After two-plus years of erupting into distinguishable peaks, the American coronavirus-case curve has a new topography: a long, never-ending plateau. Waves are now so frequent that they’re colliding and uplifting like tectonic plates, the valleys between them filling with virological rubble. With cases quite high and still drastically undercounted, and hospitalizations lilting up, this lofty mesa is a disconcerting place to be. The subvariants keep coming. Immunity is solid against severe disease, but porous to infection and the resulting chaos. Some people are getting the virus for the first time, others for the second, third, or more, occasionally just weeks apart. And we could remain at this elevation for some time. Coronavirus test-positivity trends, for instance, look quite bad. A rate below 5 percent might have once indicated a not-too-bad level of infection, but “I wake up every morning and look … and it’s 20 percent again,” says Pavitra Roychoudhury, a viral genomicist at the University of Washington who’s tracking SARS-CoV-2 cases in her community. “The last time we were below 10 percent was the first week of April.” It’s not clear, Roychoudhury told me, when the next downturn might be. Part of this relentless churn is about the speed of the virus. SARS-CoV-2, repped by the Omicron clan, is now spewing out globe-sweeping subvariants at a blistering clip. In the United States, the fall of BA.2 and BA.2.12.1 have overlapped so tightly with the rise of BA.5 that the peaks of their surges have blended into one. And a new, ominous cousin, BA.2.75, is currently popping in several parts of the world. [Read: Is BA.5 the ‘reinfection wave’?] At the same time, our countermoves are sluggish at best. Pathogens don’t spread or transform without first inhabiting hosts. But with masks, distancing, travel restrictions, and other protective measures almost entirely vanished, “we’ve given the virus every opportunity to keep doing this,” says David Martinez, a viral immunologist at the University of North Carolina at Chapel Hill. More variants mean more infections; more infections mean more variants. It’s true that, compared with earlier in the pandemic, hospitalization and death rates remain relatively low. But a high rate of infections is keeping us in the vicious viral-evolution cycle. “The main thing is really this unchecked transmission,” says Helen Chu, an epidemiologist and vaccine expert at the University of Washington. We might be ready to get back to normal and forget the virus exists. But without doing something about infection, we can’t slow the COVID treadmill we’ve found ourselves on. The speed at which a virus shape-shifts hinges on two main factors: the microbe’s inherent capacity for change, and the frequency with which it interacts with hospitable hosts. Coronaviruses don’t tend to mutate terribly quickly, compared with other RNA viruses. And for the first year or so of the pandemic, SARS-CoV-2 stuck to that stereotype, picking up roughly two mutations a month. But then came Alpha, Delta, Omicron and its many subvariants—and SARS-CoV-2 began to outstrip the abilities of even flu viruses to birth versions of itself that vaccinated and previously infected bodies can’t easily recognize. BA.1 sported dozens of typos in its genome; BA.2 was able to rise quickly after, in part because it carried its own set of changes, sufficient to stump even some of the defenses its predecessor had raised. The story was similar with BA.2.12.1—and then again with BA.4 and BA.5, the wonkiest-looking versions of the virus that have risen to prominence to date. Nothing yet suggests that SARS-CoV-2 has juiced up its ability to mutate. But subvariants are slamming us faster because, from the virus’s perspective, “there’s more immune pressure now,” says Katia Koelle, an evolutionary virologist at Emory University. Early on in the pandemic, the virus’s primary need was speed: To find success, a variant “just had to get to somebody first,” says Verity Hill, a viral genomicist at Yale. Alpha was such a revision, quicker than the OG at invading our airways, better at latching onto cells. Delta was more fleet-footed still. But a virus can only up its transmissibility so much, says Emma Hodcroft, a viral phylogeneticist at the University of Bern. To keep infecting people beyond that, SARS-CoV-2 needed to get stealthier. [Read: The coronavirus will surprise us again] With most of the world now at least partially protected against the virus, thanks to a slew of infections and shots, immune evasion is “the only way a new variant can really spread,” Hill told me. And because even well-defended bodies have not been able to fully prevent infection and transmission, SARS-CoV-2 has had ample opportunity to invade and find genetic combinations that help it slither around their safeguards. That same modus operandi sustains flu viruses, norovirus, and other coronaviruses, which repeatedly reinfect individuals, Koelle told me. It has also defined the Omicron oligarchy. And “the longer the Omicron dominance continues,” Hill told me, the more difficult it will be for another variant to usurp its throne. It’s unclear why this particular variant has managed a monopoly. It may have to do with the bendability of the Omicron morphs, which seem particularly adept at sidestepping antibodies without compromising their ability to force their way inside our cells. Scientists also suspect that at least one Omicron reservoir—a highly infected community, a chronically infected individual, or a coronavirus-vulnerable animal—may be repeatedly slingshotting out new subvariants, fueling a rush of tsunami-caliber waves. Whatever its secret, Team Omicron has clearly spread far and wide. Trevor Bedford, who studies viral evolution at the Fred Hutchinson Cancer Center, estimates that roughly 50 percent of the U.S. may have been infected by early members of the BA gang in the span of just a few months; each encounter has offered the virus countless opportunities to mutate further. And if there’s a limit to the virus’s ability to rejigger its genome and elude our antibodies again, “we haven’t detected it yet,” Martinez, of UNC Chapel Hill, told me. Such malleability has precedent: Versions of the H3N2 flu virus that have been bopping around since the ’60s are still finding new ways to reinvade us. With SARS-CoV-2, the virus-immunity arms race could also go on “very, very long,” Koelle told me. To circumvent immunity, she said, “a virus only has to be different than it was previously.” So more variants will arise. That much is inevitable. The rate at which they appear is not. Three things, Koelle told me, could slow SARS-CoV-2’s roll. First, the virus’s genome could get “a little more brittle, and less accepting of mutations,” she said. Maybe, for instance, the microbe’s ability to switch up its surface will hit some sort of ceiling. But Koelle thinks it’s unwise to count on that. Instead, we, the virus’s hosts, could give it fewer places to reproduce, by bolstering immunity and curbing infections. On the immunity front, the world’s nowhere yet near saturated; infections will continue, and make the average person on Earth a crummier place to land. Better yet, vaccinations will shore up our defenses. Billions of people have now received at least one dose of a COVID-19 shot—but there are still large pockets of individuals, especially in low-income countries, who have no shots at all. Even among the vaccinated, far too few people have had the three, four, or even five injections necessary to stave off the worst damage of Omicron and its offshoots. Simply getting people up to date would increase protection, as could variant-specific updates to vaccine recipes, likely due soon in the U.S. and European Union. But the appetite for additional shots has definitely ebbed, especially in the U.S. Retooled recipes also won’t see equitable distribution around the globe. They may even end up as a stopgap, offering only temporary protection until the virus gets “pushed to a new point” on its evolutionary map and circumvents us again, Hill said. Which leaves us with coordinated behavioral change—a strategy that exactly no one feels optimistic about. Precautionary policies are gone; several governments are focused on counting hospitalizations and deaths, allowing infections to skyrocket as long as the health-care system stays intact. “Everyone