In the 1980s, doctors at an English hospital deliberately tried to infect 15 volunteers with a coronavirus. COVID-19 did not yet exist—what interested those doctors was a coronavirus in the same family called 229E, which causes the common cold. 229E is both ubiquitous and obscure. Most of us have had it, probably first as children, but the resulting colds were so mild as to be unremarkable. And indeed, of the 15 adult volunteers who got 229E misted up their nose, only 10 became infected, and of those, only eight actually developed cold symptoms. The following year, the doctors repeated their experiment. They tracked down all but one of the original volunteers and sprayed 229E up their nose again. Six of the previously infected became reinfected, but the second time, none developed symptoms. From this, the doctors surmised that immunity against coronavirus infection wanes quickly and reinfections are common. But subsequent infections are milder—even asymptomatic. Not only have most of us likely been infected with 229E before, but we’ve probably been infected more than once. This tiny study made little impression at the time. In the ’80s and ’90s, coronaviruses still belonged to the backwater of viral research, because the colds they caused seemed trivial in the grand scheme of human health. Then, in the spring of 2020, scientists urgently searching for clues to immunity against a novel coronavirus rediscovered this decades-old research. Before the emergence of SARS-CoV-2, which causes COVID-19, only four known coronaviruses were circulating among humans, including 229E. All four of these coronaviruses cause common colds, and in the most optimistic scenario, experts have told me, our newest coronavirus will end up as the fifth. In that case, COVID-19 might look a lot like a cold from 229E--recurrent but largely unremarkable. That future may be hard to imagine with intensive-care units filling up yet again during this Delta surge. But the pandemic will end. One way or another, it will end. The current spikes in cases and deaths are the result of a novel coronavirus meeting naive immune systems. When enough people have gained some immunity through either vaccination or infection—preferably vaccination—the coronavirus will transition to what epidemiologists call “endemic.” It won’t be eliminated, but it won’t upend our lives anymore. With that blanket of initial immunity laid down, there will be fewer hospitalizations and fewer deaths from COVID-19. Boosters can periodically re-up immunity too. Cases may continue to rise and fall in this scenario, perhaps seasonally, but the worst outcomes will be avoided. We don’t know exactly how the four common-cold coronaviruses first came to infect humans, but some have speculated that at least one also began with a pandemic. If immunity to the new coronavirus wanes like it does with these others, then it will keep causing reinfections and breakthrough infections, more and more of them over time, but still mild enough. We’ll have to adjust our thinking about COVID-19 too. The coronavirus is not something we can avoid forever; we have to prepare for the possibility that we will all get exposed one way or another. “This is something we’re going to have to live with,” says Richard Webby, an infectious-disease researcher at St. Jude. “And so long as it’s not impacting health care as a whole, then I think we can.” The coronavirus will no longer be novel—to our immune systems or our society. Endemicity as the COVID-19 endgame seems quite clear, but how we get there is less so. In part, that is because the path depends on us. As my colleague Ed Yong has written, the eventuality of endemic COVID-19 does not mean we should drop all precautions. The more we can flatten the curve now, the less hospitals will become overwhelmed and the more time we buy to vaccinate the unvaccinated, including children. Letting the virus rip through unvaccinated people may get us to endemicity quickest, but it will also kill the most people along the way. The path to endemic COVID-19 will also depend on how much the virus itself continues to mutate. Delta has already derailed summer reopening plans in the U.S. And with so much of the world still vulnerable to infection, the virus has many, many opportunities to luck into new variants that may yet enhance its ability to spread and reinfect. The good news is this virus is unlikely to evolve so much that it sets our immunity back to zero. “Our immune responses are so complex, it’s basically impossible for a virus to escape them all,” says Sarah Cobey, an evolutionary biologist at the University of Chicago. For example, levels of antibodies that quickly neutralize SARS-CoV-2 do indeed drop over time, as happens against most pathogens, but reserves of B cells and T cells that also recognize the virus lie in wait. This means that immunity against infection may wane first, but the protection against severe illness and death are much more durable. [Read: Your vaccinated immune system is ready for breakthroughs] Protection against severe illness and death was, in fact, the original goal of vaccines. When I spoke with vaccine experts as the trials were under way last summer, they universally told me to temper expectations. Vaccines against respiratory viruses rarely protect against full infection because they are better at inducing immunity in the lungs than in the nose, where respiratory viruses gain their first foothold. (Consider: The flu shot is 10 to 60 percent effective depending on the year.) But “the extraordinary efficacy” from the initial clinical trials raised expectations, Ruth Karron, the director of the Center for Immunization Research at Johns Hopkins University, told me. With the Pfizer and Moderna vaccines 95 percent effective against symptomatic infection, eliminating COVID-19 locally, like measles or mumps in the U.S., suddenly seemed possible. Then came the less pleasant surprise: new variants, like Beta, Gamma, and now Delta, that erode some protection from vaccines. “We now are where we thought we would be a year ago,” Karron said. The vaccines still protect against serious illness very well, as expected, but herd immunity again seems out of reach. The virus will continue to circulate, but fewer people will get sick enough to be hospitalized or die. Highly publicized outbreaks among vaccinated people, such as in Provincetown, Massachusetts, already show this pattern playing out. And entire countries with high vaccination rates, such as the U.K., Iceland, and Israel, are also seeing spikes with only a fraction of their pre-vaccine deaths. The timing and severity of reinfections and breakthrough infections once COVID-19 becomes endemic depends on how quickly the protective effects of immunity against the virus wanes. And that, in turn, depends on a combination of two factors: first, how quickly our immune systems get rusty against SARS-CoV-2, and second, how quickly this coronavirus evolves to disguise itself. The immunological machinery is simply harder to rouse against an old enemy. But a reinfection or breakthrough infection does reinvigorate the immune response. A breakthrough case acts “like a booster for the vaccine,” as Laura Su, an immunologist at the University of Pennsylvania, told my colleague Katherine J. Wu. In the 229E study, the doctors also found that the volunteers who did not get infected the first time were more likely to be infected when exposed a year later, compared with volunteers who got sick the first time—suggesting that more recent illness is more protective. The virus itself will also change with time. As more people gain immunity via either infection or vaccination, the coronavirus will try to find ways to evade that immunity too. This is a natural consequence of living with a circulating virus; the flu also mutates every year in response to existing immunity. But in the endemic scenario, where many people have some immunity, the coronavirus will not be able to infect as many people nor replicate as many times in each person it infects. “I’m very confident that the rate of adaptation is going to be set by the prevalence of SARS-CoV-2 in the world,” Cobey says. You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down. Reinfections with the four common coronaviruses are likely driven by a combination of our immunity fading and the viruses themselves evolving. Putting together everything we do know, a pattern starts to emerge: We are likely first exposed to these common coronaviruses as children, when the resulting disease tends to be mild; our immune systems get rusty; the virus changes; we get reinfected; the immune response is updated; the immune system gets rusty again; the virus changes again; we get infected. And so on. In the best case, COVID-19 will follow the same pattern, with subsequent infections being mild, says Stephen Morse, an epidemiologist at Columbia University. “If the burden of disease is not high, we take [the virus] very much for granted,” he says. Still, these colds are not completely benign; one of the common-cold coronaviruses has caused deadly outbreaks in nursing homes before. In a less good scenario, COVID-19 looks like the flu, which kills 12,000 to 61,000 Americans a year, depending on the season’s severity. But deaths alone do not capture the full impact of COVID-19. “A big question mark there is long COVID,” says Yonatan Grad, an immunologist and infectious-disease researcher at Harvard. There are still no data to prove how well the vaccines prevent long COVID, but experts generally agree that a vaccinated immune system is better prepared to fight off the virus without doing collateral damage. The transition to endemic COVID-19 is also a psychological one. When everyone has some immunity, a COVID-19 diagnosis becomes as routine as diagnosis of strep or flu—not good news, but not a reason for particular fear or worry or embarrassment either. That means unlearning a year of messaging that said COVID-19 was not just a flu. If the confusion around the CDC dropping mask recommendations for the vaccinated earlier this summer is any indication, this transition to endemicity might be psychologically rocky. Reopening felt too fast for some, too slow for others. “People are having a hard time understanding one another’s risk tolerance,” says Julie Downs, a psychologist who studies health decisions at Carnegie Mellon University. With the flu, we as a society generally agree on the risk we were willing to tolerate. With COVID-19, we do not yet agree. Realistically, the risk will be much smaller than it is right now amid a Delta wave, but it will never be gone. “We need to prepare people that it’s not going to come down to zero. It’s going to come down to some level we find acceptable,” Downs says. Better vaccines and better treatments might reduce the risk of COVID-19 even further. The experience may also prompt people to take all respiratory viruses more seriously, leading to lasting changes in mask wearing and ventilation. Endemic COVID-19 means finding a new, tolerable way to live with this virus. It will feel strange for a while and then it will not. It will be normal. from https://ift.tt/2UqHdUN Check out http://natthash.tumblr.com
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The numbers are remarkable. More than 100 million people in the United States have likely been infected by SARS-CoV-2 and 167 million people are fully vaccinated. Yet despite this huge population of people with at least some level of immunity, the Delta variant has sent case and hospitalization numbers soaring. Florida is on its way to having twice as many people hospitalized now than during any previous wave, when essentially no one was vaccinated. One way to think about it, as the epidemiologist Ellie Murray has laid out, is that if Delta is as transmissible as the CDC thinks, we need a much higher percentage of our population vaccinated for immunizations and natural infection alone to cause the virus to peter out. Even when the huge majority of people in a given place have gotten COVID-19 or a shot, there might still be outbreaks, as the Brown University public-health expert Ashish Jha fears will happen in South Dakota after the Sturgis Motorcycle Rally. These realities have already smashed the more optimistic projections of late spring, including my own. Having stared at these numbers for months and months with the COVID Tracking Project at The Atlantic, I never thought that we’d see hospitalization numbers higher than they were during the winter peak in any state. But here we are. It’s time for a data-driven reset on the basic knowns and unknowns of this pandemic, a task that must be undertaken with great humility. The virus keeps changing, and so does our understanding of the social and biological components of the pandemic. But in exploring both the knowns and the unknowns, we can see how complex the pandemic has become—and that we’re still lacking crucial data because of the failings of state and federal government. The Knowns1. The vaccines work very well to reduce the likelihood of an individual being hospitalized or dying from COVID-19.Let’s begin with the best bit of good news. Based on the available data, all the vaccines given in the United States appear to confer a solid level of immunity against severe outcomes such as hospitalization and death. Over a three-month period this summer, the CDC recorded 35,937 deaths from COVID-19—but just 1,191 of those who died were fully vaccinated. In other words, 96.7 percent of deaths this summer have been in the unvaccinated. Hospitalization data look similar, with few fully vaccinated people requiring hospitalization. The CDC’s data mirror what other institutions have found. The New York Times was able to compile data from most states on the percentage of people with breakthrough cases who were hospitalized. Although the proportion of breakthrough patients varied by an order of magnitude from as low as .2 percent of total hospitalizations in Texas to 4.7 percent in Arkansas, in every state more than 95 percent of hospitalized people were unvaccinated. This is also consonant with data from the United Kingdom, which, because of its National Health Service, has better data than exists in the U.S. Many other, smaller studies in various states show very similar results. In Israel, data showed that fully vaccinated patients who were hospitalized were much more likely to have comorbidities such as hypertension, diabetes, and heart failure. So this is known: At this moment in the pandemic, fewer than 5 percent of the people being hospitalized and dying are fully vaccinated. 2. Even high levels of vaccination in local regions is not enough to prevent the spread of the Delta variant.Although the randomized controlled trials on vaccine efficacy indicated that the vaccines conferred substantial protection from symptomatic infection—with efficacies touted at about 95 percent for the mRNA vaccines—their real-world performance is almost certainly lower, though to what extent is not exactly clear. (More on that in a minute.) At the same time, more and more evidence suggests that some people with breakthrough infections can transmit the virus. Combine those two facts with Delta’s extremely high transmissibility, and we’ve found ourselves in a world where even well-vaccinated communities can see quick growth in cases. Back in the pre-variant days of the pandemic, 70 percent vaccination was seen as a rough goal to achieving herd immunity, the point at which viral growth could no longer be sustained in a community. Yet San Francisco, which has 70 percent of its population vaccinated, has nonetheless seen a similar case surge to the one in Maricopa County, home to Phoenix, Arizona, where only 43 percent of residents are vaccinated. Although, statistically, counties and states with higher vaccination rates have lower case counts and hospitalization rates, they have still become areas with high levels of community spread. [Read next: Why is it taking so long to get vaccines for kids?] There are probably different transmission dynamics within these cities. Young, unvaccinated people are likely responsible for a good deal of transmission. There are, after all, still 50 million kids under 12 who are not eligible for the vaccines. But it’s also likely that older, vaccinated people are responsible for some spread as the amount of virus increases in the community. In a number of places, this has not caused major increases in hospitalizations, but that’s not universally true. Perhaps the most startling example is The Villages, in Florida. Centered on a retirement community, this metropolitan area has close to 90 percent of its over-65 population immunized, yet it has seen a surge of cases and hospitalizations. 