Over the past month, the number of new COVID cases in my social circle has become impossible to ignore. I brushed off the first few—guests at a wedding I attended in early April—as outliers during the post-Omicron lull. But then came frantic texts from two former colleagues. The next week, a friend at the local café was complaining that she’d lost her sense of smell. My Instagram feed is now surfacing selfies of people in isolation, some for the second or third time. Cases in New York City, where I live, have been creeping up since early March. Lately, they’ve risen nationally, too. On Tuesday, the national seven-day average of new COVID cases hit nearly 49,000, up from about 27,000 three weeks earlier. The uptick is likely being driven by BA.2, the new, more transmissible offshoot of Omicron that’s now dominant in the United States. BA.2 does seem to be troubling: In Western Europe and the U.K. in particular, where previous waves have tended to hit a few weeks earlier than they have in the U.S., the variant fueled a major surge in March that outpaced the Delta spike from the summer. At least so far, the official numbers in the U.S. don’t seem to show that a similar wave has made it stateside. But those numbers aren’t exactly reliable these days. In recent months, testing practices have changed across the country, as at-home rapid tests have gone fully mainstream. These tests, however, don’t usually get recorded in official case counts. This means that our data could be missing a whole lot of infections across the country—enough to obscure a large surge. So … are we in the middle of an invisible wave? I posed the question to experts, and even they were stumped by what’s really happening in the U.S. [Read: Another COVID wave is looming] For a while, COVID waves were not all that difficult to detect. Even at the beginning of the pandemic, when the country was desperately short of tests, people sought out medical help that showed up in hospitalization data. Later, when Americans could easily access PCR tests at clinics, their results would automatically get reported to government agencies. But what makes this moment so confusing is that the COVID metrics that reveal the most about how the coronavirus is spreading are telling us less and less. “Why we’re seeing what we’re seeing now is one of the more challenging scientific questions to answer,” Sam Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundation, told me. Not only is our understanding of case counts limited, but all the epidemiological data we do have in the U.S. is rife with biases, because it’s collected haphazardly instead of through randomized sampling, he said. The data sets we rely on—case counts, wastewater, and hospitalizations—are “blurry pictures that we try to piece together to figure out what’s going on,” Jennifer Nuzzo, an epidemiologist at Brown, told me. An invisible wave is possible because cases capture only the number of people who test positive for the virus, which is different from what epidemiologists really want to know: how many people are infected in the general population. That’s always produced an undercount in how many people are actually infected, but the numbers are becoming even more uncertain as government testing sites wind down and at-home testing becomes more common. Unlike during past waves, each household can request up to eight free rapid tests from the federal government, and insurance companies are required to reimburse Americans for the cost of any additional rapid tests they purchase. These changes in testing practices leave even more room for bias. [Read: Get ready for a wave of missed infections] Sheer pandemic fatigue probably isn’t helping, either. People who are over this virus could be ignoring their symptoms and going about their daily lives, while people who are getting reinfected may be getting milder symptoms that they don’t recognize as COVID, Nuzzo said. “I do believe we are in a situation where there’s more of a surge happening, a larger proportion of which is hidden from the usual sort of sensors that we have to detect them and to appreciate their magnitude,” Denis Nash, an epidemiologist at the City University of New York, told me. He was the only expert I spoke with who suggested that we might be in a wave that we’re missing because of our poor testing data, though he too wavered on that point. “I wish there was a clear answer,” he said. Instead of relying solely on case counts to gauge the size of a wave, Nash said, it’s better to take into account other metrics such as hospitalizations and wastewater data, to triangulate what’s going on. Positivity rate—the percent of tests taken that have a positive result—can be more informative than looking at the raw numbers, too. And right now, the nationwide positivity rate is telling us that an increasing number of people are getting sick: Nationwide, 6.7 percent of COVID tests are coming back positive, versus 5.3 percent last week. Unlike traditional COVID testing, wastewater surveillance, which is a process of detecting SARS-CoV-2 in public sewage, doesn’t reveal who exactly might be infected in a particular community. But by analyzing sewer data for evidence of the coronavirus, it can provide an early signal that a surge is happening, in part because people may shed virus in their feces before they start feeling sick. Nationwide levels of COVID in wastewater have climbed steadily in the past six weeks, suggesting more of a wave than the case counts indicate, though they vary greatly by region and can’t account for the chunk of the population who doesn’t use public utilities, says Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. Scarpino noted a rise in certain areas, including Boston and New York, but he didn’t characterize them as a wave. “Multiple data sets are showing [a] plateau in some places,” he said. “It’s that combined trend across multiple data sets that we’re looking for.” If America is indeed not experiencing a big wave at all, that would be breaking with our recent history of following in Europe’s path. One possibility is that “the immunological landscape is different here,” Scarpino said. At the peak of Omicron’s sweep across the U.S., in January, more than 800,000 people were getting infected each day, partly a function of the fact that just 67 percent of eligible Americans are fully vaccinated. Most of those who recovered got an immunity bump from their infection, which might now be protecting them from BA.2. Even with all the data issues we have, the relatively slow rise in new cases “does raise the possibility of there being less population vulnerability” in the U.S., Nuzzo said. But, she noted, this doesn’t mean people should think we’re done with the pandemic. States in the Northeast and Midwest are seeing far more cases than the South and the West. As this wide regional variation suggests, many pockets of the country are still vulnerable. In all likelihood, we’re seeing elements of both scenarios right now. There could be many more COVID infections than the reported numbers indicate, even while the situation in the U.S. may be unique enough to prevent the same pattern of spread as in Europe. Regardless, the course of the pandemic would be far less uncertain if we had data that truly reflected what was happening across the country. All the experts I spoke with agreed that the U.S. desperately needs active surveillance, the kind that involves deliberately testing representative samples of the population to produce unbiased results. It would tell us what percentage of the general population is actually infected, and how trends differ by age and location. Now that “we’re moving away from blunt tools like mandates, we need data to inform more targeted interventions that are aimed at reducing transmission,” Nuzzo said. In some ways, not knowing whether we are in an invisible wave is more unsettling than knowing for certain. It leaves us with very little to go on when making personal decisions about our safety, such as deciding whether to mask or avoid indoor dining, which is especially frustrating as the government has fully shifted the onus of COVID decision making to individuals. “If I want to know what my risk is, I just look to see if my friends and family are infected,” Scarpino said. “The closer the infection is to me, the higher my risk is.” But we can’t continue flying blind forever. It’s the third year of the pandemic—why are we still unable to tell how many people are sick? [Read: America is starting down it’s first so what wave] But our inability to nail down whether we’re in a wave is also an indication that we’re closer to the end of this crisis than the beginning. An encouraging sign is that COVID hospitalizations aren’t currently rising at the same rate as cases and wastewater data. Nationally, they’re still close to all-time lows. Hospitalization data, Nuzzo said, is “one of our more stable metrics at this point,” though it lags behind the real-time rise in cases because it usually takes people a few weeks to get sick enough to be hospitalized. Even if BA.2 is silently infecting large swaths of the country, it doesn’t seem to yet be causing as much severe illness as previous waves, thanks to immunity and perhaps also antiviral drugs. If that trend holds, it may mean we are seeing a decoupling of cases and hospitalizations (and, thus, with deaths too). “This is the kind of thing we really want to see—we can absorb a big surge without a lot of people having severe infection and dying,” Nash said. Still, it’s impossible to say for certain. For that, yet again, we’d need better data. from https://ift.tt/xuWTigX Check out http://natthash.tumblr.com
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If you tried to imagine the perfect gym teacher, you’d probably come up with someone a lot like Hampton Liu. He’s a gentle, friendly guy who spends most of his time trying to figure out how to make the basics of exercise more approachable, and he talks frequently about how he never wants anyone to feel shame for their ability or skill level. In other words—and with apologies to good gym teachers, who almost definitely exist—he’s probably the polar opposite of whoever lorded over your middle-school physical-education class. And Liu is a gym teacher of sorts. He has amassed millions of followers across YouTube, Facebook, and TikTok by teaching a remedial PE course for adults from his Arkansas backyard. In many of his videos, he wears a T-shirt and jeans instead of specialized athletic gear, and he uses little or no equipment. The most popular installments take viewers through super-common exercises—squats, lunges, push-ups, pull-ups—with variations tailored to many different capability levels. For someone who has never exercised at all, a push-up might start as—or might just be—lying on your back and “bench-pressing the air” in order to expand your range of motion. There are several more types of push-up that Liu tells viewers to master before they assume the hands-and-toes position that’s long been taught to American kids as the One True Push-Up. (Kneeling variation acceptable for girls, if they must.) Teaching a series of increasingly difficult movements, called a “progression” by fitness pros, is common at every level of exercise instruction and meant to build capacity over time. All progressions start somewhere, and most of the ones you can find on YouTube, through instructional services such as Peloton, or in classes at your local gym will assume a baseline of ability that a lot of people don’t have. The first step, for example, might be a standard squat, performed without weights. Over time, you might graduate to squatting while you hold a 25-pound kettlebell, and then to kicking out to the side with one leg in order to challenge a different group of muscles. But what if you can’t do a squat? [Read: Peloton is stuck, just like the rest of us.] Liu focuses on teaching progressions for novices, which work toward the skills that other types of exercise instruction take for granted. There’s a real audience for these, he told me. Lots of people seem to assume that their inability to do sets of those basic moves is an irreversible failure—for many of them, it’s been their lot in life since elementary-school gym class. For decades, exercise instruction for adults has functioned on largely the same principle. What the fitness industry calls a “beginner” is usually someone relatively young and capable who wants to become more conventionally attractive, get swole, or learn a trendy workout such as high-intensity interval training or barre. If you’re a novice looking for a path toward these more intense routines, most of the conventional gyms, fitness studios, and exercise experts that offer them don’t have much for you—come back when you’ve developed on your own the endurance and core strength to avoid barfing, crying, or injuring yourself in the first 10 minutes. The situation is even worse if you have no designs on getting ripped and instead just want to build a baseline of capability, whether that’s for hoisting your toddler, shaking off the stiffness of a desk job, or living independently as you age. On the surface, this is pretty dumb. More than three-quarters of Americans don’t currently hit the CDC’s recommended minimums for regular exercise, and the fitness industry is a graveyard of once-buzzy businesses that abruptly stopped growing—much to their investors’ chagrin—at least in part because they never had a plan to turn anyone into a customer who wasn’t already pretty fit. But the numbers suggest that there is enormous demand for services such as Liu’s: His super-popular videos make him just one recent example of the teachers and trainers who have found significant audiences by courting true beginners. In doing so, they’ve created entry points for more types of people to do something near-universally regarded as essential to mental and physical health. Why has the industry itself been so slow to catch up? For most inactive Americans, the problem with working out starts where their relationship to exercise does: in gym class. According to Natalia Mehlman Petrzela, a historian at the New School and the author of the forthcoming book Fit Nation: The Gains and Pains of America’s Exercise Obsession, public-school physical