just wants some sense of normalcy,” UW’s Roychoudhury said. Even many people who consider themselves quite COVID-conscious have picked up old social habits again. “The floodgates just opened this year,” Martinez said. He, too, has eased up a bit in recent months, wearing a mask less often at small gatherings with friends, and more often bowing to peer pressure to take the face covering off. Ajay Sethi, an infectious-disease epidemiologist at the University of Wisconsin-Madison, still works at home, and avoids eating with strangers indoors. He masks in crowded places, but at home, as contractors remodel his bathrooms, he has decided not to—a pivot from last year. His chances of suffering from the virus haven’t changed much; what has is “probably more my own fatigue,” he told me, “and my willingness to accept more risk than before.” The global situation has, to be fair, immensely improved. Vaccines and treatments have slashed the proportion of people who are ending up seriously sick and dead, even when case rates climb. And the virus’s pummel should continue to soften, Hill told me, as global immunity grows. Chu, of the University of Washington, is also optimistic that SARS-CoV-2 will eventually, like flu and other coronaviruses, adhere to some seasonality, becoming a threat that can be managed with an annually updated shot. But the degree to which the COVID situation improves, and when those ease-ups might unfold, are not guaranteed—and the current burden of infection remains unsustainably heavy. Long COVID still looms; “mild” sicknesses can still leave people bedridden for days, and take them away from school, family, and work. And with reinfections now occurring more frequently, individuals are each “more often rolling the die” that could make them chronically or seriously ill, Hodcroft, of the University of Bern, told me. In the Northern Hemisphere, that’s all happening against the backdrop of summer. The winter ahead will likely be even worse. And with transmission rates this high, the next variant may arrive all the sooner—and could, by chance, end up more severe. “How much do we want to restrict our own freedoms in exchange for the injury that may be caused?” Hodcroft said. “That’s something that hard science can’t answer.” from https://ift.tt/4FEntYu Check out http://natthash.tumblr.com
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Well, here we go again. Once more, the ever-changing coronavirus behind COVID-19 is assaulting the United States in a new guise—BA.5, an offshoot of the Omicron variant that devastated the most recent winter. The new variant is spreading quickly, likely because it snakes past some of the immune defenses acquired by vaccinated people, or those infected by earlier variants. Those who have managed to avoid the virus for close to three years will find it a little harder to continue that streak, and some who recently caught COVID are getting it again. “People shouldn’t be surprised if they get infected, and they shouldn’t be surprised if it’s pretty unpleasant,” Stephen Goldstein, a virologist at the University of Utah, told me. That doesn’t mean we’re about to have a surge on the scale of what we saw last winter, or that BA.5 (and its close cousin BA.4) will set us back to immunological square one. Goldstein told me that he takes “some level of comfort” in the knowledge that, based on how other countries have fared against BA.5, vaccines are still keeping a lot of people out of hospitals, intensive-care units, and morgues. The new variant is not an apocalyptic menace. But it can’t be ignored, either. Infections (and reinfections) still matter, and by increasing both, BA.5 is extending and deepening the pandemic’s ongoing burden. “We will not prevent all transmission—that is not the goal—but we have to reduce the spread,” Maria Van Kerkhove, an infectious-disease epidemiologist at the World Health Organization, told me. “It’s not over, and we are playing with fire by letting this virus circulate at such intense levels.” The age of Omicron began shortly after Thanksgiving, as the new variant swept through the U.S., ousting its predecessor, Delta. That initial version of Omicron, now known as BA.1, was just the first of a mini-dynasty of related variants that have since competed against one another in a grim game of succession. BA.2 took over from BA.1, and caused a surge in the spring. BA.4 and BA.5 are spreading even more quickly: First detected in South Africa in January and February, they have since displaced BA.2 all over the world, leading to surges in both cases and hospitalizations. In the U.S., BA.5 now accounts for about 54 percent of all COVID infections, and BA.4, about another 17 percent. (Most of this article will deal with BA.5 alone because it already seems to be outcompeting its cousin.) Hospitalizations have risen to their highest level since March. You might assume that a new variant gains dominance by being inherently more transmissible than its forerunners. Using that logic, buttressed by some back-of-the-envelope calculations, some commentators have claimed that BA.5 is as transmissible as measles, making it among the most contagious viral diseases in history. But those calculations are “fully wrong,” Trevor Bedford, a virologist at the Fred Hutchinson Cancer Research Center, told me. Variants can spread rapidly without being any better at finding new hosts, as long as they’re better at slipping past those hosts’ immune defenses. That property—immune evasion—likely enabled BA.1 to oust Delta last winter. It might also explain why BA.5 is rising now. When people are vaccinated or infected, they develop antibodies that can neutralize the coronavirus by sticking to its spike proteins—the studs on its surface that the pathogen uses to recognize and infect our cells. But BA.4 and BA.5 have several mutations that change the shape of their spikes, which, like swords that no longer fit their sheaths, are now unrecognizable to many antibodies that would have disarmed older variants. That’s why, as many studies have now consistently shown, antibodies from triple-vaccinated people, or people who had breakthrough infections with earlier variants, are three to four times less potent at neutralizing BA.4 or BA.5 than BA.1 or BA.2. This means that most people are now less protected against infection than they were two months ago—and that some people who got COVID very recently are getting reinfected now. “I hear from a lot of people who just had COVID in February, March, or April and now have it again,” Anne Hahn, a virologist and immunologist at Yale, told me. As my colleague Katherine J. Wu has reported, the consequences of reinfections are still unclear. It’s unlikely that each subsequent bout of COVID is worse for an individual than the previous one; this idea has proliferated because of a recent preprint, which really only showed that getting reinfected is worse than not being reinfected. Nor should people worry that, as one viral news article recently suggested, “it is now possible to be reinfected with one of Omicron’s variants every two to three weeks.” BA.5 is different from its forebears but not from itself; although someone could catch the new variant despite having recently had COVID, they’d be very unlikely to get infected again in the near future. [Read: You are going to get COVID again … and again … and again] Though previous immunity has been dialed down a few notches, since BA.5 showed up, it hasn’t disappeared entirely. “We’re seeing that new infections are disproportionately people who haven’t been infected before,” Meaghan Kall, an epidemiologist at the U.K. Health Security Agency, told me. About 70 percent of those who currently have COVID in England are first-timers, even though they account for just 15 percent of the country’s population. This clearly shows that although reinfections are a serious problem, the population still has some protection against catching even BA.5. The degree to which the new variant escapes immunity is also a shadow of what we saw last winter, when Omicron first arrived. For comparison, antibodies in vaccinated people were 20 to 40 times worse at neutralizing BA.1 than the original coronavirus. BA.5 reduces their efficiency threefold again—a small gain of sneakiness on top of its predecessor’s dramatic flair for infiltration. “BA.5 is doing what Omicron does but