3. There is still a lot of randomness to where the worst outbreaks occur.Although, again, statistically, places where more people are vaccinated are faring better than places where fewer people are vaccinated, there is enormous variability lurking in the numbers. Some of it may be explainable by policy decisions and political allegiances. But some of it is also just luck. Back in the spring, when the variant we were most worried about was called Alpha, Michigan and almost Michigan alone got absolutely torched, matching its peak for hospitalizations from the winter. This didn’t happen anywhere else, though some epidemiologists expected it to, based on the experience of European countries. Alpha just kind of went away, and it seemed like the U.S. might be in the clear. Enter Delta. In this surge, a piece of Missouri began to take off before the rest of the country. Would it be like Michigan? As we all now know, the answer was no. The southeastern United States is now experiencing huge outbreaks as many states come close to matching or surpassing their pandemic peaks in cases and hospitalizations. The health-care system in north Florida is under pressure that few places have seen at any time during the entire pandemic. Why there? Why not somewhere else with similar vaccination rates and political opposition to viral countermeasures? No one knows with total certainty, and we’re unlikely to ever find out. 4. Kids remain at the lowest risk of any group for hospitalization and death. And kids are at higher risk of hospitalization now than ever before in the pandemic.One of the rare blessings of the pandemic has been that children have proved uniquely able to deal with the attacks of SARS-CoV-2. Their risk of serious illness has always been very, very low. And the available evidence suggests that this has not changed. COVID-NET, which is a CDC sample of hospitals, shows that the rate of hospitalizations for kids has varied in the pandemic from about .3 hospitalizations per 100,000 to 1.5 hospitalizations per 100,000. That rate is rising quickly now, but it remains within the historical envelope of the pandemic in the United States—at about 1 hospitalization per 100,000 children. Similar trends hold true for age subgroups such as 0–4, 5–11, and all under 18. And hospitalization rates for children younger than 18 remain considerably lower than the peak hospitalization rates of adults 18–49 (10 in 100,000), 50–64 (28 in 100,000), and 65 and older (72 in 100,000). That said, the CDC’s COVID-NET data do not cover the whole country—it pulls data from 99 counties across 14 states, representing about 10 percent of the U.S. population. And it has no data from hospitals in the worst-hit state, Florida. If we look at the pediatric hospital admissions gathered by the Department of Health and Human Services, we can see that they are at record highs now, surpassing the worst day of the winter surge and still headed straight up. Although the overall numbers are still low—the 7-day average of hospital admissions is fewer than 300 per day—children in the southeast are being hospitalized at almost double the rate as at any other time in the pandemic. Some states are seeing two or even three times as many admissions of kids as at any time in the pandemic. It’s important to note that there could be multiple reasons why we’re seeing this increase in pediatric hospital admissions. Taken alone, the increases do not mean that the average Delta-variant infection is more severe in children than previous SARS-CoV-2 strains. In an early Scottish study, the data were worrisome, but the bigger problem is that almost all the data available for school decision makers are from before the Delta wave. The nation’s children will be back in the classroom before we’ll definitively know whether Delta hits kids harder than previous variants. Still, the kids’ numbers are tracking quite closely with their adult numbers—and it’s not totally clear whether this is a meaningful shift compared with earlier stages of the pandemic. And what all the data taken together seem to suggest is that there is an absolutely monster wave of COVID-19 circulating in the South, and that our current case numbers do not come close to capturing the true number of infections in that region of the country. 5. Vaccinated people can be infected with and transmit the virus.Breakthrough infections for vaccinated people were always going to happen. No vaccine provides perfect immunity, and the immune system is strange and somewhat unpredictable. But there was some logic to the hope that maybe these infections wouldn’t transmit the virus forward. Because the large majority of vaccinated people have mild symptoms, the thinking went, perhaps they would have lower viral loads, and therefore be less likely to spread the virus. How well the vaccines protect against any infection (not just symptomatic infection, hospitalizations, or death) is a hotly disputed topic. A variety of data suggest that vaccination does help prevent exposures to the virus from becoming infections, and that, obviously, helps slow the spread of an outbreak. But it’s also become clear that vaccinated people who do get infected can spread the virus. The most recent piece of evidence came when American scientists were able to culture virus from samples taken from vaccinated people who’d gotten infected. Those same people showed similar viral loads to unvaccinated people. And yes, even those with asymptomatic infections. Although that’s bad news, there is some good news too: Breakthrough infections appear to be significantly shorter than infections in the unvaccinated. That would reduce the amount of time that people with breakthrough infections could spread the virus. There will undoubtedly be many more studies along these lines, and the papers cited above are preprints, meaning that they have not yet been peer-reviewed. But the data, including unpublished studies cited by public-health officials, are pointing in the same direction: Breakthrough infections are happening. And when they do, those people can spread the virus. The Unknowns1. How many people have had COVID-19? That is, how many people have some immunity, from vaccination or prior infection?We already know that we’ve been undercounting the true number of infections over the course of the pandemic. Sure, we have a tally of cases, but that count is almost entirely of cases confirmed by a positive test result. And as the conditions of the pandemic have changed, the relationship between that case count and the actual number of infections has varied. It’s such a basic question that it seems absurd to ask, and yet we simply don’t know how many Americans have had COVID-19. This is not a purely academic question. Natural infection should confer some level of immunity, though whether natural immunity is as protective as the vaccines is unclear. Regardless, it’s important to know how many naive immune systems are out there for the virus to get at. We know the number of fully vaccinated people with reasonable precision—call it a bit shy of 170 million people. But how best to estimate how many people have been infected? The CDC has done some testing of the levels of antibodies in the U.S. population, but the data are incomplete and imprecise; you could not simply multiply the percentages of people with antibodies by the number of people in the country and get an accurate number. Through hospitalization and death data, we know the rough shape of the infection waves. There was a large New York–centric wave in spring 2020; a smaller, southern-focused summer wave; then last winter’s massive nationwide wave. In 2021, there was a small spring wave centered on the upper Midwest, and now there’s the current massive summer wave in the Southeast. One can add up all the cases from those waves and find roughly 36 million confirmed cases. But for each era of the pandemic, there has been varying testing availability and usage—not to mention a large pool of asymptomatic infections. That’s led to very different and still-unknown case-detection rates through time. Public-health officials know they severely undercounted in the beginning of the pandemic, a problem that improved through the year. But in 2021, the availability of at-home tests and COVID-19 denialism—particularly in the less-vaccinated right-wing areas where the virus is flourishing—among other factors, may have driven down the number of cases that we’re confirming. Vaccinated people with mild cases may also have less incentive to get tested, because they know they are unlikely to have major complications. The CDC itself initially did not recommend that fully vaccinated people get tested after exposure, before changing that guidance in late July. Some institutions also dropped testing regimes for vaccinated people, and some testing sites scaled back their services. All this to say: Both interest and access may be lower than earlier in the pandemic. [Read next: The vaccine scientist spreading vaccine misinformation] The CDC does make an estimate of the total number of infections. That number was 120 million with a range from 103 million to 140 million before the Delta wave. How many people have been infected since June 1? The CDC has counted about 3 million cases, but who knows what the relationship of that number is to the true number of infections. Then, there is one final unknown regarding immunity: What is the overlap between the people who have been infected and the vaccinated? The U.S. does not have these data, but they’re a pretty important component of our current situation. If there were no overlap between the 170 million vaccinated, and there have been 150 million infections, we’d be looking at 320 million people with some immunity, nearly the whole country. But it’s likely that there is a good deal of overlap. And the more overlap, the more dry tinder there is to keep this pandemic going. When everyone in the United States has been vaccinated or infected, it won’t mean that the pandemic is over, but our collective immune systems will have become a more formidable opponent for the many strains of SARS-CoV-2. 2. How well do the vaccines work to prevent infection?As noted, all available data show that the vaccines remain remarkably effective at reducing the risk of hospitalization and death from COVID-19. But past that very important outcome, the data are much murkier. So the effectiveness of the vaccines is a matter of perspective. What people might refer to as vaccine effectiveness can have different meanings, and therefore the nature of their data and calculations can vary. If we want to talk about vaccine effectiveness precisely, we need to specify effectiveness against an outcome (infection, symptomatic disease, hospitalization, death). We also need to define the temporal parameters: across how long of a time period? When were the vaccines administered? We need to break out the different vaccines. We need to have a rough understanding of the variants in circulation when a given study was done. And finally, we need to specify which population is under discussion—young, old, immunocompromised, health-care workers, etc. Sure, all these factors can be rolled up, and had to be rolled up during the vaccine approval process, into a single number to determine vaccine efficacy. That number came out to 95 percent in the original trials for the mRNA vaccines. Effectiveness is what comes from empirical observations. As these results have been released, what we’ve usually heard is something like this from the CDC vaccine-effectiveness page: “mRNA COVID-19 vaccines offer similar protection in real-world conditions as they have in clinical trial settings, reducing the risk of COVID-19, including severe illness, among people who are fully vaccinated by 90 percent or more.” But here’s the thing. Change one of the crucial variables, and the picture changes. That’s led to the publication of multiple conflicting studies. A New England Journal of Medicine study found Pfizer’s effectiveness against symptomatic disease from the Delta variant to be 88 percent. That’s great! But a preprint paper working with Mayo Clinic data found much lower effectiveness against infection, especially for the Pfizer vaccine, which the authors contend had an effectiveness of just 42 percent against infection after Delta became prevalent in the populations that they studied. These findings are both surprising and disconcerting. [Read next: Masks are back, maybe for the long term] There is wide variability in international studies as well. In slides prepared by the CDC for the expert panel that provides recommendations on vaccines, we can see the same kind of difficult-to-explain results. Pfizer looks great in the English/Scottish and Canadian data, even against infection and symptomatic disease, but Israeli and Qatari data do not show the same performance. It may be that these data can be reconciled in some way. For example, the NEJM study looked at symptomatic disease, while the Mayo Clinic paper may have picked up more asymptomatic disease. But even that would not be too reassuring at a population level because, as noted above, it now seems likely that vaccinated people with asymptomatic infections can spread the virus, at least sometimes. And the Israelis, at least, didn’t seem to show a major difference between vaccine effectiveness in preventing infection and symptomatic infection. There are many other possible explanations. Could the effectiveness of the vaccines fade more quickly than hoped, so those with less recent vaccinations are more likely to get infected? Could there be a problem with the distribution of some of the Pfizer doses, which require the most intense cold storage of any of the immunizations? Maybe the way that the studies picked their subject populations or did the data work pushed the results one way or another. And none of this touches on the effectiveness of the Johnson & Johnson vaccine, which had a lower efficacy in trials. For the time being, it seems prudent to assume that it’s possible that one or more of the vaccines will be found to have substantially lower real-world performance in preventing Delta infection and/or symptomatic disease. 3. Why have so many more people been hospitalized in the United States than in the United Kingdom?After a glorious June, when cases in the U.S. fell to their lowest levels since the beginning of the pandemic, more virus began to circulate around the country. The United Kingdom had just seen a surge, but it did not result in an accompanying surge of hospitalizations or deaths. That seemed to portend good things for the United States. On June 1, when the Delta wave began to take off in the U.K., approximately 40 percent of its population had been fully vaccinated. The wave ran high—reaching 80 percent of the case peak from the winter—but hospitalizations reached only 15 percent of the winter peak before the wave began to succeed. This was fantastic news from a British perspective. Fast-forward a month and cross the Atlantic Ocean. When the Delta wave began to take off in early July in the U.S., roughly 47 percent of the U.S. population was fully vaccinated. But in the American context, hospitalizations have not only risen to 50 percent of their pre-pandemic peak, but they continue to rise. Several southern states are seeing their all-time peaks in hospitalizations, despite three previous waves of infection and millions of vaccinated residents. Florida had a larger share of its population vaccinated at the start of the American Delta wave than the U.K. did when it saw the variant’s exponential rise. Yet, in Florida, the state now has nearly double the number of COVID-19 patients in hospitals than it has ever had during the pandemic. It will take a long time to tease out the different factors between the U.S. and the U.K. Obviously, for example, the United States is a much larger country with distinct types of urban structures. But there are several other immediate pathways for thinking about why things are playing out so unlike in the U.S. The U.K.’s vaccination strategy was substantially different from the American one, despite the overall similarity of vaccination rates. It could also be that American unvaccinated people were spread more unevenly through the country than the unvaccinated in the British context, with different epidemiological effects. Looking at Florida, though, one thing stands out. For reasons few epidemiologists could understand, the state had not been hit as hard as neighboring places with similar populations and politics. Look at almost any metric before the Delta wave, and Florida fared pretty well relative to New York, California, or Illinois. Not until the current Delta wave has Florida experienced a surge comparable to those seen in other big states. The U.K., by contrast, was hit with two massive COVID-19 waves in which the death rate was nearly twice what it was in the U.S. That suggests that a much greater percentage of the U.K. contracted the virus, giving them some natural immunity. The virus may have run out of bodies to attack. Perhaps, in Florida, the state’s good fortune in previous waves—along with the political opposition to societal countermeasures—could be one of the factors driving this gigantic increase in COVID-19. 