education became more widespread in the United States during the Cold War, as the federal government began to worry that America was falling behind Europe and not producing enough combat-ready kids to challenge the Soviets. (That concern stretches back to the early 20th century and has endured for decades beyond the fall of the U.S.S.R.) Perhaps unsurprisingly, building physical instruction around a national inferiority complex instead of childhood well-being has had some consequences, the most enduring of which is an obsession with testing “fitness” instead of teaching practical physical skills and helping kids explore new activities. The limitations of traditional American PE can be evoked pretty tidily with a single phrase: the Presidential Fitness Test. If you’re not familiar with the test or have repressed those memories, it was a biannual quasi-military exercise developed in the 1960s that required children as young as 6 to, among other things, run a mile as quickly as possible, do as many pull-ups as their little arms could handle, and get weighed, usually while all of their peers looked on. The criteria for passage varied over the years, and, in between tests, schools weren’t required to teach kids anything in particular that would help them improve their scores on the skill components. Instead, the test reflected the priorities of the system that created it: For example, kids deemed “overweight” couldn’t fully pass the test, even if they outperformed their classmates. The whole system was a big missed opportunity: Instead of engendering curiosity about physical activity and giving kids skills to build their capability, PE separated them into the physical haves and have-nots. Public-health officials admitted as much when they discontinued the test in 2013. As it turns out, you can’t just teach millions of children that exercise is painful, humiliating, or a punishment for their failures and expect them to swan into adulthood with healthy, moderate beliefs about their bodies. Instead, they follow the lessons they’ve learned about themselves, and about exercise: Some people avoid ever entering a gym again and shy away from activities that might draw attention to their physical capabilities, such as hiking or dancing. Others emerge confident that they were born with the keys to the kingdom of athleticism. Petrzela says that this dichotomy colors much of how American adults think about exercise, including who pursues careers in fitness, who can get hired in the industry, and how the audience for fitness services is defined. The fitness industry has changed a lot and for the better in the past 15 years—gym teachers have begun to piece together curricula that are more encouraging and creative, exercise gear is available in a larger array of sizes, and people who run fitness businesses have started to realize, however slowly, that shame might not be quite as reliable of a sales tool as it once was. But lots of stereotypes persist, and not just in the minds of people who are already regular exercisers. If you’ve been told all your life that only thin people are healthy, and that exercise is designed to make you healthier, then it’s only natural to believe that for a particular exercise regimen to “work,” it must make everyone who does it thin. If a business can’t create rock-hard abs for its instructors, what could it possibly do for you? Equating thinness with instructor competence or exerciser success is pretty much a nightmare for all involved, from elementary school through adulthood, and it never abates. Petrzela, who also spent years as a fitness teacher, says that this is a common source of anxiety for people in that line of work, who risk losing their careers and credibility if their bodies change. It’s also not a great way to assemble a workforce with an intuitive understanding of what millions of inactive Americans need from them, whether that is beginner-level strength instruction or yoga-pose modifications for larger bodies. Research consistently suggests that movement—not elaborate boot-camp routines or long-distance running, just movement by itself—is a boon to both physical and mental health. Glenn Gaesser, an exercise physiologist at Arizona State University, argues that regular exercise has a much larger positive effect, in the long term, than dieting or intentional weight loss; and that for larger people, the effect of increased fitness is even more significant. Creating an environment where those same people can’t find instruction that addresses their needs—or where they can’t access it without being browbeaten if they don’t also restrict their diets and lose weight—only harms their health. How to cater to this very large group of people isn’t some kind of long-unsolved mystery. The YMCA’s network of nonprofit facilities has offered popular, low-cost exercise activities and sports instruction for people across a wide range of ages and abilities for decades. Richard Simmons became a superstar in the 1980s and ’90s because there was real demand for his kinder, gentler approach and broadly accessible moves, even among people who wanted to exercise for weight loss. More recently, the gym chain Planet Fitness has become enormously successful with its beginner-friendly, no-shame, low-cost pitch to the general public. Couch to 5k, an app-based running program, has become an extraordinarily popular entry point for true beginners who want to start jogging. But these are the exceptions in the industry, not the rule. Media attention and lavish funding are still overwhelmingly aimed at businesses and exercise personalities that promise the kind of punishment that only a small portion of the population can take—and that most people don’t even want. The responsibility for figuring out how to help more people find accessible introductions to exercise usually falls to the people who actually need these services in the first place, or to those who were clued into that need in intimate ways. Liu began making his instructional videos after his mom passed away in early 2020; he had spent the previous several years caring for her after a debilitating stroke. “I always think about, Would this be able to help her if she were still around?” he told me. “It never hurts to add an easier step.” For Casey Johnston, who developed an eight-week starter course called Liftoff: Couch to Barbell, the impetus was her own experience attempting to pick up strength training. She tried a popular beginner’s program, but when she got in the gym, she realized that she wasn’t yet strong enough to lift a barbell, even without any weights attached. The bar itself weighs 45 pounds—more than lots of true beginners would be able to maneuver safely on their own. Johnston, who felt much more comfortable on the cardio machines, had to work her way up to that initial threshold using free weights. “The things that are mundane about strength training feel very intimidating to somebody who’s totally new to it,” she told me. “It’s this big, heavy barbell, or this big, complicated-looking squat rack, or the bench that only extremely jacked, really sweaty bros who are yelling ever use.” But Johnston bet that plenty of people would give it a try if she could make it more accessible. So far, that bet has paid off for Johnston: Between her newsletter, called She’s a Beast, and her beginner’s program, she has replaced the income that she lost after getting laid off from a media job last year. Liu, too, now makes instructional material for beginners as his full-time job. Jessamyn Stanley, a fat yoga instructor with almost half a million Instagram followers and two successful books, has built a thriving virtual yoga business with The Underbelly, which has its own widely available app for phones and smart TVs. There is a very real market for this kind of fitness instruction, and lots of people really want to avail themselves of it. [Read: For women, is exercise power?] If you want to find truly beginner-level exercise services in person instead of online, things can be a little trickier. Morit Summers and Francine Delgado-Lugo opened Form Fitness in Brooklyn in 2018 after meeting in a more typical gym where Summers, who published Big and Bold: Strength Training for the Plus-Size Woman last year, was a trainer. “We really wanted to create a space where people could walk in and realize that you don’t have to have an aesthetic goal,” Delgado-Lugo, who’s also a personal trainer and health coach, told me. Scaling the business has been a bit slower going for Form than it has been for some of its online counterparts, partly because the studio has to pull in people from the surrounding area instead of the entire world, and partly because there’s no tried-and-true method for getting your fitness business in front of people who are used to being ignored or belittled by the industry. But Delgado-Lugo and Summers have done it, even with pandemic interruptions, and novices make up the bulk of their business. As it turns out, if people know you’re not going to punish them or shame them or try to put them on a diet, many of them feel more comfortable asking you to teach them things. It is, of course, not entirely logical that any of these things should have to be profitable in order to exist, or that people who want to provide these services should have to make the math work out on their own in order to do so. To make exercise instruction and equipment available for everyone, no matter their level of fitness or mobility, would be a public good—improving population health, reducing health-care costs, and making millions of people’s lives better. This is the type of thing that a functional modern society should endeavor to provide to its members, regardless of individual ability to pay. As Petrzela, the historian, pointed out to me, these services have been freely given to the public in the past. Before the private-sector fitness industry exploded in the 1980s, tax-funded recreation centers, youth sports leagues, and community pools were much more plentiful in the United States, she said, even if unevenly distributed among predominantly white and Black neighborhoods. “This is part of a greater austerity politics, which is affecting every aspect of our lives,” she told me. She calls it “the privatization of the good life”: Public funding for facilities and programming dries up, and wealthier people buy gym memberships and Pelotons and enroll their kids in private sports leagues. “In my lifetime, I have seen the prices of fitness products and experiences skyrocket,” Petrzela said. Poorer people can’t afford those things, and their neighborhoods are less likely to be safe for outdoor recreation, or to have intact sidewalks and functional playgrounds. The numbers bear out this split: Among the best predictors of how much exercise Americans get is how much money they make. Liu thinks about the financial costs of exercise constantly. His instructional videos are supported by advertising instead of membership fees, he focuses on moves that use body weight or that can be done with around-the-house objects such as chairs or towels, and his full recommended routine is available on his website, free of charge. Because of Liu’s huge subscriber numbers, he can run a business without directly charging for the majority of his output, which isn’t possible for most teachers who go it alone. “I want to make as much knowledge free as possible,” he told me. “The more options people have, the more likely that someone will find something that they like and stick to it.” from https://ift.tt/SFzpkf9 Check out http://natthash.tumblr.com If you commuted to work today on a bus, train, or metro system, you probably saw more mouths and noses than usual. On Monday, a Trump-appointed federal judge struck down a CDC rule that mandated masks on all U.S. transportation networks, including in airports and on planes. Airline passengers who were mid-flight when the news broke cheered and ripped their masks off, discarding them in trash bags that unmasked flight attendants helpfully brought up and down the aisle. Over the past several months, vaccine requirements in restaurants, mask mandates in schools and retail spaces, and testing requirements for workers have all been reversed. But the end of airplane masking in particular has inspired a disproportionate reaction—of both extreme relief and utter outrage. One pilot reportedly called the end of the mandate “the most important announcement I’ve ever made.” An ER doctor wondered how “people who claim to love kids are totally cool” with babies dying from COVID. Why, exactly, is this rollback so different from all other rollbacks? In some ways, the masking rules on transportation should matter less for public health than other masking mandates, not more. Most people who don’t work in transportation probably spend relatively little time in train stations, buses, and Jetways, as compared with workplaces, where mask requirements are already scarce. Joseph Allen, who directs Harvard’s Healthy Buildings program, told me that, in general, ventilation is also better on trains and airplanes than it is in restaurants, offices, and homes. (That’s true only as long as the HVAC system is actually turned on, which it tends not to be while a plane is on the tarmac.) On buses, ventilation depends on whether the driver has the vehicle in air-recirculation mode. “There’s been too much attention on the risk in airplanes for a long time,” Allen said. “Airplanes are not where super-spreading is happening.” In the broadest sense, removing the transportation-network mandate is not likely to have an enormous, near-term effect on the trajectory of the pandemic. Even if mask compliance on subways and buses suddenly went down to, say, 10 percent in a major American city, any increase in cases or hospitalizations “would probably be small—small to the level of not being detectable by our current surveillance systems,” David Dowdy, an epidemiologist at Johns Hopkins University, told me. Whether or not masking on buses keeps community spread in check, it has other benefits. “For me, the mask mandate is not simply a tool to control transmission, but rather one that makes our essential spaces safer and accessible for everyone,” Anne Sosin, a public-health researcher at Dartmouth, told