On April 13, Robert Redfield, the director of the U.S. Centers for Disease Control and Prevention, appeared on the Today show and assured viewers that the worst was nearly behind us. It had been a month since the last gathering of fans in an NBA arena; a month since the fateful week when Americans began panic-buying bottled water and canned beans. The segment’s host, Savannah Guthrie, was broadcasting from home in upstate New York. With the light of a makeshift camera reflecting in her glasses, she asked Redfield to address reports that we could be facing another three weeks of social distancing. “We are nearing the peak right now,” Redfield told her. “Clearly we are stabilizing in terms of the state of this outbreak.” By July, the number of daily cases had doubled. The death total had shot past 100,000. As Redfield looked ahead, his tone became more ominous. The fall and the winter, he said in an interview with the Journal of the American Medical Association, “are going to be probably one of the most difficult times that we’ve experienced in American public health.” It is now widely accepted among experts that the United States is primed for a surge in cases at a uniquely perilous moment in our national history. “As we approach the fall and winter months, it is important that we get the baseline level of daily infections much lower than they are right now,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told me by email. For the past few weeks, the country has been averaging about 40,000 new infections a day. Fauci said that “we must, over the next few weeks, get that baseline of infections down to 10,000 per day, or even much less if we want to maintain control of this outbreak.” This may be the most salient warning he has issued at any point in the pandemic. Cutting an infection rate as high as ours by 75 percent in a matter of weeks would almost certainly require widespread lockdowns in which nearly everyone shelters in place, as happened in China in January. That will not happen in the United States. Donald Trump has been campaigning for reelection on just the opposite message. He has promised that normalcy and American greatness are just around the corner. He has touted dubious treatments and said at least 34 times that the virus will disappear. This disinformation is nearing a crescendo now that the election looms: Trump has been teasing a vaccine that could be available within weeks. The cold reality is that we should plan for a winter in which vaccination is not part of our lives. Three vaccine candidates are currently in Phase 3 clinical trials in the U.S., and the trials’ results may arrive as early as November. But even if they do—and even if they look perfect—it would not mean that a vaccine would be widely available. On Wednesday, Redfield said in a congressional hearing that a vaccine was unlikely to be widely available until summer of next year, if not later. Fauci may be even less optimistic. He told my colleague Peter Nicholas that if the clinical trials go well, it could mean a few million doses could be available by early 2021. By the time we got to 50 million to 100 million doses, he estimated, “you’re going to be well into 2021.” If each person needs two doses, as many experts expect, that would be enough to vaccinate roughly 11 percent of the population. The virus is here to stay. At best, it would fade away gradually, but that would happen after, not before, the winter. The sooner we can accept this, the more we can focus on minimizing the losses of the bleak and grisly coming months. Some of our fate is now inevitable, but much is not. There are still basic things we can do to survive. Some of the physical elements of winter weather make viruses more difficult to escape. The coronaviruses that cause the common cold reliably peak in winter months, as do influenza viruses. There is some mystery as to why. It seems partly due to the air: Viruses travel differently in air of different temperatures and humidity levels. In typical summer weather, the microscopic liquid particles that shoot out of our mouths don’t travel as efficiently as they do in dry winter air. Cold weather also drives us inside, where air recirculates. “As things get colder, activities and people will start moving indoors, and unfortunately that’s going to increase transmission risk, and the risk of super-spreading events,” Tom Ingelsby, the director of the Center for Health Security at Johns Hopkins, told me. The public-health directives that have allowed many businesses to reopen in recent months—by opening windows and doing as much as possible outdoors—will no longer be feasible in regions where temperatures plunge as the days grow short. [Read: The winter will be worse] Winter days also wear on our body’s defense mechanisms. When people become more sedentary, our immune systems become less vigilant, and our overall resilience flags. Symptoms of depression, too, tend to run high in winter. This year these symptoms will be accompanied by restrictions on social life and concerns for health and economic security, leaving us physiologically vulnerable. “There is a growing sense of behavioral fatigue, and a real need for segments of the population to get back to work,” says Albert Ko, the chair of the department of epidemiology of microbial diseases at Yale School of Public Health. “I think the resurgence is going to be worse than what we’ve seen in the summer.” Isolated people may feel especially compelled to travel and gather at the holidays, even though those gatherings may be perilous. They could lead to bigger spikes in COVID-19 cases than some states saw after Memorial Day and July 4, when people who insisted on gathering could generally do so outdoors. The winter holidays often involve multigenerational gatherings for prolonged periods indoors—preceded and followed by interstate travel. This is a worst-case combination during a pandemic. “A lot of what we’re expecting about what might happen this winter comes from previous pandemics,” says Stephen Kissler, a research fellow at the Harvard School of Public Health. Flu pandemics tend to travel in waves, and often the first fall and winter waves are the worst. There are striking similarities so far between the current pandemic and the 2009 influenza pandemic, Kissler told me. “There was patchy transmission in the spring, in New York City and some other places, but then there was a unified wave that hit the entire country. It started right around now, the beginning of September.” In a typical cold-and-flu season, many of us are protected—or partially protected—by antibodies to circulating viruses. But with COVID-19, the number of people with antibodies is still low. Even in the cities hardest hit by the disease, it seems that roughly 85 percent of people are still without antibodies. And if the immunity these antibodies confer is incomplete or short-lived, the number could effectively be even higher. This goes against the president’s allusions to how we might safely defeat the virus with “herd immunity.” Winter has already hit some places in the Southern Hemisphere hard. South Africa has seen a surge in COVID-19. Melbourne has been locked down due to a winter resurgence. The U.S. fell prey to our sense of exceptionalism in the early stages of this pandemic. We watched idly as the virus spread in China and Iran, South Korea and Italy, and only after it was circulating widely among us did we begin to accept that we were not somehow immune. If we cling to that fiction, we are setting ourselves up to be unprepared once again. This is not inevitable. There’s still time to break out of the patterns of thinking that have brought the U.S. to the point of leading the world in deaths and economic losses. There are basic ideas and measures we can take to mitigate and prepare. I’ve been worried about this winter since last winter, so over the past few months I’ve spoken with dozens of experts about what can be done. Here is a distillation of the recurring recommendations. None of them should be revelatory. But that’s precisely the point. Accept reality“Outbreak responses are chess, not checkers,” says Stephen Thomas, the chief of the infectious disease division at State University of New York Upstate. We are playing against a tiny, inanimate ball of genetic material. We are not winning, because we are thinking short term, moving in only one direction, and not seeing the entire board. Do not waste your time and emotional energy planning around an imminent game-changing injection or pill in the coming months. A pandemic is not a problem that will be fixed in one move, by any single medication or a sudden vaccine. Instead, the way forward involves small, imperfect preventive measures that can accumulate into very effective interventions. Groups of practices that minimize the spread of disease are sometimes known as prevention bundles. Our COVID-19 bundle includes important drugs, such as dexamethasone and remdesivir, which seem to help certain patients in specific situations. It also involves behaviors, too, such as distancing and masking. “Any action you take has the potential for numerous secondary and tangential benefits,” Thomas said. [Read: A vaccine reality check] A vaccine will be part of our bundles, hopefully before too long. But it will not instantly eliminate the need for everything else. If we can accept that masks will be a part of our lives indefinitely, we can focus on improving their effectiveness and making them less annoying to wear, Yale’s Ko said. “And it’s not just the design of masks themselves; we can come up with more innovative ways to promote face-mask use.” For one thing, they could be made more ubiquitous by employers and state agencies. Governments could even, as Luxembourg’s did, send masks to everyone by mail. Plan for more shutdownsAmerica’s “reopening” process is going to be less an upward line toward normalcy and more a jagged roller coaster toward some new way of life. In July, California ordered businesses and churches in some counties to again halt indoor activities after the state saw a rise in positive tests and admissions to intensive care units. In August, the University of North Carolina sent students home barely a week after they had arrived. These sorts of moves shock the system if it relies on uninterrupted forward progress. Everyone will be better prepared if we plan for schools to close and for cities and businesses to shut back down, even while we hope they won’t have to. “Many workplaces that have reopened don’t have clear guidelines as to when they will consider shutting back down or reducing capacity in buildings,” Kissler told me. Every place that’s reopening should assume that it might have to navigate further closures. “Having clear triggers for when and how to pull back would help us avoid what happened this spring, where everything shut down in a week,” Kissler said. “It was utter chaos. I’m afraid that scenario will play out again. We have the opportunity to avoid that.” Live like you’re contagiousEven if you’ve had the virus, plan to spend the winter living as though you are constantly contagious. This primarily means paying attention to where you are and what’s coming out of your mouth. The liquid particles we spew can be generated simply by breathing, but far more by speaking, shouting, singing, coughing, and sneezing. While we cannot stop doing all of these things, every effort at minimizing unnecessary contributions of virus to the air around others helps. Along with masking and distancing, time itself can effectively be another tool in our bundles. It’s not just the distance from another person that determines transmission, it’s also the duration. A shorter interaction is safer than a longer one because the window for the virus to enter your airways is narrower. Any respiratory virus is more likely to cause disease if you inhale higher doses of it. If you do find yourself in high-risk scenarios, at least don’t linger. Fredrick Sherman, a professor at Mount Sinai School of Medicine, recommends that if someone near you coughs or sneezes, “immediately exhale to avoid inhaling droplets or aerosols. Purse your lips to make the exhaling last longer. Turn your head fully away from the person and begin walking.” Read: We need to talk about ventilation Even as it gets colder, continue to socialize and exercise outdoors when possible—even if it’s initially less pleasant than being inside. It’s worth thinking about sweaters, hats, and coats as protective measures akin to masks. During the holidays, don’t plan gatherings in places where you can’t be outdoors and widely spaced. This may mean postponing or canceling long-standing traditions. For a lot of people, that will be difficult and sad. For some, it will be a welcome relief. In either case, it’s better than sending a family member to the ICU. Build for the pandemicThis is an overdue opportunity to create and upgrade to permanently pandemic-resistant cities, businesses, schools, and homes. Now is the moment to build the infrastructure to keep workers safe, especially those deemed essential. Poor indoor air quality, for example, has long been a source of disease. Businesses can minimize spread by making ventilation upgrades permanent, as well as enshrining systems that let people work from home whenever possible. “We should be decreasing the density of indoor spaces as much as possible through telecommuting, shifting work schedules, changing work or school flows to spread people out,” the Center for Health Security’s Inglesby said. Instead of being ordered to take down temporary street dining areas, restaurants might build roofs over them to bear ice and