In mid-June, Joanna Dreifus hit a pandemic milestone. The final member of her household—her teenage son—reached the point of full vaccination. “We had about two weeks where I thought, Phew, we’re okay,” Dreifus, a special-needs-education consultant in New York City, told me. Then the Delta variant took over. By July Fourth weekend, murmurs of post-vaccination infections, though uncommon, were starting to trickle into her social-media feeds. “I knew I’d need to stock up on more tests,” Dreifus said. She estimates that she’s now using at-home antigen tests—the over-the-counter ones that return results in minutes—to screen her family for the coronavirus about three times a month. She pulls them out when anyone feels a sniffle coming on, or when she and her kids, 15 and 18, are about to visit her elderly, vaccinated parents. Dreifus knows the vaccines are still doing their part, but “Delta has basically taken us back to many of our pre-vaccination precautions,” she told me. Combined with masking, distancing, and socializing mostly outdoors, tests bring her extra peace of mind. Dreifus’s decision turned out to be prescient. In early July, the CDC was still insisting that fully vaccinated people didn’t need to mask indoors, or seek out tests after virus exposures if they didn’t have symptoms—guidelines that hinged on the assumption that vaccinated people were almost never getting infected. By month’s end, spurred by Delta’s rise, the agency rolled those recommendations back. Vaccines clearly still curb a person’s chances of catching the coronavirus and passing it on. But they can’t stave off those outcomes completely, especially in the parts of the United States where the super-transmissible variant is running rampant. Right now, that’s just about everywhere. As infections skyrocket, many Americans, like Dreifus, are clamoring once again for tests. Over-the-counter, at-home tests in particular have been flying off pharmacy shelves and out of online inventories, as companies scramble to scale up demand. People are turning to these tests when they feel sick, to avoid an onerous trip to a testing site or a doctor’s office or the days-long wait that tends to come with laboratory-based tests. At-home tests are also being heavily marketed as an option for folks who feel healthy to screen themselves before they venture out into the world. At an extreme, rapid tests have even become bouncers for big events--sports games, weddings, concerts, clubs—whereby negatives sometimes green-light people to enter packed indoor settings, or even strip off their mask. “I still see people throwing parties and testing people as they come in at the door,” Omai Garner, a clinical microbiologist and diagnostics expert at UCLA, told me. But that, Garner and other experts say, is exactly the wrong approach. Tests have never completely ruled out that someone is infected or infectious, which means they don’t work as one-off tickets to freedom, carte blanche to ditch other public-health recommendations. Delta has made blasé approaches to testing all the more precarious. And with the world only partly vaccinated, interpreting test results has gotten trickier as well. Coronavirus testing is in a much different place than it was a year ago. Thanks to the rise of at-home diagnostics, people with means and access no longer have to tangle with the backlogged laboratory testing that plagued the country earlier in the pandemic. Dozens of FDA-authorized tests now include a home-collection option; although some need to be shipped out for processing, require a prescription, or call for telehealth supervision, others are available over the counter and can run from start to finish at home, no proctor necessary. “It’s about availability and ease of use,” says Benedicte Callan, a health-policy researcher in New Jersey, who’s been regularly buying a popular at-home version of an antigen test called the BinaxNOW, made by Abbott Laboratories, for her family. The credit-card-size contraption runs at roughly $25 for a pair of shallow-nose-swab tests, and can return a result in about 15 minutes. These tests are helping to fill a big diagnostic chasm. Last winter and spring, as health departments pivoted their resources to vaccines, many mass testing sites closed, and surveillance efforts petered out. Demand for tests plummeted so sharply that Abbott reportedly instructed factory workers to destroy their inventory earlier this summer, depleting their stocks just before demand skyrocketed again. Now, with Delta blazing, turnaround times for laboratory tests have ballooned into several-day waits—potentially too late to stop an outbreak. Researchers have long known that rapid antigen tests, although convenient, sacrifice some accuracy for their art. Compared with PCR-based laboratory tests, they’re not very good at rooting out the coronavirus when it’s present in low amounts. Whereas PCR testing involves repeatedly xeroxing SARS-CoV-2’s genetic material, so that it can be detected even when it’s exceedingly scarce, antigen tests just scan for what’s already floating around—a coarser kind of survey. (A different type of rapid test pantomimes the PCR’s process and is thus more accurate, but some models can cost two or three times more, and are often sold out.) Garner says the tests will work best for people who already feel ill. “If you’ve got a kid and they come home with a fever, that’s a good way to use it,” he told me. Trials run by test makers show that when antigen tests are taken in the first few days after someone’s symptoms start, their results can match up with those of PCR tests more than 80 percent of the time, though data collected by independent research groups have often produced slightly less stellar results. When antigen tests are used in people who feel healthy, however, their performance tends to take a nosedive. Studies have found that some of the tests might catch fewer than half of the symptomless infections identified by PCR. The people the tests miss might be recently infected, for instance, and incubating the virus at low levels before it truly takes off. They can still be contagious. “Literally all that tells you is, at that minute, you didn’t have a ton of virus,” Garner told me. (False positives, too, can become a concern, but they’re less of an issue when case rates are high, as they are now.) Some accuracy issues can be averted by taking these tests several times a week, if people can find and afford them. Low-level infections that are missed one day could be caught the next. And at the community level, some researchers have argued, widespread, frequent testing could help identify many of the people who are harboring the most virus, and are potentially most poised to spread it—a sort of quantity patch for the tests’ quality flaws. Repeat testing is what the FDA now recommends for people using over-the-counter tests as asymptomatic screens. The two-pack BinaxNOW tests, for instance, are meant to be taken fewer than three days apart; some models advocate that rapid tests be taken almost daily. “It’s clear that testing, particularly rapid testing, will be needed to manage this next phase of the pandemic,” John Koval, Abbott’s director of public affairs for rapid diagnostics, told me. But often, that’s not how people rely on rapid tests. “Using these one-off, for one event, is not watertight,” Alison Buttenheim, a behavioral scientist at the University of Pennsylvania who studies vaccines, told me. Negatives—even a pair of them—can’t guarantee that the virus wasn’t there, just that it wasn’t measured. And tests can’t predict the future if they’re taken days in advance of an event. Delta has a penchant for building to high levels in the airway, which does likely make it easy to detect, but it accumulates fast, so it might leave open only a small opportunity to pinpoint the virus before it hops into someone else. “It’s a tighter, earlier window,” Susan Butler-Wu, a clinical microbiologist at the University of Southern California, told me. Federal documentation for most rapid tests still calls negative results “presumptive,” noting that sometimes, it’s a good idea to confirm with a laboratory test. Vaccination complicates all of this further. An infection that takes root in an immunized person simply won’t look the same as it does in someone who’s never seen the virus before; with shot-trained immune cells at the ready, the pathogen will get stamped out faster. Researchers are still figuring out how commonly, and for how long, vaccinated people may be contagious. For them, positive results could merely be an indication of debris from the virus, after immune cells have defeated it—junk that doesn’t actually pose a transmission threat. Sometimes, a symptomless positive is just “your vaccinated body doing the exact thing it’s supposed to do,” Jennifer Nuzzo, the lead epidemiologist for the COVID-19 Testing Insights Initiative at the Johns Hopkins Coronavirus Resource Center, told me. Until we know more, positive test results should still send people into isolation. But vaccines might lower the likelihood that positives are infectiously meaningful. None of this should imply that vaccines have made tests obsolete. Rather, testing etiquette is getting rewritten, as the virus continues to shape-shift and the nature of infections change. Having testing available, in any form, certainly offers more protection than not. But navigating all the uncertainties of life with Delta—and any variants beyond—demands reckoning again with the limitations of tests, and squaring them with the current pandemic moment. Interpreting a test result isn’t just about checking a cartridge for a colored line, or the words positive or negative. If you have symptoms, live in a high-transmission county, or had a recent exposure to a known COVID-19 case, you have a higher so-called pre-test probability and can have good confidence in a result that says the virus is there. But the converse of that is also true: Negatives might not actually be negatives if they seem like they shouldn’t be. When in doubt, Butler-Wu recommends considering the goal of testing and setting expectations accordingly. Or, as she said a colleague once rather vividly described it to her: “Doing a test is like picking your nose. Don’t do it unless you have a plan for what to do with what you find.” At best, a test can stop you from heading out the door with a burgeoning infection. At worst, it could mistakenly embolden someone to take an unnecessary risk. “You have to consider: What’s the cost of being wrong?” Buttenheim told me. Tests sample individuals, but their results affect entire communities. That makes it all the more troubling that self-testing has become so socioeconomically stratified. Most tests’ current prices—and woefully inadequate availability—make them unaffordable to many Americans, including some of the same communities that already lack access to mass testing sites. (Weekly two-packs of the BinaxNOW for a family of four would run up a monthly bill of about $400.) The global portrait for at-home testing looks even worse; many other countries haven’t had the supply or infrastructure necessary to roll out at-home tests, says Neha Agarwal, who leads the PATH Diagnostics Program, a nonprofit that’s been tracking coronavirus tests. A lot of over-the-counter tests also don’t require people to report their results, potentially stymieing efforts to track whom the virus is infecting, and forecast where it might head next. As we approach our third year of facing off against this virus, many of us, as hosts, are different now: more knowledgeable and, thanks to vaccines, far better defended. We have more and better tests. But like everything else in our pandemic toolkit, tests will fail when they’re asked to bear the prevention burden alone. from https://ift.tt/2WCVcHH Check out http://natthash.tumblr.com
