Though the coronavirus continues to spread around the world, the end appears to be in sight in the United States. And with that hopeful end, this will mark the last episode of Social Distance. James Hamblin, Maeve Higgins, and returning co-host Katherine Wells gather to say goodbye to the show, reflect on what we’ve learned these past 15 months, and listen to voicemails from past guests. Listen to their conversation here: What follows is a transcript of their conversation and voicemails, edited and condensed for clarity: Maeve Higgins: We have a voicemail from Dr. Stephen Thomas that I’d love to listen to. James Hamblin: Yeah, he was one of my sources early in the pandemic talking about disaster preparedness. And then, coincidentally, he ended up becoming the coordinating principal investigator for the Pfizer-vaccine clinical trial and kept me updated on that throughout. Hi, this is Dr. Stephen Thomas calling. I’m a physician-scientist of infectious diseases from Syracuse, New York, and the coordinating principal investigator for the Pfizer-BioNTech [COVID-19] vaccine trial. So what would I recommend [for] people to keep themselves informed about public health? I think the first thing is to make sure that you are going to multiple sources: your local Department of Health, the CDC, magazines like The Atlantic, The New York Times, The Washington Post, the L.A. Times. Journalists have done an incredible job at getting to the facts in a very nonpartisan, evidence-based way. In terms of what I’ve learned personally and professionally—I guess, professionally, what I’ve learned is: Leadership matters. Whether you’re a leader or a follower, you can make a big difference in situations like the one that we’re still in right now. You always go farther and faster if everyone’s in the boat [facing] the same way and rowing at the same time. A lot of us have been saying for a long time that a pandemic like this was possible and that the planets would align someday. Personally, I think that it’s been a very interesting experiment, seeing how people view science, how people view medicine, and how people make decisions about their health. There’s been a lot of very promising aspects and also some somewhat concerning trends that we’ve seen in the country. And I think there’s a lot of work to do on that front. Higgins: We also heard from the amazing Dr. Art Caplan, Jim. Great guest. Hamblin: Yeah! He’s a renowned bioethicist who was on very early, talking about how we think about rationing care and, more recently, about how we think about privacy, vaccine passports, and vaccine mandates. Hey, it’s Art Caplan calling from NYU. Living through the pandemic, I’ve learned that a lot can be done professionally on Zoom. (Laughs.) We don’t have to go to work five days a week. We won’t be doing that at NYU in my shop ever again. I’m sure we’ll stick to three days. I’ve learned that it’s very important to make sure you know how to cook. I hadn’t given that much value, but a year indoors has convinced me that that’s a vital skill to be completely cultivated. (Laughs.) And how do we hold our institutions to account? We better make sure that politics can’t influence science. We’ve got to build more walls between our science agencies and politicians. Donald Trump and his henchmen wound up undermining scientific messages, even though they’re out after Dr. Fauci based on nothing except revenge and ideology. Politics goes after science. Science is weak. It isn’t able to protect itself very well. We’ve got to figure out structures that let the science be heard without letting the politicians bully or threaten or undermine the content of the messages that scientists and doctors have to offer. They’re not the last word, but they ought to be heard. Hamblin: We also heard from F. T. Kola, a writer and a friend of yours, right, Katherine? Katherine Wells: Yes, I actually got to see her the other day for the first time since the pandemic began, and she’s very well. She got COVID very early in the pandemic. She’s one of the many people who had a severe case of COVID, recovered, but dealt with long-COVID symptoms long afterwards. There are still so many people who are dealing with those effects. And she called in with some lovely reflections on this past year: I want to thank you for the show. I will miss it, and I know a lot of people will too. My greatest lesson [of the pandemic] was to see how intimately, inescapably, deeply connected we are to the people around us. I feel like that has informed every rule of how to get through the pandemic, what to do and how to do it. If we want to be well, if we want to be safe, if we want to be happy, the only remote chance of guaranteeing that comes from caring for each other, particularly and especially the most vulnerable. One of the most beautiful, simple things we did during the pandemic is to wear a mask. It’s a beautiful thing to wear a mask, knowing that the benefit is experienced by the people you protect by doing so. You don’t necessarily do it for yourself. And I think that that responsibility you have to each other is obviously ongoing. We need to ensure that everybody has access to vaccines globally. And that goes beyond the human world into the environment, into the other species that live on this planet … I will never get over the utterly bizarre fact that a minuscule virus living in a bat or some other host on the other side of the world would wreak havoc in my lungs six months later. Just the idea that it had traveled through many people to me and that I was the end chain in its journey is kind of fascinating, from an epidemiological point of view. But it’s also a tangible and real chain of human experience and human suffering. In the hospital, I also really learned what love might look like. It looks like a nurse at the beginning of a global pandemic—who knows very little about the virus they’re encountering because nobody knows very much at that stage—putting on PPE and entering my room to bathe me or feed me or just provide some human comfort at potential great risk to themselves. It just looks like caring for a total stranger. And I don’t think that we can get out of this or other imminent challenges to come—future pandemics, the consequences of climate change—unless we think about what others across the globe or down the street need. It’s not easy. I’ve made many errors. It’s hard to do it without stumbling. I’m hoping there will be a time of remembering and memorializing the people we’ve lost. And I hope that our love and duty towards each other is a scene in that. Thanks for everything. Higgins: We talked to people while they were sick with COVID. We talked to people while they were still suffering with long COVID. It’s put so many people through so much grief, if they’ve lost somebody, and pain, if they’ve experienced it themselves. Hamblin: Yeah, and speaking of which, I was texting with Bootsie Plunkett. [She] got COVID pretty early on, was on the show with us, and had some longer-term symptoms in recovery. But she’s doing well now. She tells me she went to Red Lobster, as she was looking forward to during her long convalescence. Higgins: So, the podcast is ending. And the pandemic is kind of ending in the U.S. We’ve done episodes about how this pandemic could follow past pandemics, in particular AIDS, where people treated that as an emergency that ended. But obviously it never ended, especially in marginalized communities and poor countries. This last voicemail came in from a listener on the anniversary of the AIDS pandemic in the U.S.: Jim, Katherine, Maeve, Kevin, A. C., everybody who’s a part of the show, I just wanted to call and say thank you. As I hear you announce the penultimate show, it’s a bit emotional. I’m just leaving the National AIDS Memorial in San Francisco today. This is Saturday, June 5, which is the 40th anniversary of the first clinical reports of AIDS, another pandemic that we’ve all faced. And it’s not the same in any way as COVID—dramatically different. But some of the themes that you’ve covered, the discriminatory responses, misinformation and missteps in the federal government, they apply too. And AIDS is not gone. And I appreciate what you’ve said many times, which is that we won’t live without COVID. But I’m so, so grateful to all of your team for the work over the last year and four months. Thank you for doing this. Higgins: Beautiful message. Thank you so much for that. And thank you both, Jim and Katherine. Thanks to the producers. Thanks to The Atlantic, to all the incredible writers and scientists and doctors and guests and, just, people who know about COVID from having COVID who spoke to us. And Jim, thank you for all those nights that you didn’t even sleep so that you could try and come up with answers. We really appreciate you. from https://ift.tt/2Sm86bE Check out http://natthash.tumblr.com
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During a pandemic, no one’s health is fully in their own hands. No field should understand that more deeply than public health, a discipline distinct from medicine. Whereas doctors and nurses treat sick individuals in front of them, public-health practitioners work to prevent sickness in entire populations. They are expected to think big. They know that infectious diseases are always collective problems because they are infectious. An individual’s choices can ripple outward to affect cities, countries, and continents; one sick person can seed a hemisphere’s worth of cases. In turn, each person’s odds of falling ill depend on the choices of everyone around them—and on societal factors, such as poverty and discrimination, that lie beyond their control. Across 15 agonizing months, the COVID-19 pandemic repeatedly confirmed these central concepts. Many essential workers, who held hourly-wage jobs with no paid sick leave, were unable to isolate themselves for fear of losing their livelihood. Prisons and nursing homes, whose residents have little autonomy, became hot spots for the worst outbreaks. Black and Latino communities that were underserved by the existing health system were disproportionately infected and killed by the new coronavirus, and now have among the lowest vaccination rates in the country. Perhaps that’s why so many public-health experts were disquieted when, on May 13, the CDC announced that fully vaccinated Americans no longer needed to wear masks in most indoor places. “The move today was really to talk about individuals and what individuals are safe doing,” Rochelle Walensky, the agency’s director, told PBS NewsHour. “We really want to empower people to take this responsibility into their own hands.” Walensky later used similar language on Twitter: “Your health is in your hands,” she wrote. Framing one’s health as a matter of personal choice “is fundamentally against the very notion of public health,” Aparna Nair, a historian and anthropologist of public health at the University of Oklahoma, told me. “For that to come from one of the most powerful voices in public health today … I was taken aback.” (The CDC did not respond to a request for comment.) It was especially surprising coming from a new administration. Donald Trump was a manifestation of America’s id—an unempathetic narcissist who talked about dominating the virus through personal strength while leaving states and citizens to fend for themselves. Joe Biden, by contrast, took COVID-19 seriously from the off, committed to ensuring an equitable pandemic response, and promised to invest $7.4 billion in strengthening America’s chronically underfunded public-health workforce. And yet, the same peal of individualism that rang in his predecessor’s words still echoes in his. “The rule is very simple: Get vaccinated or wear a mask until you do,” Biden said after the CDC announced its new guidance. “The choice is yours.” From its founding, the United States has cultivated a national mythos around the capacity of individuals to pull themselves up by their bootstraps, ostensibly by their own merits. This particular strain of individualism, which valorizes independence and prizes personal freedom, transcends administrations. It has also repeatedly hamstrung America’s pandemic response. It explains why the U.S. focused so intensely on preserving its hospital capacity instead of on measures that would have saved people from even needing a hospital. It explains why so many Americans refused to act for the collective good, whether by masking up or isolating themselves. And it explains why the CDC, despite being the nation’s top public-health agency, issued guidelines that focused on the freedoms that vaccinated people might enjoy. The move signaled to people with the newfound privilege of immunity that they were liberated from the pandemic’s collective problem. It also hinted to those who were still vulnerable that their challenges are now theirs alone and, worse still, that their lingering risk was somehow their fault. (“If you’re not vaccinated, that, again, is taking your responsibility for your own health into your own hands,” Walensky said.) Neither is true. About half of Americans have yet to receive a single vaccine dose; for many of them, lack of access, not hesitancy, is the problem. The pandemic, meanwhile, is still just that—a pandemic, which is raging furiously around much of the world, and which still threatens large swaths of highly vaccinated countries, including some of their most vulnerable citizens. It is still a collective problem, whether or not Americans are willing to treat it as such. Individualism can be costly in a pandemic. It represents one end of a cultural spectrum with collectivism at the other—independence versus interdependence, “me first” versus “we first.” These qualities can be measured by surveying attitudes in a particular community, or by assessing factors such as the proportion of people who live, work, or commute alone. Two studies found that more strongly individualistic countries tended to rack up more COVID-19 cases and deaths. A third suggested that more individualistic people (from the U.S., U.K, and other nations) were less likely to practice social distancing. A fourth showed that mask wearing was more common in more collectivist countries, U.S. states, and U.S. counties—a trend that held after accounting for factors including political affiliation, wealth, and the pandemic’s severity. These correlative studies all have limitations, but across them, a consistent pattern emerges—one supported by a closer look at the U.S. response. “From the very beginning, I’ve thought that the way we’ve dealt with the pandemic reflects our narrow focus on the individual,” Camara Jones, a social epidemiologist at Morehouse School of Medicine, told me. Testing, for instance, relied on slow PCR-based tests to diagnose COVID-19 in individual patients. This approach makes intuitive sense—if you’re sick, you need to know why—but it cannot address the problem of “where the virus actually is in the population, and how to stop it,” Jones said. Instead, the