snow, and accommodate space heaters. Keeping people safe will save us economically: If restaurants, shops, offices, schools, and churches offer only indoor options, then they can expect attendance and business to suffer even further—either because of legally imposed limits to capacity or because people don’t feel safe going out. Building for pandemics also extends beyond physical infrastructure, to child care for workers, public transit, safe housing and quarantine spaces, and supply chains for everything from masks to air filters to pipette tips. We could make sure that sick people have places to go to seek care, and that they aren’t compelled to spread the virus by basic financial imperatives. Hunt the virusDeveloping fast and reliable ways to detect the coronavirus will become only more crucial during the winter cold and flu season. Symptoms of the flu and other respiratory diseases can be effectively indistinguishable from early and mild symptoms of COVID-19. Natalie Dean, a biostatistician at the University of Florida, told me that testing will be needed to identify real cases and assure others in schools and workplaces that their coughs are not due to coronavirus. Being able to distinguish who among the sniffling masses truly needs to quarantine for two weeks will be vital to keeping essential workers safe and present. The flu vaccine will be useful in helping to prevent a disease that can look very similar to COVID-19. But returns to normalcy in the coming year will depend on advancements in testing for the coronavirus itself. As of now, PCR tests, the most widely used forms of diagnostic testing, are not suited for efficient, massive-scale screening. They cannot identify every infection reliably enough, and are too resource intensive to use as a comprehensive surveillance system. Some experts hope that November will be a watershed month for new ways of testing, as numerous novel point-of-care tests should have come to market by then. These will theoretically allow for on-premises testing at schools, offices, and polling stations—with results obtained in minutes. There are already concerns about the accuracy of such tests, but if they work well they would be the most effective tool in our bundle. Results would ideally be coordinated nationally, with real-time tracking, to inform precise and minimal shutdowns. All of these measures are contingent on reconceptualizing how this pandemic ends. They depend on common facts and clear information. There will be no fireworks or parades, only a slow march onward. Whether technological advances can help us chip away at the spread and severity of this disease will depend on how we use, distribute, and understand them. Throughout the pandemic, America’s most significant barrier to this progress has been Donald Trump. Since February, he has depicted his response to the virus as a success by minimizing the threat. He has exaggerated and lied about treatment options, about the availability of tests, and about the importance of preventive measures such as masks. This week, after Redfield testified that a vaccine would not be widely available until mid- to late 2021, Trump contradicted him and said Redfield was “confused.” [Read: America is trapped in a pandemic spiral] Trump’s insistence that normalcy is on the horizon trades long-term safety for short-term solace. Under his administration, the agencies that typically assure the accuracy and proper usage of medical products like tests and vaccines—the FDA and the CDC—have been weakened and politicized. In August, the White House urged a rewrite of CDC guidelines to discourage testing asymptomatic people who have had high-risk exposures to people with COVID-19. This week, The New York Times reported that this happened over the objections of CDC scientists. In coming months, “direct-to-consumer” sales of COVID-19 tests are expected to further clutter the information landscape. It will be up to the FDA to ensure that they work. Tests and vaccines will be worthless if the public can’t or simply doesn’t trust them. The lack of a scientific basis for a shared reality—and willingness to accept that reality—continues to be America’s greatest weakness in this pandemic. This is all the more reason to prepare ourselves for the months ahead. Build emotional reserves where you can. Make concrete plans for how to isolate and quarantine; to maintain access to credible information; to get medical care quickly. Consider simple ways to help your communities. The process will serve you well, no matter how bad winter gets. Offer to help friends and family care for children. Ask yourself what you can do, right now, for the people who would be burdened most by new waves of illness. Do you have neighbors who wouldn’t be able to get out at all? Do you have elderly relatives who will be totally alone? “If you can teach them how to use Zoom right now,” Kissler advised, “that might be easier to do while we can still do it in person.” from https://ift.tt/3cc0zBp Check out http://natthash.tumblr.com
0 Comments
While in California, Katherine Wells has been wearing two masks—one for the coronavirus, and one for the wildfire smoke—but she isn’t sure how to interpret the air quality warnings. James Hamblin, her co-host on the podcast Social Distance, wants to know how air pollution like smoke interacts with COVID-19. They called John Balmes, a pulmonologist who’s studied inhaled pollutants for decades and serves as the physician member of the California Air Resources Board. Listen to their conversation here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. Here is a transcript of their conversation, edited and condensed for clarity: Katherine Wells: I know there have been summers with some of these elements before, but is this surprising to you? John Balmes: Well, yes and no. It’s certainly the worst air quality I’ve experienced since I moved to the Bay Area in 1986. But it doesn’t really surprise me. This wildfire season was predicted to be particularly bad because of the drought we had. And it was predicted to be hot and dry this summer. What was unexpected were the lightning strikes. Wells: Last week, that orange day, was surreal. What was your experience of that as a person living there? Balmes: Well, you know, I’m a big Tolkien fan so it seemed like Mordor that day. The sun looked like the Evil Eye of Sauron. The air quality wasn’t even that bad that day though, because that light was [created by] the smoke plume up high blocking out the sun. We had heavy fog in the marine layer protecting the air we breathe from being really bad. It wasn’t good, but it was actually Friday of last week where there was more sun but the air quality got into “purple,” very unhealthy for everyone. Wells: When you say “purple” ... I’ve come out to California just recently and the air quality indicators are all new to me. Can you orient me a little bit? Balmes: Sure. Your listeners should get familiar with airnow.gov ... that will give the Air Quality Index for your location. Zero to 50 is green, and that’s healthy air. Fifty-one to 100 is yellow, that’s moderate, which can start to be a problem for people with preexisting lung disease or heart disease. One hundred and one to 150 is orange, and that’s when it’s especially harmful to people with preexisting heart and lung disease. At 150 one to 200—red—it becomes unhealthy for everyone. Even people without heart and lung disease may experience symptoms. And then 201 to 300, that’s purple, that’s definitely unhealthy for everyone at that point. Even healthy people are advised not to exercise outdoors. Most healthy people will not experience symptoms in the red zone. James Hamblin: And with the AQI, when you talk about people getting sick, you’re talking about having short-term symptoms, versus having long-term effects from levels of exposure? Balmes: Yes, the AQI is focused on short-term effects, but those short-term effects can be serious for people with preexisting lung and heart disease. Wells: That is really good to know. I spent a couple of hours outside at 150 and now I feel like I have a cold. Balmes: That could be related to being outside in the bad air quality. One of the risk factors for smoke exposure is an increased risk of lower respiratory tract infections. That’s acute bronchitis and pneumonia, which is particularly problematic in the midst of the COVID-19 pandemic. Hamblin: Does it increase your risk of having more severe disease once you’ve been infected, if you’ve been living in a place that has high levels of exposure to particulate matter versus someplace else? Balmes: Yes, there’s a building evidence with regard to air pollution, and particulate matter in particular, and COVID-19. The best studied association is severity of COVID-19, including one study out of Harvard, that I believe is actually getting published just this week, where they looked at county-level data. Counties with more chronic exposure to PM2.5—particulates that are 2.5 microns or smaller—had more COVID-19 deaths. And that’s chronic exposure, not acute heavy exposure. But other studies from China and Italy, for example, suggest that short-term levels of PM2.5 do increase the risk of severe COVID-19. What is less clearly understood, but there are some studies that are suggestive, is whether exposure to air pollution and particulate matter in particular increases your risk of getting the infection. There are good reasons to suspect that it would increase your risk of infection, but that’s not been as well established as the severity of COVID-19. Hamblin: And what most people are really afraid of is getting a severe case. And you’re talking about where the air-quality index might be on the low or safe side, but people have just been chronically exposed to it; that’s the sort of effect that might put you at risk of more severe COVID-19 if you do contract the virus. Balmes: Yes, the Harvard study, that was actually surprising because that was a U.S. study. It’s not in New Delhi. It wasn’t during wildfire season. U.S. PM2.5 levels aren’t that bad compared to many other parts of the world. And there was still an increased risk. There was an 8 percent increased risk for every one microgram per meter cubed—that’s the unit of measurement of PM2.5. And that was actually a pretty strong effect. Hamblin: Wow. Wells: In terms of practical advice for how to handle this, even if it goes on for a month, you can get an air purifier, you can not go outside. But if you live in an area that has even slightly elevated air pollution for years, I mean ... have you spent time in communities with elevated air pollution? Balmes: I’ve done research all over the world with regard to air pollution and have been in India, for example, and in cities in Africa, where there is often a lot of biomass smoke from cooking on solid fuels outdoors. We do know a lot about chronic exposure to PM2.5. And there are all sorts of health effects related to that exposure. The Global Burden of Disease, which comes out every couple of years, has listed PM2.5 as the most important environmental risk factor for death and disability worldwide. And in places like India, it’s a huge component of disease burden. In terms of wildfire smoke, we just don’t have those kinds of chronic exposure studies because the community hasn’t been exposed chronically before. In general, that’s not entirely true there. There was an air inversion in Northern California over the Yurok Reservation. They had bad air for like a month. And the CDC actually used that to study weather masks and air purifiers helped with regard to respiratory symptoms. And that study showed that if people stayed indoors, they did better. It also showed that the HEPA air purifiers worked. What they found, somewhat surprisingly, was wearing a respirator like an N95 ... I think they weren’t officially N95s then but ... wearing a respirator didn’t actually protect you. Wells: What? Balmes: Their feeling was that people went outdoors, thinking they could spend as much time as they wanted … that was the handwaving answer to why that might have occurred. We do know that N95s protect people from wildfire smoke. Unfortunately, cloth masks don’t. Cloth masks, which we’re wearing to protect others from the wearer transmitting the virus, work for that. But they don’t protect against inhaling fine particles because those 2.5 microns sized particles go right through the weave of a cloth mask. A surgical mask is better. That will get you about 20 to 30 percent reduction in wildfire smoke. P.M. 2.5. But an N95 will get 95 percent reduction if it fits you properly. And even if you haven’t been properly fitted, it probably will give you 80 percent reduction or so. The trouble is N95s aren’t necessarily available to the general public now because of their reservation for health-care workers and other first responders. But a type of N95 that is available is an N95 with an exhalation valve, which is actually more comfortable to wear. Wells: Right, so I have one of those, but I’ve been wearing that. And then a cloth mask over it for COVID-19. Balmes: Perfect. You’re great. That’s the way you should do it. Wells: But it’s not comfortable! (laughs) Balmes: (laughs) I didn’t say it was comfortable. But it protects you and it protects others. Wells: I want to protect everyone and also be comfortable at the same time. But it doesn’t seem like that’s going to be the case. Balmes: I can tell you that if you’re just walking, you don’t have to worry about infecting others with an N95 with an exhalation valve. Wells: Oh, really? Balmes: You have to breathe hard enough to open the valve. If you’re exercising—if you’re jogging or cycling—that will open the valve. If you’re just walking, it won’t. As a matter of fact, we’re trying to get CDC to not be so strict about the use of N95s with exhalation valves for the public. I’m totally fine with health-care workers not using them, but, you know, there’s a grocery store that won’t let me in unless I put masking tape on or wear another mask over it. Wells: With an N95 with masking tape over the mouth and an orange sky, you’re painting a vivid picture. So just to sum up: what do we need to know about air quality and COVID-19? Balmes: We think that there is an increased risk of COVID-19 with poor air quality, and that includes poor air quality due to wildfires smoke, and so people should try to reduce their exposure as much as possible. And the best thing to do is to stay indoors with the windows closed and portable air cleaners in any room that they want to spend a lot of time in. from https://ift.tt/3c5zWhu Check out http://natthash.tumblr.com The federal government is telling states to prepare for a vaccine as early as November. But a major trial has been put on hold. On this episode of Social Distance, James Hamblin and Katherine Wells look to staff writer Sarah Zhang for answers—and updates on a vaccine. But before a vaccine arrives, is testing our best hope? Staff writer Alexis C. Madrigal joins to explain “rapid testing.” New methods could massively increase the number of tests, but are there obstacles to these breakthroughs making a difference? Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. Here is a transcript of a portion of their conversation with Alexis C. Madrigal, edited and condensed for clarity: Katherine Wells: Of course, a vaccine is the way out. But the vaccine’s not coming anytime soon, at least in a widespread way, regardless of how fast we can get it done. Testing is the middle option. Testing is the way we can manage this situation until there is a vaccine. Is that true? Would testing allow us to get this under control? Alexis C. Madrigal: It is the thing that I can imagine doing that. Whether or not that happens is slightly different. In the good scenario for testing, it is something that can help a lot. It probably isn’t going to be enough on its own, but it can help a lot. Testing is going to be a big part of any way back to normalcy. Wells: Let’s start with the optimistic scenario. Madrigal: What people are trying to develop right now are faster tests, something on the order of a few minutes. They’re inexpensive paper-strip-type tests, more like pregnancy tests. And [they] would decentralize testing radically so you wouldn’t have to go to a testing center. You would just be able to buy these things at retail or maybe go to a testing kiosk. Wells: Is this, like, you just spit on a paper strip and it turns a color? Madrigal: Yeah, or you swab your nose … It’s an easy test. It’s a fast test. And it’s a cheap test. Instead of costing from $10 to $150, it costs from $2 to $10. James Hamblin: Are people already using prototypes of this sort of testing? Wells: Is this what they have at the White House? Madrigal: Such tests exist in some places. [The health-care company] Abbott quite famously says they’re going to produce 50 million of these tests in the month of October. And a variety of other companies are also working on similar things. What the White House has been using primarily are similar, but instead of a little paper strip, there’s a little desktop machine and a testing pod that you put into the machine. People have been calling them “point-of-care tests.” These tests look for antigens instead of trying to find direct evidence of the genome of the virus, for RNA. They are faster, but they have two problems. They’re less sensitive, which means you’re less likely to catch every positive. They’re also less specific, which means that if you really deployed them at scale, you’d be likely to actually create a lot of false positives. And there are different camps of people who are worried more about one problem or more about the other. Hamblin: In a screening test, you don’t mind some false positives. You can send people to go get [a more accurate PCR test] if they’re positive on this test. And theoretically, that would be efficient. But it’s the false negatives that can render a screening test actually worse than nothing. Madrigal: This had been my thought about it. Really interestingly, some of the major proponents of the test are the ones most worried about the false positives. Because the numbers are supposed to be so huge. Let’s say you’re doing a million tests a day with these—which is really what Abbott is promising very soon to be able to at least have the capacity to do—you could be generating close to as many false positives as total positives right now on PCR tests. Hamblin: That’s a lot. Madrigal: Right? It’s because the scale of it is so enormous, particularly if they’re deployed in very low-prevalence areas where there’s really not a ton of virus. And people are worried that that may snarl the various testing systems. And also, people might lose faith in using these tests if they think the chance of a false positive is so high. Wells: I know what the world looks like right now with somewhat limited and sporadic testing, with test results that can take anywhere from a day to two weeks. What would the world look like if we were doing a million rapid tests a day with an uncertain number of false positives? Madrigal: And an uncertain number of false negatives, like Jim was saying. Well, I think the mega-happy scenario would be that, in that big dragnet of screening, you would catch enough contagious people that you would start to really bring down the rate of transmission. One of the things that I’ve been thinking about from watching these numbers all the time is that, with our current set of strategies, we tend to do a pretty good job at bringing the rate of transmission down to, like, around 1. Wells: And by “1,” you mean the average number of people that someone is passing it on to. Right now, each person on average passes it to one other person. Madrigal: Exactly. And so, we can’t really get to truly suppressing the virus and back to normal life. But also, most places are not actually also seeing huge runaway outbreaks. And when places do a lot of the things that every public-health person says to do: mask, wash your hands, social distance, avoid large gatherings … all that stuff appears to get us down to around 1. And so we’re kind of balanced on this knife edge where we’ve had a pretty hard time getting to suppression the way that Asian countries have. But we’re also not getting torched all the time. And so what I would hope testing would do, in the happy scenario, is be the thing that helps us start to drive way lower than one 1. Wells: Would that look like: I wake up every morning and I test myself? Madrigal: The way that it would start to roll out first—and the way that it almost certainly will with the Abbott test called BinaxNOW, their first very simple test—would be workplaces and schools. These are tests that could be done by a school nurse. It’s kind of unclear whether they’re going to be rolled out straight up for screening, like you’ll just go into the Ford plant and once a week you’ll do this test. One of my sources said, “You know, we’ve been pedaling testing strategies for months and without the ability to do lots of tests.” And no one cared. Now, suddenly, there’s this idea that maybe there’s going to be all these tests available. And now people are scrambling to put together strategies. The kind of strategy that strikes me as most likely is some kind of regular testing, and testing within groups that sort of makes sense to test together. These strategies, which have kind of been on the shelf, will get rapidly developed … primarily, I think, by companies, nursing homes that are already supposed to be doing some of this kind of testing, high-risk workplaces, emergency responders … If that starts to work and suddenly there’s tons of tests, in this happy scenario, you will take a test a lot. Like, more than once a week. In a lot of the modeling that people have done, you need to get to sub-weekly testing for everybody. That means billions of tests a month. Wells: And how many tests are we doing, for comparison? Madrigal: Right now, we’ve never gotten to 25 million PCR tests in a month. Wells: Is there any way that we could get to this scale with the more accurate, uncomfortable nose-swab test—the PCR tests that you send off to a lab? Madrigal: I think, basically, no. The supply chains for all that stuff really started to break down at the end of July during the Sun Belt surge. In fact, testing peaked back on July 29. We are now doing more than 100,000 fewer tests on average per day now than we were then. And it’s a global market. Europe looks like it’s heating up again. So, we kind of tapped out PCR tests. This is going to be the way that we’re going to get to more tests and certainly more accessible and faster tests. Wells: Faster, cheaper, more accessible, less vulnerable to supply-chain issues. Madrigal: That’s the idea. That you can actually have more information more regularly. One of the things that people realized about the testing system that the U.S. built during the crisis-response phase was that it was more or less useless for contact tracing. You’re not getting results back for days and days. By the time you get the results back and they go send contact tracers out, it’s too late. You’ve already infected everyone you would have infected. It ended up being downright wasteful to do contact tracing. When you look at the U.S., we just have not had a lot of success with those strategies. Wells: Every month there’s a new strategy that’s going to fix everything, and then it breaks down because of basically a lack of federal coordination and failures in all sorts of maybe expected ways. Madrigal: We’re pushing these good ideas and these technologies through a flailing administrative state and through a federal health-care and public-health system that wasn’t really designed to do this. Even the stuff we do well, like technological development, is now coming up against bureaucratic—and I mean bureaucratic in a positive sense here—bureaucratic nodes and networks necessary to actually get something like this implemented. And of course, now we also have the election, which just adds this layer of fuzz around absolutely every single thing that’s happening. from https://ift.tt/35xcLvo Check out http://natthash.tumblr.com President Donald Trump has never hidden his ambivalence about testing for the coronavirus. In June, when he told an arena of supporters in Tulsa, Oklahoma, that he had instructed “his people” to “‘slow the testing down, please,’” the disclosure prompted one of the more dire news cycles of the pandemic. The president said repeatedly that he wanted the United States to reduce its testing. But in the weeks that followed, testing increased. Not so now. In the past month, the number of tests conducted in the United States has actually drifted down—and that may be partly because of Trump-administration policy. The United States now reports about 100,000 fewer daily tests than it did in late July, according to the COVID Tracking Project at The Atlantic. Some of this decline is due to reduced demand: The surge of infections across the South and West has subsided, and when fewer people are sick, fewer people seek out tests. Yet this cannot explain all of it. In the Midwest, the number of confirmed cases is growing faster than the number of tests, which has been a sign of a growing outbreak throughout the pandemic. [Read: A devastating new stage of the pandemic] The decline in reported tests has come just as other changes have hit the testing system. In recent weeks, the Trump administration has taken unprecedented steps to interfere with guidance from the Centers for Disease Control and Prevention. As a result of White House meddling, the CDC now recommends against testing asymptomatic people, the group that may spread the virus the most. At the same time, new antigen-testing technology is rolling out nationwide. While quicker tests in greater numbers should help curb the virus, they are also decentralizing data collection. So far, the U.S. has reported only about 200,000 antigen-test results. But some evidence suggests that these tests are being used on a much wider scale than is understood: Thousands, if not tens of thousands, of antigen tests may already be happening every day without their results appearing in any public data. Just as dark matter can’t be observed directly, even though it makes up much of the universe, this “dark testing” does not show up in the data but may already account for a substantial chunk of the coronavirus testing done in the U.S. [Read: The plan that could give us our lives back] The result of these changes is that some once-trustworthy numbers and measurements—such as the number of tests conducted in each state, and the percentage of tests that come back positive—now seem less reliable. Over the past months, as states have developed their testing systems, the picture of the pandemic clarified, but now it is blurring again. In the immediate future, antigen tests could roll out nationwide, allowing health-care workers to catch outbreaks before they erupt. Or the national testing system could deteriorate further under White House pressure, meaning that states and cities might realize that an outbreak is growing only when hospitalizations bloom. As we stand at this crossroads, still confirming tens of thousands of cases a day, the shape of the pandemic is going to change again, and we may not have