each passing month, more studies emerge documenting how the coronavirus alters the function of vital organs such as the heart and the brain. The public has been cultured to think that most SARS-CoV-2 infections are trivial, and the repercussions brief, especially for the young, healthy, and privileged. But long COVID breaks the binary of severe and mild. “It’s going to continue to affect people, even people who are protected from severe illness during the acute phase of infection,” Michael Peluso, an infectious-disease physician and long-COVID researcher at UC San Francisco, told me. [Read: The Biden administration killed America’s collective pandemic approach] No matter where the true numbers on long-COVID risk sit, they are too large to ignore. “Whether it’s 10 percent or 50 percent, at both levels you have to do something about it,” Gurdasani said. Statistics will help sharpen and clarify the condition’s boundaries, and are still worth seeking out. They will not, however, change long COVID’s threat, at its core. Davis, who is nearing her second anniversary of developing long COVID, feels this deeply. She is still experiencing cognitive dysfunction and memory loss. Her heart still races when she stands. “You cannot live your life like you used to,” she told me. “Your life just becomes this shell.” For individuals, for societies, “this is not going away.” Even after much of the world puts the pandemic in its rearview, long COVID will keep filling hospitals and clinics. It will dot the pages of scientific texts, and linger in the bodies of millions of people worldwide. Hospitalizations and ICU admissions are not the only COVID outcomes that can buckle a health-care system. That strain is already being felt by the health-care workers on long COVID’s front lines. Yonts, the Children’s National pediatrician, told me that she’s currently booking patients “out to Memorial Day.” COVID’s global crisis can, in some ways, end when we decide to treat it as done. But that is not an option for a growing fraction of the planet, who cannot put COVID fully behind them. “This is going to be the pandemic after the pandemic,” Gurdasani said. from https://ift.tt/oV1LZFa Check out http://natthash.tumblr.com
Supply was not the problem. Nor were doubts about the vaccine’s safety or efficacy, concluded a report from around that time by the National Foundation for Infantile Paralysis, now known as the March of Dimes, which had funded research into the vaccine. But the “initial excitement” had nevertheless “faded,” and vaccine proponents found themselves in an incremental slog to reach the remaining unvaccinated Americans. Well into the 1960s, doctors held “Sabin Oral Sundays,” dispensing sugar cubes dosed with a drop of the oral vaccine invented by Albert Sabin. It would ultimately take more than two decades to go from ringing church bells to polio eradication in the U.S. Today, with COVID vaccinations stalled and rates in children particularly low, the COVID vaccination campaign has drawn comparisons, usually unfavorable, to that for polio. But history has a way of flattening lengths of time. Vaccine uptake in children has never been immediately universal—not for polio, not for measles, chickenpox, HPV, or any other childhood shot. In the past, vaccines have routinely taken years to go from FDA approval to being mandated in schools to high vaccination rates. COVID vaccines, meanwhile, have been available for kids under 16 for mere months, and only under emergency use. In this time, the most enthusiastic have gotten their two shots, amounting to some 26 percent of children ages 5 to 11 and 57 percent of teens ages 12 to 17. These rates, which are so far below that of adults that they suggest many vaccinated parents aren’t vaccinating their kids yet, have already prompted much hand-wringing for being too low. But every successful vaccination campaign has had to go beyond the most enthusiastic—to reach for the parents who are indifferent or hesitant, those who might not have the time or easy access to doctors. In the past, a combination of persuasion and mandates has eventually managed to accomplish this, but both tactics have their limits. Three historical examples—polio, measles, and HPV—are instructive here. No past vaccine is a perfect analogue for COVID, but each illuminates the challenges of a task as gargantuan as trying to immunize every child in America. For more than a year after the coronavirus first appeared, experts sought to reassure parents that COVID is far less deadly for kids, and this message, some now argue, has turned vaccinating kids into an uphill climb. But convincing parents that a disease that is familiar, that they have seen many kids recover from, is in fact worth preventing is not at all unique to COVID. With polio, this campaign of mass persuasion began while the vaccine was still under development. In 1938, President Franklin D. Roosevelt founded the National Foundation for Infantile Paralysis to combat polio, after his own suspected bout of the disease. The foundation’s massive and massively successful fundraising efforts elevated polio “from a relatively uncommon disease into the most feared affliction of its time,” the historian David Oshinsky writes in Polio: An American Story. “If you looked at polio, in terms of other dangerous childhood diseases, it ranks rather low in numbers,” Oshinsky told me. “But what the March of Dimes did, basically, was to turn this disease and the prevention of it into a national crusade. Having the president of the United States as a polio survivor certainly helped dramatically.” By the time a vaccine finally became available, in 1955, people who had donated dimes over the years were invested in the vaccine’s success. They were ready for it. The church bells were ready too. But this message about polio’s danger could go only so far, as the foundation’s report a few years later lamented. In its survey of public acceptance of the polio vaccine, the report found a pattern that would prove recurrent: The unvaccinated were less likely to be wealthy, to be highly educated, or to see their doctors regularly. Other reports noted that white people were also more likely to be vaccinated than those who were nonwhite. Polio cases fell markedly as the vaccine rolled out, but when outbreaks did happen, they clustered in poor, urban neighborhoods of color, says Elena Conis, a historian of medicine at UC Berkeley and the author of Vaccine Nation: America’s Changing Relationship With Immunization. In 1963, the head of the CDC declared racial disparities in vaccination a “blot” on the nation’s record. Also in 1963, the first measles vaccine was approved. That vaccine was an inflection point in America’s vaccination history, Conis argues, changing both the type of disease considered worth vaccinating against and the role of federal and state governments in immunization. If polio struck fear in the hearts of parents, measles did not. Measles was seen as a routine childhood illness—as “inevitable as ‘wornout shoes’ and scraped knees,” according to one doctor Conis quotes. About one to four in every 10,000 children who got measles died, which was dramatically less deadly than other diseases parents knew to vaccinate against in the ’60s, such as smallpox or diphtheria, but still more than 100 times deadlier than chickenpox. “Even though people in the 1950s and ’60s thought measles was no big deal,” Conis says, “I think if people had to see their kids through today, they would think it’s a big deal.” Measles is “mild relative to stuff we can’t fathom.” Historically, Americans accepted far more illness and death in children than we’re used to today—a shift caused in no small part by the success of childhood