Can you think of a good reason not to try a cicada, other than “ew”? I’ve posed this question to numerous friends and family, even my partner’s extended relatives, now that Brood X is swarming parts of the United States. Eating cicadas just makes sense, even for someone like me, who’s been a stalwart vegetarian since basically the last time they appeared, in 2004. They’re a bountiful and easy-to-forage protein source, they very likely won’t make you sick, and they’ve made appearances on some Native American and Chinese dinner tables for centuries. (Even Aristotle ate them.) Plenty of evidence suggests that they don’t feel pain the way other creatures do, if that kind of thing is important to you. I watched Fear Factor back when Joe Rogan was cool, I’d remind everyone. “Ew” alone cannot stop me. Except maybe it can! a tiny voice burbled in my head as I pulled into the packed driveway at Cicadafest last Saturday afternoon. The event at the Green Farmacy Garden, a medicinal-plant sanctuary and educational garden in Fulton, Maryland, promised live music, cicada-inspired art, and yes, a cicada tasting menu. Throughout the garden, I could see maybe 30 people, a mix of couples and families, milling around. Volunteers, some barefoot, were running platters of cicadas in and out of the building. Among them was Veri Tas, the garden’s events and communications manager, a vegan who swore off industrial meat and dairy a decade ago and who was inspired to host Cicadafest partly as a way to try insect protein. You could easily have mistaken the event for a neighborhood barbecue hosted by someone’s environmentalist aunt, were it not for the conspicuous collection of folding tables holding our snacks. I approached them hesitantly, trying to ignore the beady red eyes and disapproving screeches of their cousins from the nearby bushes. [Read: The biggest party of 2021 is about to start] And lo—the spread before me was truly something to behold. Air-fried cicadas! Cicadas covered in vegan chocolate! Skewers of grilled cicadas licked by charcoal flames! Roasted cicadas, rolling around a lasagna tray like gumballs in the world’s most quarter-starved dispenser! To the left were all the condiments you could ever ask for: Barbecue sauce, cocktail sauce, malt vinegar, ketchup, Italian dressing, spicy cashew dressing, Soyaki, and more. Air-fried felt like a safe place to start, especially once I noticed the flurry of Old Bay seasoning being sprinkled onto each batch. I grabbed a set of two on a toothpick, declining the extra roll in even more Old Bay (I’m at work here). The cicadas, once pale, were now golden and browned, their signature eyes turned black from the heat. I popped one into my mouth. Not bad! Certainly not buggy. The entire critter crackled in my mouth like a piece of earthy popcorn. I caught a subtle nuttiness underneath the crunch, almost reminiscent of a roasted chickpea. By the fourth or fifth chew I was almost starting to like it, until I swallowed and realized that a teeny-tiny leg was lingering on my tongue. The toothpick went into the trash, along with the other cicada. Next up was a chocolate-covered cicada, which by comparison felt like cheating. Thanks to the thickness of the coating, I was easily able to pretend that I was eating a large chocolate-covered raisin. From there, it was all downhill. My third and fourth cicadas, which were grilled, tasted like smokier, chewier versions of the air-fried one, with a slightly meatier flavor that made it clear why cicada eaters compare them to shrimp. Nowhere was that shellfish flavor more evident than in the oven-roasted cicada, though I was quickly distracted from that thought by the realization that the bug had exploded in my mouth like a Gusher. My tongue awash in bug guts, I reconsidered all the choices I’d made in my life that had brought me to that moment. [Read: Restaurants have a new problem, and it has red eyes and is super loud] It turns out that cooking technique is everything. The roasted cicadas hadn’t been blasted with enough heat to properly dry up the squish. Other attendees I consulted agreed with me: the crunchier, the better. When deciding what cooking methods to highlight at Cicadafest, Tas told me, they had consulted foragers before embarking on a series of test runs. Tas and the other volunteers had learned to harvest the cicadas at dusk on the very same day that they’d emerged from their shells, ensuring that their adult exoskeletons (and massive wings) wouldn’t develop. Loading them into the freezer right away served the dual purpose of preserving them and killing them gently. When it came time to play in the kitchen, sautéed cicadas were quickly ruled out for being “too buggy,” and a shrimp-boil-inspired experiment was abandoned following disastrous results. “My brother decided to try boiling them with beer and Old Bay,” Tas explained. “He put one in his mouth and spat it right out all over the place.” So aside from the “ew” factor, why aren’t we all eating cicadas? Part of the problem is that while pound for pound, cicadas have about as much protein as red meat, you would need to eat a lot of bugs to get anywhere close to the weight of a burger patty. But if you want to eat just a few, you’re back in snack territory, where plenty of fine non-insect options await. In 2013, my colleague James Hamblin wrote that for him, the big turnoff wasn’t cicadas’ classically buggy look, but the plain fact that they’ve spent 17 years underground. Valid. But during all that beauty sleep, cicada nymphs remain tightly nestled inside their waterproof exoskeletons. From another perspective, cicadas are a food that comes prepackaged and individually wrapped. [Read: Will we ever stop eating animal meat? ] Other entomophagists (that’s someone who eats bugs, which I guess is what I do now) and I will tell you what you’ve no doubt heard before: There’s a lot to be gained environmentally from incorporating insects into the Western diet. It’s true—farming bugs for human and animal consumption has a much lower CO2 output than the food production it could hypothetically replace. But guess what other dietary changes can also help curb CO2 emissions? Eating beans, cooking with less gas, reducing food waste, and all sorts of other adjustments that don’t result in stray legs and liquified guts in my mouth. I wanted to come home from Cicadafest with my head held high, sweeping bugs off trees and right into the oven for my meat-eating friends to munch on with glee. But for me, the joy within those exoskeletons is limited, no matter how much Old Bay is sprinkled on top. Cooking them would feel like a game of Russian roulette, and I can’t in good conscience risk feeding someone I love a spring-loaded soft one. I lost this round, but call me back in 17 years when we’ve perfected the recipe. from https://ift.tt/3p6RaSd Check out http://natthash.tumblr.com
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As the coronavirus pandemic took hold last spring and people around the world went into lockdown, a certain type of news story started to spring up—the idea that, in the absence of people, nature was returning to a healthier, more pristine state. There were viral (and fake) reports of dolphins in the canals of Venice, Italy, and pumas in the streets in Santiago, Chile. But new research shows that the true effect of suddenly removing people from so many environments has turned out to be much more complex. “It was surprising how variable the responses were,” says Amanda Bates, an ecologist at Memorial University, in Newfoundland and Labrador, who led an international team of more than 350 researchers in an effort to study how lockdowns have affected the natural world. “It’s impossible to say,” Bates says, whether the consequence of people’s sudden disappearance “was positive or negative.” The team collected and analyzed data from hundreds of scientific monitoring programs, as well as media reports from 67 countries. As many would expect, it did find evidence of nature benefiting from the sudden drop in air, land, and water travel. Wildlife also benefited from reduced air and noise pollution as industry, natural-resource extraction, and manufacturing declined. There was less litter found on beaches and in parks, and beach closures in some areas left the shoreline to wildlife. In Florida, for example, beach closures led to a 39 percent increase in nesting success for loggerhead turtles. Ocean fishing fell by 12 percent, and fewer animals were killed by vehicle strikes on roads and in the water. Ocean noise, which is known to disrupt a variety of marine animals, dropped dramatically in many places, including in the busy Nanaimo Harbour, in British Columbia, where it fell by 86 percent. But there were also many downsides to the lack of humans. Lockdowns disrupted conservation-enforcement and research efforts, and in many places illegal hunting and fishing increased as poor, desperate people looked for ways to compensate for lost income or food. The ecotourism activities that provide financial support for many conservation efforts dried up, and many restoration projects had to be canceled or postponed. Parks that were open to visitors were inundated by abnormally large crowds. And in many places, hikers expanded trails, destroyed habitats, and even trampled endangered plants. The researchers estimate that delays to invasive-species-control programs caused by lockdowns will have a huge impact. Failure to remove invasive mice from remote seabird-nesting islands could lead to the loss of more than 2 million chicks this year alone. The scale of these negative impacts was unexpected, Bates says. “I thought we were going to see more positive impacts,” she says, adding that it highlights just how much some ecosystems depend on human support to keep them viable. “I don’t think some of these systems would be persisting without our intervention.” And some of the changes led to complex cascades, where it was difficult to disentangle the positive from the negative. Snow geese, for example, are usually hunted, to stop them from feeding on crops during their northward migration across the United States and Canada. But this year they faced less hunting pressure, and so arrived in the high Arctic larger and healthier than usual, according to hunters in Nunavut. It might be good for the geese, but they also graze fragile Arctic tundra and degrade the habitat for other species, so more geese will have knock-on effects on the rest of the ecosystem that could persist for years. As the world slowly gets back to normal, the data collected during this time of disruption will be useful in developing more effective forms of conservation that take into account all the ways that humans influence their surroundings, says Rebecca Shaw, the chief scientist for the World Wildlife Fund. “The cool thing will be to watch how these responses change over time as human mobility gets back to normal, and to use the information to better design conservation actions to increase biodiversity both near and far, away from human populations,” she says. Alison Woodley, a strategic adviser at the Canadian Parks and Wilderness Society, agrees. She says the positive impacts that were seen are likely to be temporary shifts, and so finding ways to develop more resilient conservation systems will be vital. “The common thread is the need for long-term, stable, and adequate funding to make sure that conservation is resilient and that the positive aspects of conservation are overcoming the negative,” she says. That will benefit not just nature, but humans as well, Woodley says. There is a growing realization that protecting nature offers our best defense against future pandemics, by reducing the contact and conflict between humans and animals that can lead to viruses jumping from one species to another. “Preventing future pandemics and restoring our life-support system requires decisions and management by people to protect