U.S. could have widely distributed rapid antigen tests so that people could regularly screen themselves irrespective of symptoms, catch infections early, and isolate themselves when they were still contagious. Several sports leagues successfully used rapid tests in exactly this way, but they were never broadly deployed, despite months of pleading from experts. The U.S. also largely ignored other measures that could have protected entire communities, such as better ventilation, high-filtration masks for essential workers, free accommodation for people who needed to isolate themselves, and sick-pay policies. As the country focused single-mindedly on a vaccine endgame, and Operation Warp Speed sped ahead, collective protections were left in the dust. And as vaccines were developed, the primary measure of their success was whether they prevented symptomatic disease in individuals. Vaccines, of course, can be a collective solution to infectious disease, especially if enough people are immune that outbreaks end on their own. And even if the U.S. does not achieve herd immunity, vaccines will offer a measure of collective protection. As well as preventing infections—severe and mild, symptomatic and asymptomatic, vanilla and variant—they also clearly make people less likely to spread the virus to one another. In the rare event that fully vaccinated people get breakthrough infections, these tend to be milder and shorter (as recently seen among the New York Yankees); they also involve lower viral loads. “The available evidence strongly suggests that vaccines decrease the transmission potential of vaccine recipients who become infected with SARS-CoV-2 by at least half,” wrote three researchers in a recent review. Another team estimated that a single dose of Moderna’s vaccine “reduces the potential for transmission by at least 61 percent, possibly considerably more.” Even if people get their shots purely to protect themselves, they also indirectly protect their communities. In Israel and the U.S., rising proportions of immunized adults led to plummeting case numbers among children, even though the latter are too young to be vaccinated themselves. “For people who do not get vaccinated and remain vulnerable, their risk is still greatly reduced by the immunity around them,” Justin Lessler, an epidemiologist at Johns Hopkins, told me. There’s a catch, though. Unvaccinated people are not randomly distributed. They tend to cluster together, socially and geographically, enabling the emergence of localized COVID-19 outbreaks. Partly, these clusters exist because vaccine skepticism grows within cultural and political divides, and spreads through social networks. But they also exist because decades of systemic racism have pushed communities of color into poor neighborhoods and low-paying jobs, making it harder for them to access health care in general, and now vaccines in particular. “This rhetoric of personal responsibility seems to be tied to the notion that everyone in America who wants to be vaccinated can get a vaccine: You walk to your nearest Walgreens and get your shot,” Gavin Yamey, a global-health expert at Duke, told me. “The reality is very different.” People who live in poor communities might not be near vaccination sites, or have transportation options for reaching one. Those working in hourly jobs might be unable to take time off to visit a clinic, or to recover from side effects. Those who lack internet access or regular health-care providers might struggle to schedule appointments. Predictably, the new pockets of immune vulnerability map onto old pockets of social vulnerability. According to a Kaiser Family Foundation survey, a third of unvaccinated Hispanic adults want a vaccine as soon as possible—twice the proportion of unvaccinated whites. But 52 percent of this eager group were worried that they might need to miss work because of the reputed side effects, and 43 percent feared that getting vaccinated could jeopardize their immigration status or their families’. Unsurprisingly then, among the states that track racial data for vaccinations, just 32 percent of Hispanic Americans had received at least one dose by May 24, compared with 43 percent of white people. The proportion of at least partly vaccinated Black people was lower still, at 29 percent. And as Lola Fadulu and Dan Keating reported in The Washington Post, Black people now account for 82 percent of COVID-19 cases in Washington, D.C., up from 46 percent at the end of last year. The vaccines have begun to quench the pandemic inferno, but the remaining flames are still burning through the same communities who have already been disproportionately scorched by COVID-19—and by a much older legacy of poor health care. For unvaccinated people, the pandemic’s collective problem not only persists, but could deepen. “We’re entering a time when younger children are going to be the biggest unvaccinated population around,” Lessler told me. Overall, children are unlikely to have severe infections, but that low individual risk is still heightened by social factors; it is telling that more than 75 percent of the children who have died from COVID-19 were Black, Hispanic, or Native American. And when schools reopen for in-person classes, children can still spread the virus to their families and communities. “Schools play this fairly unique role in life,” Lessler said. “They’re places where a lot of communities get connected up, and they give the virus the ability, even if there’s not much transmission happening, to make its way from one pocket of unvaccinated people to another.” Schools aren’t helpless. Lessler has shown that they can reduce the risk of seeding community outbreaks by combining several protective measures, such as regular symptom screenings and masks for teachers, and trying their use to community incidence. But he worries that schools might instead pull back on such measures, whether in reaction to the CDC’s new guidance or because of complacency about an apparently waning pandemic. He worries, too, that complacency may be commonplace. Yes, vaccines substantially lower the odds that people will spread the virus, but those nonzero odds will creep upward if other protective measures are widely abandoned. The onset of cooler weather in the fall might increase them further. So might the arrival of new variants. The Alpha variant of the new coronavirus (B.1.1.7, now the most common U.S. lineage) can already spread more easily than the original virus. The Delta variant (B.1.617.2, which has raised concerns after becoming dominant in the U.K. and India) could be more transmissible still. An assessment from the U.K. suggests that a single vaccine dose is less protective against Delta than its predecessors, although two doses are still largely effective. For now, vaccines are still beating the variants. But the variants are pummeling the unvaccinated. “My biggest concern is that those who are unvaccinated will have a false sense of safety and security as cases drop this summer,” says Joseph Allen, who directs Harvard’s Healthy Buildings program. “It might feel like the threat has fully diminished if this is in the news less often, but if you’re unvaccinated and you catch this virus, your risk is still high.” Or perhaps higher: In the U.S., unvaccinated people might be less likely to encounter someone infectious. But on each such encounter, their odds of catching COVID-19 are now greater than they were last year. When leaders signal to vaccinated people that they can tap out of the collective problem, that problem is shunted onto a smaller and already overlooked swath of society. And they do so myopically. The longer rich societies ignore the vulnerable among them, and the longer rich nations neglect countries that have barely begun to vaccinate their citizens, the more chances SARS-CoV-2 has to evolve into variants that spread even faster than Delta, or—the worst-case scenario—that finally smash through the vaccines’ protection. The virus thrives on time. “The longer we allow the pandemic to rage, the less protected we’ll be,” Morehouse’s Camara Jones says. “I think we’re being a bit smug about how well protected we are.” Ian Mackay, a virologist at the University of Queensland, famously imagined pandemic defenses as layers of Swiss cheese. Each layer has holes, but when combined, they can block a virus. In Mackay’s model, vaccines were the last layer of many. But the U.S. has prematurely stripped the others away, including many of the most effective ones. A virus can evolve around a vaccine, but it cannot evolve to teleport across open spaces or punch its way through a mask. And yet, the country is going all in on vaccines, even though 48 percent of Americans still haven’t had their first dose, and despite the possibility that it might fall short of herd immunity. Instead of asking, “How do we end the pandemic?” it seems to be asking, “What level of risk can we tolerate?” Or perhaps, “Who gets to tolerate that risk?” Consider what happened in May, after the CDC announced that fully vaccinated people no longer needed to wear masks in most indoor places. Almost immediately, several states lifted their mask mandate. At least 24 have now done so, as have many retailers including Walmart, McDonald’s, Starbucks, Trader Joe’s, and Costco, which now rely on the honor system. The speed of these changes was surprising. When The New York Times surveyed 570 epidemiologists a few weeks before the announcement, 95 percent of them predicted that Americans would need to continue wearing masks indoors for at least half a year. Some public-health experts have defended the CDC’s new guidance, for at least four reasons. They say that the CDC correctly followed the science, that its new rules allow for more flexibility, that it correctly read the pulse of a fatigued nation, and that it may have encouraged vaccination (although Walensky has denied that this was the CDC’s intention). In sum, vaccinated people should know that they are safe, and act accordingly. By contrast, others feel that the CDC abrogated one of its primary responsibilities: to coordinate safety across the entire population. In the strictest sense, the CDC’s guidance is accurate; vaccinated people are very unlikely to be infected with COVID-19, even without a mask. “You can’t expect the CDC to not share their scientific assessment because the implications have problems,” Ashish Jha, who heads the Brown University School of Public Health, told me. “They have to share it.” Harvard’s Joseph Allen agrees, and notes that the agency clearly stated that unvaccinated people should continue wearing masks indoors. And having some flexibility is useful. “You can’t have 150 million people who are vaccinated and ready to get back to some semblance of what they’re used to, and not have this tension in the country,” he told me. The new guidelines also move the U.S. away from top-down mandates, recognizing that “decisions are rightly shifting to the local level and individual organizations,” Allen wrote in The Washington Post. If some organizations and states pulled their mask mandate too early, he told me, “that’s an issue not with the CDC but with how people are acting based on its guidance.” It’s true, too, that the CDC is in a difficult position. It had emerged from a year of muzzling and interference from the Trump administration, and was operating in a climate of polarization and public fatigue. “When agencies are putting out recommendations that people aren’t following, that undermines their credibility,” Jha told me. “The CDC, as a public-health agency, must be sensitive to where the public is.” And by May, “there was a sense that mask mandates were starting to topple.” But that problem—that collective behavior was starting to change against collective interest—shows the weaknesses of the CDC’s decisions. “Science doesn’t stand outside of society,” Cecília Tomori, an anthropologist and a public-health scholar at Johns Hopkins, told me. “You can’t just ‘focus on the science’ in the abstract,” and especially not when you’re a federal agency whose guidance has been heavily politicized from the get-go. In that context, it was evident that the new guidance “would send a cultural message that we don’t need masks anymore,” Tomori said. Anticipating those reactions “is squarely within the expertise of public health,” she added, and the CDC could have clarified how its guidelines should be implemented. It could have tied the lifting of mask mandates to specific levels of vaccination, or the arrival of worker protections. Absent that clarity, and with no way for businesses to even verify who is vaccinated, a mass demasking was inevitable. “If you’re blaming the public for not understanding the guidance--wow,” Duke’s Gavin Yamey said. “If people have misunderstood your guidance, your guidance was poor and confusing.” Meanwhile, the idea that the new guidance led to more vaccinations is likely wrong. “I’ve overseen close to 10,000 people being vaccinated, and I’ve yet to hear ‘I can take the mask off’ as a reason,” Theresa Chapple-McGruder, a local-health-department director, told me. Although visits to the site vaccines.gov spiked after the CDC’s announcement, actual vaccination rates increased only among children aged 12 to 15, who had become eligible the day before. Meanwhile, a KFF survey showed that 85 percent of unvaccinated adults felt that the new guidance didn’t change their vaccination plans. Only 10 percent said they were more likely to get vaccinated, while 4 percent said they were less likely. Vaccination rates are stuck on a plateau. Creating incentives for vaccination is vital; treating the removal of an important protective measure as an incentive is folly. The latter implicitly supports the individualistic narrative that masks are oppressive burdens “that people need to get away from to get back to ‘normal,’” Rhea Boyd, a pediatrician and public-health advocate from the Bay Area, told me. In fact, they are an incredibly cheap, simple, and effective means of collective protection. “The pandemic made clear that the world is vulnerable to infectious disease and we should normalize the idea of precaution, as we see in other countries that have faced similar epidemics,” Boyd said. “But recommendations like this say, This is something we put behind us, rather than something we put in our back pocket.” Collective action is not impossible for a highly individualistic country; after all, a majority of Americans used and supported masks. But such action erodes in the absence of leadership. In the U.S., only the federal government has the power and financial freedom to define and defend the collective good at the broad scales necessary to fight a pandemic. “Local public health depends on guidance from the federal level,” Chapple-McGruder said. “We don’t make local policies that fly in the face of national guidance.” Indeed, the CDC’s guidance prompted some local leaders to abandon sensible strategies: North Carolina’s governor had planned to lift