Losing a parent may be one of the most destabilizing events of the human experience. Orphans are at increased risk of substance abuse, dropping out of school, and poverty. They are almost twice as likely as non-orphans to die by suicide, and they remain more susceptible to almost every major cause of death for the rest of their life. Because of the pandemic, some 200,000 American children now face these stark odds. Even after two years that have inured the country to the carnage of the coronavirus, the scope of the loss is so staggering that it can be hard to comprehend: Caregiver loss during the pandemic is now responsible for one out of every 12 orphans under the age of 18, and in every public school in the United States, on average two children have lost a caregiver to the pandemic. COVID-19 case counts rise and fall, but “orphanhood doesn’t come and go. It is a steadily rising slope, and the summit is still out of sight,” Susan Hillis, the co-chair of the Global Reference Group on Children Affected by COVID-19, told me. “It’s not like you’re an orphan today and then you’re recovered in two weeks.” [Read: The staggering number of kids who have lost a parent to COVID-19] Even if orphans face an immense set of challenges, their fate isn’t sealed: For decades, researchers have known that programs that tap into children’s extraordinary resilience can help orphans overcome the unthinkable, especially if kids get help in the immediate aftermath of a death. And yet, so far, the plight of pandemic orphans has not proved to be much of a pressing issue in the United States. No law or executive order has provided any resources specifically for pandemic orphans, even as Congress and the White House have spent trillions of dollars to help Americans get through this crisis. And while a memorandum issued by President Joe Biden yesterday promises that the administration will develop a plan for orphans, it’s poised to be too little, too late. “It really doesn’t outline any plan or commitment,” Rachel Kidman, a social epidemiologist at Stony Brook University, told me. And the inaction goes deeper than that: With a few exceptions, even the parts of the country most inclined toward action don’t seem to be doing much to help these kids. “No one has even established a system for figuring out who these children are,” Hillis said. The pandemic’s orphanhood crisis matters most for orphans, but it also matters for the rest of us. If America can’t do anything to help the children most profoundly affected by COVID, what hope is there to make any sort of long-lasting changes as we try to leave the pandemic behind? A 10-year-old in New York City who lost her father in the first wave of early 2020. Four children in Boynton Beach, Florida, left behind by a single mother who died 48 hours after being taken to the hospital. A 6-year-old boy and an 8-year-old girl from McAlester, Oklahoma, who lost their mother to COVID just two and a half years after losing their father to liver failure. With COVID deaths now nearing 1 million, all types of American children have been orphaned by the pandemic. But the well-documented racial and ethnic disparities in the virus’s toll are further compounded in caregiver loss. For example, the COVID death rate for Hispanic Americans is just slightly higher than that for white Americans, but Hispanic caregiver loss is more than double that of white Americans. Similar trends hold for other groups, according to an analysis by Dan Treglia, a social-policy researcher at the University of Pennsylvania and an expert contributor at the COVID Collaborative, a coalition of experts in health, education, and economics. Because of how easily COVID can spread within a household, some kids have lost both parents; others may have lost a grandparent who was a primary caregiver. Almost a quarter of American children live with one parent and no other adults, meaning it can take only a single death for catastrophic loss to occur. Because these children are disproportionately low-income and nonwhite, they already face systemic barriers that amplify the fallout of orphanhood—and many families are unprepared from the start. Unlike some other diseases that leave children orphaned, COVID strikes quickly. It’s more like a car crash than cancer. With COVID, “somebody drops dead in weeks,” Hillis said. It’s so sudden that no one has even thought about, “Oh my goodness, who’s gonna take care of the kids?” [Read: There is no one pandemic anniversary. There are millions of them.] Despite the urgency, the national response is not meeting the moment. The federal government has set aside funds to help pay for the funerals of Americans who died from COVID. While that’s a laudable effort that helps offset costs at a crucial moment, the money is hardly the kind of investment needed to support the long-term needs of orphaned children. Yesterday, as part of the presidential memorandum addressing the long-term effects of COVID, the Biden administration made a vague promise that federal agencies would draw up a report within several months outlining how they’ll support “individuals and families experiencing a loss due to COVID-19.” But Mary C. Wall, a senior policy adviser on the White House’s COVID-19 Response Team who will serve as the “bereavement lead,” told me that the effort won’t have a dedicated team and will be focused on raising awareness about existing resources for families rather than implementing initiatives that would require