The writer F. T. Kola had COVID-19 in March, and she’s still dealing with the aftermath. She returns to the podcast Social Distance to ask about whether she should donate plasma, and if she should worry about “reinfection.” Also on this episode: Atlantic senior editor John Hendrickson talks about disability at the Democratic National Convention. Read his definitive story on Joe Biden and stuttering. Listen to their conversation here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. Here’s a sample of the conversation with F. T. Kola, edited for length and clarity. James Hamblin: Are you still doing well? F. T. Kola: I’m doing so much better. I’ve been very lucky, but I’m still recovering, slowly getting back to normal strength. I went for a 25-minute walk with a slight hill two days ago, and I’m still recovering from that. I’m dealing with the damage that the virus did and the trauma it inflicted on my body, but the virus is gone. Hamblin: Remind me, this was March when you were diagnosed? Kola: Yes, my viral course was March 6, when I developed symptoms, to March 23 when I left hospital. And then I came home, began the recovery period, and have tested positive for antibodies, which leads me to my question. One of my dearest wishes has been to donate plasma, ever since I found out I have this antibody-rich blood. And now I’m not sure what I am doing when I hopefully donate plasma. What does it look like they can do with it? Hamblin: This idea of testing convalescent plasma, or plasma from people who have recently had the disease, goes back a long time. Even in the 1919 pandemic, we attempted to use plasma that you just sort of distilling out the antibodies in the blood of people who’d been sick-- Katherine Wells: Can I ask what plasma is? Hamblin: You take the red and white blood cells out of blood and you’ve just got this yellowish plasma that should just have proteins in it, including these antibodies. And in theory, they should be antibodies that would work as if your own body had made them and protect you from the disease, or at least help to stop the virus. It’s a nice idea that has been tried in other respiratory viruses to mixed effect. There’s even a lot of debate about whether it helped during the 1918-1919 influenza pandemic, but it was definitely tried. And the debate continues now for what we’re seeing as to whether it actually helps with coronavirus. The Mayo Clinic has done a big study and it seems like there could be some benefit, depending on the case, depending on when it’s given, depending on an individual’s physiology and how they respond to it. But the reason it was just in the news is because on Sunday, the FDA gave plasma an emergency use authorization, allowing doctors to use it to treat COVID-19. Wells: Yeah. I saw this headline: “FDA Issues Emergency Use Authorization for Convalescent Plasma as Potential Promising COVID–19 Treatment, Another Achievement in Administration’s Fight Against Pandemic.” That’s a news release from the Food and Drug Administration, a nonpartisan scientific organization designed to protect our health. Hamblin: Yeah, that alone is really concerning and unprecedented, as well as the language from the Commissioner thereafter in a press conference misstating how effective plasma is, exaggerating these effects in a way that seems to be in line with the need for the administration to have some success in fighting the pandemic right now, politically. Kola: So my vision of what this would look like was probably always a little bit wrong in that they weren’t going to take the plasma from me, immediately give it to another patient, and that patient was going to be sitting up rosy-cheeked the next day? Hamblin: Until now, they would have done it in a research setting. And it still could be used in a study that could help us identify if plasma is useful if given, for instance … during days four and six … to patients between ages 20 and 40 … who have respiratory symptoms. I’m optimistic there will be use cases like that. The work just remains to be done to identify them. But when you lump it all together, too broadly, we’re not seeing a big effect. Though now that there is this emergency authorization, people might just request that their doctor prescribe it. Wells: Is there any downside to giving people plasma, even if you don’t know if it’s going to be specifically helpful to them? Hamblin: There theoretically shouldn’t be, but there could be and that is the reason that you don’t just authorize these things, that you have an FDA to make sure that something is safe and effective. Kola: It seems like people have antibodies within three months of them having COVID-19. And I definitely had antibodies back in May when I was given an antibody test, but given the news out of Hong Kong, it looks like those antibodies may wane over time? When I imagine the plasma, am I imagining blood that has actual antibodies in it, or does it have the memory of how to make antibodies? What’s actually in the plasma? Hamblin: You’re just getting the antibodies themselves. The act of producing them will involve the white blood cells that should be taken out of plasma-- Wells: They’re the things that make the antibodies ... and that have a memory of how to make them? Hamblin: Right. When you transmit plasma, you’re not teaching someone to make antibodies. That’s what happens by exposing them to the virus. That’s vaccination. Transmitting plasma grants what’s called “passive immunization” where you temporarily have these antibodies until your blood clears them out. Then you’d theoretically have to get another transfusion. Kola: So there would be the possibility that, having had COVID-19 in March, and maybe being called upon to donate plasma in October, my blood might not have the antibodies anymore that it had in May? Hamblin: Yeah, that remains possible. Kola: Wow. Wells: Is that upsetting? Kola: I think it’s like much to do with COVID-19, just one of the confusing complexities. I know that I had the antibodies at one point. I can’t know for sure that I have them now without another antibody test. Being someone who had it relatively early, my experience of the virus is myself and everyone around me learning about it almost in real time. Hamblin: Well, if it helps reassure ... I guess Katherine can explain the immunology here because we had a whole episode on this ... but there is more to your body’s memory than just the presence of antibodies themselves. There are immune messaging pathways such that even if you lost your antibodies, it’s possible that your body might be able to quickly make new ones and call them back and have other ways of fighting off this virus so that, if you are reinfected, it is not so bad, even if you don’t actively have the antibodies. Kola: Can you explain how people like me who had COVID-19 and are hopeful about immunity should interpret the information from Hong Kong, because that was obviously, on the face of it, quite scary for people who’ve had an experience that they wouldn’t wish to go through again. Wells: Can you explain the Hong Kong news, Jim? Doctors in Hong Kong reported the first case of confirmed reinfection, which is obviously terrifying, but what does it really mean? Hamblin: Well, I respect that both of you saw it as terrifying. I didn’t. Because you had a person who was infected but did not get sick. His body cleared out the virus in a way that is what you’d expect. I’m not even certain how you define infection other than a positive test. And I would expect people to have the capacity to test positive again. What we don’t want to see is people having a second bout of severe disease. And we have not seen that. If you got vaccinated, you still could be expected to test positive. There could be times when your body’s been exposed to the virus and has some in your nose ... and the test comes out positive. But it doesn’t mean you’re sick. It doesn’t mean you have COVID-19. The same thing can happen with any respiratory virus. Wells: What do we know about the person in Hong Kong? Just that the person had it, tested positive, cleared the virus, and then tested positive again? Hamblin: Yeah, and the second infection, it’s reported, was asymptomatic. And that’s exactly how you want it to work. Just because you’ve had the virus, when you come into contact with it again, it doesn’t mean it won’t populate your nasopharynx: that you won’t have virus with you for a little bit and that a swab couldn’t test positive. But it does mean that your body will get it out before it causes illness. Either zero symptoms or mild symptoms should be what you hope for. Your immune system doesn’t make it so that the virus just can’t enter your nose. Kola: That’s really reassuring. I mean, I have assumed this whole time, in the absence of any other information, that I should behave as if I can get the virus again. I guess my last question is: even if I could be reassured that if I were to get it a second time, and it wouldn’t be like the very traumatic first experience, what does that mean in terms of my ability to spread it to other people? Hamblin: That is likely going to vary depending on a person’s own immune response. We have different degrees to which our bodies eradicate a virus when we see it again. For some people, it will barely be with us at all. For others, we will not so efficiently clear it out. It’s very unlikely that we’ll have disease as severe the second time. But depending how long it’s been, the shape of our immune system, the infectious dose, how much virus you were exposed to ... it’s impossible to know right now because this is our first documented case of reinfection at all. We’re going to need to have thousands of people who’ve tested positive after having it to get a sense of how many of them seem to be able to spread it before we know for sure. But I hope this is reassuring. This is what you expect, and I am reassured that we have not seen, so far, people who’ve had two bouts of serious illness. Or even a bout a very serious illness and then a bout like a bad cold. We haven’t even seen that. from https://ift.tt/2GeyAp0 Check out http://natthash.tumblr.com
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With her thin eyebrows arched high on her forehead, Robyn Openshaw urged her 212,000 fans to stand up to a new menace: contact tracing. Openshaw, a widely followed health blogger who goes by “Green Smoothie Girl” on Facebook, had recently heard of a bill in Congress that would provide $100 million to mobile health clinics to help monitor the spread of COVID-19. “Are you willing to hand over your freedom and create a health police state?” she asked her viewers, punctuating her statements with a karate chop to the air. “We will hold them accountable for the rollout of what looks an awful lot like communism.” Openshaw is so suspicious of contact tracing that when restaurants she dines at ask her for a phone number so they can call her if someone else at the restaurant tests positive for COVID-19, she sometimes gives them a fake number, she told me later. Her fears are ill-founded. Contact tracers recommend that infected people self-isolate, but they have no power to enforce isolation. Most countries with coronavirus outbreaks have started contact tracing, and of them, only China is Communist. But Openshaw’s outraged reaction to the concept helps explain a major problem bedeviling the American pandemic response: Contact tracing does not work as well here as it has in other rich countries. Contact tracing, the last two-thirds of health wonks’ “test-trace-isolate” mantra, was supposed to get us out of the pandemic. It’s meant to work like this: Let’s say Aunt Sally tests positive for COVID-19. A tracer working for the local public-health department calls her and asks for her contacts—anyone she’s spent more than 15 minutes with recently—and asks her to self-isolate. Then the tracer calls those “close contacts” of Aunt Sally’s, and asks them to self-isolate too. The tracer doesn’t tell Aunt Sally’s contacts that she is the person who tested positive, only that someone they were in contact with did. In the United States, this whole process is failing, allowing Aunt Sally to continue roaming about town, infecting others and spreading COVID-19. There is no national contact-tracing program in the U.S., and contact tracers who work for the 40 local health departments in areas with the most coronavirus cases have reached just a fraction of the patients who have tested positive, a Reuters investigation found earlier this month. In Maryland, 25 percent of those called by contact tracers don’t pick up. At one point in Miami, contact tracers were able to reach only 17 percent of the infected. In Houston, New Jersey, and California’s Inland Empire, half of the people reached by contact tracers won’t cooperate. In Philadelphia, a third of COVID-19 patients claimed they had no contacts. Philadelphia is one of the country’s most densely populated cities; it’s hard to believe that a third of the people who got sick there had no contact with their fellow Philadelphians. Some of these numbers might not be totally accurate in the long run. For instance, some health departments might count a person who picks up a contact tracer’s second or