large areas of land and ocean, and to sustainably manage the rest of the landscape. And to do it in an integrated way,” Woodley says. The post appears courtesy of Hakai Magazine. from https://ift.tt/3fyPWfx Check out http://natthash.tumblr.com Two weeks ago, for the first time in a year, I intentionally walked out of my front door without a mask. I didn’t even have one in my pocket. I have been vaccinated and was planning to be outdoors only, and so I was certain that going unmasked posed no risk to anyone. Still, the moment was eerie and profound. And not just because I had that phantom sense of having left the house without my keys, or my phone, or my pants. Last spring, New York City was the global epicenter of the coronavirus pandemic. Well over 10,000 people are estimated to have died here before most states began to see any significant effects. Freezer trucks idled in Manhattan parking lots as morgues overflowed, and thousands of bodies were buried in mass graves. The trauma touched everyone personally, and most people in the city have since been extremely vigilant about masks. [Read: Excuse me if I’m not ready to unmask] So for those of us in New York City, the shift to going barefaced seems especially dramatic. I imagined that it would feel like a culminating event, a transition to an ending. Then about two blocks after leaving home unmasked—and after nearly a year and a half of treating my mask as an extension of myself—that sense evaporated. Walking around without a mask is, it turns out, like riding a bike: It’s exhilarating for the first minute, and then you just take it for granted, and your mind goes back to worrying about other things, such as trying not to get hit by cars. This is a pivotal moment in the pandemic. So much of the year’s anxiety and confusion converges in our relationship to masks, which have come to be about far more than blocking aerosolized secretions. Mask mandates are being lifted around the country as cases of COVID-19 plummet. The all-encompassing threat of the pandemic suddenly feels like a blip on the national radar, thanks to a massive vaccination campaign and a deep-seated desire to talk about anything else at all. When the CDC advised two weeks ago that vaccinated people no longer need to wear masks, indoors or out, the change around New York City was nearly instantaneous. Nationally, the move correlated with a bump in vaccine demand. For some, this is jarring, even scary—especially for those who have not yet gotten vaccinated, who have post-traumatic anxieties after life-threatening bouts with COVID-19, or who are at high risk of complications. The pandemic is not over, and the past year has seen a barrage of experts insisting that masks save lives. Wear a mask. Wear a mask. Wear a mask. Out in public, it’s impossible to know who’s been vaccinated. Many businesses have opted to continue requiring masks indoors, while others have not. It is true, from a purely scientific perspective, that vaccinated people don’t seem to pose a meaningful risk to others, or to themselves, if they forgo a mask. We have not seen a terrible number of serious breakthrough cases, and vaccinated people do not seem to serve as asymptomatic spreaders of the disease. But real tensions exist between mask science and mask guidelines. From a guideline perspective, having different rules for vaccinated and unvaccinated people creates a minefield for public venues, businesses, and other institutions where employees have no way of distinguishing between who is and isn’t vaccinated. A school system may be able to verify the immune status of its students and faculty, but a restaurant or grocery store cannot sort everyone who comes through the door. [Read: Are outdoor mask mandates still necessary?] This has inspired heated debate and inflamed instincts to assign blame. Is the CDC being too vague, too progressive, or simply careless in its advice? Should local governments step in with clear directives? Are businesses supposed to decide for themselves and enforce rules however they choose? Do those decisions involve liability? Are we looking for definitive answers that don’t exist? This gap between science and guidelines is not new; it’s a constant source of friction in public health. Take, for example, the recommendation that we exercise for 150 minutes a week, or that men limit themselves to two alcoholic drinks a day. These numbers are not divinely ordained. Exercising for an hour every day would likely be even better for our health, as would restricting alcohol intake to one or zero drinks, instead of two. But the guidelines are meant to consider what’s practical and actionable for people in a real-world context, as opposed to the pure dictates of ideal physiology or toxicology. If you advise people that teetotaling is the only true path, or that they need to spend every day in the gym, they may throw up their hands and do neither. The same risk applies to mask guidelines. A purely scientific approach does not offer clarity, and it may leave many of us in an awkward position. There could be hundreds of pages of specific circumstances in which masks are or are not recommended, based on airflow patterns, the demographics of the people in proximity to you, local rates of transmission and vaccination, and so on. None of these variables is independent of the others. There’s no immediate way out of this uncertainty. The acute phase of the pandemic provided a rare opportunity for simple messaging on masks and other interventions. First, the guideline was: Do not leave home. Later, it was: If you leave home, wear a mask. Emergencies have a way of focusing our attention on discrete tasks. Now that the threat is less, and half the country’s adults have been vaccinated, simple guidelines have given way to riddles: If I’m outside at a party with 13 people but two of them are only partly vaccinated and two are not at all, and some of them go inside some of the time, and we are a choir but we don’t sing more than the first verse of a song, do I need a mask? This ambiguity is a by-product of progress. Things are not going to get any clearer anytime soon—and let us hope that they don’t. Some degree of immunity will wane in the coming months, and the warm weather will fade; cases will continue to percolate, and then surge in certain places. The risk, at that point, will not likely warrant another lockdown—but it also can’t be entirely disregarded. As long as the pandemic persists, we will all need to be flexible and solicitous of those around us, and we will all need to wear a mask in certain situations. Anyone who feels more comfortable wearing a mask should absolutely continue to do so. Anyone who questions your choice and tries to explain to you that it’s unnecessary should be told that their explanation is unnecessary. When in doubt, wear one. Remember how much nicer it is to throw on your mask occasionally than it is to wear a mask everywhere you go. [Read: The Texas mask mystery] Masks may be recommended during “cold and flu and COVID-19 season” indefinitely. But guidelines change as situations do. The value of any preventive measure depends on where you are, and where the virus has been surging. Masks are just one of the tools in our kit of interventions. Like any tool, they are not simply good or bad, any more than a bandage or an EpiPen is good or bad. The value of the intervention depends entirely on when and how it’s used. Wearing a life jacket while you’re in a dinghy lost at sea is a great idea. Wearing a life jacket in your living room while watching Pirates of the Caribbean is a less valuable intervention. Likewise, as SARS-CoV-2 grows less ubiquitous, the value of a mask declines in step. As your community gets vaccinated, you can feel more and more comfortable in the knowledge that adding a mask will not add much benefit. The same principle applies to the future. If SARS-CoV-2 surges again in the fall or winter—nationally or in specific states or counties—then the value of masks could rise again. You may end up being asked to wear a mask in one place but not another, even if you’re fully vaccinated. This wouldn’t be a contradiction or a flip-flop; it wouldn’t mean that experts can’t make up their mind and shouldn’t be trusted. It would mean that a sweeping mandate is the most effective mask guideline, in that moment, to beat back a resurgence. I hope that isn’t necessary in many situations, because I’m already extremely used to not wearing a mask. I hope this summer involves a lot more opportunities to leave home without one, to see faces without that constant reminder of this tragic year. But I’m also not about to throw out my stockpile. from https://ift.tt/3vxu8pY Check out http://natthash.tumblr.com Now that Jim’s “Quite Possibly Wonderful Summer” is coming to fruition, a lot of listeners have been considering the present and future. Can you go to a tango festival? What should parents be watching for? And why, exactly, is the surgeon general wearing that uniform? Hit play for answers and a short history lesson from Ruth Fairbanks, a listener and history professor, in conversation with hosts James Hamblin and Maeve Higgins. What follows is a transcript of their conversation, edited and condensed for clarity: Maeve Higgins: I have to say, you know, since I [have] been hosting this show, I’ve learned that the listeners of the show are extremely smart. And do you remember last week, you know, you’ve been speaking with the surgeon general and we played a clip of Vivek Murthy. That’s his name, right? James Hamblin: Yes. Higgins: And I asked you, like, why does he wear a uniform? Like, who is he like? His position was kind of confusing. And you didn’t know exactly either. Hamblin: Well, I said I didn’t know about the uniform. He’s an adviser to the president, which would clarify. But in general, the surgeon general is sort of a communications job. I said [he], you know, speaks for America’s doctors. I really should have said “America’s public-health institutions.” But the surgeon general has generally been the kind of person who could issue, like … a CDC guideline. It’s more like: He’s everyone’s doctor, and here’s what he’s advising. So it’s more one very smart person’s advice that you might take or leave. Higgins: But I think during the show you were like, “I don’t know. Maybe a listener could be a bit more accurate about that.” Hamblin: And then specifically with regard to the uniform, which I wasn’t prepared to talk about. You catch me in so many interesting questions, but that’s why I enjoy chatting with you, Maeve. It’s an interesting role. And we had someone write in about that. Higgins: Yeah, that’s right. Do you want to give her a call now so that she can tell us properly, once and for all, about the surgeon general? Her name is Dr. Ruth Fairbanks. She’s literally a college professor. She’s a senior instructor at Indiana State University. And I don’t know how to say this—Terre Haute? Hamblin: Indiana State, isn’t it? Yeah, Terre Haute. Oh, Terre Haute. That’s what we said in Indiana, growing up. I suppose there are other ways it could be pronounced, if you’re not from Indiana. Higgins: So Dr. Fairbanks teaches history and gender studies, and one of her classes is in the history of American health policy. Hamblin: Oh, perfect. So she can tell us about the uniform. Ruth Fairbanks: Hi, Jim. Hi, Maeve. It’s really nice to meet you. Higgins: Hi, lovely to meet you. Fairbanks: I’ve listened to Social Distance since it began, and I also remember listening to Maeve in America. Hamblin: Oh, wow. Longtime Maeve fan. Higgins: That’s so lovely. Thank you so much. And we absolutely were delighted with your email, because my big question was, what is going on with his uniform? Fairbanks: Well, one of the classes that I teach is a class on the history of American health policy. And one of the things that we cover in my course is a little bit about public health, as well as how we finance health