4. What percentage of infections are we confirming as “cases”?Positivity rates—as my colleagues at the COVID Tracking Project argued over and over—are a fraught metric, especially when used as a threshold for crucial decisions. However, as a coarse measure of whether testing is adequate, they do help tell the story of the case numbers that are coming out of the American South. Note that the goal for positivity rate in most states was under 3 percent. In the Florida panhandle and adjacent counties in Alabama and Georgia, the positivity rate in many counties is greater than 25 percent. That’s comparable to many jurisdictions in the days of highly constrained testing supplies during the first wave of the pandemic. Not coincidentally, these areas are also seeing massive increases in hospitalizations, and because severe illness is largely occurring in unvaccinated people, we will also see a rise in deaths. [Read next: How the pandemic ends is different now] On its face, elevated positivity rates have historically meant that public-health surveillance was missing a greater share of the infections in a community. But there’s more evidence that this is what’s happening. Relative to previous waves, the ratio of cases to hospitalizations is lower. Last winter, we confirmed 12 million cases in December and January. This wave, we’ve confirmed fewer than 3 million cases since July 1. Last winter, we peaked at more than 120,000 COVID-19 patients in the hospital at one time. Right now, we’re already over 64,000. So we are showing 25 percent of the cases and 50 percent of the hospitalizations. In addition, at-home tests such as the Abbott BinaxNOW and other types of testing in institutional settings like schools may not be getting reported to authorities. It’s really all a mess. There are more precise ways to look at these data in particular hospital systems and areas, but the upshot is that either Delta is making people sicker—which, as noted above, is a real possibility—or our case-detection rate has fallen. Or, just to muddy things, maybe both. 5. How many people will die?For people in countries with access to vaccines, the good news is that it seems almost certain that fewer people will die in this wave of COVID-19 than in the winter surge. Fewer both in absolute terms and in the percentage of COVID-19 infections as the vaccines make many more people less vulnerable to severe illness. This is an unmitigated good (and one that is a moral imperative to extend to the rest of the world). But millions of unvaccinated people are still getting infected. And for them, the old mathematics of COVID-19 will hold. Older people who get sick are more likely to die. The more comorbidities an infected person has, the more likely they are to die. Here, again, on a national level, there is good news. The most vulnerable group—people older than 75—are being infected at about 10 percent of the rate at the winter peak. That’s a major decline. But in specific areas, which is to say, yet again, Florida, that trend is not holding. There, the rate of hospital admissions is up for every single age bracket, from young people to those older than 80. And people who are between 50 and 79 years old are being admitted to the hospital at higher rates than ever in the pandemic. Some of those people are going to die, and the numbers will not be small. There is also hope that better therapeutics and improved care practices will push the death rate down. But there is pressure in the other direction too. With the hospitals in hard-hit areas under tremendous burden, they are less likely to be able to provide the highest standard of care. Florida is already reporting a seven-day average of more than 150 deaths a day, a number that seems likely to rise as the statistics work their way through the system. Florida’s peak over the winter was about 180 deaths a day. The big question in all this, then, is: Does Florida portend what’s likely to happen in the rest of the country? That’s not yet clear, and let’s hope not. 6. What are the risks of long COVID?This section is more a list of questions than it is of answers. There’s so much that we don’t know about the risks of long COVID. For example, how susceptible are adults with mild infections to long COVID? How about kids? How about breakthrough infections? And asymptomatic infections? Post-viral syndromes have long been understudied. Long COVID is a bundle of the unexplained aftereffects of a virus that we’ve never encountered before. That’s an especially hard thing to study. Yet, pushed by patient advocates, scientists are trying to get a handle on the depth of the problem. According to one meta-analysis of research, at least some symptoms persist longer than two weeks for 80 percent of COVID-19 patients. An English survey found that more than 10 percent of people who had COVID-19 said the disease’s effects were still having a “significant effect on my daily life” 12 weeks after infection. Another found only 2 percent of people experiencing symptoms 12 weeks after infection. And another found 38 percent of post-COVID people with at least one symptom 12 weeks out. Many research studies and anecdotal stories speak to the prevalence of these problems. But the specifics are really hard to pin down, as are the risk factors. And what of post-vaccination infection? Will the immunizations prove effective at reducing long COVID too? One small study of health-care workers found extended symptoms in some people with breakthrough infections. If the Delta variant really begins to move across the whole country, there will be a lot of breakthrough infections. If you are relatively young and healthy, you could always bet that you’d probably come out of a COVID-19 infection just fine, neither hospitalized nor dead. That’s doubly true for the vaccinated. But long COVID is the big, spinning question mark in all the risk calculations that human beings must continue to make. Dave Luo and Lindsey Schultz contributed reporting to this story. from https://ift.tt/3sqkODF Check out http://natthash.tumblr.com This is, in some ways, a mea culpa. For the past year or so, I’ve been reporting on the COVID-19 vaccines, a job that’s required me to convey, again and again, how inoculations work to boost immunity and why. The shots are new, and immunology is complex. So I, like so many others in journalism and science, turned to analogies to help make the ideas of disease prevention and public health tangible. Vaccines, as I’ve written, protect us a lot like umbrellas block out the rain, sunscreens shield us from burns and cancers, and castle guards fend off raids. Analogies, metaphors, similes, and the like are evocative and memorable. They transform the abstract into the concrete. And they very often work, especially when used to depict a virus or an infection, which are almost entirely unseen. But a lot of the ideas we link to COVID-19 vaccines—including plenty I’ve used—don’t totally hit the mark. Too many focus on vaccines’ individual perks. And they end up skating over one of the greatest benefits of immunization: a boost in wellness at the community level, by cutting down on transmission and, by extension, illness for everyone else. For immunization to truly pack a punch, Amanda Simanek, a social epidemiologist at the University of Wisconsin at Milwaukee, told me, “we all have to do it.” Unfortunately, communal benefit is harder to define, harder to quantify, and harder to describe than individual protection, because “it’s not the way Americans are used to thinking about things,” Neil Lewis, a behavioral scientist and communications expert at Cornell, told me. That’s in part because communal risk isn’t characteristic of the health perils people in wealthy countries are accustomed to facing: heart disease, stroke, diabetes, cancer. Maybe that’s part of why we gravitate toward individual-focused comparisons. Slipping into a pandemic-compatible, population-based frame of mind is a big shift. In the age of COVID-19, “there’s been a lot of focus on the individual,” Lewis told me. That’s pretty at odds “with how infection works.” Analogy aside, this is how a vaccine does its job: Each inoculation contains a harmless mimic of a pathogen that immune cells memorize. Vaccines “ready the immune system” so the body isn’t caught unaware when the real thing comes along, Jennifer Gommerman, an immunologist at the University of Toronto, told me. After vaccination, immune cells are faster and more efficient; they can vanquish viruses before serious illness sets in. That’s vaccination’s big objective. But vaccines also curb the number of infectious particles that exit the body to infect someone else. When this pattern gets repeated over and over, viruses start to run out of viable hosts—making it harder for them to spread, and reducing the burden of disease for everyone. Months of evidence show all of this is true of the COVID-19 vaccines. Immunizations also work best when their limits aren’t being constantly tested. To be fair, a lot of analogies describe this dynamic quite well. Post-vaccine infections and illnesses will depend, to some degree, on the physiology of the individual, in the same way that sunscreen won’t have as much staying power on a person who’s extremely fair-skinned. But they will be more likely to happen in people exposed to gobs of virus, in the same way that folks carrying umbrellas will still probably get wet in a hurricane. Those events will also be more frequent with certain viral variants, in the same way that even well-armored castles might fall to a particularly powerful invader. Neither sunshine nor rain nor war, however, is truly infectious, not in the way a virus is, and this very important dimension is where personal-risk analogies start to tank. One person’s decision to eschew a seat belt, airbag, or life jacket rarely affects someone else’s fate. This language is very much in keeping with the United States’ pandemic response, which, as my colleague Ed Yong has written, prioritized individualism, exceptionalism, and free will. We turn to individualistic analogies because they are culturally salient. But they can end up being an “extreme mismatch,” Lewis told me: At heart, public health is a collective endeavor, from which no one is exempt. I’ve seen attempts to course-correct. Twitter is rife with accusations that remaining unvaccinated is akin to drunk driving, smoking, or harming children. But these comparisons, while hinting at communal risk, can backfire. “We know that shaming of any kind just doesn’t work,” Cora Scott, the director of public information and civic engagement for the city of Springfield, Missouri, told me. Cast as enemies, people “shut down and stop listening,” Lewis said. Analogies like these also misportray the unvaccinated, many of whom haven’t been able to access their shots, or are still ineligible, or haven’t been given accurate information about the vaccine and the seriousness of COVID-19. Scott, who leads vaccine outreach efforts in her community, told me she’s been favoring a different analogy: casting the spread of infection as fire, and humans as the kindling that the flames need to persist. I’ve tried this one myself, and vaccines fit in nicely, too. They’re sprays of flame retardant that can waylay fire on the move, while also shielding vegetation from the worst of the burn. The more trees are protected, the sooner the fire has nowhere left to go. Another option: thwarting bugs with insecticides, given that curbing an infestation in one apartment slashes the chances that it will move next door. Michael D. L. Johnson, an immunologist at the University of Arizona, offers a vivid alternative—installing a toilet in lieu of defecating in a bucket “and smearing it over your front lawn,” which would make the neighbors very unhappy and potentially seriously sick. The point isn’t really to converge on the perfect vaccine analogy. I’m not sure one exists; no single comparison can speak to all questions, concerns, and enthusiasms about vaccination. Analogies can also falter against fear and distrust. Many of the people who are holding out on getting their shots are worried about the dangers the vaccines could pose to them as individuals. Here, experts bring in other outreach and communication strategies, including fielding individual questions, reducing barriers to access, sharing stories from within a community, and tapping local leaders as trustworthy sources. Johnson has also been working to equip friends, colleagues, and family members with the skills to detect and avoid misinformation. “I want them to be able to vet the science for themselves,” he told me. Maybe the ideal analogy remains elusive for another reason: Nothing really is quite like a vaccine. Vaccines leverage the body’s natural capability to stave off pathogens, and stymie the serious symptoms of disease. They make bodies inhospitable to infectious threats, by buttressing the immune system’s in-house tactics. They accomplish that simply, often through just one or two brief injections that teach immune cells the nature of a particular threat, sometimes conferring protection that lasts a lifetime. They do all of this without exposing someone to an actual virus, and reduce the chances that someone else will be exposed. On an individual level, vaccines “make the immune system smart,” Gommerman told me. On a population level, they make it possible to safely coexist with a virus. Most people don’t have to think about the many shots they received as children, because those immunizations successfully tamed a threat. When vaccines work, people stop noticing them. And that makes vaccines, quite frankly, better than any fire preventative, umbrella, sunscreen, airbag, seat belt, insecticide, or military-grade weapon I can think of. All figurative comparisons fall short in some way because vaccines are, literally, one of the best tools for protection that we have ever invented. from https://ift.tt/3g0nAun Check out http://natthash.tumblr.com In September 2020, just before COVID-19 began its wintry surge through the United States, I wrote that the country was trapped in a pandemic spiral, seemingly destined to repeat the same mistakes. But after vaccines arrived in midwinter, cases in the U.S. declined and, by summer’s edge, had reached their lowest levels since the pandemic’s start. Many Americans began to hope that the country had enough escape velocity to exit its cycle of missteps and sickness. And though experts looked anxiously to the fall, few predicted that the Delta variant would begin its ascent at the start of July. Now the fourth surge is under way and the U.S. is once again looping through the pandemic spiral. Arguably, it never stopped. This new surge brings a jarring sense of déjà vu. America has fallen prey to many of the same self-destructive but alluring instincts that I identified last year. It went all in on one countermeasure—vaccines—and traded them off against masks and other protective measures. It succumbed to magical thinking by acting as if a variant that had ravaged India would spare a country where half the population still hadn’t been vaccinated. It stumbled into the normality trap, craving a return to the carefree days of 2019; in May, after the CDC ended indoor masking for vaccinated people, President Joe Biden gave a speech that felt like a declaration of victory. Three months later, cases and hospitalizations are rising, indoor masking is back, and schools and universities are opening uneasily—again. “It’s the eighth month of 2021, and I can’t believe we’re still having these conversations,” Jessica Malaty Rivera, an epidemiologist at Boston Children’s Hospital, told me. But something is different now—the virus. “The models in late spring were pretty consistent that we were going to have a ‘normal’ summer,” Samuel Scarpino of the Rockefeller Foundation, who studies infectious-disease dynamics, told me. “Obviously, that’s not where we are.” In part, he says, people underestimated how transmissible Delta is, or what that would mean. The original SARS-CoV-2 virus had a basic reproduction number, or R0, of 2 to 3, meaning that each infected person spreads it to two or three people. Those are average figures: In practice, the virus spread in uneven bursts, with relatively few people infecting large clusters in super-spreading events. But the CDC estimates that Delta’s R0 lies between 5 and 9, which “is shockingly high,” Eleanor Murray, an epidemiologist at Boston University, told me. At that level, “its reliance on super-spreading events basically goes away,” Scarpino said. In simple terms, many people who caught the original virus didn’t pass it to anyone, but most people who catch Delta create clusters of infection. That partly explains why cases have risen so explosively. It also means that the virus will almost certainly be a permanent part of our lives, even as vaccines blunt its ability to cause death and severe disease. The U.S. now faces a dispiriting dilemma. Last year, many people were content to buy time for vaccines to be developed and deployed. But vaccines are now here, uptake has plateaued, and the first surge of the vaccine era is ongoing. What, now, is the point of masking, distancing, and other precautions? The answer, as before, is to buy time—for protecting hospitals, keeping schools open, reaching unvaccinated people, and more. Most people will meet the virus eventually; we want to ensure that as many people as possible do so with two doses of vaccine in them, and that everyone else does so over as much time as possible. The pandemic isn’t over, but it will be: The goal is still to reach the endgame with as little damage, death, and disability as possible. COVID-19 sent the world into freefall, and although vaccines have slowed our descent, we’d still be wise to steer around the trees standing between us and solid ground. “Everyone’s got pandemic fatigue—I get it,” Rivera told me. “But victory is not you as an individual getting a vaccine. It’s making sure that SARS-CoV-2 doesn’t bring us to our knees again.” 