third call, instead of the first, as a nonresponse. But even giving U.S. health departments the benefit of the doubt, response rates here are far lower than those in other countries. Less than 1 percent of sick people fail to respond to contact tracers in Iceland, Ævar Pálmi Pálmason, who leads the country’s tracing effort, told me. In New Zealand, 86 percent of people contacted by tracers respond within 48 hours. “The U.S. contact-tracing effort has been a dismal failure compared with many of its peer countries,” says Lawrence Gostin, a professor of global-health law at Georgetown University. Contact tracers are not to blame. Tracers tend to be relatively low-paid, civic-minded workers who make calls relentlessly in an attempt to rescue the nation from a ruthless pandemic. But they’re struggling for three main reasons. There are too many cases to trackIn July, I called up a contact tracer in Texas to see what her job was like. She was worried that she’d be fired if she talked with the press, so I won’t disclose her name here. Every day, she gets on her laptop, sets herself to “available,” and signs into Microsoft Teams. She spends all day clicking a button to see if there’s a new contact she can call. She enjoys the work, but she had some concerns. The big one was that she felt like a public-health Sisyphus. “It’s literally too late to do contact tracing in Texas,” she said. That month, Texas had 15,000 new cases on some days. “How are you going to go back and find all those old contacts? You can’t really trace if everyone and their cousin has it.” The countries where contact tracing has worked best set up their tracing systems before cases exploded, and as cases grew, they hired more tracers. The U.S. has not done this. In June, when states were in the throes of reopening, only seven states and Washington, D.C., met the Centers for Disease Control and Prevention’s recommendation of 30 contact tracers per 100,000 residents, according to an NPR analysis. According to the latest data from Test and Trace, an organization that grades states on their testing and tracing capabilities, only seven states are currently considered “fully prepared to test and trace.” States meet this threshold if they have a test-positivity rate of 3 percent or less, provide test results in two days or less, and employ five to 15 contact tracers per positive test. “When we started to see cases start to rise back up, hospitalizations start to increase, and then people are looking at contact tracing as this thing that’s going to stop that? Well, that’s just not what contact tracing is able to do at that point,” says Candice Chen, a health-policy professor at George Washington University. What’s more, once a tracer asks Aunt Sally to isolate, ensuring that she actually does so can be hard, especially if she doesn’t get paid leave from work, or if she lives in a cramped apartment with lots of other people. In Iceland, the government set up a special quarantine hotel as an option for people to isolate away from their families. But few places in the U.S. have set up free hotels for isolation. Larry Wile, the medical director of a health department in southwest Michigan, told me that a nearby county had set up a COVID-19 motel, but abandoned the effort when its staff quit out of fear of getting infected. Now, Wile said, the best his tracers can do is tell infected people to stay away from their family members and wash their hands. Testing takes too longIn Iceland, Pálmason has been tested twice. Both times, he took the test at 10 a.m. and got his results by eight that evening. In the U.S., coronavirus tests are taking days to come back—largely because there are too many different kinds of tests and no national testing strategy—which further hampers contact tracers’ work. The infected are walking around for days, unwittingly infecting others. And people are naturally less likely to be able to rattle off the names of everyone they encountered five days ago, as opposed to whom they saw yesterday. The logistical testing delays are exacerbated by quirks of the American health-care system that are making it even harder for people to get tested and quickly quarantine. Many people can’t get paid leave from work unless they provide proof of a positive COVID-19 test. So if Aunt Sally is feeling sick but her test results haven’t come back yet, she might be required to report to work or forfeit her paycheck for the day. “If that test isn’t showing up for a week, then they’ve already been exposing people for a week,” said another Texas contact tracer, who asked to remain anonymous, because she’s not authorized to speak with the press. Many Americans fear and distrust governmentIt’s likely that the first time many Americans heard the term contact tracing was this spring. Before that, some public-health departments were little more than two people and an old computer, having lost a quarter of their workforce through aggressive budget cuts since 2009. Because the U.S. has had such an enfeebled public-health system for so long, the public doesn’t trust public-health workers at a time when it’s crucial that they do so. When called by a department they’ve never heard of and asked for a list of all their friends, Americans could be forgiven for thinking, Who the hell are these people? Besides Openshaw, many others got up in arms about H.R. 6666, the contact-tracing bill. Some worried that its bill number was too close to the sign of Satan. “United States Citizens, contact your neighbor, your relatives, and your friends, and warn them that contact tracing is a ploy for the worst crime against humanity: democide and population control,” a man named Demetrios Alexandros wrote on Facebook, using a term for the murder of people by the government. Someone started a petition on whitehouse.gov soon after the bill was introduced, saying it was reminiscent of life in “NAZI Germany.” This is despite the fact that the U.S.’s methods for contact tracing aren’t especially aggressive. In South Korea, which conducted a very successful tracing operation, tracers used cellphone data and credit-card transactions to find sick people’s contacts. In the U.S., tracers rely only on phone numbers and names provided voluntarily by individuals. Still, contract tracing depends on trust, and many Americans don’t trust the government enough to give up their contacts or follow quarantine orders. Of the 121 agencies Reuters surveyed, more than three dozen said they had been hindered by peoples’ failure to answer their phone or provide their contacts. About half of the people whom contact tracers call don’t answer the phone, because they don’t want to talk with government representatives, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said during a June news conference. Examples of this distrust abound. A video with more than 325,000 views on YouTube recommends that people avoid contact tracers because they are tied to the Clinton Foundation and Bill Gates. In eastern Washington, angry locals threatened a contact tracer’s life. Some contact tracers have reported that people think they are identity thieves. (It doesn’t help that some actual scammers are posing as contact tracers.) “I think that the politicization of contact tracing in America is definitely hampering its success,” Steve Waters, the head of Contrace, which helps connect contact tracers with health departments, told me recently. “In some areas, it’s perceived as a political act to not participate in contact tracing.” These trust issues have become especially pronounced in the Black and Hispanic communities, two populations that have been disproportionately affected by COVID-19. Black and Hispanic people are more than twice as likely as white people to get COVID-19, and are more than four times as likely to be hospitalized with it. Several experts told me that wariness of the government in these communities has been exacerbated by the Trump administration’s public-charge rule, under which immigrants might jeopardize their green card if they accept public benefits. “If the word gets out in a community, ‘Don’t talk to the government, because we are worried the government will do bad things to us,’ then you don’t have trust,” John Auerbach, the president of Trust for America’s Health, a nonprofit that promotes public health, told me. Some state and local officials have cleared a path for contact tracers. Few people pick up calls from numbers they don’t recognize, so in Massachusetts, the contact-tracing operation asked phone companies to display its phone number as “Massachusetts COVID team,” even for people who don’t have caller ID. That small change persuaded many more people to answer their phone, according to K. J. Seung, a global-health expert who leads the state’s tracing effort. But not all places have done this; elsewhere, some people still think contact tracers are robocallers. People have more trust in public-health workers when local health departments, governors, and the president speak with one voice. But some officials have downplayed the virus, some have taken it seriously, and others have ignored it entirely. Other than claiming that the U.S. has gotten “good at” it, Donald Trump hasn’t said much about contact tracing. But perhaps his actions should speak louder than his words: When someone in the White House gets sick, the executive branch traces all of that person’s contacts. from https://ift.tt/32IXS6f Check out http://natthash.tumblr.com On the first day of summer, Siberia and I were the same temperature. In Verkhoyansk, roughly 3,000 miles northeast of Moscow, a searing week ended in an afternoon hotter than any before recorded north of the Arctic Circle. Half a planet away in New England, a thermometer under my tongue gave the same reading: 100.4 degrees Fahrenheit. In a human, this is the clinical threshold for a fever. We had also been too hot for too long, Siberia and I. Most days since mid-May, I have lived in a body a degree or two and occasionally three above normal. Siberia is even more pyretic, averaging more than nine degrees above the 20th-century norm from January onward. Russian friends sent photos of berries flushed ripe a month early. Dark clots of mosquitoes stuck on window screens. In places, the land itself is wobbly and out of joint, as melting permafrost opens large slump pits and gullies. By May, tundra peat was burning. The boreal forests broke into wildfires. These configurations are now the worst that Russia has seen, blazing on toward autumn. The heat across northern Eurasia is uncanny but not mysterious. Our atmosphere, saturated with the carbon of burned fossil fuels, is becoming that of a prehuman time, one last present on Earth 3 million years ago. The poles are warming at about twice the rate of temperate regions, making Siberia’s current climate anomalies the future of those regions too. Such transformations crack open ecological worlds and the lives within them. Given the scale and implication of events in northern Eurasia, calling this season the Summer of Siberia would not be hyperbole. [Read: America is being pummeled by disasters] Yet it is my malady, not Siberia’s, that rules conversations and headlines. I am too hot because of a persistent case of COVID-19, what its sufferers have begun calling “long COVID.” Mine is one case among millions, a pace of infection that, like distant wildfires, will roar into fall. So perhaps it is no wonder that, from America, Eurasia’s heat feels like an abstraction. Siberia and its inhabitants are far; much suffering is close. How do we take in the ruptures of a burning world when our own bodies are alight? My body has been alight for months now. From within this illness, I have come to think that Siberia and I endure more than a coincidence in temperature. Our fevers are stoked by related patterns of economic production, patterns both relatively new and seemingly inevitable. And my corporeal fire says something about how a continental fire can go unseen, offering a lesson in the implications of duration: how as a condition lingers, its origins or significance grow harder to see. Long COVID and climate change are alike in this: live ill for long enough, and the absence of health threatens to become normal. Two summers ago, I was in Russia, on a comma of rocky Bering Sea beach called Napkum Spit. It was August, the turquoise water free of ice and full of spotted seals. Far off, a gray whale spouted, its breath tracking a shimmering mist against the horizon. North and south from this place, Indigenous kin and culture are nourished by hunts of grey and bowhead whales. For Yupik and Chukchi, peoples whose ancestors have lived along the Bering Sea for thousands of years, whales’ flesh is food, their beings woven into the necessities and ceremonies of daily life. I was on Napkum Spit because of a different kind of whaling. My work as a historian had led me to the logbooks of the New England fleet, which began killing Bering Sea cetaceans in the 1840s. These sailors hunted whales for oil and baleen, to light homes and brace corsets where I now live, in Rhode Island, and all along the Eastern Seaboard of the United States. I wanted to see what marks remained in this whaling ground. I expected something tangible, even