care in this country. And we start in the colonial period. And so my students cover the establishment of the Marine Hospital Service, which started in 1798. And that is the origin of the United States Public Health Service. It grew out of the Marine Hospital Service, where Congress established and John Adams signed into law that the American government would pay for the direct care of merchant seamen—sailors on merchant ships—would provide for their direct care if they were injured or ill. Higgins: Was that because nobody was doing that? Or was that from the goodness of their hearts? Fairbanks: Seamen are a very interesting case. And it wasn’t just the United States. Great Britain had a long-standing tradition also of providing some care for seamen. And it’s because this was an occupation that at once exposed people to a variety of bad weather that could cause serious health problems, and falls, and poor food; and also exposure to disease and poor living conditions. This was a very vulnerable population at the same time that it was a very important population, because for Great Britain, anything related to oceangoing was really essential, as they have this huge empire. And then the American colonies and the brand-new United States: All of the new states are along the Eastern Seaboard, and the ocean is the highway. And they’ve also just declared independence from the major imperial power. It’s really important that they also have access to the ocean. So it’s essential for the nation, as well as the population is very vulnerable. And then the other thing is that charity care would have only been provided to people who were in that community ,and sailors, of course, when they put ashore, they don’t have a home community. So they were always outsiders. So they would have been blocked off from any access to any charity care. And some of these are still typical of American health-care delivery that we deliver— some of it according to a group that we’ve sort of picked apart as like: This group is eligible for health care, not the whole population, but just this group is. And then also we typically do organize our health care, a lot of it, based on location and your membership in a community. That’s why some states, of course, have expanded [Medicaid] under the [Affordable Care Act] and some states have not. This tradition dates back to the colonial period in the United States, where people who are defined as outside, then … they don’t get the same access. But then over the course of time, the Marine Hospital Service begins to accept quarantine responsibilities, because they’re doctors who are paid by the government. So they’re an existing thing that can be used for this other job. And then they gradually begin to take on other responsibilities too: investigations [of] diseases like hookworm and pellagra and attempts to control the spread of malaria, to control mosquitoes, and then gradually take on more and more of these responsibilities. And sometime around the turn of the century, the name changes first to the Public Health and Marine-Hospital Service, and then just the Public Health Service. Hamblin: From the 19th to 20th century. Fairbanks: Around that time. It goes through stages. And one thing is: You can watch the effects of wars on the expansion of American public-health efforts. And a big expansion was around the First World War, an effort at malaria control, and also coming out of the First World War. The Public Health Service was the origin of the Veterans Administration, the VA system. And also efforts to control the spread of venereal disease, both in the First World War and especially in the Second World War. A lot of those focused on the areas around military bases. Hamblin: And I think we even skipped over the Civil War. Some developments there with U.S. Sanitary Commission and the Union Army trying to keep people from dying of unsanitary conditions, actually leading to creation of an agency there. Fairbanks: Actually, this is an excellent point. The U.S. Public Health Service is not just physicians or health-care providers. It encompasses a lot of other professions and expertise. A lot of engineers, for instance, work in the Public Health Service and also veterinarians, statisticians, mathematicians. Higgins: So you can actually be a “vet” vet. Fairbanks: Yes. [Laughing.] Higgins: Did you get that? Hamblin: So I did misspeak when I said “represents the nation’s doctors.” That was a comment that kind of figuratively—like, just one voice for doctors. But in fact, at an official capacity, the surgeon general speaks for all these people, engineers, veterinarians. Fairbanks: And while most of the time they have been physicians, before Dr. Murthy was confirmed a second time, there was an acting surgeon general and that surgeon general was, by training, a nurse. I’m not sure if any of the ones who have been actually confirmed have not been physicians, but this wasn’t the first time that a nurse was the acting surgeon general. Hamblin: And do people in the Public Health Service wear uniforms, or just the surgeon general? Fairbanks: They all wear uniforms. That’s one of the uniformed services of the United States. Their uniform is more like that of a Navy uniform and their ranks, because you progress quite similar to military ranks. And the ranks are based more on Navy ranks than on Army ranks. The rank of the surgeon general, I think, is a vice admiral or some sort of admiral, and you look at the bars on the sleeves [that] indicates the rank. But just above the bars, on the sleeves of that dress uniform, you see the insignia, the symbol of the Public Health Service is a caduceus, which is the medical symbol with the two snakes and the wings, but it’s crossed with an anchor. And the anchor is hearkening back to the origins of this being the Marine Hospital Service. Hamblin: So we have this branch, which is a uniformed service, sort of on par with Army, Navy, Air Force, and yet is devoted to health. And we just don’t hear about it quite as much, apart from the surgeon general. Higgins: Why is that? Why don’t we? Fairbanks: We just maybe don’t realize who we’re hearing about. For instance, a few years ago, when there was the Ebola outbreak in Liberia and the United States sent people to help in Liberia. Those were Public Health Service officers. Those were commissioned officers in the U.S. Public Health Service … when people from the CDC had these strike teams that would go around the world when there was an outbreak and they would do ring vaccination to try to prevent the spread and ultimately eradicated smallpox. The CDC is part of the Public Health Service. National Institutes of Health also started out in [the] Public Health Service. The Indian Health Service started out and the Public Health Service. And a lot of the people who staff Indian Health Service facilities are commissioned in the U.S. Public Health Service. Hamblin: Instead of carrying weapons, people, uniformed members of the health service carry, I assume, vials of antibiotics or vaccines. Fairbanks: Or the engineers carry whatever engineers with shovels, construction equipment. Higgins: Okay, so I’ve seen more movies about SEALs. Hamblin: We like to have movies about elite teams like SEALs, like, the elite of the elite. Maybe if there is or could be a section of the Public Health Service that’s just these highly trained 12 people. Higgins: But those are the lot who went to Liberia probably. Fairbanks: Yeah, they do it all the time. Hamblin: Well, it’s just a branding thing then, I guess. Higgins: Well, it’s fascinating to learn the origins. And it’s also so ironic to me that, you know, from conflict comes this expertise almost like the opposite of preventative health. If it wasn’t for the Civil War, then they wouldn’t be so good at dealing with dysentery. You know, it’s like in Northern Ireland during the Troubles, the doctors in Belfast were the best ever at dealing with kneecaps. You know, they’re, like, world-renowned because so many people had their kneecap shot. Hamblin: Oh, it’s quite true. So many advancements in public health have come through times of war. And hopefully we can continue to invest in public health even when there’s not war. Just pandemics. from https://ift.tt/3i39OZJ Check out http://natthash.tumblr.com With 165 million people and counting inoculated in the United States, vaccines have, at long last, tamped the pandemic’s blaze down to a relative smolder in this part of the world. But the protection that vaccines offer is more like a coat of flame retardant than an impenetrable firewall. SARS-CoV-2 can, very rarely, still set up shop in people who are more than two weeks out from their last COVID-19 shot. These rare breakthroughs, as I’ve written before, are no cause for alarm. For starters, they’re fundamentally different from the infections we dealt with during the pre-mass-vaccination era. The people who experience them are getting less sick, for shorter periods of time; they are harboring less of the coronavirus, and spreading fewer particles to others. Breakthroughs are also expected, even unextraordinary. They will be with us for as long as the coronavirus is—and experts are now grappling with questions about when and how often these cases should be tracked. Breakthroughs can offer a unique wellspring of data. Ferreting them out will help researchers confirm the effectiveness of COVID-19 vaccines, detect coronavirus variants that could evade our immune defenses, and estimate when we might need our next round of shots—if we do at all. “The more complete and precise data we have about the pathogen and how it spreads through the community, the better off we’re always going to be,” Jay Varma, the senior advisor for public health in the New York City mayor’s office, told me. But testing too often can sometimes cause as much damage as testing too little. The nation has yet to settle into its late-pandemic testing patterns, and decide which types of breakthroughs warrant the most attention. On May 1, after weeks of reporting all post-vaccination infections, regardless of whether they were linked to symptoms, the CDC narrowed its focus to cases involving hospitalization or death—a move that prioritizes investigations of “cases that have the most public-health significance,” Tom Clark, who leads the agency’s vaccine-evaluation unit, told me. The decision sparked controversy. Although hospitalization and death are among the most serious consequences of a coronavirus infection—and reasonable priorities for a public-health system with limited resources—the agency’s decision may have been premature, experts told me. Most of the world remains unvaccinated, and will for a while yet; our knowledge of SARS-CoV-2 and its capacity to shapeshift is still growing by the day. One of the best hopes for staying ahead of the pathogen is to watch it closely, in its many iterations, across a diverse set of hosts. Stopping a small fire from spreading is far easier than erasing the damage a conflagration has left—but we’re still figuring out how many stray sparks we’ll need to track. This early in our relationship with SARS-CoV-2, the perks of testing for breakthrough cases are clear. The trio of authorized vaccines in the United States, made by Pfizer, Moderna, and Johnson & Johnson, proved spectacular at staving off symptomatic cases of COVID-19, especially in its severest forms, during clinical trials. In the real world, the protective punch of immunizations can take a slight dip, particularly in people who weren’t well represented in the vaccine makers’ studies. Certain people have naturally different susceptibility to infection, in the same way that certain types of bark catch fire more easily. The first round of vaccine vetting also didn’t formally look into the shots’ potential to curb asymptomatic infections, or transmission—data that are now being gathered in real time. It’s because of breakthroughs—and how few of them