COVID-19 restrictions after two-thirds of the state had been vaccinated, but did so the day after the CDC’s announcement, when only 41 percent had received their first dose. Meanwhile, Iowa and Texas joined Florida in preventing cities, counties, schools, or local institutions from issuing mask mandates. Rather than ushering in an era of flexibility, the CDC has arguably triggered a chain of buck-passing, wherein responsibility for one’s health is once again shunted all the way back to individuals. “Often, Let everyone decide for themselves is the easiest policy decision to make, but it’s a decision that facilitates spread of COVID in vulnerable communities,” Julia Raifman, a health-policy researcher at Boston University, told me. The CDC’s own website lists the 10 essential public-health services—a set of foundational duties arranged in a colorful wheel. And at the center of that wheel, uniting and underpinning everything else, is equity—a commitment to “protect and promote the health of all people in all communities.” The CDC’s critics say that it has abandoned this central tenet of public health. Instead, its guidelines centered people who had the easiest and earliest access to vaccines, while overlooking the most vulnerable groups. These include immunocompromised people, for whom the shots may be less effective; essential workers, whose jobs place them in prolonged contact with others; and Black and Latino people, who are among the most likely to die of COVID-19 and the least likely to have been vaccinated. During a pandemic, “someone taking all the personal responsibility in the world may still be affected by a lack of coordinated safety,” Raifman said. “They may be vaccinated but less protected because they are immunosuppressed and get the disease working in a grocery store amidst unmasked people. They may have a child who cannot be vaccinated, and miss work if that child gets COVID.” As Eleanor Murray, an epidemiologist at Boston University, said on Twitter, “Don’t tell me it’s “safe”; tell me what level of death or disability you are implicitly choosing to accept.” When Rochelle Walensky said, “It’s safe for vaccinated people to take off their masks,” she was accurate, but left unaddressed other, deeper questions: How much additive burden is a country willing to foist upon people who already carry their disproportionate share? What is America’s goal—to end the pandemic, or to suppress it to a level where it mostly plagues communities that privileged individuals can ignore? “When you’re facing an epidemic, the responsibility of public health is to protect everybody, but those made vulnerable first,” Boyd, the pediatrician, told me. “If you have protection, the CDC is glad for you, but their role is not the same for you. Their role is to keep those most at risk of infection and death from exposure.” America is especially prone to the allure of individualism. But that same temptation has swayed the entire public-health field throughout its history. The debate about the CDC’s guidance is just the latest step in a centuries-old dance to define the very causes of disease. In the early 19th century, European researchers such as Louis-René Villermé and Rudolf Virchow correctly recognized that disease epidemics were tied to societal conditions like poverty, poor sanitation, squalid housing, and dangerous jobs. They understood that these factors explain why some people become sick and others don’t. But this perspective slowly receded as the 19th century gave way to the 20th. During those decades, researchers confirmed that microscopic germs cause infectious diseases, that occupational exposures to certain chemicals can cause cancers, that vitamin deficiencies can lead to nutritional disorders like scurvy, and that genetic differences can lead to physical variations among people. “Here … was a world in which disease was caused by germs, carcinogens, vitamin deficiencies, and genes,” wrote the epidemiologist Anthony J. McMichael in his classic 1999 paper, “Prisoners of the Proximate.” Public health itself became more individualistic. Epidemiologists began to see health largely in terms of personal traits and exposures. They became focused on finding “risk factors” that make individuals more vulnerable to disease, as if the causes of sickness play out purely across the boundaries of a person’s skin. “The fault is not in doing such studies, but in only doing such studies,” McMichael wrote. Liver cirrhosis, for example, is caused by alcohol, but a person’s drinking behavior is influenced by their culture, occupation, and exposure to advertising or peer pressure. The distribution of individual risk factors—the spread of germs, the availability of nutritious food, one’s exposure to carcinogens—is always profoundly shaped by cultural and historical forces, and by inequities of race and class. “Yet modern epidemiology has largely ignored these issues of wider context,” McMichael wrote. “The field has moved forward since then,” Nancy Krieger, a social epidemiologist at Harvard told me. Epidemiology is rediscovering its social side, fueled by new generations of researchers who don’t come from traditional biomedical backgrounds. “When I started out in the mid-1980s, there were virtually no sessions [at academic conferences] about class, racism, and health in the U.S.” Krieger said. “Now they’re commonplace.” But these connections have yet to fully penetrate the wider zeitgeist, where they are still eclipsed by the rhetoric of personal choice: Eat better. Exercise more. Your health is in your hands. This is the context in which today’s CDC operates, and against which its choices must be understood. The CDC represents a field that has only recently begun to rebalance itself after long being skewed toward individualism. And the CDC remains a public-health agency in one of the most individualistic countries in the world. Its mission exists in tension with its environment. Its choice to resist that tension or yield to it affects not only America’s fate, but also the soul of public health—what it is and what it stands for, whom it serves and whom it abandons. from https://ift.tt/3irxY0j Check out http://natthash.tumblr.com The best immune systems thrive on a healthy dose of paranoia. The instant that defensive cells spot something unfamiliar in their midst—be it a living microbe or a harmless mote of schmutz—they will whip themselves into a frenzy, detonating microscopic bombs, sparking bouts of inflammation, even engaging in some casual cannibalism until they are certain that the threat has passed. This system is built on alarmism, but it very often pays off: Most of our encounters with pathogens end before we ever notice them. The agents of immunity are so risk-averse that even the dread of facing off with a pathogen can sometimes prompt them to gird their little loins. Ashley Love, a biologist at the University of Connecticut, has seen this happen in birds. A few years ago, she stationed healthy canaries within eyeshot of sick ones, infected with a bacterium that left the birds sluggish and visibly unwell. The healthy canaries weren’t close enough to catch the infection themselves. But the mere sight of their symptomatic peers revved up their immune systems all the same, Love and her colleagues report today in Biology Letters. Love, who did the research as a graduate student at Oklahoma State University, had an inkling that the experiment would work before she did it. In 2010, the psychologist Mark Schaller, at the University of British Columbia, and his colleagues described a similar reaction in humans looking through photos of people who were sneezing or covered in rashes. The study subjects’ immune cells then reacted aggressively when exposed to bits of bacteria, a hint that the pictures had somehow whipped the body into fighting form, Schaller told me. That 2010 study, Love told me, “sort of blew my mind,” because it didn’t follow the typical trajectory of the immune system reacting to an ongoing assault. Instead, the cells were internalizing visual cues and buttressing themselves preemptively—raising shields against an attack that hadn’t yet happened, and perhaps never would. It was what you might call bystander immunity, and it was totally bizarre. Love decided to try her own version in domestic canaries, among the many bird species susceptible to a pathogen called Mycoplasma gallisepticum. She infected 10 canaries with Mycoplasma, then placed them in sight of microbe-free birds. In parallel, she had two other cadres of healthy canaries scope each other out, as a symptomless point of comparison. Throughout the 24-day experiment, the uninfected canaries acted as most songbirds do, feeding, chirping, and bopping cheerily around their cages. But about a week in, the birds dosed with Mycoplasma became mopey and lethargic, and developed a nasty form of pink eye. “I could approach the cage and just pick them up,” Love told me. (Some Mycoplasma species can cause disease in humans; this one doesn’t.) The birds watching their beleaguered peers never got infected themselves. But when Love and her colleagues examined the canaries’ blood, they found that some of the birds’ immune responses had swelled in near lockstep with the sick birds’ symptoms. Cells called heterophils—inflammation-promoting foot soldiers that fight on the front lines of many avian infections—had flooded the bloodstream, similar to how they would in the presence of Mycoplasma, Love said. The birds’ blood was also rife with so-called complement molecules, which can shred bacterial cells, or flag them for other types of destruction. The uptick was temporary. As the symptoms of the sickened birds abated, their observers’ immune cells quieted down as well. Love told me she suspects that these little flare-ups might have primed the watchful birds for a possible tussle with the pathogen—perhaps cloaking them in a light layer of armor, akin to a very crude and very ephemeral vaccine. To confirm that idea, Love would have needed to expose the onlooker birds to Mycoplasma while their immune systems were still raring to go, an experiment she is working on now. Without those data, “it’s hard to know what this means,” Jesyka Meléndez Rosa, an immunologist at Humboldt State University who wasn’t involved in the study, told me. The immunological surge did seem driven by the disease cues that the other birds emitted, because samples taken from the canaries who’d peeped on only healthy birds stayed comparatively inert. But what the researchers found could have just been a blip—noticeable, yet not strong enough to alter the trajectory of a subsequent infection. A bystander immune response could even be a net negative for the witness, wasting precious bodily resources or unnecessarily damaging healthy tissues. Heterophils and complement molecules also comprise just a small subset of the immune system’s arsenal, much more of which would be marshaled into quelling a Mycoplasma invasion. Letícia Soares, a disease ecologist at Western University who wasn’t involved in the study, told me she wished she’d been able to see how well the observer birds’ immune responses simulate what happens in infected birds who eventually recover. Still, the potential payoff is “huge,” Meléndez Rosa said. A well-timed burst of immune activity, especially one kick-started in advance, could theoretically help the birds thwart illness and death, or maybe even stave off infection entirely. Birds are also “highly visual” animals, Soares told me, capable of tuning in to even slight changes in appearance. That intel could then spark a body-wide stress response, like a security camera tripping alarms throughout a well-protected building. “The idea of that is fascinating,” Soares said. The connective tissue that links visual cues to immune activation is still scientifically foggy. At first, “it all seems kind of magical,” Schaller, the University of British Columbia psychologist, told me. But it’s also sensible (literally) for animals to glean information from their environment and react accordingly. “We’re stimulus-response devices,” he said. “We perceive something in some way, and our body responds.” Several experts told me that they wouldn’t be surprised if nonvisual signals—including the sounds, sensations, or even smells of a stranger’s sickness—could clue animals into the risks of infection as well. Love told me she hopes to figure out whether animals can tune their immune responses to the severity of the disease symptoms they see. The paper speaks to the strange appeal of visible disease, says Cécile Sarabian, an expert in sickness behaviors at the Kyoto University Primate Research Institute who wasn’t involved in the study. The signs and symptoms of infection are often a pain for the individual who experiences them. But they also “alert others, and prepare other potential hosts,” she told me. Spotting symptoms alone isn’t good enough. In the past year and a half, SARS-CoV-2 has benefited from its ability to spread silently from person to person. Humans have also taken a multitude of other measures—masking, distancing, and the like—to keep the coronavirus at bay, acts of avoidance that Schaller says count as a kind of behavioral immunity. Still, Schaller and others think it’s interesting to consider what sorts of infections count as truly “asymptomatic.” Even if an infected person isn’t feeling outright ill, they might be beaming out slight signals that betray their status, and influencing those around them. “We’re pretty sensitive to some pretty subtle stuff,” Schaller said. “It could be that we are able to pick up on other people’s sicknesses, even if those people are not yet aware.” If an infection is to persist in a population long term, it must become communal; perhaps the experience of it is as well, in ways we don’t yet appreciate. Soares, who’s had long COVID for more than a year, told me that we urgently need to understand “how this societal crisis will affect our health in general.” This pandemic, and many that have come before it, is a reminder of what researchers are now starting to systematically define: Even those who aren’t directly touched by a pathogen can still feel its effects. from https://ift.tt/3cs1gIo Check out http://natthash.tumblr.com Throughout the pandemic, people have had to make impossibly tough decisions. Kathleen Turner, a 52-year-old intensive-care nurse in San Francisco, has been haunted by hers. Since COVID-19 patients started overwhelming her hospital last spring, she has had to give patients sedatives knowing they would likely have lasting negative health consequences, and systematically deny relatives a chance to say goodbye to dying loved ones. Last year, Turner was following guidelines when she told a woman that she could not visit her dying mother—on Mother’s Day. “I upheld the rule on the piece of paper,” she told me. “But in terms of what would a good person do? It’s not that.” Collectively, these experiences have fundamentally shaken her sense of morality. “Am I really a good