1. NowThe U.S. is not back to square one. The measures that stymied the original coronavirus still work against its souped-up variant; vaccines, in particular, mean that half of Americans are heavily protected in a way they weren’t nine months ago. Full vaccination (with the mRNA vaccines, at least) is about 88 percent effective at preventing symptomatic disease caused by Delta. Breakthrough infections are possible but affect only 0.01 to 0.29 percent of fully vaccinated people, according to data from the Kaiser Family Foundation. Breakthroughs might seem common—0.29 percent of 166 million fully vaccinated Americans still means almost 500,000 breakthroughs—but they are relatively rare. And though they might feel miserable, they are much milder than equivalent infections in unvaccinated people: Full vaccination is 96 percent effective at preventing hospitalizations from Delta, and unvaccinated people make up more than 95 percent of COVID-19 patients in American hospital beds. The vaccines are working, and working well. Vaccinated people are indisputably safer than unvaccinated people. But although vaccinated individuals are well protected, highly vaccinated communities can still be vulnerable, for three reasons. First, unvaccinated people aren’t randomly distributed. Instead, they tend to be geographically clustered and socially connected, creating vulnerable pockets that Delta can assault. Even in places with high vaccination rates, such as Vermont and Iceland, the variant is still spreading. [Read: The 3 simple rules that underscore the danger of Delta] Second, Delta could potentially spread from vaccinated people too—a point of recent confusion. The CDC has estimated that Delta-infected people build up similar levels of virus in their nose regardless of vaccination status. But another study from Singapore showed that although viral loads are initially comparable, they fall more quickly in vaccinated people. That makes sense: The immune defenses induced by the vaccines circulate around the body and need time to recognize a virus intruding into the nose. Once that happens, “they can control it very quickly,” Marion Pepper, an immunologist at the University of Washington, told me. “The same amount of virus might be there at the beginning, but it can’t replicate in the airways and lungs.” And because vaccinated people are much less likely to get infected in the first place, they are also much less likely to transmit Delta than unvaccinated people, contrary to what some media outlets have claimed. Still, several lines of evidence, including formal outbreak descriptions and more anecdotal reports, suggest that vaccinated people can transmit Delta onward, even if to a lesser degree than unvaccinated people. That’s why the CDC’s return to universal indoor masking made sense, and why vaccinated people can’t tap out of the pandemic’s collective problem. Their actions still influence Delta’s ability to reach their unvaccinated neighbors, including immunocompromised people and children. “If you’re vaccinated, you did the best thing you can do, and there’s no reason to feel pessimistic,” Inci Yildirim, a vaccinologist and pediatric infectious-disease expert at Yale, told me. “You’re safe. But you will need to think about how safe you want people around you to be.” Third, Delta’s extreme transmissibility negates some of the community-level protection that vaccines offer. If no other precautions are taken, Delta can spread through a half-vaccinated country more quickly than the original virus could in a completely unvaccinated country. It can even cause outbreaks in places with 90 percent vaccination rates but no other defenses. Delta has “really rewound the clock,” Shweta Bansal, an infectious-disease ecologist at Georgetown University, told me. “Communities that had reached safety are in danger again.” Vaccines can still reduce the size and impact of its surges, turning catastrophic boils into gentler simmers. But the math means that “there’s not really a way to solve the Delta problem through vaccination alone,” Murray said. Here, then, is the current pandemic dilemma: Vaccines remain the best way for individuals to protect themselves, but societies cannot treat vaccines as their only defense. And for now, unvaccinated pockets are still large enough to sustain Delta surges, which can overwhelm hospitals, shut down schools, and create more chances for even worse variants to emerge. To prevent those outcomes, “we need to take advantage of every single tool we have at our disposal,” Bansal said. These should include better ventilation to reduce the spread of the virus, rapid tests to catch early infections, and forms of social support such as paid sick leave, eviction moratoria, and free isolation sites that allow infected people to stay away from others. In states where cases are lower, such as Maine or Massachusetts, masks—the simplest, cheapest, and least disruptive of all the anti-COVID measures—might be enough. States such as Louisiana and Florida, where Delta is spreading rapidly, “really need to be talking about a powerful response like closing indoor dining and limiting capacity at events,” Murray said. Louisiana has now reinstituted an indoor mask policy, as have several counties and cities in other states. But several Republican governors, including Greg Abbott of Texas and Ron DeSantis of Florida, have preemptively blocked local governments or schools from imposing such mandates, even as Asa Hutchinson of Arkansas now seeks to reverse a similar law that he regrets passing. There are better ways to do this. On a federal level, Congress could make funding contingent on local leaders being able to make their own choices, Lindsay Wiley of American University, an expert in public-health law, told me. On a state level, leaders could pass mask mandates like Nevada’s, which is “ideal,” Julia Raifman, a health-policy expert at Boston University, told me. It automatically turns on in counties that surpass the CDC’s definition of high transmission and shuts down in counties that fall below it. An off-ramp is always in sight, the public can see why decisions have been made, and “policy makers don’t have to constantly navigate the changing science,” Raifman said. Vaccine mandates can help too. Emily Brunson, an anthropologist at Texas State, has studied vaccine attitudes and thinks that broad, top-down orders “wouldn’t play well, and the pushback could do more harm than good.” But strong mandates that tie employment to vaccination are easily justified in hospitals, long-term-care facilities, and prisons—“high-risk settings where vulnerable people don’t have a choice about being exposed,” Wiley told me. Mandates are also likely for university students, government employees, and the military, who already have to meet medical conditions for attendance or employment. The calculus around safety has shifted in another important way. In the first three surges, older people were among the most vulnerable to COVID-19; now 80 percent of Americans over 65 are fully vaccinated. But kids under 12 remain ineligible for vaccines—and the timeline for an emergency-use approval stretches months into the future. Children are less likely to become seriously ill with COVID-19, but more than 400 have already died in the U.S., while many others have developed long COVID or the inflammatory condition called MIS-C. Rare, severe events are more poignant when they affect children, and they can accumulate quickly in the Delta era. As my colleague Katherine J. Wu reports, pediatric COVID-19 cases are skyrocketing and hospitalizations have reached a pandemic high. [Read: Delta is bad news for kids] Virtual learning took a huge toll on both children and parents, and every expert I asked agreed that kids should be back in classrooms—with protections. That means vaccinating adults to create a shield around children, masks for students and staff, better ventilation, and regular testing. “Schools must continue mitigation measures—I feel very strongly about this,” Caitlin Rivers, an epidemiologist at Johns Hopkins, told me. Otherwise, Delta outbreaks are likely. Such outbreaks have already forced nine Mississippi schools to go remote and put 800 people from a single Arkansas district in quarantine. And other respiratory illnesses, including respiratory syncytial virus (RSV), are already showing up alongside COVID-19. “Schools have no choice but to close once there’s a large outbreak,” Brunson said. “A whole generation of children’s education and well-being hangs in the balance.” The coming weeks will mark yet another pivotal moment in a crisis that has felt like one exhausting string of them. “I think people are right to be hurting, confused, and angry—things didn’t have to turn out this way,” Eleanor Murray, the epidemiologist, told me. But “piecemeal, half-assed responses” allowed for the uncontrolled spread that fostered the evolution of Delta and other variants. “People should be demanding that we don’t repeat those same mistakes from last year.” “I feel dispirited too, but when the virus moves, we have to move—and sometimes, that means going backwards,” Rivers told me. Daily caseloads are now 36 per 100,000 people; once they fall below 10, “and preferably below five, I’ll feel like we’re in a better place.” 2. NextBut then what? Delta is transmissible enough that once precautions are lifted, most countries “will have a big exit wave,” Adam Kucharski, an infectious-disease modeler at the London School of Hygiene and Tropical Medicine, told me. As vaccination rates rise, those waves will become smaller and more manageable. But herd immunity—the point where enough people are immune that outbreaks automatically fizzle out—likely cannot be reached through vaccination alone. Even at the low end of the CDC’s estimated range for Delta’s R0, achieving herd immunity would require vaccinating more than 90 percent of people, which is highly implausible. At the high end, herd immunity is mathematically impossible with the vaccines we have now. This means that the “zero COVID” dream of fully stamping out the virus is a fantasy. Instead, the pandemic ends when almost everyone has immunity, preferably because they were vaccinated or alternatively because they were infected and survived. When that happens, the cycle of surges will stop and the pandemic will peter out. The new coronavirus will become endemic—a recurring part of our lives like its four cousins that cause common colds. It will be less of a problem, not because it has changed but because it is no longer novel and people are no longer immunologically vulnerable. Endemicity was always the likely outcome--I wrote as much in March 2020. But likely is now unavoidable. “Before, it still felt possible that a really concerted effort could get us to a place where COVID-19 almost didn’t exist anymore,” Murray told me. “But Delta has changed the game.” [Read: Your vaccinated immune system is ready for breakthroughs] If SARS-CoV-2 is here to stay, then most people will encounter it at some point in their life, as my colleague James Hamblin predicted last February. That can be hard to accept, because many people spent the past year trying very hard to avoid the virus entirely. But “it’s not really the virus on its own that is terrifying,” Jennie Lavine, an infectious-disease researcher at Emory University, told me. “It’s the combination of the virus and a naive immune system. Once you don’t have the latter, the virus doesn’t have to be so scary.” Think of it this way: SARS-CoV-2, the virus, causes COVID-19, the disease—and it doesn’t have to. Vaccination can disconnect the two. Vaccinated people will eventually inhale the virus but need not become severely ill as a result. Some will have nasty symptoms but recover. Many will be blissfully unaware of their encounters. “There will be a time in the future when life is like it was two years ago: You run up to someone, give them a hug, get an infection, go through half a box of tissues, and move on with your life,” Lavine said. “That’s where we’re headed, but we’re not there yet.” None of the experts I talked with would predict when we would reach that point, especially because many feel humbled by Delta’s summer rise. Some think it’s plausible that the variant will reach most unvaccinated Americans quickly, making future surges unlikely. “When we come through, I think we’ll be pretty well protected against another wave, but I hesitate to say that, because I was wrong last time,” Rivers said. It’s also possible that there will still be plenty of unvaccinated people for Delta to infect in the fall, and that endemicity only kicks in next year. As my colleague Sarah Zhang wrote, the U.K. will provide clues about what to expect. If endemicity is the future, then masks, distancing, and other precautions merely delay exposure to the virus—and to what end? “There’s still so much for us to buy time for,” Bansal told me. Suppressing the virus gives schools the best chance of staying open. It reduces the risk that even worse variants will evolve. It gives researchers time to better understand the long-term consequences of breakthrough infections. And much like last year, it protects the health-care system. Louisiana, Florida, Arkansas, Mississippi, Alabama, and Missouri all show that Delta is easily capable of inundating hospitals, especially in largely unvaccinated communities. This cannot keep happening, especially because health-care workers are already burning out and facing a mammoth backlog of sick patients whose care was deferred during previous surges. These workers need time to recover, as does the U.S. more generally. Its mental-health systems are already insufficient to address the coming waves of trauma and grief. COVID-19 long-haulers are already struggling to access medical support and disability benefits. The pandemic’s toll is cumulative, and the U.S. can ill-afford to accumulate more. Punting new infections as far into the future as possible will offer a chance to regroup. Curbing the coronavirus’s spread also protects millions of immunocompromised Americans, including organ-transplant recipients and people with autoimmune diseases, such as multiple sclerosis and lupus. Because they have to take drugs that suppress their immune system, they won’t benefit from vaccines and have no choice in the matter. Even before the pandemic, they had to carefully manage their risk of infection, and “we’re not helping them by making surges longer,” Inci Yildirim, the Yale vaccinologist, said. She and others are testing ways of boosting their vaccine responses, including giving