me. People who are at risk because they are very elderly, or who get a bit less benefit from the vaccines because they’re immunocompromised, or who have small children, can generally avoid bars and concert venues if they want to. Buses and metros are much harder to steer clear of. Black and Hispanic Americans, who have gotten sick and died at higher rates than their white peers throughout the pandemic, are more likely to use public transportation—and more likely to support mask mandates there. All the experts I spoke with said the change in policy itself was less significant than the manner in which that change was carried out. Other pandemic restrictions have generally been allowed to expire or repealed by the same authorities that instituted them. The public-transportation mask mandate was implemented by the CDC and repealed by a federal judge in Tampa, Florida. If the Biden administration doesn’t appeal the ruling—or if it appeals and loses—then the federal government’s ability to enact restrictions could be limited far beyond this summer. “If something unpredictable happens next, where we need CDC to put in mandates, that authority’s in question,” Allen said. That could be especially dangerous if the country is dealing with a new variant or a new pathogen that spreads to new areas via interstate travel. The rollback of the transportation-network mandate also feels different because it was among the very last, broad restrictions that were still in place. Throughout the pandemic, public-health experts have touted a Swiss-cheese approach to protection: No single approach is perfect, whether it be masking, vaccination, or social distancing; but layering them all together helps cover up the holes. Each restriction that gets pulled back is another slice of cheese gone, another way the population becomes more vulnerable. Now, with no more masking on airplanes, trains, and buses, we’re almost dairy-free. Until this week, transportation hubs were the only place left where many Americans were required to be masked. A handful of regional transit agencies, including in New York City and Portland, Oregon, are still demanding that their riders cover up. But in communities across the country, Americans face few, if any, pandemic restrictions. A vaccination requirement for federal workers still stands. But other than that, Sosin said, “this is the last domino to fall.” from https://ift.tt/awWyuGY Check out http://natthash.tumblr.com As the United States nears its numbing, millionth COVID death and shrugs its shoulders at a rise in cases, some Americans are feeling left behind. Immunocompromised people have suffered disproportionately throughout the pandemic, and even those who have been fully vaccinated wonder if they’re really safe. News stories highlight their struggles to adapt to a society that “doesn’t seem to care whether they survive.” “I could just go outside and within two weeks, I could be dead,” a fibromyalgia sufferer told ABC News last month. She went on to say, “It kind of feels like immunocompromised people are getting sacrificed.” This dramatic coverage underscores the continuing risks of the pandemic, especially for those who are most vulnerable: Immunocompromised people who get vaccinated aren’t quite as safe as the general vaccinated population. (The degree of added risk depends on the underlying condition.) But well-intentioned stories on this issue sometimes overstate the case, claiming that COVID shots for the immunocompromised are “ineffective” or “cannot work on everyone.” That is incorrect, and it hinders uptake of vaccines. The shots do provide these patients with very meaningful protection as a rule, Jennifer Nuzzo, the director of the Pandemic Center at Brown University School of Public Health, told me. To suggest otherwise “is just a complete distortion … It’s just scaring people, and it’s not saving lives.” When the mRNA vaccines finally arrived, at the end of 2020, their value for immunocompromised people remained unclear. Members of this high-risk group were specifically excluded from the first trials performed by Pfizer and Moderna. Patients and their doctors had only scientific scraps to guide them in the months that followed: small, preliminary studies that recorded antibody levels after shots. The initial results weren’t promising at all. One study found that just 54 percent of organ-transplant patients, who require the most powerful immune-dampening drugs, had detectable antibodies after two vaccine doses; and when present, these protective proteins accumulated in much lower quantities than were observed in the general population. Some astute patients had their own antibody levels measured and declared themselves “vaccinated but not protected” when the results came up short. Sure enough, when Omicron arrived last fall, immunocompromised people were hit the hardest. A study conducted by Kaiser Permanente in California showed that immunocompromised patients who had received three Moderna doses were just 29 percent protected from Omicron infection—as compared with the 71 percent protection afforded others. Some patients’ antibody levels can still be low after three, four, or even five vaccine doses. (Three primary doses and two boosters are now recommended for this population.) Yet there’s a silver lining. Antibodies matter, but they matter most for preventing illness, at any level of severity. Regarding the most dangerous outcomes from disease, recent research from the CDC indicates that—shot for shot—the immunocompromised achieve most of the same benefits as healthy people. One study, published in March, looked at the pandemic’s Delta wave and found that three doses of an mRNA vaccine gave immunocompromised people 87 percent protection against hospitalization, compared with 97 percent for others. Another CDC report, also out last month, suggested that on the very worst outcomes—the need for a breathing tube, or death—mRNA vaccines were 74 percent effective for immunocompromised patients (including many who hadn’t gotten all their shots), and 92 percent effective for the immunocompetent. A 10-to-20-percentage-point gap in safety from the most dire outcomes is consequential, especially for those who are most susceptible to the disease. Still, these results should reassure us that the immunocompromised are not fighting this battle unarmed. That reassurance means all the more when so many members of the chronic-disease community feel left for dead by the casual reversals of pandemic funding and restrictions. But in place of measured consolation from the experts, they find offhanded comments saying that the vaccines “don’t work” for them (as one public-health-school dean tweeted earlier this month). This despairing rhetoric can’t be helping to encourage vaccination. The CDC hasn’t published data on what proportion of the immunocompromised remain unvaccinated or undervaccinated, but one survey of 21,000 autoimmune patients taking immunosuppressive medications, conducted by a network of rheumatology clinics, found that, as of last September, one in four hadn’t received any shots. Several clinicians involved with this population told me that, even now, many patients are unvaccinated. [Read: America is zooming through the pandemic panic-neglect cycle] When Anne Mills, a physician in Virginia with rheumatoid arthritis, went public with her inoculation experience last year, she hoped to reassure her friends in the autoimmune community that the shots are safe and effective. “We’re still looking at very high response rates and very robust protection against severe disease,” she told me. Now that her entire family is vaccinated, Mills feels better able to mentally compartmentalize her condition, and she is working and traveling again while maintaining some precautions. But she worries that many immunocompromised people have gotten the message that vaccination isn’t worth it. Michael Putman, a rheumatologist at the Medical College of Wisconsin who cares for many patients receiving immunosuppressive medications for autoimmune diseases, confirms that it’s a battle to get his patients inoculated. “The idea that the vaccines don’t work for immunocompromised people has definitely contributed to hesitancy,” he told me. Many autoimmune sufferers worry that the shots might lead to a flare-up of their disease symptoms. Some of Putman’s patients have decided not to take that risk after reading news stories suggesting that the injections wouldn’t help them much anyway. Ironically, patients with rheumatologic conditions, like Putman’s, are generally among the most protected within the immunocompromised cohort, as measured both by antibody production and clinical outcomes. A large CDC analysis of two-dose vaccine regimens within the immunocompromised population found that rheumatologic patients saw an 81 percent decrease in their risk of COVID hospitalization. Next came solid-cancer patients (79 percent protection), blood-cancer patients (74 percent), and those born with immune deficiencies (73 percent). Organ-transplant recipients were the least safe from COVID after vaccination, with just 59 percent of their hospitalizations prevented after two doses. Robert Rakita, a transplant-infectious-disease specialist at the University of Washington, told me that some of his patients have died from COVID despite having had three or four mRNA injections. He recommends that all vaccinated organ recipients continue to wear a mask and avoid crowded indoor activities. But such patients make up just 8 percent of the 7 million Americans estimated to be taking medications that weaken their immune system. When COVID reporting casually lumps together all “immunocompromised” patients, it papers over these differences. Readers are left to think that a fibromyalgia patient and a kidney recipient face similar risks. For chronically ill people, political power derives in part from group solidarity; the larger the contingent, the louder the voice. Yet in pursuit of visibility and justice, the “vaccinated but vulnerable” category may be expanded well beyond what the science suggests, to include not only organ-transplant patients, but also people with diabetes, asthma, obesity, or high blood pressure. According to this paradoxical arithmetic, half of the country can end up in the “high risk” category by some definition. In truth, we all remain vulnerable to COVID; inoculation isn’t 100 percent effective in any demographic. The threat of long COVID also lingers. But the peril is far more concentrated than generic references to “chronic conditions” or “comorbidities” would suggest. Age continues to be, far and away, the most powerful risk factor for becoming seriously ill from the coronavirus. Putman, the rheumatologist, uses an example of a 64-year-old doctor counseling a 24-year-old autoimmune patient to take precautions. The patient should probably be admonishing the doctor instead, he told me. When the vaccine campaign began, with shots for the oldest Americans in nursing homes and elsewhere, news coverage emphasized seniors’ feelings of joy and relief. But the immunocompromised have been described in very different terms, even as vaccines are saving their lives too. Stories focus on their uncertainty and fear—and may end up adding to the same. from https://ift.tt/4xTHZNP Check out http://natthash.tumblr.com Almost exactly 12 months ago, America’s pandemic curve hit a pivot point. Case counts peaked—and then dipped, and dipped, and dipped, on a slow but sure grade, until, somewhere around the end of May, the numbers flattened and settled, for several brief, wonderful weeks, into their lowest nadir so far. I refuse to use the term hot vax summer (oops, just did), but its sentiment isn’t exactly wrong. A year ago, the shots were shiny and new, and a great match for the variants du jour; by the start of June, roughly half of the American population had received their first injections, all within the span of a few months--a remarkable “single buildup of immunity,” says Virginia Pitzer, an epidemiologist at Yale. The winter surges had run their course; schools were letting out for the season; the warm weather was begging for outdoor gatherings, especially in the country’s northern parts. A confluence of factors came together in a stretch that, for a time, “really was great,” Katelyn Jetelina, an epidemiologist at the University of Texas Health Science Center at Houston, told me. It’s now the spring of 2022, and at a glance, the stop-SARS-CoV-2 stars would seem to be aligning once more. Like last time, cases have dropped from a horrific winter peak; like last time, people have built up a decent bit of immunity; like last time, rising temperatures are nudging people outside. Already, one of the pandemic’s best-publicized models is projecting that this summer could look about as stellar as the start of last. These trends don’t guarantee good times. If anything, national case counts—currently a woeful underestimate of reality—have started to creep upward in the past couple of weeks, as an Omicron subvariant called BA.2 continues its hostile takeover. And no one knows when or where this version of the virus will spit us out of its hypothetical surge. “I have learned to not predict where this is going,” says Theresa Chapple, a Chicago-area epidemiologist. [Read: America is staring down its first so what? wave] In crisis, it’s easy to focus our attention on waves—the worst a pandemic can bring. And yet, understanding the troughs—whether high, low, or kind of undecided—is just as essential. The past two years have been full of spastic surges; if the virus eventually settles down into something more subdued, more seasonal, and more sustained, these between-bump stretches may portend what COVID looks like at baseline: its true off-season. At these times of year, when we can reliably expect there to be far less virus bopping around, our relationship to COVID can be different. But lulls are not automatic. They cannot be vacations. They’re intermissions that we can use to prepare for what the virus serves up next. Lulls, like waves, are the products of three variables—how fast a virus moves, how hospitable its hosts are to infection, and how often the two parties are forced to collide. Last year’s respite managed to hit a trifecta: a not-too-speedy