person? There’s that seed of doubt,” she said. Health-care workers have had it especially hard during the pandemic, triaging who gets access to life-saving medication and reusing personal-protective equipment with the risk of contaminating patients, colleagues, and themselves. But other people have also been forced into unenviable scenarios. Undertakers have had to empty out old graves to make space for more dead bodies. Many of us have wrestled with whether to visit a parent or grandparent given the possibility of exposing them to the virus. In some cases, these situations have left people with what psychologists call “moral injury”—residual feelings of shame, guilt, and disorientation after having violated their own ethical code. Often, moral injury manifests as feelings of betrayal at the leaders and institutions that forced them into making these decisions in the first place, which may lead to behaviors such as substance abuse and social isolation. We’re only beginning to understand pandemic trauma. Every COVID-19 death has unleashed a river of grief still flooding over the bereaved. Millions of coronavirus survivors are still ravaged by what the disease did to them. Even those who haven’t personally been touched by the virus have had to contend with lost jobs, anxiety, and missed opportunities. But for some people, the past year has also fundamentally broken their moral compass. Moral injury is not a new idea. In 1994, Jonathan Shay, a clinical psychiatrist, coined the term after noticing that some American soldiers who had experienced traumatic events in Vietnam returned with profound changes to their character. These shifts, he wrote, were markedly different from what would ordinarily be recognized as PTSD: They were predominantly triggered by events that violated a soldier’s moral code rather than, say, narrowly escaping death and then dealing with lingering fear and helplessness. Moral injury is not considered a mental illness, and researchers are still working to clarify the boundaries of what exactly fits into the concept and what behavioral changes it leads to. But what they do know is that exposure to morally injurious events is associated with mental-health conditions such as depression. Since Shay introduced the idea, psychologists and psychiatrists have expanded the scope of moral injury to include all sorts of scenarios: police officers who must make split-second decisions about whether to shoot someone, firefighters who have to choose whom to save before a burning building collapses, even journalists covering tough stories such as Europe’s 2015 migrant crisis. During the pandemic, the notion has gained new traction with all the tough positions people have been put in. Grieving relatives who can’t say goodbye to their dying loved ones, mourning families who can’t attend funerals, and patients themselves who have been inadequately treated—all might be contending with moral injury. “I think the whole population has got potential to develop those difficulties,” says Neil Greenberg, a psychiatry professor at King’s College London. He told me that people may be asking themselves, “Did I do the right thing? Did others do the right thing?” The core features of moral injury are feelings of betrayal by colleagues, leaders, and institutions who forced people into moral quandaries, says Suzanne Shale, a medical ethicist. As a way to minimize exposure for the entire team, Kathleen Turner and other ICU nurses have had to take on multiple roles: cleaning rooms, conducting blood tests, running neurological exams, and standing in for families who can’t keep patients company. Juggling all those tasks has left Turner feeling abandoned and expendable. “It definitely exposes and highlights the power dynamics within health care of who gets to say ‘No, I'm too high risk; I can't go in that patient's room,’” she said. Kate Dupuis, a clinical neuropsychiatrist and researcher at Canada’s Sheridan College, also felt her moral foundations shaken after Ontario’s decision to shut down schools for in-person learning at the start of the pandemic. The closures have left her worrying about the potential mental-health consequences this will have on her children. For some people dealing with moral injury right now, the future might hold what is known as “post-traumatic growth,” whereby people’s sense of purpose is reinforced during adverse events, says Victoria Williamson, a researcher who studies moral injury at Oxford University and King’s College London. Last spring, Ahmed Ali, an imam in Brooklyn, New York, felt his moral code violated when dead bodies that were sent to him to perform religious rituals were improperly handled and had blood spilling from detached IV tubes. The experience has invigorated his dedication to helping others in the name of God. “That was a spiritual feeling,” he said. But moral injury may leave other people feeling befuddled and searching for some way to make sense of a very bad year. If moral injury is left unaddressed, Greenberg said, there’s a real risk that people will develop depression, alcohol misuse, and suicidality. People suffering from moral injury risk retreating into isolation, engaging in self-destructive behaviors, and disconnecting from their friends and family. In the U.K., moral injury among military veterans has been linked to a loss of faith in organized religion. The psychological cost of a traumatic event is largely determined by what happens afterward, meaning that a lack of support from family, friends, and experts who can help people process these events—now that some of us are clawing our way out of the pandemic—could have serious mental-health repercussions. “This phase that we’re in now is actually the phase that’s the most important,” Greenberg said. The cost of letting moral injury fester is high: Feelings of betrayal and a loss of trust may even further erode our sense of unity, says Cynda Rushton, a professor of clinical ethics and nursing at Johns Hopkins University. "Those wounds have to be named, acknowledged, and healed—otherwise they remain in our bodies, hearts, and minds in ways that degrade our well-being and integrity and our democracy," Rushton told me. These societal effects may already be surfacing among health-care workers in the U.S.: A recent survey shows that a quarter of them are seeking early retirement as a result of the pandemic, and about 12 percent are considering a career change away from medicine. One of the most powerful ways to start the healing process, Greenberg said, is to try to help people create a meaningful narrative about what happened. Doing so involves helping people realize that, in most cases, they are not to blame for what happened. “It's a story that doesn't end up with it all being my fault, or being the boss’s fault,” Greenberg said. “It ends up with: No one asked to be in this situation.” Turner’s circumstances at work have gotten better over the past few months: Her hospital has fewer COVID-19 patients and the staff is now better equipped. But when she leaves the hospital at the end of her shift and walks home, she’s overwhelmed by a sense of alienation. She passes people who are back to sitting inside coffee shops and chatting in the park, but she can’t just let go of what she’s been through. from https://ift.tt/3xbCJPL Check out http://natthash.tumblr.com Any diagnostic test worth its salt has precision on its side. It can pinpoint the presence of this condition, but not that one; it can, when used for an infectious disease, distinguish between microbes that look very much the same. For most of the pandemic, that exactness has been a major asset for the hundreds of tests that detect SARS-CoV-2. But the discerning nature of most tests has also opened up a weak point for the coronavirus to exploit. With the virus mutating into new and concerning variants, a few of the tests designed to recognize its original iteration are now getting duped. What was once a singular target has split itself off into many, many bull’s-eyes, each a little different from the next, and we’re having trouble taking aim. This isn’t yet a crisis, and perhaps it never will be. Most tests are still performing very well against all known versions of the coronavirus, and researchers have work-arounds that will buttress others against the virus’s shape-shifting. But keeping tabs on test performance is crucial, especially while the pandemic rages on in many parts of the world. “From a global perspective, it’s absolutely necessary to do what we can to make sure we have a good grip on the virus and its mutations,” Neha Agarwal, the associate director of the PATH Diagnostics Program, an organization that has been tracking SARS-CoV-2 tests, told me. As long as it has hosts to infect, the coronavirus will continue to rejigger its genes, which means that test manufacturers will need to closely track the virus’s movements and tailor their products to follow it. More than a year out from the time when experts first got eyes on the virus, tests are in need of a touch-up. Most of the coronavirus tests deployed in the United States detect specific stretches of RNA, the genetic material of the virus’s genome, usually chosen because they’re unique to SARS-CoV-2 (or at least the virus family it’s in). When the tests fail, it’s because they’re picky. These molecular tests search the genomic manuscript with about as much precision as the Ctrl+F function on a computer, which means that even single-letter typos—that is, simple RNA mutations—can discombobulate them. According to the FDA, almost none of these tests is actually pinging back variant-related false negatives, with perhaps the exception of the Accula, made by Mesa Biotech. A document from the company says the test can occasionally be stumped when it encounters mutations in a gene called N (which produces the nucleocapsid protein), leading it to mistakenly say that no virus is present at all. But that’s an extreme case. Three other molecular tests identified by the FDA as being affected by mutations are still able to at least partially register the pathogen. (At least two more recently identified by researchers may soon join the list of tests whose detective powers are weakened, but not obliterated, by variants.) [Read: Fewer Americans are getting COVID-19 tests] One test on the FDA’s list, Thermo Fisher Scientific’s TaqPath, targets a segment of the S coronavirus gene (which encodes the spike protein). A snippet of that segment is missing from several variants of concern—including the very contagious Alpha (B.1.1.7), the dominant form of the coronavirus in the U.S.—rendering S effectively invisible to the TaqPath. But most molecular tests, including the TaqPath, have a de facto insurance policy: They generally scan the genome for multiple RNA segments at a time--two, three, sometimes more—making it nearly impossible for the virus to elude the test’s scrutiny entirely. The TaqPath, for instance, detects two additional gene segments outside of S, both of which are intact in Alpha, and will still spit out a positive result. A slightly different set of issues is now playing out with antigen tests—a type of rapid test that can usually be done outside a lab—which detect coronavirus proteins. While molecular tests essentially scan genomes letter by letter for precise spelling, tests that search for proteins work more like a reader skimming words for overall meaning. Typos might slip by unnoticed, making antigen tests tougher to flummox with minor mutations. However, while molecular tests typically have multiple targets, antigen tests tend to have only one, usually the nucleocapsid protein, which makes them more “brittle,” says Alex Greninger, the assistant director of the clinical-virology laboratories at the University of Washington Medical Center. In a recent paper, not yet published in a scientific journal, Greninger and his colleagues found that a common nucleocapsid-hunting antigen test called the Sofia, made by Quidel, might not recognize a very small fraction of coronavirus variants, incorrectly marking infected samples as virus-free. Greninger told me that the test-confounding mutation is present in less than 0.5 percent of SARS-CoV-2 genomes cataloged to date, so the test itself is fine for now. But the mistake it’s making isn’t necessarily an anomaly. Another recent study, also not yet peer-reviewed, claims a similar issue with a test called the PanBio, made by Abbott. The PanBio isn’t available in the U.S., but it’s similar to another test made by Abbott, the BinaxNOW, that has been authorized by the FDA. (I reached out to the manufacturers behind several of the affected tests. Quidel and Mesa Biotech did not respond to repeated requests for comment. Manoj Gandhi, Thermo Fisher’s senior medical director for genetic-testing solutions, said the company was aware of the issue, but told me that the TaqPath wouldn’t need to be modified, because of its “built-in redundancy.” Kim Modory, a spokesperson for Abbott, defended its tests’ performance, noting that the company “conducted a thorough analysis of the new variants, and we are confident that our tests remain effective at detecting these strains.”) Even if they’re rare, false negatives due to variants can have a ripple effect on our ability to contain the virus. Antigen tests have already stirred controversy because they aren’t as good as molecular tests at identifying infections, especially in people who don’t have symptoms or in whom the virus is somewhat scarce. False negatives could endanger the people who take these tests, and those around them, by wrongly reassuring them that they are infection-free. They can also help variants fly under the radar, skewing our sense of which versions of the virus are blazing through a given community. A positive antigen test usually means the coronavirus is present, but negatives are having a harder and harder time saying anything at all. [Read: The black hole in America’s COVID-19 data] For that reason, many of the experts I talked with are pinning their hopes on the molecular approach to keep testing going as the coronavirus continues to splinter into new lineages. Now that scientists are clued in to the many distinctive patterns that certain variants produce on molecular tests, they’re using them as quick, preliminary screens to tease apart different versions of the virus. When the TaqPath picks up two familiar genes but fails to detect S, for example, researchers may flag the specimen as an Alpha candidate. What was initially viewed as a diagnostic fumble has become a valuable litmus test for mutation. “We took advantage of the failure,” Esther Babady, the medical director of the microbiology service at Memorial Sloan Kettering Cancer Center, told me. Other researchers, including Yale’s Chantal Vogels, have used similar strategies to develop tests that can tell Alpha from Beta (B.1.351) and Gamma (P.1). A few companies, including Thermo Fisher, are marketing products that can do the same. The signatures that variants are registering on tests