the tools we need to see how. The first major change to beset the testing system is entirely because of Trump. Two weeks ago, the CDC changed its official guidance about when Americans should get a coronavirus test. The agency had once maintained that everyone who was exposed to the virus should get tested for it. Now it altered this advice: If someone was exposed to the virus but did not yet have symptoms of COVID-19, they did not necessarily need a test, the guidance said. The edit was small but significant. It also made no sense. Scientists have known for months that people can spread the coronavirus before they develop symptoms of COVID-19, and some evidence suggests that truly asymptomatic people—that is, those who are infected but never develop symptoms--may be more efficient spreaders than anyone else. The only way to distinguish between a healthy person and an asymptomatic person who has COVID-19 is to test them. But this is exactly what the CDC now recommends against. “To say you don’t have to test asymptomatic people—while knowing at least half of infections are driven by asymptomatic people—is idiotic,” Kristian Andersen, an immunology professor at Scripps Research, told us. [Read: America is trapped in a pandemic spiral] This change in guidance did not originate inside the CDC, according to CNN and The New York Times. Instead, the change was imposed on the agency by the White House, acting on the advice of Scott Atlas, a neuroradiologist and conservative policy wonk who has started to advise Trump on the pandemic. Atlas fought with Robert Redfield, the CDC’s director, over the new policy, according to the Times. Atlas, who has no background in infectious disease, has advocated for a so-called herd-immunity approach, asserting that the federal government should protect only the elderly and the most vulnerable from COVID-19. This would lead to many more American deaths—Sweden, which pursued a similar policy, has a higher case-fatality rate than the United States, the European Union average, Iran, and more than 100 other countries, according to data from Johns Hopkins University—and it may not even work. But more important, herd immunity has nothing to do with testing. There is no reason that advocates of the herd-immunity approach should oppose testing, unless their goal is to let an outbreak spiral beyond control before anyone notices, Andersen said. “If you don’t test [asymptomatic people], you have a lower reported number of cases, but you end up with more cases overall. And you end up with more deaths and more hospitalizations, which you can’t hide, because you lose control of the virus.” The change to the CDC guidance is not the only disruption of the testing landscape. In the past month, doctors and hospitals have started to use faster but less sensitive tests to look for the coronavirus. Unlike the gold-standard PCR tests, which detect genetic material from the virus, these tests look for the presence of chemicals, called antigens, that make up the virus. As we’ve written, these antigen tests will be a crucial tool in defeating the pandemic, because they will let offices, nursing homes, and other semipublic places identify contagious but asymptomatic people before they spread the virus. We believe that dark testing is happening, because we see a hole where data about antigen testing should be. Millions of antigen tests are now being manufactured every month. Quidel, a $6 billion company that makes one of the most widely used antigen tests, says that it began producing at least 1 million tests a week earlier in the summer. In recent days it has upped that rate to nearly 2 million. “We don’t have any inventory,” Doug Bryant, its chief executive, told us. “We ship every day with what we have.” Becton Dickinson, which makes a competing antigen test, has predicted that it would be manufacturing 2 million tests a week by the end of September. Some federal agencies have made these tests central to their national strategy. In August, the Centers for Medicare and Medicaid Services announced that it would buy antigen tests from Quidel and Becton Dickinson, for nursing homes nationwide. Estimates calculated from agency data suggest that it will distribute 2 million to 4 million tests to more than 13,000 nursing homes by September 30. [Read: The most American COVID-19 failure yet] Yet these millions of tests are missing from the public data. Only six states, representing 50 million people, make separate antigen-test data readily available. Those data show that a mere 215,000 antigen tests have been reported since early August, when they first appeared on state dashboards. Even if the data are taken as representative of the U.S. as a whole, and scaled accordingly, they imply that only 1.4 million antigen tests have ever been conducted—far fewer than the number of tests that companies have shipped since June, which is on the order of tens of millions. Even though the Department of Health and Human Services has spent tens of millions of dollars distributing tests, it could not tell us how many of the tests have been used. The agency has said that it is aware of the reporting issue, and in late August, it threatened to fine nursing homes that do not report test results accurately. (The department did not respond to multiple requests for comment.) In some ways, a small data gap is not surprising: Data about antigen tests are virtually guaranteed to be spottier than data about PCR tests. Antigen tests are conducted and analyzed in the same places where they’re used: nursing homes, doctors’ offices, and schools. PCR tests, meanwhile, must be analyzed at a central lab or hospital. Because labs and hospitals regularly report large amounts of data to public-health agencies, but schools and nursing homes do not, PCR data will almost always be more complete. But this dark testing is missing from other places you might expect it to show up. For instance, under CDC rules that define who has a “case” of COVID-19, a person who tests positive on an antigen test is said to have a “probable case.” If antigen tests were flooding the market, states would report hundreds of thousands of probable cases. Yet again, there’s a gap: Most states do not report probable cases as a separate category. Of the more than 6.3 million COVID-19 cases reported in the United States, only 80,000 are “probable.” The antigen tests are missing here, too. The dark-testing problem is certain to get worse. Quidel and Becton Dickinson say they will produce about 4 million tests a week, combined, by the end of September. Quidel is “building towards 5 million tests a week next year,” Bryant said. A third company, Abbott Laboratories, claims that in October, it will begin producing 50 million of its cheaper coronavirus tests a month. Abbott’s prospective volume alone is more than double the number of PCR tests ever conducted in a month nationwide; it means that dark testing would encompass as many as two in every three American coronavirus tests conducted by the end of year. All of this is to say: Antigen tests are being produced by the millions and showing up in our testing data in small numbers that require major and unreliable extrapolation. [Read: How I mastered the art of ventilating my home] What’s actually happening? There are multiple possibilities: First, perhaps only tens of thousands of antigen tests have actually been conducted, even though millions exist. For now, most antigen tests require a desktop machine, so the throughput for any individual location is limited. “You can run eight Quidel tests in the same amount of time you can run a full PCR plate of 384” tests, Andersen, the immunologist, said. “I would assume these tests would be dwarfed by PCR capacity—I would hope.” Second, perhaps most test locations are simply not reporting test data back to state authorities; few point-of-care locations are set up to report these data electronically, so the hassle factor is high. Third, some states may be lumping antigen tests in with their PCR testing or case numbers. Researchers at the COVID Tracking Project at The Atlantic think at least 10—and perhaps as many as 30—states are lumping antigen tests in with PCR tests, which would hide them from our analyses. Finally, probable cases might not show up in the data, because nearly everyone who gets a positive antigen test is quickly retested by PCR. That’s what happened to Ohio Governor Mike DeWine, who tested positive for the virus on a rapid antigen test last month, then tested negative for it when retested by PCR later in the day. Of course, some combination of factors could be at play simultaneously. This is the current state of pandemic tracking: It is difficult to know whether millions of tests have been conducted at all. And if the data system is missing so many tests now, when maybe hundreds of thousands of antigen tests are being done each week, imagine what this will look like in a few months, when 1 million antigen tests might be completed each day. There is little doubt that we will lose the ability to track the large majority of tests completed in the country. That could ultimately be a good thing, because it would signify that tests are so ubiquitous—and such a regular feature of everyday life—that they no longer need to be tracked as systematically. But because that change has come now, just as officials within the Trump administration are acting to suppress testing as never before, it has introduced uncertainty and disorder. If the number of tests completed each day continues to fall in the data, what will that reveal? It could mean that every American who wants a test can get one. Or it could mean that the president has finally succeeded in reducing testing. from https://ift.tt/3bLw2ua Check out http://natthash.tumblr.com Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at [email protected]. Dear Dr. Hamblin, I’m an American living in Germany, and I’ve been following how some people in the United States have opposed lockdowns due to fears about “shutting down the economy.” It seems to me that even to those who believe the economy is what matters most, having a complete national lockdown for a few weeks is economically better than what the U.S. is going through now. Should the U.S. have done that? And is it too late? Mike Kukula Berlin, Germany Perhaps the least enviable status of any country during the pandemic is indefinite limbo—in which economic and physical suffering remain high, and no end is in sight. It happens when a country has an outbreak, haphazardly and incompletely shuts down, and then attempts to reopen without changing much of what allowed the virus to spread in the first place. The country is divided over the false binary of financial and health security. The reopening is not enough to ensure economic prosperity, but the restrictions are also not enough to contain the virus and prevent needless death. This is where the U.S. finds itself right now. Most of us are still making compromises in daily life, severely limiting our social interactions. At the same time, many businesses are struggling, in part because they are only partly open. Limitations on the number of people who can enter a store or sit down at a restaurant allow for businesses to continue operating, but with less revenue. Yet, as they are open, governments justify easing up on safety nets meant to help them get through the pandemic. Consumers are still going out less and spending less than usual, and unemployment remains higher now than at any point since 2011. But despite all these sacrifices, the U.S. also has nearly 40,000 new coronavirus cases a day, far more than many other industrialized countries. The virus continues spreading so widely and insidiously that some hot spots are impossible to discern while they can still be contained. A preliminary analysis of one August biker rally in Sturgis, South Dakota, for example, suggested that the gathering may have led to some 266,000 infections and at least $12 billion in health costs. Given limited data and testing, it’s difficult to know precisely. In much of the country, contact tracing is essentially used to construct maps after an outbreak. It is a palliative measure rather than a preventive strategy. [Read: Why there’s no national lockdown] In an attempt to end the limbo, some experts have proposed that a “second shutdown”—for part or even all of the United States—could save money and lives. Though far from the only way forward, this would mean reattempting what we didn’t manage to do in the spring: Lockdowns that are precisely implemented and coordinated, in which nonessential businesses are closed and people are ordered to shelter in place. Instead, we had a patchwork of shutdowns determined by cities and states as they saw fit (or didn’t). A “second shutdown” would not mean that the entire country is under the same directives, but it would mean that everyone is operating from the same playbook. As case counts once again creep up, a “second shutdown” might be the pandemic equivalent of calling tech support and describing an elaborate problem with your computer only to hear in response: Have you tried turning it off and turning it back on again? The goal would be to essentially wipe the slate (nearly) clean. Hypothetically, if everyone were truly, absolutely sheltered in place for several weeks, the case count would drop to zero. The closest real-world example would be China, or to a lesser extent, places like Germany, where shutdowns have led to major drops in caseloads. The shutdown would end when we are able to implement widespread testing and tracing to contain cases before they turn into outbreaks. The value of such a