vaccinations. [Read: Why a three-dose vaccine for young kids might actually work] To persuade parents to vaccinate their kids against measles in the 1960s, though, public-health officials began emphasizing rare but severe complications: ear infections, pneumonia, and swelling in the brain that could lead to deafness or even death. One ad campaign featured a 10-year-old girl named Kim who had become partially deaf and mentally impaired after a measles infection. This worked, to a certain extent. Measles cases fell after the vaccine became available, but the disease persisted, once again, in poorer, nonwhite neighborhoods with lower vaccination rates. Parents in “the middle class and upper class were easily persuaded that measles was worth preventing, but those living in poverty spoke of more pressing priorities,” Conis writes. “Long lines and short hours in out-of-reach public health clinics did not help.” In short, the U.S. didn’t learn the lessons from polio vaccination, she told me. The “same exact pattern” of uneven vaccine uptake took hold with measles. Inconsistent funding for vaccination stymied efforts too. In 1962, emboldened by the success of the polio vaccine, President John F. Kennedy signed the Vaccination Assistance Act, allocating federal money for immunization efforts, which were previously seen as largely state and local responsibilities. But that funding lapsed under Nixon in the 1970s, and measles also resurged. Later, the Carter and Clinton administrations would expand the federal government’s role in vaccination; today, it both purchases vaccine doses and sets the recommendations for who should get them. Faced with measles outbreaks in cities in the ’70s, though, public-health officials began utilizing another tool that remains in place to this day: mandates in schools, which are set state by state. “One of the justifications for making measles vaccines and other vaccines mandatory through school is it does have a kind of equalizing effect,” says James Colgrove, a sociomedical-sciences professor at Columbia. (School mandates existed for polio and other earlier vaccines, but they were patchwork and largely not enforced.) And this did work to raise vaccination rates dramatically. By 1980, all 50 states had measles-vaccine mandates in place. The year after that, 96 percent of American schoolchildren had been vaccinated for measles. As more and more vaccines were approved in the U.S., they were added piecewise to state immunization requirements. This process generally took years; the chickenpox vaccine, which became available in 1995, was not required in schools in any state. until 1998, and only reached all 50 in 2015. Jumping quickly to mandates has backfired before. In 2006, Merck’s vaccine for the human papillomavirus, or HPV, won FDA approval, and the company immediately embarked on a state-by-state campaign to pass bills adding it to the list of mandated vaccines for school. The effort failed spectacularly. HPV is a virus that can cause cancer, but it was by no means a well-known one. As Merck tried to promote its vaccine, it instead became consumed in the culture wars over teenage sexuality. Opponents argued that school mandates were inappropriate because the sexually transmitted virus doesn’t spread in classrooms like airborne or gastrointestinal viruses do. This kind of mandate wouldn’t have been unprecedented, though, because the vaccine for hepatitis B, which can also be sexually transmitted, was already routinely required for schools. But the HPV vaccine drew far more attention because it was also the first vaccine ever approved only for girls. (Years after this initial controversy, the vaccine was later approved for boys and men to prevent genital warts and anal cancer.) Moreover, adding vaccines to the school immunization list was usually a quiet bureaucratic process overseen by state health boards. Merck’s strategy, of lobbying for laws in state legislatures, was more aggressive, and it turned the process into an intensely political one where politicians were explicitly asked to weigh in. “Merck’s role in all of that ended up muddying the waters,” Colgrove says. To this day, the HPV vaccine is required in only three states plus D.C., and as a result, only half of eligible teens have gotten all of their shots—even though the HPV vaccine is about as effective and durable as vaccines get. “Historically,” Conis told me, “we’ve turned to mandates when voluntarism wasn’t cutting it. But in recent years, we in some cases didn’t wait for that.” The HPV vaccine is a stark example. Mandating vaccines in schools has been a key policy in raising U.S. vaccination rates, but as Conis and other scholars have noted, mandates do contain a tension between respecting individual autonomy and protecting the public. The U.S. as a whole tends to mandate more vaccines than other Western countries, and the number has doubled since the ’90s. “We entered this century with a longer list of mandatory vaccines for kids than we ever had before. To me, it’s not at all surprising that that saw a rise in vaccine hesitancy and skepticism in the face of this. It’s possible we used up a lot of goodwill in doing that,” Conis said. By the time COVID arrived, had we used up too much to immediately mandate one more? Not only have no states mandated the current emergency-use COVID vaccines for schoolchildren, but 17 have already banned schools from requiring it. (A handful will require the vaccine when it is fully approved by the FDA for children.) Experts worry that pushback against COVID vaccination could, in some cases, turn into a pushback against all childhood vaccinations. “A handful of years ago, there was no strong correlation between political ideology and vaccine hesitancy,” Asheley Landrum, a psychologist at Texas Tech University who studies science communication, told me. Now “vaccination in general and childhood vaccination in particular has become really entangled with people’s political identity.” Still, political polarization doesn’t entirely account for the low COVID vaccination rates in children. A good number of parents whose kids are unvaccinated are not opposed: They are planning to vaccinate their kids, or they want to wait and see. And while mandates can work, they can also push people away. “Once you go down the mandate road, you’re sort of making the persuasion road a little rockier,” says Julie Downs, a psychologist and behavioral scientist at Carnegie Mellon. “So maybe we do want to go down the persuasion road with kids a little bit before we get to the mandate mode.” Perhaps, in time, as COVID fades from the headlines, Landrum told me, vaccines might not provoke the same strong feelings. They might become less politicized, less partisan, and more routine. The viability of school mandates will also depend on how well the vaccines perform, especially in the long term. As my colleague Rachel Gutman has noted, the flu actually kills more kids every year than many diseases for which vaccines are mandated. But no states currently require the flu shot, because although schools track vaccines when kids start elementary or middle school, they don’t have a way of tracking shots for every kid every single year. If COVID vaccines are needed annually, they’ll be a lot harder to slot into the current vaccine-requirement system. But whether they will be needed so frequently is, as yet, still unclear. It hardly feels this way living through it, but in historical terms, we are still very, very early into our efforts to vaccinate against COVID. from https://ift.tt/Q1V08sN Check out http://natthash.tumblr.com If the coronavirus has one singular goal—repeatedly infecting us—it’s only gotten better at realizing it, from