virus met fresh vaccines while plenty of people were still on high alert. It was enough to stave off COVID’s worst, and tamp transmission down. This time around, some of the variables are a bit different. The virus, for one, has changed. In the past year, SARS-CoV-2 has only gotten better at its prime operative of infecting us. High transmissibility nudges the natural set point of the pandemic higher: When the virus moves this fast among us, it’s simply harder to keep case levels ultralow. “We have a lot less breathing room than we used to,” says Alyssa Bilinski, a health-policy researcher at Brown University. The situation arguably looks a bit better on the host side. By some estimates, population immunity in the U.S. could be near its all-time high. At least 140 million Americans--perhaps many more—have been infected with SARS-CoV-2 since the pandemic’s start; some 250 million have dosed up at least once with a vaccine. Swirl those stats together, and it’s reasonable to estimate that more than 90 to 95 percent of the country has now glimpsed the coronavirus’s spike protein in some form or another, many of them quite recently. On top of that, America has added a few tools to its defensive arsenal, including a heftier supply of at-home tests to identify infection early and super-effective oral antivirals to treat it. But any discussion of immunity has to be tempered with a question: immunity … against what? Although defenses against serious illness stick around pretty stubbornly, people’s safeguards against infection and transmission erode in the months after they’ve been infected or vaccinated—which means that 90 to 95 percent exposed doesn’t translate to 90 to 95 percent immune. Compared with last spring, the map of protection is also much patchier, and the range of immunity much wider. Some people have now banked several infections and vaccinations; others are many months out from their most recent exposure, or haven’t logged any at all. Add to that the trickiness of sustaining immunity in people who are older or immunocompromised, and the mediocrity of America’s booster campaign, and it’s easy to see how the country still has plenty of vulnerable pockets for the virus to exploit. [Read: Will Omicron leave all of us immune?] Then there’s the mess of us--our policies and our individual choices. The patterns of viral spread “depend a lot on what we as a society do, and how we interact,” Yonatan Grad, who studies infectious-disease dynamics at Harvard, told me. A concerted effort to mitigate transmission through masking, for instance, could help counteract the virus’s increased contagiousness, and squish case curves back down nice and low. But the zeal for such measures is all but gone. Even amid the rise of actual waves, “the willingness to take on interventions has gotten smaller,” Yale’s Pitzer told me. During declines and lulls, people have even less motivation to act. The more the virus is allowed to mosey about, the more chances it will have to mutate and adapt. “Variants are always the wild card,” says Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison. Already, America is watching BA.2—the speedier sister to the viral morph that clobbered the country this winter (now retconned as BA.1)—overtake its sibling and spark outbreaks, especially across the northeast. Perhaps BA.2 will drive only a benign case bump. Maybe a sharp surge will happen, but contract quickly, ushering the country out of spring with even more immunity on its side. Or BA.2’s rise will turn dramatic and prolonged, and sour summer’s start all on its own. Nor is BA.2 the worst-case scenario we could imagine, Sethi told me. Though it’s faster than BA.1, it doesn’t appear to better sidestep the immune shields left behind by infection or vaccines. SARS-CoV-2’s relentless mutational churn could still slingshot something far more problematic our way; already, a slew of recombinant variants and other Omicron subvariants are brewing. I asked Deshira Wallace, a public-health researcher at the University of North Carolina at Chapel Hill, what would make this summer less than rosy—or possibly, close to cataclysmic. “Continuing as is right now,” she told me. The pandemic is indeed still going, and the U.S. is at a point where excessive mingling could prolong the crisis. Tracking rises in cases, and responding to them early, is crucial for keeping a soft upslope from erupting into a full-on surge. And yet, across the nation, “we’ve been seeing every single form of protection revoked,” Wallace said. Indoor mask mandates have disappeared. Case-tracking surveillance systems have pulled back or gone dark. Community test and vaccination sites have vanished. Even data out of hospitals have begun to falter and fizz. Federal funds to combat the pandemic have dried up too, imperiling stocks of treatments and care for the uninsured, as the nation’s leaders continue to play chicken with what it means for coronavirus cases to stay “low.” And though many of the tools necessary to squelch SARS-CoV-2 exist, their distribution is still not being prioritized to the vulnerable populations who most need them. Spread is now definitively increasing, yet going unmeasured and unchecked. Americans would have less to worry about if they reversed some of these behavioral trends, Wallace told me. But she’s not counting on it. Which puts the onus on immunity, or sheer luck on the variant side, to countervail, which are gambles as well. Say no new variant appears, but immunity inevitably erodes, and no one masks—what then? Behavior is the variable we hold most sway over, but America’s grip has loosened. Last year, around this time, “there were more protections in place,” Wallace said. “Now it just feels like we’re in chaos.” Even last summer’s purported reprieve was a bit of an illusion. That lull felt great because it was the pandemic’s kindest so far in the United States. But even at its scarcest, the virus was still causing “about 200 deaths per day, which translates to about 73,000 deaths per year,” Bilinski told me. That’s worse than even what experts tend to consider a very bad flu season, when annual mortality levels hit about 50,000 or 60,000, Harvard’s Grad told me. (Stats closer to 10,000 or 20,000 deaths in a season are on the “low” end.) To chart a clearer future with COVID, even during lulls, the United States will have to grapple with a crucial question, says Shruti Mehta, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health: “What’s the acceptable level of mortality per day?” There’s a bit of a bind to work through here. With SARS-CoV-2’s dominant variants now as fast-spreading as they are, infections will remain tough to stave off, at least in the near term. The U.S. is growing only less equipped to track cases accurately, given the shift to home tests, which are rarely reported; community-level data collection is also in disastrous flux. So in some respects, the success of future COVID off-seasons might be better defined by hospitalizations or deaths, UT Health’s Jetelina noted, as many other infectious diseases are. It’s the exact shift that the Biden administration and the CDC have been pushing the population toward, and there is at least some logic to it. Thanks in large part to the potency of vaccines, infections have continued to untether from serious illnesses; speedy diagnostics and treatments have made a big dent as well. (Consider, for instance, that COVID hospital admissions have now dipped below last summer’s lows, even though documented cases have not.) But merely tracking hospitalizations and deaths as a benchmark of progress doesn’t prevent those outcomes; they’ve already come to pass. By the time serious illness is on the rise, it’s too late to halt a surge in transmission that imperils high-risk groups or triggers a rash of long-COVID cases. That makes proactiveness during case lulls key: The virus doesn’t have to be actively battering a country’s shields for them to get a shoring up. It’s tempting to chill during low-case stretches—“ignore the virus for a little while, stick our heads in the sand,” says Andrea Ciaranello, an infectious-disease physician at Massachusetts General Hospital. But it’s wiser, she said, to realize that efforts to build capacity at community, state, and federal levels can’t rest during off-seasons. Lulls do tend to end. It’s best if they don’t catch people off guard when they do. I asked nearly a dozen experts where they’d focus their resources now, to ameliorate the country’s COVID burden in the months and years ahead. Almost all of them pointed to two measures that would require intense investments now, but pay long-term dividends—all without requiring individuals, Chapple told me, to take repeated, daily actions to stay safe: vaccines, to blunt COVID’s severity; and ventilation, to clean indoor air. Other investments could similarly pay off when cases rise again. More widespread wastewater-surveillance efforts, Ciaranello says, could give public-health officials an early glimpse of the virus. Paid-sick-leave policies could offer workers the flexibility to isolate and seek care. If masking requirements stay in place on buses, trains, subways, and planes, they could more seamlessly move into other indoor public places when needed. “The more we’re willing to do that’s happening in the background, the more headroom we have,” Bilinski told me. [Read: We’re entering the control phase of the pandemic] Most essential of all, vaccines, tests, masks, and treatments will need to become and remain available, accessible, and free to all Americans, regardless of location, regardless of insurance. Supply alone is not enough: Leaders would need to identify the communities most in need, and concentrate resources there—an approach, experts told me, that the U.S. would ideally apply both domestically and abroad. A truly good summer would be one in which “we felt like the risk level was more comparable across populations, across individuals,” Mehta told me. America, much less the globe, is nowhere near that benchmark yet.
from https://ift.tt/RdYtfH5 Check out http://natthash.tumblr.com The World Health Organization formally declared the coronavirus a global pandemic on March 11, 2020. More than two years later, the pandemic has no clear end date in sight. There have been false starts toward a sense of normalcy: the drop in cases in the summer of 2020, the race to get “shots in arms” in 2021, the few weeks of “hot vax summer,” and the end of mask mandates in many states in March. But, as my colleagues have reported, even though Congress recently cut coronavirus funding, the pandemic is not over for the unvaccinated, the elderly, the immunocompromised, or Black and brown Americans, who are twice as likely to have died from COVID as their white counterparts. Long COVID, a mysterious set of debilitating symptoms without a cure, has left many feeling like science has failed them too. We exist now in a moment of record-setting deaths, confusing public-health guidance, and little understanding of how, or when, normal begins. To help make sense of what society has experienced, we asked our Instagram followers to share one sentence that describes their “new normal” and three words that characterize their hopes for our post-COVID world. Read their responses in The Atlantic’s COVID Time Capsule, a reflection on the past two years captured in our current moment. In one sentence, how would you describe your new normal? Subdued happiness, bedeviled by impending doom “I care less about devoting my life to work and more about living.” “I can no longer tell the difference between loneliness and solitude.” “I have found joy and beauty all around me.” Becoming a wife and mother during COVID has been bittersweet “Nothing seems simple anymore.” “I live hyperlocally, focus on outdoor activities, and no longer travel.” “The thought of leaving the house twice in one day makes me shudder.” “Mask in the glove box and rapid test in the closet.” “Missing my dad.” A balance of savoring life and the guilt we made it through okay “I have turned into an antisocial goblin.” “Going out maskless seems weird now, like you are naked.” “So much loss.” Share three words to describe your hope for the future Empathy, compassion, understanding “Hug loved ones.” “Belief in science.” “Hope, love, empathy.” “Peace of mind.” “Vaccination for toddlers.” “To be calm.” “Return to sanity.” Remember our humanity “Freedom from fear.” “See faces again.” “Dinner with friends.” “No more masks.” “All are vaccinated.” To add your reflections to the time capsule, share it on social media with your thoughts and tag us—@theatlantic on Instagram, Facebook, and Twitter. from https://ift.tt/FjA3gCE Check out http://natthash.tumblr.com When coronavirus variants emerged in full force in late 2020, the news suddenly turned into alphanumeric soup. Remember? The U.K. variant, B.1.351, GR/501Y.V3. After this initial period of chaos, the World Health Organization came up with a sanity-preserving system that renamed those variants, respectively, Alpha, Beta, and Gamma. And down the Greek alphabet we went, until we got to Omicron. The system worked. Lately however, the post-Omicron news landscape is turning into alphanumeric soup again. An Omicron subvariant called BA.2 is now globally dominant. BA.4 and BA.5 have just been discovered. And a cornucopia of new recombinants have names that seem to follow some inscrutable logic: XD (a recombinant of Delta and BA.1), XE (a recombinant of BA.1 and BA.2), XF (a different recombinant of Delta and BA.1), and so on, all the way down to XS (a recombinant of Delta and BA.1.1). Would it help if I told you that the names do actually follow a coherent internal logic, which is quite pleasing once you’ve read and digested all 1,800 words laying out the rules? No? Okay, well, I will instead try to explain where the rules came from and why they are still used, despite the WHO’s much simpler Greek-letter system. Back in March 2020, scientists who study viral evolution began tracking how the novel coronavirus was changing. They ran into a very basic communication problem: What to call a new lineage after its genome was sequenced? “People in the U.S. were calling it one thing; people in Europe were calling it another,” says Áine O’Toole, a postdoctoral researcher at the University of Edinburgh. So O’Toole’s adviser, Andrew Rambaut, and a group of collaborators came up with a naming system. They called it Pango. And O’Toole, who is now the chair of Pango’s lineage-designation committee, worked on a piece of software called pangolin, which allowed scientists to assign a likely Pango name to any viral genome. (Yes, Pango is a tongue-in-cheek reference to pangolins, which were briefly suspected to have had a role in the coronavirus’s origin—several of the team’s computational tools are named after animals—and yes, this became confusing when pangolin lineage could be used to mean either viral lineages found in pangolins or lineages assigned by the pangolin tool. Again, scientists talking among themselves didn’t quite anticipate how their jargon might be interpreted by others.) At this point, no one yet knew the dramatic role that variants would play in the pandemic. Scientists were mostly interested in tracking lineages to see how the virus spread from country to country. And there were only two main lineages of the coronavirus at first: A and B. As the virus accrued different mutations in different places around the world, scientists used the Pango system to name sublineages by adding numbers. B.1.1.7, for example, is the seventh sublineage to be discovered of B.1.1, which in turn is the first sublineage discovered of B.1. You might know B.1.1.7 better as “Alpha.” O’Toole remembers overhearing the BBC talk about “B.1.1.7” over Christmas in 2020. “It was very surreal for me,” she told me. “I remember saying to my sister, ‘Oh, you know that name there?’ And she’s like, ‘Yeah, it’s awful.’” These names were designed for scientists tracking lots and lots of different variants. For the general public, she said, “we hadn’t considered how difficult it would be to tell apart B.1.1.7, B.1.351, and B.1.128.” [Read: We can now see a virus mutate like never before] Until late 2020, though, the general public didn’t really need to tell different lineages apart. Alpha was the first variant to truly change the pandemic’s trajectory. The world now needed a system that distinguished “variants that are epidemiologically important” from “variants that simply exist.” The WHO Greek-letter system is meant to do the former, the Pango system the latter. This division of responsibility has worked fairly well, though Omicron has made things a little more complicated. The variant that the WHO originally designated as Omicron is called B.1.1.529 under Pango. Scientists then quickly found further subvariants of Omicron, which you might know as BA.1, BA.2, and BA.3. This is because when names get too long under the Pango nomenclature system, the first part of the name gets replaced with a new letter—or a pair of letters if all the single letters are taken. When the Omicron subvariants were described, the next available pair of letters was BA. So instead of B.1.1.529.2, we have BA.2. By chance, we ended up with some relatively easy-to-remember Omicron subvariant names. BA.1 and BA.2 have caused big, successive waves in parts of Europe. The two subvariants are actually quite distinct from each other, almost as evolutionarily divergent as Alpha was from Delta. But the WHO decided back in February that BA.2 should still be considered Omicron, and more recently, it decided BA.4 and BA.5 should be too. Could an Omicron subvariant look and behave so differently that it actually should get a new Greek letter? In retrospect, BA.2 falls in a somewhat debatable zone: The BA.2 wave got as big, if not bigger, than the original BA.1 wave in some European countries, but it’s not looking to be quite as dramatic yet in the U.S. There’s a balance, O’Toole said, between giving a lineage a name as soon as possible and giving it a name when you know its epidemiological importance. The earlier we try to designate variants with Greek-letter names, the less we know about what they’re potentially capable of. The WHO has also designated many variants of interest—Epsilon, Eta, Iota, and Lambda, to name a few—that did not end up making a big epidemiological impact. In recent months, more recombinants have appeared too, and this is not a coincidence. This coronavirus, like other coronaviruses, has always been capable of recombination. But early on, different lineages were so similar to one another that recombination just meant swapping very similar sequences—in other words, it didn’t mean much. Recently, however, parts of the world have seen a Delta wave followed by a BA.1 wave followed by a BA.2 wave. High co-circulation of several distinct lineages means more potential for recombination. The Pango system anticipated recombinants from the beginning, reserving the letter X for recombinant lineages. Then you just go down the alphabet and keep adding letters or numbers as usual. The WHO is monitoring one recombinant, XD, and if any recombinants start driving cases upward, they too could get a Greek-letter name. That new lineages with confusing Pango names are making it into the news even before we understand their importance reflects a truly unusual level of media and public interest in the nitty-gritty of viral evolution. A naming system that follows the Greek alphabet might seem to imply a linear progression of new variants. But viral evolution is more like watching a tree branch and grow. And you don’t know which branches will become stunted and which will go on to grow long and dense with twigs. Nor can you know which distant branches might fuse with one another into a recombinant branch that itself grows long and dense. The Greek-letter system is meant to highlight the most important branches in this tree of viral evolution. But it doesn’t cover everything—not even close. The Pango system now encompasses more than 2,000 lineages, the majority of which are consigned to obscurity. And in all likelihood, most of the alphanumeric-soup names in the news today will go back to obscurity soon too. If they don’t, well, then we’ll probably all have a new Greek letter to learn. from https://ift.tt/JK6tTO2 Check out http://natthash.tumblr.com Photo Illustrations by Aaron Turner Lucy Esparza-Casarez thinks she caught the coronavirus while working the polls during California’s 2020 primary election, before bringing it home to her husband, David, her sister-in-law Yolanda, and her mother-in-law Balvina. Though Lucy herself developed what she calls “the worst flu times 100,” David fared worse. Lucy took him to the hospital on March 20, the last time she saw him in the flesh. He died on April 3, nine days before their wedding anniversary, at the age of 69. Lucy said goodbye over Skype. During that time, Yolanda fell ill too; after two months in the hospital, she died on June 1. Balvina, meanwhile, recovered from her bout with COVID-19, but, distraught after losing two children in as many months, she died on June 16. Lucy found herself alone in her home for the first time in 23 years. Because the hospital never returned David’s belongings, she didn’t even have his wedding ring. Lucy had coped with the losses of her father, sister, and mother in the two decades before the pandemic. But she told me that what she feels now is fundamentally different. She never got to comfort David before he died, never got to mourn him in the company of friends, and never escaped the constant reminders of the disease that killed him. Every news story twisted the knife. Every surge salted the wound. Two years later, she is still inundated by her grief. “And now people are saying we can get back to normal,” she told me. “What’s normal?” The number of people who have died of COVID-19 in the United States has always been undercounted because such counts rely on often-inaccurate death certificates. But the total, as the CDC and other official sources suggest, will soon surpass 1 million. That number—the sum of a million individual tragedies—is almost too large to grasp, and only a few professions have borne visceral witness to the pandemic’s immense scale. Alanna Badgley has been an EMT since 2010, “and the number of people I’ve pronounced dead in the last two years has eclipsed that of the first 10,” she told me. Hari Close, a funeral director in Baltimore, told me that he cared for families who “were burying three or four people weeks apart.” Maureen O’Donnell, an obituary writer at the Chicago Sun-Times, told me that she usually writes “about people who had a beautiful arc to their life,” but during the pandemic, she has found herself writing about lives that were “cut short, like trees being cut down.” On average, each person who has died of COVID has done so roughly a decade before their time. In just two years, COVID has become the third most common cause of death in the U.S., which means that it is also the third leading cause of grief in the U.S. Each American who has died of COVID has left an average of nine close relatives bereaved, creating a community of grievers larger than the population of all but 11 states. Under normal circumstances, 10 percent of bereaved people would be expected to develop prolonged grief, which is unusually intense, incapacitating, and persistent. But for COVID grievers, that proportion may be even higher, because the pandemic has ticked off many risk factors. Deaths from COVID have been unexpected, untimely, particularly painful, and, in many cases, preventable. The pandemic has replaced community with isolation, empathy with judgment, and opportunities for healing with relentless triggers. Some of these features accompany other causes of death, but COVID has woven them together and inflicted them at scale. In 1 million instants, the disease has torn wounds in 9 million worlds, while creating the perfect conditions for those wounds to fester. It has opened up private grief to public scrutiny, all while depriving grievers of the collective support they need to recover. The U.S. seems intent on brushing aside its losses in its desire to move past the crisis. But the grief of millions of people is not going away. “There’s no end to the grief,” Lucy Esparza-Casarez told me. “It changes. It morphs into something different. But it’s ongoing.” By upending the entire world, COVID could have created a shared experience that countered the loneliness of grief. But most of the people I’ve been speaking with feel profoundly lonely—detached from society, from their support network, and especially from their loved ones at the moment of their death. Sabila Khan’s dad, Shafqat, had an aggressive form of Parkinson’s disease, and she knew their time together was limited. “But every time I imagined him dying, I imagined us being with him,” she told me. In her mind, the family would encircle his bed, filling his final moments with tributes of love and gratitude. Instead, none of them saw him for a full month before his death. The rehab facility where he was temporarily staying closed its doors to visitors in March 2020. The family kept in touch with him through daily calls, but after COVID hit the facility and took Shafqat’s voice, he stopped answering. On April 6, he was rushed to a hospital just three blocks away from the family’s house, but when he died 8 days later, “he might as well have been on a different planet,” Sabila told me. Donovan James Jones loved WWE and church. “He made his own decision to be baptized,” his mother, Teresita Horne, said. “He was so proud.” Most of the grievers I interviewed had similar experiences, especially during the early pandemic. From the last time they saw their loved one in person to the moment they said goodbye on a grainy screen, their separation was absolute. They weren’t allowed to visit. Communication was impossible once ventilators became necessary. Updates were scarce because hospitals were overwhelmed. There was just the waiting. Some waited while fighting for their own life. Teresita Horne had spent more than a week on a breathing machine when her 13-year-old son, Donovan, died in a different hospital; she watched him die on her phone. “I remember screaming,” she told me. “When your kids are sick, they need you, but I couldn’t be there to comfort him. I couldn’t hold his hand one last time.” These experiences share qualities with other devastating crises. Sarah Wagner, an anthropologist at George Washington University who researches death and mourning, sees similarities between the experiences of COVID grievers and people whose loved ones went missing during wars. “Families didn’t know what happened and are left to imagine those horrible last moments” in a way that “still troubles their grief years later,” she told me. Sabila Khan, for example, knows little about her father’s final days, except that he likely spent them “in a warzone of an ER,” she told me. “What was he thinking? How do I even come to terms with that?” Many grievers know that dying from COVID is long and grueling. Sherry Congrave Wilson was tearful but unflinching when she told me that Felicia Ledon Crow, her best friend of 30 years, died suffering and alone. “I just hope and pray that she had a loving nurse, someone around who was kind to her,” Congrave Wilson said. The aftermath of a COVID death is lonely too. Social rituals can help people cope with guilt and uncertainty, but during much of the pandemic, funerals, wakes, and shivas haven’t happened. Kristin Urquiza, a co-founder of the nonprofit Marked by COVID, lost her father in June 2020; aside from a bizarre virtual funeral where the connection kept glitching, she still hasn’t been able to mourn and celebrate him with the hundreds of people who loved him. And without outlets for collective expression, grief can stew. Hari Close, the funeral director, told me that some people felt they had failed their loved ones twice over, first by not being with them at the end and again by not being able to celebrate their life. After death, routine and social connection can help mourners cope. But grievers have been deprived of both because of America’s continued failure to control the pandemic. “In addition to mourning my dad, there was that extra layer of mourning my life,” Sabila said. Several people told me that friends or family members who once would have been supportive pillars became distant or unhelpful, either because they began to swallow pandemic misinformation or because