monumental. In 50 years, the Yankee fleet killed tens of thousands of whales. Around that loss, the Bering Sea ecosystem transformed, likely feeding more squid and fish in the ecological spaces once home to bowheads and grays. But these species were inaccessible to Yupik and Chukchi. By the 1880s, famine claimed families, then whole villages, many also suffering from epidemic diseases transported north by wooden ships. Had I lived in Rhode Island then, I would have lit whale-oil lamps at dusk, with baleen cinching my ribs, and seen nothing of that suffering. A hundred and twenty years later, to one recently arrived on Napkum Spit from New England, the traces of commercial whaling were imperceptible still. There were no hulking shipwrecks, or graves, or mounds of whale skulls, only that single whale spout on the horizon. The memorial to market killing is absence. The Yankee fleet ceased harrowing the waters off Siberia by 1900, yet bowhead and gray-whale populations are still shy of their former plenty. The only Bering Sea I have ever seen, the only one I can experience, would have seemed eerily bereft in 1840. That same year, I visited an abandoned mining town to the southwest. Shakhtyorsky was a Soviet creation, wrested from the tundra’s green sedges. A vein of lignite coal ran under the hills; miners, or shakhtyory, came here to peel away dirt, permafrost, and stone, then haul out fuel by the black, dusty ton. At its peak, the town was coated in a thin layer of grime, exhaled from the mines and the generators that powered heavy equipment. Coal dust stunted plant growth; coal heaps leached acid into streams. All around Shakhtyorsky, the process of extraction left the earth hollow and pocked. In miniature, it did the same to human lungs. Years of breathing sulphur and black dust caused coal workers’ pneumoconiosis, or black lung; in severe cases, lesions in the lung tissues necrotized, leaving empty, dead cavities. Yet had I flipped a switch powered by Shakhtyorsky coal in 1970, or 1980, I would have seen no sign of the scarred lands or bodies behind the light. [Read: America’s coal consumption is in free fall] Napkum Spit and Shakhtyorsky are alike in this: they are monuments to how, in the 19th and 20th centuries, people of comparative wealth could consume parts of the Arctic—as they consumed Indian cotton, Caribbean sugar, Middle Eastern oil, South American bananas, and dozens of other products from distant parts of the world—at a remove from the costs of their manufacture. Long before COVID-19 turned grocery stocking and Amazon delivery into dangerous work, consumption was healthier at a distance. And that severed use from consequence. If most Americans now pay little heed to Siberia’s burn, perhaps it is because recent history has made material plenty and heedlessness coincident. Wealth is freedom not just from bearing the consequence of using up the world, but from paying attention to it. That might have worked 200 years, ago, a century ago, even a lifetime ago. Today, the speed and intensity of 21st-century life erodes the space between the costs of production and the benefits of consumption. What starts far off in the Arctic—or in China, or anywhere—does not remain there. Or, put another way, the same dynamics that warm Siberia also warm me. There are many examples of this, how burning trees and fossil fuels alter the composition of the atmosphere while moving people and, with them, viruses. Modern agriculture, which turns petroleum into fertilizer, concentrates sites of possible infection and transmission between livestock and humans. Industrialization replaces animal homes with human ones, and with markets for fauna such as the bats that gave us this coronavirus. As loggers turn forests into furniture, they push more species into new intimacy with people. Deforestation also emits billions of tons of carbon each year. That carbon warms the planet more; a warmed planet forces more animals to move, which makes viral transfer more likely. Siberia’s wildfires are deforestation at an immense and terribly efficient scale. This year, about 50 million acres of forest and grasslands have already burned, more than a Greece’s worth of plant life blown into a pall of smoke so massive it now sits over Alaska and Washington State. A month of such burning releases as much carbon dioxide as a small country—Portugal, or Sweden—does in a year. No summer on record has seen less ice in the Arctic Ocean; the greatest losses are north of Russia’s baking landmass, in the Barents and Laptev Seas. Ice at the poles anchors the stability of our climate. Even if we pay it no heed, this hot summer in Siberia is shifting the terms of what normal is out from under us all. Playing host to the coronavirus for three months has made me think about normalcy—its shifty character, how it plays with my sense of time—and the drive to pretend that things are at stasis, despite all evidence indicating turmoil. My case of COVID-19 was never acute; I was not on a ventilator or even close, nor do I have the harsher ills of many long-haulers, who report roving pain, memory loss, tachycardia. My experience of the virus has not been an event so much as a shift, erosion rather than earthquake. The most enduring symptom is a corporeal heat wave that shows no more sign of fully lifting than the warmth in northern Eurasia. As the weeks drag on, the hale clarity of my normal self is receding. Perhaps this is just what I am now: weaker, wan, soggy-brained. An amazing and terrible thing about being human is how quickly we adapt to circumstances unthinkable just years, or months, or weeks in the past. The marine ecologist Daniel Pauly calls this the problem of “shifting baselines”: assuming that observations this year or this decade represent life at its most flourishing. A whaler fresh to the Bering Strait in 1850 saw thousands of bowheads; 50 years later, a new sailor might have assumed that the species was naturally scarce. A miner who came to Shakhtyorsky in 1980 would never breathe air free of coal dust. In April I assumed I could wake each morning and work ’til evening; now I route my days around my body’s weather. People born in Siberia early this century have watched summers warm dramatically. Their children may never know it otherwise; unless carbon emissions halt, this year’s average temperature in Siberia will likely be the norm at the century’s end. [Read: This is your life on climate change] The danger of acceptance is in how ill it leaves bodies and the places they live. I am not well, at 99.8 degrees, or 99.2, or 100.1, even if those are the temperatures I experience more days than not. The swaths of Siberia choking in smoke are not well, nor are their people. But the very slowness, the week-in, week-out constancy of climate change or enduring infection, is lulling. It is tedious to tell people I am still sick. Sustaining alarm at a thousand people dying in a day is more difficult in August than it was in April. Siberia is too hot, still, but it has not exceeded the record of 100.4 degrees Fahrenheit set in July. A 98-degree afternoon in Verkhoyansk is now not an event; it is just a day. The phenomenal becomes mere background. As summer tips toward autumn—an autumn in which there will be too little sea ice and too much virus—I do not want to forget the possibilities of my April self, or of Siberia without fire, or of whales by the tens of thousands. The need to build a society that cares for all, that does not let some hide in the safety of distance, has never been more acute. The habits of wealth need reconditioning to account for the real costs of consumption. These are forward-looking projects. My experience of this virus makes me think, however, that we should not forget a longer view, one able to see how the conditions of 2020 are not inevitable. The line of heat that connects my body and Siberia has existed for only a few centuries. It is not inevitable. Thinking past it, as this summer of our many discontents moves into fall, requires a kind of split imagination: to conjure moments of past flourishing, and a future where we might flourish again. from https://ift.tt/3hDanXf Check out http://natthash.tumblr.com Over Memorial Day Weekend, a tree tried to kill me. I was sitting on a park bench with a friend, drinking a few clandestine beers, when one of its enormous boughs snapped off at the trunk and crashed to the ground beside me, its leaves brushing my arm on the way down. After two terrifying months in New York City, it struck me as darkly funny that I could have survived living in the epicenter of the global pandemic, only to be felled by a random bonk on the head while clutching a Coors Light. My response to the near-death experience was both instinctual and embarrassing: I grabbed my phone so that I could take a photo of the giant branch and tweet about it. But as I lined up the camera, my phone sailed out of my hand and clattered to the sidewalk, spiderwebbing part of the glass. Better my iPhone than my skull, but the shattered device wasn’t an anomaly. It was only the latest casualty in a series of mishaps that have haunted me since the start of quarantine. First, some haphazard storage decisions atop my refrigerator flung a pitcher to its demise on the tile below. Bottles of cold-brew coffee, pickle relish, and cocktail sauce practically leapt off their shelves. Several times, I have grabbed something out of the fridge only to send a plastic container of leftovers to the floor, and I have knocked over too many cans of seltzer to remember the specifics. Every time something breaks or food pools on my floor, I race to get a towel or a broom or a vacuum while bellowing at my chihuahua to stay away, lightly traumatizing us both. [Read: The End of Open-Plan Everything] I have abundant personal deficiencies, but being a bull in my own personal china shop usually isn’t among them. Since the pandemic hit, I have broken, dropped, and bumped into things not only at home, but also out in the world, while setting up a picnic or loading groceries into my cart. Every time I complained to someone about denting, cracking, or obliterating another object, they chimed in with their own recent examples. One had smashed his phone screen on two separate occasions. Another, along with his wife, broke four wine glasses in the space of two months. A co-worker broke a window trying to open it, scared herself, and jumped back into a mirror, breaking it as well. Whether these people were working from home or spending more time there because they’d been laid off, spilled Tupperware and bruised knees abounded. Friends’ tales of accidental destruction are so common that they seem as if they might be part of a pattern instead of just random acts of clumsiness, even though an actual trend would be difficult to demonstrate. Spilling or dropping things is often an embarrassingly individual experience, but could those isolated incidents have a common cause? It’s possible that the pandemic has turned you into a klutz. Determining whether people have actually become clumsier during the past six months is basically impossible. Stubbing a toe or chipping a mug doesn’t generate any easily collected and analyzed data, even if it produces a lot of unfortunate anecdotes. But based on another known effect of the pandemic and how it might influence behavior, the theory seems plausible: Namely, Americans are very, very anxious and stressed out. In one survey released this summer, more than half of respondents reported feeling more stressed in May than they had in January. According to a May report from the Census Bureau, the rate of American adults who say they have symptoms of an anxiety disorder has more than tripled since the same time last year. Stress and anxiety are mental processes, but they can have unmistakably physical manifestations, such as sweating and heart palpitations. The internet is full of pop psychology about stress’s potential to interfere with fine motor skills—potentially making it harder to securely grip an object or avoid obstacles in your path. I thought I might have solved the mystery of a thousand messes in one quick Google search. [Read: Americans have baked all the flour away] That’s not quite the case, according to Gerald Voelbel, an occupational-therapy professor at New York University. When I asked him if stress affects motor skills, he responded with an emphatic no. What stress and anxiety can affect, Voelbel told me, is spatial awareness: your ability to accurately perceive where your body is in relation to the things in the world around it. “Are we conscious, are we alert, do we have the attention that we placed [our glass] at this point here and not three inches away?” Voelbel asked. When those little mental processes are hampered by stress, he said, your grip might not be as well targeted as usual, or you might bump into a glass instead of grasping it. Stress and anxiety are also very effective distractions, which is why you might forget that the bowl you’re about to elbow off the counter is there at all—even if you put it there yourself, 30 seconds before. Whether your clumsiness has actually escalated in the past six months might also be a matter of expanded opportunity. If you’re among the