Alpha to Delta to Omicron. And it is nowhere near done. “Omicron is not the worst thing we could have imagined,” says Jemma Geoghegan, an evolutionary virologist at the University of Otago, in New Zealand. Somewhere out there, a Rho, a Tau, or maybe even an Omega is already in the works. Not all variants, though, are built the same. The next one to trouble us could be like Delta, speedy and a shade more severe yet still trounceable with existing vaccines. It could riff on Omicron’s motif, eluding the defenses raised by infections and shots to an extent we’ve not yet seen. It could merge the worst aspects of both of those predecessors, or find its own successful combo of traits. Each iteration of the virus will require a slightly different set of strategies to wrangle it—the ideal approach will depend on “how sick are people getting, and which people are getting sick,” Angela Shen, a vaccine-policy expert at Children’s Hospital of Philadelphia, told me. Our actual response won’t just depend on the mix of mutations that the virus lobs our way. It will also hinge on how seriously we take those changes, and what state the virus finds us in when it slams us—immunologically, psychologically. While the next spotlight-hogging variant is still brewing, we can sketch out, in broad and not-at-all-comprehensive strokes, a subset of the cast of characters that could arise, and what it would take to fend off each one. The SharpshooterLet’s start with the worst-case scenario, because it’s also probably the least likely. A new variant checks each of the Big Three boxes: more transmissible, more deadly, and much more evasive of the defenses that vaccines and other SARS-CoV-2 flavors have laid down. In this version of events, even immunized people could suffer high rates of severe disease; additional boosters might not mount a sufficient blockade. The chasm in protection between the vaccinated and unvaccinated would start to close—perhaps rapidly, if the new variant collides with us when many people aren’t up-to-date on their shots and population immunity is low. Such a virus might be so strange-looking that some of our tests and many of our antibody-based treatments could stop working. Viral spread would also outpace what diagnostic tools we have left, obliterating contact-tracing efforts and making the pathogen harder to cordon off. Hundreds of thousands of people in the United States alone could lose their lives in a matter of months, as one recent analysis noted. Countless more would be hospitalized or saddled with the debilitating symptoms of long COVID. This future would feel most like the past—a near-reversion to “the first year of the pandemic,” Crystal Watson, a senior associate at the Johns Hopkins Center for Health Security, told me. And, accordingly, this future would launch the most dramatic response. [Read: The coronavirus will surprise us again] First, we’d have to start cooking up a new vaccine, tailored to fit a sniper-style variant’s quirks. That alone would take at least three months, by shot-makers’ current best estimates, not counting the arduous process of rolling out the updated vaccine quickly and equitably. In the interim, if we wanted to avoid the worst impacts, we’d have to lean heavily on our old standbys: high-quality masks, potentially mandated into use; restricted travel; capacity limits at—possibly even brief closures of—restaurants, bars, and gyms. (Hopefully, by this point, good ventilation and air filtration would be more widespread too.) The government might need to fund efforts to develop and distribute new tests and treatments. If the outbreak couldn’t be contained, essential spaces such as schools might consider shutting their doors again—though Natalie Quillian, the deputy coordinator of the White House’s COVID-19 response team, told me that, from the standpoint of the administration, “we really don’t see a scenario where schools need to close.” Thankfully, a variant quite this bad would be hard to come by. Viruses can’t rejigger their genomes infinitely—not if they want to keep efficiently infecting their preferred hosts. Vineet Menachery, a virologist at the University of Texas Medical Branch, thinks the virus will probably chance upon ways to dodge immunity to a greater degree than Omicron did. But, he added, “the question is, does it have to give up something else to do that?” Even if the virus remakes itself many times, we can expect that its offense will still knock up against some multilayered defenses. Slipping out of the grasp of antibodies isn’t that hard, but “just statistically speaking, I don’t think it’s possible to escape T-cell immunity,” says John Wherry, an immunologist at the University of Pennsylvania, a contributor to a recent report that modeled various scenarios for our future with COVID. The trick, then, would be rousing enough public will to use those backstop tools and duel the virus again—not a sure thing if a doom-esque variant appears anytime soon. “The acceptability of policy X, Y, or Z is not going to be the same as it was before,” Shen told me. The Escape Artist and the BruteIn a less catastrophic forecast, a variant wouldn’t pose an epic triple threat. But it could still pummel a substantial fraction of the population by ratcheting up one trait at a time. That could be any of the Big Three, but consider two examples: a juice-up in immune evasion, or a surge in virulence. All else equal, each could spark waves of serious disease and push the health-care system back to a breaking point. First, the evasive option. SARS-CoV-2 now faces huge pressure to find an immunological escape hatch. With so many people having been infected, vaccinated, or both, the coronavirus’s success has started to lean heavily on its ability to sidestep our shields. This future could be an even more dramatic version of the recent Omicron wave: None of us, no matter how many shots we’ve gotten, would truly be impervious to infection, or maybe even to serious illness. Through sheer numbers alone, this variant would be poised to land a huge swath of people in the hospital, even if it wasn’t, particle for particle, a more deadly threat. Depending on the extent to which the variant eroded vaccine effectiveness, especially against hospitalization and death, we might still need to update our shots and launch a massive revaccination campaign. From the view of the White House, a variant would have to “pass a fairly strong threshold to want to do that,” Quillian told me. “It’s a pretty extensive effort to go back and revaccinate the entire population.” In some ways, a more virulent variant that was still susceptible to vaccine-induced defenses could be simpler to deal with. We could expect that people who were up-to-date on their shots would be very well protected, as they were against, say, Delta. The focus would be on shielding the most vulnerable: the unvaccinated, the elderly, the immunocompromised, those with heavy or frequent exposures to the virus—all of whom would likely benefit from more vaccine doses, and additional focused measures around masking, distancing, testing, and treatments. And perhaps our responses would remain siloed in these groups. “It would probably take a while for us to reimpose restrictions on the general population,” Watson, of Johns Hopkins, said. [Read: The COVID strategy America hasn’t really tried] Maybe that’s not surprising. If much of society remains swaddled in safety, many people won’t see a point in reinvesting in vigilance. The suffering of the people who we are already cultured to see as sickly or close to death—or who are concentrated in already marginalized communities—can be easy to overlook. “If it’s the elderly, the immunocompromised, unfortunately, I think