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America’s hot vax summer began exactly how it was billed—less pandemic, more vacci-cations. Over the past few months, Americans have gone nuts with travel. Airbnbs are booked months in advance. Good luck finding a rental car. Even cruises are back … unfortunately. For a couple of days in July, airports were busier than they were at the same point in 2019. But you know what happened next. Would-be travelers expecting a carefree summer did not have this Delta in mind when forking up for plane tickets and hotels. Now Americans with travel plans are finding themselves stuck in the pandemic’s purgatory phase. Seventy-three percent of adults have gotten at least one COVID-19 vaccine shot, and the vaccines remain extraordinarily protective. But America is getting pummeled. The United States is hitting 150,000 new coronavirus cases per day. ICUs can’t keep up, overwhelmed with unvaccinated patients. People are concerned about breakthrough infections among the vaccinated and rising cases among young children, who don’t yet have access to the vaccines. As Americans have way more travel freedom than during any previous surge, the Delta variant is making hapless travelers very, very confused about whether to still go on what they thought would be a dreamy end-of-summer junket. For many, vacation season has turned into something far more anxiety-inducing than relaxing. Unlike during past pandemic surges, not that many Americans are outright dropping their vacation plans. I got a hint of this when I emailed Helane Becker, an airline-industry analyst at the investment bank Cowen, and received the following auto-response: “Hello. For the first time in 29 years, I am off the grid. I will have no access to email this week.” Once Becker returned to the grid, she pointed me to the TSA's handy tracker of how many travelers are passing through airport checkpoints every day. Fewer people are flying now than in June and July, but it’s back-to-school season. The same trend happens every year, Becker told me. There are still almost three times the number of travelers every day than there were during the height of the previous pandemic surge, in January. It’s much the same with Airbnbs: Cancellations relative to bookings on Airbnb are around 25 percent right now, up from 20 percent earlier in the summer but nothing like the rate from the pre-vaccine days of the pandemic, says Jamie Lane, the head of research at AirDNA, a research firm that studies vacation rentals. In spring 2020, that rate topped out at 121 percent. Take a look at new bookings and you’d have a hard time even knowing that the Delta variant was a thing, he told me. “Most Airbnb hosts have been pleasantly surprised with the amount of demand they’re seeing,” Lane said. That’s not to say there are no signs of people second-guessing their travel plans. “Americans do seem a bit concerned about traveling,” Becker said. “It’s substantial enough that we’re seeing airlines make note of it.” Southwest recently claimed that last-minute cancellations are eating into its profits, and Frontier has blamed Delta—the variant, not the airline—for a sag in bookings. (Delta the airline hasn’t noted any decline because of the variant, but please just refer to it as B.1.617.2.) Meanwhile, the research company Morning Consult polls Americans every week on how comfortable they feel about going on vacation, and yes, there’s been a modest Delta dip. Just over half of people are willing to go on a trip right now, the lowest percentage since May 1. The most obvious reason for this discomfort might be sheer safety concerns: People could be hesitant to take a risk with this variant, especially if they have young, unvaccinated children. And with case numbers so high, surely some people have had to abandon plans not out of choice but because they’ve tested positive for the coronavirus. While most states, with the exception of Hawaii, aren’t asking tourists to stay away, Americans who want to go abroad still have to contend with a jigsaw puzzle of changing travel restrictions: Sure, you technically can go to Greece, but the country’s current COVID-19 wave has put it on the State Department’s “Do Not Travel” list. None of these decisions is new, really. They’re mostly the same types of genuinely vexing, headache-inducing safety calculations Americans have had to make all pandemic long. But this time, companies are largely done making our lives any easier. If you do decide that the Delta variant just isn’t worth the risk of traveling, don’t expect any of the flexible policies from earlier in the pandemic. “At this point, if you cancel, it’s on you,” says Bob Mann, a travel-industry analyst. “The likelihood is that people get no refund—at most airlines, not even a credit toward future travel.” So what’s the actual risk that travel poses to Americans right now? Well, it’s complicated. As my colleague Amanda Mull has written, the race between vaccinations and variants has added even more twists and turns in the game of pandemic risk assessment. Undoubtedly, the Delta variant makes everything even more dangerous for the vaccine holdouts. (The CDC continues to recommend that Americans delay travel until they’re fully vaccinated.) For the vaccinated, the Harvard epidemiologist Bill Hanage says that the risk of infection while traveling is still relatively low in many situations. “It would probably be worth avoiding a crowded nightclub in Florida at the moment regardless of vaccine status,” he said in an email. But there are other considerations. Beyond factoring in many individual safety variables—for instance, if you’re traveling with or returning to people who are elderly or immunocompromised—travelers also have to think ahead to logistical hurdles. “My own family was planning on a trip to Iceland this month,” Hanage said, “which we canceled at short notice because of the chances of disruption (travel with unvaccinated kids is hard if you are not sure they will be out of quarantine in time to enjoy the trip).” The reason Americans seem so jumbled about whether to cancel their trips right now is that Americans are jumbled about basically every activity right now. We’re living in a swirl of pandemic life and normalcy, and that makes for some pretty muddled messaging. After Americans were told that vaccines were a portal to the Before Times and that vaccinated people could chuck their masks, the whiplash from having to re-mask and stress about everything all over again can be maddening. “All of this is creating a lot of confusion,” says Kasisomayajula Viswanath, a health-communication professor at Harvard. “And when people are confused, you know what they do? They just do the best for themselves and their families, having to cope with this tide of information. People have decided they can't just put a stop to their lives.” This is how Becker felt about her own “off the grid” vacci-cation—a sojourn in Ecuador and the eastern Galápagos Islands with her family. “We had canceled and postponed this vacation twice because of COVID, and I was adamant about not doing it again,” she said. “We were going and I am not at all sorry.” from https://ift.tt/3Dj2GR9 Check out http://natthash.tumblr.com If evolution is a numbers game, the coronavirus is especially good at playing it. Over the past year and a half, it’s copied itself quickly and sloppily in hundreds of millions of hosts, and hit upon a glut of genetic jackpots that further facilitate its spread. Delta, the hyper-contagious variant that has swept the globe in recent months, is undoubtedly one of the virus’s most daring moves to date. This variant is the product of unfettered transmission, and will thrive further on it; if allowed to, Delta could morph into something even more formidable. “Delta is already a really strong competitor,” Michal Tal, an immunologist at Stanford University, told me. “It could get significantly worse.” We can’t precisely predict what worse will look like. There is no playbook for evolution. Delta could continue to ratchet up its rate of spread, or it could be ousted by another super-infectious variant. But the speed that has powered Delta’s transmission for months probably can’t sustain SARS-CoV-2 forever, at least not on its own. Humanity’s collective immunity to the virus is growing, which means the next variants we encounter might be better off taking a tack that relies a lot more on stealth. “There’s some sort of tipping point where immune evasion becomes a bigger fitness advantage than transmission,” Stephen Goldstein, an evolutionary virologist at the University of Utah, told me. No one yet knows exactly where that tipping point is—just that we will probably, eventually, collide with it. This transition will mark a new stage in our extended parlay with SARS-CoV-2. Viruses depend intimately on their hosts—and the global population no longer looks or acts as it did when this one was a fresh threat. A large fraction of us, especially in vaccine-wealthy countries such as the United States, now have some degree of immunity, simultaneously suppressing the pathogen’s ability to pass among us and pressuring it to circumvent those shields. Our defenses are upping the ante for the virus. And the virus will likely rise to meet it. The cyclical nature of this game might sound disheartening. But nothing will ever put us back at square one. Even as the virus evolves away from us, we can give chase. As immunity builds, our dalliances with the virus will trend milder, shorter, and less frequent. With vaccination on our side, we’re giving the virus fewer turns at the board, and slowing the pace at which the game is played. Although we can’t yet trounce SARS-CoV-2 for good, we can buy ourselves time to make our next decisive move. In broad strokes, the rules of evolutionary play are simple enough. Researchers still aren’t sure where, or in whom, most variants arise, but they’re clearly more likely to sprout when the coronavirus is allowed to stick around and make more and more of itself, whether in an individual person or in a whole population. Mutations happen like typos during a virus’s messy replication; the majority are inconsequential, even detrimental to the pathogen. But scattered among these genetic glitches will be the occasional windfall, a mistake that helps one version of the virus outcompete its kin. Those proportionally rare events become more absolutely common when given more opportunities to occur. “The longer the virus persists, the more opportunities it’ll have to sample what makes it more fit,” Oliver Fregoso, a virologist at UCLA, told me. SARS-CoV-2’s self-xeroxing process isn’t particularly error-prone compared with many of the respiratory viruses we regularly tussle with. All else equal, that’s great news: In the few short days most infected people need to marshal immune responses and purge the pathogen, the coronavirus has barely enough time to tweak its genome once, if at all. “The virus that comes out is going to be basically identical to the virus that goes in,” Goldstein told me. And any variants that do arise have little chance to accumulate in high enough numbers to matter. Most mutants “never make it past the person who’s infected,” Siobain Duffy, an evolutionary virologist at Rutgers University, told me. Many that do exit are doomed to extinguish before they can locate their next host. [Read: The coronavirus is here forever. This is how we live with it.] But all bets are off when the body’s barriers start to break down. Since the pandemic’s start, several independent research groups have uncovered evidence that variants may have an easier time arising in people with weak immune systems, including those taking immunosuppressive drugs—meaning that “immunocompromised people probably have a role to play” in SARS-CoV-2’s evolution, says Ravindra Gupta, a virologist at the University of Cambridge who has been studying this link. Some struggle to clear the virus for months, giving the pathogen time to spawn a menagerie of mutants. Most of the pathogen’s progeny will still be evolutionary duds. But the more of them are made, the higher the chance that one will rise above the fray and tumble back out into the world. Though it’s tough to prove definitively, this may be the origin story of Alpha, Delta’s super-transmissible forerunner. Its genome is pockmarked with an unusual number of mutations, the telltale sign that a variant may have been stewing inside a single person. These prolonged infections can’t explain everything. Delta’s genome, for instance, is relatively clean. Its roots might lie in a different sort of numeric abundance—many brief infections in rapid succession. A variant’s success is also contingent on the specifics of the board it’s playing on, and which opponent it’s facing. Consider, for instance, the Beta and Gamma variants, which both carry mutations that make them much less recognizable to antibodies, a trait that likely helps them wriggle their way into well-defended hosts. They appear to have gained traction in South Africa and Brazil, respectively, where a somewhat large fraction of the population may have already been infected by an older version of the virus. Delta, however, seems to have sprouted first in India, which was slammed later in the pandemic, and where far fewer people had seen SARS-CoV-2 before. In that environment, Delta didn’t need much covertness to establish itself—just a penchant for seriously speedy spread. That strategy helped Delta rapidly outstrip several of its wilier but more sluggish competitors and hopscotch across the globe. A virus’s primary objective is to spread, through whatever means it can. So far, Delta has had little