with a marginally more effective immune evasion,” Kall told me. “I don’t believe that it represents a massive paradigm shift.” Why, then, does it feel like we’re in a reinfection wave right now, with anecdotal reports being prominent in a way they weren’t seven months ago? It’s because Omicron completely changed our baseline. Before its arrival, only a third of Americans had ever experienced COVID. By the end of February, almost 60 percent had. We’re hearing more about reinfections now in part because the number of people who could possibly be reinfected has doubled. BA.5’s impact on society will differ greatly around the world. Both South Africa and the U.K. have experienced only small rises in hospitalizations and deaths despite surging BA.5 cases, showing that “protection from vaccines against severe disease and death is still really strong,” Kall said. Portugal hasn’t been so lucky, with deaths climbing to levels that approach those of the first Omicron surge. These differences should be expected. On top of their demographic differences, countries are now complicated patchworks of immunity; citizens vary in how many times they’ve been infected or vaccinated, which vaccines they’ve gotten, and which variants they’ve encountered. Still, it’s possible to predict what might happen as BA.5 ascends in the U.S. by looking at its effective reproduction number, or Rt—the average number of people whom each infected person then infects. The original version of Omicron, BA.1, “came in really hot,” Trevor Bedford told me. With an initial Rt of between 3 and 3.5, he estimates that it infected almost half the country in a few months, including 3 million to 4 million people a day at its peak. (These numbers are higher than the official counts, which have always been underestimates.) BA.2 was less ferocious: With an initial Rt of 1.6, it infected about one in 10 Americans in the spring, and peaked at roughly 500,000 daily infections. BA.4 and BA.5 have a slightly higher Rt but should “mostly mirror the BA.2 epidemic,” Bedford told me. It might not look that way on recent charts of new cases, where the close overlap between BA.4/BA.5’s rise and BA.2’s decline creates “the illusion of a plateau,” Bedford said, but the U.S. is nonetheless experiencing its third Omicron surge. He expects BA.5 to infect 10 to 15 percent of Americans over the next few months. Of course, it doesn’t have to. The Biden administration, other political leaders, and many media figures have promoted laxer COVID policies, on the grounds that vaccines are still reducing the risk of death and hospitalization. But this stance is foolish for several reasons. Even if the infection-fatality ratio for COVID—the risk that an infected person will die--falls to the level of seasonal flu, rare events stack up when the virus is allowed to spread unchecked. Bedford estimates that in such a scenario, COVID could still plausibly kill 100,000 Americans every year, “which is a lot!” he said. “It’s not like in the peak of the pandemic, but it’s a major health burden.” That burden is still mainly borne by the elderly; low-income workers; Black, Latino, and Indigenous Americans; and immunocompromised people. The entire Omicron dynasty may well have arisen from chronic infections in immunocompromised patients, in whose bodies the virus can evolve more rapidly, which suggests a self-interested case for preventing infections in this group, along with the more obvious moral rationale. Death isn’t the only outcome that matters, either. Even without sending people to the hospital, infections can lead to the persistent and in many cases disabling symptoms of long COVID—a risk that vaccines seem to lower but not fully avert. “I’m not worried about dying from COVID, but I’m personally cautious because of worries about long COVID,” Bedford told me. “I’m not a hermit, but I’m taking mitigation measures to try not to get sick.” And even “mild” infections can still be awful. Dan Barouch, an infectious-disease specialist at Harvard Medical School, told me that friends and colleagues have “felt pretty terrible at home, sometimes for weeks, but weren’t sick enough to go to the ICU and get intubated. There’s a lot of time missed from school and work.” Waves of sick employees are still disrupting sectors that were already reeling from the Great Resignation—including the health-care system. An exodus of experienced colleagues and untenable levels of burnout have trapped health-care workers in a chronic state of crisis, which persists even when hospitalization numbers are low, and deepens whenever the numbers climb. Preventing infections still matters, and vaccines are still a crucial means of doing so. After a frustrating delay, Omicron-specific boosters are on the way, and the FDA has recommended that these include components of BA.4 and BA.5. The updated shots won’t be ready until October at the earliest, by which time new variants could have arisen. But “even if we don’t nail the match exactly,” Goldstein said, these boosters should expand people’s antibody repertoire, leaving them better defended against not just the Omicron dynasty but also other variants that could follow. Still, “it’s important not to overpromise the efficacy of Omicron-specific boosters,” Barouch said. In terms of preventing infections, clinical data suggest that they’ll be modestly better than current vaccines, but not substantially so. And even if we get the long-desired shots that protect against all coronaviruses, it may be difficult to persuade Americans to get them. Vaccines were never going to end the pandemic on their own. They needed to be complemented by other protective measures such as masks, better ventilation, rapid tests, and social support like paid sick leave, which were either insufficiently deployed or rolled back. And with stalled COVID funding jeopardizing supplies of tests, treatments, and vaccines, the U.S. will continue its long streak of being underprepared for new variants. Consider BA.2.75, another member of the Omicron family, which has many spike mutations not seen in its cousins. In India, where that subvariant was first identified, it seems to be spreading at a rate double that of BA.5 and comparable to that of BA.1, Bedford told me. This worrying picture is based on a small number of samples, and BA.2.75’s actual pace may be slower. It may also struggle to spread in places like the U.S., where BA.5 already rules. But no matter what happens, this round of variants won’t be the last we contend with. The belief that viruses inevitably evolve into milder versions is a myth: Such futures are possible but in no way guaranteed. The coronavirus could yet evolve into more severe variants, although vaccines would still be expected to blunt their sting. It could become even more contagious, although the traits that would give it a speed boost, such as higher viral loads or tighter attachments to human cells, can’t ratchet up forever. “It’s already super-transmissible, and there’s not much to gain there,” Anne Hahn told me. Immune evasion is another matter. The virus is likely now locked with the human immune system in a perpetual evolutionary arms race. A variant emerges to circumvent our existing immunity, then vaccines and infections gradually rebuild our defenses … until another variant emerges. This is exactly what happens with flu, but the coronavirus seems to be changing even more quickly. The big uncertainty is whether the next variants will erode immunity to the small degrees that scientists expect (as BA.5 is doing) or whether they’ll do something dramatic and unexpected (as BA.1 did). This is what “living with COVID” means—a continual cat-and-mouse game that we can choose to play seriously or repeatedly forfeit. The stakes of that game depend on a very simple question: Should we still care about preventing infections? If the answer is “not so much,” which is the implicit and sometimes explicit posture that America’s leaders have adopted, then BA.5 changes little. But if the answer is “yes,” as I and most of the experts I talk to still believe, then BA.5 is a problem. from https://ift.tt/PEcwZXU Check out http://natthash.tumblr.com “Men, it’s on us now,” someone said on Twitter just hours after Roe v. Wade was overturned on June 24. “Either start wearing contraceptives or get a vasectomy.” In the two weeks since, the suggestion that