measure is entirely contingent on the quality of the plan for how to emerge from it. The plan cannot be to hope that that virus goes away and then to simply go back to what we were doing before. A more successful shutdown wouldn’t likely mean closing down the whole country at this point. That would be a dire move, and feel especially unnecessary in a place such as New York City, which was once the global epicenter of the outbreak, but after months of intense measures, now seems to have contained the virus. But if cases keep going up elsewhere, an effective shutdown may affect swaths of the country for several weeks at a time. That would require federal, state, and city governments to work in tandem, and Americans to trust them. It would require financial reassurances that businesses and their workers could survive the shutdown. It would require ensuring that Americans have health-care coverage should they test positive, so there would be no incentive to avoid testing and reporting cases. Because of failures on each of these things, the U.S. was unable to coordinate an emergency response between states and cities and prevent the virus from taking hold everywhere. Some places entirely shut down while others continued to hold mass gatherings. Even though the federal government spent trillions of dollars supporting businesses and people who lost their jobs, its actions were temporary, and didn’t go far enough: From March to April, unemployment rose from 4 percent to more than 14 percent, the biggest jump since the Great Depression. Even if a better-orchestrated series of shutdowns might ultimately save us money and lives, the political and emotional will to do it again are unlikely, especially so close to an election. [Read: The scariest pandemic timeline] But shutting down doesn’t have to be as economically damaging as it was to the U.S. Countries such as Denmark were able to do so without the same massive jump in unemployment by ensuring that people stayed financially secure. In theory, a shutdown should cost a country a lot of money in the short term, but cost less than limbo in the long run, which prolongs our return to anything resembling normalcy. The U.S. didn’t operate under this framework in the spring. A more deliberate process could have discrete promises about how long the shutdown would last, and exactly what kinds of support could be counted on, from day one. It could even involve a week or two of advance notice. At a fundamental level, what stands in the way of such a move is the American tendency to see shutdowns as breaches of personal liberty. Individuals would have to be willing and able to isolate themselves after high-risk contacts, to resist our innate temptation to flout restrictions, and to submit to tracing and monitoring at a level that Americans don’t seem likely to tolerate in the same way that other citizens have. But the current state of half-shutdown limbo is also not exactly freedom either, and every way to break out of it will involve an idea of freedom that is collective rather than individual. A shutdown is a bitter pill at any time, for everyone. We are all weary of isolation and uncertainty. Going through another round of shutdowns would feel too excruciating for many to consider. Even if it might be a prudent path forward, a large-scale shutdown is not inevitable in the U.S., nor is it likely. Instead, by every indication, we will choose to persist in limbo. Still today, nine months into the pandemic, after losing some 190,000 lives, our overall approach is to do more of the same. When we are already fatigued and economically shattered, leaders have every incentive to tell people that the end is right around the corner. Our limbo only ensures that it is not. “Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity. from https://ift.tt/2ZmfVhE Check out http://natthash.tumblr.com Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Army ants will sometimes walk in circles until they die. The workers navigate by smelling the pheromone trails of workers in front of them, while laying down pheromones for others to follow. If these trails accidentally loop back on themselves, the ants are trapped. They become a thick, swirling vortex of bodies that resembles a hurricane as viewed from space. They march endlessly until they’re felled by exhaustion or dehydration. The ants can sense no picture bigger than what’s immediately ahead. They have no coordinating force to guide them to safety. They are imprisoned by a wall of their own instincts. This phenomenon is called the death spiral. I can think of no better metaphor for the United States of America’s response to the COVID-19 pandemic. The U.S. enters the ninth month of the pandemic with more than 6.3 million confirmed cases and more than 189,000 confirmed deaths. The toll has been enormous because the country presented the SARS-CoV-2 coronavirus with a smorgasbord of vulnerabilities to exploit. But the toll continues to be enormous—every day, the case count rises by around 40,000 and the death toll by around 800—because the country has consistently thought about the pandemic in the same unproductive ways. Many Americans trusted intuition to help guide them through this disaster. They grabbed onto whatever solution was most prominent in the moment, and bounced from one (often false) hope to the next. They saw the actions that individual people were taking, and blamed and shamed their neighbors. They lapsed into magical thinking, and believed that the world would return to normal within months. Following these impulses was simpler than navigating a web of solutions, staring down broken systems, and accepting that the pandemic would rage for at least a year. These conceptual errors were not egregious lies or conspiracy theories, but they were still dangerous. They manifested again and again, distorting the debate around whether to stay at home, wear masks, or open colleges. They prevented citizens from grasping the scope of the crisis and pushed leaders toward bad policies. And instead of overriding misleading intuitions with calm and considered communication, those leaders intensified them. The country is now trapped in an intuition nightmare: Like the spiraling ants, Americans are walled in by their own unhelpful instincts, which lead them round and round in self-destructive circles. “The grand challenge now is, how can we adjust our thinking to match the problem before us?” says Lori Peek, a sociologist at the University of Colorado at Boulder who studies disasters. Here, then, are nine errors of intuition that still hamstring the U.S. pandemic response, and a glimpse at the future if they continue unchecked. The time to break free is now. Our pandemic summer is nearly over. Now come fall, the season of preparation, and winter, the season of survival. The U.S. must reset its mindset to accomplish both. Ant death spirals break only when enough workers accidentally blunder away, creating trails that lead the spiraling workers to safety. But humans don’t have to rely on luck; unlike ants, we have a capacity for introspection. The spiral begins when people forget that controlling the pandemic means doing many things at once. The virus can spread before symptoms appear, and does so most easily through five P’s: people in prolonged, poorly ventilated, protection-free proximity. To stop that spread, this country could use measures that other nations did, to great effect: close nonessential businesses and spaces that allow crowds to congregate indoors; improve ventilation; encourage mask use; test widely to identify contagious people; trace their contacts; help them isolate themselves; and provide a social safety net so that people can protect others without sacrificing their livelihood. None of these other nations did everything, but all did enough things right—and did them simultaneously. By contrast, the U.S. engaged in … 1. A Serial Monogamy of SolutionsStay-at-home orders dominated March. Masks were fiercely debated in April. Contact tracing took its turn in May. Ventilation is having its moment now. “It’s like we only have attention for only one thing at a time,” says Natalie Dean, a biostatistician at the University of Florida. As often happens, people sought easy technological fixes for complex societal problems. For months, President Donald Trump touted hydroxychloroquine as a COVID-19 cure, even as rigorous studies showed that it isn’t one. In August, he switched his attention to convalescent plasma—the liquid fraction of a COVID-19 survivor’s blood that might contain virus-blocking antibodies. There’s still no clear evidence that this century-old approach can treat COVID-19 either, despite grossly misstated claims from FDA Commissioner Stephen Hahn (for which he later apologized). More generally, drugs might save some of the very sickest patients, as dexamethasone does, or shorten a hospital stay, as remdesivir does, but they are unlikely to offer outright cures. “It’s so reassuring to think that a magic-bullet treatment is out there and if we just wait, it’ll come and things will be normal,” Dean says. [Read: How the pandemic defeated America] Other strategies have merit, but are wrongly dismissed for being imperfect. In July, Carl Bergstrom, an epidemiologist and a sociologist of science at the University of Washington, argued that colleges cannot reopen safely without testing all students upon entry. “The gotcha question I’ve handled most from reporters since is: This school did entry testing, so why did they get an outbreak?” he says. It’s because such testing is necessary for a safe reopening, but not sufficient. “If you do it and screw everything else up, you’ll still have a big outbreak,” Bergstrom adds. This brief attention span is understandable. Adherents of the scientific method are trained to isolate and change one variable at a time. Academics are walled off into different disciplines that rarely connect. Journalists constantly look for new stories, shifting attention to the next great idea. These factors prime the public to view solutions in isolation, which means imperfections become conflated with uselessness. For example, many critics of masks argued that they provide only partial protection against the virus, that they often don’t fit well, or that people wear them incorrectly. But some protection is clearly better than no protection. As Dylan Morris of Princeton writes, “X won’t stop COVID on its own is not an argument against doing X.” Instead, it’s an argument for doing X along with other measures. Seat belts won’t prevent all fatal car crashes, but cars also come with airbags and crumple zones. “When we layer things, we give ourselves more wiggle room,” Dean says. Several experts I’ve talked with have been asked: What now? The question assumes that the pandemic lingers because the U.S. simply hasn’t found the right solution yet. In fact, it lingers because the familiar solutions were never fully implemented. Despite claims from the White House, the U.S. is still not testing enough people. It still doesn’t have enough contact tracers. “We have the playbook, but I think there’s a confusion about what we’ve actually tried and what we’ve just talked about doing,” Dean says. A successful response “is never going to be one thing done perfectly. It’ll be a lot of different things done well enough.” That resilience disappears if we create… 2. False DichotomiesA world of black and white is easier to handle than one awash with grays. But false dichotomies are dangerous. From the start, COVID-19 has been portrayed as a disease that mostly causes mild symptoms in people who quickly recover, and occasionally causes severe illness that leads to hospitalization and death. This two-sided caricature—severe or mild, sick or recovered—has erased the thousands of “long-haulers” who have endured months of debilitating symptoms at home with neither recognition nor care. Meanwhile, as businesses closed and stay-at-home orders rolled out, “we presumed a trade-off between saving lives and saving the economy,” says Danielle Allen, a political scientist at Harvard. “That was foolishness of the most profound degree.” The two goals were actually aligned: Epidemiologists and economists largely agree that the economy cannot rebound while the pandemic is still raging. By treating the two as opposites, state leaders rushed to reopen, leading a barely contained virus to surge anew. [Read: Long=haulers are redefining COVID-19] Now, as winter looms and the pandemic continues, another dichotomy has emerged: enter another awful lockdown, or let the virus run free. This choice, too, is false. Public-health measures offer a middle road, and even “lockdowns” need not be as overbearing as they were in spring. A city could close higher-risk venues like bars and nightclubs while opening lower-risk ones like retail stores. There’s a “whole control panel of dials” on offer, but “it’s hard to have that conversation when people think of a light switch,” says Lindsay Wiley, a professor of public-health law at American University. “The term lockdown has done a lot of damage.” It exacerbated the false binary between shutting down and opening up, while offering … 3. The Comfort of TheatricalityStay-at-home orders saved lives by curtailing COVID-19’s spread, and by giving hospitals some breathing room. But the orders were also meant to buy time for the nation to ramp up its public-health defenses. Instead, the White House treated months of physical distancing as a pandemic-ending strategy in itself. “We squandered that time in terms of scaling up testing and contact tracing, enacting policies to protect workers who get infected on the job, getting protective equipment to people in food-processing plants, finding places for people to isolate, offering paid sick leave … We still don’t have those things,” says Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School and regular Atlantic contributor. The country is now facing the fall with many of the same problems that plagued it through the summer. Showiness is often mistaken for effectiveness. The coronavirus mostly spreads through air rather than contaminated surfaces, but many businesses are nonetheless trying to scrub and bleach their way toward reopening. My colleague Derek Thompson calls this hygiene theater—dramatic moves that appear to offer safety without actually doing so. The same charge applies to temperature checks, which can’t detect the many COVID-19 patients who don’t have a fever. It also applies to the porous and inefficient travel bans that Trump and his allies still tout as policy successes. These tactics might do some good—let’s not conflate imperfect with useless—but they cause harm when they substitute for stronger measures. Theatricality breeds complacency. And by emphasizing solutions that can be easily seen, it exacerbated the American preference for ... 