reason to switch up its tactics. Although the variant appears to carry at least a couple of mutations that help it evade certain antibodies—a probable perk when it infiltrates someone with immunity—most scientists have been much more concerned about Delta’s ability to hack its way quickly and efficiently into cells. The variant is so transmissibly supercharged that it can crest in the body, and probably hop into new hosts, before many of the most potent immune defenses kick into high gear. A virus doesn’t need to be invisible if it can get in and out before security has time to spot it. But the more people Delta and its comrades infect, the more they disadvantage themselves. “Delta is leaving behind it people with high antibody titers,” Sarah Cobey, an evolutionary biologist at the University of Chicago, told me. Those fast-acting immune fighters stick around and can rapidly purge the variant should it try its luck in the same person again. Humans are also steadily adding to the ranks of the protected with vaccines, which offer even stronger safeguards. To keep itself going, SARS-CoV-2 will need to dodge these defenses. This, then, is the inevitable push and pull of coexisting with a virus long-term. Immunity shortens and softens infections; virus evolution stretches them back out. Once a large proportion of the population can thwart the virus, SARS-CoV-2 will need to find new ways to “stick around a day or two more,” Bill Hanage, an epidemiologist at the Harvard School of Public Health, told me. The goal is the same—to keep the coronavirus in circulation—but the virus must take a different route to achieve it. That appears to have driven some of the sneaky changes in flu viruses and common-cold coronaviruses that allow them to reinfect old hosts. The more pressure on a pathogen, the more incentive it has to escape. [Read: Will the next variant be more deadly?] In the worst-case scenario, a variant could arise that would “make it like the vaccines did not exist,” Hanage said. But at the moment, “there is no such variant like that.” And it would probably be extraordinarily difficult for one to manifest. Even the most evasive variants we know of—the ones that have stumped certain antibodies—aren’t fully duping vaccinated bodies, which harbor a slew of other immunological guards. Hanage also pointed out that many people’s immune systems have been trained on different triggers—distinct brands of vaccines, unique variants, or some combination thereof. A new version of SARS-CoV-2 would find skirting all of those blockades at once to be nearly impossible. Viruses aren’t infinitely mutable; sometimes, to keep themselves in contention, they must make sacrifices. Several experts told me they’re hopeful that the coronavirus might struggle to max out both transmission and immune evasion at once, requiring some sort of trade-off between the two. Some of the most powerful anti-coronavirus antibodies target SARS-CoV-2’s spike protein, which the virus uses to unlock and enter our cells. If the virus altered the protein to sidestep those antibodies, it might make itself less recognizable to the immune system. But it could also hurt its ability to infect us at all. That might help explain why Beta has, so far, remained only a supporting character in the coronavirus’s ensemble cast. Another hint comes from Alpha, which didn’t seem to benefit all that much when it acquired an antibody-eluding mutation last spring, despite widespread fears. There is, in other words, probably a limit to just how bad SARS-CoV-2 can get: Even the most careful dog breeders cannot turn a bulldog into a bear. What lies ahead might, in some ways, feel never-ending, like a series of checks with no checkmate. Vaccine recipes can be tweaked to accommodate new variants, and boosters can refresh fading immune memories. But that doesn’t make extra shots enjoyable to take. Vaccines, however, aren’t just reactive. They are also proactive interventions that curb the number of times the virus gets to roll the evolutionary dice, cutting down on the number, intensity, and duration of infections, and the chance that they’ll pass to others. A more vaccinated world creates a more hostile global environment for SARS-CoV-2. Mutations will still occur, but fewer of them will be of consequence; lineages will still splinter, but they’ll do so less often. “The overriding effect of vaccination should be to reduce the rate of [virus] adaptation,” Cobey told me. Variants, after all, can’t adapt when they’re starved of hosts to infect. Glimmers of early evidence suggest that this slowdown has already begun. One recent study, not yet published in a peer-reviewed journal, found that SARS-CoV-2’s shape-shifting rate is lower in highly immunized countries, the expected outcome of a virus knocking up against new immune walls. Gupta, of the University of Cambridge, also hopes that we’ll someday cook up vaccines that can stamp out infection and transmission to an even greater degree—or ones that direct immune cells to hit the virus in spots that can’t mutate without hamstringing it. “That will force the virus into a corner,” he told me. We’d need those types of inoculations less often, too. “I don’t envision a constant cat-and-mouse game.” This is not yet our reality. Billions of people around the world have yet to receive a single inoculation; even the vaccine-rich U.S. is deep in a dire summer surge. Delta’s rampant spread is driving more disease, more death—and more opportunities for mutation in the virus. In the absence of vigilant masking and distancing, people are getting battered with gobs of virus, testing the protective limits of even recently inoculated bodies. New variants will continue to appear at unprecedented speeds “until we get to the point where the virus is not allowed to replicate this often, or this quickly,” Jennifer Dien Bard, a clinical virologist at Children’s Hospital Los Angeles, told me. Unabated transmission also raises the risk that some people could become viral mixing vessels: Should two variants come to occupy the same cell, they could swap hunks of their genome with each other, birthing hybrids with the nastiness of both parents in tow. Where transmission occurs unabated, “that is definitely a risk,” Lisa Gralinski, a coronavirologist at the University of North Carolina at Chapel Hill, told me. Viruses don’t want things. But if they did, it would be very close to this. A continued arms race with the virus is inevitable; hitting the immunological tipping point probably is too. How quickly we reach it, and how disadvantaged we are when we do, are not. Masking, distancing, ventilation, and other interventions can limit viral spread, but vaccines remain our most powerful tools: They put some of the controls back in our hands, allowing us to safely accelerate our acquisition of immunity. Anyone who isn’t inoculated will eventually become infected, likely within the next few years, creating many of the same immunological hurdles for the virus to clear—but with a devastating public-health cost. “There’s no scenario we choose where we don’t impose selective pressure on this virus,” Goldstein, of the University of Utah, told me. “But are we going to do it while we prevent people from dying, or not?” from https://ift.tt/3jjFIlb Check out http://natthash.tumblr.com After months of anticipation, Americans have a fully licensed COVID-19 vaccine. Today, the FDA announced the approval of Pfizer-BioNTech’s shot for people 16 and older—the first complete thumbs-up among the three vaccines available in the U.S. The pervasive mood has been: Finally. Pfizer’s shot was given its emergency use authorization—the vaccine’s training wheels—back in December, and the company submitted its application for full approval in May. While America’s emergency-use vaccination rollout has saved an untold number of lives, many institutions, including some universities and hospitals, have been waiting for formal approval to mandate vaccinations. Health officials have expressed hope that approval will help convince people who are vaccine-hesitant to get a shot. Especially as COVID-19 cases skyrocket and hospitals strain under the Delta variant, the FDA has to stop “dragging its feet” on vaccine approvals, many people have argued. Lives are at stake. The urgency, the medical scientist Eric Topol recently wrote in The New York Times, “cannot be overstated.” Except this hasn’t been the only mood. While the approval timeline for Pfizer has felt like forever to many, less than four months from application to full FDA approval is much faster than usual for a completely new type of drug—even a priority vaccine ordinarily takes up to eight. The timeline has been so fast, in fact, that a group of scientists recently called for the agency to slow down in the name of safety. “If the FDA listens to us, they won’t give serious consideration to approving a covid-19 vaccine until 2022,” the group said. Some people want the FDA to speed up. Others want it to be more cautious. All of this can be head-spinning for anyone who just wants the agency to do whatever actually works to get us out of this horrendous pandemic. If one thing has defined America’s vaccination rollout, it’s exactly these competing pressures. There’s a fundamental tension between the right to get access to a drug people are desperate for and the right to protection from dangerous failures of quality. The first demands speed; the second requires time. Today’s Pfizer approval relieves some of this tension, but there’s far more pushing and pulling to come. Similar debates persist over the Moderna and Johnson & Johnson vaccines and, even more pressing, over emergency use authorization for vaccinating young children, who are returning to schools amid outbreaks without any access to shots. For many people, the reflexive position remains: Get vaccines into arms. If the FDA doesn’t hurry up, it is killing Americans. But imagine the cost of the agency taking a controversial safety shortcut. For full FDA approval to bring all the benefits it could, people need to trust that such approval means something. The full FDA approval of America’s three available vaccines has long been a foregone conclusion. The shots are impressively powerful, the safety data after hundreds of millions of injections are colossal, and COVID-19 certainly hasn’t lost its teeth. So why wait? The recent push to fast-track full approval for these vaccines is based on two premises. First, the FDA has been taking unreasonably long. The agency has already reviewed the initial data for the vaccines as they rolled in, there have been massive global scientific scrutiny of and consensus about them, and signing off on the latest longer-term data shouldn’t take months, the argument goes. Second, the vaccines’ emergency-use status has been a dam wall holding back a flood of vaccination that could help turn the pandemic around. [Read: The coronavirus is here forever. This is how we live with it. ] We have good reason to be cautious about both assumptions. Let’s start with the FDA. The agency’s full approval is more than just a formality. Yes, the vaccines are a tremendous success. But while early, publicly available data have now been thoroughly scrutinized, the agency has access to enormous amounts of more recent information that needs to be combed over for any surprises or signs of possible undetected issues. On a press call about the approval announcement, Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, said that the agency reviewed hundreds of thousands of pages of new data from Pfizer. Even for an agency as well resourced as the FDA, thorough analysis and consideration of so much information is a heavy lift, especially for multiple vaccines at once; Moderna’s application for full approval arrived hot on the heels of Pfizer’s, on June 1. (In response to questions on the call, Marks declined to comment on the timeline of a full approval for Moderna.) And it’s not just a lot of data from the clinical trials of the vaccine. The trials and other studies by the manufacturers established the vaccine’s efficacy and basic safety, along with common and not-so-common possible reactions. Now that it’s been rolled out, though, the regulators have to look for signals of very rare issues that wouldn’t show up even in trials of tens of thousands people. We’ve already seen how crucial this effort can be. When Pfizer submitted its application for full approval, the link between the currently available mRNA vaccines and some cases of heart inflammation hadn’t been established. The CDC informed us about this potential risk in mid-May. A safety issue particularly affecting younger people was a serious development in the regulatory process of a vaccine approval that includes 16- and 17-year-olds. The