they were simply exhausted. When Rekha, a family friend of mine who lives in Seattle, lost her dad in 2013, “everyone I knew showed up and took care of me,” she told me. That didn’t happen when her mother died of COVID this January because “everyone’s depleted,” she said. (The Atlantic is identifying Rekha by only her first name to protect her extended family’s desire for privacy.) Shafqat Khan loved activism, sports, and books—American, British, South Asian classics and serials, and, “when he was especially desperate,” his daughter Sabila’s young-adult novels, she said. While support has vanished, reminders of loss have proliferated. Many people have found themselves isolating in now-emptier homes. The phones on which they watched their loved ones die sit in their hands every day. The disease that has caused them so much pain has been perpetually on the news and on people’s lips—a miasma of triggers that has kept their grief raw. “To have to confront on an almost hourly basis everyone’s feelings about this situation that we’re in made it so much worse,” Kristin Urquiza told me. Many of the people I interviewed felt that their loved ones immediately became statistics—that their individual tragedy was subsumed by the pandemic’s enormity, and that people were constantly discussing every aspect of the crisis except for grief. “In American culture, grief is already a very isolating experience, but it has been even more isolating this time around—which is weird because we’re all supposed to be in this collective experience together,” Rekha said. The pandemic’s circumstances have left her and millions of others in an almost paradoxical state of mass isolation. They’ve all shared in the same tragedy but feel so very alone. When COVID grievers tell others about their loss, they tend to get the same responses. Do you know how they were exposed? Did they have a preexisting condition? Were they vaccinated? Every griever I interviewed has faced these questions, from online trolls and close friends alike, and with shocking immediacy. People regularly ask Rekha if her dead mother was vaccinated before they offer condolences or sympathies. “It’s not just one time; it’s all the time,” she said. “It’s all the time,” Kristin Urquiza echoed. “Pretty much from every person,” says Christina Faria, who lost her mother, Viola, late last year. In 1989, the grief expert Kenneth Doka coined the term disenfranchised grief to describe situations where people struggle to cope with losses that aren’t “socially sanctioned, openly acknowledged, or publicly mourned.” That’s exactly what many Americans who have lost someone to COVID are experiencing. The words we normally use to console grievers honor the relationships that death disrupts: I’m sorry for your loss. But the questions that COVID grievers get “reduce the person to the disease,” Rebecca Morse, who studies death and loss at Divine Mercy University and is a former president of the Association for Death Education and Counseling, told me. And they cast judgment upon the circumstances around their infection, “which makes these deaths stigmatized and shameful,” Morse said. If the deceased was unvaccinated, went to a bar, or had preexisting health problems, their life becomes devalued, and their death becomes less tragic. When hearing about Viola’s death, “everyone is like, ‘Oh, she was 76’ or ‘She had heart surgery’ or ‘She was overweight. What did you expect? Of course she was going to be the one to die,’” Christina told me. Especially after vaccines became available, COVID became lumped with causes of death such as lung cancer, liver disease, and AIDS, which society classifies as self-inflicted and therefore worthy of blame rather than sympathy. Instead of getting support, many COVID grievers have been forced to defend their loved ones and justify their grief. “Everyone is having a fear response,” Rekha told me. They’re grasping for signs that their choices, or their lack of preexisting conditions, make them safe. But that instinct easily turns data into stigma. If someone’s death fits with population-wide trends—if they were older, chronically ill, or unvaccinated—their loss is explicable, and therefore dismissible. The compulsion to explain away a death is so strong that although Rekha’s mother was thriving, beyond having high blood pressure, even people who knew her were quick to retrofit poor health onto their memories. They’ll claim she was frail, as if “COVID was the last little bit of her dying anyway,” Rekha told me. “And, like, You were around her, and she was fine!” At the other extreme, people whose deaths don’t fit with population-wide trends are also dismissed as statistical outliers who inconveniently complicate accepted notions of safety. Teresita Horne keeps hearing that kids aren’t at risk from COVID, even though she knows many parents who have lost children of Donovan’s age. “You don’t hear about them,” she told me. The odds that a child will die of COVID are incredibly low, but if your child is part of the numerator, it doesn’t matter how large the denominator is. Similarly, vaccines are extremely effective at preventing COVID deaths—but some vaccinated people still die, Christina’s mother among them. “Everyone assumes she wasn’t vaccinated,” she told me. “They want to believe that people didn’t do all the things they needed to do to be safe—and that’s not true for a lot of people.” When Cleavon Gilman, an ER doctor, honors such folks on Twitter, he gets accused of undermining confidence in vaccines, or even being an anti-vaxxer. “It’s gotten to the point where if someone was vaccinated and died from COVID, people think you shouldn’t talk about it,” he told me. Grievers must also deal with lies and mocking. On the day that Esparza-Casarez’s husband died in April 2020, she watched a press conference in which Donald Trump stated that the virus “is going away.” Zach, an artist who lives in St. Louis, saw a clip of Ted Cruz mocking masks at the Conservative Political Action Conference while his father lay dying in a hospital. (The Atlantic has agreed to identify him by only his first name to avoid heightening tensions in his family that have already been exacerbated by the pandemic.) “It was just a punch in the gut … the mania, the cheering, the applause,” he told me. “Imagine if you lost someone to cancer and half the country was making fun of cancer all the time,” he said. “Imagine that it’s just everywhere, every day, and it doesn’t go away.” Mark Urquiza loved karaoke, the Dallas Cowboys, hunting, NASCAR, and people; he was the life of the party and “never met a stranger,” his daughter, Kristin, said. These dynamics have silenced many grievers, deepening their already intense isolation. Martha Greenwald, a writer in Kentucky, runs a site called Who We Lost where people can post stories of their loved ones; many do so because the site doesn’t allow comments, making it a rare space where they can share their grief without risking judgment. Sympathy is even scarcer for people whose loved ones bought into COVID disinformation. Kristin Urquiza’s father, Mark, took COVID seriously at first but let his guard down in May 2020. Trump had said it was time to reopen society, Arizona Governor Doug Ducey lifted restrictions, and Mark, a lifelong Republican, said, “Why would they say it’s safe if it’s not safe?” Kristin recalled. “That’s when I lost the battle with my dad.” Later, after he caught COVID, most likely at a bar, and before he went into the hospital for the last time, she asked him if he felt betrayed. “My dad never, ever hesitated with his words, but there was just this long pause, and he quietly said yes,” she told me. People have told her that Mark deserved what he got. But Kristin sees him as yet another victim of the disinformation that ran rampant among his social circles, his media universe, and the elected leaders he trusted. “That shouldn’t result in a death sentence,” she said. For more than two years, COVID has tested America’s institutions—its political apparatus, its information networks, its public-health system, its hospitals—and found them all wanting. Several grievers told me stories in which many failing systems crashed down upon their loved ones. A refugee with a family to feed isn’t eligible for financial assistance and so carries on working at an oil change station throughout a COVID surge, and gets infected. Local hospitals are overwhelmed, so a mother moves in with her daughter elsewhere in the country and catches COVID from her grandkids. An immunosuppressed organ-transplant recipient dies of COVID after their child brings it home from school. The employees at a doctor’s office don’t learn that they’re COVID-positive for days, because the holidays have created a backlog of tests, so a mother who turns up for an appointment in the intervening time gets COVID from them. These complicated chains of events mean that “if you lost someone to COVID, you don’t even know where to begin to find accountability,” Alex Goldstein, who runs a memorial Twitter account called @FacesofCovid, told me. Do you blame Trump or Joe Biden? Your governor or your mayor? The person who infected your loved one or the person who infected that person? Those who sow misinformation or those who buy into it? The entire world? “Blame has been placed all over, and responsibility is so diffuse,” Wagner, the anthropologist at George Washington University, told me. “It’s harder to create clear narratives,” which makes the tragedy feel that much more senseless. Many grievers end up blaming themselves. Should I have pulled them out of that nursing home? Should I have pushed them harder to get vaccinated? And worst of all: Did I give them COVID? “There are so many little pivot points where things could have gone a different way,” Rebecca Morse, the death-and-loss expert, told me. “Imagining what could or should have been done can increase both your anger and your guilt.” Rekha told me that her anger comes in waves, “and I don’t even know what to be angry at,” she said. “I feel like we’re all culpable to different degrees.” Many grievers are finding the current phase of the pandemic especially hard. For the families of the first 100,000 Americans to die of COVID, “there was at least a sense that the world had stopped,” Sabila Khan told me. Now, grieving families are told that we must learn to live with the virus that only just tore a hole in their lives. Jeannina Smith, a doctor at the University of Wisconsin at Madison, cares for organ-transplant recipients, who are on immunosuppressive drugs and are therefore particularly vulnerable to disease; she told me that she lost more patients in the Omicron surge than at any previous point in the pandemic. “They did everything right—they got vaccinated and boosted and were so careful,” Smith said, and their loved ones must now mourn them “while society is saying that COVID is over.” Felicia Ledon Crow loved orchids, tulips, DIY, reggae, and walks. She and her friend Sherry Congrave Wilson talked about “getting old together” and being “these crazy hip old ladies,” Congrave Wilson told me. After Christina Faria’s mother died on December 29, 2021, her friends said it was a harsh reminder that the pandemic wasn’t over. “But here we are, not even three months later, and no one talks about her anymore,” Christina told me in March. She has several disabilities that make her vulnerable to respiratory infections, and Viola was her primary caregiver; she’s now struggling to pay her bills, keep her home, and protect her health. And yet, she told me, her friends are getting annoyed that she still wants to wear a mask when she isn’t required to. Many grievers are starved for sympathy and patience because our popular understanding of grief is wrong. An influential but misleading model suggests that it progresses through five stages—denial, anger, bargaining, depression, and acceptance. But in fact, it doesn’t involve discrete stages, doesn’t proceed along a predictable linear path, and might not end in acceptance. “Closure” is a simplistic myth. Grief, as it actually unfolds, is erratic, and in many cases slow. Rekha remembers feeling pressured to move past her dad’s death in 2013; she now feels an extreme version of the same compulsion, as if society is insisting that this is the moment for everyone to move past their pandemic grief together. In mid-March, after an especially tough week, she told her husband that she didn’t know why she was having a bad flare-up of grief. He reminded her that her mother died a month ago. “I had internalized this feeling that it’s time to be done with it,” she said, “and I have to remind myself that it just happened.” Even people who lost their loved ones at the start of the pandemic are still hurting. “Time itself heals nothing,” Morse told me. Time simply gives people chances to learn ways of coping. But those chances have been stripped away by two years of social isolation and upended daily routines. And “without grappling with the daily reality of the loss, the mind doesn’t fully process what happened,” Natalia Skritskaya, an expert in prolonged grief at Columbia University, told me. Instead, many people “created a time capsule,” Morse said, locking their grief away without ever learning how to live with it. When society reopens, the capsule does too, and the grievers reemerge, still raging and sorrowful while everyone else has moved on. “You’re repeating the same parts of grief all over again and not able to get past it,” Keyerra Snype, a health-care worker, told me. She lost her grandmother Shirley during the first COVID surge, and more than two years later, “it’s difficult all over again,” she said. David Casarez loved sci-fi, golf, California’s Moonstone Beach, and gardening. “I called him the ‘orchid whisperer,’” his wife, Lucy, said. Others are trapped in a pandemic time capsule, too, including those whom we rely on to witness death, prevent it, or deal with its aftermath. Hari Close, the funeral director, told me that “even though people think we are used to death, it’s been overwhelming trying to comfort families in their loss,” especially while losing family members and colleagues himself. Cleavon Gilman, the ER doctor, told me that many health-care workers are traumatized after two years of repeatedly