new funds. At some point, Wall said, the program might request additional funding, but that ask could run into problems, given that Congress struggled to reach a deal for even basic COVID-fighting supplies such as treatments, tests, and vaccines. It’s not just the Biden administration that’s been slow to confront the greatest mass-orphanhood event in a generation. Only in the past few months has there been any political movement anywhere in the country. Representatives Bonnie Watson Coleman of New Jersey and Haley Stevens of Michigan, both Democrats, introduced a resolution in March to “raise awareness” of COVID’s impact on bereaved children, but it’s little more than a hopeful call to arms. At the state level, targeted efforts seem to be the exception, not the rule. California State Senator Nancy Skinner introduced a bill to set up trust funds of $4,000 to $8,000 for each of the state’s more than 20,000 pandemic orphans. It is working its way through the legislature, and a spokesperson for the senator said he was not aware of any resistance. At the local level, some counties are moving forward on their own as well. Santa Clara County, California, set aside $30 million in federal relief funds, a portion of which will be used to identify and support children who lost caregivers to COVID (the details of the program haven’t been announced). [Read: How did this many deaths become normal?] This patchwork of efforts is better than nothing, but without a stronger centralized national strategy, tens of thousands of children are likely to fall through the cracks. The irony is that the U.S. already has the know-how to piece together that strategy. During the HIV epidemic, the U.S. helped orchestrate an impressive response to the world’s orphanhood needs. The President’s Emergency Plan for AIDS Relief, established in 2003, earmarks 10 percent of its annual $7 billion budget specifically for orphans. “If we wanted to focus on children at home, we could absolutely do that,” Kidman said. “The expertise is there if the will is there.” What America needs to be doing right now, Kidman said, is providing help—financially and psychologically—to both orphans and their families. Experts I spoke with applauded promoting mental-health services for children, but warned that counseling isn’t sufficient. And if yesterday’s memorandum is any clue, the White House has no clear plan for the unique psychological challenges of orphanhood, and could even end up simply rebranding existing mental-health services as a bereavement program. Regular cash transfers can reduce trauma and anxiety symptoms among orphans and boost school completion by 22 percent. It’s unlikely that the White House’s plan to reimburse funeral costs will have the same effect. “The cost of a funeral is a drop in the bucket. These families need sustained financial support,” Joyal Mulheron, the founder of Evermore, a bereavement nonprofit, told me. One promising approach is “cash plus care” programs, which stabilize families with regular cash infusions coupled with interventions that help enhance caregivers’ parenting skills. [Read: The year of postponed grief] That said, some funds may already be available–just untapped. Bereaved children have long been eligible for Social Security benefits, yet the best available data suggest that less than half of all orphans are receiving the financial resources already allocated for them. The Biden administration is sensibly trying to connect children with existing benefits, but Wall offered few details about how the administration will actually achieve that. Popular legislation such as the expanded child tax credit, which temporarily slashed poverty, could be a lifeline for the disproportionately low-income children orphaned by COVID—but Congress allowed that temporary benefit hike to expire at the end of last year. Solving the orphanhood crisis might not feel as urgent as, say, developing a vaccine did. But time is of the essence. A toddler who lost his father in March 2020 is getting ready to enter kindergarten this fall. A junior-high kid who lost her mother is now a sophomore in high school learning to drive. Children change with breathtaking speed, and several experts I spoke with told me that early intervention may be crucial for reducing trauma and improving overall health. “If we miss this critical period with children, then they are going to have this burden carried forward,” Kidman said. “We can’t come back in five years and mitigate their pain. This has to happen now.” At every stage of the pandemic, there’s been a glimmer of hope that some of the trauma would finally lead to lasting change. Perhaps the country would realize that our health-care system is nowhere near good enough. That paid sick leave is necessary to keep illness out of the workplace and protect society’s most vulnerable members. That the nation’s indoor air is long overdue for an upgrade. But as the pandemic enters year three, it’s becoming clear that America is adamant about changing as little as possible. Yes, we’re in a relative lull of case counts and deaths. But just because people aren’t dying at the same rate they were at the pandemic’s peaks doesn’t mean the crisis is over for the 200,000 children set adrift in one of the most unimaginable ways possible. “Pretending that these kids can just go back to normal is going to be a mistake,” Kidman said. “There isn’t a normal for them to go back to.” from https://ift.tt/lhLOjmK Check out http://natthash.tumblr.com