small amount of early data for that age group had been a sticking point back at the emergency-use-authorization stage. Now investigating whether the incidence of this potential side effect might be higher for Moderna’s vaccine than for Pfizer’s is reportedly the reason Moderna still hasn’t received emergency use authorization for adolescents. Then there’s the quality-control side of the task. One of Pfizer’s drug specialists recently described the company’s earliest attempt at manufacturing a COVID-19 vaccine as an “absolute and utter failure.” By the end of this year, Pfizer will have produced an estimated 3 billion doses, the most of any company. That lightning-fast progress is awe-inspiring—and a little nerve-racking. You really want to be confident that regulators are on top of this. The FDA has to be thorough, especially with the first of a new type of drug with completely new production processes, like this mRNA vaccine. It’s not enough that the vaccine used in trials was safe: We must be assured that the shots we’ll get in the arm have the same quality. That quality is not simply baked in. Last winter, for example, the European Medicines Agency, the European Union’s equivalent of the FDA, reported that the contents of some batches of the BioNTech-Pfizer vaccine they had tested weren’t all the same, and the source of the discrepancies had to be resolved before the agency authorized it for rollout. It’s so easy to take the rigors of our current systems for granted. We are used to them preventing disasters. In the 1950s, a world without the FDA's current level of caution, the manufacturing fail that derailed the 1950s polio-vaccine campaign led to the deaths of 11 people and sickened far more. Today, we worry about millions of vaccine doses being discarded because they might have been contaminated, but those shots don’t get as far as people’s arms. Ensuring that these kinds of issues are identified and smoothed out is the everyday business of drug regulation. It’s not always fast or predictable. No agency can always get everything right, of course, including the FDA. They can go too fast, and they can go too slow. But having a system in which pharmaceutical companies knew that scrutiny would be relatively superficial would be tempting fate: Lowering oversight can be a quick path to lowering standards. Both the European Medicines Agency and Health Canada are releasing the complete data packages that companies submit with their applications. All of that data plus what’s in publicly reported safety-monitoring systems will be combed over by many others down the line, including some who will be trying to discredit the vaccines. If there are problems, we need the FDA to spot them first and deal with them. Confidence in specific vaccines and in the system that regulates them is a very long game. Now for the second case for fast-tracking vaccine approvals. People arguing that full FDA approval will supercharge vaccination point to two factors: more vaccine mandates, and removing the reason for a substantial proportion of vaccine hesitancy. The Pfizer approval is indeed a green light for significant vaccine mandates at a range of institutions. The Pentagon announced today that it would go forward with mandating vaccination for America’s 1.4 million active-duty service members. New York City will now require every employee of its Department of Education to be vaccinated. Major pushes like these could make a substantial difference for vaccination numbers. At the same time, we can’t predict all reactions to mandates, especially in parts of the country where they have been strongly resisted. Back in 2015, school vaccine mandates were strengthened after measles outbreaks linked to Disneyland hit California and surrounding states. Researchers have called the groundswell of opposition to the removal of nonmedical vaccine exemptions at the time a turning point in the U.S.—it led to the mainstreaming of anti-vaccine sentiment and a shift to a highly politicized civil-liberties focus for the movement. It’s a volatile issue. [Read: Vaccination in America might have only one tragic path forward] I wouldn’t rush to predict the impact of full approval on general vaccine hesitancy, either. People have been noting the results of a Kaiser Family Foundation poll suggesting that three out of 10 unvaccinated Americans say they are more likely to get vaccinated after full FDA approval. But as the poll’s authors point out, that might just be a stand-in for safety concerns—most of the respondents either thought the vaccines were already “approved” or weren’t sure what their status was. We don’t really know how common the concern is, or how much it would affect behavior. At the moment, arguing that the vaccines aren’t actually FDA-approved is an easy tactic used to try to convince people that the vaccines are still experimental or were never properly tested. Anti-vaccine arguments can shape-shift pretty quickly, though. The claim could indeed be retired after today, at least for Pfizer, but expect some to simply pivot to saying that the vaccines are still experimental because the trials aren’t over yet. (Although Pfizer’s trials have delivered the answers we needed to start using the vaccine, they technically won’t be complete until the last collection of follow-up data on the participants.) Indeed, that the trials are still following people well into 2022 is the foundation of the argument from some scientists that FDA approval shouldn’t be granted now at all. None of this is to advocate for the idea that approvals should be slow for the sake of it. Being slow, after all, isn’t a guarantee that corners aren’t cut. The FDA needs to be able to maintain its standards, uncompromised by political or other pressures, because community confidence in its approvals has to be solid. That doesn’t mean it shouldn’t be questioned or challenged. This process of emergency use authorization for vaccines for the general population was a first, and the system could surely be improved for the future. One of the areas that could be improved straightaway is greater transparency for the fraught issue of vaccinating young children. Unlike adults merely waiting by choice on full approval, kids under 12—one of the country’s largest unvaccinated populations—have no access to COVID-19 vaccines at all. Emergency authorization of Pfizer’s vaccine for this age group is expected, but the timeline for this still is unclear, even though America is experiencing a pediatric outbreak of COVID-19 as children are returning to school. On top of this, we’re not getting the same detailed information from pharmaceutical companies that we got for the big Phase 3 trials. For those, the protocols were public, providing blueprints of how the trials would be run. The ones for the children’s trials aren’t. [Read: The school year is going to be a mess—again] Again, push and pull. The journalist Michelle Goldberg spoke to many people’s concerns when she wrote that she “can hardly overstate the frantic helplessness” she feels over the “bureaucratic caution” that’s stopping vaccines getting to kids under 12. Yet some scientists are arguing that we should completely forgo early emergency use authorization for them, and wait the extra months it will take to gather the longer-term safety data needed for full FDA approval. I don’t think there is a solid justification for denying young children access to vaccination on the same emergency use basis as adults. But we can expect the arguments about EUAs and vaccination for children to get far more intense: Even for COVID-19, children are the prime focus of anti-vaccine activism. Pressure from parents in favor of vaccination is likely to increase too. Now that Pfizer’s vaccine is fully approved, the door is open for doctors to prescribe it “off label”—that is, using it outside the specific parameters that the FDA has approved. This could ratchet up the pressure to vaccinate even before the data and the EUA are in—perhaps even before we know how low a dose is enough for the very young. (In the FDA’s press briefing, the acting commissioner, Janet Woodcock, said that preemptively vaccinating children “would be a great concern.”) We’ve gotten used to the emergency-use-authorization world. We can’t predict for sure what open season on marketing for the vaccines will be like. Some things may be simpler, but others may get more complicated. What is certain: We need widespread confidence on efficacy, safety, and the reliability of vaccine quality. The FDA’s job is to make sure that confidence is well placed and difficult to undermine. Even when it seems as though the agency is lumbering along, a perception that corners were cut under pressure would only make things worse. from https://ift.tt/3B7zF9i Check out http://natthash.tumblr.com Since early summer, three pandemic clocks have been ticking. The first pertains to the coronavirus’s Delta variant, which has sent daily case numbers soaring more than tenfold since June. The second clock is more predictable: The school year starts, as it always does, in late August or early September. The third clock counts down to the authorization of vaccines for children under 12, which was optimistically supposed to come this fall. After the FDA pushed for a larger trial to collect more safety data in kids, it will likely take longer. These three timelines have now managed to converge in the worst way possible: Just as Delta is climbing to a new peak, millions of children who still cannot be vaccinated are going to spend hours a day indoors at school. And many of them will do so without masks, thanks in part to mask-mandate bans in some of the same states that are currently experiencing the worst outbreaks. “Are you allowed to use swear words?” is how Sean O’Leary, a pediatrician at the University of Colorado, replied when I asked him how he felt going into the school year. This fall was supposed to herald the return of in-person classes everywhere. After the virus brought the 2020 spring semester to an abrupt halt, schools fumbled through another year with a mix of in-person and virtual learning. Now Delta threatens to wreak havoc on a third school year. The risk the coronavirus poses to an individual child is still very low--fewer than 1 percent of sick kids need ICU treatment—and with millions of the most vulnerable adults now vaccinated, the danger of kids bringing the virus home from schools is also much reduced from last year. But Delta will make for a bumpy school year even without very sick kids. Students who get infected or even just exposed at school will have to miss classes to isolate or quarantine for seven to 14 days at a time. And if cases truly get out of control, schools will have to shut down and return to remote learning. Parents will again have to scramble for last-minute child care. The fewer mitigations a school has in place—masks, testing, ventilation, vaccination for students over 12—the more likely this is to happen. “Not using those measures is a surefire way to mean more kids have to be out of school and have interruptions due to quarantine and individual school closures,” says Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. At just one school district in Florida, a state that has banned mask mandates, 8,400 students were in quarantine or isolation after one week of school. In Alabama, some districts are already being forced back to virtual learning. [Read: Delta is bad news for kids] Parents had hoped that this school year would go smoothly—even somewhat normally. Last year’s experiences suggested that schools could indeed stay open with the right mitigations and low community spread. “The big takeaway was: With moderate efforts, we could pretty much control transmission pretty well,” says Alyssa Bilinski, a public-health researcher at Brown University who has modeled COVID-19 in schools. Cases dropped to an all-time national low in June, and things looked good—until Delta. Now schools have to deal with a more transmissible variant and more community transmission of the virus. This is “not how we were planning to go back to school,” Bilinski says. School districts, especially those bound by state laws banning mask mandates, have been slow to adapt to a steep rise in community transmission. Delta does not require a complete overhaul of school mitigation strategies compared with last year. The same tools still work. “Delta may be more transmissible, but it can’t defy the laws of physics,” says Amanda Simanek, a public-health researcher at the University of Wisconsin at Milwaukee. “We have a good sense of how successful mitigations were with other variants that weren’t as transmissible. We’re going in not totally blind.” But with Delta, schools may have to add measures to reduce spread