millions of Americans now working from home—or sequestered there while looking for work—the most easily obliterated objects you regularly encounter are probably in your kitchen. When cooking your own meals, pouring your own drinks, and washing your own dishes, you’re giving yourself more chances to snap a wine glass than if all you had to do was be served at a table, eat an office desk lunch out of a plastic container, or grab a paper sack full of takeout. If you’re also caring for children while at home, homeschooling via Zoom while you also try to work and keep your house in order, that would potentially ratchet up both your stress level and the number of people available to grab imprecisely at breakable objects or bump into things that might fall over. Voelbel compared this phenomena to the old statistic about most car accidents happening close to home: Being stuck in your house might make you more complacent in comfortable surroundings. It might concentrate your usual clumsiness and, when it comes to your dishes, do so in a highly apparent way. Voelbel told me there might also be an emotional element to why everyone I know can rattle off a list of all the things they’ve accidentally destroyed lately. Things don’t have to be happening more frequently for them to be more noticeable. Many accidents are frustrating, but when people are already highly agitated—by, I don’t know, a pandemic—these incidents can cause an outsize emotional reaction, which makes them stick out in people’s minds. It’s like an emotional sunburn: You’re already red and raw, and when you bump into something when you’re in that state, it hurts far worse than it would have under normal circumstances. It would be difficult for any particular person to determine if their accelerated quarantine clumsiness is real, a function of their attention, or both. No matter what, it seems unlikely to decline soon—for the foreseeable future, many Americans will be working and parenting from home, laboring within a pressure cooker of stress. With summer nearly over, much of the country will soon lose the opportunity to spend lots of time blowing off steam outdoors. In the meantime, it might be smart to get a case for your phone and some hard-plastic drinking glasses. Think of them as safety gear for the long haul. from https://ift.tt/3gxBuBv Check out http://natthash.tumblr.com In 24 hours, the testing landscape of the United States has transformed. Yesterday morning, all of the tests for COVID-19—traditional or rapid—that had received emergency authorization from the Food and Drug Administration required an expensive machine and cost at least tens of dollars. In the afternoon, the pharmaceutical company Abbott announced that it had received FDA authorization to distribute a new type of test. This test requires only a coated-paper card and a small swab, and the scale of its production is stunning: Abbott says it will begin manufacturing 50 million of these tests a month in October. The tests will cost just $5 apiece. That wasn’t the only news. This morning, the Trump administration announced that it would be purchasing 150 million of these tests from the company. For comparison, states have reported fewer than 75 million tests total over the past six months, according to the COVID Tracking Project at The Atlantic. Many experts have hailed Abbott’s new test as a huge milestone, and a rapid acceleration toward a plan that could give Americans back some sense of normalcy. Deployed widely and often enough, tests like Abbott’s might allow for kids to return to school, office workers to head back to cubicles, and essential employees who have been working throughout the pandemic a greater degree of safety. At a time when so many people are desperate to escape the pandemic, this kind of testing holds the tantalizing promise of a pre-vaccine way out of the quagmire. [Read: The Plan That Could Give Us Our Lives Back] Abbott’s test itself is not quite the fulfillment of that grand vision, though—at least not yet. Michael Mina, a Harvard epidemiologist who has pushed for the deployment of this kind of rapid test, was not ready to declare that the new era had begun. “This is the type of test that we’ve been waiting for, but may not be the test,” Mina told me. The fine details of the FDA’s emergency use authorization, the regulatory sign-off that allows a test to be sold, are significant. Antigen tests such as this one detect viral protein and are less sensitive than the gold-standard PCR tests that detect viral RNA. So, to gain acceptance, Abbott showed data confirming that its test was able to classify a pool of samples in nearly the same way as PCR tests of the same samples. Although its performance was impressive, the number of samples was far smaller than would be tested under normal circumstances—just 102. Also, the FDA’s authorization allows Abbott’s test to be used only on people with symptoms of COVID-19 within seven days of their symptoms beginning. It cannot be used to test people at any time, an approach that is often called screening. Mina said that limits the potential of the test, because it can’t be used to detect people who carry the virus but don’t show symptoms, and asymptomatic and presymptomatic people are thought to transmit a substantial percentage of infections. Kristian Andersen, an infectious-disease researcher at Scripps Research, noted that Abbott developed an app to go along with the test that would provide proof that a person had recently tested negative. To Andersen, this is clear evidence that “Abott didn’t just have symptomatic diagnostics in mind here, but also screening of asymptomatic people.” Symptomatic people are much more likely to have the virus, decreasing the chance of a false positive. For asymptomatic people, even in an area with lots of infections, Andersen worried that the current tests were not sensitive enough, and would generate a substantial number of false results. (In May, Abbott was embroiled in a controversy over the sensitivity of another one of its rapid tests, Abbott ID Now.) Andersen and Mina both offered up prospective solutions to increase the test’s sensitivity. For example, a future version of the test could look for two viral targets. Or two tests could be packaged together, one of which would be a slightly more expensive test that you’d take if you got a positive on the first. That is to say, many questions remain about the test, about Abbott’s strategy, about the Trump administration’s distribution of the tests, and more. With the potentially big news, I reached out to Abbott’s lead scientist on the project, John Hackett, to address some of the questions about how the new test might be deployed, improved, and criticized. I’ve condensed and lightly edited our conversation for clarity. Abbott’s FDA authorization might be limited right now, but the company’s vision is clearly bigger than its current regulatory status. Alexis C. Madrigal: How do you see these tests being used? John Hackett: This project was built around the concept: What do we need to start to move our society back to normal? How do we get people back to work? How do we ensure these workforces will be as safe as possible? How do we get people back to school? That was the goal. So we really did want to have tests that could be as broadly distributed as possible. Madrigal: 50 million tests a month is a huge number. That’s more than twice the number of tests the U.S. completes in a month. How did you ramp up production so massively? Hackett: This was the challenge of this program. We needed some sort of reliable testing that could be affordable and that doesn’t require instrumentation. You need scale. The more frequently you could test people, frankly, even tests with lower sensitivity would be very effective at identifying people quickly and slowing the spread. As we were developing the test, there were people working in parallel looking at supply chain and logistics. Abbott took a lot of risk—hundreds of millions of dollars were spent building two new manufacturing facilities focused solely on those tests. We hoped we could come to a solution that would be where we needed it from an overall accuracy perspective, but if you weren’t building capability simultaneously, there was no way it could be the answer. [Read: A Dire Warning From Covid-19 Test Providers] Madrigal: With the current sensitivity of the test, there are some questions about it as a screening test. The [emergency use authorization] doesn’t allow that yet. What would you have to do to roll this out as an FDA-authorized screening test? Hackett: The FDA is starting to create templates for over-the-counter-type testing. We’re looking at that. And trying to explore the challenges. When you think about going to home testing, there are a lot of factors involved. This test is very easy to use; there’s no question. But you’d have to worry about how people store them. Are they sitting in their hot car? This test will be a major step, but we do have to continue to explore others. Madrigal: So, right now, this test still needs to be done in some kind of a facility. But when I look at the number of tests you’re able to produce, it makes me think that at-home testing is where you’re ultimately driving, even if you aren’t allowed to do screening in general yet. Is that true? Hackett: This is really a critical first step. The first primary thought was being able to do tests where people gather: a workplace is a good example, or a school. There, you can have a health-care provider—it doesn’t have to be a doctor, could be a school nurse, an occupational health specialist—who would use [the test] with very limited training. Any facility that has a CLIA certificate [in this case, a kind of waiver] for testing in a new-patient setting would be capable of using this. We recognize there could be value in home testing, and we’ll continue to look at this. There are concerns. When you go to home testing, how effective is the sampling a person does? That’s the importance of why we chose a nasal swab [which just goes in the nostril] instead of nasopharyngeal [which goes way up in the nose]. It’s night and day in terms of pain. And you do need a trained health expert to do nasopharyngeal. We’ll explore other pathways to getting more testing to the people who need it. Madrigal: One complication with widespread antigen testing is that it’s blurring the national picture of the pandemic. These tests aren’t really being reported, so even though this type of test is [extremely valuable?], they’re currently creating a hole in the data. Have you given some thought to the data-reporting side of this? Hackett: People testing are supposed to report positives. For example, if you were an employer using a test like this, that is the responsibility of the health group. We have created the Navica app, a complementary mobile app that goes with the test. We weren’t using it for that purpose, but it is one that allows the person to get a digital health pass. We were thinking about: How can you lock in testing a test result and be able to verify that you were, in fact, tested? If you were an employer, you could know the employees have done the testing at whatever interval you wanted to do the testing. The default setting for that is seven days, but that could be modified. Madrigal: Take my kids’ school as an example. It wants to do rapid testing. How would the school go about getting your tests and doing this testing? How would it actually work? [Read: Why Can’t We Just Have Class Outside?] Hackett: We at Abbott do testing of critical staff. This is the sort of thing that can be set up. You need some health-care providers and to figure out what is the interval of testing that would achieve what your goal is overall or what you think is appropriate. Then it is really just organization. Again, I think that’s where the Navica app would be a real plus. If you went into a school building, they could just check; it would be like a boarding pass. And if, unfortunately, you were positive, you’d get a message to quarantine and see your doctor. Madrigal: But that sounds like broad screening to me, not diagnostic testing of someone with symptoms. Hackett: Well, that comes back to the health-care provider. For this test, you still need, in essence, a prescription, saying that these individuals are suspected or they have symptoms. This test, the indication is for seven days or less after the onset of symptoms. Madrigal: How do you improve a test like this? How do you take the basic components and say “This is how we’re going to get to this sensitivity and this specificity”? Hackett: Well, this is a situation where, obviously in this outbreak, there has been very little time to react. We haven’t had the normal time frames that we would to develop tests like these. There was a tremendous amount of work that went into the process, every level of this. What protein of the virus should we target? Then, looking at the reality in this format, during the extraction process off of the swab, you need to be able to separate the proteins that are part of that virus in order to be able to detect them. So would you choose spike or nuclear protein? What type of swab? Abbott’s got a long history of this in the