4. Personal Blame Over Systemic FixesSARS-CoV-2 spread rapidly among America’s overstuffed prisons and understaffed nursing homes, in communities served by overstretched hospitals and underfunded public-health departments, and among Black, Latino, and Indigenous Americans who had been geographically and financially disconnected from health care by decades of racist policies. Without paid sick leave or a living wage, “essential workers” who earn a low, hourly income could not afford to quarantine themselves when they fell ill—and especially not if that would jeopardize the jobs to which their health care is tied. “The things I do to stay safe, they don’t have that as an option,” says Whitney Robinson, a social epidemiologist at the University of North Carolina at Chapel Hill. [Read: Immunology is where intuition goes to die] But tattered social safety nets are less visible than crowded bars. Pushing for universal health care is harder than shaming an unmasked stranger. Fixing systemic problems is more difficult than spewing moralism, and Americans gravitated toward the latter. News outlets illustrated pandemic articles with (often distorted) photos of beaches, even though open-air spaces offer low-risk ways for people to enjoy themselves. Marcus attributes this tendency to America’s puritanical roots, which conflate pleasure with irresponsibility, and which prize shame over support. “The shaming gets codified into bad policy,” she says. Chicago fenced off a beach, and Honolulu closed beaches, parks, and hiking trails, while leaving riskier indoor businesses open. Moralistic thinking jeopardizes health in two ways. First, people often oppose measures that reduce an individual’s risk—seat belts, condoms, HPV vaccines—because such protections might promote risky behavior. During the pandemic, some experts used such reasoning to question the value of masks, while the University of Michigan’s president argued that testing students widely would offer a “false sense of security.” These paternalistic false-assurance arguments are almost always false themselves. “There’s very little evidence for overcompensation to the point where safety measures do harm,” Bergstrom says. Second, misplaced moralism can provide cover for bad policies. Many colleges started their semester with in-person teaching and inadequate testing, and are predictably dealing with large outbreaks. UNC Chapel Hill lasted just six days before reverting to remote classes. Administrators have chastised students for behaving irresponsibly, while taking no responsibility for setting them up to fail—a pattern that will likely continue through the fall as college clusters inevitably grow. “If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases,” Robinson says. “I don’t know what [colleges] were expecting.” Perhaps they fell prey to … 5. The Normality TrapIn times of uncertainty and upheaval, “people crave a return to familiar, predictable rhythms,” says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security. That pull is especially strong now because the pandemic’s toll is largely invisible. There’s nothing as dramatic as ruined buildings or lapping floodwater to hint that the world has changed. In some circles, returning to normal has been valorized as an act of defiance. That’s a reasonable stance when resisting terrorists, who seek to stoke fear, but a dangerous one when fighting a virus, which doesn’t care. The powerful desire to re-create an old world can obscure the trade-offs necessary for surviving the new one. Keeping high-risk indoor businesses open, for example, helps the virus spread within a community, which makes reopening schools harder. “If schools are a priority, you have to put them ahead of something. What is that something?” says Bill Hanage, an epidemiologist at Harvard. “In an ideal world, they would be the last to close and the first to open, but in many communities, casinos, bars, and tattoo parlors opened before them.” A world with COVID-19 is fundamentally different from one without it, and the former simply cannot include all the trappings of the latter. Cherished summer rituals like camps and baseball games have already been lost; back-to-school traditions and Thanksgiving now hang in the balance. Change is hard to accept, which predisposes people to … 6. Magical ThinkingBack in April, Trump imagined the pandemic’s quick end: “Maybe this goes away with heat and light,” he said. From the start, he and others wondered if hot, humid weather might curb the spread of COVID-19, as it does other coronavirus diseases. Many experts countered that seasonal effects wouldn’t stop the new virus, which was already spreading in the tropics. But, fueled by shaky science and speculative stories, people widely latched on to seasonality as a possible savior, before the virus proved that it could thrive in the Arizona, Texas, and Florida summer. This brand of magical thinking, in which some factor naturally defuses the pandemic, has become a convenient excuse for inaction. Recently, some commentators have argued that the pandemic will imminently fizzle out for two reasons. First, 20 to 50 percent of people have defensive T-cells that recognize the new coronavirus, because they were previously exposed to its milder, common-cold-causing cousins. Second, some modeling studies claim that herd immunity—whereby the virus struggles to find new hosts, because enough people are immune—could kick in when just 20 percent of the population has been infected. Neither claim is implausible, but neither should be grounds for complacency. No one yet knows if the “cross-reactive” T-cells actually protect against COVID-19, and even if they do, they’re unlikely to stop people from getting infected. Herd immunity, meanwhile, is not a perfect barrier. Even if the low thresholds are correct, a fast-growing and uncontrolled outbreak will still shoot past them. Pursuing this strategy will mean that, in the winter, many parts of the U.S. may suffer what New York City endured in the spring: thousands of deaths and an untold number of lingering disabilities. That alone should be an argument against … 7. The Complacency of InexperienceWhen illness is averted and lives are spared, “nothing happens and all you have is the miracle of a normal, healthy day,” says Howard Koh, a public-health professor at Harvard. “People take that for granted.” Public-health departments are chronically underfunded because the suffering they prevent is invisible. Pandemic preparations are deprioritized in the peaceful years between outbreaks. Even now, many people who have been spared the ravages of COVID-19 argue that the disease wasn’t a big deal, or associate their woes with preventive measures. But the problem is still the disease those measures prevented: The economy is still hurting, mental-health problems are growing, and educational futures have been curtailed, not because of some fearmongering overreaction, but because an uncontrolled pandemic is still afoot. If anything, the U.S. did not react swiftly or strongly enough. Nations that had previously dealt with emerging viral epidemics, including several in East Asia and sub-Saharan Africa, were quick to take the new coronavirus seriously. By contrast, America’s lack of similar firsthand experience, combined with its sense of exceptionalism, might have contributed to its initial sloppiness. “One of my colleagues went to Rwanda in February, and as soon as he hit the airport, they asked about symptoms, checked his temperature, and took his phone number,” says Abraar Karan, an internist at Brigham and Women’s Hospital and Harvard Medical School. “In the U.S., I flew in July, and walked out of the airport, no questions asked.” Even when the virus began spreading within the U.S., places that weren’t initially pummeled seemed to forget that viruses spread. “In April, I was seeing COVID patients in the ER every day,” Karan says. “In Texas, I had friends saying, ‘No one believes it here because we have no cases.’ In L.A., fellow physicians said, ‘Are you sure this is worse than the flu? We’re not seeing anything.’” Three months later, Texas and California saw COVID-19 all too closely. The tendency to ignore threats until they directly affect us has consigned the U.S. to … 8. A Reactive RutIn March, Mike Ryan at the World Health Organization advised, “Be fast, have no regrets … The virus will always get you if you don’t move quickly.” The U.S. failed to heed that warning, and has repeatedly found itself several steps behind the coronavirus. That’s partly because exponential growth is counterintuitive, so “we don’t understand that things look fine until right before they’re very not fine,” says Beth Redbird, a sociologist at Northwestern. It’s also because the coronavirus spreads quickly but is slow to reveal itself: It can take a month for infections to lead to symptoms, for symptoms to warrant tests and hospitalizations, and for enough sick people to produce a noticeable spike. Pandemic data are like the light of distant stars, recording past events instead of present ones. This lag separates actions from their consequences by enough time to break our intuition for cause and effect. Policy makers end up acting only when it’s too late. Predictable surges get falsely cast as unexpected surprises. This reactive rut also precludes long-term planning. In April, Michael Osterholm, an epidemiologist at the University of Minnesota, told me that “people haven’t understood that [the pandemic] isn’t about the next couple of weeks [but] about the next two years.” Leaders should have taken the long view then. “We should have been thinking about what it would take to ensure schools open in the fall, and prevent the long-term harms of lost children’s development,” Redbird says. Instead, we started working our way through a serial monogamy of solutions, and, like spiraling army ants, marched forward with no sense of the future beyond the next few footsteps. These errors crop up in all disasters. But the COVID-19 pandemic has special qualities that have exacerbated them. The virus moved quickly enough to upend the status quo in a few months, deepening the allure of the hastily abandoned past. It also moved slowly enough to sweep the U.S. in a patchwork fashion, allowing as-yet-untouched communities to drop their guard. The pandemic grew huge in scope, entangling every aspect of society, and maxing out our capacity to deal with complexity. “People struggle to make rational decisions when they cannot see all the cogs,” says Njoki Mwarumba, an emergency-management professor at the University of Nebraska at Omaha. Full of fear and anxiety, people furiously searched for more information, but because the virus is so new, they instead spiraled into more confusion and uncertainty. And tragically, all of this happened during the presidency of Donald Trump. Trump embodied and amplified America’s intuition death spiral. Instead of rolling out a detailed, coordinated plan to control the pandemic, he ricocheted from one overhyped cure-all to another, while relying on theatrics such as travel bans. He ignored inequities and systemic failures in favor of blaming China, the WHO, governors, Anthony Fauci, and Barack Obama. He widened the false dichotomy between lockdowns and reopening by regularly tweeting in favor of the latter. He and his allies appealed to magical thinking and steered the U.S. straight into the normality trap by frequently lying that the virus would go away, that the pandemic was ending, that new waves weren’t happening, and that rising case numbers were solely due to increased testing. They have started talking about COVID-19 in the past tense as cases surge in the Midwest. “It’s like mass gaslighting,” says Martha Lincoln, a medical anthropologist at San Francisco State University. “We were put in a situation where better solutions were closed off but a lot of people had that fact sneak up on them. In the absence of a robust federal response, we’re all left washing our hands and hoping for the best, which makes us more susceptible to magical thinking and individual-level fixes.” And if those fixes never come, “I think people are going to harden into a fatalistic sense that we have to accept whatever the risks are to continue with our everyday lives.” That might, indeed, be Trump’s next solution. The Washington Post reports that Trump’s new adviser--the neuroradiologist Scott Atlas—is pushing a strategy that lets the virus rip through the non-elderly