to the same level as before. “There’s no single intervention that’s the magic bullet, but a set of layered interventions can work together to stop COVID. I would say it’s still true for Delta. It’s just that you need more,” says Meagan Fitzpatrick, an infectious-disease modeler at the University of Maryland School of Medicine. For example, schools might layer on surveillance testing of students without symptoms—Baltimore has such a program, but it’s still rare in schools across the country. And vaccines for teachers and students over 12 are new tools that were unavailable last year. O’Leary told me he is “very optimistic, even with the Delta variant,” about schools that have mitigation measures in place. The problem, however, is that many schools across the country are doing less rather than more. Nine states have passed bans on mask mandates. And with less remote learning and more kids in school this year, as well as a more transmissible variant, the United States is almost certainly going to see more cases among students than last year. [Read: Delta has changed pandemic risk calculus] “We’re really nervous and quite disappointed,” Kendra Babitz, the COVID-19 state testing director for the Utah Department of Health, told me this week. I reached out to Babitz because Utah had pioneered a“test to stay” scheme last year, in which exposed students who tested negative on a rapid antigen test and had no symptoms were allowed to return to school instead of quarantining for 10 days. The CDC published a report highlighting the success of the program, and epidemiologists have pointed to it as a model for other schools. Utah’s legislature even passed a bill requiring “test to stay” in schools. However, that same legislature also banned school districts from requiring masks, which were required in Utah schools last year. Because case rates in the state are already higher than last fall’s and still rising, Babitz is worried. The “test to stay” plan is triggered when a certain number of students in a school test positive over a two-week period. With so much spread in the community, “our worst-case scenario that we’re planning for is to test roughly 30 percent of the state’s schools within a work week, which would be around 300 schools,” she said. She currently doesn’t have the staff to go and test tens of thousands of students in 300 schools. Without other measures in place, the testing system is overwhelmed. “We’ve been reduced to just ‘test to stay,’” she said. “This was never meant to be an end-all, be-all prevention measure.” In the U.S.’s fragmented public-health system, no single entity is responsible for authorizing vaccines and monitoring variants and deciding school-reopening plans. That means we’ve landed in an extremely frustrating situation where unvaccinated kids are going back to school amid a Delta wave. Communities with high adult vaccination rates and detailed school mitigation plans are the best positioned to weather it. Those without are heading into another very rocky school year. from https://ift.tt/3zbjabN Check out http://natthash.tumblr.com Are you someone who enjoys the unsolicited opinions of strangers and acquaintances? If so, I can’t recommend cancer highly enough. You won’t even have the first pathology report in your hands before the advice comes pouring in. Laugh and the world laughs with you; get cancer and the world can’t shut its trap. Stop eating sugar; keep up your weight with milkshakes. Listen to a recent story on NPR; do not read a recent story in Time magazine. Exercise—but not too vigorously; exercise--hard, like Lance Armstrong. Join a support group, make a collage, make a collage in a support group, collage the shit out of your cancer. Do you live near a freeway or drink tap water or eat food microwaved on plastic plates? That’s what caused it. Do you ever think about suing? Do you ever wonder whether, if you’d just let some time pass, the cancer would have gone away on its own? Before I got cancer, I thought I understood how the world worked, or at least the parts that I needed to know about. But when I got cancer, my body broke down so catastrophically that I stopped trusting what I thought and believed. I felt that I had to listen when people told me what to do, because clearly I didn’t know anything. Much of the advice was bewildering, and all of it was anxiety-producing. In the end, because so many people contradicted one another, I was able to ignore most of them. But there was one warning I heard from a huge number of people, almost every day, and sometimes two or three times a day: I had to stay positive. People who beat cancer have a great positive attitude. It’s what distinguishes the survivors from the dead. There are books about how to develop the positive attitude that beats cancer, and meditation tapes to help you visualize your tumors melting away. Friends and acquaintances would send me these books and tapes—and they would send them to my husband, too. We were both anxious and willing to do anything in our control. But after a terrible diagnosis, a failed surgery, a successful surgery, and the beginning of chemotherapy, I just wasn’t feeling very … up. At the end of another terrible day, my husband would gently ask me to sit in the living room so that I could meditate and think positive thoughts. I was nauseated from the drugs, tired, and terrified that I would leave my little boys without a mother. All I wanted to do was take my Ativan and sleep. But I couldn’t do that. If I didn’t change my attitude, I was going to die. People get diagnosed with cancer in different ways. Some have a family history, and their doctors monitor them for years. Others have symptoms for so long that the eventual diagnosis is more of a terrible confirmation than a shock. And then there are people like me, people who are going about their busy lives when they push open the door of a familiar medical building for a routine appointment and step into an empty elevator shaft. The afternoon in 2003 that I found out I had aggressive breast cancer, my boys were almost 5. The biggest thing on my mind was getting the mammogram over with early enough that I could pick up some groceries before the babysitter had to go home. I put on the short, pink paper gown and thought about dinner. And then everything started happening really fast. Suddenly there was the need for a second set of films, then a sonogram, then the sharp pinch of a needle. In my last fully conscious moment as the person I once was, I remember asking the doctor if I should have a biopsy. The reason I asked was so that he could look away from the screen, realize that he’d scared me, and reassure me. “No, no,” he would say; “it’s completely benign.” But he didn’t say that. He said, “That’s what we’re doing right now.” Later I would wonder why the doctor hadn’t asked my permission for the needle biopsy. The answer was that I had already passed through the border station that separates the healthy from the ill. The medical community and I were on new terms. [Read: I Thought Stage IV Cancer Was Bad Enough] The doctor could see that I was in shock, and he seemed pretty rattled himself. He kept saying that he should call my husband. “You need to prepare yourself,” he said, twice. And once: “It’s aggressive.” But I didn’t want him to call my husband. I wanted to tear off my paper gown and never see that doctor, his office, or even the street where the building was located ever again. I had a mute, animal need to get the hell out of there. The news was so bad, and it kept getting worse. I couldn’t think straight. My little boys were so small. They were my life, and they needed me. Three weeks later, I was in the infusion center. Ask Google “What is the worst chemotherapy drug?” and the answer is doxorubicin. That’s what I got, as well as some other noxious pharmaceuticals. That oncologist filled me and my fellow patients up with so much poison that the sign on the bathrooms said we had to flush twice to make sure every trace was gone before a healthy person—a nurse, or a family member—could use the toilet. I was not allowed to hug my children for the first 24 hours after treatment, and in the midst of this absolute hell—in the midst of the poison and the crying and the sorrow and the terror—I was supposed to get a really great positive attitude. The book we were given several copies of, which was first published in 1986 and has been reissued several times since, is titled Love, Medicine and Miracles and was written by a pediatric surgeon named Bernie Siegel. He seems less interested in exceptional scientific advances than in “exceptional patients.” To be exceptional, you have to tell your body that you want to live; you have to say “No way” to any doctor who says you have a fatal illness. You have to become a channel of perfect self-love, and remember that “the simple truth is, happy people generally don't get sick.” Old angers or disappointments can congeal into cancer. You need to get rid of those emotions, or they will kill you. In 1989 a Stanford psychiatrist named David Spiegel published a study of women with metastatic breast cancer. He created a support group for half the women, whom he taught self-hypnosis. The other women got no extra social support. The results were remarkable: Spiegel reported that the women in the group survived twice as long as the other women. This study was hugely influential in modern beliefs about meditation and cancer survival. It showed up in the books my husband read to me, which were filled with other stories of miraculous healings, of patients defying the odds though their own emotional work. But I was so far behind. From the beginning I couldn’t stop crying. I began to think I was hopeless and would never survive. I needed help, and I remembered a woman my husband and I had talked to in the first week after my diagnosis. Both of us had found in those conversations our only experience of calm, our only reassurance that we were doing the right things. Anne Coscarelli is a clinical psychologist and the founder of the Simms/Mann-UCLA Center for Integrative Oncology, which helps patients and their families cope with the trauma of cancer. We had reached out to her when we were trying to understand my diagnosis. Now I needed her for much more. For the first half hour in her office, we just talked about how sick I felt and how frightened I was. Then—nervously—I confessed: I wasn’t doing the work of healing myself. I wasn’t being positive. “Why do you need to be positive?” she asked in a neutral voice. I thought it should be obvious, but I explained: Because I didn’t want to die! Coscarelli remained just as neutral and said, “There isn’t a single bit of evidence that having a positive attitude helps heal cancer.” What? That couldn’t possibly be right. How did she know that? “They study it all the time,” she said. “It’s not true.” David Spiegel was never able to replicate his findings about metastatic breast cancer. The American Cancer Society and the National Center for Complementary and Integrative Health say there’s no evidence that meditation or support groups increase survival rates. They can do all sorts of wonderful things, like reducing stress and allowing you to live in the moment instead of worrying about the next scan. I’ve learned, whenever I start to get scared, to do some yoga-type breathing with my eyes closed until I get bored. If I’m bored, I’m not scared, so then I open my eyes again. But I’m not alive today because of deep breathing. When I began to understand that attitude doesn’t have anything to do with survival, I felt myself coming up out of deep water. I didn’t cause my cancer by having a bad attitude, and I wasn’t going to cure it by having a good one. And then Coscarelli told me the whole truth about cancer. If you’re ready, I will tell it to you. Cancer occurs when a group of cells divide in rapid and abnormal ways. Treatments are successful if they interfere with that process. That’s it, that’s the whole equation. Everyone with cancer has a different experience, and different beliefs about what will help. I feel strongly that these beliefs should be respected—including the feelings of those who decide not to have any treatment at all. It’s sadism to learn that someone is dangerously ill and to impose upon her your own set of unproven assumptions, especially ones that blame the patient for getting sick in the first place. That meeting with Anne Coscarelli took place 18 years ago, and never once since then have I worried that my attitude was going to kill me. I’ve had several recurrences, all of them significant, but I’m still here, typing and drinking a Coke and not feeling super upbeat. Before I left that meeting, I asked her one last question: Maybe I couldn’t think my way out of