we’re not viewing them in the same light as we would if it was the whole population,” Menachery, the UTMB virologist, said. Which groups ultimately end up shouldering the brunt of the virus’s burden will dictate the extent of our response. Perhaps more of us would be galvanized into camaraderie if a variant pulled a wild card and upped its virulence in an unexpected group. If young adults or children, for instance, suddenly became a prime target, “I have to believe the response would be different,” says Tom Bollyky, the director of the global-health program at the Council on Foreign Relations, and a contributor to the report on future-COVID scenarios. (Menachery thinks a sudden downshift into kids would be unlikely—that’s not a typical modus operandi for coronaviruses.) The SprinterThere’s a third axis on which the virus could shift—sheer transmissibility. Some mutation, or combination of them, could make the virus a bit more efficient at zipping between bodies. But without an accompanying supercharge of virulence, or extreme immune evasion, “I’m not sure there’d be much of a response, to be honest with you,” Watson said. Some people might feel motivated to sign up for a booster. A few localities might push for masking again. Or not. And should a bump in spreadability team up with a drop in virulence, the public’s reaction might be more muted still. People might get sick, but with immunity on our side, the proportion of cases that wind up in the hospital would also dwindle—a deceptively comforting statistic to see. “I have a hard time believing anyone’s going to care, unless there’s more severity,” says Adam Lauring, a virologist at the University of Michigan. Perhaps we’d see this variant’s annual hospitalization and death burden on par with or below the flu’s, a level of suffering that Americans have already implicitly (and perhaps misguidedly) decided is fine. [Read: We’re entering the control phase of the pandemic] But souped-up transmissibility is an insidious parlor trick. It helps viruses catch entire populations off guard. Even a somewhat defanged variant can sow chaos if it’s given the opportunity to spread far and wide enough, and find the vulnerable among us. And we’d still be in deep trouble if a fleet-footed variant hit us at a time when we’d let our vigilance over vaccination slip, or if efforts to dose up the world’s population equitably were still lagging behind. Plenty of suffering can unfold outside of hospitals as well. Less-severe SARS-CoV-2 infections can still seed long COVID. Hours would still be lost to isolations and illnesses. And though population immunity might be higher than ever right now, protection isn’t spread evenly: Too many Americans haven’t gotten any shots at all, and many of those who have remain vulnerable because of their age or health conditions. Even if, somehow, the virus were to become completely, truly benign, total complacency could be dangerous. A virus we let spread is a virus that suddenly has “more hosts in which to evolve,” Geoghegan, the University of Otago virologist, told me. Among them might be immunocompromised individuals, who could harbor the virus long-term. It could tinker with its genome until, “by chance, it comes up with the perfect combo of mutations,” she said, and then roar back into the population at large. Menachery also worries about SARS-CoV-2’s penchant for stewing and shape-shifting in other animal species. That’s what has the potential, he told me, to give us SARS-CoV-3—to spark the next coronavirus pandemic. We can’t say when the next threat will appear, or how formidable it will be. But we do have some control over its emergence: The more chances we give the virus to infect us, the more chances we give it to change itself again. from https://ift.tt/64C3uej Check out http://natthash.tumblr.com The United States reported more deaths from COVID-19 last Friday than deaths from Hurricane Katrina, more on any two recent weekdays than deaths during the 9/11 terrorist attacks, more last month than deaths from flu in a bad season, and more in two years than deaths from HIV during the four decades of the AIDS epidemic. At least 953,000 Americans have died from COVID, and the true toll is likely even higher because many deaths went uncounted. COVID is now the third leading cause of death in the U.S., after only heart disease and cancer, which are both catchall terms for many distinct diseases. The sheer scale of the tragedy strains the moral imagination. On May 24, 2020, as the United States passed 100,000 recorded deaths, The New York Times filled its front page with the names of the dead, describing their loss as “incalculable.” Now the nation hurtles toward a milestone of 1 million. What is 10 times incalculable? Many countries have been pummeled by the coronavirus, but few have fared as poorly as the U.S. Its death rate surpassed that of any other large, wealthy nation—especially during the recent Omicron surge. The Biden administration placed all its bets on a vaccine-focused strategy, rather than the multilayered protections that many experts called for, even as America lagged behind other wealthy countries in vaccinating (and boosting) its citizens--especially elderly people, who are most vulnerable to the virus. In a study of 29 high-income countries, the U.S. experienced the largest decline in life expectancy in 2020 and, unlike much of Europe, did not bounce back in 2021. It was also the only country whose lowered life span was driven mainly by deaths among people under 60. Dying from COVID robbed each American of, on average, nine years of life at the lowest end of estimates and 17 at the highest. As a whole, U.S. life expectancy fell by two years—the largest such decline in almost a century. Neither World War II nor any of the flu pandemics that followed it dented American longevity so badly. Every American who died of COVID left an average of nine close relatives bereaved. Roughly 9 million people—3 percent of the population—now have a permanent hole in their world that was once filled by a parent, child, sibling, spouse, or grandparent. An estimated 149,000 children have lost a parent or caregiver. Many people were denied the familiar rituals of mourning—bedside goodbyes, in-person funerals. Others are grieving raw and recent losses, their grief trampled amid the stampede toward normal. “I’ve known multiple people who didn’t get to bury their parents or be with their families, and now are expected to go back to the grind of work,” says Steven Thrasher, a journalist and the author of The Viral Underclass, which looks at the interplay between inequalities and infectious diseases. “We’re not giving people the space individually or societally to mourn this huge thing that’s happened.” After many of the biggest disasters in American memory, including 9/11 and Hurricane Katrina, “it felt like the world stopped,” Lori Peek, a sociologist at the University of Colorado at Boulder who studies disasters, told me. “On some level, we owned our failures, and there were real changes.” Crossing 1 million deaths could offer a similar opportunity to take stock, but “900,000 deaths felt like a big threshold to me, and we didn’t pause,” Peek said. Why is that? Why were so many publications and politicians focused on reopenings in January and February—the fourth- and fifth-deadliest months of the pandemic? Why did the CDC issue new guidelines that allowed most Americans to dispense with indoor masking when at least 1,000 people had been dying of COVID every day for almost six straight months? If the U.S. faced half a year of daily hurricanes that each took 1,000 lives, it is hard to imagine that the nation would decide to, quite literally, throw caution to the