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If the United States has been riding a COVID-19 ’coaster for the past two-plus years, New York and a flush of states in the Northeast have consistently been seated in the train’s front car. And right now, in those parts of the country, coronavirus cases are, once again, going up. The rest of America may soon follow, now that BA.2—the more annoying, faster-spreading sister of the original Omicron variant, BA.1—has overtaken its sibling to become the nation’s dominant version of SARS-CoV-2. Technologically and immunologically speaking, Americans should be well prepared to duel a new iteration of SARS-CoV-2, with two years of vaccines, testing, treatment, masking, ventilation, and distancing know-how in hand. Our immunity from BA.1 is also relatively fresh, and the weather’s rapidly warming. In theory, the nation could be poised to stem BA.2’s inbound tide, and make this variant’s cameo our least devastating to date. But theory, at this point, seems unlikely to translate into practice. As national concern for COVID withers, the country’s capacity to track the coronavirus is on a decided downswing. Community test sites are closing, and even the enthusiasm for at-home tests seems to be on a serious wane; even though Senate Majority Leader Chuck Schumer announced a new deal on domestic pandemic funding, those patterns could stick. Testing and case reporting are now so “abysmal” that we’re losing sight of essential transmission trends, says Jessica Malaty Rivera, a research fellow at Boston Children’s Hospital. “It’s so bad that I could never look at the data and make any informed choice.” Testing is how individuals, communities, and experts stay on top of where the virus is and whom it’s impacting; it’s also one of the main bases of the CDC’s new guidance on when to mask up again. Without it, the nation’s ability to forecast whatever wave might come around next is bound to be clouded. [Read: America is about to test how long “normal” can hold] We can’t react to a wave we don’t see coming. “I keep thinking back to this idea of If we don’t measure it, it won’t happen,” says Shweta Bansal, an infectious-disease modeler at Georgetown University. (As President Donald Trump once put it, “If we stop testing, we’d have fewer cases.”) In reality, “it’s very well happening, and we just don’t see it yet.” There is still no guarantee that the next wave is nigh—but if it is, the U.S. is poorly positioned to meet it. Americans’ motivational tanks are near empty; the country’s stance has, for months, been pretty much whatevs. The next wave may be less a BA.2 wave, and more a so what? wave—one many Americans care little to see, because, after two years of crisis, they care so little to respond. Colloquially, epidemiologically, a wave is a pretty squishy term, a “know it when you see it” notion that gets subjective, fast. “There is no technical definition,” says C. Brandon Ogbunu, a mathematical modeler studying infectious-disease dynamics at Yale. And with COVID-19, there’s no consensus among experts on exactly when waves begin or end, or how sharp or tall one must be to count. A reasonable delineation for a wave might involve an unexpected deviation from a baseline low—a sudden and sustained uptick in cases that eventually trends back down. That concept might seem intuitive, and yet it’s rife with assumptions: Unexpected, baseline, sudden, sustained--all of these require prior intel on how a disease typically behaves, says Justin Lessler, an infectious-disease modeler at the University of North Carolina at Chapel Hill. Researchers have spent decades building those knowledge bases for diseases like the flu. But “we don’t know what ‘normal’ conditions for COVID-19 are going to look like yet,” he told me. That makes the start of a wave tough to identify even when testing data abound; no single inflection point guarantees a shift from not a wave to definitely a wave. Technically, the BA.1 wave that reached its zenith in mid-January may not have even ended yet, because experts haven’t decided what threshold it would need to reach to do so. Lessler proposed that last summer’s pre-Delta nadir might serve as a tentative benchmark. “If we were sustained there, it wouldn’t be the worst thing ever,” he told me. But despite the relief much of the nation has been feeling the past couple of months, “most places haven’t even gotten there.” Still, new waves can begin before their predecessors conclude. The experts I spoke with said that an increase in SARS-CoV-2 cases that ratched up counts by more than a couple percentage points a week, lasted at least 14ish days, and impacted a large swath of the country, would definitely trip alarm bells. On the whole, the United States does not seem to be at alarm-bell level quite yet, Ogbunu told me. Maybe, if cases don’t rise sharply enough, or to a high enough amplitude, the country won’t get there with BA.2 at all. But it’s too soon to tell. The latest estimates put BA.2 at the root of about 70 percent of sequenced infections in the United States. That’s right past the proportion at which BA.2 started putting a serious squeeze on other countries, says Sam Scarpino, the managing director of pathogen surveillance at the Rockefeller Foundation. “Once you get into the 50 to 60 percent BA.2 range is when you see cases going up,” he told me. Experts can’t yet know if the U.S. will be more resilient, or less. Watching only the