cancer, but wasn’t it still important to be as good a person as I could be? Wouldn’t that karma improve my odds a little bit? Coscarelli told me that, over the years, many wonderful and generous women had come to her clinic, and some of them had died very quickly. Yikes. I had to come clean: Not only was I un-wonderful. I was also kind of a bitch. God love her, she came through with exactly what I needed to hear: “I’ve seen some of the biggest bitches come in, and they’re still alive.” And that, my friends, was when I had my very first positive thought. I imagined all those bitches getting healthy, and I said to myself, I think I’m going to beat this thing. from https://ift.tt/3D83vw1 Check out http://natthash.tumblr.com Last week, the psychologist Steven Taylor was at a socially distanced get-together with some relatives and their friends when the conversation turned to the chaos in Afghanistan. Someone mentioned the sickening footage of desperate Afghans clinging to American military aircraft as they departed. Then one man made a remark that caught Taylor off guard: The videos, he said, were funny. Others agreed. Taylor was appalled. It was one of the most disturbing things he’d heard all week. Worse, he doesn’t think it was an isolated instance of casual sadism. Taylor studies disaster psychology at the University of British Columbia, and he knows how intense, sustained stress can desensitize the mind. What most concerned him about the incident was what it suggested about the pandemic’s effects on our experience of other disasters and, more broadly, our ability—or inability—to empathize. For the better part of two years now, the world has been living through a pandemic. The suffering has not been parceled out evenly, but virtually everyone has felt the pain in one way or another. Meanwhile, the world’s baseline drumbeat of catastrophe has not faltered. Wildfires have filled the skies with smoke; earthquakes have leveled cities; buildings have collapsed without warning. It is worth asking, then, how, if at all, the most universal of disasters is changing the way we process these crises—and how we’ll react to disasters for the rest of our lives. [Read: A mental-health crisis is burning across the American West] The question is really two questions: one about the victims of future catastrophes and the other about the observers who will watch those catastrophes play out from a safe remove. The first question, at least, has a fairly straightforward answer. After surviving a disaster, Taylor told me, a minority of people become more resilient, so that, should another disaster strike, they are better able to cope. For most people, though, the stress compounds: Surviving one crisis puts one at greater risk of having an unhealthy psychological reaction to another. In California, a state that now burns on an annual schedule, wildfire survivors I’ve spoken with have described feeling “haunted” by subsequent blazes. “There is a sense in which people’s coping reserves are sort of finite entities,” says Joe Ruzek, a PTSD researcher at Palo Alto University. “So if you have to cope a whole lot”—as so many people have over the past year and a half—“you can kind of diminish your resources.” In this way, the pandemic has left everyone more vulnerable to the psychological effects of tomorrow’s earthquakes, mass shootings, and pandemics. [Read: Two disasters are exponentially worse than one] The second question is trickier. For those of us lucky enough to observe a disaster from afar, the experience of having lived through one before could make us more empathetic toward the survivors. Or it could leave us fatigued to the point of inurement, like the people who said at Taylor’s get-together that they found the Afghanistan videos funny. At this point, psychologists told me, which of those effects prevails is anyone’s guess. In his research on post-disaster empathy, Kang Lee, a developmental neuroscientist at the University of Toronto, has found that children as young as 9 can become more generous in the aftermath of disasters. The caveat, he says, is that most studies in the area have focused on short-term disasters with well-defined beginnings and ends, such as earthquakes. Few, if any, look at long, drawn-out disasters, like pandemics. “This,” he says, “is very new to psychologists.” [Read: This is not a normal mental-health disaster] To gauge the pandemic’s effects on generosity, Lee suggests looking at data on charitable giving—an imperfect but nonetheless useful barometer. Sure enough, in 2020, despite a severe economic downturn and mass unemployment, donations in the United States hit an all-time high. But philanthropy experts predict a return to normal this year, which would mirror Lee’s findings on kids and shorter-term crises: Over time, he and his colleagues observed, children tend to revert to their regular levels of generosity. He suspects that in the later phases and aftermath of a pandemic, with its roller-coaster trajectory and vertiginous uncertainty, people may be less inclined toward empathy. This could be especially true when the people in need of empathy are far away from the people with the resources to help—say, in Haiti or Afghanistan. In unpublished research, Lee has found that racial and national biases tend to sharpen after disasters. When humans’ reserves of generosity run low, we give what little we have to people who look like and live where we do. Perhaps when they run low enough, we can even laugh at fleeing masses clinging to an airplane on the other side of the world. People “are just burned out,” Taylor said. “They’ve had enough atrocity and stress for the time being, and they just don’t want to hear any more of that.” He doesn’t think the people he encountered last week are unique. “My concern,” he said, “is that many people are just tuning this stuff out.” If that is the case, if fatigue is in fact swamping empathy, it would be a darkly ironic outcome: the disaster survivors more vulnerable than ever to trauma, the onlookers less willing than ever to help. Whether this comes to pass in the immediate future, Lee, for one, does not much worry about more extreme coldheartedness calcifying into the norm. In his research, he has found disasters’ effects on empathy to be short-lived. If he’s right, then the pandemic is unlikely to change us, at least in this particular way. We will neither be more inured nor more attuned to the suffering of others. And that is both very reassuring and not reassuring at all. from https://ift.tt/3gov2zx Check out http://natthash.tumblr.com For the past year and a half, humans around the world have been asked to do something we’re pretty bad at, even in the best of circumstances: figure out what constitutes safety, and act accordingly. A well-understood risk doesn’t necessarily improve our thought processes, thanks to a host of cognitive biases and external pressures that pull some people away from the lowest-level danger and push others toward clear peril. In the United States, at least, the circumstances for making these decisions during the pandemic have been far from ideal, as millions of people have been yanked in either direction by misinformation or political stratification or financial necessity. Vaccination was a reprieve from this calculus of personal danger, at least for a while—get vaccinated, get your family and friends vaccinated, get back to a far more normal version of life. To a certain extent, that logic holds: The vaccines are still doing a fantastic job preventing hospitalization and death from the coronavirus’s far-more-transmissible Delta variant. But as COVID-19 cases and hospitalizations have roared back, concerns about breakthrough cases among the vaccinated and increased transmissibility among kids have muddied a lot of people’s ability to gauge their own day-to-day risk, just as they’d begun to venture back out into the world and hug, eat, and laugh in the same airspace together again. In some ways, pandemic life is more confusing than ever. What makes our current moment tricky is that pandemic risk has never been more highly variable, which means the list of things to consider about any given situation is longer and has fewer hard-and-fast rules. Vaccinated people are still far safer than they’ve been for most of the past year and a half, and the unvaccinated are in even more danger than they were in March 2020. The Delta variant is, in some respects, a whole new ball game. What rules are we playing by now? Delta behaves differently from those that came before it in key ways: It spreads between people far more effectively, it seems more likely to cause a contagious “breakthrough infection” in vaccinated people, and it appears to spread more readily and lead to symptomatic disease more often among kids too young to be vaccinated. Whether Delta causes more virulent disease is, for now, an open question. We’ll get to more open questions shortly. Because of these differences, there are two categories of things you should consider when you contemplate booking a vacation or responding to a wedding invite. The first is what you might reasonably know about your situation and the event at hand. “It’s your vaccination, and then the vaccination levels of people around you, and then the disease rates happening around you,” Tara Kirk Sell, a researcher who studies risk communication at the Johns Hopkins Center for Health Security, told me. “Do you have kids or not? Are they going to school?” All these types of questions, she said, help paint a picture of the potential danger you might represent to unprotected people around you, should you get sick. The less likely you are to be exposed and the fewer unvaccinated or immunocompromised people you could conceivably infect, the more confident you should feel. Assessing risk pre-vaccination was often bleak, but at least the variables at play were somewhat limited: ventilation, masks, crowds, local spread. Now the number of additional, usually hyper-specific questions that people must ask themselves is itself a barrier to good decision making, says Jennifer Taber, a psychologist at Kent State University who studies health risk assessment. “When people feel like things are uncertain, they engage in avoidance,” Taber told me. That can manifest in disparate ways. An unwillingness to acknowledge that many new things are safe for the average vaccinated person is avoidance. So is a refusal to continue taking even minor precautions for the benefit of others. All this is made worse given that accurate answers to risk-related questions can be frustrating to gather and difficult to parse, especially in places where local governments limit data collection, and where admitting to being vaccinated can be social apostasy. “There are so many things that make it harder, and not a lot of things that make it easier right now,” Taber said. “Even within the context of good information, there’s so much uncertainty that it makes it really hard for people to make really well-informed decisions.” That brings us to the second, murkier category of information to consider when gauging the safety of a situation: What do we actually know about the Delta variant and the risks it presents? The situation is, unfortunately, evolving. Because the United States is testing at only a fraction of the rate of countries such as Israel and the U.K.—stop me if this is giving you flashbacks to the spring of 2020—the frustrating reality is that we just do not have a reliable picture of how much infection is currently happening here. When you don’t have an accurate denominator on which to base things such as rate of breakthrough, hospitalization, or death, you have a pretty useless fraction. (Unfortunately, for similar reasons, we are also short on accurate numerators—the CDC is not tracking things like breakthrough infections, and state-level data are sparse.) [Read: The messiest phase of the pandemic yet] Unvaccinated people tend to be clustered both geographically and socially in the United States, and so national or even state-level rates of vaccination are not terribly useful in understanding personal risk. The catastrophic spikes in infection currently devastating places with low vaccination rates such as southern Louisiana and southeastern Missouri change how even vaccinated people in those places should think about socializing or traveling, relative to their counterparts in places with high community buy-in on vaccines. Because they are far more likely to be exposed to the virus than someone living in, say, Vermont or Maine, the knock-on effect is a far greater likelihood of spreading the infection to others. And as Florida’s current outbreak makes clear, even middle-of-the-road statewide vaccination rates will not be enough to dampen Delta’s spread on their own. These gaps in information and state-by-state discrepancies make any sort of risk generalizations difficult, if not counterproductive. What we do know is that vaccination remains the best way to stay healthy, by far: According to a survey of hospitals from ABC News, 94 percent of COVID-19 patients in ICUs at the end of July were unvaccinated, and most of the rest had health problems that likely contributed to decreased vaccine effectiveness. Young, healthy vaccinated people who are working in person or socializing in crowds should take precautions around elderly or immunocompromised friends and family, even if they are also vaccinated, but overall, vaccinated people still can feel quite confident in their personal safety. How the vaccines are doing against any level of infection is less clear. The most recent and comprehensive data available—from the U.K.