men can or should express solidarity with women by getting vasectomies to prevent unwanted pregnancies has proliferated online. The tone varies from flirty (“getting a vasectomy is the new 6-foot-4”) to pointed (“i don’t want to hear a peep out of anyone with a dick until the vasectomy appointment is scheduled”), but the overarching message is the same: “If you create sperm and can get someone pregnant, go get a vasectomy,” one viral tweet read. “We are tired.” This is not just a Twitter phenomenon. Etsy sellers now offer colorful T-shirts that state, somewhat nonsensically, vasectomies prevent abortions or if you’re so against abortions, get a vasectomy. The same phrases have been appearing on posters at pro-abortion-rights rallies, too, while the rhetorical suggestion that the government mandate vasectomies pops up on protest signs, Instagram feeds, and baseball caps. Even Senator Elizabeth Warren jokingly suggested state-mandated vasectomies in an interview with The Atlantic’s executive editor, Adrienne LaFrance. Google Trends shows a small increase in vasectomy searches during the first week of May, when the draft decision first leaked, followed by a second, larger one starting in late June. Doctors have also reported higher interest in the procedure. “We have never seen a vasectomy spike like this in response to a single political or social event,” the Florida-based urologist Doug Stein told me. Doctors like Stein, who has been dubbed “The Vasectomy King” by local press, have spent years evangelizing for the procedure. Now their cause is suddenly ascendant. The nation’s vasectomy influencers are in the spotlight. “I’d like to be part of this massive wave that’s happening now,” Sarah Miller, an abortion provider and family doctor based in Boston, told me. It has long been her personal mission to make vasectomies more accessible and popular, and she sees the current climate as an opportunity. “What did you call me? A ‘vasectomy influencer’? I like that,” she said. As it happens, she’d just gotten an email from a graphic designer offering to help her turn vasectomy into a “mass movement” and “aggressively promote the fact that men should be stepping up and doing this publicly.” In the past, Miller has helped Planned Parenthood affiliates and community health centers start or restart their vasectomy services; she trains young physicians in how to perform the procedure; she got her private practice credentialed with every insurance company she could and with Medicaid, offering a sliding scale of fees for the procedure; and she participates in World Vasectomy Day, an annual event during which vasectomy providers all over the world perform the procedure all day, generally offering discounts. The vasectomy is “a fantastic form of permanent contraception; it’s just not widely discussed and promoted,” Miller said. At least until now. Stein, a co-founder of World Vasectomy Day, has also been training new vasectomy providers, and has performed the procedure tens of thousands of times himself. In fact, he no longer practices any other kind of medicine. It’s not that a urologist who treats other kinds of problems can’t do vasectomies, but he posed a question: Would you rather listen to a guitarist who practices the guitar for 20 hours a week, or one who practices for just one hour? He practices all the time. (“The scrotum is my instrument,” he told the Tampa Bay Times in 2014.) [Read: When a vasectomy becomes a guys’ weekend] Stein is known for placing bold, pro-vasectomy billboards around Florida and in some places he visits. “I want to blast that thought into [men’s] brains and have them ponder it as they drive the next 10 miles on their journey,” he told me. He’s looking to spark a cultural shift, and he thinks the response to the Dobbs decision could be the start of one. When we spoke, he said he had been on the phone with young men all morning. “Many of them are saying that they have considered the vasectomy for quite some time and the Roe v. Wade overturn was the final impetus that they needed to make the call and get on the schedule.” After the initial rush, the rates will definitely drop back down, he said, but today’s vasectomies will continue to pay dividends for the movement. “Acceptance rises as couples see their friends happily enjoying the freedom that vasectomy provides.” Esgar Guarín, a family doctor from Iowa who performs vasectomies at his practice and operates a mobile vasectomy clinic, has also noticed a sharp uptick in inquiries about the procedure. He told me that his website, SimpleVas, saw a 250 percent increase in traffic after the Dobbs decision, and that his practice scheduled as many patients that first weekend as it normally would in two weeks. “I do between 40 and 50 vasectomies every month, and in the first couple of days after the overturn of Roe v. Wade I had 20 patients sign up,” he said. The trend is bittersweet, he told me: sweet that men want to be useful, and bitter that so many hadn’t bothered before now. “It took violating the right of a person to make decisions about her own body for men to realize that we need to be part of the equation in a more proactive way.” Guarín doesn’t even like to discuss vasectomy and abortion in the same sentence, he said, “as if one could cancel the other. That is not the case. Both should be free choices that an individual makes.” Guarín is best known for performing his own vasectomy one Friday night about six years ago. “That always gets people’s attention,” he responded when I asked about it. He’d finished his work for the day and just decided that the time was right. “I called my wife and I said, ‘Dear, I’m gonna get my vasectomy.’ She was awfully excited. She came in. She recorded the whole thing.” The stunt might have been provocative, and it’s definitely metal, but Guarín meant for it to be a practical demonstration. “The message I want to convey is about the simplicity of the procedure.” (It’s an outpatient procedure that generally takes less than 20 minutes; the vas deferens, which transports the sperm into semen, can be severed with or without a scalpel.) Guarín is extremely serious about vasectomies but recognizes the utility of gimmicks. He says the assumption that vasectomies are emasculating is born of ignorance, and this ignorance persists because there isn’t enough conversation about the method. When a woman tries a new form of birth control, she’ll tell her friends about it over drinks without hesitation, but men don’t want to talk about their vasectomies and expose themselves in that way. He had mixed feelings about a segment he was asked to film for The Daily Show, for the show’s first episode in the aftermath of the Supreme Court decision. In the video, the interviewer asks goofy questions of a stone-faced Guarín. “Do you have to wear one of those cones? … If I get a vasectomy, how high will my voice go after that?” It ends with Guarín performing a vasectomy on a man named Travis. He was happy for the opportunity to promote vasectomies on a national platform, and to show how Travis could get in, get snipped, and get out in simple, easy steps. “It was great to talk about what men can do in terms of participating in contraception, but, you know, still there was this idea of emasculation,” Guarín said. Jokes aside, that concern is very real for men. He also worries that the news cycle will move on quickly, after only surface-level conversation about the procedure, and that interest will die down. “I want to be wrong, though,” he said. “I really want to be wrong.” Public attention to vasectomies has been fleeting in the past, and the procedure has long maintained a weird, somewhat corny reputation. The “I got a vasectomy” essay is its own genre of pun-laden, graphic personal writing, which usually comes with a tinge of martyrdom. A first-person account published in The New York Times Magazine in 1990 humble-bragged about taking one for the team, unlike “guys who allowed their women to get slit open like pigs.” More recently, the actor Rob Delaney wrote about his vasectomy for The Guardian, becoming the celebrity face of cool-guy self-sacrifice: “I figured after all my wife, Leah, and her body had done for our family, the least I could do was let a doctor slice into my bag and sterilize me.” Guarín’s Daily Show segment fit right into this tradition, even if the doctor himself wasn’t