we’re finding—that we know that the vaccines are performing well in a broad range of people, knocking back both disease and infection, even as the number of coronavirus variants carrying antibody-dodging mutations continues to rise. By the end of April, when more than 100 million Americans had finished their shots, the CDC had received documentation of 10,262 post-vaccination infections of all severities, according to a report published this week. (That’s a definite undercount of the true number, but breakthroughs are still a tiny fraction of the millions of SARS-CoV-2 infections that have been reported to the agency since the vaccine rollout began.) Breakthroughs could also eventually clue researchers in to how well the vaccines thwart very rare or late-appearing consequences of infection, including long COVID. And the future of COVID-19 booster shots hinges on carefully archiving breakthroughs. Clusters of these post-vaccination infections compelled public-health officials to alter the dosing schedules for measles and chicken-pox vaccines, for example. A subset of the test samples collected from breakthrough cases can also be sequenced, as part of the search for unusual mutations in a pathogen’s genome. Genetic surveillance has, for months, been the pandemic’s bellwether for variants; more than 1.6 million SARS-CoV-2 genomes from around the world have been cataloged in an ever-growing database. Of those 10,000 breakthrough cases, 555—roughly 5 percent—came with sequencing data. Although that’s not a highly representative sample, dozens of those sequences turned up as coronavirus variants that can bypass certain immune defenders. Across the country, the news on variants and vaccines seems mixed, experts told me. One recent study, out of Washington State, found that variants—including several known to stump certain antibodies in the lab—were dominating sequenced breakthroughs. But in Minnesota, post-vaccination infections “just reflect what’s circulating in the community,” Stephanie Meyer, the COVID-19 Epidemiology and Data Unit Supervisor at the Minnesota Department of Health, told me. If a variant were to consistently pop up among the vaccinated, researchers would need to understand why. A new version of the virus might be more efficient at infecting people, or have a new way of eluding the immune system. To tease out those possibilities, researchers need data, the more comprehensive, the better. “Asymptomatic, mild symptoms, hospitalized, passed away—all that information is important,” says Ryan McNamara, a virologist at the University of North Carolina at Chapel Hill, where he and his colleagues are sequencing samples from breakthrough cases across the spectrum of severity. “If you’re asking what variant is driving worse clinical outcomes, you need both ends of the data,” he told me. Many public-health laboratories at the state and local level have been diligently tracking breakthroughs of all kinds for months, and are unsure of whether to mirror the CDC’s shifting priorities. “Previously, labs were sequencing all the breakthrough cases we could get our hands on,” Kelly Wroblewski, the director of infectious disease at the Association of Public Health Laboratories (APHL), told me. “Now states are scrambling, trying to sort it out.” Some states, such as Illinois and Tennessee, quickly followed the CDC’s lead. Others are hesitant. For now, “we’re not changing what we’ll be sequencing,” Myra Kunas, the director of Minnesota’s state public-health laboratory, told me. Some of the same vaccine attributes that make breakthroughs rare also make them difficult to unearth and sequence. When sparks of virus do take hold in a vaccinated person, their fire still seems to burn extremely low—though infected, these people simply don’t carry much virus. That’s great news from a clinical standpoint, but not for someone hoping to identify a virus variant. Proper sequencing requires rounds of shredding and scanning pieces of the coronavirus’s genome, then cobbling them back together into a readable format. Sometimes, the samples from vaccinated people are barely enough to prompt a positive from a test, let alone yield a decent sequence. Other barriers stand in the way of comprehensive sequencing. Antigen tests can catch breakthrough infections, but aren’t usually compatible with sequencing. And many of the labs that process coronavirus tests don’t have sequencing infrastructure, or enough storage to keep hundreds of samples on standby. In many parts of the country, researchers are having trouble tying vaccination records to test results, making it difficult to prioritize specimens for further genetic analysis. Sequencing only 5 percent of breakthroughs is low, experts told me. Minnesota’s lab, for instance, has been able to sequence about a fifth of its 2,500 or so breakthrough specimens. But processing all post-vaccination infections in this way isn’t a reasonable expectation. Fervor for testing has also waned nationwide since the vaccine rollout began. Most vaccinated people don’t need to regularly seek out tests, especially if they’re not feeling sick. The CDC has loosened guidelines about quarantine and associated testing for fully vaccinated people, even after known exposures, and has also recommended that the immunized be “exempted from routine screening testing programs, if feasible.” In recent weeks, several college and professional sports organizations that had for months implemented routine testing for athletes and staffers announced that they were cutting back on screening for the immunized. Programs like these might have otherwise revealed some breakthroughs. But hunting for these cases has other drawbacks. Earlier this month, the New York Yankees, a team that continued to regularly test its fully vaccinated personnel, recently reported nine positive tests—most connected to asymptomatic cases. Many experts framed the detection of mostly symptomless infections as proof that the shots were doing their job, but worried about rote reliance on testing as a security blanket, and wondered about the possibility of false positives. Vaccinated people are so unlikely to catch the virus that administering a bunch of tests wastes resources and increases the likelihood for errors, says Omai Garner, a clinical microbiologist at UCLA Health. Chasing constant reassurance about infections after vaccination could also send the wrong message, Saskia Popescu, an infection-prevention expert at the University of Arizona, told me. “If we’re telling people they can be unmasked and we’re still [frequently] testing them, what’s the signal we’re sending?” Vaccinated people in high-risk settings, such as health-care workers and long-term-care-facility residents, might have more reason to test going forward, especially in areas where caseloads are high. Collecting data from these populations will lend itself to studies of real-world vaccine effectiveness—an endeavor the CDC is still engaged in. But “there’s no recommendation that you get tested randomly” if you’re vaccinated, says Kristen Ehresmann, the director of infectious-disease epidemiology, prevention, and control at Minnesota’s Department of Health. This creates a strange bind for public-health officials who depend on the data that testing programs yield. As collective immunity around the nation builds, finding its weak spots is becoming harder. “We’re running into this potential of losing our pipeline for studying variants in the population,” Wroblewski, of APHL, told me. The CDC’s revised guidelines on monitoring post-vaccination infections could, in some ways, be seen as pragmatic. More severe sickness is relatively straightforward to tabulate, and hospitalizations and deaths lend themselves to a more comprehensive census. (One big caveat is that the agency is including in its counts cases of hospitalization or death that weren’t necessarily caused by COVID-19, but simply involved a positive post-vaccination test.) “With viruses, and with any infectious disease, there’s no end to how much work you can do,” Robin Patel, the director of the Infectious Diseases Research Laboratory at Mayo Clinic, told me. “You have to stop somewhere.” The agency’s decision to shunt attention away from quieter breakthroughs could also help normalize mild or silent coronavirus infections—ones that have been effectively tamed by our suite of lifesaving shots—as a typical experience in the era of COVID-19 vaccines. Though the pandemic will eventually be declared over, SARS-CoV-2 is not exiting the human population anytime soon. Periodic liaisons with the virus will remain a part of everyday life; they might even remind our dormant immune cells to stay on guard. In Minnesota, Meyer and Ehresmann, of the state’s health department, are continuing to collect data on breakthroughs and variants “at perhaps a more detailed level than what CDC is asking for,” Ehresmann told me. That’ll be the case, she added, “as long as that information is helping us in our decision making.” There’s no clear milestone for their team to meet—the virus, if anything, has proved unpredictable—but maybe they’ll change their criteria once caseloads are lower, and more information on vaccine effectiveness is available. I asked Meyer when she thinks her job will get easier. She laughed. “If you figure that out,” she said, “can you let us know?” A total moratorium on SARS-CoV-2 diagnostics isn’t in the cards. Pandemic or no, “we will always have to test for this virus,” Garner, of UCLA Health, told me. But “it is not sustainable to track and trace the way we have for over a year now,” Meyer said. Eventually, the nation will hit upon a more sustainable approach to testing that both helps individuals in clinical settings and serves public-health objectives en masse. The coronavirus will become, perhaps, another seasonal respiratory pathogen that flares up each winter, joining the rotating cast of usual suspects. Surveillance of the virus, in its many iterations, will be modeled on what’s done for the flu, with labs regularly soliciting specimens from around the nation and sequencing them. We will approach a reality in which our relationship with the virus settles into a tense but sustainable truce, in which small fires flare up every once in a while. We’ll be able to see many of them coming, because we’ll know where to look. from https://ift.tt/2TrQRpz Check out http://natthash.tumblr.com Bowen the goldendoodle is never home alone. When he first came home as a puppy, last June, his parents were working remotely because of the pandemic. If they try to leave their Boston apartment for even a few minutes now, he makes his unhappiness audible. “He’s whining and barking, and we just don’t want to upset the neighbors,” Jon Canario told me. So they don’t. Wherever they go, he goes. Wherever he can’t go, they don’t go. When Canario and his partner, Scott Greenspan, celebrated a recent birthday, they ordered takeout instead of dining at the restaurant. They ate in a park—with Bowen, of course. Unfortunately for everyone in this scenario, Bowen’s parents will have to go back to the office later this year. They don’t know exactly when or exactly how many days a week, but they know it’s coming, and they need to figure out what to do. A dog walker? Bowen would still need to get comfortable being alone for several hours a day. Doggy day care? Incredibly expensive. Alternate days working from home so someone is always there with Bowen? If it’s possible. If the pandemic was the perfect time for being at home with a new puppy, the end of the pandemic is proving to be a rude awakening for those very same puppies. The humans they got used to having around all the time—truly all the time in some cases—will soon have places to be. “I’ve never in my life spoken to a client, until the last few months, where they’ve literally never left the dog alone,” says Elisha Stynchula, a dog trainer in Los Angeles. Not to get groceries, not to get mail, not even