third doses, timing their doses around other medications, or using adjuvant substances that trigger stronger immune responses. But for any of that to work, “you need the luxury of some level of COVID-19 control,” Yildirim said. Finally, the U.S. simply needs more time to reach unvaccinated people. This group is often wrongly portrayed as a monolithic bunch of stubborn anti-vaxxers who have made their choice. But in addition to young children, it includes people with food insecurity, eviction risk, and low incomes. It includes people who still have concerns about safety and are waiting on the FDA’s full approval, people who come from marginalized communities and have reasonable skepticism about the medical establishment, and people who have neither the time to get their shots nor the leave to recover from side effects. Some holdouts are finally getting vaccinated because of the current Delta surge. Others are responding to efforts to bring vaccines into community settings like churches. It now takes more effort to raise vaccination rates, but “it’s not undoable,” Rhea Boyd, a pediatrician and public-health advocate, told me last month. Measures such as indoor masking will “give us the time to do the work. 3. EventuallyPandemics end. But this one is not yet over, and especially not globally. Just 16 percent of the world’s population is fully vaccinated. Many countries, where barely 1 percent of people have received a single dose, are “in for a tough year of either lockdowns or catastrophic epidemics,” Adam Kucharski, the infectious-disease modeler, told me. The U.S. and the U.K. are further along the path to endemicity, “but they’re not there yet, and that last slog is often the toughest,” he added. “I have limited sympathy for people who are arguing over small measures in rich countries when we have uncontrolled epidemics in large parts of the world.” Eventually, humanity will enter into a tenuous peace with the coronavirus. COVID-19 outbreaks will be rarer and smaller, but could still occur once enough immunologically naive babies are born. Adults might need boosters once immunity wanes substantially, but based on current data, that won’t happen for at least two years. And even then, “I have a lot of faith in the immune system,” Marion Pepper, the immunologist, said. “People may get colds, but we’ll have enough redundancies that we’ll still be largely protected against severe disease.” The bigger concern is that new variants might evolve that can escape our current immune defenses—an event that becomes more likely the more the coronavirus is allowed to spread. “That’s what keeps me up at night,” Georgetown’s Shweta Bansal told me. To guard against that possibility, the world needs to stay alert. Regular testing of healthy people can tell us where the virus might be surging back. Sequencing its genes will reveal the presence of worrying mutations and new variants. Counterintuitively, these measures become more important nearer the pandemic endgame because a virus’s movements become harder to predict when transmission slows. Unfortunately, that’s exactly when “public-health systems tend to take their foot off the gas when it comes to surveillance,” Bansal told me. As of May, the CDC stopped monitoring all breakthrough infections and focused only on those that led to hospitalization and death. It also recommended that vaccinated people who were exposed to the virus didn’t need to get tested unless they were symptomatic. That policy has since been reversed, but it “allowed people to get lax,” said Jessica Malaty Rivera, who was also a volunteer for the COVID Tracking Project at The Atlantic. “We’ve never tested enough, and we’re still not testing enough.” With Floridians once again facing hours-long lines for tests, “it’s a recap of spring 2020,” Samuel Scarpino, the infectious-disease expert, told me. “We continue to operate in an information vacuum, which gives us a biased and arguably unusable understanding of COVID-19 in many parts of the U.S. That makes us susceptible to this kind of thing happening again.” What we need, Scarpino argues, is a nimble, comprehensive system that might include regular testing, wastewater monitoring, genetic sequencing, Google-search analyses, and more. It could track outbreaks and epidemics in the same way that weather forecasts offer warnings about storms and hurricanes. Such a system could also monitor other respiratory illnesses, including whatever the next pandemic virus turns out to be. “My phone can tell me if I need to carry an umbrella, and I want it to tell me if I should put a mask on,” Scarpino said. “I’d like to have that for the rest of my life.” [Read: Vaccines are great. Masks make them even better.] Since last January, commentators have dismissed the threat of COVID-19 by comparing it to the flu or common colds. The latter two illnesses are still benchmarks against which our response is judged--well, we don’t do that for the flu. But “a bad flu year is pretty bad!” Lindsay Wiley, at American University, told me, and it doesn’t have to be. Last year, the flu practically vanished. Asthma attacks plummeted. Respiratory infections are among the top-10 causes of death in the U.S. and around the world, but they can often be prevented—and without lockdowns or permanent mask mandates. The ventilation in our buildings can be improved. Scientists should be able to create vaccines against the existing coronaviruses. Western people can wear masks when they’re sick, as many Asian societies already do. Workplaces can offer paid-sick-leave policies and schools can ditch attendance records “so that they’re not encouraging people to show up sick,” Wiley said. All of these measures could be as regular a part of our lives as seat belts, condoms, sunscreen, toothpaste, and all the other tools that we use to protect our health. The current pandemic surge and the inevitability of endemicity feel like defeats. They could, instead, be opportunities to rethink our attitudes about the viruses we allow ourselves to inhale. from https://ift.tt/2VGFPhH Check out http://natthash.tumblr.com The timing of the latest COVID-19 surge isn’t great for children. Millions have already started the school year, the rest will do so in the coming weeks, and COVID-19 vaccines aren’t yet available for the 50 million Americans who haven’t reached their 12th birthday. Vaccine availability will not bring this pediatric outbreak to a halt. But it will help curb the spread of the virus for everyone, and give many families a better sense of how to plan for the future. To that end, as we hurtle toward the fall, parents, teachers, and pediatricians are eager to know when, exactly, the youngest Americans will have a shot at getting a shot. Even though the timeline is still uncertain, the government and vaccine makers have offered hints to help us understand how the process might unfold. Vaccines for young kids are most likely to be authorized via the same emergency-use mechanism that allowed adults to get their shots starting last December. The process is a bit of a push-and-pull between vaccine makers and the government. The companies have to recruit participants, perform clinical trials, collect data, and submit that information to the government, and the FDA has to tell the companies what sorts of data it’s looking for, how much, and over what timeline. Once the FDA grants an emergency-use authorization, the CDC has to weigh in, offering recommendations to the nation’s doctors and public-health bodies about when and how the shots should be used. (The latter step took only one day after the FDA authorized each of the Pfizer, Moderna, and Johnson & Johnson vaccines for adults.) [Read: Why kids might be key to reaching herd immunity] Everyone involved has some control—but not full control—over how long it’s all going to take. A Pfizer spokesperson told me that the company plans to submit an EUA application for the 5-to-11-year-old group “by the end of September,” and for the six-month-to-5-year-old group “shortly thereafter.” Then the FDA will take the reins. Moderna, which is still awaiting U.S. authorization of its vaccine in 12-to-17-year olds after submitting an application in June, did not respond to a request for comment. But the company recently told CNBC in a written statement, “We expect to have a package that supports authorization in winter 2021/early 2022.” The FDA has been saying since May that it expects vaccines to be available for kids under 12 on a “fall or winter timeline.” But it hasn’t offered much in the way of updates. When I asked the agency for its best estimate of when it might issue an emergency-use authorization for either the Pfizer or Moderna shots in young kids, a spokesperson referred me to comments that the director of the agency’s Center for Biologics Evaluation and Research made in early July indicating that he expected results from the clinical trials “later this year.” [Read: We are turning COVID-19 into a young person’s disease] As we get closer to that amorphous deadline, you can keep an eye out for signs of progress. The first milestone will come when the clinical trials in vaccines for kids stop accepting new participants. Once that happens, the company’s researchers can put all their effort into evaluating the trial itself. (For context, Pfizer finished enrolling 12-to-15-year-olds on January 22 and submitted its application to the FDA on April 9.) As of today, both the Pfizer and Moderna trials are still listed as “recruiting” in the National Library of Medicine’s clinical-trial database; you can check their status here and here, respectively. A more obvious milestone will be reached when either vaccine maker submits an application for an EUA. (Pfizer’s application for 12-to-15-year-olds was approved on May 10, a month after the company submitted it.) Late last month, The New York Times reported that Pfizer and Moderna were extending the recruitment phases for their clinical trials among young kids at the FDA’s behest, because the agency is concerned about having a large-enough sample size to detect rare side effects. Critics of the agency, including the leadership of the American Academy of Pediatrics, argue that this demand for more participants will make the authorization process drag on for longer than necessary, prolonging the harm caused to kids by not offering them the vaccines. [Read: Delta is bad news for kids] Exactly how much time the extra recruiting will take isn’t clear. Saad Omer, the director of the Yale Institute for Global Health, told me that several of his friends and colleagues working on the clinical trials have said that parents are eager to sign their kids up, so the new directive might not slow things down very much. The real limiting factor, he said, will be the amount of follow-up that the FDA wants from these new participants. The agency has not made public the exact time period it’s requesting of drugmakers for the pediatric trials. In a document of guidelines for trials in all age groups from June, it recommended at least six months of data on adverse events after each injection before full licensure would be granted—an interval that would push the process back to February, no matter what. Of course, emergency-use authorization could happen sooner—after all, the agency signed off on the shots for adults after only two months’ worth of safety data last year. But there’s no guarantee that it will be similarly lenient with the adverse-effects data for small children. The current surge in pediatric cases won’t help the trials, either. Rampant spread of the virus last fall did speed up vaccine trials among adults, because it meant that drugmakers had more COVID-19 cases in their data sets, and more evidence to prove that their shots had been effective. But that same grim equation doesn’t hold for the safety data that will be most relevant for kids, because the presence or absence of adverse effects does not depend on people’s being sick. [Read: COVID-19’s effects on kids are even stranger than we thought] Couldn’t these questions have been resolved months ago if clinical trials in kids had simply started sooner? As frustrating as the delay is, it’s a common phenomenon in drug testing, which tends to start with healthy adults and then expand to include other populations. Nahid Bhadelia, the director of Boston University’s Center for Emerging Infectious Diseases Policy and Research, told me that people who are immunocompromised, pregnant, or under 18 “tend to get left out in trials,” both because they’re harder to recruit and because of a perception that they’re at higher risk from any potential side effects. Even if every child in America were made eligible for a vaccine today, they wouldn’t necessarily get one anytime soon. As of two months ago, just over half of parents of 3-to-11-year-olds in one survey said their child would likely not get a shot when it becomes available. And even if every child in America did get a jab today, their immunity wouldn’t ripen until well after Labor Day. Vaccines for the under-12s simply aren’t going to eliminate the anxiety around the back-to-school season. [Read: The best way to keep your kids safe from Delta] In the meantime, the strategies we’ve learned to use throughout the pandemic will keep kids safer. Masking, quality ventilation, frequent testing, and vaccinating as many adults and adolescents as possible will all help lower case rates among children. That, in turn, will keep more of them out of the hospital and help them avoid the virus’s still-unknown long-term consequences. from https://ift.tt/37wDQid Check out http://natthash.tumblr.com Two and a half weeks ago, as the next school year approached, a pediatric cardiologist from Louisiana headed into the Georgia mountains with her husband, their three young children, and their extended family. It was, in many ways, a fairly pandemic-sanctioned vacation: All nine adults in attendance were fully vaccinated. The group spent most of the trip outdoors, biking, swimming, and hiking. Then, on the last night of the outing—July 27, the same day the CDC pivoted back to asking vaccinated people to mask up indoors—one parent started feeling sick. A test soon confirmed a mild breakthrough case of COVID-19. None of the other adults caught the coronavirus on the trip, the cardiologist told me, which she points to as “total proof that the vaccine worked.” (The Atlantic agreed not to name the cardiologist to protect her family’s privacy.) But within a week, six of the eight kids on the trip—all of them too young to be eligible for vaccines—had newly diagnosed coronavirus infections as well. The infected group included two of the cardiologist’s three sons. Both boys, ages 5 and 11, had just a smattering of cold-like symptoms, the cardiologist said. Even so, the entire ordeal has been rough on their household, which is now split—quite literally—into isolation zones. “My middle son is negative,” she said. “So we have to keep our children on separate floors of our house.” The 7-year-old is missing the first few days of second grade to quarantine. The eldest son, an ardent soccer player about to start sixth grade, had a spat of chest pain and now needs cardiac clearance before he’s able to take the field again. The family’s predicament is a microcosm of the dangerous and uncertain moment so many Americans face as the pandemic once again changes course. The COVID-19 vaccines have done an extraordinary job of stamping out disease and death. But as the hypertransmissible Delta variant hammers the United States, the greatest hardships are being taken on by the unvaccinated, a population that includes some 50 million children younger than age 12. Across the country, pediatric cases of COVID-19 are skyrocketing alongside cases among unimmunized adults; child hospitalizations have now reached an all-time pandemic high. In the last week of July, nearly 72,000 new coronavirus cases were reported in kids--almost a fifth of all total known infections in the U.S., and a rough doubling of the previous week’s stats. “It’s the biggest jump in the pandemic so far” among children, Lee Beers, the president of the American Academy of Pediatrics, told me. Last week, that same statistic climbed to nearly 94,000. The most serious pediatric cases are among the pandemic’s worst to date. In the South, where communities have struggled to get shots into arms and enthusiasm for masks has been spotty, intensive-care units in children’s hospitals are filling to capacity. In several states, health workers say that kids—many of them previously completely healthy—are coming in sicker and deteriorating faster than ever before, with no obvious end in sight. Kids