wind. Why, then, is COVID different? Many aspects of the pandemic work against a social reckoning. The threat—a virus—is invisible, and the damage it inflicts is hidden from public view. With no lapping floodwaters or smoking buildings, the tragedy becomes contestable to a degree that a natural disaster or terrorist attack cannot be. Meanwhile, many of those who witnessed COVID’s ruin are in no position to discuss it. Health-care workers are still reeling from “death on a scale I had never seen before,” as an intensive-care nurse told me last year. The bereaved face guilt on top of sadness: “I think about the way it would run through families and tight-knit groups and the huge psychological toll as people think, Am I the one who brought it in?” Whitney Robinson, a social epidemiologist at the University of North Carolina at Chapel Hill, told me. And though 3 percent of Americans have lost a close family member to COVID, that means 97 percent have not. The two years that were shaved off of the average life span undid two decades of progress in health, but in 2000, “it didn’t feel like we were living under a horrible mortality regime,” Andrew Noymer, a demographer at UC Irvine, told me. “It felt normal.” To grapple with the aftermath of a disaster, there must first be an aftermath. But the coronavirus pandemic is still ongoing, and “feels so big that we can’t put our arms around it anymore,” Peek told me. Thinking about it is like staring into the sun, and after two years, it is no wonder people are looking away. As tragedy becomes routine, excess deaths feel less excessive. Levels of suffering that once felt like thunderclaps now resemble a metronome’s clicks—the background noise against which everyday life plays. The same inexorable inuring happened a century ago: In 1920, the U.S. was hit by a fourth wave of the great flu pandemic that had begun two years earlier, but even as people died in huge numbers, “virtually no city responded,” wrote John M. Barry, a historian of the 1918 flu. “People were weary of influenza, and so were public officials. Newspapers were filled with frightening news about the virus, but no one cared.” Fatalism has also been stoked by failure. Two successive administrations floundered at controlling the virus, and both ultimately shunted the responsibility for doing so onto individuals. Vaccines brought hope, which was dashed as uptake stagnated, other protections were prematurely rolled back, and the Delta variant arrived. During that wave, parts of the South and Midwest experienced “a shocking level of death and transmission that was on par with the worst of that previous winter wave,” Robinson said, and even so the policy response was anemic at best. As Martha Lincoln, a medical anthropologist at San Francisco State University, told me in September 2020, if salvation never comes, “people are going to harden into a fatalistic sense that we have to accept whatever the risks are to continue with our everyday lives.” [Read: America is trapped in a pandemic spiral] America is accepting not only a threshold of death but also a gradient of death. Elderly people over the age of 75 are 140 times more likely to die than people in their 20s. Among vaccinated people, those who are immunocompromised account for a disproportionate share of severe illness and death. Unvaccinated people are 53 times more likely to die of COVID than vaccinated and boosted people; they’re also more likely to be uninsured, have lower incomes and less education, and face eviction risk and food insecurity. Working-class people were five times more likely to die from COVID than college graduates in 2020, and in California, essential workers continued dying at disproportionately high rates even after vaccines became widely available. Within every social class and educational tier, Black, Hispanic, and Indigenous people died at higher rates than white people. If all adults had died at the same rates as college-educated white people, 71 percent fewer people of color would have perished. People of color also died at younger ages: In its first year, COVID erased 14 years of progress in narrowing the life-expectancy gap between Black and white Americans. Because death fell inequitably, so did grief: Black children were twice as likely to have lost a parent to COVID than white ones, and Indigenous children, five times as likely. Older, sicker, poorer, Blacker or browner, the people killed by COVID were treated as marginally in death as they were in life. Accepting their losses comes easily to “a society that places a hierarchy on the value of human life, which is absolutely what America is built on,” Debra Furr-Holden, an epidemiologist at the Michigan State University, told me. These recent trends oozed from older ones. Well before COVID, nursing homes were understaffed, disabled people were neglected, and low-income people were disconnected from health care. The U.S. also had a chronically underfunded public-health system that struggled to slow the virus’s spread; packed and poorly managed “epidemic engines” such as prisons that allowed it to run rampant; an inefficient health-care system that tens of millions of Americans could not easily access and that was inundated by waves of sick patients; and a shredded social safety net that left millions of essential workers with little choice but to risk infection for income. Generations of racist policies widened the mortality gap between Black and white Americans to canyon size: Elizabeth Wrigley-Field, a sociologist at the University of Minnesota, calculated that white mortality during COVID was still substantially lower than Black mortality in the pre-pandemic years. In that light, the normalizing of COVID deaths is unsurprising. “When deaths happen to people who are already not valued in a million other ways, it’s easier to not value their lives in this additional way,” Wrigley-Field told me. While epidemics flow downward into society’s cracks, medical interventions rise upward into its peaks. New cures, vaccines, and diagnostics first go to people with power, wealth, education, and connections, who then move on; this explains why health inequities so stubbornly persist across the decades even as health problems change. AIDS activism, for example, lost steam and resources once richer, white Americans had access to effective antiretroviral drugs, Steven Thrasher told me, leaving poorer Black communities with high rates of infection. “It’s always a real danger that things get worse once the people with the most political clout are okay,” Thrasher said. Similarly, pundits who got vaccinated against COVID quickly started arguing against overcaution and (inaccurately) predicting the pandemic’s imminent end. The government did too, framing the crisis as solely a matter of personal choice, even as it failed to make rapid tests, high-quality masks, antibody cocktails, and vaccines accessible to the poorest groups. The CDC’s latest guidelines continue that trend, as my colleague Katherine J. Wu has argued. Globally, the richer north is moving on while the poorer south is still vulnerable and significantly unvaccinated. All of this “shifts the burden to the very groups experiencing mass deaths to protect themselves, while absolving leaders from creating the conditions that would make those groups safe,” Courtney Boen, a sociologist at the University of Pennsylvania, told me. “It’s a lot easier to say that we have to learn to live with COVID if you’re not personally experiencing the ongoing loss of your family members.” Richard Keller, a medical historian at the University of Wisconsin at Madison, says that much of the current pandemic rhetoric—the premature talk of endemicity; the focus on comorbidities; the