telling families that their loved one has died, “hearing that shrill cry on the phone over and over, and then going outside to see a world that’s acting like we’re lying about the numbers.” (Gilman also lost three colleagues to the pandemic: two nurses who died of COVID and a mentor who died of suicide after witnessing the first surge.) Alanna Badgley, the EMT, felt like something broke after Omicron arrived. In February, “at one point, I just started crying and couldn’t stop,” she told me. “I’m just so sad, and I don’t know how to feel better. It’s not like depression. It feels like grief.” Some of the grievers I talked with feel kinship with COVID long-haulers, whose lives have been flattened by months or years of relentless symptoms and who similarly feel dismissed, ignored, and isolated. They didn’t die of COVID, but many nonetheless lost much of their former life. After getting infected in October 2020, Alexis Misko can no longer muster enough energy to stand for more than 10 minutes or sit upright for more than an hour. She was once an occupational therapist and an avid hiker, and “I grieve constantly for that person,” she wrote in 2021. Nick Güthe told me that after getting long COVID, his wife, Heidi Ferrer, went from being “one of the healthiest people I knew” to living with extreme fatigue and excruciating pain. “In the last weeks of her life, she couldn’t walk, eat most foods she enjoyed, or read a book,” Nick said. “It felt like bees were stinging her ankles all day long.” Heidi died of suicide last May. The doctor who treated her at the hospital and confirmed her death to Nick had never heard of long COVID. In her book The Myth of Closure, Pauline Boss, a therapist and pioneer in the study of ambiguous loss, offers some advice for pandemic grievers: “It is not closure you need but certainty that your loved one is gone, that they understood why you could not be there to comfort them, that they loved you and forgave you in their last moments of life,” she wrote. Instead of waiting for a clean but mythical endpoint to one’s loss, it is better to search for “meaning and purpose in our lives after this horrific time in history,” she said. Nick Güthe now pours his energy into raising awareness of long COVID, in part to honor one of Heidi’s last requests to him. “I’ve had to talk a lot of people with long COVID off the same ledge that my wife was on, and it’s been hard to turn away from that,” he said. “I’ve saved quite a few people at this point.” Alex Goldstein also feels compelled to continue posting tributes to the deceased on his @FacesofCOVID account, because it’s all the recognition that some grievers get. “A lot of folks tell me that when it’s late at night and they’re thinking about their loved one, they’ll go to the tweet and look at replies from strangers around the world,” he told me. Four days after her dad died, Sabila Khan started a Facebook group for COVID grievers, which now has 14,000 members. Shafqat was an activist who spent years advocating for Pakistani immigrants, and “this has become a way for me to keep his memory and good work alive,” Sabila told me. “It gives me purpose in my grief.” In contrast to these grassroots efforts, national moments of mourning and remembrance have been rare and fleeting. A few art projects have powerfully commemorated the losses, but briefly. After collective tragedies, “the rites and rituals of mourning are meant to bring groups back together,” Wagner, the anthropologist, told me. “We’re seeing a process that’s almost antithetical to that, because mourning has been so fragmented and suspended.” Sabila told me that even as a Muslim, she felt more solidarity among fellow Americans after 9/11 than over the past two years. “We didn’t have that rallying moment with COVID,” she told me. Shirley Snype loved butterflies, the Investigation Discovery channel, the color purple, and “her kitten, Cici,” her granddaughter Keyerra said. Some of the people I interviewed felt relieved when Biden presided over a lighting ceremony in February 2021, when the COVID death toll was just half what it currently is. But Kristin Urquiza told me that such gestures are “insignificant in comparison to the massive amount of death and suffering that we’ve had.” The nonprofit that she co-founded, Marked by COVID, is pushing the U.S. toward actions more fitting in scale. It wants the first Monday of March to be marked as a national COVID Memorial Day, and for permanent memorials to be erected around the country. “Putting my grief into a physical thing would take off some of the emotional heaviness,” Keyerra Snype told me. And having a solid, lasting memorial would go some way to assuring grievers that their loss is real, and that their loved ones mattered. Urquiza said that she’s striving for the country not just to remember her dad but to remember everything that cost him his life. “We can’t just put this in a memory hole, or we’ll forget,” she said. “I don’t want anyone to ever feel what I’ve had to feel.” Wagner has seen similar dynamics after past atrocities, in which bereaved family members found themselves having to fight for recognition and reconciliation. “Why on earth should someone who lost multiple members of their family not be allowed to be with their grief, instead of bearing the responsibility for repairing society?” she said. “When it isn’t politically expedient for those in positions of power to commemorate the deaths and extend forms of reparation, it falls on the families.” If there’s one thing Teresita Horne wants the world to know about Donovan, it’s that “he was one of the kindest souls anyone would have met,” she told me. Kindness is also the thing she most wants from everyone else, no matter their politics or their positions on the pandemic’s numerous controversies. One million people died in just over two years. It should be incontestable that they are gone, that they mattered, and that the millions more who loved them should get the grace and space to grieve and mourn. All portraits featured here are courtesy of family and friends of the people pictured. from https://ift.tt/PldYfS9 Check out http://natthash.tumblr.com By this point in the pandemic, the benefits of boosters seem pretty darn clear. Boosters continue the immune system’s education on the coronavirus, upping the quantity of defensive fighters available, while expanding the breadth of variants that vaccinated bodies can snipe. During Omicron’s winter wave, people who received a booster were less likely to be infected, hospitalized, or killed by the virus than those without a boost; older people and other high-risk populations, especially, benefitted from dosing up again. With a menagerie of antibody-dodging subvariants now dominating the world’s stage, and more certainly on the way, boosters feel more “necessary” than ever before, says Marion Pepper, an immunologist at the University of Washington. And yet, and yet. Eight months on from President Joe Biden’s announcement of his ambitious plan to revaccinate every eligible adult, tens of millions of eligible, vaccinated Americans—many of whom gladly signed up for their initial doses—still haven’t opted for an additional shot. Just 30 percent of the United States’ population is boosted, putting the country below most other Western nations. And with daily COVID vaccination rates only a notch above their all-time nadir and barriers to inoculation rising, the nation might be bogged down in its booster doldrums for a good while yet—leaving Americans potentially vulnerable to yet another catastrophic surge. [Read: America is staring down its first so what? wave] At face value, boosting should be one of the simplest actions a vaccinated American can take to fight COVID-19: just get one more shot. The very nature of the shots is an encore; at one point, the people who now need them “must have already decided a shot would be worthwhile,” says Van Yu, a psychiatrist at NYU who’s been working to immunize his city’s homeless population. For many, though, boosting is not about getting just another shot. Experts have not always sold boosters as the same slam dunk as the initial COVID-19 vaccination series; accordingly, unboosted people haven’t treated it as such. The country’s booster problem is the culmination of months of such confusion. It is also an exacerbation of the inequities that plagued the country’s initial immunization efforts. Booster uptake may present its own issues, but those only piled on the problems that vaccination efforts had encountered in all the months before. When the first shots debuted more than a year ago, the message felt mostly uniform. “Everyone was in agreement: These vaccines are fantastic; everyone who’s eligible should get them,” says Gretchen Chapman, a behavioral scientist at Carnegie Mellon University who studies vaccine uptake. And so hundreds of millions of people did. For boosters, experts presented nothing like that unified front. After an initial series of doses, shot-sparked defenses against hospitalization and death held up spectacularly well, but the safeguards against infection dropped far faster, making breakthroughs commonplace. Divided over what they hoped vaccines could afford—a shield against serious illness, or a blockade against as many infections as possible—experts began to argue over the need for additional shots, especially in the young and healthy. After boosters began their slow trickle out, the message to the public wasn’t that “everyone should get them,” but a sputtering of wishy-washy snippets as eligibility ballooned: Revaccinate the immunocompromised and the elderly and those with comorbidities! Let some younger, healthier people get more shots—if they’re exposed to the virus a lot—but don’t say they should! All right, everybody is allowed to boost, but only if you want to? Fine, fine, you’re all supposed to boost right now—why aren’t you boosted?? The arrival of Omicron was clarifying. The variant was so riddled with mutations that it quickly hopscotched over several of the shields raised by just one or two doses of original-recipe shots, warranting a top-off for the body’s defense. But not every expert has yet been swayed. “To date, we don’t have a variant resistant to protection against severe disease,” says Paul Offit, a pediatrician and vaccinologist at Children’s Hospital of Philadelphia who maintains that a duo of shots is enough for people who aren’t high-risk. Just a few months ago, Offit told his then-doubly-dosed son, who’s in his 20s, that he didn’t need an additional shot. (His son, Offit told me, still eventually got one.) [Read: Omicron has created a whole new booster logic] Punted out into the public, this messy discourse warped into confusion, consternation, and apathy. “When the scientists don’t agree, what are the rest of us supposed to do?” says Rupali Limaye, a behavioral scientist at the Johns Hopkins Bloomberg School of Public Health. In practice, it has meant that the large group of people who signed up for their first-round doses have now splintered into new booster factions. Kaleo Grant, a 23-year-old middle-school assistant sports coach in Brooklyn, told me that three of these sects exist just within his nuclear family. His father, who “took forever” to be persuaded to get his first shots, is now adamantly against boosting; his mother, who’s immunocompromised, scheduled more doses as soon as she could. Grant himself, meanwhile, is unboosted and torn. “It’s exactly what stresses me out so much—the divisiveness, even among people I know and trust,” Grant said. He was “super excited” to get his first doses last year, when the virus felt terrifying and the shots were billed as a fast track back to socializing. Both his concern over the virus and his enthusiasm for the shots have since ebbed, especially after he came down with COVID in December. Compared with the first doses, boosters feel “less urgent and maybe less necessary,” he told me, “more like a chore.” Nor have the logistics of booster recommendations been easy to follow. In the past few months, the FDA and the CDC have issued roughly half a dozen shifts in guidance—over not only who should boost, but also when they should boost, how many boosts to get, and whether booster brands should be mixed. So maybe it’s no surprise that people have started to come to their own conclusions about just how necessary boosters are. In a January poll, run by the Kaiser Family Foundation, some eligible-but-unboosted respondents said they’d forgone an additional dose because they felt they were all set after the initial injections; others were shirking the shots because they weren’t convinced that they’d work. The erratic narrative on vaccines writ large also hasn’t done the U.S. booster campaign any favors. When the shots were fresh out of the gate, Americans were set up to believe that they could take an initial course of doses and be done--with COVID vaccines, maybe even with the pandemic itself. But as more data emerged, it became evident that the shots’ protective powers had been oversold. Vaccines operate best in gradations, blunting and truncating the worst symptoms of disease; they never completely obliterate risk. “We failed to communicate that,” says Jessica Fishman, the director of the Message Effects Lab at the University of Pennsylvania. The arrival of boosters, then, felt to some like an admission that the first shots were a bungle—that the government and scientists had “made a mistake,” says Nina Mazar, a behavioral scientist at Boston University’s Questrom School of Business. Misinformation, including false rumors that the boosters were dangerous, or a ploy by vaccine makers to earn extra cash, then seeped into the gaps in understanding. [Read: Seriously, why not get a fourth shot?] Even if the message on boosters had been clearer from the get-go, that wouldn’t have ensured that people got them. Vaccination rates have tended to track with risk perception, Limaye told me. But danger, at the moment, feels minimal. COVID cases have plunged from their Omicron peak, and “most people know a lot of people with it and those cases were mild,” says Noel Brewer, who studies attitudes toward vaccination at the University of North Carolina at Chapel Hill. Similar messages have been sent by pundits and world leaders, as entire