—suggest that current vaccine regimens are somewhat less effective against Delta than against previous strains of the virus, but the difference isn’t enormous. If that information feels at odds with reports you’ve heard about breakthrough infections in the U.S., it isn’t necessarily—uncontrolled spread of a highly infectious disease means that even relatively uncommon events are going to happen in pretty large numbers. Speaking of breakthroughs: One thing that needs to be accounted for is the potential of infecting others if you become sick, even after getting vaccinated. A few weeks ago, the CDC raised eyebrows by estimating that vaccinated people who manage to get infected by Delta may produce the same amount of virus in their nose as unvaccinated, Delta-infected people do—an unexpected sign that vaccinated people could be equally contagious when infected. But the agency’s analysis was based on specific and fairly extreme circumstances: an outbreak in Provincetown, Massachusetts, among a mostly vaccinated group during a week of festivities in which people crowded into old, poorly ventilated buildings. A large analysis of Delta transmission in the U.K. found that vaccinated people carry, on average, lower levels of virus in their nose, which suggests less ability to transmit the virus; a recent study from Singapore found that vaccinated patients were able to clear the virus much faster, shortening the number of days during which they might be contagious. (Although no data are available quite yet, the efficiency with which vaccinated people clear the virus is also thought to make the sometimes severe post-viral COVID-19 symptoms commonly known as long COVID considerably less likely, by preventing the illness from settling in the lungs.) What must be acknowledged now, a year and a half into the pandemic, is that COVID-19 is not the only risk that people need to balance. Forgoing regular socializing, routine medical checkups, and in-person schooling might be worthwhile in the short term, but abstaining from all of those things in perpetuity comes with its own dangers. “What we’ve given up is not nothing,” Kirk Sell told me. “Something that has been lost in the past year and a half are the trade-offs, and the introduction of readily available and highly effective vaccines and some people’s refusal to get them just makes all of this internal math so much trickier.” As someone who studies risk communication, she said, she hates the phrase “an abundance of caution.” If you find yourself determining that things you want to do are pretty low-risk and still shy away from them, you’re likely cutting yourself off from opportunities that may provide significant health benefits, such as getting out to exercise or resuming regular social relationships with vaccinated friends and family. Kirk Sell uses her own decision calculus as an example of what those kinds of evaluations might look like: She thinks it’s very important for her kids to have school in person, even though they are too young to be vaccinated, but she is also actively lobbying the school to implement ways to make that safer, such as enhanced ventilation and filtration. For parents whose kids did relatively well in Zoom school or whose community is in the middle of a serious outbreak, she says, the best conclusion might be a different one, and it might change for any parent as the school year progresses and local case rates go up and down. Try thinking about precautions in non-pandemic terms, Kirk Sell advises. Every day, people follow safety rules that might not be personally necessary for them, but that also aren’t onerous enough to be harmful—doing so is simply part of living in a society in which you share norms and risk with those around you. “I can swim, but when I go out kayaking, I still wear a life jacket, because it’s required as a general safety approach,” she explained. “Just because you are safe doesn’t mean you don’t have any rules to follow anymore.” This is, perhaps, somewhat understating it: Before Kirk Sell was a scholar, she was an Olympic-medalist swimmer who held the world record in the 100-meter breaststroke. There are few people on Earth at less personal risk from tipping out of a kayak. So, yes, you can probably find it within yourself to continue to wear a mask at the grocery store if the infection rate is growing in your area. You probably do other stuff on that same logic all the time. If you have read all this hoping to get some solid answers on what you should be doing and now feel like it would have been easier for me to publish, say, a shruggy emoji, I sympathize. It can be difficult to feel like you’re doing the right thing when what that means is so different from person to person, depending on their particular circumstances. People frequently use the behavior of those around them to guide their own understanding of risk, Taber told me, and the fact that everyone around you now has a whole host of personal circumstances to consider when making their own decisions can short-circuit our ability to do that as confidently as we might have a year ago. Americans will likely be riding this roller coaster of risk assessment for some time. Periods of confusion are natural as we learn what waves of the Delta variant under the country’s modest-at-best safety protocols look like, and we’ve yet to see how swiftly the next wave can be expected after one ends. People are tired of good behavior, and they’re tired of self-abnegating to protect others whom they perceive as refusing to protect themselves, even if that’s not an accurate understanding of why many people have yet to be vaccinated. Right now, the best that most people can do is continue to control whichever straightforward variables they can—get vaccinated, sit outside when possible, choose places that require proof of vaccination over those that don’t, avoid visiting Grandma or your cousin’s new baby the week after attending an indoor concert with a thousand screaming people, get a test if your throat is sore. The situation we’re all in is extremely complicated, but the best ways to keep yourself and others safe still aren’t. from https://ift.tt/2XHMpFj Check out http://natthash.tumblr.com On the first day of school last week, Kelly Carothers picked up her 5-year-old twins from the bus stop and noticed that the kids weren’t wearing their masks. “It’s hot on the bus,” they explained, “and no one else was wearing one.” She asked if they had worn them throughout the school day. “Well,” they said, “sometimes.” The incident confirmed Carothers’ worst fears about this school year. Public-school students in her Florida county, Hillsborough, are technically required to wear masks to school. But in an attempt to please everyone, parents may opt their kids out of mask wearing by signing a form. Masks also remain optional for teachers. According to Carothers, some of the parents in her kids’ classes have signed the mask waiver, and their kids roam around blissfully mask-free. That’s concerning, because only about half the people who are eligible for vaccines in the county are fully vaccinated, and COVID-19 is spreading widely in Florida. “The kids are sitting ducks,” Carothers told me. Carothers struggles to get her son in particular to wear his mask when other kids don’t. “I just feel like it’s all but inevitable that he’s going to get COVID.” So far, more than 500 students in the district have tested positive for COVID-19 this month. Nearly 5,600 students in the district, the seventh largest in the nation, were in isolation or quarantine as of Monday, prompting the school board to schedule an emergency meeting later today. (In response to a request for comment, a school-district spokesperson said, “Students are required to wear masks at school and on the bus, unless a parent fills out an opt-out form. We, as well as all other school districts in Florida, must follow Governor Ron DeSantis’ Executive Order that preserves a parent’s right to choose when it comes to whether their child will wear a mask to school, and also prohibits school districts from issuing blanket mask mandates.”) Carothers considered homeschooling, but neither she nor her husband can quit their jobs. And she feels like her kids need the socializing thrum of public school. So instead, the kids don’t go to restaurants. They don’t go to movie theaters. They wear masks in public, even though people have yelled at Carothers for being a “child abuser” as a result. On school days, as she sends her twins off to a building filled with other humans and their mucous membranes, she has tried to push past her own memories of getting COVID-19 in December. For parents like Carothers, this is the most stressful back-to-school season ever. Right now, many parents feel they face a set of impossible choices: Many districts don’t have a virtual-school option. They aren’t mandating that students wear masks. And they are in areas where very few people are vaccinated or wearing masks regularly. Unvaccinated parents in these communities might pass COVID-19 to their kids. If they’re unmasked, kids might spread it to one another, and possibly to their own parents. Some vaccinated parents might even be willing to take that risk—except for the fact that kids under 12 can’t be vaccinated yet. In Michigan, a man named Dave has been buying hundreds of child-size N95 masks in preparation for his 6-year-old to return to a school without a mask mandate. “When I read the announcement from the principal that they were not going to require masks,” he told me, “I was almost beside myself.” (He requested I not use his full name, because he doesn’t want to criticize his son’s school publicly.) Though the overall risk that children will be hospitalized or killed by COVID-19 remains low, the Delta variant is more transmissible, and it has been sending more children into pediatric wards in recent weeks. Because children are one of the few populations that are still not able to be vaccinated, kids now make up almost a fifth of all total COVID-19 infections, as my colleague Katherine J. Wu reported last week. Even parents whose kids are vaccinated feel uneasy. In Mason, Michigan, where 55 percent of people over 12 are vaccinated, Amy Lark plans to drive her vaccinated 13-year-old to school instead of letting her take the bus. Lark has several chronic illnesses, and she’s worried that her daughter could catch the disease at school, where there is no mask mandate, and bring it home. Most of the parents I talked with realize that their kids will probably be fine: Fewer than 400 kids have died of COVID-19 so far. They hope and pray that their fears are not warranted. But after more than a year of screaming headlines about the threat of COVID-19, it’s hard to shelve those worries and send your little one into the hot zone with a lunch box and a wet wipe. “Human perception dictates fears, not rationality,” says Alan Kazdin, a child psychologist at Yale. “Our fears do not rely on the data. They rely on our perception of danger, our perception of the consequences.” This is why people fear shark attacks more than car accidents. Still, the risk of COVID-19 transmission is undeniably reduced when everyone is masked. The anti-mandate crowd frames masks as an issue of “parents’ choice,” but child psychology being what it is, kids are unlikely to wear masks unless everyone else is doing so. A man named Kyle in Iowa told me that his 15-year-old was bullied last year for wearing a mask to school. (I am only using his first name to avoid jeopardizing his wife’s job.) Kids said the only reason his daughter was wearing one was because she was a “Democrat who created the fake disease.” Parents in politically mixed or conservative communities have few options other than to mask their own children and hope for the best. Several governors have banned mask mandates, and though some localities have successfully challenged those