from-COVID-or-with-COVID debate—treats COVID deaths as dismissible and “so inevitable as to not merit precaution,” he has written. “Like gun violence, overdose, extreme heat death, heart disease, and smoking, [COVID] becomes increasingly associated with behavioral choice and individual responsibility, and therefore increasingly invisible.” We don’t honor deaths that we ascribe to individual failings, which could explain, Keller argues, why national moments of mourning have been scarce. There have been few pandemic memorials, save some moving but temporary art projects. Resolutions to turn the first Monday of March into a COVID-19 Victims and Survivors Memorial Day have stalled in the House and Senate. Instead, the U.S. is engaged in what Keller calls “an active process of forgetting.” If safety is now a matter of personal responsibility, then so is remembrance. No one knows how many people will die from COVID in the coming years. The number will depend on our collective behavior, how many more people can be vaccinated or boosted, the length and strength of immunity, what new variants arise, and more. Andrew Noymer, the demographer, thinks that COVID will kill fewer people per year than it has in the past two, but will probably still be more lethal than the flu, which sets a plausible and very wide range of somewhere between 50,000 and 500,000 annual deaths. (COVID will also continue to cause long-term disability.) How much of this extra mortality will the U.S. accept? The CDC’s new guidelines provide a clue. They recommend that protective measures such as indoor masking kick in once communities pass certain thresholds of cases and hospitalizations. But the health-policy experts Joshua Salomon and Alyssa Bilinski calculated that by the time communities hit the CDC’s thresholds, they’d be on the path to at least three daily deaths per million, which equates to 1,000 deaths per day nationally. And crucially, the warning lights would go off too late to prevent those deaths. “As a level of mortality the White House and CDC are willing to accept before calling for more public health protection, this is heartbreaking,” Salomon said on Twitter. [Read: The millions of people stuck in pandemic limbo] If 1,000 deaths a day is not acceptable, what threshold would be? The extreme answer--none!—is impractical, because COVID has long passed the point where eradication is possible, and because all interventions carry at least some cost. Some have suggested that we should look to other causes of death—say, 39,000 car fatalities a year, or between 12,000 and 52,000 flu deaths—as a baseline of what society is prepared to tolerate. But this argument rests on the false assumption that our acceptance of those deaths is informed. Most of us simply don’t know how many people die of various causes—or that it’s possible for fewer to do so. The measures that protected people from COVID slashed adult deaths from flu and all but eliminated them among children. Our acceptance of those deaths never accounted for alternatives. “When was I offered the choice between having a society where you’re expected to go into work when you’re ill or having fewer people die of the flu every year?” Wrigley-Field, the sociologist, said to me. Even when the potential benefits are clear, there’s no universal algorithm that balances the societal disruption of a policy against the number of lives saved. Instead, our attitudes about preventing death revolve around how possible it seems and how much we care. About 40,000 Americans are killed by guns every year, but instead of preventing these deaths, “we have organized ourselves around the inevitability of gun violence,” Sonali Rajan of Columbia University’s Teachers College said on Twitter. Doing the same for COVID, as Rajan says is now happening, means prematurely capitulating to the pathogens that come next. The inequities that were overlooked in this pandemic will ignite the next one—but they don’t have to. Improving ventilation in workplaces, schools, and other public buildings would prevent deaths from COVID and other airborne viruses, including flu. Paid sick leave would allow workers to protect their colleagues without risking their livelihood. Equitable access to antivirals and other treatments could help immunocompromised people who can’t be protected through vaccination. Universal health care would help the poorest people, who still bear the greatest risk of infection. A universe of options lies between the caricatured extremes of lockdowns and inaction, and will save lives when new variants or viruses inevitably arise. Such changes are popular. Stephan Lewandowsky, from the University of Bristol, presented a representative sample of Americans with two possible post-COVID futures—a “back to normal” option that emphasized economic recovery, and a “build back better” option that sought to reduce inequalities. He found that most people preferred the more progressive future—but wrongly assumed that most other people preferred a return to normal. As such, they also deemed that future more likely. This phenomenon, where people think widespread views are minority ones and vice versa, is called pluralistic ignorance. It often occurs because of active distortion by politicians and the press, Lewandowsky told me. (For example, a poll that found that mask mandates are favored by 50 percent of Americans and opposed by just 28 percent was nonetheless framed in terms of waning support.) “This is problematic because over time, people tend to adjust their opinions in the direction of what they perceive as the majority,” Lewandowsky told me. By wrongly assuming that everyone else wants to return to the previous status quo, we foreclose the possibility of creating something better. There is still time. Steven Thrasher, the journalist, noted that a new wave of AIDS memorials is only now starting to show up, long after the start of that pandemic. COVID will similarly persist, as will the chance to reckon with its cost, and the opportunity to steel our society against similar threats. Right now, the U.S. is barreling toward the next pandemic, having failed to learn the lessons of the past two years, let alone the past century. But Wrigley-Field, the sociologist, told me that she draws inspiration from the big social movements of the past, where gains in equality that seemed impossible at first were eventually achieved. “We’re really bad judges of what is possible based on what we’re experiencing in a particular moment,” she said. “Nothing major that has mattered for health came quickly or easily.” from https://ift.tt/OJNS1mW Check out http://natthash.tumblr.com This article contains spoilers for Love Is Blind Season 2. If you’ve never seen an episode of Love Is Blind, the best way I can describe the viewing experience is this: It feels like a television producer read a Wikipedia description of the Stanford prison experiment and decided that all it needed was a little romance. The show, which concluded its second season on Netflix last week, sequesters 30 people in a studio for a week and a half to test the theory that instinctual physical attraction is an impediment to romantic love. Participants spend their time alone in tiny, closed rooms--the pods—going on “dates” through a speaker system. To be freed from the pods and graduate to the next phase of the show, they have to get engaged, with a wedding a month later. Only after an accepted proposal are couples allowed to see what the other person looks like, and until the betrothed return from a post-engagement trip to Mexico, they are cut off from the outside world. No cellphones, no internet, no support system. Everything about the show upsets me, and not just because