remain, as they have been throughout the pandemic, at much lower risk of getting seriously sick with the coronavirus, especially compared with unvaccinated adults. But the recent rash of illnesses among the nation’s youngest is a sobering reminder of the COVID-19 adage that lower risk is not no risk. With so many children unable to access vaccines and their health contingent on those around them, parents and guardians must now navigate the reality that Delta represents a more serious danger to everyone—which means it’s a more serious danger to kids as well. One of the worst parts of Delta’s summer upswing, health workers told me, is that so many of them felt powerless to stop it. The United States got a grim preview of the variant’s substantial powers when it first pummeled other countries—India, the United Kingdom—in several spots, battering unvaccinated adults before seeping down to kids. By the time Delta was spreading in earnest in America, many residents had declared the pandemic more or less over, loosening restrictions, reopening businesses, and shedding their face coverings. “As soon as mask mandates went away, COVID came back,” Angela Brown, a charge nurse at St. Louis Children’s Hospital, in Missouri, told me. “And it’s back more than it was last year.” All the while, Delta was establishing itself as a more formidable foe than the ones that had come before it—more contagious, more antibody-evasive, and, according to some early and tentative data, more apt to drive disease. Vaccines can still tame variants, but only half of Americans have gotten all the shots they need for protection against COVID-19. And those jabs have been doled out unequally, concentrating in certain age groups, geographical regions, and communities privileged by wealth, race, and educational attainment. Kids younger than 12 still aren’t eligible for shots and might need to wait until fall or winter for their green light to come through; teens, who got the FDA’s emergency nod in May, have so far been inoculated at a disappointingly low rate, far below the national average. The situation is especially bad, experts told me, in places where children can’t be cocooned by their communities—areas where rates of vaccination and adherence to infection-prevention measures have lagged in lockstep. The timing of Delta’s pediatric spike couldn’t have been worse. Many hospitals have for months been cracking under pressure from an unseasonal surge of respiratory syncytial virus (RSV) and parainfluenza—two other airway pathogens that can cause serious illnesses in the very young. Both viruses, typically fixtures of the chilly late-autumn and winter months, had all but evaporated during their typical November-to-February heyday, likely suppressed by pandemic-caliber masking and distancing. When those precautions began to slip, “boom, RSV hit us like a boulder,” Sharon Stoolman, a pediatric hospitalist at the University of Nebraska Medical Center, told me. The usual influx of pediatric traumas and the unresolved strain on hospitals from the pandemic’s relentless 18-month slog add to the stress. Several health workers told me they were terrified that they’d be unable to provide adequate care to all the sick children coming their way. “My hospital is full today—I don’t have a bed,” Melissa J. Sacco, a pediatric critical-care physician at UVA Children’s Hospital, in Virginia, told me last week. “And I’m just thinking, Please, nobody get run over by a lawn mower.” “It’s been surreal this past month,” Evelyn Obregon, a pediatric resident at the University of Florida Shands Children’s Hospital, told me. “I’ve never seen this many COVID-positive cases.” Her state is consistently reporting among the highest numbers of pediatric coronavirus cases in the country. Obregon has grown accustomed to treating about five kids with COVID-19 a night; last year, a more usual number was one. In mid-July, she treated a 2-year-old gripped with fever and dehydration. “I was shocked,” she told me. “I had never seen a toddler getting infected like this before.” Her patients are only getting younger, sometimes just weeks old. Most of her patients, she said, are from unvaccinated families. In recent weeks, Arkansas Children’s—the only pediatric hospital system in Arkansas, where vaccine uptake has been especially sluggish—has admitted far more children than at any other point in the pandemic, Jessica Snowden, the hospital’s chief of pediatric infectious disease, told me. “All of them are unvaccinated.” Last year, she said, she and her colleagues considered it a bad day when they had five to seven kids with COVID-19 in their hospital. Now they’re routinely caring for 20 or 30, nearly half of whom are under 12. Many of Arkansas Children’s new COVID-19 patients are also much more ill than before. They’re coming in with wrecked lungs, struggling to breathe; they’re not bouncing back with typical youthful resilience, despite having been very healthy before. “This COVID surge, I’ve never seen anything like it,” Linda Young, a respiratory therapist who’s been on the job for 37 years, told me. “It’s the sickest I’ve ever seen children.” It’s become common for more than half of the kids in the ICU to be on ventilators. A few have been in the hospital for more than a month. “We are not able to discharge them as fast as they are coming,” Abdallah Dalabih, a pediatric critical-care physician, told me. Some parents, Snowden said, are in disbelief. “Many people didn’t believe kids could get this thing,” she said. These early manifestations of disease will likely be just the beginning. One of the most devastating consequences of a pediatric coronavirus infection is a rare complication called MIS-C—an inflammatory condition that burbles up several weeks after a kid first encounters the virus. Some 4,000 cases of the condition have been logged throughout the course of the pandemic so far, many of which have led to full recoveries. But with Delta’s current trajectory, the country might be on the cusp of a glut of new diagnoses. “For me, that’s what I’m more scared of—what things will look like in a month,” Amelia Bray-Aschenbrenner, a pediatric emergency-medicine fellow at St. Louis Children’s, told me. Also looming is the possibility of long COVID, which can saddle people of all ages with weeks of fatigue, brain fog, and joint pain. What’s happening in the South might be a preview for the rest of the country. In Nebraska, “we are just starting to see the trickle,” Stoolman told me. The adult wards are now full and running low on staff and equipment. That means the pediatric population is next: “This week,” she told me, “we are holding our breath.” Amid all the chaos is perhaps one tentative silver lining for children. The new variant appears to be following the long-standing trend that kids are, on average, more resistant to the coronavirus’s effects. Although Delta is a more cantankerous version of the virus than its predecessors, researchers don’t yet have evidence that it is specifically worse for children, who are still getting seriously sick only a small fraction of the time. Less than 2 percent of known pediatric COVID-19 cases, for instance, result in hospitalization, sometimes far less. The alarming rise of pediatric cases seems to reflect the grimness of infectious arithmetic: More kids are falling ill because more children are being infected; more children are being infected because this virus has seeped so thoroughly into the communities most vulnerable to it. America’s pandemic portrait has, after all, warped since the early spring. People of all ages have been venturing back into social settings, often without masks. Kids are no longer being cloistered as vigilantly at home. “The more transmission you have, the more cases you have, and the more you’re going to get bad outcomes,” Sallie Permar, the chair of pediatrics at NewYork-Presbyterian Komansky Children’s Hospital, told me. Reports of more sickness—maybe even distinct sickness—from states such as Arkansas are worrisome. But maybe these startling effects are explicable. Permar said she isn’t yet seeing this trend play out on a national scale, particularly in states where demand for vaccines has been high. Perhaps kids in high-transmission states, where exposures to Delta are heavy and frequent, are simply being hit with more virus. Delta is already ace at accumulating in the airways of people of all ages, more frequently and more consistently than any variant before, according to Jennifer Dien Bard, the director of the clinical microbiology and virology laboratory at Children’s Hospital Los Angeles. More inbound pathogen might further increase the amount of virus that sticks around to run roughshod over the body. That said, experts told me, it’s still possible that new data could pinpoint a unique effect of Delta on children, especially because so much of what we know already comes from studying adults. The United Kingdom offers some encouraging clues, and might serve as a bellwether for America’s coming months. The variant’s recent reign triggered a climb in pediatric cases there as well, but kids didn’t seem to make up an unexpected proportion of the surge, Alasdair Munro, a pediatric infectious-disease physician at the NIHR Southampton Clinical Research Facility, told me. As things stand, he said, “there’s no indication” that Delta poses a particular menace to kids. [Read: Watch the U.K. to Understand Delta] Kids’ bodies can and do fight back, though an explanation for their tenacity remains elusive. One idea posits that kids’ airway cells might be tougher for the coronavirus to break into, Stephanie Langel, an immunologist at Duke University, told me. Another proposes that their immune system is especially adept at churning out an alarm molecule that buttresses the body against infection. Kids, Langel said, might even have a way of marshaling certain antibodies faster than adults, stamping out the virus before it has a chance to infiltrate other tissues. Another upside is that although the coronavirus may be changing, the tools that thwart it haven’t. Delta is a substantial enemy, but not an undefeatable one. To protect kids, the AAP has championed the same layered approach that protects adults: combining masks, good ventilation, hygiene, physical distancing, access to testing, and vaccines for everyone who’s eligible. This tag-team tactic will be especially important as kids head back to school in droves this month and next, Grace Lee, a pediatrician at Stanford University, told me. [Read: The Best Way to Keep Your Kids Safe From Delta] Of course, masks are particularly contentious. Not all countries agree on the best approach when it comes to kids. The World Health Organization doesn’t recommend face coverings for children younger than 6. In the U.K., children under 11 haven’t routinely masked during the pandemic, and Munro says that, apart from strict quarantine and isolation protocols, schools in the U.K. will be looking “more or less normal” this year. In the U.S., though, where vaccine uptake has been a disastrous patchwork and the health-care system has already come under off-season strain, the CDC has recommended universal masking in schools for everyone older than 2. Every expert I spoke with stood behind the guidance: Face coverings and other safeguards, they said, would be a must for a successful academic year. Months of data have reinforced the notion that schools haven’t been a significant source of spread for the coronavirus, Beers, the AAP president, told me, which has led the organization to to strongly recommend that children return to in-person learning. But that evidence was amassed, she stressed, “with careful precautions in place,” including masking. The fates of young Americans are already splintering—and figuring out what’s best for them has, yet again, been punted to states, counties, districts, and individual families. This creates a particularly thorny decision matrix for parents. Sacco, the pediatric critical-care physician in Virginia, said she’s relieved her first grader and third grader will be attending school with a mask mandate in place. But governors in some states, including Florida and Texas, have spoken out vehemently against school masking mandates. Many districts have already announced plans to go mask-optional. Ariangela Kozik, a microbiologist in Michigan, told me she’s anxious about sending her 5-year-old son, Alex, into a classroom where he might be one of the only children with a covering on his face. Her district has yet to issue clear masking guidelines. Alex was supposed to enter kindergarten last year, but Kozik and her partner decided to delay his start out of concern for his safety. They’re eager to move forward, and Alex will be wearing a mask no matter what, Kozik said. “I’m crossing my fingers that everyone else will be too.” from https://ift.tt/2U5HE6L Check out http://natthash.tumblr.com This spring, as New York City warmed up and the local vaccination rate surged, I met my best friend for our first restaurant meal together in months. As soon as we sat down, she began rifling through her purse. “I have something for you,” she told me. From her bag came a rectangle of clear, thick, double-layered plastic—the kind of display pocket that often dangles at the end of a lanyard. My friend had swiped a handful from her office’s supply closet. “It’s for your vaccine card,” she explained. But I already knew. When I got my first shot, in late February, I sat in the mandatory waiting area, holding my new card in one hand and my wallet in the other, trying to understand why the two objects weren’t compatible. I contemplated where I should put this brand-new golden ticket, ultimately sliding the thin piece of too-large card stock into an envelope I found in my tote. I’m going to either lose this or destroy it, I thought to myself. Indeed, I lost it—at least for a little while. Despite dutifully sliding the card into its new protective pocket after lunch with my friend, I eventually found myself tearing my apartment apart searching for it, for exactly the reasons I had feared: It was the wrong size for the one place where most people keep all their important everyday documents, and of too nebulous a purpose to sit safely in a drawer with my birth certificate and passport. Could it unlock some sort of privileges at the airport? Were restaurants going to check it? Did I need to take it to medical appointments? My card had gotten shuffled into a sandwich baggie filled with extra masks, not to be rediscovered for six weeks. With all due respect to our country’s overworked and undersupported public-health apparatus: This is dumb. The card is dumb, and it’s difficult to imagine a series of intentional decisions that could have reasonably led to it as the consensus best pick. Its strangeness had been a bit less important in the past seven months, when evidence of immunity was rarely necessary to do things within America. Now, as Delta-variant cases surge and more municipalities and private businesses begin to require proof of vaccination to patronize places such as restaurants and gyms, the rubber has met the road on this flimsy de facto verification apparatus. It’s not the highest-stakes question of this stage of the pandemic, but it’s one that’s become quite common: How did we end up with these cards? The logical step here is to ask the CDC what the deal is, but the agency, which issues the cards, isn’t saying much about them. It did not respond to my request for comment, and little is known about how the cards came to be. Their mysterious origin is tied up in the country’s light approach to keeping tabs on vaccinations, which, as my colleague Ian Bogost wrote in May, amounts to something of an honor system. America has no national database that records shots, and the Department of Health and Human Services does not know who has or hasn’t been vaccinated; the federal government relies on reporting from the states, and state governments have highly variable attitudes and strategies about vaccination and reporting. The persistent informality of these efforts is especially odd because Americans always were going to need a way to demonstrate their COVID-19 vaccination status to others. Nearly as soon as the pandemic began, experts and government leaders around the world began discussing how people might be asked to prove immunity in order to return to some elements of everyday life. The Atlantic ran its first story on the topic in April 2020. While other countries have implemented national verification systems during their vaccine rollouts, the United States’ verification efforts have varied wildly. Some states, such as California