bans in court, not all have done so. Though most parents endorse mask mandates for kids, Republicans are much less likely to support such mandates than Democrats are. In a recent Atlantic/Leger poll, Biden voters were much more likely than Trump voters to say both that they are currently wearing masks indoors and that kids should, too. Just 28 percent of Trump voters said they thought kids under 12 should have to wear masks in schools, compared with 84 percent of Biden voters. Whenever masks come up, dull school-board meetings have transformed into primal-scream gatherings for cooped-up internet MDs. Videos circulating online show anti-mask parents shouting at school-board members, crying, and wielding signs that say fear is the true virus. People have held up pictures of supposed mask bacteria; people have randomly yelled about “discrimination” and “child abuse”; people have been escorted out of board meetings. A Wisconsin reporter dryly noted that “audience members often interrupted the very speaker they were cheering for.” Kazdin, the psychologist, says anti-maskers are exhibiting “reactance,” an irrationally defiant response to being told what to do. COVID-19 precautions overlap with partisanship, to the extent that some pro-mask parents refused to tell me their political affiliation in an effort to avoid inflaming things further. Republican Representative Madison Cawthorn made an appearance at one recent school-board meeting in North Carolina, claiming that “woke, liberal government officials” are a bigger threat to children than COVID-19. In a parking lot in Franklin, Tennessee, angry parents shouted “We will not comply” and harassed medical professionals who spoke in favor of masks. “You will never be allowed in public again!” one man screamed. Last week, a California parent allegedly physically attacked a teacher over the school’s mask rules. Pro-mask parents have staged protests too, of course. But some have thrown up their hands and pulled their kids out of school. In Texas, homeschooling was already on the rise prior to this year. In 2020, the Texas Home School Coalition received a record 1,100 calls and emails from interested parents. This year, interest in homeschooling has only grown. “Last week, we hit 2,200” calls and emails, Jeremy Newman, the director of public policy at the coalition, told me recently. “It’s double the highest we ever had in 2020.” Newman said the parents are motivated by a mix of reasons: Some don’t want their kids to face more COVID-19 restrictions in public schools, but others are worried their kids’ schools aren’t being careful enough. “There are certainly a lot of families who tell us that they would never have considered homeschooling, but now they’re going to do it,” Newman said. The trend is similar nationally: The membership of the Home School Legal Defense Association, the largest national homeschooling organization, grew from 84,439 in 2019 to 105,000 this year. Many parents I spoke with considered homeschooling but didn’t want to quit their jobs or yank their kids away from their friends. Some are instead begging their neighbors to get vaccinated. Carothers nagged her nanny to get the jab. In Alabama, a man named Will, who asked that I don’t use his full name to avoid blowback at work, told me he’s still imploring a hesitant friend who is waiting for full FDA approval. “Are you gonna get it after it’s FDA-approved or is there gonna be a new reason?” he wondered. Others are taking even more drastic measures. Pranish Kantesaria, a doctor and pharmacist in the Austin area, told me he offended his daughter’s second-grade teacher when he asked whether she was vaccinated and whether she’d be encouraging mask use in the classroom. Though the school moved his daughter to a new classroom, Kantesaria is now looking to “flee the state,” as he puts it, to a place that takes COVID-19 more seriously. He pointed me to a joke he saw on Twitter: “You can live in a place that has affordable housing, warm weather, or a government that cares whether you live or die. Pick two.” In the absence of mask mandates, Kazdin recommends another tool of psychology that might help ease these tensions. Schools could try telling students that although masks are not required, the majority of students will be wearing them. Facts, reason, and rules aren’t very persuasive, he says, but social norms are. Teens know it as one of the most powerful forces in the world: peer pressure. from https://ift.tt/2XDDoNm Check out http://natthash.tumblr.com At this point, COVID-19 booster shots seem all but guaranteed for Americans. Last night, The New York Times and The Wall Street Journal reported that the White House plans to recommend a third dose of COVID-19 vaccine to most Americans who have already gotten two shots from Pfizer or Moderna. The news comes just five days after the FDA authorized third doses for people who have received organ transplants or have certain immune conditions. White House officials told the Times and the Journal that the upcoming recommendations, which might be announced as early as tomorrow, will apply to people who are at least eight months out from their second dose, and that the third shots likely won’t be available before September. But here’s the thing: Right now, not much is stopping people who have the inclination, time, money, and tolerance of dishonesty from driving to a pharmacy to get another jab. Vanity Fair recently reported that people have snuck a third dose by driving out of state or concealing their identity. Last week, ABC News revealed that an internal CDC memo estimated that at least 1 million Americans have already gotten a third shot—and that was before either announcement. All of this raises a thorny question for young, healthy Americans who are already vaccinated but concerned about breakthrough COVID-19 cases and the rapid spread of the Delta variant: If three-dose regimens are inevitable, why wait until eight months after your second one—or even a few weeks from now? I put this question to four experts in public health and immunology, and all of them told me that jumping the line probably won’t hurt you. But for a number of reasons, it simply isn’t worth it for many people. Perhaps the most straightforward argument against getting an illicit extra shot is that the public doesn’t have enough data yet to be certain that it’ll make a difference, especially for people who have already had a two-dose mRNA regimen. Immunologists do broadly believe that boosting could offer some added protection in the short term, Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. That’s not nothing, especially during a significant surge in the pandemic. But our outlook is limited by the fact that there’s virtually no data so far on whether non-immunocompromised people stand to gain any long-term protection. Pfizer shared some preliminary data from their clinical trials of booster shots in a recent earnings call, but they only show levels of antibodies in the blood—an imperfect proxy for how protected people actually are from sickness—and only track participants for a month after their third dose. Ellebedy would like to see six months’ worth of clinical data in order to make a judgment about whether the third shot truly changes things. If those data become available before you’re eligible, you probably still won’t want to finagle your way into a dose before your turn, because skipping the line conceivably could hurt your protection in at least one way. Marion Pepper, an immunologist at the University of Washington, told me that overstimulating the immune system can make your body less adept at fighting off certain infections; scientists haven’t yet figured out whether that’s true for COVID-19, but Pepper sees it all the time in her work on malaria. Your immune system “needs some time and space to calm down in between seeing one infection and the next one” so that it can hone its pathogen-detection skills, Pepper said. Hitting it with another vaccine before it’s ready might not make it any better at fighting the coronavirus. (For immunocompromised people, whose bodies likely didn’t produce enough of an inflammatory response to get sufficient protection from their first two shots, this isn’t as much of a concern. “The priority there is to let them get their immunity at a good level,” Ellebedy said.) Why the White House is reportedly recommending an eight-month timeline is not yet clear. “I was concerned to see the statements last night coming from the White House” rather than career scientists at the FDA or the CDC, Jason Schwartz, of the Yale School of Public Health, told me. Decisions about dosing, timing, and the like are “best left to the scientific officials who have the right skills and tools to think about the evidence,” he said. (White House Press Secretary Jen Psaki said during a press briefing today that the administration will “discuss next steps as it relates to boosters” tomorrow. A White House spokesperson declined to comment further to The Atlantic.) Yesterday’s reports were met with fierce pushback from many public-health experts, who objected to a policy of prioritizing boosters for healthy Americans over first-round shots and more basic interventions even before the news broke. Last week, two epidemiologists wrote in The Washington Post that third shots alone simply don’t have the power to stop the spread of the highly contagious Delta variant, which is now the main driver of coronavirus cases in the United States and worldwide. They could possibly make breakthrough infections less likely, and therefore vaccinated people less likely to spread the virus, but neither Pfizer nor Moderna has proved that publicly. The same number of shots would do much more to tame the pandemic if they were distributed as first and second doses around the world, the Post article showed. That’s not to say that you forgoing a dose will immediately teleport it to a vulnerable person in one of the dozens of countries worldwide where less than 5 percent of the population is fully vaccinated. “Vaccines that are already available and being manufactured here in the United States are not going to be rerouted to global markets right now,” Schwartz said. Even so, healthy, young Americans clamoring for bonus shots is far from the most pandemic-thwarting use of resources. Esther Choo, a professor of emergency medicine at Oregon Health and Science University, recommended that fully vaccinated, non-immunocompromised people who are concerned about their own safety spend their energy advocating for vaccine equity worldwide, which will ultimately protect them too. Faking your way to a third dose can skew data on vaccine efficacy, making it harder for epidemiologists to fight the coronavirus in the long run, Choo told me. If and when the FDA and the CDC do green-light third shots for all, choosing to get one will be a nuanced and personal decision; hopefully, by then, the public will have access to more data to guide them. (And hopefully the agencies will have offered more advice to Americans who got the one-dose Johnson & Johnson vaccine, which may be slightly less effective at preventing infection with the Delta variant than the mRNA options.) Schwartz believes that if people are “following the rules or following guidelines or following the recommendations that had been developed by responsible health authorities,” they “can in good conscience” accept a third dose that’s offered to them. Pepper said that, given her age and health status and all the information available to her right now, she wouldn’t take a third shot unless her hospital recommended it. But, she said, people over the age of 70 or 75 might want to consider it post-authorization, given evidence that antibody counts can start to wane among some older adults after a few months. Choo also told me that, for now, she wouldn’t take another vaccine dose, though she doesn’t begrudge people who want one when it’s offered. If the people around you refuse to mask up, or your Facebook feed is covered in COVID-19 conspiracy theories, “those things are so disempowering,” she said. Getting a third dose might help people feel a little more hope. Ellebedy, like Schwartz, said he would take a shot that’s offered to him, but it’s not really the outcome he wants. He has three kids at home between the ages of 5 and 12—in the group that’s still waiting on a vaccine authorization—and all of them started school today in Missouri, where only 43 percent of people are fully vaccinated. “I will personally take it. I will go. I’ll stand in the line,” he said. But “I would definitely prefer if one of my kids get it before I get a third shot.” from https://ift.tt/3y0siOJ Check out http://natthash.tumblr.com |
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