might someday make it possible for doctors to regularly deliver variant-specific diagnoses to their patients, instead of the binary “coronavirus” or “no coronavirus” conversations we deal in now. Those data have traditionally been funneled straight into public-health efforts to track the virus at the community level. But IDing certain variants that could elude antibody-based therapies could help guide treatments for individual patients as well. Still, experts stressed that standard coronavirus tests aren’t a reliable way to fully vet variants, which can be done only by sequencing the pathogen’s entire genome. Sequencing is also how researchers confirm the existence of new variants that might otherwise be mistaken for others or escape notice entirely. Testing and genome surveillance are inextricably linked: We can’t find variants if we’re not looking for them; we can’t design tests compatible with variants that we’re not aware of. The arms race between virus and test isn’t a new story. The mutational capers of SARS-CoV-2 are actually pretty mild compared with the wild rides pathogens have taken us on before. The rise of the H1N1 flu virus in 2009 bamboozled several tests, leaving researchers and companies scrambling to retool their products, some of which failed entirely against the strain. Across the board, the experts I talked with were optimistic about our ability to target SARS-CoV-2 variants, especially given the dizzying array of tests American laboratories have to choose from. Even if a few eventually fail their way into obsoletion, we will have plenty of backups; manufacturers will keep tinkering with their tests to keep them relevant. “Everything is cool, honestly,” Greninger said. “For the foreseeable future, we’re going to have a panoply of diagnostics.” More tests are already on their way, and molecular- and antigen-test manufacturers are intent on designing them to be long-lasting. For one, they’re focusing on bits of the virus’s genome that are less likely to mutate. Now that millions of SARS-CoV-2 genomes have been sequenced, identifying more steadfast regions of RNA should be easier. The tag-teaming approach—looking for multiple targets at once—is also a buffer against mutations. “The more targets there are, the more resilient the test is against changes,” Melissa Miller, the director of the clinical-microbiology laboratory at the University of North Carolina’s School of Medicine, told me. Doing this also helps tests detect just one pathogen at a time, in the same way that plugging several super-specific keywords into Google will narrow a search. Cepheid, whose two-gene Xpert tests are among those listed by the FDA as “impacted by SARS-CoV-2 mutations,” is adding a third target to its product to make it a bit more variant-proof, according to David Persing, the company’s chief medical and technology officer. [Read: One vaccine to rule them all] Still, it’s hard to ignore the game of whack-a-mole we’ve locked ourselves into. No test can be completely impervious to evolution’s hijinks. The coronavirus has infected more than 170 million people around the world, and will be with us for some time yet; it has had countless opportunities to morph into new forms, far faster than any test could be whipped up in a lab. The nature of tests—which search for pathogens after they’ve invaded the body—forces their design to be reactionary. The virus barrels on; tests give chase. Some of those mutational moves will be zigzaggy and unpredictable. But experts assured me that researchers and companies are keeping close watch, tracking the virus’s many modifications and ensuring that tests are still up to snuff, similar to what’s been done for years with the flu. Testing is, at its core, about keeping the virus in our line of sight—even through a costume change or two. from https://ift.tt/2Sil9L5 Check out http://natthash.tumblr.com Deep in the densely forested foothills of southern Oregon, near the town of Butte Falls, Lanette and Steve Martin lived with their son and his family—until last year, when a wildfire chased them away from their home. As embers the size of charcoal briquettes landed on their front deck, the retired couple and their family jumped into their cars, leaving behind five chickens and a cat. “If we’d waited another 10 minutes, we would have been engulfed in flames,” Steve Martin says. That same day, September 8, 2020, an urban fire fueled by hot, dry weather and strong winds tore through the nearby towns of Talent and Phoenix, in the Rogue Valley. Alma Alvarez, a migrant worker, was working about 15 miles away when the fire began raging toward Phoenix, where her two younger children, ages 10 and 13, were home alone. Alvarez rushed back to find her neighborhood already in flames. The family escaped with the kids’ birth certificates and their cat, but everything else was gone. That night, they slept in their car. “All we would think about was the fire and if it could come get us in our sleep,” Alvarez says, in Spanish. The next night, they checked into a hotel, the first of many where they would stay in the months to come. The conflagrations, part of what were later labeled the Labor Day fires, killed at least three people and displaced roughly 8,000 in southern Oregon’s Jackson County. In mid-April, after bouncing between temporary homes for more than seven months, both Alvarez’s family and the Martins finally landed in the same place: the Redwood Inn in Medford, Oregon. This was no coincidence. The motel is part of Project Turnkey, a $65 million statewide initiative to convert hotels and motels into free housing for survivors of the September 2020 fires, as well as other people experiencing homelessness. For Alvarez and the Martins, Project Turnkey offered much-needed stability—and a step toward a more permanent home. [Read: A mental-health crisis is burning across the American West] Situated on a busy street lined with inexpensive motels, the Redwood Inn is one of as many as 20 motels that Oregon plans to purchase by the end of June. Collectively, the motels could shelter about 1,000 households. Project Turnkey is modeled on a similar program in California that began last summer. Cities and nonprofits have long rented hotel rooms for unhoused people, but states actually buying hotels is something new, triggered by the coronavirus pandemic and the need for socially distanced shelters. Ernesto Fonseca, who leads Hacienda Community Development Corporation, an Oregon housing organization that serves Latino communities, says supporting Project Turnkey was a “no-brainer”; it’s a relatively quick and cheap way to provide emergency shelter and housing. But “it’s also not a permanent solution,” he says. The state is putting up the money to buy the buildings, but local organizations have to run them—and cobble together the funds to do so. Rogue Retreat, a nonprofit, and the city of Medford received $2.55 million to buy the 47-unit Redwood Inn, which is prioritizing wildfire survivors. Later, the motel will house members of the general homeless population, who will pay a small rent. But for now, local and state grants, along with FEMA reimbursements, are paying the Redwood Inn’s estimated $91,000 monthly operational cost. When the Martins pulled into the motel’s parking lot on April 12, they let out a sigh of relief. As a handful of new residents lingered outside, ready to move in, the Martins explained that their move-in date had been repeatedly delayed. Just that morning, the state had informed them that they could have one of the first eight rooms that were ready. Inside the seating area of a makeshift lobby, Rogue Retreat staff members told them about a program that can connect residents with permanent housing, while emphasizing that there was no time limit on their motel stay. Steve Martin seemed on the verge of tears as he signed the paperwork: “Our next option was the back of my pickup,” he told the staff. The couple passed around a phone with pictures of their former home, a four-bedroom house that held them and their son’s family of three. Lanette Martin called it her “Shangri-la.” For five years, they were caretakers of the 40-acre property, where their power came from solar panels and their water came from mountain springs. In exchange, the Martins—who live on a fixed income—paid just $700 per month in rent. Now, the couple can’t find even a studio apartment for that price: In 2020, rents and home values skyrocketed amid high demand driven by the fires and an influx of out-of-state arrivals during the pandemic. The Martins lived in several friends’ homes after the fires, but had to leave the latest one when it sold in less than 24 hours—a typical occurrence nowadays in Jackson County, where Medford is located. [Read: California’s wildfire are 500 percent bigger due to climate change] From 2013 to 2017, nearly a third of Jackson County residents were severely rent-burdened, spending more than 50 percent of their monthly income on rent, according to Oregon Housing and Community Services. And that was before the September 2020 wildfires exacerbated the county’s already acute affordable-housing shortage. Of the nearly 2,500 homes destroyed in Jackson County, 60 percent were mobile homes. The Martins lacked renter’s insurance and hadn’t applied for FEMA assistance. Their son’s family, however, now lives in a FEMA trailer, one of about a hundred Jackson County households the agency is housing; another hundred are on its waitlist. The state is providing hotel rooms and RVs to an additional 765 Jackson County fire survivors. As the Martins sorted their few belongings into their room at the Redwood Inn, their 7-year-old dog, Keyeva, stretched out on the bed. Keyeva had made it out of the fire, but the Martins’ five chickens died in their coop, and their cat was nowhere to be found. Living in the Redwood Inn rent-free means they can save up for a down payment on a house, the Martins explained. “We’re not looking for a handout,” Steve Martin says. “We’re just looking for a hand.” A few days later, the aroma of pork tacos and homemade salsa filled the air of an upstairs motel room at the Redwood Inn. Alvarez and her family were taking advantage of their room’s kitchenette; Rogue Retreat had spent extra time preparing units that already had kitchenettes to accommodate people with specific dietary or medical needs. Lanette Martin has type 2 diabetes, and two of Alvarez’s three children have hemophilia, a bleeding disorder. [Read: Tracking down a catastrophic fire’s first spark] After they moved in, one of Alvarez’s first tasks was to give her 10-year-old son, Anthony Gonzalez, the weekly injection that helps his blood clot properly. Alvarez and her children moved from California to Oregon last year, drawn by the state’s good public schools and booming hemp industry. But the wildfires burned many of the region’s farms, and Alvarez has had trouble finding jobs trimming hemp. According to the Oregon Climate Change Research Institute’s 2021 report, wildfires in the state are expected to become more intense and frequent. Fires tend to have the greatest impact on marginalized communities, whose members are often left with few resources following climate-related disasters, says Alessandra de la Torre, a staff member at Rogue Climate, a southern-Oregon climate-justice organization. The group helps run a wildfire-relief mutual-aid facility that, seven months after the fires, was still supplying food and clothes to about 300 people a week. “We can’t allow for people to be sleeping in their cars right after a disaster or an emergency,” she says. “Because, at the end of the day, you still have to go to your job the next day. Your kids have to go to school.” Sinking into their new beds in the Redwood Inn, Alvarez’s two younger children eagerly asked their mom and 22-year-old brother, Diego Gonzalez, about school—when they could start going, and whether it would be in-person or virtual. They also asked if they could walk or take the bus to get there, because their mom and brother needed to work. While the family figured out transportation, the kids spent their first days in the motel watching TV, playing video games, and tending to their cat, Biscuit. “They don’t go out anywhere,” Alvarez says. “They’re locked up.” Now, most weekdays the kids wait outside for a bus to take them to school. Meanwhile, Alvarez, after finally landing one of the few remaining local hemp jobs, returns to the motel each evening, exhausted from working 10-hour days to save up for a small rental house or apartment. Alvarez’s 13-year-old daughter, Alma Gonzalez, says she hopes to one day have a room of her own, and a dog. Anthony Gonzalez says he wants a backyard to run around in. “We just want to be kids,” his sister adds. But for now, the family crowds together in the Redwood Inn. “Hopefully,” Diego Gonzalez says, “from here, it’s not much farther until we can have a home.” This article appears courtesy of High Country News. from https://ift.tt/3fXQA6x Check out http://natthash.tumblr.com While COVID-19 case counts in the United States continue to drop, you might still be reading worrisome headlines about variants and “breakthrough” infections. Fortunately, The Atlantic staff writer Katherine Wu explains to James Hamblin and Maeve Higgins why these shouldn’t alarm us just yet. And staff writer Sarah Zhang drops in to help figure out how to keep pandemic puppies from being too anxious as people return to pre-pandemic routines. What follows is a transcript of their conversation, edited and condensed for clarity: Maeve Higgins: People are ready to party, but if people are still getting COVID-19 after the vaccine, even if it’s not that often, how worried should we be? Katherine Wu: I think there’s two ways to answer that question. Collectively, we should not be super worried. I think on a population level, these so-called breakthrough infections where people are getting infected with the virus and very occasionally getting sick despite being fully vaccinated … it’s so, so, so rare. And even the people who are picking up the virus don’t seem to be getting as sick; in short, the vaccines are doing their job. That’s why I don’t want to downplay how concerning this can be for that individual person who does get infected or sick, or the worries of the people around them. It’s really tough to talk about these breakthrough infections because we do want to track them and pay attention to them on an individual level. But broadly, I do not see anything that is unexpected, to be totally honest. James Hamblin: Can you catch up just on the basic numbers? How many cases have been reported in the U.S. and how are we defining cases? Wu: There’s kind of two numbers that I can tell you at this point. One is going to be a number that is only current through the end of April, and that’s back when the CDC was tracking all breakthrough infections that were reported to them regardless of severity. So if you test positive for this virus and your health department reports it to CDC, they’re