to take out the trash. Now these very attached pandemic puppies will have to deal with being alone—and not just alone-in-the-other-room alone or alone-for-five-minutes alone. Some of them are having a rough time of it. “We have been seeing a tremendous increase in inquiries for help,” says Malena DeMartini, a dog trainer who specializes in separation anxiety. “They’re like, ‘I have been able to not really leave for my job, because of the pandemic. But that can’t last forever.’” DeMartini says the dogs she hears about can be divided into two camps. The first are the pandemic puppies that cry when their humans leave but just need time and perhaps a bit of training to adjust to a new routine. The second group has genuine separation anxiety—to the point where the dogs are tearing up the blinds, biting at the door trim, or barking nonstop. They’re not just upset about being alone. “They are terrified,” DeMartini said. “These phobias are really irrational-sounding to us, but the dog him- or herself perceives it in a very real way.” Most dogs will, fortunately, fall into the first camp, but they and their owners will still need to stumble through a transition period. Going straight from home all day to eight hours at the office will be rough—on dogs and their humans both. [Read: Pay no attention to that cat inside the box] But many dog owners are having trouble making plans, because their employers still have not said when they will have to go back to the office or how often. “We don’t know exactly what this world is going to look like for us and our dogs even six months from now,” says Jane Yates, whose rescue dog, Jasper, has serious separation anxiety. Yates and her husband, who live in Oregon, adopted Jasper in October and quickly realized that he wasn’t like other dogs they’d had. “I finally realized I needed to call in the professionals when I had gone out for a walk,” she told me. “I could hear him from about a block away, howling and barking.” They’ve been working with a trainer on DeMartini’s team to slowly—very, very slowly—get Jasper comfortable with two hours alone. At first, Yates was simply picking up and putting down her coat and keys, then leaving for seconds, and then minutes at a time. She doesn’t think Jasper will ever be comfortable with a whole workday alone. Gillian Cooper, who got her Yorkipoo, Teddy, last June, told me that she’s been in touch with multiple dog walkers and doggy day cares—to make sure she has multiple options once she is out of the house full-time for her attorney job again. “I’m worried because there’s so many people with dogs. I’m worried these places are going to book up,” she said. She’s been doing some separation training at home with Teddy in his crate. When she leaves, she also turns on (1) a cheap security camera, (2) a white-noise machine to mask outside noises that might startle him, and (3) the radio or the TV, especially The Office, a show that she often has on in the background when she’s at home. “I feel like it might be familiar to him now. I have no idea,” Cooper said, laughing a bit at the idea. Whatever it takes, right? Teddy does whine a little when she leaves, but he eventually settles down. Because the security camera has sound detection, Cooper gets a notification on her phone whenever he cries. When that ping comes, she said, “it’s hard to not want to go home.” [Read: Why do dogs look so sad?] This theme came up over and over again in my conversations: It’s not just dogs that have gotten used to being with their humans all the time; humans have gotten used to being with their dogs all the time. Carlos Dinkel, who most days works two feet away from his dalmatian, Apollo, told me that he recently spent a weekend away, leaving Apollo with a trusted friend. “I’m always used to looking back, because he follows me around the apartment,” Dinkel said. “And I caught myself doing that a lot.” When Julie VanSciver had to return to the office two days a week and leave her puppy, Penelope, she was more worried about herself. Penelope had helped VanSciver enormously with her anxiety during the pandemic, and seeing her dog sad when she left in the morning was really hard. Normally, VanSciver told me, “she’s pretty much glued to my side. All day.” Penelope, it should be said, is doing just fine. The past year has upended the social lives of dogs and humans alike. Trainers told me of situations that would not have been possible if not for the pandemic: dogs that had never had guests in their home, dogs that had never had a stranger walk within six feet of them, and dogs that didn’t go outside during shutdowns and learned to pee in the shower. These dogs will have to adjust to post-pandemic life. But so will humans. from https://ift.tt/3wIbWKF Check out http://natthash.tumblr.com When a person has a mental-health crisis in America, it is almost always law enforcement—not a therapist, social worker, or psychiatrist—who responds to the 911 call. But most officers aren’t adequately trained to deal with mental-health emergencies. And while laws intended to protect civil liberties make it exceedingly difficult to hospitalize people against their will, it is remarkably easy to arrest them. As a result, policing and incarceration have effectively replaced emergency mental-health care, especially in low-income communities of color. In many jails, the percentage of people with mental illness has continued to go up even as the jail population has dropped. Today, nearly half the people in U.S. jails and more than a third of those in U.S. prisons have been diagnosed with a mental illness, compared to about a fifth in the general population. When the justice system steps into mental-health care, the results are often deadly. According to a Washington Post database, nearly one-quarter of fatal police shootings involve a person with mental illness. Once inside a jail or prison, the mental-health care a person receives generally ranges from inadequate to abusive; suicide rates are disturbingly high. America’s criminal-justice system has a mental-illness crisis, and to fix it we need to understand how we got here. One popular explanation blames “deinstitutionalization”: the emptying of state psychiatric hospitals that began in the 1950s. When the hospitals were shut down, the story goes, patients were discharged with no place to get psychiatric care. They ended up on the streets, eventually committing crimes that got them arrested. As a result, jails and prisons essentially became the new asylums. It’s an idea with roots in a theory developed in the 1930s by a British psychiatrist, Lionel Penrose, who argued that there was an inverse relationship between the number of people held in prisons and those in asylums. Today, the “Penrose hypothesis” is largely regarded by scholars and historians as an oversimplification of the problem, yet variations of it are regularly repeated in the media. The truth is far more complicated. The first psychiatric hospital was established in 1773, but asylums were few and far between until the mid-1800s. In 1841, a former schoolteacher named Dorothea Dix visited a Massachusetts jail to teach a Bible class. She was appalled to find it filled with people with mental illness, living in horrific conditions; traveling around the country, she found similar conditions in other jails. Residents were kept in “cages, closets, cellars, stalls, pens!” she later wrote in a letter to the Massachusetts legislature. “Chained, naked, beaten with rods, and lashed into obedience!” She started lobbying states to create asylums, and eventually she helped establish or expand more than 30 institutions. Many more were created in the decades that followed; by the height of institutionalization in 1955, roughly half a million people were living in state-run psychiatric facilities. These were designed to be safe, therapeutic places where people with mental illness could live quality, productive lives. Occasionally, they succeeded. Some self-sufficient asylum communities provided both employment and sustenance for residents: small-scale agricultural production, laundries, and bakeries. But as more patients were moved into these institutions, the facilities quickly outgrew their capacity, and staff struggled just to keep up with patients’ needs. When a public psychiatric hospital in Worcester, Massachusetts, opened in 1833, for example, it had 120 beds. Just 13 years later, it had almost 400. The problem grew significantly worse during World War II, when many doctors and other staff were drafted, leaving the hospitals dangerously understaffed. The resulting conditions looked remarkably similar to those seen in jails and prisons today. This was the beginning of the end for the state hospital system—but other factors sped it up. In 1954, the FDA approved the use of the antipsychotic drug chlorpromazine—also known by its trade name, Thorazine—to treat mental illnesses like schizophrenia and bipolar disorder. Its apparent ability to control psychosis—combined with a heavy marketing campaign that made it one of the first blockbuster drugs—helped promote the notion that mental illness could be cured with medication. Specialty inpatient psychiatric hospitals would no longer be needed because patients would no longer need the kind of intensive care they promised to provide. Almost a decade later, President John F. Kennedy signed the Mental Retardation Facilities and Community Health Centers Construction Act. (It turned out to be the last bill Kennedy would sign.) Under the 1963 law, he said, “custodial mental institutions” would be replaced by community mental-health centers, thus allowing patients to live—and get psychiatric care—in their communities. In 1965, the creation of Medicaid accelerated the shift from inpatient to outpatient care: One key part of the Medicaid legislation stipulated that the federal government would not pay for inpatient care in psychiatric hospitals. This further pushed states to move patients out of costly state facilities. In reality, though, few community mental-health centers were built, creating an extreme shortage of mental-health care. Thorazine, initially touted as a miracle drug, soon proved to have serious side effects. More critical was the growing recognition that the treatment of mental illness is complicated: Conditions like bipolar disorder and schizophrenia cannot be “cured” with a simple drug regimen the way an antibiotic can knock out an infection. And Medicaid, now the largest payer of mental-health-care services in the country, has severely limited the number of inpatients that hospitals and other facilities can serve. The dream of community-based care turned out to be largely a failure. It’s tempting to think that if the promises of deinstitutionalization had materialized—or if the state hospitals had never been shut down—far fewer people with mental illness would be in jails and prisons today. At first glance, the numbers seem to bear this out: The population of people living in asylums dropped from a high of more than half a million in 1955 to barely more than 100,000 in the mid-1980s. (Those numbers have continued to fall in the intervening years, and today there are negligible numbers of people in long-term psychiatric facilities.) As the asylum population steadily shrank, the number of incarcerated people grew. The deinstitutionalization theory is also tempting because it points to a clear solution: If the lack of long-term inpatient beds drove large numbers of people with mental illness into jails and prisons, then presumably building more hospitals and community mental-health centers would solve the problem. But the theory falls apart on closer scrutiny. It’s not the case that the majority of people with mental illness were suddenly on the streets when institutions closed: Even in 1950, only about a third of people with mental illness were living in psychiatric hospitals and other facilities. More than half already lived in