countries—including the United States—have pushed the narrative that COVID is manageable, inconsequential, “endemic,” largely in retreat. SARS-CoV-2 now feels more ubiquitous, less terrifying, much more like background noise; the precautions that defined the past two years of crisis have started to disappear. The urgency of boosters simply doesn’t square with the idea that masking, surveillance, gathering restrictions, proof-of-vaccination protocols, and remote schooling and work are no longer necessary, says Neil Lewis, a behavioral scientist at Cornell University. “There’s a conflict in saying, ‘Take off your mask, but also go get another shot,’” he told me. That’s not great timing for some people who were reluctant to get even their first shots, and now feel no impetus to invest again. “We were lucky to get them to get one dose,” says Danielle Ompad, an epidemiologist at NYU. One fact about boosting hasn’t changed. Asking people to get an additional shot means … asking people to get an additional shot, and that’s become harder than ever. As shot uptake has dropped off, vaccination sites have closed, while community outreach has pulled back. Yu, the NYU psychiatrist, told me the teams that offered vaccines and tests at homeless shelters in his neighborhood are no longer visiting as often. And with federal funding for vaccination lapsing, Americans who don’t have insurance may need to pay out of pocket for what shots they can find. “Access is different now,” Ompad told me. Add to that the challenges the vaccination campaign has faced from the beginning—among them employers that don’t offer paid time off for immunization, the hassles and costs of traveling for a shot, scheduling troubles for people without internet access, and the persistent paucity of medical centers in certain parts of the country, especially ones that are rural or low-income. Daniel Arias, a 23-year-old warehouse worker in Manhattan, told me he had to travel an hour each way for his first two Pfizer doses last year; “I just haven’t wanted to take the time” to get another, he said. Even if he had more flexibility in his schedule, vaccines aren’t really on his priority list. He’s caught the virus twice, and heard that “getting COVID is better for your immune system than getting the vaccine.” (Some researchers have argued that a past infection should count as a dose of vaccine, but the CDC disagrees; either way, pursuing infections is definitely not a safe or reliable way to acquire immunity.) And two years into the pandemic, “I have life to think about,” Arias said. “And at the end of the day, it’s sadly about convenience.” Other boost-ambivalent people are worried about the shot’s side effects. Lydia Guillory, a 36-year-old marketing specialist in Ohio, has been putting off her third dose, even though she’s been eligible for it since August, because she takes immunosuppressive drugs to manage multiple sclerosis. After her second Pfizer shot last spring, she felt some of her autoimmune symptoms temporarily worsen, and her fear of experiencing another flare-up has kept her from making the leap toward another dose. “If I was not going through all this extra stuff,” Guillory told me. “I would have gotten all the shots.” (Had she received her third injection on time, she might now already be eligible for a fourth and a fifth.) “I’m just scared of another setback,” she said. Gaps such as these could exacerbate disparities down the road. Boosts go to people who are at least a few months out from their initial doses; individuals who were vaccinated later in the rollout are reaching that point only now. Recent data from New York City, Lewis noted, show that those delayed-vaccine populations are disproportionately Black, and already more likely to be suffering some of the pandemic’s worst effects. The inequities that plagued early vaccination efforts, Lewis told me, are rearing their head again. Now that certain high-risk individuals are being asked to boost again, those first around the booster track are starting to lap those left behind. Without more attention paid to the vulnerable, boosting becomes a vicious disparity cycle: “Whatever inequities you have with first doses are likely to be amplified,” UNC’s Brewer told me. Boosting rates among Black and Hispanic people lag those of their white neighbors, according to a February Kaiser Family Foundation poll. [Read: America’s flu-shot problem is also its next COVID-shot problem] Issues with access, at least, have straightforward (though still difficult-to-implement) solutions. “We need to make the process easier, and more convenient,” Fishman, of UPenn, told me. Reviving and more evenly distributing community vaccination efforts could help. Stand-alone sites could take walk-in appointments; teams of volunteers could bring vials and syringes directly to the places where people live and work. Paid sick leave, subsidized transportation, or even financial incentives for vaccinations could make a big difference too. Perhaps most crucial, additional federal funding to keep vaccines free for everyone would mean shots stay within reach of some of society’s most at-risk members. Clearer policies have a role to play too. Many workplaces, for instance, issued strict requirements for initial doses last year. But booster mandates have been sparser. With eligibility ever-changing, and the possibility of annual shots on the table, that’s logistically understandable, but it sends an implicit message, Lewis told me: “One inference people are making is If boosting was really that important, the government or my boss would be issuing a mandate.” (New Mexico’s Department of Health has, for certain workers.) Even a tweak to some terminology could help. One or two shots are needed to become “fully vaccinated” in the CDC’s eyes; boosts don’t change that, which makes the shots “sound kind of optional in a way that the primary series doesn’t,” Chapman, of Carnegie Mellon, told me. But ultimately, bridging the booster gap will mean engaging people’s concerns: respecting individuals’ values, partnering with community messengers, and engendering trust among those who have historically had little reason to give it—the same approaches that have any chance of closing the chasm in America’s overall immunization rates. More than 20 percent of Americans remain entirely unvaccinated, according to the CDC. “I worry we’ve given up on those people,” Offit, the CHOP pediatrician, told me.
from https://ift.tt/7uGoyCZ Check out http://natthash.tumblr.com Well, here we are again. After our fleeting brush with normalcy during Omicron’s retreat, another very transmissible new version of the coronavirus is on the rise—and with it, a fresh wave of vacillation between mask-donning and mask-doffing. The Omicron offshoot BA.2 is now the dominant variant around the world and in the United States. Case counts are rising in a number of states. It’s too early to tell whether BA.2 will cause a major spike in cases here like it recently did in Europe, but that possibility is worth preparing for by having good masks on hand—and being mentally ready to put them on again. If the thought of re-masking feels exasperating to you, you’re not alone. As Katherine J. Wu has pointed out in The Atlantic, many people just don’t care that much about COVID-19 anymore, let alone BA.2. Most Americans are no longer required to wear masks in indoor public spaces (though in some places, masks are still mandatory in crowded settings such as hospitals and prisons). People who are vaccinated and boosted are hugely protected from severe illness. Making the most of this recent reprieve, I did something I’d dreamed of since the beginning of the pandemic: screamed my lungs out in a tiny karaoke booth with unmasked friends and didn’t think twice about it. It was awesome. [Read: America is staring down its first ‘So what?’ wave] But as much as I want to hold tight to that freedom, I also really don’t want to get sick again. As I’ve learned firsthand, having COVID can be miserable, even for the healthy and vaccinated, and long COVID is still a frightening possibility, as is inadvertently infecting my aging parents. Masking remains an effective and easy way to avoid getting sick whenever your risk of getting COVID increases, whether that’s because of a menacing new variant, an uptick in cases in your town, or thousands of unmasked strangers sharing a concert venue with you. So how do you know when it’s time to start again? The answer will be different for everyone. “I get that people are fatigued, and I get that it’s cumbersome,” George Rutherford, an epidemiologist at UC San Francisco, told me. But people need to make decisions based on their own risk, which can vary greatly, depending on who you are and where you live, he said. Tom Murray, an associate professor specializing in infectious diseases at the Yale University School of Medicine, agrees. “Like all things COVID, it’s not a straightforward yes or no answer,” he told me. “It’s an individualized decision.” [Read: The Biden administration killed America’s collective pandemic approach] Every uptick in risk, at the individual or community level, is an argument for wearing a mask. In general, your chances of getting seriously sick from COVID are higher if you’re of an advanced age, immunocompromised, living with certain medical conditions, unvaccinated, or un-boosted. Community-level risk goes up when local case counts, hospitalizations, and test positivity rates rise. The latest CDC guidance on masking, from February, also depends on both personal vulnerability and the level of COVID in a community. The agency calculates community risk for each U.S. county daily based on local COVID-related hospital admissions, hospital-bed occupancy, and new cases, and its rubric is much more lenient than it was last year. People in low-risk counties, which are green on the CDC’s color-coded map, are not instructed to mask or not mask—they can do whatever feels right. Yellow means that people at high risk of severe illness should talk with their medical provider about wearing a mask. In red counties, indoor masking is recommended across the board. As of publication, the map is mostly green (95.6 percent of counties) with blotches of yellow (3.8 percent) and specks of red (0.6 percent). By the old metrics, universal masking would have been recommended in at least 22 percent of counties. The new system has received mixed reviews from epidemiologists and public-health experts. Murray commended the color-coded map, and Rutherford called the new guidance “straightforward advice that gets right to the core of it.” However, it has its drawbacks. The agency’s formulas might underestimate a given county’s risk, for example. Yonatan Grad, an assistant professor of immunology and infectious diseases at the Harvard T. H. Chan School of Public Health, told me that he worries about relying on case counts and hospitalizations—the former because many people are self-testing and not reporting their results to local health authorities, and the latter because hospitalizations reflect how the virus was spreading weeks ago, not now. (The CDC did not respond to requests for comment.) Other experts have argued that the new guidance, with its focus on individual rather than collective behavior, puts an additional burden on high-risk people, who are especially vulnerable if others around them choose not to mask. In light of this, people who are high-risk should use N95 masks, because they’re specifically designed to protect the wearer, Murray noted. Although the CDC recommendations are a useful framework for thinking about masking when no broader policies are in effect, ultimately, the decision to mask is a personal one, experts told me. Regardless of your county’s risk level, Murray said, “if you’re most comfortable and feel safest wearing a mask, you should definitely wear a mask. It’s not harmful.” Grad argued that masking could be made as convenient as possible by ensuring high-quality N95 masks are widely available. (The CDC has an online tool for finding free ones.) But the decision to mask can still be an uncomfortable one. Much as you might try to be consistent with your personal masking preferences, in reality, people’s perceptions of risk can change depending on the social context. I’ve shown up to parties wearing a mask, then sheepishly removed it because nobody else was wearing one. On the flip side, I’ve felt pressured to put on a mask at concerts where the crowd generally seemed more cautious, even if I felt safe because vaccination cards were checked at the door. When I’m stressed about deciding whether to put on a mask, I remind myself that it’s just one of many precautions that can be layered to help reduce risk, along with testing before gathering and opting to socialize outdoors. This isn’t the last time that a spike in COVID risk will prompt uncertainty about masking. Many epidemiologists believe that risk levels will fluctuate year after year, as new variants emerge and cases surge alongside colds and the flu each respiratory-virus season. Since mandates seem to be less and less likely, Americans need to get used to making informed decisions about masking for themselves. That will take time. “I do think we’re seeing the transition from pandemic to endemic COVID, and the policies are really starting to reflect that,” Murray said. So long as COVID remains unpredictable, however, “there may be situations where broader masking policies would again make sense,” Grad said. [Read: Mask mandates are illogical. So what?] Like all transitions, this is an awkward one, and we’ll likely have to endure many more moments of masking faux pas before we fine-tune what we’re comfortable with as a society. Masking, Grad said, is something “we should work to normalize so that people can feel free to make the decision to mask when they feel like it is important to them.” That will be a tall order in the U.S., where masking has become needlessly polarized. But in many parts of the world, people don masks every virus season without much prompting from officials. Maybe, even here, reason—or at least the desire not to get sick—will eventually prevail. from https://ift.tt/p4B7YI0 Check out http://natthash.tumblr.com |
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