it’s plainly a bad idea. Contestants who have known each other for a few days start calling each other their best friend. Most participants who fail to bond with a stranger through a wall are not named or acknowledged, scuttling in the background like the non-playable characters in a video game. Everyone involved is constantly clutching metal wine glasses because sobriety is a longtime enemy of compelling reality television, and so is Chardonnay that lurches up and down in its glass, belying an edit that might not be strictly chronological. But, regrettably, Love Is Blind is also tremendous content, and the show has turned into a big hit for Netflix and a hot subject for social-media gossip. Last weekend, my friend David warned me that he had started watching it with his girlfriend on a whim. On Monday, he sent me an update. “I started Saturday morning reading a Jonathan Franzen novel,” he wrote. “Now I’m ten pages deep in the Love Is Blind subreddit.” This is a popular trajectory for fans of the show: The contestants open up their most intimate moments for the general public, and then the general public wants more, scrutinizing their Instagram accounts, podcast appearances, and anything else that might provide definitive proof of who sucks and who should be celebrated and, most important, how people should behave in matters of the heart. And it’s that last part—that consensus-building about the right and wrong ways to experience some of life’s most difficult moments—that makes the show land. Love Is Blind is so harrowing and so enthralling because it’s not just about 30 striving contestants—it’s also about the rest of us. [Read: Love Is Blind was the ultimate reality-TV paradox] One of the most jarring things about the show is how quickly and completely some participants’ boundaries disappear. What starts out functionally similar to eavesdropping on a series of deranged Tinder dates turns into watching couples bond over tales of childhood trauma and adult violence and deep personal insecurity, all within days of being introduced to one another’s voices in the pods. This season, Iyanna and Jarrette, two contestants who get engaged, swapped stories of parental abandonment and attempted murder by a onetime friend. Two other women, Danielle and Deepti, shared details of years-long struggles to make peace with their bodies and feel confident after dramatic weight loss; they eventually got engaged to the men who listened. If you walked into a room where two strangers were discussing these topics, you’d apologize and leave. But part of the prurient thrill of reality TV is being invited to stay and see the squirmy interior lives of others. I asked Kirk Honda, a Seattle-based psychologist and couples therapist who has built a following on YouTube by breaking down the interpersonal dynamics on popular reality dating shows, why Love Is Blind is so effective at getting people engaged in such strange circumstances. He told me that the show is built for fast intimacy. Producers, he suspects, look for people who really do want to get married, and then cast members are plied with alcohol, cut off from their social lives, given virtually nothing to do all day outside the pods but think about the people they’ve talked with, and forced into competition for a small group of potential mates. When participants aren’t in the pods, they’re in standard-issue reality-TV housing segregated by gender, gossiping about their pod dates. The normal hopes and tensions of dating get cranked up to 11—if you don’t do everything you can to bond with the person you’re most interested in, one of your new friends could yank your future husband out from under you. Love Is Blind claims to stand in opposition to dating-app culture, but it replicates a common anxiety caused by those apps: You can never feel confident that someone you’re really beginning to care about isn’t simultaneously having the same conversations with half a dozen other people. These dynamics also push participants to rationalize things that are made into obvious red flags for viewers. Deep into their pod courtship, Shayne accidentally reveals to Natalie that he’s continued to pursue another contestant. When Natalie says that she feels misled, Shayne blows up and nearly quits the show—but they get engaged anyway. When Iyanna accepts Jarrette’s proposal, she does it knowing that he already proposed to another woman and got turned down. Danielle and Nick spiral into the same fight over and over again. Deepti and Shake bond over their shared cultural roots and dating histories but seem to gloss over Shake’s obsession with having a skinny partner, even though Deepti has been open with him about her body insecurities. Once they’ve met face-to-face, Shake tells anyone who will listen that he’s not attracted to Deepti as soon as she’s out of earshot. [Read: The ‘dating market’ is getting worse] To producers’ credit, this sets the show up for incredible fireworks. Decisions on whether to stay together or break up are made at the altar. Brides are in their big white dresses and grooms are in their tuxes. Their wedding parties are full of their actual friends, and their families mostly try to muster support. It’s nearly impossible not to root for some of these people to get left at the altar and humiliated in front of the world, even though you know virtually nothing about them. You’re encouraged to scoff. You’d never act a fool under these circumstances. You’d never spill your darkest secrets on Netflix. You certainly wouldn’t fall in love with some bozo in the next room after four days. You wouldn’t get reality-TV married. You might, though. To me, that’s the most unsettling part of Love Is Blind. Most of the contestants seem well-meaning, if a little desperate for companionship, which isn’t particularly rare. The conflicts are blown up for entertainment value, but they’re mostly identical to the stuff of normal relationships—unlike most other dating shows, there are few hoops to jump through except engagement and marriage, which makes some of the drama distressingly familiar. All couples argue, and lots of them have the same argument over and over again. Defensiveness, poor communication, and hurt feelings have turned us all into jerks on occasion. Every day, people try to push past insecurities without dealing with them, try to reconcile conflicting desires that make for an uneasy fit with an otherwise lovely partner, try to tell the difference between anger issues that can be resolved and those that are more likely to devolve into abuse. Sometimes they tell themselves that these efforts are going better than they really are because they so badly want that to be true. There’s nothing all that fantastical about any of it, which is maybe why it invites such close examination and rowdy discussion by fans online. There but for the grace of God go many of us, even if cameras aren’t capturing our fights and disappointments. If we can all just agree on the right way to argue, the right person to blame for a broken heart, and the right way to fall in love, maybe we’ll all do better the next time we try. from https://ift.tt/fVXgLdl Check out http://natthash.tumblr.com Americans, by and large, are putting the pandemic behind them. Now that Omicron is in the rearview mirror and cases are plummeting, even many of those who have stayed cautious for two full years are spouting narratives about “going back to normal” and “living with COVID-19.” This mentality has also translated into policy: The last pandemic restrictions are fading nationwide, and in his State of the Union address on Tuesday night, President Joe Biden declared that “most Americans can remove their masks, return to work, stay in the classroom, and