hamming it up. But historians of the feminist movement and reproductive rights told me that today’s turn toward vasectomies is novel. “Second-wave feminists in the 1970s certainly discussed men needing to pay child support and take part in child-rearing on an equal basis,” Tamar Carroll, the author of Mobilizing New York: AIDS, Antipoverty, and Feminist Activism, told me, but they did not call on men to go in for sterilizing procedures. “I don’t recall much discussion of vasectomy,” she said. Women in the 1970s hoped for the creation of a male birth-control pill, but they didn’t know if men could be trusted to take it. Even if today’s entreaties for vasectomy are not completely new, she added, they are at least “different in the volume of calls and their reception.” Until the early 1970s, some providers weren’t sure that elective vasectomies were always legal, and they remained uncommon throughout the decade. Most of the men who got them were well-off, white, and married, says Annelise Orleck, a history professor at Dartmouth and the author of Rethinking American Women’s Activism. Their vasectomies sometimes doubled as statements of support for social causes. Paul Ehrlich, for example, the famous fretter about population growth, touted his vasectomy. So did the activist Abbie Hoffman, who underwent the procedure in solidarity with his then-wife, who’d had a horrible experience with an IUD; he reportedly wore a gold pin to commemorate it. This small pro-vasectomy movement instigated a significant cultural backlash. Magazines and newspapers started publishing arguments that vasectomy was harming marriages, and that not enough attention had been paid to the “psychological stress” involved, or to the risk that vasectomized men would be cuckolded. Even now, 50 years later, the Guttmacher Institute estimates that only 3 percent of women under the age of 30 rely on a partner’s vasectomy as a contraceptive. The proportion is higher among middle-aged women, but still tops out at just 18 percent. Vasectomies remain most common among men who are in monogamous relationships, and who are college-educated and affluent. (The provision of the Affordable Care Act that requires most private health insurance to cover contraception notably does not require coverage for vasectomies.) For vasectomies to become a more popular form of birth control in the U.S. in the long term, the conversation about them will have to be deeper than reactive tweets. It will likely still be corny: Guarín always takes the time to talk with his patients about the “act of love” they’re undertaking for their partner, for example, and for the children they already have. “An individual is allowing a total stranger to grab his testicles with sharp instruments—imagine how vulnerable that is,” he told me. Physicians should “seize the opportunity to talk about what it means for men to be part of the reproductive equation … That’s what I would love to see at this moment.” from https://ift.tt/W4lJC1O Check out http://natthash.tumblr.com Two weeks into the pandemic, a box of Cheerios sent me into an existential tailspin. I’d just returned from an unnerving trip to a New York City supermarket, where bandanna-masked customers with carts full of toilet paper dodged one another like bandits. As I unpacked my groceries, I was gripped by fear. If I don’t Lysol the living daylights out of this cardboard, I wondered, will I die? I kept up the cleaning for weeks. My garbage bin, like so many in America, turned into a disposable-wipe repository. It took until May 2020 for the CDC to confirm that the coronavirus is rarely transmitted by touching things. My Cheerios boxes became markedly less soggy, but even then, other, more public surfaces—elevator buttons, subway poles, shopping-cart handles—remained in a continuous wash cycle. I knew this because signs everywhere told me they had recently been cleaned. Today, it’s well understood that because the coronavirus spreads through the air, good ventilation and air filtration are far more effective at disrupting transmission than wiping down surfaces. Best practices for avoiding infection during a surge include opening a window when gathering indoors, opting for outdoor dining, and masking. In March, the Biden administration made air quality a pillar of its COVID response (finally). Meanwhile, study after study has found that the risk posed by lingering virus on surfaces is low compared with the threat it poses in the air. Which raises the question: Why in the world is so much cleaning still happening? Although most people are no longer disinfecting their groceries, signs flaunting cleanliness are still all over the place. Public bathrooms tout regular spray-downs with disinfectant. Elevators advertise self-cleaning buttons. At my local Marshalls, the cashier sanitizes the credit-card reader after every use—even if I use Apple Pay! A recent issue of United Airlines’ in-flight magazine was “treated with an antimicrobial process,” according to its cover. Signs lining the queue for a Delta flight in June read, cryptically: Certified by Lysol Pro Solutions. It’s not just the cleaning, either. Months after mask mandates have lifted and vaccine requirements have eased—meaningful interventions that do protect people—you’ll still come across QR-code menus, floor stickers placed six feet apart (has anyone ever used these correctly?), temperature screening, and hand-sanitizing stations. In 2020, The Atlantic’s Derek Thompson dubbed such measures “hygiene theater”: precautions that are far more performative than useful at stopping the spread of the coronavirus. Somehow, in 2022, the show goes on. Some places hardly bothered with pandemic protections, theatrical or otherwise, in the first place. Among those that did, some of the pushy signs and other small measures you might still find are likely vestiges of a more cautious time—the flimsy plexiglass shield that no employee has bothered to remove, the long-empty dispenser of hand sanitizer. Perhaps in some cases, like the constant wipe-downs at Marshalls, performative cleanliness has simply become part of the employee script, like asking customers to sign up for a credit card. But hygiene theater also continues to rear its useless head in much more deliberate ways, lingering in offices, airports, and shops, often proudly touted as a service to patrons. Joseph Allen, an associate professor at the Harvard T. H. Chan School of Public Health, told me that he recently stayed at a hotel where the remote control was sheathed in a disposable wrapper that said it had been sanitized. Just another day in pandemic-era travel. One simple explanation for hygiene theater’s enduring appeal is that some Americans who remain pandemic-cautious (and the businesses that cater to them) still don’t understand that this virus primarily spreads through face-to-face airborne transmission. Though the messaging on this point is now abundantly clear, confusion is understandable. At the beginning of the pandemic, studies did detect potentially infectious remnants of the coronavirus on surfaces in cruise ships and hospitals, and the health messaging at the time reflected those findings. The idea stuck. “I don’t blame the public at all,” Allen told me. “The science has changed every day for two years.” A related reason might be that some people who do understand how the virus spreads see no harm in erring overwhelmingly on the side of caution. Though it’s irrational, they feel more secure knowing—or better yet, seeing—that their surroundings have recently been cleaned or that attempted safety protocols are in place. As customers have come to expect a higher level of visible hygiene, some businesses might feel as though they have no choice but to supply the theatrics. They’re left with an inflated standard that they don’t dare to burst. If we’re talking about actual safety, it would make more sense to ask both customers and employees to simply wear good masks when infection rates are high. But America has never been especially prudent about effective COVID interventions, and hygiene theater has the perk of shifting the perceived burden of safety onto other people, implying that protection against COVID is a service to be provided rather than a personal act of self-preservation and community good. This seems to add to the pressure on businesses that want to remain pandemic