going to count it even if you’re asymptomatic. That was in kind of like the 10,000 range. But I really hesitate to do math here because it’s super tempting to be like, “Oh, there were about 10,000 of these cases. And by that point, like, I don’t know, 100 million people were vaccinated. So let’s just divide.” That’s super tricky because we know that not all 100 million of those vaccinated Americans were exposed to the virus, so they didn’t all have the opportunity to get infected. We can’t just say like, “Oh, this is exactly how effective the vaccines are and the way that the CDC is sort of tracking that number.” If you look on their data tracker, they actually add people to that fully vaccinated column the day they get their second shot. And we know that full vaccination in terms of, like, how immune, [how] protected you are, doesn’t really kick in until a couple of weeks later. So it’s really hard to do that kind of math, but that is still pretty good odds in terms of the big picture. Ten thousand people by the end of April. We also do know that’s an undercount, because given that there are probably going to be … a decent more number of asymptomatic infections after people are vaccinated. And again, that is the vaccine doing its job. It’s keeping you from getting sick. At the start of May, we started to transition into this different set of numbers as the CDC stopped tracking breakthrough cases that were not associated with hospitalization or death. So now they’re only tabulating on their website cases where people ended up in the hospital or ended up dying and were also positive for the coronavirus. That doesn’t always mean the coronavirus caused their sickness or death, but they tested positive and they also happened to be in the hospital. So it’s tough. And when the CDC made the switch, it was kind of controversial, because people were like, “Well, how are we going to get the full range of data here? How are we going to know if there’s, like, a variant that is more consistently making people sick if we don’t have anything to compare that to?” But as you can imagine, the numbers have really dropped since the CDC did this. And so now it’s current through May 24, 2021. There have been 2,454 hospitalized or fatal vaccine-breakthrough cases reported to CDC, where the person was also positive for the coronavirus. Hamblin: I mean, do you have a sense that there are many people in there who had, you know, say a heart attack or a car accident and died because of that and are included in that number? Is there any way to know how much of that is actually attributable to a serious case of COVID-19? Wu: So to the CDC’s credit, they do actually put some little asterisks on this little spreadsheet here. Five-hundred-forty of those 2,000-plus cases were actually reported as asymptomatic. So we know that not everything in that bucket that we just described is like someone dying of COVID-19, which I think is an important distinction to make, because I have seen some people talking about this on Twitter or in different news outlets and saying like, “Oh, this is the percentage of breakthrough cases where COVID-19 is killing people.” And that’s not quite accurate. I mean, it may have had something to do with it. I can’t know the internal workings of every person’s body that is in this list, but I think it’s safe to say that sometimes infections just happen at a really unfortunate time. So it’s really hard to draw firm conclusions based on just this number alone. Hamblin: Yeah. Do you know why they made that switch toward tracking in this new way? So, not tracking just every single person who’s tested positive but only the hospitalization or death cases? Wu: Yeah, it’s a really good question. And it’s a question that I think stirred a lot of debate in the past few weeks as this became more public knowledge. Basically, the CDC justified this by saying we are keeping track of the cases, quote unquote, of most public health and clinical concern, though that also felt a little weird to me because, again, COVID-19 is not necessarily the direct cause of hospitalization or death in these cases. I suspect there’s also kind of a pragmatism at work here just because it’s really hard to cast a net wide enough to say confidently that we are really getting a good sense of all the symptomatic cases or—God forbid—we’re trying to get a sense of every single infection, asymptomatic or not, that’s out there. You know, hospitals and other places through which people pass when they’re really sick—they’re going to keep pretty good medical records. It’s probably going to be easier to figure out if a person has been fully vaccinated or not. So to tell if they qualify for a breakthrough case, it’s just easier to to track. Higgins: Yeah, but the line in your piece that really struck me was the goal of vaccination isn’t eradication, but a détente in which humans and viruses coexist with the risk of disease at a tolerable low. That helped me to think about it in a more practical way, I guess. Wu: Yeah. And I think also thinking long-term here, I could see this kind of being a more sustainable way to track breakthrough infections just because, like, labs across the country have just been slammed with, like, “Please sequence everything, please test everything,” for so long now. It’s really tough and that wouldn’t necessarily be the most sustainable way to go forward. But I also do worry that this is soon; this happened even before everyone in our country, at much less the world, was eligible for a vaccine and had access to a vaccine. So “What are we missing by putting our blinders on?” I think is a huge question here. Hamblin: Right. Are we picking up on any trends as to who is prone to break through cases that are significant, any relationship to how long ago people were vaccinated or to age or chronic conditions, or is it too soon to see any patterns? Wu: Yeah, I think the short answer is that it’s too soon to see any huge patterns, though a couple slight and maybe unsurprising ones have been picked up. The first is that the majority of the breakthrough cases that are documented as being related to hospitalization or death, they are occurring in people who are over the age of 65. And we did kind of expect that vaccines might not be quite as efficacious in people who are older just because their immune systems are a little sleepier. But apart from that, it’s not huge. I think the other thing that people are really on the lookout for is are we seeing that particular version of the virus that has specific mutations? Is it consistently eluding the vaccines? And mostly the answer seems to be no. But it’s really, really hard to tell because less than 10 percent of these reported breakthroughs have actually been whole-genome sequenced, which means we can read the entire virus’s genome from start to finish. I think that’s something that a lot of people are concerned about with relation to what breakthroughs are we tracking and how many should we be tracking at once. Higgins: You know, I’m still in Ireland and they just released information about the first person who’s definitely gotten the virus twice in the space of eight months. So is it like that? Is it the same thing where, like, your body was able to cope with it and then you get a lesser version of it? Because she didn’t get it as bad the second time. Wu: Hmm. First off, that’s very good to hear. That hopefully means her body built up some pretty decent defenses that maybe weren’t perfect against the second version of the virus, if it was a different variant. If we were to see that a majority of people who are vaccinated and getting infected are getting infected with a variant, and the proportion of those people who are getting this variant exceeds the proportion of people in the population who are getting this variant who are just unvaccinated, yeah, I would maybe start to be a little concerned, but it’s not the end of the world. I would also want to look at how severely are these people getting sick, because you’re right, it is kind of similar with both natural infection and a vaccine. The body sees this invader or something that looks a lot like it and it prepares a bunch of defenses and squirrels them away. And maybe it kind of learned the wrong version of the virus. But it can still tell a few things. I think about it as like a mug shot. You take a mug shot of a criminal and he comes back, but he has grown a mustache and you feel a little bit confused. But for the most part, it’s still like, Okay, I still kind of know what’s going on and I’m still going to take care of this. So I’m still mostly okay with it. Higgins: I know those eyes anywhere. Even if you are wearing glasses with fake eyebrows and a fake mustache. Wu: The virus is like, How did you know? Hamblin: So it sounds like you’re not extremely concerned by what you’re seeing in terms of breakthrough cases at this point. And there’s nothing that we’ve learned that should change the overall messaging that most people have gotten about vaccines being extremely effective and how life should basically be able to go on as pretty close to normal as long as you and the people you’re spending your time around are vaccinated, correct? Wu: Yeah, I think that’s right. And it’s probably worth it to point out that for months now there have been all these headlines about like, “Oh, these scientists tested this variant in the lab. And all of these antibodies were like, Oh, crap, what’s going on? I don't recognize this thing.” And there were really terrifying numbers about, like, 40-fold reduced efficacy. In a vacuum it is true that some of those antibodies were not doing as good a job against the virus, but those were single antibodies. The immune system is so complicated. It has so many different arms and branches. Basically, the immune system is not putting all of its defensive eggs in one basket. And what’s been really encouraging is that when people really zoom out and don’t just look at what’s happening in a laboratory petri dish, they’re seeing the vaccines are still really effective against variants. It’s another reason why we shouldn’t obsess too much over only antibodies. Even though they’re great, they’re not the whole picture. Hamblin: I'm not the only one, it turns out, who has gotten gotten a pet during the pandemic, who now is like extremely attached. He can't be not in the same room as me or my wife or he goes crazy. And that's not just me. Higgins: I've read it, too. And that's why we're going to talk to Sarah. So will you stay with us, Katie? Because we're going to talk to your other colleague. Was there then because you wrote about this. I would love to. And if Wu: If I cry about the puppies, you just have to bear with me, OK? Higgins: If your weeping gets too loud, we're going to mute you. Wu: OK, but please don't minimize my pain. Higgins: Hi Sarah, are you here? Sarah Zhang: Hi. Yes, I am here. Higgins: Thank you so much for joining us. So yeah, of course. Hamblin: And you have a cat with you. Zhang: I have two cats though I would say they're maybe not super relevant for this story because I actually believe one of my cats cannot wait for me to go back to the office. And in fact, because one has this horrible habit of yelling at one of us, either me or my partner nonstop from 10 a.m. to two p.m. every day until he finally decides to go to sleep. And a couple of days ago, my my partner was out of town for a few days and he was totally fine. So I think he just wants the humans to leave. Wu: That is not my experience. So I have three cats because I'm crazy. Two of them are deeply attached to me. Like I'm actively worried about what’s going to happen when both my partner and I leave, like they crawl in my lap, they will tap me on the shoulder and asked me to pick them up. Higgins: How do they talk to you? I'm they are all giant cats and they walk on their back legs. Wu: I said cats, but I've meant jaguars. Higgins: Wow, that's cool. Wu: No, they are normal sized cats and they get up behind me on the couch, or if I am deploying bad work habits and lying down while I work, they will come up behind me and access my shoulder. Wu: Oh they're saying stop slouching inside. Higgins: Yeah but did you, what did you learn [Sarah]? I mean Jim, you probably have more questions because you're worried about Moses cats. Hamblin: To me, cats, they're fickle and sometimes want things that you don't always know. But the puppies, they kind of just wear everything on their, sleeves. And Moses, he follows me into the bathroom. He can't be alone at all when I'm worried about not being with him all the time. And so there you wrote an excellent story about this. And I'm wondering what I should do to wean my one year old puppy from constantly needing my presence. Zhang: Well, you're not alone. Literally. I spoke to many dog owners who are in the same boat. And, you know, one trainer I spoke to said that she had never in her life talked to someone before who had literally never left their pet until this pandemic. And by never she meant, like, not even to go get the mail or to take out the trash or get groceries. Literally the dog is with you at your side looking at you all the time.. There are dogs with like real separation anxiety where you cannot even leave them for a second before they start howling. And I spoke to one woman who had a dog who, you know, she took a walk and she could hear him barking and howling from a block away. And so what she had to do, literally, was go through this training where first she wouldn't even leave him. She would just kind of do the things that you would do before you went out the door. So she picked up her keys and then put them down and put on her coat, put them down. And because this is COVID, she wouldd put on her mask and take it down until he got used to that and stopped reacting to that. And then it was like literally like leave for a few seconds, a minute, a few seconds, a minute. And she said like literally five minutes was like we're having a party here. She lives in Oregon. So she's working in her garage in the cold for like minutes or hours at a time while her dog is acclimating to this new work-apart reality. Hamblin: Gotcha. So it's you getting the dog used to it, sort of training it in small increments so they're not dramatic. Zhang: Yeah, exactly. And I think one thing that I thought is really interesting is apparently dogs are smart enough to realize that you're leaving them for longer and longer periods of time and they start dreading that it's going to get even longer and longer. What you actually [should] do is do longer and then shorter and the longer and then shorter, so that they can't feel like they can predict what you're about to do. Hamblin: Yeah, that makes total sense. That's really helpful. from https://ift.tt/3g0K5yk Check out http://natthash.tumblr.com I got my first COVID-19 vaccine recently. The whole experience was tremendously routine: I showed my registration, stood in a waiting area, saw a nurse, got the jab, waited 