move forward safely.” Other rich, highly vaccinated countries are following much the same path. In the U.K., for example, those with COVID-19 no longer have to self-isolate. It helps that these countries have more vaccine doses than they know what to do with, and a stockpile of tools to test and treat their residents if and when they get sick. But in the global South, COVID-19 is much harder to ignore. More than a year after the start of the mass-vaccination campaign, nearly 3 billion people are still waiting for their first shot. While an average of 80 percent of people in high-income countries have gotten at least one dose, that figure stands at just 13 percent in low-income countries. In the poorest countries, virtually no booster shots have been administered. Such low vaccination rates are taking their toll. Although the official death count in India is about 500,000, for example, the reality might be closer to 5 million excess deaths—and most of those deaths happened after vaccines were introduced in the global North. The rush in the rich countries to declare the pandemic “over” while it continues to ravage the global South is completely predictable—in fact, the same trend has played out again and again. Infectious diseases such as malaria, tuberculosis, and HIV that are now seen as “Third World diseases” were once serious threats in rich countries, but when incidence of these diseases began to decline there, the global North moved on and reduced investments in new tools and programs. Now, with COVID-19, the developing world has once again been left to fend for itself against an extremely transmissible virus without the necessary vaccine doses, tests, and treatment tools. Some pandemics never truly end—they just become invisible to people in the global North. You may know malaria as an infectious disease that affects poor “tropical” countries. But for several thousands of years, malaria was a global menace. During the 20th century alone, the disease is estimated to have accounted for up to 5 percent of all human deaths. It was eradicated from the global North by the 1970s, but the rest of the world was left behind. In 2020, there were an estimated 240 million malaria cases, and nearly all of the 627,000 deaths occurred in sub-Saharan Africa. For a disease that affected even our neolithic ancestors, the world had to wait until 2021 for the first-ever malaria vaccine. Though the World Health Organization recently endorsed this partially effective malaria vaccine, expanded manufacturing and scale-up plans remain undetermined. [Read: Two ways of making malaria-proof mosquitoes] The same phenomenon has unfolded with tuberculosis, a disease so old that DNA of TB bacteria have been identified in Egyptian mummies. “Consumption,” as TB was once called, was highly prevalent in Europe and North America. From the 1600s to the 1800s, TB caused 25 percent of all deaths in Europe. By the 1980s, TB case numbers had decreased significantly in the West, largely thanks to drug treatments and reductions in poverty. But again, TB remains a problem in developing countries (and among marginalized populations within the global North). In 2020, TB killed 1.5 million people, more than 80 percent of whom lived in low- and middle-income countries. Investments and innovations to make the disease less devastating have been scarce: For example, the TB vaccine we use today is more than 100 years old, and it has limited efficacy in adults. Unlike malaria and tuberculosis, HIV/AIDS was identified only 40 years ago, and still we’ve seen the same trend. After the infection emerged in the early 1980s, it went from a condition thought to affect only gay men in the global North to a global pandemic that, yes, mostly affects the global South today. In 2020, nearly 38 million people globally were living with HIV, and 680,000 people died from AIDS-related illnesses, with two-thirds of both cases and deaths in Africa. When effective antiretroviral drugs first became available in the early 1990s, they were expensive and mainly accessible to people in high-income countries. For these lifesaving tools to reach the global South took incredible activism and years of effort, and millions of people (mostly Africans) died as a result of this inaction. Even today, we do not have a vaccine against AIDS. Despite the continued toll of these “big three” infectious diseases, they are rarely spoken of as pandemics. “By epidemic we actually mean a pandemic that no longer kills people in rich countries,” wrote Peter Sands, the CEO of the Global Fund, an international group that combats these diseases. “By endemic we actually mean a disease the world could get rid of but hasn’t. HIV/AIDS, TB and malaria are pandemics that have been beaten in rich countries. Allowing them to persist elsewhere is a policy choice and a budgetary decision.” With the coronavirus, the global South is being left behind once again. Rich countries are already rapidly losing interest, and if the virus continues to fizzle out in these areas, they might show less urgency in sharing vaccines and other resources, stop investing in new products to fight the virus, and place the burden of disease control primarily on resource-strapped low-income countries. Rich countries such as the United States have donated hundreds of millions of doses to the COVID-19 Vaccines Global Access Facility (COVAX), but citing supply issues, the initiative didn’t even get halfway to its goal of delivering 2 billion doses last year. [Read: Democracies keep vaccines for themselves] Even if rich nations continue to offer charity and donations, they seem less likely to support efforts that would let lower-income countries procure and manufacture their own tools to battle this virus. HIV medication became affordable to the global South only when countries such as India started manufacturing their own generic pills. The same must happen for COVID-19 vaccines to be more accessible. After Omicron, some have suggested that it’s too late to meet the WHO’s target of vaccinating 70 percent of the world by mid-2022. When we should be redoubling efforts to increase vaccination, the narrative that it’s too late to vaccinate the world could have a chilling effect on the global COVID-19 vaccination campaign. The developed world is repeating its mistakes again, and this will have devastating consequences for billions of people. Diseases becoming “endemic” should not be code for inaction or lack of consideration for those with few resources and many vulnerabilities—in both the global North and the global South. Even when they’re invisible to some, high death and infection rates cannot be seen as acceptable or normal. [Read: Endemicity is meaningless] For now, the biggest problem with the global North proclaiming that the coronavirus pandemic is “over” is that it manifests the opposite outcome. Eventually, even rich countries will bear the brunt of tuning out COVID-19. Allowing infectious diseases to circulate in any part of the world within large populations of unvaccinated people will almost surely result in the emergence of new variants that will affect all nations. Privileged people should not get to decide on their own that a global pandemic is over. The way out is the same as it’s always been: making sure we get everyone to the finish line, not just a select few. Humanity did this with smallpox and could soon achieve this with polio and guinea-worm infections. The real barrier to ending this COVID-19 crisis around the world is not science or resources—it’s us. from https://ift.tt/ViM2ad9 Check out http://natthash.tumblr.com |
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April 2023
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