communities, with family or on their own. Furthermore, the vast majority of incarcerated people with mental illness belong to a subset of the population that likely would never have been served by state psychiatric hospitals in the past. State-hospital patients were largely white and middle-aged or older, and divided roughly evenly between men and women; today’s incarcerated population is largely young, male, and not white. (More than half of the U.S. prison population are people of color.) One study suggests that closing the state psychiatric facilities increased the incarcerated population by less than 10 percent. So what accounts for the extraordinary levels of mental illness we see in our jails and prisons? In large part, the sheer number of incarcerated people. In a July 1971 press conference, President Richard Nixon declared a war on drugs, calling “drug abuse” America’s “public enemy number one” and setting the stage for tough-on-crime policies. These laws, like mandatory minimum sentences for possession and other drug-related crimes, disproportionately affected people of color and pushed incarceration rates to record levels. Between 1972 and 2009, the prison population alone grew 700 percent. As huge numbers of people were swept into jails and prisons, logically many of them had mental illness. The crackdown on drug crimes made them especially vulnerable to incarceration. Substance use is common among people with mental illness, in part because it can serve as a form of self-medication. Around three-quarters of incarcerated people with mental illness are known to also have a substance-use disorder. At the same time, the advent of “broken windows” policing in the 1980s—the idea that in order to prevent bigger crimes, police need to crack down on low-level quality-of-life crimes—disproportionately affected people with mental illness: A person acting erratically could be charged with disorderly conduct, or a person without access to a bathroom could be charged with public urination. Tough-on-crime rhetoric also helped enforce the persistent assumption that people with mental illness are dangerous and need to be kept off the streets to protect the rest of us. Judges have told me repeatedly that they fear offering bail or other alternatives to people with mental illness lest the person in question end up on the front page after committing some heinous crime. But people with mental illness are far likelier to be victims than perpetrators of violence—and since police are the default first responders, it’s no surprise that people with mental illness are more likely to end up getting arrested. In order to truly fix our broken approach to mental illness, there needs to be a change in attitude: one that goes from seeing people as inherently dangerous to treating them as human beings in need of help. Recent years have seen a spate of police killings of people with mental illness, but also a renewed focus on law enforcement’s role in responding to mental-health crises. Attention has been heightened in the wake of recent episodes of police violence, including the death of Daniel Prude in March 2020, when officers were called to help him while he was in a psychotic state. Police departments around the country have adopted training programs to teach officers how to respond to people in psychiatric distress. The most common model, the Crisis Intervention Team program, is being used in more than 2,500 communities nationwide—though there’s little empirical evidence of its success, and it’s unclear whether a few hours of instruction can overcome entrenched use-of-force practices. And some jurisdictions have gone a step further, dispatching mental-health workers to respond to 911 calls. In St. Paul, Minnesota, for example, social workers accompany specially trained police officers on mental-health-related calls, assessing needs and directing people to resources like counseling or shelters. In Eugene, Oregon, unarmed outreach workers and medics respond to many mental-health emergencies instead of officers. And programs that offer alternatives to incarceration have been growing, too. In the more than 300 mental-health courts across the country, people who agree to certain conditions—usually treatment, including medication and regular check-ins with a judge—can avoid jail and prison time. But America has gone without a real system of mental-health care for so long that mental illness is often seen as a permanent feature of the criminal-justice system. In many prisons and jails, the urgent question is not how to reduce this surging population but how to build larger and better psychiatric units and treatment facilities inside the walls. Rikers Island, for example, now has specialized therapeutic units for people who might need hospitalization or who have just returned from a psychiatric hospital. While people with mental illness who do end up in the criminal-justice system have a constitutional right to adequate mental-health care, it would be far better to disentangle psychiatric care from the criminal-justice system in the first place. It’s easy to think that if people with mental illness could be housed and treated in asylums or similar institutions, they wouldn’t be policed and incarcerated at such high rates. But it’s important to remember that those hospitals had deteriorated to conditions shockingly similar to today’s worst correctional facilities. Instead, we need to face head-on the enormous problems of mass incarceration and a system of mental-health care that effectively does not exist. No nostalgic looking back will change that. from https://ift.tt/34dy1EL Check out http://natthash.tumblr.com Every American state has laws requiring vaccination. If you want your children to attend kindergarten, you must vaccinate them against rubella. Most parents comply because they don’t want anyone going deaf from congenital rubella. And if that isn’t convincing enough, then there is the ominous threat of having to homeschool. But these laws have holes, and more people are going through them. In the past decade, the number of people seeking “philosophical exemptions”—meaning they don’t need to comply with the law, because, effectively, they disagree with it—has steadily increased. At least partly as a result, measles outbreaks are now verging on common in places where the disease was once totally eradicated. At the same time, more stringent laws may increase skepticism of vaccines, as people conflate concerns about vaccination with objections to being made to do … anything at all. Americans clearly object to sticks, even during this pandemic: States including Montana, Arkansas, and South Carolina have already banned COVID-19 vaccination requirements, before they could even be proposed. But carrots? Carrots we like. Instead of threatening punishment or withholding access to basic services such as education, some places are starting to offer incentives, largely in the form of free stuff. Get a shot and you can chase it with doughnuts, beer, baseball tickets, or all three. Earlier this month, Ohio Governor Mike DeWine upped the ante with a bombastic plan to enter vaccinated people in a $1 million lottery. It seems to have resulted in a surge in vaccination, and this week both New York and Maryland announced similar lottery prizes. These are just some of the not-so-creative-but-possibly-very-important approaches that states should take seriously. More than half of American adults have gotten at least one shot, but they were likely the most eager and, perhaps, most at-risk. Vaccinating the second half will be equally important but much more challenging. There will be places, such as schools and hospitals, where vaccine requirements are simply necessary. Some companies will deem requirements for employees vital to their business. But the solution that’s most likely to trigger minimal backlash is the same one that got almost everyone—even the most die-hard, rugged individualists—to carry a tracking device in their pocket. Ultimately, the free market, lauded by so many who object to vaccine requirements, may persuade holdouts to get a shot. Science has taken us very far, but from here on out, ending the pandemic will be up to what America does best: marketing. If behavioral economics is to be believed, people can be prompted to do things by way of small reminders known as “nudges.” These are meant to be gentler and more palatable than rules or requirements. There’s something darkly paternalistic about the term nudge, which makes me feel like I’m being manipulated into walking off a cliff. But in the classic example, nudges do things like get people to register as organ donors, by making organ donation the default. In marketing, similar approaches are used to drive sales. For example, restaurants may include certain menu items that are deliberately overpriced in order to nudge people toward an option that’s meant to seem reasonably priced in comparison. Marketing excels at creating the illusion of autonomy for the purpose of taking people’s money. But in cases of public health, nudges can feel condescending or confusing: They imply that people are stupid, and so they need to be nudged to do basic things that keep them alive. The beep that reminds you to buckle your seatbelt is helpful, but also makes me want to smack the car. The enormous label on cigarettes that says you might die if you smoke them raises questions about whether public-health officials think we don’t already know that. But even if they become annoying or eerie, nudges can feel justified when they’re used to help us sidestep distractions or misinformation. They can help people decide to do vital, prosocial acts—such as getting vaccinated to help end a pandemic that has brought life to a standstill and killed millions of people—that they wouldn’t have otherwise done. Everyone needs nudges sometimes, and no one more so than doctors themselves. A medical-record system that prompts doctors to ask every patient if they’ve gotten a vaccine—and, if they haven’t, to whip one out and offer it on the spot—can eliminate simple oversights. This sort of prompt pairs well with easy, ubiquitous access to vaccines. People could be offered a vaccine every time they walk into a pharmacy, or in places where they have time to kill, such as an airport. The goal would be to reach everyone who’s ambivalent or feels they’re too busy to get one, by making vaccination so convenient that they don’t have to go out of their way at all to get vaccinated. Instead, they’d essentially have to go out of their way not to. The nudges can even responsibly veer into the domain of small incentives. The best ones will probably involve decisions people are already familiar with making, such as deeming a lottery ticket worthwhile. The more diverse and quotidian the incentives, the greater the odds of meeting people where they are, and avoiding the divisiveness and politicization inherent in laws and requirements. If people object to this, then they have a lot to object to in American life. We lovers of freedom may protest being made to do many, many things. But we excel at consumerism, and seem to relish the belief that we are behaving autonomously. When we decide that the jeans everyone is wearing these days would also happen to look good on us, we buy them not because we feel we’ve been manipulated into doing so, but because we actually believe they’ll make us happier. The grand illusion is not new or foreign; it is our default state. The idea that vaccine hesitancy is entirely a result of lacking empathy or intelligence is dismissive and unproductive. The decisions we make in life are a result of weighing incentives for and against everything, usually shaped by emotion and personal experience. Whether these decisions are conscious or not, someone almost always has a finger on the scale. Did you really choose to eat at McDonald’s? Or did you do it because of some ads you saw as a kid, which led