infectious-disease area. You can go back to 1985; we had the first FDA-approved test for HIV. This is part of our history. from https://ift.tt/2YEskgu Check out http://natthash.tumblr.com On Sunday, the Food and Drug Administration issued an “emergency use authorization” for blood plasma to treat COVID-19. The decision was well within the agency’s remit but nevertheless generated instant controversy. President Donald Trump had just attacked the “deep state” at the FDA for holding up COVID-19 treatments; the next day, the normally staid and careful agency was cheerleading plasma as “another achievement in administration’s fight against pandemic.” The FDA commissioner, Stephen Hahn, boasted that plasma could save 35 out of 100 treated COVID-19 patients if the data held up—a claim so grossly misleading, he had to recant it. The limited evidence available suggests that infusing patients with the antibody-rich plasma of survivors is, at best, incrementally effective. One study found that patients who received plasma within three days of a COVID-19 diagnosis had marginally better outcomes than those who received it later. There is no randomized, controlled trial yet comparing patients who were given plasma with those who were not. Even so, plasma does technically meet the low bar for “emergency use authorization,” or EUA, which is a much looser standard than formal FDA approval. The 2004 law that created the EUA process requires that “it is reasonable to believe that the product may be effective.” The flexibility is helpful in emergencies, but it can also backfire if exercised too often, too carelessly, or too politically. In the EUA mechanism, experts and former FDA officials fear, the Trump administration has found a soft spot vulnerable to political pressure, which could be especially intense as the agency begins reviewing data for COVID-19 vaccines. “Almost any product that one would contemplate using for a human being would likely meet the criteria for EUA,” says Luciana Borio, a former acting chief scientist at the FDA who is now a vice president at In-Q-Tel. “Therefore it must be applied with tremendous responsibility.” The FDA maintains that politics played no role in the blood-plasma EUA, but even the appearance of political meddling can erode trust in the agency. “Their credibility as a regulatory agency I fear has been damaged already,” says Sandra Quinn, a public-health researcher at the University of Maryland. The FDA previously came under fire for issuing an EUA for hydroxychloroquine after Trump became fixated on the drug, which the agency later rescinded when the drug proved to be ineffective. With plasma, the agency has again issued an EUA following a loud and public campaign by the president based on little scientific evidence. The Trump administration is reportedly considering using the EUA process to fast-track a COVID-19 vaccine before the November election. “It just seems to be a pattern now,” says Jesse Goodman, a former chief scientist at the FDA now at Georgetown. “I’m very worried that this might happen with vaccines.” A controversial EUA for a vaccine could inflame fears that a vaccine is being rushed out. Back in 2009, when the H1N1 flu was declared a pandemic, Quinn began studying whether the public would accept a vaccine authorized under emergency use. Willingness to get such a vaccine, she found, was low: 8.7 percent of the people she surveyed said they would get a “flu vaccine that was recently developed and not yet approved by the U.S. Food and Drug Administration,” 63.5 percent said no, and 27.8 were undecided. Only 4.2 percent of Black respondents said yes, which the study attributed to the legacy of mistrust from biomedical experimentation, such as the Tuskegee study, on Black Americans. Ultimately, no EUA was necessary for the H1N1 vaccine, which was approved through normal processes because of its similarity to the seasonal flu vaccine. Only in one convoluted and somewhat exceptional case has a vaccine ever been authorized for emergency use. In 2004, a judge suspended a mandatory anthrax vaccination program for members of the military after ruling that the FDA did not follow the proper procedure for approval; the FDA ended up issuing an EUA before reaffirming the vaccine’s safety and efficacy in a formal review. (In 2001, before the EUA mechanism was written into law, the anthrax vaccine was also offered to postal workers under an “investigational new drug” protocol. Participation was extremely low, Quinn says, partly because of mistrust between management and workers who felt they were being used as “lab monkeys” or “guinea pigs.”) In some ways, vaccines are especially ill-suited for the EUA process, because they have to clear a higher bar than drugs do. Drugs are given to sick people; vaccines are given to healthy people, so the acceptable risks are much smaller. “I don't think one would want to use the vaccine based on the kind of minimal, uncontrolled, or preliminary evidence we sometimes see for therapies,” Goodman told me. “Absolutely not.” The EUA process is flexible, so it’s up to the FDA to decide what level of evidence to require for a vaccine. Goodman said he can envision a scenario in which a vaccine should be authorized for emergency use—for instance, after large clinical trials have been completed but before the FDA has finished a formal review. But given how the FDA has handled hydroxychloroquine and now blood plasma, the agency could do everything right with a vaccine and the decision might still seem suspect. Emergency use can also have the perverse effect of making it harder to study the effectiveness of a new vaccine or treatment. “When EUAs are issued, enrolling patients in clinical trials is likely to be more difficult,” says Patti Zettler, a former associate chief counsel at the FDA who now teaches law at Ohio State University. Patients may not want to join a clinical trial, in which they could get a placebo, if they can be sure to get the treatment under the EUA instead. In 2009, for example, the FDA authorized the drug Peramivir for emergency use in serious cases of H1N1 flu; only years later did a randomized, controlled trial show that the drug was ineffective in hospitalized patients. “That experience actually really reshaped the way the agency worked when I was there,” Luciana Borio told me. The agency learned a lesson—better to do the trial during the pandemic. That way, she said, "we can actually learn quickly enough which drugs have merit and which ones don’t that we can actually alter the course of the pandemic.” Unfortunately, we are relearning the same lesson during the COVID-19 pandemic, when a lack of robust clinical trials has hampered efforts to find effective treatments. Given the stakes of a COVID-19 vaccine, Zettler told me she hopes that manufacturers, which can request emergency use authorizations from the FDA, will not want to hastily roll out a vaccine either. “I hope, in this instance,” she said, “the FDA is not the only backstop here.” from https://ift.tt/32H0UYP Check out http://natthash.tumblr.com Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at [email protected]. Dear Dr. Hamblin, My girlfriend and I got a pandemic puppy. He’s a King Charles cavalier named Rooster, and he’s now six months old. We take him for walks around San Francisco a couple of times a day, and everyone wants to pet him. When he was younger, we let it happen because we wanted him to socialize. But now we’ve stopped allowing it. When people come and try to pet him, we say something like, “Sorry, we’re not doing pets today.” He naps in our bed, and it just seems too unsafe, since he might carry the coronavirus into the house. My girlfriend is good at letting people down easy, but I’m not. The other day at a coffee shop, a very young kid came running up to pet Rooster, and I said no, and she ran back and clutched her mom’s leg. Are we doing the right thing? Chris Temple San Francisco I understand your hesitation. For months, we’ve been warned about contaminated surfaces and close interactions as coronavirus vectors. If doorknobs and subway poles are considered high-touch surfaces that should be disinfected regularly, why not the fur of a dog that’s just been petted at length by a stranger? And why should dogs get to go around licking people’s hands? Is it not concerning that the stranger took down his mask just to look the dog in the eyes and tell him he’s a good boy? As the owner of a puppy myself, I know how much joy people seem to get from petting him. Most are respectful in asking to do so, but some act as if it’s their right to cuddle and play with him as long as they like—as though my dog is exempt from the laws of viral physics. I let them do it (if he’s into it), but I do sometimes feel odd being so vigilant about transmission at all other times, and then bringing my dog into my apartment after a walk on which he’s just been groped by a dozen pairs of unknown hands. [Read: I got a pandemic puppy, and you can too] Dog owners have raised three basic concerns with pandemic petting. First is the possibility that when people get really close to a puppy like Rooster and rub their hands all over his little body, they are seeding his fur with viral droplets. Second is the idea that Rooster himself could get infected and get sick. Third is the worry that dogs could get infected and then asymptomatically spread the virus to clearly vulnerable species such as humans. These are valid concerns, at least theoretically. But in practice, we luckily haven’t seen dogs getting seriously ill as a result of the virus (a German shepherd named Buddy, who contracted COVID-19 and died in July, also had cancer). Not many animals are being tested for the virus, but in the United States, the virus or antibodies have been found in just a handful of dogs and cats, two minks, one tiger, and one lion. Almost all of them had prior contact with an infected human. If dogs were as susceptible as humans to severe disease from this virus, that would have been evident by now. The same goes with dogs passing the virus to humans. If dogs were major players in the vector business, either via their respiratory secretions or fur, hopefully by now we would have traced clusters to them. We haven’t. Contaminated surfaces are proving to be less important than we initially assumed, and among them, soft surfaces such as fur are usually less likely than hard ones to harbor the virus. All that said, this virus is still finding ways to surprise us, and it’s not inconceivable that animals exposed to it could show some subtle or long-term effects that haven’t yet revealed themselves. Like everything else in this unfolding pandemic, our understanding of the pathology should be expected to change as we learn more. The Centers for Disease Control and Prevention still cautions against petting: “Because there is a small risk that people with COVID-19 could spread the virus to animals, CDC recommends that pet owners limit their pet’s interaction with people outside their household.” But the agency doesn’t go as far as to say that no one should pet your dog, and actively recommends against any attempt to disinfect your dog as if he were a countertop. Petting dogs does not seem to be a major public-health concern, but that doesn’t mean concerned individuals are being unreasonable. You’re under no obligation to indulge the dog-loving hordes, and neither is Rooster. I think the approach to striking a respectful, safe balance here should be the same as with many other social behaviors we’re navigating in this moment: Be judicious. As owners, if you want to say no petting at all ever, that’s not outlandish. No one should even begin to object. If declining makes you feel safer and helps you sleep at night, with or without your dog in your bed, that’s important in a very real way. [Read: How your dog knows when you’re sick] At the same time, if icing them out is going to make kids cry, and you don’t know how to explain germ theory to them while they’re sobbing, it may be best to just let them have this one thing. Being a kid right now is already tough. Your dog needs to socialize, and lonely people of all ages in your neighborhood do too. Any slice of normalcy and connection in these odd, isolated days can be extremely valuable. I don’t take it lightly. For those who wish to pet a dog, the best etiquette is always requesting to pet the dog before doing it—which is what all of us should have been doing even before the pandemic. Don’t wantonly reach out and grope any dog that wanders by. If you feel really moved and in need—and especially if the dog also seems in need of attention—ask the human if you can say hi. And I mean truly ask. Too often, the request is a passing “How are you?” not meant to be answered, said in haste while already reaching for the dog. Like you, I have difficulty saying no to anyone. I would probably say something like, “You’re welcome to take your chances, but he has terrible fleas.” Then I’d feel bad about lying. The best we can do is be honest about our concerns and respectful of others’. Each of us is constantly balancing our need for connection with our need for self-preservation. We’re doing so in a very literal way during the pandemic, each time we go to a