15 minutes in case of an adverse reaction, and left. Oh, and I got a button. The waiting period, of course, was when it happened. James, said the pestilential voice inside my head, while I was scrolling on my phone. James! What is it? What if they microchipped you? You know, Bill Gates, with the 5Gs and the Wi-Fis? Shut up, I’m looking at cat memes. James! You design wearable devices for a living. You know that microchipping someone is possible. Yeah, of course it is. They didn’t. So prove it, big boy. It’s true, I am the chief scientific officer of a data company that makes wearable devices. I’ve spent the past 15 years sticking tech on people, and in people. Thinking about how body-mounted devices work takes up basically my whole day, and one of my favorite mental exercises is seeing if I can pry practical insights from the wild and irresponsible conceptions of the smooth-brained garbage-people on the internet. Ergo: Had Uncle Bill microchipped me? I had 15 minutes to think it through. Here’s what I knew: * I’d watched empty syringes being filled—visibly, in front of everyone—from multiuse vials. The Pfizer vaccine, six shots per vial. I saw nurses filling the syringes, other nurses taking trays of the prefilled syringes to tables, and the syringes being used. This was done fairly haphazardly, on an as-needed basis. * The syringes were Monojects—a model manufactured by Cardinal Health, an enormous multinational company. The Monoject is easily recognized by the orange plastic housing into which its needle snaps after a single use. This prevents needlestick injuries in nurses who have to use these syringes hundreds of times a day. Good design. * The needle was narrow, I would estimate a 25 gauge. A needle’s standard gauge measurement (originally its Birmingham wire gauge) describes its diameter—and like most imperial measurements, it makes no sense whatsoever. In short, a 25-gauge needle is about half a millimeter across, with an internal diameter of about one-quarter millimeter. Needle gauge changes with medical application: When you donate blood, it usually comes out through a 16-gauge (bigger) needle; when you inject insulin, it might go in through a roughly 30-gauge (smaller) one. * The needle was likely 1.5 inches long. On bigger shoulders, a one-inch needle would be too short for intramuscular injections. These shots need to go in through your skin, through your subcutaneous fat, and then into the underlying muscle. Bigger shoulders like mine require longer needles. I saw my shot go the whole way in. No drama. * I experienced no other human contact, and thus no further opportunities for microchipping, at any point during my vaccination visit—as might be expected at a medical site set up to manage an infectious disease. Free hugs were neither dispensed nor encouraged. Everyone was double-masked, so an airborne microchip (were that even possible) also seemed unlikely. So what does that all mean? Let’s begin by ruling out the possibility that I was given a chip with 5G functionality. The most recent 5G chips are about the size of a penny, and would never fit inside those needles. (That’s putting aside the question of how one would power such a chip once it was installed.) [Read: The utter familiarity of even the strangest vaccine conspiracy theories] Could I have been given another, more generic sort of microchip, though? One defined, let’s say, as a small device with any digital-storage, transmission, or pass-through capacity at all? If we imagine that’s the goal of the conspiracy, just to implant everyone like wayward cats, then the only way to ensure reasonable coverage—let alone “a chicken in every pot, and a chip in every shoulder”—would be to prefill the syringes, not the vaccine vials, with the microchip payload. See, at my vaccination site, half a dozen shots were being drawn rapidly from the same multiuse vial—so if the alleged microchips were in suspension (that is, particles suspended in fluid), you could never be certain that each syringe would pull at least one. We can model this: Divide a quantity of fluid inside a vial that contains a number of microchips into six equal parts, for drawing up into a syringe, at random. What is the chance that you’d end up with at least one chip in each draw? If you had just six microchips in there, it would be less than 2 percent. Double that to 12 microchips per vial, and the chance of success is about 45 percent. In order to be 95 percent sure that each syringe contains at least one government-certified tracking device, do you know how many chips would need to be in the vial? Twenty-six. That would be astonishingly inefficient. And worse: If these are supposed to be unique personal identifiers, imagine the chaos of a system in which one person might carry several microchips while other, uh, “sheeple” have just one. Nor would it be ideal to affix a nonspecific microchip to the end of each needle, as appears to be the case in a photo pulled from a newly published (and unhelpfully timed) scientific paper and passed around out of context on Facebook. In that scenario, you’d be unnecessarily blasting your hardware up into the barrel of the syringe as you drew in the vaccine. The only reasonable approach—and again, I say this as someone who has to make these things work, or I don’t get paid—would be to preload a microchip into the barrel of each syringe, and then hope it makes its way out. This brings us to the geometry of the inside of the needle. Any chip is going to be approximately cuboid-shaped—again, see that Facebook pic—and would have to be small enough to pass through the needle. In other words, the chip’s axial diagonal—the distance between its two opposite corners—must be smaller than the needle’s internal diameter. Some amazing advances have been made in our ability to conceive and manufacture tiny semiconductors in the past 10 years. Consider the minuscule build for a potentially injectable temperature monitor (complete with a processor and optical communication!) out of the University of Michigan. Tiny though it is, the axial diagonal of just the base chip is more than twice the internal diameter of my needle. [Read: Why you’re probably getting a microchip implant someday] Even smaller system-on-chip builds do exist. This one from the Google-associated Verily Life Sciences, for example, could be stuck into my shoulder, and so could the one shown in the Facebook image, which is said by its creators at Columbia University to have pushed “volume efficiency to the ultimate limit.” Either of these would work, if Bill Gates really needed to know everyone’s core temperature. But this isn’t where the conspiracy becomes more plausible—the opposite is true. Now that we’ve actually found something small enough to inject, we have two colossal problems.
Here we’ve run right up against the limits of what’s possible, and as my 15-minute waiting period neared its end, I found myself imagining the tiny, low-efficiency radio antenna on the chip inside my arm, floating all alone like an astronaut through space, sending futile chirps into the unfeeling emptiness of my deltoid muscle. This was a disappointing thought. I never got to think through the logistics of these microchips’ manufacture and distribution. For instance: how to make millions or billions of them during a global semiconductor shortage; or how to manage inventory and associate each device with a database; or how to persuade major, publicly traded multinational corporations making medical supplies to expose themselves to existential corporate liability for injecting unapproved hardware into people. Or, for that matter, how to maintain the microchips after they’ve been injected and also, somehow, keep the whole thing quiet during a rollout through a global supply chain. Instead, I just sat on my ugly plastic chair in the makeshift clinic, feeling quite maudlin about the completely nonexistent chip in my arm, abandoned like Laika the dog. Then my time was up, and I went off to think about body-mounted devices that are actually real. from https://ift.tt/3wTZlnH Check out http://natthash.tumblr.com In its larval stage, Lucilia sericata looks unassuming enough. Beige and millimeters long, a bottle-fly grub may lack good looks, but it contains a sophisticated set of tools for eating dead and dying human flesh. The maggots ooze digestive enzymes and antimicrobials to dissolve decaying tissue and to kill off any unwanted bacteria or pathogens. Lacking teeth, they use rough patches on their exterior and shudder-inducing mandibles (called “mouth hooks”) to poke at and scratch off dead tissue before slurping it up. This flesh-eating repertoire is hard enough to stomach in the abstract. Now imagine hosting it on your skin. “Not everyone, psychologically, can deal with that sensation and knowing maggots are chewing on their flesh,” Robert Kirsner, the director of the University of Miami Hospital Wound Center, in Florida, told me. This is the barrier that advocates of maggot therapy face: the emotional gravity of pure human revulsion. How to convince a maggot-hesitant patient? “I would say, ‘Please give me just 24 hours of your life,’” says Kosta Mumcuoglu, a parasitologist and medical entomologist at the Hebrew University of Jerusalem. “Tomorrow at this same time, I will come back, and you can decide how to continue.” In that period, a smattering of maggots, about 32 to 50 per square inch of wound, can start cleaning out dead and dying slough and encourage remaining viable tissue to heal. In the U.S., some 6.7 million people have chronic wounds that—for one reason or another—refuse to heal for months, even years. On its own, a chronic wound can seriously diminish a person’s quality of life and eventually, if left untreated, lead to loss of a limb. In 2009, after years of improvement, rates of lower-limb amputations on diabetic adults in the U.S. (one of the country’s most preventable surgeries) began to slip in the wrong direction, growing 50 percent by 2015, with Black, low-income, or underinsured patients most likely to undergo amputation. Data suggest that, by a conservative estimate, Medicare spends an estimated $28.1 billion annually on wounds. These are “very dramatic” figures, says Steven Kravitz, the president of the Academy of Physicians in Wound Healing, “and they’re not getting better.” In some ways, this is an old problem—festering wounds are one of the most archaic threats to human life—and maggots are an old solution. Maya healers dressed lesions with cattle-blood-soaked bandages to attract flies and make wounds squirm with maggots; legend has it that Genghis Khan traveled with a wagon of larvae for wounded soldiers. Safe to say, today’s patients and doctors are more comfortable with the aseptic medical practices developed over the past century. “Our expectation is that medicine can do everything,” says David S. Jones, an epidemiologist and a historian of medicine at Harvard. “We have earned our worm-free existence.” But with rates of chronic conditions, diabetic ulcers, and hospital superbugs rising, troublesome wounds are a very current threat, pressing clinicians and patients to reconsider the role of maggots. With new approaches to harnessing their powers and new strategies for mitigating their yuck factor, maggots might shed their reputation as an erstwhile cure and take their place in the future of medicine. At any given moment, trillions of maggots, or fly larvae, are wriggling across North America. A fly mother can smell decomposition from up to 10 miles away and arrive within minutes to lay her offspring. (In some species, she will bury herself six feet underground to get to a dead body.) Scientists have witnessed adult and juvenile flies penetrate seemingly sealed barriers—including coffins and suitcase zippers—with ease. One can find maggots at lake bottoms, in camel nostrils and petroleum pits, on toadstool mushrooms and spider abdomens, and of course, in virtually every burial ground most everywhere in the world, according to the London Natural History Museum senior curator Erica McAlister, who also wrote The Inside Out of Flies. During this stage of a fly’s life (in many species, its longest), the larva is driven by a two-pronged mission to eat as much as possible and avoid being eaten. “To this end,” McAlister writes, “its body is nothing more than a basic eating machine, with no wings, no genitalia and no true legs.” In other words, maggots are hungry bags of goo traveling along streams of enzymatic saliva in search of decaying flesh. In modern medical history, these living goo bags were carefully sterilized and used in clinical settings for only one short decade, the 1930s, despite centuries of observations about their penchant for flocking to wounds. “My flesh is clothed with worms and clods of dust; My skin closeth up, and breaketh out afresh,” Job recounts in the Old Testament. In the 15th century, the eminent Iranian physician Bahaodole Razi suggested that when a wound “generates worms,” doctors should “give them some time to feed.” The French surgeon and Napoleonic buddy Baron Dominique-Jean Larrey recalled that during a 19th-century expedition in Syria, blue-fly larvae’s speedy growth “greatly terrified” wounded soldiers. These and many other historical accounts describe maggot infestations as lucky—albeit revolting—accidents and not targeted medical interventions. Not until the Civil War did the Confederate surgeon John Forney Zacharias perform, “with eminent satisfaction,” one of the first documented intentional applications of maggots. “In a single day, they would clean a wound much better than any agents we had at our command,” he wrote. But his satisfaction still didn’t translate into a wide appreciation of maggots. Decades later, during World War I, the military surgeon William Baer noted with astonishment that two seriously injured soldiers had not suffered from fever, septicemia, or blood poisoning even though they had been hidden by brush and overlooked for an entire week. Baer’s second shock: thousands of “abominable looking creatures” swarming their wounds. “The sight was very disgusting,” he wrote. A saline wash revealed a final surprise. “Instead of having a wound filled with pus,” Baer wrote, “these wounds were filled with the most beautiful pink granulation tissue that one could imagine.” At the time, antiseptic tools were still inadequate and deaths from open wounds remained stubbornly high. Rather than leave his wartime observations to the annals of history, Baer dedicated himself to exploring how to systematically—and safely—apply maggots to wounds. As an orthopedic surgeon at Johns Hopkins University, he ran a trial on 21 patients with persistent bone infections; within two months of beginning the maggot treatment, all of the patients’ wounds had healed. Baer died just two years later, in 1931, but in the decade that followed, hundreds of U.S. hospitals added maggots to their wound-healing toolkit. The larvae therapy’s popularity was short-lived. In 1928, as Baer was running