safe, even if they already have good COVID hygiene protocols in place. At Voance Salon in New York City, standard protocol is for masked and vaccinated staff to sanitize stations and tools between clients, who are required to wear masks when a CDC recommendation or mask mandate is in effect. But the salon also provides additional measures upon request, such as heavy cloth dividers between stations to wall off other guests, Voance’s owner, Rasheda Akter, told me. Precautions like these give customers “confidence to get their hair done,” she said. Meanwhile, in Santa Barbara, California, “sanitation captains” roam the dining area of a restaurant called the Lark, cleaning surfaces. The restaurant also employs the R-Zero, an ultraviolet-light-powered disinfection system that looks like a human-size lamp on wheels. There is good evidence that UVC light inactivates the coronavirus, but perhaps the device’s bigger draw is that it’s noticeable. It’s “one of the ways we tried to bring comfort and visible safety,” Skyler Gamble, the director of people and culture at Acme Hospitality, the restaurant group that owns the Lark, told me. Gamble added that the company’s strict hygiene protocols are as much for guests as they are for staff, many of whom are worried about being unable to work. “We’re asking our employees what would help them feel safe and comfortable coming to work,” he said. “For us, it’s for peace of mind.” Peace of mind can go only so far, however. The Lark is fortunate: It operates in perpetually sunny and warm Southern California, where open windows and outdoor seating can significantly bolster the safety of restaurant dining. But in general, with or without sanitation captains, dining indoors is always going to be a higher-risk pandemic activity. The same is true for traveling on cruise ships, where some of the largest early COVID-19 outbreaks occurred, and where hygiene measures—useful and otherwise—are now especially prevalent. Most major cruise lines require the majority of guests to be vaccinated, but masking policies and COVID-19 protocols vary widely. In a number of cases, cruise ships’ measures have been insufficient. In May, for example, an outbreak on a fully vaccinated Carnival Cruise forced many passengers into quarantine and prompted a highly publicized CDC investigation. No wonder so many ships feel the need for hygiene overkill. Variety Cruises, an international line based in Greece, maintains a vaccine requirement and asks employees to wear masks at all times and guests to do the same when indoors. It also screens guests for body temperature and blood oxygen content, disinfects all luggage before boarding, and steam-sterilizes the ship’s upholstery, cushions, and curtains daily, according to Constantine Venetopoulos, Variety’s PR and communications manager. Research shows that temperature checks are useless for diagnosing COVID, and some people with COVID do not have altered blood oxygen levels. Furthermore, although pulse oximeters may be more helpful than thermometers for detecting illness in the elderly, they have been found to be unreliable when used on Black, Hispanic, and Asian COVID patients. A related and more nefarious reason hygiene theater persists is that good ventilation and filtration, great measures at cutting back infection, are invisible. For companies aiming to demonstrate their concern about COVID, these practices can have less payoff because they’re harder to flaunt (or at least, they’ll seem to have less payoff until the staff has a COVID outbreak and business stalls out). Instead of a wrapped and sanitized remote control in his hotel, Allen told me, “what I would have loved to have seen was a note on my bed that said they’ve upgraded the filters and increased the ventilation rate. The other stuff is just silly.” Maybe so, but plastic-wrapping a remote is a lot easier and cheaper than installing a suite of HEPA filters and convincing people that they’re there. And thus, the theater continues. Jim Dudlicek, the director of communications and external affairs for the National Grocers Association, told me that his organization expects grocery stores’ “enhanced sanitation procedures to be permanent, as consumers will continue to look for that assurance when they choose where to shop.” At its best, hygiene theater is benign—albeit time-consuming, wasteful, and expensive. It’s never a bad idea to keep places clean or to insist on hand-washing; clean hands and surfaces are a cornerstone of public health. (Hotel-room TV remotes might not give you COVID, but they are pretty gross.) Hygiene theater becomes a serious problem, however, when it falsely reassures people that an environment is safe, giving them permission to relax their expectations and behavior. A hotel that sanitizes its common areas with hospital-grade disinfectant isn’t safe if guests are unmasked at the bar during a surge. Neither is a restaurant that uses QR-code menus but doesn’t filter its air or open its windows. The real dangers posed by hygiene theater are that it perpetuates unscientific thinking about coronavirus transmission and takes time, attention, energy, and resources away from the measures that are effective against COVID. While visibility is keeping hygiene theater alive, perhaps it will also be its downfall. Those who understand how ridiculous hygiene theater is may get into the habit of using it as a barometer for outdated standards. There are already signs that more people and businesses are updating their beliefs: Trade associations representing the banking, hospital, restaurant, and airline industries told me that they’ve shifted their recommendations for members toward improving air quality, signaling a change in consumer expectations. Maybe, eventually, plastic barriers and floor stickers will go the way of disinfected cereal boxes—humorously obsolete trash. from https://ift.tt/4iaKOpz Check out http://natthash.tumblr.com When Michelle Stokes noticed a necrotic wound on her cat, Jellyfish, last July, she and her husband had to call about 50 vets before finding one that could squeeze them in. The local emergency animal hospital was so backed up that it said the wound—serious but not yet life-threatening—wasn’t really an emergency. Jellyfish didn’t have a regular vet, because Stokes and her husband had just moved to the Cleveland area. They pulled up Google Maps and started going down the list of offices they found. It was the same response every time: no vacancies, not taking new patients, not until August or even September. Meanwhile, Jellyfish was getting sicker and more lethargic. “We just kept trying and trying and trying,” Stokes told me. “We pretty much called every single vet’s office in the greater-Cleveland area.” A week in, they finally got a lucky break. They managed to speak directly to a vet at one practice, and when Stokes sent over a photo of the wound, the vet said to bring Jellyfish in for surgery. The cat’s now doing just fine. Stokes’s scramble to find veterinary care is not unusual. Hospitals, clinics, and vet offices around the U.S. in the past year have been turning animals away because they are short staffed. This crisis has hit all levels of the system, from general practice to specialists, but animal emergency rooms—where the job is most stressful—have it the worst. Veterinary staff told me of emergency hospitals closing overnight, owners being referred hundreds of miles away for an elusive open spot, and dogs with broken bones, a true emergency, waiting hours and hours to be seen. “When I have 17 patients in the hospital and there’s me and a doctor for 15 hours, I can’t take any more pets. Because I physically can’t do it,” Kristi Hulen, a vet tech in the Seattle area, told me. The staff shortage has gotten so bad in some areas that Maureen Luschini, an emergency-care vet in central New York, put it to me bluntly: “Emergency care cannot be guaranteed for your pets right now.” There are simply not enough people to take care of all the sick animals. Veterinary medicine has dealt with staffing problems for years, but the pandemic made everything worse. After COVID hit, demand for vet appointments went up—for newly adopted pets and for older pets in whom owners observed new health issues after being at home all day. COVID precautions like curbside service also meant offices were operating less efficiently. Everything