you to try and subsequently love McNuggets, and so now you choose to get some McNuggets? The marketplace of information that’s driving people’s decisions about vaccination is already immensely cluttered with bad takes and gut instincts. Sometimes the best anyone can do is help nudge people toward a clearer view. from https://ift.tt/3fzsaPf Check out http://natthash.tumblr.com In the race to build the world’s first round of coronavirus vaccines, the spike protein—the thorny knobs that adorn each of the pathogen’s particles—was our MVP. Spike is a key ingredient in virtually every one of our current pandemic-fighting shots; it has been repeatedly billed as essential for tickling out any immune response worth its salt. “People put all their eggs in the spike basket,” Juliet Morrison, a virologist at UC Riverside, told me. And it undoubtedly paid off. In recent months, though, it’s become clear that the coronavirus is a slippery, shape-shifting foe—and spike appears to be one of its most malleable traits. Eventually, our first generation of spike-centric vaccines will likely become obsolete. To get ahead of that inevitability, several companies are already looking to develop new vaccine formulations packed with additional bits of the coronavirus, ushering in an end to our monogamous affair with spike. The potential perks of this tactic run the gamut: More vaccine ingredients could help the body identify more targets to attack, and loop in untapped reservoirs of immune cells that have no interest in spike. Multifaceted shots also up the ante for the virus, which can alter only so many aspects of its anatomy at once. “It’s like diversifying a portfolio,” William Matchett, a vaccinologist at the University of Minnesota who’s researching reformulated COVID-19 vaccines, told me. To be clear, setting our sights on spike has served us well. The vaccines we’ve built against the coronavirus continue to be astoundingly effective shields against disease largely because the protein is such an excellent teaching tool for an immune system that’s readying itself to duel. Spike, which helps the virus unlock and enter human cells, is one of the pathogen’s most salient and dangerous features, certainly among the first that will be spotted by immune cells and molecules on patrol. Vaccines that teach the immune system to recognize the spike will, in all likelihood, be vaccines that teach the immune system to act effectively, and fast--quickly enough, perhaps, to waylay an invading virus before it even has a chance to break into cells. This process, called neutralization, is carried out by specific types of antibodies, and it holds a venerated status in the field of vaccinology, David Martinez, a vaccine expert at the University of North Carolina at Chapel Hill, told me. Once a vaccinated person produces enough neutralizing antibodies, so the theory goes, they need little else to stave off sickness. And the spike protein appears to be top-notch antibody bait. “Spike is here to stay—it is absolutely necessary,” Smita Iyer, an immunologist at UC Davis, told me. But although antibodies zero in on targets with laser-sharp precision, they are easily discombobulated by change: Even subtle shifts in the spike’s structure can make it harder for molecules to glom on to the surface of the virus and bring it to heel. Antibody-dodging variants of the virus, each carrying slightly rejiggered versions of spike, have now appeared in several countries, including South Africa, Brazil, India, and the United States; more will certainly follow. [Read: One vaccine to rule them all.] None of our current vaccines has yet been completely nullified by a coronavirus variant, and vaccine makers such as Moderna and Pfizer are planning to cook up additional shots containing tweaked, variant-conscious versions of spike. The problem is, strategies like these could quickly lock us into a woefully mismatched fencing bout: Microbes mutate much faster than humans invent vaccines, and with every new thrust, we’ll have time only to parry in return. When spike operates alone, it creates an obvious immunological loophole through which a virus might slip. There’s another solution. We could simply give the immune system more hunks of the virus to target. Several vaccines containing whole coronavirus particles—which have been chemically incapacitated so they can’t cause true infections—have already been authorized, including a couple made by the Chinese company Sinopharm. Whole-virus vaccines, however, can be a pain to produce, and have delivered mixed results in the past. Several companies, including the California-based Gritstone Bio, have decided to take a more targeted tack, selecting a subset of coronavirus traits to package into some of their repertoire of inoculations. One of Gritstone’s vaccines, which is currently in human trials, contains not only spike but also chunks of two proteins that the coronavirus keeps in its interior: one called nucleocapsid, which helps the pathogen package its genetic material, and another called ORF3a, which helps newly formed coronavirus particles mosey out of cells. Neither of those internal proteins will be of much interest to neutralizing antibodies, which are built to latch on to only the outsides of pathogens as they bop around the body. But virus innards can be good fodder for another group of immune defenders—T cells—which recognize and kill infected cells that chew up pathogens and display chunks of them on their surface. If antibodies are like cameras that focus on a virus’s superficial appearance, T cells are X-rays that go a few layers deeper. T cells are already an essential part of the immune response our bodies mount to our current vaccines, because they react very strongly to spike. But Andrew Allen, Gritstone’s CEO, told me that the T cells in our bodies could be doing more, if given the chance. T cells in people who have been infected by the coronavirus can home in on many parts of the virus that aren’t packaged into most vaccines. Some of these immune targets, encouragingly, have mutated more slowly than spike, raising hopes of protection that’s both potent and long-lived. Early studies suggest that new coronavirus variants that bamboozle certain antibodies are still nowhere near stumping the body’s diverse cavalry of T cells. [Read: The body is far from helpless against coronavirus variants.] Strong and versatile T-cell responses may, on occasion, be powerful enough to fend off the coronavirus largely on their own. That could make spike-plus vaccines a huge boon for people who are on drugs that blunt the ability of immune cells called B cells to produce antibodies, such as the ones taken for certain types of autoimmune disease. Matchett, of the University of Minnesota, recently led a study (not yet peer-reviewed) showing that an experimental vaccine containing only nucleocapsid—a design that would specifically bait T cells, but not neutralizing antibodies--curbed the severity of COVID-19 in laboratory hamsters and mice. The rodents still got sick, “but the T cells are coming in and doing cleanup and preventing more disease from occurring,” he said. The experiment was just proof of concept: A spike-free vaccine probably isn’t in the cards. But a shot that includes nucleocapsid makes for a pretty good insurance policy. What vaccine makers are after is “more layers of protection,” on top of the successful foundation the current vaccines have laid, Padmini Pillai, an immunologist at MIT, told me. Another company, California-based ImmunityBio, plans to push the pro-T-cell paradigm even further. It has several versions of a spike-nucleocapsid combo vaccine in clinical trials, some of which are being delivered as drops into the mouth, and will soon be testing out an intranasal spray. Patrick Soon-Shiong, the company’s CEO, told me that this route of administration is a much better pantomime of how the coronavirus actually enters the human body—through the airway, where it will encourage the production of unique populations of antibodies and T cells tailor-made to guard these tissues. Many of those T cells will even hunker down in and around the lungs, where they can head off the virus immediately, something that doesn’t happen as efficiently when we inject vaccines into our deltoids. “I think local immunity is going to be what we need, if we’re thinking ahead,” Donna Farber, an immunologist at Columbia University, told me. Some next-generation vaccines could operate as solo acts for the un-immunized; others could be boosters for people whose defenses against the coronavirus are no longer up to snuff. The spike-plus approach isn’t foolproof. Stuffing too many triggers into a vaccine could backfire if, for instance, an extraneous protein ended up distracting cells from spike. A poorly designed vaccine could also rev up T cells, but sap resources away from the B cells that might otherwise pump out neutralizing antibodies to stop the virus before it infects our tissues. “We need to make sure we have balance,” Pillai told me. Worse still would be a vaccine candidate that inadvertently drives an overzealous immune response, burning up healthy tissues alongside the sick. There’s even precedent for this with the coronavirus that caused the 2002 SARS epidemic: Lab mice fared worse with the pathogen after taking a vaccine that included nucleocapsid. “I wouldn’t necessarily rule [nucleocapsid] out as a target yet,” Martinez, of UNC, told me. “But we have to proceed with a lot of caution.” On one point, every expert I spoke with agreed: We’ll need to keep pace with the changing coronavirus for a good while yet. Even after the pandemic is declared over, the coronavirus will linger. Human and virus will need to grow accustomed to each other, forging a détente that hopefully grows more peaceful over time. To accelerate that truce, our approaches to vaccination might need to become less reactive--responding to the virus after it alters itself—and more proactive, anticipating its next moves. Surveillance centers around the world have, in recent months, begun to sequence samples of the virus at an accelerated pace, cataloging every tweak in its genome, while researchers work to model the ways viral genes and proteins might change. SARS-CoV-2 has learned the strength of its costume changes and won’t be easy to put down. But perhaps our next round of vaccines will move us closer to the possibility of one-shot-fits-all. from https://ift.tt/3hKb1oH Check out http://natthash.tumblr.com We've all been suffering during the coronavirus pandemic in one way or another, and as the U.S. starts to emerge, we'll need to reckon with that. The Atlantic's Ed Yong discusses his piece on pandemic trauma, how to think about it, and what he's learned through talking to psychiatrists and other experts. What follows is a transcript of their conversation, edited and condensed for clarity: James Hamblin: So now you're back from working on your book and writing about the pandemic again. Your first piece back on the subject is about the trauma of the moment. And how are you defining the trauma of the pandemic? Ed Yong: Yeah, I think this has clearly been an intensely stressful 14 months. The pandemic uprooted so much of our lives. It caused sickness and death. Like I say in the piece, there is an ongoing debate among psychologists and psychiatrists about how to define the word trauma. And one of the people I spoke to talks about “big-T” and “little-t” trauma. Big-T is like what you would officially classify as trauma. So, like, death, injury—people who have obviously been very sick from COVID-19, people who’ve lost loved ones to COVID-19. And then there are all the sorts of little-t traumas, the things that we might colloquially call traumas that are undoubtedly influential on mental health, things like losing a job, being isolated from your loved ones, being trapped in this atmosphere of fear and uncertainty for a long time. And I think I don’t really