and New York, are now trying to retrofit digital vaccine verification into the country’s piecemeal system, whereas others, such as Texas and Florida, have passed laws to punish businesses that try to check patrons’ status or have outlawed the use of verification systems entirely. So now the only consistent vaccine documentation in America is the too-big, too-little cards, and they are precisely the “bad outcome” that the Princeton professor Ed Felten predicted in December they would be: a document designed to be a personal record that ends up being used as an official license to breathe on strangers in sealed rooms. Although the CDC isn’t talking, there is much to suggest that the vaccine cards were indeed never meant to be evidentiary. The card’s template was initially publicly accessible on a number of state-government websites, and is still available on Florida’s. An official in Missouri, where the template was taken down at law enforcement’s request, told NBC News that the state had originally posted it to make things easier for local vaccine providers. Try to imagine governments freely distributing their templates for driver’s licenses, passports, or other documents intended to certify a particular identity or status. The vaccination card is much closer, physically and aesthetically, to an appointment-reminder card you get from the dentist when you schedule your next teeth cleaning. (The FBI has since clarified that printing your own vaccine card is illegal.) When you hold one of the vax cards, you can see how people would immediately misunderstand it as something that’s meant to be kept on your person. Although too big for a wallet, they’re also too small to easily keep track of outside a wallet. “It’s absolutely the wrong size,” Alison Buttenheim, a professor at the University of Pennsylvania School of Nursing who has studied vaccine documentation, told me. She noted that the cards don’t match the dimensions of any other common vaccine documentation she knows of, including the yellow booklet that the WHO uses for international travelers, which is bigger. As we were talking, Buttenheim briefly misplaced her own folded-over vaccination card; it slid a little too far into one of her wallet’s compartments. (At this point, I should admit that I again lost mine in my apartment for most of a day after getting it out to examine for this article.) A better option, Buttenheim told me, might have involved two pieces: a larger document with information about follow-up appointments and side effects, for example, which would have cut down on the amount of stuff that needed to go on a more durable, wallet-size, and ideally harder-to-fake plastic card. Such a system would also avoid data-privacy concerns that can come with smartphone-app verification systems, as well as the accessibility issues inherent in requiring people to own a smartphone to prove their ability to work or access services. Those requirements are the hardest on the poor or elderly, for whom COVID-19 poses the greatest health risk. And the technology for some of those apps is, uh, still being refined. New York City’s smartphone verification app—not to be confused with New York State’s Excelsior Pass, or its new Excelsior Plus Pass—appears to accept photos of restaurant menus as proof of vaccination. A spokesperson for Mayor Bill de Blasio has said that’s because the city’s app doesn't verify anything; it simply gives users a place to store a photo of their vaccine card. But let’s hold our focus on the most important point of inquiry: What’s the deal with the cards? When Bogost looked into them in May, a historian at the CDC guessed that their design was likely inherited, but no one seemed to know from what. “Like so much of our vaccine rollout, I'm guessing someone had to produce this in, like, eight hours,” Buttenheim said. “There was not time to workshop it and focus-group it and pressure-test it and rapid-cycle prototype it.” But she also noted that the card’s backside includes a date in tiny print in the lower left-hand corner, which likely indicates when the design was finalized or printed. Buttenheim’s and mine are both dated September 3, 2020—months before any vaccine received an emergency-use authorization from the FDA, and before the mass-vaccination effort had taken any real shape. Preparation well in advance is important, of course, but it’s even better if it retains some flexibility to respond to new needs (such as vaccine verification) as they arise. What seems most likely is that maybe no one thought far enough forward to consider the cards’ eventual off-label usage. “While I don’t know for sure, the size of the COVID-19 vaccine card is likely a prime example of public health being a bit antiquated,” Jen Kates, the senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, told me via email. “The large vaccine cards on paper are a relic from the past, and they’ve never been updated. No one thought to do so now.” She compared the low-tech cards to some jurisdictions’ use of fax machines to send data to the CDC at the height of the pandemic. Everyone I talked with eventually landed on the same conclusion, more or less. “I don't think it’s that deep,” Chelsea Cirruzzo, a public-health reporter at U.S. News & World Report, whose tweet about the oversize vaccine cards recently went mega-viral, told me. “I think someone just printed out a bunch of cards that are easy to write your name and vaccine brand on, without thinking about wallets.” Maybe the dimensions were determined by the even subdivision of an existing inventory of card stock. I even called my mom, Pamela Mull, who has considerable professional expertise when it comes to federal agencies printing out flimsy and questionably useful cards—she worked for the Social Security Administration for decades before retiring in the mid-2000s. Her verdict? “Nobody thought about it.” For weeks, I’ve been trying to figure out why I feel so antagonized by something as innocuous as the moderately suboptimal design of the vaccine cards. Sure, they’re unwieldy on a number of levels, and they’re being asked to serve a purpose for which the country should have—and certainly could have—provided a better, more secure answer. But so what, really? It’s just a typical story of American government inertia. Maybe hoping for more is naive. That assumption is precisely the problem. When I was vaccinated, in late winter, my appointment was at one of the country’s first FEMA-run mass-vaccination sites, on its second day of operation. Even as the site was still getting its sea legs and the military personnel who ran it were learning their new duties, it was a marvel of efficiency at a grand scale; I went from freezing at the back of a block-long line to sitting in the mandated post-vaccination waiting area in less than 15 minutes. On my second visit, I didn’t wait a single second. At its peak, the site vaccinated 3,000 Brooklyn residents every day in the gymnasium of Medgar Evers College, all with an astonishingly effective government-funded vaccine that had been developed years faster than any other immunization in human history. The American vaccination mobilization, at its best, is a clear testament to how untrue the country’s common assumption of government ineptness can be. When funding and resources and political will are concentrated, doing something that will make millions of people’s lives better—even something that sounds like a pipe dream—is possible, and it becomes possible extremely quickly. The inconvenient paper vestige that vaccinated Americans now carry of that experience is an exasperating reminder not of the shots themselves, but of all the other missed opportunities our government has had to ease the pandemic’s many predictable problems. from https://ift.tt/3sdFcba Check out http://natthash.tumblr.com Late last month, as the Delta variant of the coronavirus filled hospitals across the under-vaccinated South, Tucker Carlson took to his usual perch as the most-watched host on the most-watched cable-news network, just asking questions about the COVID-19 vaccines. “Tonight, congressional Democrats have called for a vaccine mandate in Congress,” Carlson said, as if flabbergasted by every word. “Members and staffers would be required to get a shot that the CDC told us today doesn’t work very well and, by the way, whose long-term effects cannot be known.” (The CDC did not say this.) Carlson’s Facebook followers commented eagerly on the video clip, spreading unfounded fears about vaccination among themselves. “Completely disappointed in our government, don’t believe a word they speak! Will not get the shot!” one person wrote. Together, Carlson and his viewers are a placenta and embryo, gestating dangerous ideas and keeping the pandemic alive. It’s no secret that Carlson’s audience, and Fox’s, are overwhelmingly Republican and right-wing. And in poll after poll, Republicans are much less likely than Democrats to say they have been vaccinated and much more likely to say they definitely won’t be vaccinated. The partisan gap in vaccinations has only grown over time. Some hard-core Carlson fans have been vaccinated, of course. Understanding how they made their decisions about vaccination could be the key to getting other Republicans on board—and, ultimately, to getting the country to herd immunity. In the past week, I’ve spoken with more than a dozen Trump voters, most of them regular watchers of Tucker Carlson Tonight who say they’ve been fully vaccinated. I found most of them through Twitter, which is not ideal because Twitter users are wealthier, younger, and more educated than the general population. However, this perhaps explains why their thoughts don’t resemble those on Carlson’s Facebook fan page. Despite their love of Carlson, my interviewees had somehow heard accurate information about vaccines. They weren’t worried about being magnetized or microchipped or otherwise maimed by the federal government. Certain elements of their lives worked in favor of vaccination: Everyone I spoke with said their family members were also vaccinated, and they all read or watch other news in addition to Carlson’s show. Most of the vaccinated Tucker viewers see the show primarily as a form of entertainment. They like that Carlson veers offbeat, like the time he claimed the National Security Agency spied on him, and that he sticks it to the libs a little. They find other media commentators condescending. Where liberals see an angry, deluded racist, conservatives see a politically incorrect Jon Stewart. These Carlson fans don’t look to him as a source of genuine vaccine information, but as a funny id who stirs things up. “A lot of modern American conservative thought tends to be a little bit contrarian,” said Carter Sibley, a 46-year-old Californian who got vaccinated in April, “and folks who are inclined to question the mainstream line.” But one factor seemed to have played the biggest role in my interviewees’ decision to get vaccinated: a genuine fear of COVID-19. My interviewees said they got vaccinated because they knew themselves to be at risk, wanted to protect others, or simply had no problem with vaccines. “I grew up in a generation where, when the vaccination comes out, you get it,” said Tom Busyn, a 54-year-old in Minnesota. The fact that the vaccine is not yet fully FDA approved did not give him pause. “I knew that I was basically a guinea pig, and it didn’t bother me.” Most did not agree with what Carlson has said about the COVID-19 vaccines, but they support his right to question them, to play devil’s advocate. “Let’s THINK for ourselves, and ask questions about things we don’t understand or need more information about,” a 50-something in New York named Maureen Westphal told me via email. Despite these viewers’ assertions that they don’t take the network’s shows seriously, Fox News appears to have deepened the partisan vaccination divide. Fox hosts--especially Carlson—have repeatedly downplayed COVID-19 and raised questions about the safety and efficacy of the vaccines. A new working paper, which has not yet been peer reviewed, found that higher viewership of Fox News within a county was associated with lower COVID-19 vaccination rates. The effect could not be explained by differences in partisanship, local health policies, preexisting vaccine hesitancy, or local COVID-19 death rates. A peer-reviewed study published this past February found that Fox News viewers were less likely to say they intended to get vaccinated than CNN or MSNBC viewers were. This is just the latest sign that news consumption is influencing Americans’ pandemic behavior. Last year, a working paper found that a 10 percent increase in Fox News viewership in an area led to a 1.3-percentage-point reduction in adherence to stay-at-home orders. (A similar paper published around the same time found roughly the same thing.) Another study found that conservative-media use, including watching Fox News, was correlated with believing conspiracy theories, such as the idea that the CDC was exaggerating the seriousness of the virus in order to undermine Trump’s presidency. Fox News viewers were more likely than those who watched CNN or MSNBC to say that the media had “greatly exaggerated” the risks of COVID-19, according to a Pew survey released last year. It’s not clear whether Fox News makes people believe conspiracies or whether the type of people who believe conspiracies are likelier to watch Fox News. In response to a request for comment, a Fox spokesperson pointed to past comments by Carlson in which he says he is in favor of vaccines, in general, and acknowledges that the COVID-19 vaccine may have some benefits. The spokesperson also sent me surveys showing that people who get their news from Fox were more likely to get vaccinated than those who watched far-right news sources such as One America News Network, watched no TV news, or got their news from Facebook. But the network’s critics aren’t persuaded. Most of the examples that Fox likes to cite to argue that its personalities are pro-vaccination are “either taken out of context or sandwiched in between coverage attacking vaccines or undermining public health,” Angelo Carusone, the president of the progressive media watchdog Media Matters for America, told me. And even the valid examples, he said, “are a drop in a bucket compared to Fox News personalities’ efforts undermining the vaccine.” The power of shows like Carlson’s is less in the information they offer than in the assumptions they perpetuate, says Kathleen Hall Jamieson, a communications professor at the University of Pennsylvania. “If you hear the word lie tied to Anthony Fauci, and Anthony Fauci now comes on in a completely different venue, the assumption is, you can’t trust Anthony Fauci,” she says. As Jamieson suspected, the Fox News viewers I spoke with deem most politicians hypocritical and mendacious. Several mentioned, unprompted, the time Vice President Kamala Harris said during a debate last October that she wouldn’t take a vaccine just because Trump told her to. They hate the back-and-forth on masks, the liberal officials who closed beaches without evidence, and, yes, the constant media appearances of Fauci, whom they see more as an emblem of the Democrats than as a renowned scientist. They brought up the times that liberals bent COVID-19 rules in their favor while bashing conservatives who did the same. “BLM protests don’t spread the virus, or they do but it’s worth it because that Target ain’t gonna burn itself, or something,” said Tom Paynter, a 50-year-old in Washington State. This distrust is why, perhaps, my interviewees overwhelmingly oppose government vaccine mandates. In fact, they said they wished government officials would stop encouraging, coercing, or otherwise telling people to get vaccinated—even if that means more people die. Freebies don’t appeal to them, either. “Is the Biden administration saying that Republicans and other demographic groups are too stupid to get the life-saving message but greedy enough to want $100?” Michael J. Rosen, a 60-year-old in Philadelphia, wrote via email. Give it some time, they said. Let people make their own choices. Republicans aren’t the only group who are vaccine hesitant, of course. As many white Republicans have pointed out, Black Americans, who disproportionately vote Democrat, are less likely than Hispanic, white, or Asian Americans to have been vaccinated. Medicine’s long history of racism helps explain, if not justify, why many African Americans are now wary of a government-run program to inject something into them. “There’s a fear that they’re in some kind of project, some kind of test,” says Jodi Faustlin, the