his clinical trials, Alexander Fleming discovered penicillin. The mass production of antibiotics by the mid-’40s quickly shunted medical maggots aside. “Fortunately maggot therapy is now relegated to a historical backwater,” opined the University of Sheffield microbiologist Milton Wainwright in 1988, “a therapy the demise of which no one is likely to mourn.” Maggots’ modern renaissance began shortly thereafter, in the early ’90s. Up until that time, Mumcuoglu, the parasitologist, was more interested in the many ways that bugs like mites, lice, and ticks could wreak havoc on the human body. Then, one day, a colleague approached Mumcuoglu about a patient who had already lost his right leg and risked his left to amputation. “This physician didn’t know what to do,” Mumcuoglu recalls, and asked about the possibility of maggot therapy. Mumcuoglu had never tried it, but together they quickly found, sterilized, and applied maggots to the wound. To everyone’s surprise, the patient’s remaining leg was saved. From that moment, Mumcuoglu began to evangelize maggot therapy as a valid wound-care option when other, more palatable alternatives had failed. Already, maggots were experiencing something of a global revival. In South Wales, the Biosurgical Research Unit at Princess of Wales Hospital began selling larvae in 1995, followed shortly by German and Belgian maggot factories. By 1996, the newly formed International Biotherapy Society began hosting annual meetings about larval therapy and other biologically aided treatments. And in California, Ron Sherman, an entomologist turned doctor turned maggot advocate, was running studies on maggot therapy at UC Irvine. After the Food and Drug Administration began approving maggots as a prescription-only medical device, Sherman’s lab was one of the first in the country to obtain federal permission to sell them, in 2004. By 2008, maggot therapy was being administered about 50,000 times annually worldwide, as a growing body of research continued to demonstrate why the stomach-turning approach was worth tolerating. In a three-year randomized clinical trial, for example, University of York scientists found that larvae debrided leg ulcers significantly faster than standard wound-healing gels did. In another study of foot-ulcer treatments, researchers at Trafford College, near Manchester, concluded that maggot therapy was significantly better than gels at reducing the area of a wound. Individual case studies have also described the effectiveness of maggot therapy for severe electrical burns or methicillin-resistant Staphylococcus aureus (MRSA) infections. A 2012 study conducted at two French hospitals found that maggots could outperform scalpels when it came to quickly clearing dead tissue from nonhealing wounds. During the COVID-19 pandemic, University of Southern California surgeons demonstrated that maggot therapy could even be conducted via telemedicine. Kravitz told me that by now, the evidence is clear: “Maggot therapy is a good way of treating lots of wounds. There’s very little downside to it.” It’s by no means a cure-all, he said, but for the worst-of-the-worst wounds, it is a worthwhile intervention to deploy. Still, our overwhelming bias against the technique has largely prevailed. “Their use in the United States has been slight, in part because of squeamishness,” The New York Times noted in 2005, shortly after maggots received FDA clearance. “People talk about it, but for many, I don’t think it’s a go-to,” Kirsner said. “You want to position wound centers as being cutting-edge or novel—not old-fashioned or archaic.” A cohort of scientists and entrepreneurs is trying to do just that. Many medical offices, for example, now contain maggots in “biobags” thin enough for larval secretions to pass through but thick enough to hide the grubs from view (and keep them from escaping). Other start-ups have tried to circumvent actual bug application by developing gels containing maggot enzymes. Entomologists at North Carolina State University have even genetically tweaked blowfly maggots to also produce a human growth factor that could boost their healing powers. But for the most part, advocates of maggot therapy are left to depend on the power of testimonials—a strategy with a long track record. “Nothing short of experience could convince them,” wrote Baron Larrey of his accidentally maggot-infested soldiers. Left to do what they do best, maggots will frequently prove that they’ve earned their keep. “You saw it once,” Mumcuoglu says, “and it was enough to convince you.” Limited research supports this strategy and suggests that disgusted patients will still give maggots a go—especially when faced with an extreme alternative, such as amputation. In a 2002 to 2003 investigation of the treatment’s “yuk factor,” Dutch doctors found that 94 percent of surveyed patients who had received maggot therapy said they would recommend it to others, despite unpleasant side effects such as odor, pain, and itching. Being temporarily infested ultimately compares favorably to life accompanied by the constant smell and sight of decaying flesh. “Worms growing in your skin is one of the most appalling things I can imagine,” says Jones, the Harvard historian of medicine. “But these maggots are the lesser of two evils. You’re not comparing maggots to nothing; you’re comparing it to this other, barbaric thing.” Living with a festering wound forces people to confront the same uncomfortable point as maggots do: We all live in bodies that will eventually decay, and once they do, we are all little more than larvae food. Whether we like it or not, maggots await us on the other side of what the cardiologist and poet John Henry Stone described as “the rigid final fact of a body.” What if maggots could help some of us enjoy better lives before we reach that terminus? That’s the terrible beauty of this solution. By leaving a space open in modern medicine for maggots, we have to face more squarely the natural symbiosis that affords us existence. We don’t usually think of our body as an ecosystem composed of only 43 percent human cells—we’re made more of bacteria, viruses, fungi, and archaea than anything else. From that perspective, maggots are simply another guest in our teeming anatomy—a healer that we’re lucky to cohabit alongside. from https://ift.tt/3wJzKxI Check out http://natthash.tumblr.com If you ask some people, America is in the middle of a public-health crisis. No, not that one. Legislators in 16 states have passed resolutions declaring that pornography, in its ubiquity, constitutes a public-health crisis. The wave of bills started five years ago, with Utah, which went a step further this spring by passing a law mandating that all cellphones and tablets sold in the state block access to pornography by default. (The measure will not go into effect unless five other states pass similar laws, but that’s very possible: Alabama is now considering a similar bill.) Groups such as the National Center on Sexual Exploitation, an anti-obscenity nonprofit that produced model legislation for the porn-blocking bill and the public-health-crisis bills, argue that pornography increases problematic sexual activity among teens, normalizes violence against women, contributes to sex trafficking, causes problems in intimate relationships, and is “potentially biologically addictive.” NCOSE seems to have pushed Utah state Senator Todd Weiler to support the public-health-crisis legislation in 2016. “They told me, ‘If you can pass this, we can get this passed in 15 more states. We just need one legislator to stick his neck out,’” Weiler told Governing magazine in 2019. Arizona state Representative Michelle Udall told me that she introduced her state’s public-health-crisis bill in 2019 after hearing from constituents involved with the anti-porn group Fight the New Drug, and that NCOSE gave her a booklet with data and studies on porn. She read that the average age at which children are being exposed to pornography is 11, and she had an 11-year-old at the time. She wanted the resolution “to improve awareness of the issue, especially as we talk about children and their exposure,” she told me. Content filters that block kids from accessing porn have broad support among public-health experts. But, these same experts say, porn is not a public-health crisis. Though the state-level measures don’t do much beyond “calling for” research and policy changes, they run the risk of stigmatizing adults who watch porn. Several public-health experts told me they worry that the measures are creating more problems than they solve, by telling people that a small but regular part of their sex life is actually a “crisis.” This stigma will likely disproportionately affect people who already feel ashamed about the porn they watch, but leave relatively unruffled those who embrace porn—even in its most exploitative forms. That sense of crisis can spur some people who disapprove of porn to commit violence. The man who killed eight people at several spas in Atlanta in March plotted further “similar acts” against “the porn industry,” police said. In April, a mansion owned by the executive of Pornhub, one of the most popular porn sites, burned down in an apparent act of arson. Whether porn is actually harming the health of adults who watch it is frustratingly hard to determine. Most studies of porn raise questions of correlation and causation: Is someone depressed and lonely because they watch too much porn? Or are depressed, lonely people drawn to porn? Public-health experts worry that teens, in particular, incorrectly see porn as an instruction guide for having sex. For that reason, researchers, policy makers, and porn stars alike support limiting kids’ access to porn. The best way to do that, and to contextualize whatever they do happen to see, is through a combination of content filters, comprehensive sex education, and conversations about how porn isn’t a realistic view of sex. “You need to instill in your child their own personal brain filters,” Emily Rothman, a health-sciences professor at Boston University, told me. Porn can be bad for adults too. A small number of adults—roughly 11 percent of men and 3 percent of women—consider themselves somewhat addicted to porn, even though a number of scientists dispute whether “addiction” is an appropriate label for watching lots of porn. Believing that porn is morally “bad” is strongly correlated with feeling like you have an addiction to pornography, regardless of how much porn you actually watch. “The best predictor of self-perceived sexual-use problems, like pornography addiction, is high levels of religiosity,” says Bryant Paul, a media professor at Indiana University and a faculty affiliate of the Kinsey Institute, which studies human sexuality. “It’s a better predictor than actual amounts of use.” Even setting addiction aside, porn might pose other problems. Some studies have found that watching porn reduces sexual satisfaction, especially for men who watch porn more than once a month. Watching porn is associated with increased aggression in some people, although not in the majority of porn users. But other studies have found that watching porn can be part of a healthy sex life, especially for sexual minorities, women, and couples. In one study, Taylor Kohut, a psychologist at Western University, in Ontario, found that couples who watched porn together “reported more open sexual communication and greater closeness than those that did not.” Another of his studies found that most partnered people think porn has had “no negative effects” on their relationship, and many also thought that watching porn improved their sexual communication, sexual experimentation, and sexual comfort. “There’s a lot of evidence to suggest that couples that watch porn together, it can improve their sex lives,” says Paul, who wasn’t involved in those studies. If the United States is in a sex recession, pornography could help Americans get back in the black. Porn might also be helpful for individuals whose sexuality has not always been widely accepted. For LGBTQ people living in conservative areas, watching pornography might be the only sexual experience they’re able to access. One study found that for women, watching porn “was associated with their own and their partner’s higher sexual desire and with higher odds of partnered sexual activity.” In a recent paper arguing that pornography does not qualify as a public-health crisis, Rothman and a colleague write, “For some, pornography use is associated with health-promoting behaviors, including increased intimacy, ‘safer’ sexual behaviors (e.g., solo masturbation), and feelings of acceptance.” Anti-pornography groups dismiss all of these findings. They say that the porn-positive studies are outliers in a sea of research showing porn’s detrimental effects on relationships. But here’s the thing: Kohut has observed that in relationships, what seems to matter is that partners have similar opinions about porn. If you both like porn, he suggests, watching it will probably be fine for your sex life. Some couples might even find that they can build intimacy by showing porn to each other, as a way to tell each other what you like. But if only one of you watches porn, and the other hates it, you might encounter relationship tensions like those of couples who fight over marble countertops or in-laws or baby names. The secret to a happy relationship that includes porn, in Kohut’s view, is to find someone who likes it the same amount as you do. A recent Atlantic/Leger poll of 1,002 Americans largely supported this acceptance of porn. We presented participants with a list of questions about porn, and many of them yawned and said, “So what?” Most Americans have watched porn, according to the poll. But most spend less than 20 minutes a week watching it, and 79 percent of those who watch porn said they don’t feel addicted to it (17 percent of respondents who had watched porn in the past year said they had ever felt like they were addicted to pornography). Only 6 percent of people said they’d begun watching porn when they were younger than 12. Most said that watching porn had no effect on them or their relationships, and 79 percent of those with children said they didn’t struggle to control their children’s access to porn. And just like public-health experts, most respondents—53 percent—said they didn’t think porn was a public-health crisis. Only 25 percent said it was. Porn makes for an easy target. But legislators focused on labeling it as a public-health crisis should consider what problems they are actually trying to solve. Many researchers and adult-entertainment workers support measures that would reduce kids’ access to porn, ensure that porn videos portray only consenting adults, and mandate fair wages for sex workers. Calling adults’ legal use of pornography a “public-health crisis” doesn’t do any of that. from https://ift.tt/3crZ4kf Check out http://natthash.tumblr.com |
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