just took longer. Meanwhile, vets and vet techs started leaving the field. “All of my friends who were at retirement age—that were in their early 60s—just retired immediately,” Carrie Jurney, a veterinary neurologist in the Bay Area, told me. Staying in the job wasn’t worth the risk of getting COVID. The veterinary field also skews quite female, and mothers without child care quit or switched to more flexible remote work. Over the course of the pandemic, those who remained saw their jobs get worse. Owners stressed by lockdowns became angrier and more unruly toward veterinary staff. “In the pandemic, people forgot how to be a person,” says Melena McClure, an emergency vet who lives in Austin. And overworked staff no longer had the time to really sit down and explain to distraught owners what was happening to their pet, which didn’t help in these volatile situations. “Yelled at, threatened, I’ve been called every horrible name that there’s ever been written or spoken,” Hulen said. Jurney said she’s fired more clients in the past year and a half than she ever had to do in the previous 20 years of her career. Receptionists bore the brunt of this bad behavior. “We’ve had much higher turnover than we’ve ever had before,” says Gary Block, who runs a veterinary hospital with his wife in Rhode Island. He estimates they lost about 80 percent of their receptionists last year. [Read: Why are people acting so weird?] The low wages in veterinary medicine only added to the problem. “McDonald’s is paying $15, $16” an hour, Block says. “There are still veterinary technicians, I’m sure, that are making less than that amount in Rhode Island.” He and his wife have recently raised pay, but they’ve had to offset that by raising fees for care. “This is a slow-moving tsunami,” Liz Hughston, a vet tech and president of the National Veterinary Professionals Union, told me. “The true depths of the staffing crisis hasn’t been felt up until this point because, I think, we had what a lot of people thought was an inexhaustible supply of young starry-eyed people who want to work with puppies and kittens all day.” Historically, when people working in the industry burned out, new ones took their place. The turnover rate for vet techs was high even before the pandemic: 23.4 percent a year, according to a January 2020 American Animal Hospital Association survey. Many experienced vet techs end up leaving for human medicine, where many of their skills apply and the pay is better. Veterinarians too are dealing with burnout, and broader risks to mental health. Their turnover rate is 16 percent, much higher than it is for doctors in human health care. Female veterinarians are also 3.5 times as likely to die by suicide as the general population, and male vets are about twice as likely, according to a 2018 CDC study. Jurney, the neurology specialist, is also president of the nonprofit Not One More Vet, which operates a crisis hotline and gives out emergency grants to veterinarians who need help. In the past two years, she says, “the demand for our services went up tenfold.” Lisa Moses, a veterinarian and bioethicist at Harvard, attributes the burnout to the “constant and cumulative impact” of moral distress on the job. People who decide to become vets, vet techs, and support staff tend to do so because they love animals. But the job also comes with watching a lot of animals suffer: Some owners have to let their pets die because they cannot afford care while others might refuse euthansia and instead subject animals to futile medical treatments. In a 2018 survey that Moses conducted, 62 percent of vets said they sometimes or often encountered cases in which they could not “do the right thing.” More than 75 percent said these cases have caused them moderate or severe distress. In understaffed hospitals and clinics, overworked vets are finding that they cannot provide their desired level of care and attention to each animal. “It’s kind of self-reinforcing. The fewer people and staff there are, everyone gets more overworked,” Moses told me. And the more stressed out and overworked they are, the more likely they are to quit. Amidst this staffing crisis, animals are sometimes getting worse care. Some 24/7 emergency hospitals have had to cut their hours and turn away patients. Luschini, the emergency vet in central New York, has had to send patients as far away as Philadelphia. Whenever one large emergency center is full, Block told me, finding another one with an open spot is like “musical chairs.” And emergency hospitals are constantly operating in an “orange” tier, where wait times may stretch past 10 hours, and staff must turn away all animals but those with immediately life-threatening injuries or illnesses. When Emily Knobbe’s puppy, Hazelnut, was bleeding from a six-inch gash on her leg, the emergency room in Portland, Oregon, was so full that Knobbe had to sit on a nearby set of stairs waiting. It took 14 hours to get Hazelnut bandaged up. The vet said that the cut, while bad, hadn’t caused injury to the tendon or bone. But in the days afterward, Knobbe noticed that the dog wasn’t putting any weight on that limb. It took several more days to get an appointment with Hazelnut’s normal vet, who referred Knobbe to a specialist, which required another week of waiting. Eventually she learned that Hazelnut’s Achilles tendon was 80 percent ruptured. The injury had gotten worse in the time it took to get a proper diagnosis, giving Hazelnut a 50/50 chance of losing her leg. Knobbes wonders if the busy hospital had missed the tendon damage because the vets were so overworked. Hazelnut ended up getting surgery and is now doing just fine on all four legs. For Knobbes, though, having to wait and wait was a truly awful experience. “We felt very powerless in that moment,” she told me, “just knowing she was in pain for weeks at a time and we just couldn’t get her in anywhere.” [Read: I got a pandemic puppy, and you can too] For hospitals, understaffing means constant triage. If a pet comes in needing to be rushed to surgery, said Hulen, the Seattle-area vet tech, she has to turn her attention away from all other patients. “Things get missed. Medications get missed. Walks get missed. Feedings get missed,” she told me. “It’s not right.” Certain labor-intensive procedures are also put aside. For example, Block’s Rhode Island animal hospital is the only one in the state with a ventilator. But using the ventilator requires the dedicated attention of a tech and a veterinarian. When things get busy, the hospital has to announce it is no longer taking ventilator cases. “These animals are literally having trouble breathing,” Block told me. “We have the equipment and the skill set to provide care, but we have to choose”: Does the vet stay with the one patient in need of a ventilator, or should they attend to five or six other ICU patients in that same amount of time? When general practitioners are too busy, pets who can’t see them for routine or preventive care end up needing emergency care. “We’ve seen tons of parvovirus in dogs. There’s been an uptick in calicivirus virus in cats,” Luschini said, referring to infections that can be vaccinated against or treated early by any vet. Specialists are overbooked, too. Jurney, the veterinary neurologist, said that a normal, fully booked day before COVID might have included one or two surgeries plus five appointments. The day before we spoke, she told me, she’d had one surgery and 12 appointments. And that wasn’t even her busiest day in the past two weeks. The vets and vet techs I spoke with didn’t really see things getting better in the short term. Pay has gone up, though not always as much as inflation. Corporate veterinary practices have recently started offering bonuses as high as $100,000 to vets who sign three-year contracts. But there is an underlying supply-and-demand problem. More Americans are getting pets, while the number of people going into the veterinary profession has not been keeping pace. By 2030, the U.S. will need nearly 41,000 additional veterinarians and nearly 133,000 credentialed vet techs, according to a recent Mars Veterinary Health report. Any solutions are likely years off. The current mess is not about to be fixed anytime soon. from https://ift.tt/sznfic2 Check out http://natthash.tumblr.com The maskless man a few rows back was coughing his head off. I