CEO of the Center for Primary Care in Evans, Georgia, where the vaccination rate is 39 percent. “That’s particularly among our African American population.” Republican vaccine hesitancy is more confounding, though, because the COVID-19 vaccines were developed under a Republican president, and conservatives have no obvious reason to be vaccine-averse. In fact, during the presidency of George W. Bush, Republicans were more likely to believe in the safety of certain vaccines, such as for smallpox, than Democrats were. Some experts tacitly agree with my vaccinated Tucker fans that it’s too late for the media or the government to try to persuade people who don’t like the media or the government. Some suggested moving vaccination out of large pharmacies and into the offices of private doctors, who might be more trusted among conservatives. But even this move is unlikely to reach everyone: A quarter of Americans don’t have a primary-care doctor. A strategy based on fear might be more likely to succeed. Older Republicans seem, rationally, more afraid of COVID-19 than younger Republicans are. The partisan difference in vaccination status is not as large among older Americans: More than 63 percent of senior citizens in Trump-voting counties have been vaccinated, compared with about 71 percent of those in counties that went for Biden, according to a May poll. The paper on Fox News’s vaccination impact also shows the effect was strongest among people under 65. Some experts, despairing at the huge numbers of people who haven’t gotten their shots, now recommend essentially scaring the young and unvaccinated into vaccinating, perhaps by hammering home the threat of long COVID. Older Republicans remember children paralyzed by polio; maybe younger Republicans could be introduced to 40-year-old long-COVID patients who haven’t breathed properly in a year. “If you’ve lost taste and smell, that’s some sort of neurological involvement,” says Brian Castrucci, the president of the de Beaumont Foundation, which has polled Republicans about their views on vaccination. “Does that just go away?” COVID-19 needs a “Magic Johnson moment” for younger adults, he told me, referring to the basketball star who, by revealing his HIV diagnosis, convinced young men of the seriousness of the virus in the early ’90s. For some Americans, the recent rise of the Delta variant appears to be one such moment. In Enterprise, Alabama, where only 36 percent of people are vaccinated and where 73 percent of people voted for Trump in 2020, a family doctor named Beverly Jordan had a day recently in which every patient had either already been vaccinated or received a shot that day. “That was just a wonderful day,” she told me. “I went home so excited because I felt like we’d really turned a corner.” As Tucker Carlson knows well, fear can be persuasive. from https://ift.tt/3fJdZI4 Check out http://natthash.tumblr.com The number of kids contracting the coronavirus is rising. In the week that ended with July 29, more than 70,000 children got COVID-19, representing nearly a fifth of all cases. Though a vanishingly small number of kids have died of the disease--358 since the start of the pandemic, as of July 29—some states, like Florida, now have dozens of children hospitalized. Few parents want to hear that their little ones may get COVID-19, no matter how low their odds of death. The problem, of course, is that kids under 12 can’t be vaccinated yet. Until they can be, the best way to protect them is simple: Vaccinate all the eligible adults and teens around them. “The single most important thing parents can do is to get vaccinated and to vaccinate all their kids who are 12 and older,” Yvonne Maldonado, an epidemiologist and pediatric infectious-disease professor at Stanford Medical School, told me. Kids spend the majority of their time around adults, and existing contact-tracing data suggest that adults are the ones getting kids sick. “There is with Delta, we think, a reasonably high household attack rate, meaning that one person in the household gets sick and other people are at risk of getting sick,” says Ashish Jha, the dean of the Brown University School of Public Health. [Read: Masks are back, maybe for the long-term] COVID-19 outbreaks are larger in under-vaccinated areas, so it stands to reason that kids in those areas would come into contact with more COVID-infected adults. That’s exactly what the numbers show: COVID-19 rates among kids appear to be rising in states where fewer adults are vaccinated. Among the states with the largest recent increases in child COVID-19 cases, according to the most recent report from the American Academy of Pediatrics, are Louisiana, Missouri, Arkansas, and Florida—states where relatively few adults are vaccinated. Conversely, vaccinating more adults and older children seems to decrease the number of COVID-19 cases among younger kids. In Israel, COVID-19 cases in unvaccinated kids plummeted after adults got vaccinated in large numbers earlier this year—even though schools reopened in March. One study, also out of Israel, found that every 20-point increase in adult vaccination rates in a community halved the number of kids testing positive for COVID-19. “Every time somebody gets vaccinated, everybody around them becomes a little more protected,” Jha says. Some have worried, because of a CDC slideshow reported on by The Washington Post a few weeks ago, that vaccinated adults pose as much of a risk to the unvaccinated, including children, as unvaccinated adults do. But this is not the case, Jha and others say. Vaccinated people are less likely to get infected. If you don’t get infected, you can’t spread COVID-19 to others. Although initially, infected vaccinated and unvaccinated people may be similarly contagious for a short period, vaccinated people clear the virus more more quickly, making them less contagious overall. And among vaccinated people, “we haven’t seen studies that show asymptomatic transmission, even with the Delta variant, to others, although symptomatic transmission is clearly occurring,” says Monica Gandhi, a professor of medicine at UC San Francisco. [Read: Yes, the pandemic is bad again] For parents living in states or cities with low vaccination rates, experts recommend masking children under 12 indoors, including in schools. And if you’re a vaccinated but symptomatic adult, it might be a good idea to mask at home too. But really, the solution to parents’ worries about their children is universal vaccination, which creates rings of protection around kids. School starts in a few weeks. Young kids need adults and teens to get their shots. from https://ift.tt/3lC7hrf Check out http://natthash.tumblr.com It certainly feels like we’ve been here before. Nationally, coronavirus case numbers are the highest they’ve been since the start of 2021. Hospitalization rates are on a roaring upswing in nearly every state. Young kids—many of them still ineligible for immunization—are gearing up for another pandemic school year. And even while SARS-CoV-2 continues to shape-shift, we’re struggling to get more shots into arms. The summer is starting to feel a lot like the long, hard winter many people were sure they’d left behind. Last week, the CDC played what probably seemed like one of the most obvious cards left in its hand: asking fully vaccinated people to once again mask in public indoor spaces, in places where the virus is surging. This recommendation echoed one the agency had controversially dispensed with in May—and has clearly saddled immunized Americans with a serious case of masking déjà vu. “It’s been an abrupt 180,” Helen Chu, an infectious-disease physician and epidemiologist at the University of Washington, told me, and for many people, “that’s made it difficult.” In the past week and a half, I’ve spoken with, texted, emailed, messaged, and tweeted dozens of sources, readers, friends, family members, and total strangers about the CDC’s announcement. My correspondences have been a mix of emotions. Some are relieved that the CDC has officially reunited vaccines and masks, a scientifically powerful pairing that many experts think never should have been broken up. But I also heard frustration, confusion, even betrayal. There was a sense that we’re in a morose backslide, a worry we’ll never be rid of pandemic behaviors initially pitched to us as “temporary.” In America’s version of the pandemic, flimsy masks have already been forced to carry so much symbolic heft. Now they’ve taken on yet another weight: the sense that the precautionary limits we’ve put on our lives might never, ever end. “So much of the previous messaging was ‘Wear a mask until we have a vaccine developed’ or ‘until we have people vaccinated,’” says Gretchen Chapman, a psychologist who studies decision-making behavior around vaccines at Carnegie Mellon University. Masks were a stopgap, and shedding them was a reward for rolling up our sleeves. “Now,” Chapman told me, “it seems to some people like that reward is getting taken back.” To be clear, we aren’t exactly where we were during previous surges. Nearly 60 percent of the country is at least partially immunized, and the shots are still holding their own against all known forms of SARS-CoV-2. Vaccinated people are still less likely than the uninoculated to contract the pathogen, pass it on, or, especially, come down with disease. A variant like Delta does somewhat muddy the odds—it is perhaps the wiliest version of the virus to date, and can dodge certain immune defenses. It accumulates stubbornly in an infected person’s airway, poising itself to spread more efficiently, and growing evidence suggests that it might also be likelier to land people in the hospital. And a truly staggering amount of this variant is flitting around. Even excellent defenses can take a beating when they’re repeatedly called to the fore. By limiting the virus’s access to human airways, masks can set vaccinated immune systems up for success. And they help protect vulnerable people in the vicinity, by corralling the problem and curbing its spread. “I’ve always thought the real strength of vaccines is keeping you from getting severely ill,” Chu told me. “Masks work on the other end of the spectrum.” Their return to the pandemic frontlines makes logical sense. Still, some vaccinated people can’t help but feel a bit like “suckers,” Chapman said. Many people covered up dutifully while awaiting their shots, then tossed their masks aside because the government said they could—only to reel from the whiplash of last week’s switcheroo. The guidelines for the unvaccinated (that is, keep masking) haven’t changed, while the immunized are once again being called upon to act. “Asking people to mask up again is triggering a lot of emotional stuff,” Lindsey Leininger, a public-health-policy expert at Dartmouth, told me. “You can’t tell people that those feelings are invalid.” Masking, at least at pandemic levels, also doesn’t feel sustainable in the long term. Although vaccines confer protection against disease that’s expected to last for many months, if not years, with one or two brief jabs, masks require constant reinvestment and vigilance. They falter when we wear them incorrectly; they vary immensely in quality; they can tear or fall apart or fall off; they can be forgotten at home. “It’s on you to do it right every time,” Chapman told me. “People love the set-it-and-forget-it approach, where you only have to intervene once. Enduring behavior change is often a very thorny problem.” “Keep on masking” also feels like a pretty sharp departure from the initial selling points for face coverings. These accessories were meant to be deployed until something better came along, and the most unpalatable aspect of the CDC’s new mask ask might be the uncertainty it comes with. This time, there’s no well-signed off-ramp. The vaccines are already here; they’ve already been made available to most Americans. We hit the milestones we laid out and still feel stuck. I asked nearly a dozen infectious-disease experts this week if they had set a new benchmark—the next bellwether to signal to the vaccinated that they can divorce themselves from pandemic-level masking. Everyone agreed on only one thing: There isn’t a clear-cut answer, not yet. At this stage of the pandemic, the goal isn’t to stop all infections but to prevent as many cases as possible from turning into life-threatening or chronic illnesses. “The outcome here is to prevent people from dying in large numbers, and figure out who those [highest-risk] people are, and to keep our health-care systems ready,” Yvonne Maldonado, a pediatric-infectious-disease physician and vaccine expert at Stanford, told me. Meeting that goal might mean reaching a “low” transmission rate, such as 10 new coronavirus cases for every 100,000 people over a seven-day period, as the CDC stipulates. Or it could mean sky-high vaccine uptake—a percentage well into the 80s or even 90s, to account for Delta’s eagerness to spread. (That last option is contingent on expanding immunization eligibility to the 50 million Americans younger than age 12.) But too much remains in flux to pin down those statistics. Immunity is neither uniform across people nor static in individuals. Even though vaccine efficacy seems to have taken a bit of a hit since Delta’s rise, experts still don’t know how often immunized people are catching the virus and passing it on. It’s also unclear when, or how quickly, our immune cells’ memory of the virus will start to fade. If people are slipping back toward vulnerability, the threshold for “high enough” vaccination will be hard to define. The virus, too, will keep changing, and could one day bamboozle even bodies whose immune safeguards remain intact. As bad as Delta is, “it’s not the scariest thing you could imagine,” John Moore, a virologist at Cornell, told me. Humans could sharpen their weapons too. Some experts, including Kanta Subbarao, a virologist and infectious-disease expert at the Doherty Institute in Melbourne, are hopeful for a next-generation vaccine that could be delivered not as a shot to the arm but as, say, a nasal spray. That could better marshal local, airway-specific immune defenses to head the virus off at its point of entry, potentially making infection and transmission even less likely. But we don’t need a perfect vaccine to bring the pandemic to a close. We already have all the supplementary tools we need: masks, ventilation, tests, and more—strategies whose effects are additive when used together. Recent modeling work backs this logic up. To quash outbreaks, we’ll need not only vaccines but measures to stave off the exposures that strain our bodies to begin with. Some of these tactics—masks included—have proved themselves so effective that many people might never drop them. The off-ramp that many people imagined may simply not exist. Although pandemic-caliber masking won’t be universally embraced long-term, Maldonado, the Stanford vaccine expert, thinks we’re headed toward a “soft stop” on masking and a societal rethink on face coverings. “I think people are going to be feeling uncomfortable without masks for some time,” she told me. Masks might slip on socially or seasonally, as people move in and out of public spaces, or when the temperature drops in winter. Public-health officials could also recommend face coverings intermittently in lockstep with outbreaks, or as a method to tide people over between boosters. “If people are smart, they will continue to mask if they’re in high-risk situations,” at least for a while, Maldonado told me, and perhaps not just for SARS-CoV-2 but for other airway viruses as well. Those practices have long been commonplace elsewhere, and if the United States and many other Western countries haven’t hopped on board before, maybe they will now. Australians have “really come full circle on masks,” Subbarao, the Melbourne vaccine expert, told me. “I don’t see a lot of pushback on it.” Instead of thinking of masks as a pandemic Band-Aid, maybe we can consider them an obvious fixture of our future, even beyond SARS-CoV-2’s global reign. The end of this crisis, after all, isn’t really about an end to prevention behaviors such as masking or distancing, but an end to the worst phases of our relationship with this virus. Adopting new strategies isn’t admitting defeat, nor is dusting old ones off. We can, and should, expect masking to wax and wane as risk waxes and wanes. “We have to learn as we go and adapt our strategies as needed,” Subbarao told me. “This is just one more example of that.” from https://ift.tt/2TWQ1l1 Check out http://natthash.tumblr.com |
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