restaurant, to a park with friends, or out at all. The virus isn’t going away, so continuing to reach out to people is vital. The way to minimize the risk of offense, rejection, or general awkwardness is always good communication. That comes from respect for people’s beliefs and boundaries. Letting people down easy doesn’t come naturally to many of us. But people probably won’t give up on asking to pet puppies or taking their dog to the park. So frank communication is a skill many of us could use idle pandemic time to perfect. Take each annoying pet request as an opportunity to practice the art of saying no. Draw boundaries around your space and time. Teach Rooster that he owes his affection to no one, and that his respect and attention must be earned. “Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity. from https://ift.tt/31vOIuA Check out http://natthash.tumblr.com On this episode of Social Distance, the comedian Maeve Higgins is back home in New York after weathering the pandemic’s first peak in her native Ireland. She joins James Hamblin to talk about her strange journey back to the United States, and the strange moment the country finds itself in. James Fallows returns to reflect on the Democratic National Convention and why politics (unlike comedy) might actually be better without the crowds. The conventions became televised spectacles more than half a century ago, so perhaps the straight-to-camera speeches offer a frankness that better fits the medium. Listen to their conversation here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. Here’s a sample of their conversation, edited for length and clarity. James Hamblin: How weird is it, as a former presidential speechwriter, to see things happening without audiences in our new pandemic Zoom world? James Fallows: It’s really weird, but I think if we had been having this conversation before the first night, I think we’d have a very different tone, or at least I would. Conventions have always been these bizarre combinations of state fair, freak show, and prom. They have no real reason to exist, except people like to get together and they give a party free airtime on TV. The shift has been more radical than it might seem if you hadn’t been to these conventions before. But I thought that overall it was only 10 percent as embarrassing as I expected and 200 percent as effective. I thought it was much more effective than most people would rationally have expected, even five minutes before it went on air. Hamblin: What made it so much more effective? We were just talking about live comedy, which Maeve does, and how ineffective that seems to be over Zoom calls. Maeve Higgins: You really miss the audience at a comedy show, but I didn’t miss the audience with the politicians. I was glad that they were just speaking to me. Fallows: One thing that became obvious when this was being played out, and wasn’t as obvious before it happened, is that it was a fairly tight two-hour segment on TV, as opposed to the hours and hours that these would normally go on. And the difference is, there was never more than two hours of actual content in one of these five- or six-hour shows. It was padded out with all this bloviation, with the anchors weighing in to say, “Well, this was good; this was bad.” Most of the blubber was rendered out of it. You had more planning on what they wanted to get across. Also, I think, a point that should have been obvious 50 or 60 years ago—and was even commented on when John F. Kennedy was learning how to use TV—is that TV is fundamentally a cool medium, an intimate medium, and the people who were appearing last night acted as if they understood that. And there’s a very different way, whether you’re performing live in a comedy club or you’re giving some speech someplace, or if you’re orating in an arena of 20,000 people—there’s a different vibe than there is if you’re delivering something to camera. It was as if they had actually thought that there’s not going to be an audience there, that they had actually planned it. Hamblin: So that’s a good thing to come of the moment? Fallows: Yes, it’s a good thing, in just an immediate operational sense. It will be interesting to see if Donald Trump can deal with that when the Republican convention comes, because he is a person who lives for the arena of 20,000 people … and he will not have that. And there’s a question of whether he can do what Michelle Obama and, I think, even Bernie Sanders effectively did: just talking intimately in the cool medium of TV without a crowd, as opposed to the hot medium that William Jennings Bryan and Donald Trump, despite their obvious differences, both thrive on. from https://ift.tt/34i4Am5 Check out http://natthash.tumblr.com For about a week this past September, I adopted a wellness routine that—at the time—felt like neurotic overkill. I didn’t bother with masks or hand sanitizer; back then, the virus we now know as SARS-CoV-2 was still presumably nestled in the warm body of an unknown animal. Instead, each morning, I spritzed my arms and legs with picaridin, a chemical repellent meant to ward off parasitic bugs. Then I covered myself with one of several increasingly crusty sets of khaki pants and long-sleeved shirts that I had infused with the insecticide permethrin. Only then, force field up, would I venture outside. I had come to Dakar, Senegal, to get close—but not too close—to Aedes aegypti, a globally invasive mosquito that is arguably the worst animal in the world. The species carries yellow fever and dengue, both of which can cause more severe disease in young adults than SARS-CoV-2; Zika virus, which can lead to birth defects; and chikungunya virus, which can leave victims with debilitating joint pain. Unlike viruses that travel person-to-person, most of these pathogens can spread only in places where mosquitoes live. Then again, aegypti’s range is immense. All told, her bites—and only females bite—cause an estimated 400 million infections each year, which means that several dozen people have been infected in the time it took you to read this sentence. In 2019, when the World Health Organization compiled a list of threats to global health, dengue got a whole slot to itself. Zika showed up in another slot, sharing billing with Ebola, SARS, and “disease X,” the prospect of some then-unknown pathogen with epidemic potential. In Senegal, my own illusion of invulnerability lasted until I met Mawlouth Diallo, a medical entomologist from the Pasteur Institute in Dakar. Wearing a matching blue kaftan set, he sat with me in my hotel lobby for more than an hour, earnestly explaining his team’s mosquito research in smooth, French-accented English. Finally, I had to ask a nagging, basic question. “Sitting here, right here,” I said, gesturing to the air-conditioned lobby, “where is the nearest Aedes aegypti?” Diallo seemed confused at the question. “Where?” “Like, could we go find some of them outside right now?” “No, it is inside,” he said, then laughed out loud at the expression on my face. “For sure, aegypti is inside the hotel.” When dengue broke out in Dakar in 2009, the city’s Lebanese population was hit the hardest. One reason, Diallo said, was that mosquitoes and wealthy foreigners are both drawn to luxury indoor environments. In this lobby, he said, the best place to find Aedes aegypti would be the flowerpots. I laughed with him, albeit less easily. Of the 3,000-plus mosquito species alive, most are fairly harmless. Only a handful are a concern for public-health officials. But Aedes aegypti is different. Whether in Rio de Janeiro, New Delhi, or Miami-Dade County, it will breed in clean water supplies, it will come indoors, it will make a beeline toward human odor, and it will bite when the sun is up, circumventing bed nets that protect at night. Masks to prevent the spread of COVID-19 won’t make a difference. Neither will staying at home, unless you live in a closed, air-conditioned house. No other mosquito is so perfectly suited to live with, and on, human beings. The problem will get worse. Beyond the tropics and subtropics, the species has strongholds in Florida, Texas, California, and Arizona, and at least one population has managed to survive multiple winters in Washington, D.C. One recent study projected that by 2050, thanks to the climate crisis, the North American range of Aedes aegypti will extend to Chicago; in China, its range will go as far north as Shanghai. In response, the world is readying an arsenal of shiny new biological tools. But as scientists and policy makers plan to subvert the species’ evolutionary future, it’s especially important to grapple with its origins, the kind of processes that begin long before once-obscure pathogens emerge from clear-cut rainforests or animal markets. In tropical Africa, especially Senegal, researchers are uncovering the shared history of aegypti and its favorite host, learning how environmental change, slavery, and colonialism turned a local mosquito into a global menace. After chatting in the hotel lobby, Diallo agreed to find me some mosquitoes. Outdoors, we walked half a block and poked around a construction site, looking for standing water in buckets and concrete blocks before fending off a nervous manager. Then Diallo saw a tire leaning against a wall. Reaching inside with a discarded coffee cup, he scooped out a little water—in which he pointed out at least a dozen larvae. [Read: A new way to keep mosquitoes from biting] Cup in hand, Diallo hailed us a cab and negotiated a fare to the Pasteur Institute. In his lab, he led me into a room full of mesh cages of aegypti from all over the country. The mosquitoes looked, in my paranoid imagination, very eager to get out. That afternoon, when I returned to my hotel, I walked over to the pool. I waited until nobody was watching, then bent to look into the wet, shaded basin under one of the large flowerpots. The shadows wriggled, and I recoiled. The next morning, despite all my defenses, I noticed the first bites on my arm. Aedes aegypti, whatever else you want to say about it, is a good-looking animal. Entomologists have described it to me as “elegant,” “quite attractive,” and even “beautiful.” Photographs often show it perched delicately on pink skin, displaying long limbs with black-and-white jailbird stripes. That pretty pattern belies an ugly disposition; the name of its scientific genus is derived from the Greek for “unpleasant.” Fair enough. But aegypti wasn’t always unpleasant. Within the past few thousand years, somewhere in Senegal or farther down the continent in modern-day Angola, biologists suspect that aegypti took its first step toward world domination. Early hints of this story surfaced in the 1960s, when medical entomologists in the Rabai region of Kenya saw the species breeding in earthenware pots of water and feasting on their human hosts. “Every house they’d go into would just be teeming with these mosquitoes,” says the Princeton evolutionary biologist Lindy McBride, who has revisited the same sites. No surprise so far. This was the familiar, human-obsessed aegypti. But outside the Rabai houses, researchers spotted another form of aegypti. This variant laid its eggs in holes in the trunks of trees, not pots of water; it preferred to bite animals, not people. Yet it wasn’t a new species. It was a trace of the ancestral aegypti, a relic of a more innocent time. Scientists have since found undomesticated populations of the species across tropical Africa. They hope to understand not just how the domesticated form picked up its particularly nightmarish set of skills, but how other species might be bending the same way under the same forces. “If we can understand where [aegypti] comes from and how it works, the hope is, we can figure out how to stop it,” says Noah Rose, a postdoc in McBride’s lab at Princeton. Senegal, especially, might be the key. Starting in 2017, Rose went on a series of road trips across sub-Saharan African countries. In Senegal, Rose teamed up with the ecologist Massamba Sylla, who had already discovered something unique about the country’s mosquitoes. After an hour-and-a-half-long cab ride inland from Dakar, during which I watched the scenery change from very dusty to extremely dusty, I met Sylla in a café in the city of Thiès. Over croissants and café au lait, we flipped through photos from his expeditions on his laptop as he described his lifelong, wife-vexing passion for field entomology. “Once it catches you, you put all your time into doing it,” he said. During his travels, Sylla discovered a pattern. Senegal’s climate ranges from desert in the northwest to tropical rainforest in the southeast; as these habitats blend into one another, so do the parasites. In dry cities on the coast such as Saint Louis and Dakar, Sylla and collaborators found only domesticated mosquitoes. But in towns in the far southeast, they collected almost exclusively undomesticated mosquitoes, breeding in tree holes or in the husks of fallen fruit. Between the two extremes, Sylla found a continuum of domesticated and undomesticated aegypti. [Read: No one knows exactly what would happen if mosquitoes were to disappear] When Rose came to the country in August of 2018, he and Sylla drove along the same gradient, from