national curve can also be misleading. Country-wide data show only a gargantuan average; these numbers smooth and conceal the case rises that have already been erupting in isolated patchworks. That sort of variability is a product of where humans have carried this new subvariant; of the immune landscape that vaccinations and past versions of the virus have left behind; and of the local defenses, such as masking (or not), that people are leveraging against BA.2, says Bansal, who’s been leading efforts to map how different communities will be impacted by future variants. And patchiness is to be expected. And these more regional waves still matter, even if they seem at first easier to ignore. [Read: Will Omicron leave most of us immune?] They will, in many cases, mark the places least prepared to weather another surge in infections. Tests, while more abundant, have remained inaccessible to many of those who need them; without tests, treatments, too, will drift out of reach. And Malaty Rivera worries that, even now, we don’t know which parts of the country are being hardest hit, thanks to underdiagnosis and underreporting. Some places that appear to be coasting on plateaus or trending down may not be as well positioned as they first seem. Wastewater surveillance, which homes in on virus particles extruded in waste, could help—but these monitoring sides aren’t distributed evenly, either. As things stand, the national map of where the virus is moving is full of blank spots and dark patches. Even unmeasured waves, if they grow big enough, have ways of breaking over us. At worst, the virus could eventually surprise us with a rash of hospitalizations—a sign that the initial bump of cases, one we should have responded to, is already in our rearview. Not all case rises have to spell disaster. Since November, when Omicron was first identified, more Americans have been vaccinated for the first time, or boosted, or infected; rapid tests have become more available; and the oral antiviral Paxlovid has hit far more pharmacy shelves. All these factors, plus a springtime flocking into the outdoors, especially in the northern U.S., could help blunt a potential wave’s peak; some may even help uncouple a rise in infections from a secondary surge in hospitalizations and deaths. “Those are the numbers I’m more interested in,” says David S. Jones, a historian of science at Harvard University. If cases go up, but the most severe outcomes stay trim, Jones told me, he’ll feel far less concerned; this wave won’t have to feel like the one the country just weathered, by any stretch. It’s certainly a reasonable future to hope for, but not an outcome that can be taken for granted. Even now, less than half of Americans are boosted, and health-care systems and their workers are reeling from the most recent surge. And although the Senate has reached a deal on an additional $10 billion of emergency funds for pandemic prevention efforts, that sum is less than half of the original $22.5 billion the Biden administration originally asked for. Without more money to keep mitigation tools flowing freely into the community, Bansal also worries about the implications of focusing too hard on hospitalizations. Taking a so-what approach until a substantial number of severe cases show up, as CDC guidance advises Americans do, is “just too late,” she told me. “The story’s already been written for those individuals who have been infected.” Nor are hospitalizations and deaths the only outcomes that matter, as millions of people in the United States alone continue to grapple with the debilitating symptoms of long COVID, which vaccines only partly diminish. Outbreaks are dialogues; rises in cases can be driven by a new version of the virus, but also by us. Nearly two years ago, Jones and Stefan Helmreich, an anthropologist at MIT, warned that speaking of epidemics as waves “cast them as natural phenomena”—disasters that blow through us, in ways beyond our control. But the trajectory of an epidemic is actually “deeply shaped by human action, both before such disasters hit and as they are managed,” they wrote. Waves don’t just happen to us. They are also, unlike the ocean swells they evoke, shaped by us. Scientifically, calling whatever’s coming a “BA.2 wave” is fair, because BA.2 is ousting its competitors. Still, its peculiarities—or the peculiarity of any next wave—might be less about the quirks of the variants involved and more about how readily we respond. (Certainly, if it’s not BA.2 that troubles us imminently, it’ll be another SARS-CoV-2 offshoot.) Human actions can slow rises in cases. They can also accelerate them. And when infections take off, it’s not always easy to tell who holds the steering wheel—pathogen or host. “Every outbreak since the beginning of humankind has a behavioral component, an immunological component, and a viral component,” Yale’s Ogbunu told me. “Where one ends and another begins is never completely clear.” But Americans are too far along in this pandemic, and too familiar with the tools we need to manage it, to shirk culpability entirely. Pre-vaccine variants pummeled us when we were poorly defended. The antibody-dodging BA.1 circumvented some of our immune shields. BA.2 isn’t a perfect match for our shots, either. And yet, fresh off of its sibling’s winter crush, we would be remiss to be twice fooled. from https://ift.tt/cags5Rn Check out http://natthash.tumblr.com |
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