population in a bid to reach herd immunity. This policy was folly for Sweden, which is nowhere near herd immunity, and now has one of the world’s highest COVID-19 death rates and a regretful state epidemiologist. Although the White House has denied that a formal herd-immunity policy exists, the Centers for Disease Control and Prevention recently changed its guidance to say that asymptomatic people “do not necessarily need a test” even after close contact with an infected person. This change makes no sense: People can still spread the virus before showing symptoms. By effectively recommending less testing, as Trump has specifically called for, the nation’s top public-health agency is depriving the U.S. of the data it needs to resist intuitive errors. “When there’s a refusal to take in the big picture, we are stuck,” Mwarumba says. The pandemic is now in its ninth month. Uncertainties abound as fall and winter loom. In much of the country, colder weather will gradually pack people into indoor spaces, where the coronavirus more readily spreads. Winter also typically heralds the arrival of the flu and other respiratory viruses, and although the Southern Hemisphere enjoyed an unusually mild flu season, that’s “because of the severe precautions they were taking against COVID-19,” says Eleanor Murray, an epidemiologist at Boston University. “It’s not clear to me that our precautions will be successful enough to also prevent the flu.” Schools are reopening, which will shape the path of the pandemic in still-uncertain ways. Universities are more predictable: Thanks to magical thinking and misplaced moralism, the U.S. already has at least 51,000 confirmed infections in more than 1,000 colleges across every state. These (underestimated) numbers will grow, because only 20 percent of colleges are doing regular testing, while almost half are not testing at all. As more are forced to stop in-person teaching, students will be sent back to their communities with COVID-19 in tow. “I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control,” Murray says. Further spikes will likely occur after Thanksgiving and Christmas, as people who yearn to return to normal (or who think that the country overreacted) travel to see their family. Despite that risk, the CDC recently dropped its recommendation that out-of-state travelers should quarantine themselves for 14 days. But many of the experts I spoke with thought it unlikely that “we’ll have cities going full New York,” as Bergstrom puts it. Doctors are getting better at treating the disease. States like Massachusetts, New York, and New Jersey have managed to avoid new surges over the summer, showing that local leadership can at least partly compensate for federal laxity. A new generation of cheap, rapid, paper-based tests will hit the market and make it easier to work out who is contagious. And despite the spiral of bad intuitions, many Americans are holding the line: Mask use and support for physical distancing are still high, according to Redbird, who has been tracking pandemic-related attitudes since March. “My feeling is that while things are going to get worse, I’m not sure they’ll be catastrophic, because of situational awareness,” Bill Hanage says. Meanwhile, Trump seems to be teeing up a vaccine announcement in late October, shortly before the November 3 election. Moncef Slaoui, the scientific head of Operation Warp Speed, told NPR that it’s “extremely unlikely” a vaccine will be ready by then, and many scientists are concerned that the FDA will be pressured into approving a product that hasn’t been adequately tested, as Russia and China already have. Many Americans share this concern. A safe and effective vaccine could finally bring the pandemic under control, but its arrival will also test America’s ability to resist the intuitive errors that have trapped it so far. Vaccination has long been portrayed as the ultimate biomedical silver bullet, separating an era when masks and social distancing mattered from a world where normality has returned. This is yet another false dichotomy. “Everyone’s imagining this moment when all of a sudden, it’s all over, and they can go on vacation,” Natalie Dean says. “But the reality is going to be messier.” This problem is not unique to COVID-19. It’s more compelling to hope that drug-resistant bacteria can be beaten with viruses than to stem the overuse of antibiotics, to hack the climate than to curb greenhouse-gas emissions, or to invest in a doomed oceanic plastic-catcher than to reduce the production of waste. Throughout its entire history, and more than any other nation, the U.S. has espoused “an almost blind faith in the power of technology as panacea,” writes the historian David Segal. Instead of solving social problems, the U.S. uses techno-fixes to bypass them, plastering the wounds instead of removing the source of injury—and that’s if people even accept the solution on offer. A third of Americans already say they would refuse a vaccine, whether because of existing anti-vaccine attitudes or more reasonable concerns about a rushed development process. Those who get the shot are unlikely to be fully protected; the FDA is prepared to approve a vaccine that’s at least 50 percent effective—a level comparable to current flu shots. An imperfect vaccine will still be useful. The risk is that the government goes all-in on this one theatrical countermeasure, without addressing the systemic problems that made the U.S. so vulnerable, or investing in the testing and tracing strategies that will still be necessary. “We’re still going to need those other things,” Dean says. Between these reasons and the time needed for manufacturing and distribution, the pandemic is likely to drag on for months after a vaccine is approved. Already, the event is exacting a psychological toll that’s unlike the trauma of a hurricane or fire. “It’s not the type of disaster that Americans specifically are used to dealing with,” says Samantha Montano of Massachusetts Maritime Academy, who studies disasters. “Famines and complex humanitarian crises are closer approximations.” Health experts are burning out. Long-haulers are struggling to find treatments or support. But many Americans are turning away from the pandemic. “People have stopped watching news about it as much, or talking to friends about it,” Redbird says. “I think we’re all exhausted.” Optimistically, this might mean that people are becoming less anxious and more resilient. More worryingly, it could also mean they are becoming inured to tragedy. The most accurate model to date predicts that the U.S. will head into November with 220,000 confirmed deaths. More than 1,000 health-care workers have died. One in every 1,125 Black Americans has died, along with similarly disproportionate numbers of Indigenous people, Pacific Islanders, and Latinos. And yet, a recent poll found that 57 percent of Republican voters and 33 percent of independents think the number of deaths is acceptable. “In order for us to mobilize around a social problem, we all have to agree that it’s a problem,” Lori Peek says. “It’s shocking that we haven’t, because you really would have thought that with a pandemic it would be easy.” This is the final and perhaps most costly intuitive error ... 9. The Habituation of HorrorThe U.S. might stop treating the pandemic as the emergency that it is. Daily tragedy might become ambient noise. The desire for normality might render the unthinkable normal. Like poverty and racism, school shootings and police brutality, mass incarceration and sexual harassment, widespread extinctions and changing climate, COVID-19 might become yet another unacceptable thing that America comes to accept. from https://ift.tt/3m47gKm Check out http://natthash.tumblr.com On Wednesday, Natalia Mehlman Petrzela got in a line near her home in New York City’s West Village that snaked down the sidewalk and wrapped around the corner of the block. New Yorkers will queue up for virtually anything; I was once velvet-roped outside a budget pasta joint, among other indignities. But at 5:45 in the morning, Petrzela and her neighbors weren’t anticipating a sample sale or a particularly good bagel. They just wanted to work out. That was the first day the city’s gyms were allowed to reopen at diminished capacity after nearly six months of pandemic shutdown, and people were really excited to get back on the elliptical before dawn. “I don’t know if I’m proud of that or not,” Petrzela, who worked at the gym years ago as an instructor before becoming a history professor at The New School, told me. Either way, she was happy to be back. As soon as she got through the door, she said, “the guy behind the desk said, ‘It wouldn’t be opening day without you, Natalia.’” After all the city had been through, Petrzela found it surprisingly poignant to see—and be remembered by—someone familiar. In a quest for normalcy over the past few months of closures, the desire among gym-goers to get back at it has seemed subordinate only to people’s urge to return to bars and restaurants. Some gyms have moved equipment onto sidewalks or into parking lots to satisfy their most dedicated patrons and generate a little revenue. Yoga classes have popped up in parks. In New Jersey and California, gyms opened in brazen defiance of shutdown orders and hosted the occasional cluster of coronavirus cases. Other gyms quietly resumed conducting business as exercise speakeasies, inviting only the clients they believed could keep their secret. I’ve spent my entire adult life listening to people complain about sticking to a gym routine, lament paying so much for a membership, or joke about hating exercise. Many of those people, of course, went to the gym anyway, which I always presumed was out of obligation to their health, to beauty standards, or to both. When gyms shut down, Americans’ purchase patterns soon indicated that many people were finding relatively straightforward work-arounds to their formerly gym-bound exercise habits. Bicycle shops across the country sold out of adult-size bikes. In many places, expensive Pelotons are still back-ordered up to eight weeks. Even simple hand weights and kettlebells have been hard to come by. [Read: I joined a stationary biker gang.] Months later, however, it’s become clear that for many former gym-goers, streaming classes and newfound running habits haven’t been able to fully replace their old routines. Although concerns linger about the dangers of huffing and puffing indoors with strangers during a pandemic, people have started to filter back into gyms in places where they’ve reopened, waving goodbye to their virtual-yoga teachers in pursuit of a more collective experience. Their eager return has revealed that physical activity and the desire to go to the gym may be related, but they’re not quite the same. The gym has taken on a role all its own in American life. In the past 70 years, physical activity in America has transformed from a necessity of daily life into an often-expensive leisure activity, retrofitted into the foundation of people’s identities. As a concept, fitness was a response to the flourishing, sidewalk-free postwar American suburbs and what the fitness pioneer Bonnie Prudden dubbed “the tyranny of the wheel”: Americans went from strollers to school buses to cars, stripping out much of the on-foot transportation that had long characterized life in cities or on farms. “In the ’50s and ’60s, the body became a problem, and exercise developed—it had to develop—because people realized that we were all going to die of heart attacks,” Shelly McKenzie, the author of Getting Physical: The Rise of Fitness Culture in America, told me. With new middle-class needs came new marketing. Jack LaLanne’s instructional exercise TV show introduced much of the country to the active pursuit of physical fitness in 1951, paving the way for workout tapes from fitness megastars such as Richard Simmons and Jane Fonda. In the ’70s, exercise began to leave the home, both through the popularization of jogging and weightlifting and in more organized ways, such as Jazzercise classes. The American fitness market has been thriving ever since, absorbing things such as yoga and ballet and creating whole new workouts, such as step aerobics. Gyms, too, have flourished. There’s now a gym for virtually everyone with 10 bucks a month to spare, from the inexpensive Planet Fitness, which offers its members a low-pressure environment and a monthly free-pizza night, to Equinox, the ultra-expensive luxury chain that offers high-end skin-care products in its locker rooms. No matter how they package it, these businesses aren’t just selling physical activity; they’re providing people with a way to adhere to expectations that the industry itself helped set. “Exercise, and especially public exercise, came to signify mental, emotional, and even spiritual health and virtue,” Marc Stern, a historian at Bentley University, wrote in 2008. In return for the effort, gym-goers attain the type of body that proves their virtue to all who see them. [Read: The church of CrossFit] That these physical standards are difficult to achieve is the point. “We live in a culture in which being industrious is highly, highly valorized,” Petrzela, the New School professor, who is working on a book about fitness’s place in American culture, told me. “Many people want to be perceived as people who value exercise, because it shows they’re committed to self-improvement, and to hard work.” Above and beyond movement itself, part of the satisfaction of gym-going comes from performing those values around other people who share them, and from achieving what that community regards as