dry Dakar in the south to where the countryside flushes green and rivers block the roads. The trip was not without risk: A decade earlier, another American researcher working in the southeast with Sylla flew back home before developing flu-like symptoms—Zika, it turned out, which he then transmitted to his wife through sex. This time, though, no one got sick, and the collection process they followed was alarmingly easy. They collected the eggs in oviposition traps lined with filter paper, upon which the eggs can survive dormant for months. Once back in New Jersey, Rose submerged the eggs in water; most hatched overnight. “You’ve suddenly just transferred a whole population of mosquitoes between continents,” he told me, “with almost no effort expended.” Rose tested mosquitoes from across the Senegal transect and other countries, imprisoning them in plexiglass cages and presenting them with two olfactory options. They could fly down a tube that led to his own arm, or down another that led to a hapless guinea pig. Screens shielded both Rose and the guinea pig from actual bites. These tests, recently summarized in the study, show that places in northern Senegal near Dakar — with severe dry seasons but crawling with people, who come with their own water supply — host the most human-craving mosquitoes Rose harvested anywhere in Africa. But the country also contains the widest range of aegypti behaviors, from almost exclusive animal-biting in the southeast to exclusive human-biting in the northwest. This diversity suggests that Senegal could be where the transformation happened. Scientists still don’t know the specific reasons for the change. But here’s one plausible scenario of aegypti evolution, described to me by the biologist Jeffrey Powell at Yale University. Imagine a city near or encroaching on the forest. The climate slides into a drought, and animals are scarce. But human communities still offer warm-blooded bodies to drink from and cisterns of clean water to lay eggs in, enough to support aegypti until the rains return. Now imagine aegypti, over several generations, adapting to this new, more reliable lifestyle. Some 500 years ago, after our domesticated aegypti had evolved in dry coastal cities in Senegal, Angola, and elsewhere on the African continent, European ships arrived on the Atlantic coast and began to carry away human beings. As the global tragedy of slavery unfolded, aegypti unleashed itself on the wider world. Dakar, a French- and Wolof-speaking city clogged with determined street vendors, honking cabs, and clomping horse-drawn carts, was once the administrative center of French West Africa. Now it’s Senegal’s capital. The larger metropolitan area, home to some 3 million people, is still trying to cram itself onto the Cape Verde peninsula, which curls out into the Atlantic from the westernmost point of Africa like an arm bent at the elbow. When the Portuguese sailed into the peninsula’s enclosed harbor in 1444, the city of Dakar did not exist. For societies living between the Senegal and Gambia Rivers, the Atlantic was a dead end. Trade came instead from the Muslim world to the east. But after Europeans arrived, the slave-trading outposts they built along the African coast began to exert their own gravity. To meet the European demand for enslaved people, some societies launched massive manhunts against neighbors. Normal economies collapsed. Famines struck, leaving victims so hungry that they offered themselves up to enslavers. “This predatory business, which reduced the producer to an export commodity, pushed Senegambian societies into a state of regression,” writes the West African historian Boubacar Barry. “Violence became the dominant motive force of their history.” At staging grounds such as Goree Island, enslavers conducted invasive physical examinations to screen out unhealthy people. After loading their captives on boats, though, they locked many inside the hold in rank, appalling conditions rather than risk having them revolt or jump overboard. Disease and death were rampant. For the crew and a profitable percentage of the captives to survive the two-to-four-month journey across the ocean, the ships also needed to carry dozens of water barrels. The concentrated humanity combined with the abundant standing water offered domesticated aegypti everything it needed to stow along. Meanwhile, the same bottomless avarice that brought enslaved people and aegypti to the Caribbean had terraformed their destination. After uprooting indigenous populations, enslavers cleared large areas for sugarcane, then razed even more forest for the fuel they needed to reduce cane juice to crystals. Clearing the dense, moist stands, they assumed, would also eliminate the noxious miasmas that they believed to be the ultimate source of disease. They were wrong. With forests gone, invasive species replaced insect-eating birds. Erosion caused flash floods. Loose sediments collected into marshland, creating new breeding grounds for mosquitoes. Native Anopheles mosquitoes ingested the malaria parasite from the blood of incoming West Africans and spread malaria throughout the islands. As for the arriving aegypti, it found the Caribbean’s ports and sugar plantations teeming with human victims, standing water, and pure cane juice—which the species will also drink in a pinch. By the 1640s, aegypti had made itself at home in the islands, and was quietly setting the stage for something worse. Around this time, the yellow-fever virus must have also made the trip over from Africa, likely volleying between mosquitoes and infected enslaved people or sailors during the long voyage. Yellow fever wreaks special havoc on adult immune systems that have never encountered it before. First victims get flu-like fever and aches for a few days, then appear to recover. Typically this recovery sticks. Otherwise, they get sick again, this time with jaundice—hence the “yellow”—and start vomiting up blood, hence the disease’s Spanish name, vomito negro. An early outbreak hit Barbados in 1647, leaving 6,000 people dead before rippling through the rest of the Caribbean. Yellow fever then sloshed from port to port for centuries, borne on silent wings. Ships, ports, and cities formed an invisible circulatory system. In summertime, the yellow-fever virus could materialize far outside its normal range—as in 1793, when one of America’s foundational disease outbreaks killed one in 10 Philadelphians and abated only once fall brought frost. [Read: Two ways of making malaria-proof mosquitoes] Here aegypti, itself shaped by history, began to shape history back. Once established in the Americas, as the historian J. R. McNeill argues in his 2010 book, Mosquito Empires, endemic malaria and especially yellow fever gave local populations an advantage against foreign powers, whose soldiers would show up to fight with less seasoned immune systems. All locals had to do was survive outright confrontation—and wait. Yellow fever helped Spain defend its holdings against European competitors; malaria weakened British forces during the American Revolution. When Toussaint L’Ouverture fought to liberate Haiti, yellow fever may have been his staunchest ally. The domesticated aegypti had established itself quickly across the Atlantic, altering the history of the Americas in the process. In 2018, Powell at Yale published a landmark study showing that mosquito genomes and epidemiological records reflected the historical timeline. “The histories of the slave trade, the mosquito populations, and the disease outbreaks are all telling the same story,” he said. And then aegypti kept going. After ships crossed from Africa to the Americas, they headed back to Europe laden with goods such as sugar. Soon, a few mosquitoes likely hitched a ride on this leg of the trip too. In 1801, Spain’s queen consort, Maria Luisa de Parma, suffered from a disease she called dengue. Around then, aegypti was making itself comfortable in the Mediterranean, and would go on to cause outbreaks of yellow fever and dengue there for decades. When the Suez Canal opened in 1869, it offered the species a back way out of the Mediterranean into the Pacific. Before that century’s end, the first clear outbreaks of chikungunya and dengue had appeared in Asia. Meanwhile, yellow fever kept burning through the tropics. Nobody even knew what carried it until the 1880s, when a Cuban doctor named Carlos Finlay made a then-preposterous proposal: Maybe mosquitoes caused these outbreaks. The U.S. Army pathologist Walter Reed proved Finlay’s theory in 1900, finally giving humans a chance to slow the spread of the disease by putting up screens and getting rid of standing water. Between then and now, though, the sun still hasn’t set on aegypti’s empire. Yellow fever itself has been mostly brought to heel. The breakthrough came in 1928, when competing American, French, and English research teams across Africa convened in Dakar to discuss the tragic case of one Adrian Stokes. After France had abolished slavery in Senegal, in 1848, the colonial government conquered inland states and set up peanut farms, devising new systems to profit from African labor that soon expanded into other colonies. “Senegal was a laboratory for the European powers,” says Mor Ndao, a historian of tropical medicine at Dakar’s Cheikh Anta Diop University. Disease stood in their way. Yellow fever “was an obstacle for the exploitation of the African continent,” Ndao told me. Senegal’s coastal cities had long been gripped by their own yellow-fever outbreaks, which public officials and even scientists invoked to justify race- and class-based “sanitary” segregation long after the mosquito hypothesis had proved what really carried the disease. But the death of Stokes, an Irish pathologist, offered a new way forward. [Read: How the rise of cities helped mosquitoes thrive] The year before, in 1927, Stokes had contracted yellow fever while helping isolate the virus from the blood of a Ghanaian man named Asibi. The pathologist demanded that his colleagues draw his blood and let mosquitoes bite him. Injections of that blood and bites from those mosquitoes both caused fatal yellow-fever cases in monkeys, proving that the team really had captured the infectious substance itself. Stokes died four days after contracting the virus, and was buried in Lagos. He was the first author on the pivotal scientific paper. Upon hearing of this success, the French team at the Pasteur Institute isolated their own strain from a local patient named Francois Mayali. After sharing their findings in the Dakar meeting, multiple groups of scientists started working on vaccines. Mass vaccination campaigns began in the following decades, pushing yellow fever and its bloodsucking vector out of mind and making the tropics less scary for Ndao’s would-be exploiters. Today, virtually every yellow-fever vaccine, including the one I got before visiting Dakar, bears a hint of these colonial beginnings: They still use a watered-down version of the strain taken from Asibi. With the world’s attention diverted, this win soured. During the past century, similar viruses emerged from forests in Africa and Asia. Reaching urban areas, they all found aegypti ready to ferry them from person to person. First came dengue, which leaked out into a bigger global problem as southeast Asia urbanized after World War II. Then in 2006, more than a million people in India may have caught chikungunya. This past decade, Zika emerged on a similar scale in the Americas. Even yellow fever—still the only aegypti-carried disease with a safe, publicly available vaccine—has staged a comeback: two African outbreaks in 2016. All this, remember, wrought by what were once inoffensive forest insects. Rose’s study projects that Africa’s milder, wilder populations of aegypti may crank up their own appetite for humans by 2050, as dense cities spring up across the continent. In response to that alarming forecast, a new collaboration of scientists from across the Sahel, the semiarid region south of the Sahara, is collecting more local eggs—but that research has gotten off to a slow start thanks to COVID-19 and extremist groups in the region, Rose says. Perhaps a deeper worry is that thousands of other mosquito species out there have their own capacity to change. During the Second World War, when Londoners hid in the city’s Underground tunnels to escape bombing during the Blitz, they were swarmed by a form of the mosquito Culex pipiens that had already adapted to the world’s oldest subway system. That same pest now haunts subterranean Manhattan. And just in the past four decades, Aedes albopictus, an aegypti cousin from Southeast Asia that carries many of the same diseases, has exploded its range through Europe, Africa, and the Americas. Not to mention unknown others. “We could be missing the tip of the iceberg here,” says Scott Weaver, who directs the Institute for Human Infections and Immunity at the University of Texas. “I think understanding aegypti, as a first step, will be very important.” As we approached the island, a crumbling stone fort with grass growing on top came into view, then a few buildings painted in fading pastels. Then a dock next to a small beach. The ferry engine kicked into reverse, sending