had just boarded the train from D.C. to New York City a couple of weeks ago and, along with several other passengers, was craning my neck to get a look at what was going on. This was not the reedy dregs of some lingering cold. This was a deep, constant, full-bodied cough. Think garbage disposal with a fork caught inside. No one said anything to the man (at least to my knowledge). If someone had, though, I imagine that he might have replied with a now-familiar pandemic-times refrain: “Don’t worry! It’s not COVID!” Such assurances can be perfectly fine (polite, even), say, at the height of allergy season, when you want worried-looking company to know that you are not, in fact, showering them with deadly virus. But assurances only go so far. As my colleague Katherine J. Wu recently wrote, a negative COVID test, especially in the early days of symptomatic illness, is no guarantee that you’re not infected and contagious. And even setting that concern aside, still: Whatever it was that had that maskless man hacking away like a malfunctioning kitchen appliance, I didn’t want that either! If you’re feeling sick, just because you don’t have COVID “does not mean that you rip your mask off and go get on an airplane next to other people—that’s rude,” Emily Landon, an infectious-disease physician at the University of Chicago, told me. “Maybe you’re ruining someone’s vacation … Maybe they’re going to see their mom in hospice. Let’s not ruin other people’s lives and plans.” [Read: America is sliding into the long pandemic defeat] Over the past two-plus years, the public has undergone a crash course in preventing the transmission of respiratory viruses. We have learned the importance of testing and masking and distancing and isolating and ventilating. These lessons, some better received than others, apply just as well to more familiar pathogens such as influenza and common-cold coronaviruses as to the novel one that has reshaped our lives. We understand better than ever how to be a good sick person. Now we’ll see whether anyone puts that knowledge to use. The first and most important rule of feeling sick is to stay home. This, says Ryan Langlois, an immunologist at the University of Minnesota, is at once “the easiest and the most difficult” directive. Easy because it’s so simple: Stay in your house! Do not leave! No technical expertise required. Difficult because actually following it entails major disruptions of daily life. For white-collar workers, the normalization of working from home has made this a good deal more convenient than it was (and has, one can only hope, dispelled once and for all the fiction that dragging yourself to work sick is an act of self-sacrificing fortitude; it’s not—it’s just plain inconsiderate). For much of the labor force, though, remote work isn’t an option, and more than a fifth of American workers don’t have paid sick leave. Among the country’s lowest earners—the people most likely to need it—only about a third do. (Every wealthy country in the world except the United States guarantees paid sick leave.) [Read: The real reason Americans aren’t isolating] The complicated part of isolating is knowing when to stop. No one-size-fits-all formula will spit out the right answer in every case, for every type of infection, Langlois told me. One person might be completely virus-free five days after symptom onset; another might still be highly contagious. Even for the most responsible among us, this ambiguity can make for some awkward calculus. Can you afford to miss that work meeting? How about family dinner? It would be a real pain to cancel those travel plans—but should you? After a couple of years of COVID management, we at least in theory have better tools and practices for helping people manage these situations. Many of us have gotten into the habit of regularly testing and retesting ourselves for COVID, and now is no time to stop. But Seema Lakdawala, a flu-transmission expert at the University of Pittsburgh, envisions a world with universally accessible testing for a whole range of pathogens: influenza, RSV, adenovirus, rhinovirus, seasonal-cold-causing coronaviruses, and, of course, SARS-CoV-2. Sites at every street corner would offer patients not only a diagnosis but a prescription for the appropriate medication. People in rural areas could acquire at-home tests at drug stores or order them online. Someone who tested positive only for a seasonal coronavirus could undertake a more relaxed isolation (Langlois, for one, doesn’t think it’s practical to ask people to fully stay home for a common cold, though they should certainly still mask), while someone who tested positive for influenza, which kills tens of thousands of people most years, would know to take stricter precautions. Whatever the situation, you’d know you were in the clear when you tested negative for whatever you’d originally tested positive for. For now, Lakdawala admits that a world of such universal, accessible testing remains a distant fantasy. She and the other experts I spoke with offered several more-practical pieces of guidance. Even if it gets awkward, it’s good practice to notify people you may have exposed to a pathogen, just as we’ve been encouraged to do with COVID. If you have a fever, keep to yourself as much as possible until at least 24 hours after it subsides. If you don’t have a fever, Landon told me, you should be clear to reenter society after your symptoms resolve. For a common cold, she said, that generally takes three to five days; for flu, five to seven. Certain symptoms can stick around for weeks after that, but as long as you’re not feeling disgusting, Landon said, you can responsibly venture out. (Call it the “ew” test.) Leaving isolation with a lingering cough is fine, Saskia Popescu, an epidemiologist at George Mason University, told me, “as long as it’s not that wet, nasty cough.” (If you’re really interested in the nitty-gritty, you can always consult the CDC’s 206-page door-stopper on isolation precautions, but Popescu does not recommend: “I wouldn’t subject anyone to that.”) If you’re still symptomatic after the recommended isolation period, or if you must venture out before it’s over, whether on an essential errand or because your employer doesn’t grant sick leave, you should wear a high-quality mask. The same is true, Landon told me, of that ambiguous period when you feel a little off and are just starting to wonder whether you’re coming down with something: If you’re not sure, mask up. People tend to be quite contagious during that stage, and the worst thing that can happen is you take a minor superfluous precaution and wake up the next morning feeling fine. Yes, masks can be uncomfortable, and yes, it’s a tragedy that such a fundamental health intervention has been co-opted into the culture war, but they remain one of the most effective, least disruptive tools at our disposal for fighting all types of respiratory infections. An N95 or KN95 is best, but a surgical or cloth mask is better than nothing, Lakdawala said, especially because plenty of people can’t afford to continually replenish a stock of top-notch disposables. Health-care providers and employers, she suggested, could offer free masks, which would protect patients, workers, and those around them. Like widespread testing, a continuous supply of free masks and universal paid sick leave are merely a distant vision. Congress is currently struggling to prop up our most basic public-health infrastructure during a pandemic, leaving Americans to figure out COVID for themselves. The same will likely apply to all the other familiar viruses we reacquaint ourselves with. Whether the more modest, behavioral changes we’ve adopted over the past two-plus years outlast the pandemic is anyone’s guess. In this era of perpetual flux, one constant has been the disconnect between what we know we ought to do and what we actually end up doing. Better to know than not to, but personal experience hasn’t left me optimistic that knowledge will reliably translate into action. On the train, after a few minutes of fruitless waiting to see whether the man a few rows back would stop coughing, I gathered my bags and relocated to another car. At first, all was quiet. Then two people started to cough. from https://ift.tt/5p7WeqL Check out http://natthash.tumblr.com |
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