want to make that much of a distinction between those two things. Both of them were keenly felt over the past 14 months. Both of them influenced the mental health of people who’ve lived through the pandemic. And both of them are things we think we still need to be talking about now. Maeve Higgins: It’s amazing that you list all of these things, and sometimes even when we talk to people on the show, they’re so careful to point out, “Well, yes, this did happen to me, but it wasn’t as bad as, you know, X, Y, and Z.” Like, I don’t even want to mention specifics because everyone is in this kind of, like, “Oh, I can handle this because it hasn’t been the worst thing that’s happened.” Yong: Yeah, I think there’s a lot of that happening. When you see the sort of full scope of the pandemic, it’s sometimes easy to sort of minimize what you yourself have gone through. And I think for people who haven’t really dealt with mental-health problems before or who are sort of used to a normal baseline of stress, dealing with something very unusual, like a pandemic, can actually be very jarring. They almost don’t expect to feel as stressed out or as bad as they have. And this could be anyone from doctors and nurses, who obviously have a very stressful job. And it could be parents, who are used to just the baseline rigors of being a parent, but maybe not used to having to do that 24/7 without any child support. In the midst of this crisis where schools are shutting down … the pandemic ramps everything up to the nth degree. And it’s not surprising, I think, that even people who think of themselves as sort of hyper-competent folks who are caregivers, who are used to dealing with stress, have found these months very, very hard. Higgins: Absolutely. Jim, I was going to say to Ed about that line in his piece: “If you’ve been swimming furiously for a year, you don’t expect to finally reach dry land and still feel like you’re drowning.” And that really hit us, I think, because it’s not just snapping back and everything’s fine. So, do you feel like this applies to—I mean, everybody, like you said, but especially—health-care workers and other folks who’ve been on the front lines? Yong: Yeah, I think this is going to be a very common experience. I don’t think it’s going to apply to everyone, but some people—maybe who are listening to this podcast—are just going to be fine. And for them, I feel joyous and happy, and I hope that it continues in that vein. But I know that a lot of people have been running on adrenaline and running on fumes for a long time. And they’ve now hit this point, in the U.S. specifically, where things are starting to feel a bit better. People are feeling safer, vaccinations are rising, cases are dropping. And yet now, when they finally get a chance to exhale, they’re finding it unexpectedly hard. And, actually, I don’t think that we should be surprised at that. A lot of the literature from other kinds of disasters or other kinds of traumatic experiences, including soldiers who return from war, health-care workers in the aftermath of crisis—we see that people, when they get a chance to breathe, often finally get a chance to look back and think about everything that has happened to them in the times before when they were just sort of trying to get past. And it’s in those moments, when you really get to take stock of actually how tired or anxious or stressed you’ve been, that a lot of people suddenly collapse in a way. People who I spoke to who work in trauma say that this is a very common experience, but I think it can be all the more jarring because we don’t expect it. We expect that when things are better, we will feel better. But of course, how we feel right now isn’t just defined by the current moment, but by everything we have experienced in the past. And everything we've experienced in the recent past has been kind of awful. Higgins: I hate that about our brains, they just collect it all up, right? Yong: Yeah, yeah. They collect it all up. And in some ways, it’s unfortunate. But, you know, it’s seen in another way, like integrating across all your past experiences and using that to determine your current state of mind. You could just call that learning. But it’s also, in many ways, a totally reasonable way of acting. And I think it causes problems when we forget about how our responses to grief and loss actually work. It’s not just the case that things get better and people just snap back into their previous normal behavior. We need to collectively allow people who are struggling in this moment to have the time to not feel so good. Hamblin: That’s something I’ve heard doctors advise people, especially older people, after a significant hospitalization for anything in normal times, pneumonia or a fracture, that you shouldn't have the expectation that life is going to go back to the exact same way that it was. You’ve been through something and it’s going to be slightly different now, but doesn’t have to be in a worse way. You just need to think that there will be a change. Did you get any insight from people you spoke to in covering this piece about how to navigate that in post-pandemic times? I mean, thinking about things as, they’re not going to be the same as they were, but you can still find ways to be okay. Yong: On an individual level, I guess just even acknowledging that that is how things might play out is really important and it sort of goes against some of our popular conceptions of how grief and coping work. People I talked to spoke about this very popular five-stage model where you sort of cycle through clearly defined stages of denial, anger, bargaining, depression, and acceptance. And that model is wrong. That's not actually how people cope with traumatic events. So there are no discrete stages. They don’t occur in a linear cycle. They can take a long time to resolve, and that resolution might not take the form of acceptance. So I think just having a better understanding of the nuanced and meandering ways in which our reactions to these problems will play out is really important. We can actually start thinking about numbers of people who might be experiencing prolonged effects of pandemic trauma. We know, for example, at the height of the winter surge, we had 132,000 Americans who were hospitalized. Based on what we know from past coronavirus epidemics and studies coming out of Italy with this one, we know roughly around a third of those people will probably develop PTSD, which works out to about 40,000 or so. We also know that at least 580,000 Americans have died from COVID-19. Each of those deaths, on average, leaves nine bereaved close relatives of parents, children, siblings, spouses, grandparents. In general, about 10 percent of bereaved people develop prolonged grief disorder, which means that your grief is intense, it’s incapacitating. You don't get over it, even after a year or more. So that means that we probably have about half a million Americans who are experiencing that kind of severe, prolonged, intense grief. Which is the population of a reasonably sized city. That’s a lot of people. And here I’m only really talking about those big-T traumas. We're not talking even about people who are grieving friends. We’re not talking about long-haulers who are still experiencing symptoms, not talking about folks who are dealing with all the little traumas like unemployment and isolation and all the rest. Higgins: And those people who were hoping to start families who kind of lost that time. Yong: Yeah, the value of life lost. So many people and students who were looking forward to graduating and starting college, people whose businesses were on hold for years. There’s so much loss, the rhetoric of individual resilience only gets us so far. It almost shifts the blame away from institutional failures. You know, we’ve talked in the show about the systemic failures that allowed the pandemic to just spread readily in the United States. But there are now going to be systemic failures that affect who gets access to care, who has the time and the capacity to actually heal. We’re now entering a phase where employers are forcing people to return to the office; where people will increasingly want to seek mental-health support for everything they’ve experienced but will run headlong into the dramatic dearth of mental-health-care providers in the U.S., the labyrinthine nature of the insurance requirements. It’s going to be hard. And I don’t think that we should allow the idea that people individually can often be resilient in the face of hardships to [erase] the fact that a lot of people will encounter massive structural barriers to feeling whole again. Hamblin: Yeah, I’m trying to resist the inclination to ask for individual advice about what people can do, because that plays into the exact problem that you're talking about. Higgins: You've got to stay hydrated, everyone. Yong: Everyone try to do yoga, go for a walk. We can all just rattle off a list of those tips, right? I don’t think that they’re unimportant, but one of the people I spoke to said that America is just not very good at talking about loss and about giving space for grieving and mourning. And she said, by and large, it’s all about consumption to help numb you out. It feels true. It feels like that’s where we're headed, that you’re expected to just deal with it. And Jim, you talked about health-care workers. I feel like this is especially true for that community of people … there’s plenty of stigma around even seeking care for mental health and a lack of institutional support for nurses and doctors and other health-care workers in doing so. And I worry for people who endured a long, long marathon of having to stare this pandemic really in the face and how they’re going to be feeling now even as things start improving nationally. Hamblin: Yeah, well, maybe that’s some helpful personal advice we could give people, is talk to people around you about how you’re feeling or at least ask how they’re feeling, especially in trying to make sure that they have someone they can open up to. Yong: One person I spoke to talked about how normalizing the collective trauma is going to be important in recovery. And I think what you just meant by talking about the stuff is sort of why [I wrote] this piece: to put words to this experience that I spent a lot of people are going to be going through. What we talked about, this disconnect between expecting to feel better and actually not, taking time for that to happen. Higgins: And it's often like I remember when we were kids, we used to kind of joke because my dad would always get sick on his days off because he worked all the time. And it was when he stopped that his body kind of gave. He was in construction, you know. And so, it feels a bit like that, too, because I know Jim and I were talking before you called, Ed, about how people are taking off their masks. That’s such a visual sign that things are better again. But maybe that’s the time, then, that it all hits you. Maybe if you haven't been physically sick yourself. Yong: Yeah, I agree. And I think you’re right. In talking about the physical aspects of this to you, like I've been saying to folks, everything I'm seeing now reminds me of going to university for the first time, and like your dad on his days off: As soon as terms finished, I got sicker than I’ve ever been. You run and run and run. And the minute you stop, your body just gives out. And I think there are reasons for that. The stress affects the immune system. And ironically, for this conversation, it makes people more vulnerable to respiratory viruses, and not only do people become sicker, they often mentally crash, too. This is what we discussed earlier, that often it’s when you get to stop swimming and reach dry land, that you start to feel like you’re actually drowning. from https://ift.tt/3ys9KZu Check out http://natthash.tumblr.com |
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