a deep rumble through the deck. This is Goree Island. Within sight of Dakar, it’s the kind of place where aegypti likely hitched a ride across the Atlantic. A UNESCO World Heritage Site, the island is already steeped in the global memory of slavery. First established as a coastal base by the Portuguese, Goree was controlled by the Dutch, the British, and the French until Senegal achieved independence in 1960. After disembarking and buying admission to Goree, I headed southeast, passing a massive baobab tree and a few lounging stray kittens on my way to a museum called the House of Slaves. Since the 1990s, historians have argued that Goree was a relatively minor location in the overall slave trade—that perhaps “only” 33,000 captive human beings came through the island—and that the role of this specific house might have been mostly symbolic. But memory, once established, doesn’t work that way. The three U.S. presidents before the current one came here, and when Nelson Mandela visited, the story is that he sat by himself for five minutes in a cramped chamber marked for “recalcitrant” captives—and then came out shaken, his eyes red. After the entrance, visitors pass through a pink courtyard. The ground floor under the house is divided by stone walls into various dim holding chambers, each room labeled by the museum with a sign in French: “women,” “children,” “the sick.” Running your hand along the wall, you can feel the occasional seashell embedded in the stone. [Read: The quest to make a better mosquito repellent] Behind the house, visitors paused for selfies in the Door of No Return, an empty frame backlit by the sky and ocean. I waited my own turn. The conceit here is that anyone kept under this house and then led through that door never came back. Their world was forever altered. The wider world was also altered, both by the tragedy of slavery and by its still-unfolding consequences, among them 400 million annual infections. For this insect problem, at least, fixes are in the works. By asking questions about where aegypti came from, scientists such as Diallo and Sylla in Senegal and their overseas colleagues hope to save lives too. Understanding aegpyti’s evolution on its home turf might also help us anticipate and counter copycat trends in other mosquitoes or disease-vector species. And unravelling why aegypti and its viruses are so good at parasitizing us could also help us fight them. For example, if McBride can pinpoint the genes and neurological systems that control the domesticated aegpyti’s fixation on people, hijacking that system to find new chemical repellents could be easier. So would crafting new kinds of bait, which would manipulate aegypti to avoid populated areas and head elsewhere. “We might be able to design a super-stimulus that would be more attractive than humans, that would pull them into traps,” she says. But the limiting factors in 2020 are focus and funding, especially with another virus falling on the world like an anvil. “I’m optimistic that people are finally understanding we can’t continue this boom and bust funding cycle,” Weaver says, “where a new outbreak occurs and we put a lot of resources into that virus—whether it be chikungunya, or Zika, now SARS-CoV-2—and we do that by taking away resources from other diseases.” For now, though, public-health systems across the Global South have also been diverted to coronavirus work, scientists say, leaving papers unpublished and mosquitoes uncollected. And whereas vaccines for Zika and chikungunya have been in development for many years, the fact that the outbreaks of those diseases are unpredictable and their victims clustered in poorer countries—unlike those of the more widespread COVID-19—means that the vaccines are difficult to test and less lucrative for the pharmaceutical industry, and thus still haven’t made it to market. As for engineering options to target the mosquitoes themselves, new technologies are already out in the world, aiming to reshape this little critter at the nexus of so much suffering. One option is a bacterium called Wolbachia, bred into laboratory aegypti and then into wild populations. A greedy pathogen itself, the bacteria competes with the viruses that want to piggyback on the mosquito’s life cycle. Tested in Indonesia, Malaysia, and even in Fresno, California, it reduces the mosquito’s ability to spread disease. An even more formidable option might be the gene drive, a type of genetic modification that would spread altered genes from a few sterile or disease-free mosquitoes throughout entire wild populations. The method is undergoing preliminary testing in Burkina Faso and elsewhere, and aegypti is high on the list of potential targets. Meanwhile, less fancy kinds of genetically altered aegypti are already out in the wild. From 2013 to 2015, for example, one mosquito-control program released millions of modified male mosquitoes designed by a British company called Oxitec in the city of Jacobina, Brazil. The idea was that when they mated with wild females, the resulting offspring would die in infancy, causing populations to plummet—which they did. Apparently, though, not all those doomed offspring actually died. Some found a way to live and breed, passing on little bits of themselves. As Powell and other researchers pointed out in an eyebrow-raising study this past September, the wild aegypti population near Jacobina now contains a sprinkling of mosquito genes from Mexico and Cuba, where the Oxitec mosquitoes’ ancestors were harvested. This crossbreeding might have actually strengthened the Jacobina aegypti, the study suggested—sparking a media firestorm, a fierce response from Oxitec, and concern from several of Powell’s Brazilian co-authors. “I thought I was pretty conservative,” Powell said, “but it seems like that got blown out of hand.” This summer, both the U.S. Environmental Protection Agency and the state of Florida granted Oxitec permits to begin releasing a version of the same technology in the Florida Keys, although there are still regulatory hurdles to clear. As we continue to influence its evolution, aegypti, as it always does, is beginning to respond. Standing on Goree Island, though, I didn’t think much about the wizardry of all these fixes in the works, or the engineering required, or the consideration of known and unknown consequences. Instead, I took a moment to dwell on what has already happened. And maybe with this past in mind, or maybe because of a simpler superstition, I didn’t walk through the threshold of the Door of No Return when I got to it. I just stood there, blinking in the light, looking out at the turquoise waves. Ousmane Balde contributed reporting. from https://ift.tt/3hqMhi4 Check out http://natthash.tumblr.com Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at [email protected]. Dear Dr. Hamblin, I’m a healthy 72-year-old living in Berkeley, California. My daughter, son-in-law, and grandkids recently moved here across the country, and now we have a bubble together. I offered to help with child care as they work from home. Now I’m not sure whether I should. My 6-year-old grandson’s school is fully online, and he needs someone to supervise him during class (six hours every day). But our family bubble is slightly complicated now that my 3-year-old granddaughter’s preschool is open. My doctor said I could monitor my grandson if we both wore masks. But another expert friend said grandparents shouldn’t even try to help out with child care right now. Is there any way to do it safely? Alison Klairmont Berkeley, California This is a difficult situation, emblematic of one that so many families are facing as schools reopen and carefully curated bubbles slowly burst. When a child is in contact with a dozen other students, and those students are in contact with their families, and their families are in contact with co-workers, the risk of transmission can grow precipitously. At the same time, socialization is vital to children’s development. School teaches kids interpersonal skills and helps them build emotional resilience, which will serve them throughout their lives—including during future pandemics. Without schools reopened, many people, such as your daughter and son-in-law, are essentially asked to choose between work and child care. Every option involves sacrifices. The instinctive advice for any doctor or public-health official to give right now is to play it safe. Grandparents and other “high-risk” groups should avoid child care, because reopenings involve too many variables and unknowns. Schools have opened safely in other countries, but none had the degree of community spread that we currently have in much of the United States. I don’t truly know what that advice means, though. Many families rely on elders to help with child care even in normal times. If you don’t take care of your grandson while he’s in Zoom school, your daughter and her husband will have a much harder time working. If people can’t work, they can’t make money. If they can’t make money, a kid might eventually not have a home from which to school. [Read: The School Reopeners Think America Is Forgetting About Kids] In an ideal system, there would be child care for all who need it. As it is, we are dealing with the immediate conditions in the real world, where parents rely on extended family. Your grandkids stand to learn from your presence, and your family would surely appreciate it. So I do think you can justify helping with child care. It just needs to be done carefully. Once kids are back in school—even one in a family, even part-time—they could carry the virus home to anyone else in the family. There is some evidence of an age gradient, meaning younger kids are less likely to be infectious than older kids. If that proves true, your 3-year-old granddaughter should pose a low risk of seeding an outbreak in your family. But we don’t know the exact odds. For that reason, I’d recommend behaving as though your family bubble is no longer a bubble at all. Interact with your family at a distance outdoors or in well-ventilated spaces, masked when possible. (I hope this proves too cautious, and that widespread, rapid testing will mean this impersonal way of existing is temporary.) You’re fortunate to live in Northern California, where the climate is temperate enough to spend a lot of time outside. We still do not have evidence of outdoor transmission happening at any significant scale. So if you have a yard or a patio or a porch with Wi-Fi, use it lavishly. Put out an umbrella or make your family build you a gazebo to compensate you for your time. If they refuse, settle for a pergola. [Read: Why Can’t We Just Have Class Outside?] Even while outdoors, it’s ideal to wear masks and avoid getting too close, especially if you have to be with someone for six hours. Being in close proximity for a long time may mean that a person who is emitting only a small amount of the virus could end up exposing you to enough that you get infected. (It doesn’t help that kids tend to fidget and pull at their own masks, which in many cases are too big for them.) When you must be indoors, choose a room that’s well ventilated and spacious. Keep windows open if possible. If it gets too cold, put on a sweater. If it gets too hot, use a window fan to help increase airflow. The goal is to dilute any virus that does make its way into the air. If you absolutely must be in a poorly ventilated space, purifiers with high-efficiency particulate air (HEPA) filters can add protection, cleaning the air like the water in a fish tank, so that no virus can linger for long. These measures are still not being taken in many school districts where systemic ventilation overhauls are budgetary fantasy. Many ventilation systems are old. Some classrooms have only one power outlet, and a mass deployment of air-purification units is limited by the building’s electrical grid. In cities such as New York, there is not enough space to have class outside. All of this is a concern not just to teachers, staff, and students, but to entire communities surrounding schools. As your situation shows, the convening of a preschool can alter the lives of grandparents. The exact degree of risk involved is nebulous without robust testing and tracing that could identify outbreaks to minimize the losses. [Read: We Need to Talk About Ventilation] On a personal note, my mother is navigating a somewhat similar situation. She’s a retired elementary-school teacher. She spent her career working with kids who had fallen behind their peers in reading. This semester, the school system asked her to come out of retirement because they urgently needed a reading specialist. She reasoned that as long as the schools were going to be open, these kids were going to need help. She teaches small numbers of kids, and they wear masks, or try to. Most of the school’s windows don’t open, including hers. I’m concerned for her. I also understand why she felt that she couldn’t leave these kids without a reading teacher. We’re all making compromises. The best we can do is be judicious in deciding which risks we take and vigilant in how we take them. from https://ift.tt/3l0Dbe7 Check out http://natthash.tumblr.com |
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