success. This psychological cycle of work and reward means that there’s all the more to lose when gyms go dark. If you spent hours every week in Pilates class or carefully monitoring your protein macros in pursuit of gains, where do the energy and care put into those rituals go when you’re asked to stay home? “Those kinds of things really do matter to people,” Stern told me. “Many people view the gym as that space where they’re able to demonstrate their own willingness to try to control their life, and it’s especially important in a time when that kind of control is really absent.” For some people, exercising alone in their living room doesn’t grant that same sense of role-fulfillment. Proving something to others is often a big part of proving it to yourself, and that’s difficult to do when no one else can see you. Even for people who would be physically satisfied by a solitary run, the gym can provide a clear advantage, after six months of lockdown: It’s not their home. They might be eager to return to the gym just because it’s an opportunity to spend an hour away from the family members they’ve been cooped up with for far too long, and because they see fitness as something they do only for themselves. “The home is not the place where I relax. It’s a place of multiple obligations,” McKenzie said. “If you’re a working family, and you have kids on Zoom school, that’s your priority right there.” She said that for a lot of people, starting a whole new at-home exercise routine is a psychological bridge too far. For many people, time spent working out before the pandemic was “me time,” an experience that can’t be re-created at home if your kids are watching you do a yoga video. In some ways, though, the desire to return to the gym is as much about the presence of others as it is about a focus on the self. “A lot of people who are missing the gym are not just missing exercise, but they’re missing having another institution in their social life,” Petrzela said. There’s a certain pleasure in being a regular somewhere, no matter where it is; McKenzie referred to it as the Cheers effect. Some people have regained bits and pieces of those social interactions as certain types of local businesses have reopened. I, for one, can’t quite account for the level of excitement I felt when I first saw Beatrice, my favorite bartender at my favorite wing place, when the restaurant finally reopened. For some people, their Beatrice is at the gym. “A lot of us really come to enjoy a particular instructor,” McKenzie noted. “The minute the gym closes, you don’t see that person who may have been tremendously influential in your life.” Even if those instructors have been teaching online classes to bridge the gap, the connection just isn’t the same. For people who had built a gym routine before the coronavirus changed everyone’s life, there is comfort in regaining one more psychological tentpole of normalcy, even if the circumstances—masks, lines, acrylic partitions, and fewer gym-goers allowed inside—are far from normal. You can watch all the guided yoga routines in the world, but the YouTube-famous instructor onscreen is never going to be excited to once again see your smiling face at six in the morning. from https://ift.tt/3bEgMzl Check out http://natthash.tumblr.com My obsession with ventilation began long before the pandemic. Five years ago, when I moved from central Tokyo to the coast of Japan, a blanket of humidity seemed to levitate out from the sea and the surrounding mountains, wrapping everything I owned in a moist haze. Combined with crushing summer heat, it cultivated a perfect recipe for mold. That first summer, my ventilation game was weak. The tatami mats—traditional Japanese straw flooring—sprouted dark clumps. A yeasty smell took root in the entryway, and sure enough, on close inspection, a few pairs of my shoes were baking their own bread. Books placed near windows seemed to become sentient with ever-evolving tendrils of hyphae along their spines. I asked around. Was this normal? “Oh yes. Welcome to mold country,” was the common refrain. Old-timers told harrowing stories of hanging clothes out to dry in the sun and forgetting to take them in at night. By the next morning, they’d gone feral. The wet, stagnant night air was mold heaven. I was traumatized. For 10 months of the year, the area was idyllic, livable, and most importantly, dry. But how would I survive the sticky summers? I had never once before given thought to ventilation. My personal concern is now a global one. Ventilation plays a major role in transmission of the coronavirus: The odds of catching the coronavirus are nearly 20 times higher indoors than if you’re outside. Droplets containing the virus are insidious. They can linger in a badly ventilated room, potentially spreading throughout even if you’re keeping a safe distance from others. People who are asymptomatic don’t sneeze or cough, but they still release a steady stream of aerosols as they jabber away over salads at lunch or lecture to their students at a university. “Those particles can be suspended in air for hours, and maintain infectivity,” says Jiarong Hong, a mechanical engineer at the University of Minnesota. “But,” he emphasizes, “if you do even just a little bit of a better job [of improving ventilation], you can significantly decrease risks.” Since my initial bout with mold, I’ve spent an absurd amount of time and energy on a quest to perfect the airflow in my home. What started as an act of desperation has evolved into something bigger: a way of life. Ventilation doesn’t just keep us safer during the pandemic, I’ve realized; it lifts the spirit and the mind. Allow me, this amateur ventilation expert, to teach you how to better ventilate. My initial impulse toward a mold-free life was to seal the windows and endlessly run the air conditioner. It helped, but created unintended pockets of moisture. My HVAC isn’t centralized, and because there’s no AC in the hallway, I came home from a weekend trip to find that my bedroom door had grown its own skin. The AC had generated enough of a temperature gap to produce condensation on the outside of the door: instant mold. So too with the pandemic: AC alone often doesn’t cut it, Hong told me. If an AC unit just blows air in circles, aerosols can stick around. Gross. [Read: We need to talk about ventilation] Dehumidifiers were my next idea. I bought two hulking machines, the kind you can leave on for 24 hours a day. Household dehumidifiers typically fill up with water in just a few hours as they try to keep humidity below 70 percent. But these industrial-strength ones drain continuously via a hose, so you never have to empty their tanks. Paired with the AC, the dehumidifiers transformed the atmosphere from yeasty oven to dry comfort, but the air still lacked verve and freshness. On a whim, I purchased a Vornado fan, stuck it in the corner of my living room, and turned it on. Instantly, I felt like a fool. Were fans the simple solution to this moldy puzzle? But the Vornado was no ordinary fan. It was so powerful that it seemed to inhale the room, invert it, and push it back out. The totality of how it moved all the air was a revelation. Buoyed by this fairly obvious insight, I took things further. I purchased some in-window ventilation units that you can install on your own. I fitted them tightly into windows on opposite sides of the room. One pulls in air, and the other pushes it out. Good lord. Standing in the middle of the living room with the vents and Vornado all working in concert was pure rapture. The AC and dehumidifier almost felt unnecessary. I now own three Vornados and a small army of those in-window units, strategically placed so that no particle of air stagnates in my 1,000-square-foot home. The resulting vortex of moving air eliminates any chance of particle build up, of a heaviness of atmosphere taking root. Light a cigarette anywhere in my house, and you’ll be dazzled by the flow of the smoke—up and around, through doorways, swirling toward the ceiling and then back to the floor, inscribing elegant arcs through the air—never resting until it finds its way out a window. I asked Hong whether I was crazy. Was all of this overkill? Sure, the air felt comfortable, but was it really any better? “You solved it intuitively,” Hong said. “From a fluid-mechanics point of view, you are producing a pressure gradient,” which is a fancy way of saying that the air in my house is successfully moving from one side to another. Without pressure gradient, you end up with what Hong calls a “stable circulation,” in which particles move around and around with no exit route. A big no-no. One of my rooms has only one window, and therefore only one vent. Hong admonished me. “It’s a very, very bad design to have ventilation in and out in the same place. Much better to have multiple locations.” For those of us renting homes, knocking a new hole in a wall to add a second vent can be difficult. But for businesses, adding vents could be a smart investment. Thankfully, you can create safer air without going to my extremes. If you can’t afford in-window vents, just crack as many windows as possible. Open doors between single-window rooms to help establish gradients. Do this even with the air conditioner on, or the heater come winter. Yes, it’s less energy efficient, but even one cracked window will slowly replenish stagnant air. Two cracked windows help the air better figure out how to move. You can also augment the quality of air in a single-vent room by adding a HEPA filter, which has been shown to effectively reduce dangerous aerosols. [Read: Can AC spread the coronavirus?] As for fan placement, be intentional. If they’re pointed toward walls, the fans will create pockets where air just loops in circles—that dreaded “stable circulation.” Instead, have fans blow through the room in such a way as to shuffle air toward out-vents or open windows. Since modifying the direction in which an AC blows can be difficult, it is sometimes useful to place fans perpendicular to an AC’s stream. This further helps eliminate any stagnant air pockets the AC may produce because of suboptimal placement. The final results should be clear but subtle: The goal isn’t a wind tunnel, but a gentle sense of active air. You’ll likely know if you’ve been successful, because—thanks to the vents, the open windows, and the free-flowing air—the room should feel lighter, smell better, and seem far fresher than it did before. Odors should dissipate quickly. And microparticles of spittle should be whisked away at a pace that makes contracting a virus significantly less likely. Your mold will be gone, your head clear, and your life ever safer. Become as obsessed with ventilation as I am, and you’ll develop what can be described only as “ventilation radar.” You sense the torpor of a hotel room in which the windows don’t open. You feel suffocated in a café without a breeze. You can walk into a restaurant and instinctively estimate risk, eyeballing potential dead-air hot spots and considering whether aerosols might be a problem. How many windows are open? Is the restaurant using both AC and fans? You start to bail on weakly ventilated joints. Ventilation becomes a proxy for everything. If the ventilation is bad, what about the food? If management can’t get something as obvious as the airflow in check, who knows what horrors might be going on in that kitchen. In fact, my journey has convinced me that ventilation is perhaps the fundamental aspect of home design. Ventilation—how air flows, where it flows, how much of it flows, and how quickly it’s replenished—establishes the beating heart of a building. Even the most thoughtfully designed room is insufferable if it’s unbearably stale. Five years on, the summers no longer scare me. I’m even feeling a pang of nostalgia as this one comes to an end. My floors are clump-free, my doors without skin, and my boots without bread. The air around me swirls and is full of life, and it doesn’t hang around long enough for microbial buddies to take root on surfaces. These days, the only active starter in my home is for sourdough. from https://ift.tt/3bAOjdE Check out http://natthash.tumblr.com The stairs have become my daily Everest. Just six months ago, the steep climb to my fourth-floor walk-up in Brooklyn was a nuisance only when I was carrying bags of groceries. Now, every time I mount those 53 steps, no matter how slowly, even if I’m empty-handed, my heart rate shoots up to marathon-level. I can actually feel the thud-thud in my throat. Sometimes I have to pause between landings to lie on the floor and stick my feet up in the air to avoid passing out. This unusually rapid beating can also be triggered seemingly by nothing––sitting up in bed, standing up from the toilet. I first noticed it in March, when I came down with COVID-19. Or at least, it seems clear that I came down with COVID-19. My whole household got sick just before the peak of New York City’s outbreak. Like most Americans in the early weeks of the pandemic, we were unable to get tested, so my primary-care physician diagnosed my illness based on symptoms: endless days of fever, loss of taste and smell, sore throat, nausea, exhaustion, body aches, a hacking dry cough, and an intense struggle to breathe. Most of these symptoms subsided in mid-April, but some have lingered. For months, I needed a twice-daily dose of a steroid inhaler to breathe normally. I’m more tired and brain-fogged than usual. And I’m still dealing with my racing heart. I’ve always been a bit of a fainter: Years ago, I was diagnosed with orthostatic hypotension, a sudden, rapid decrease in blood pressure that sometimes strikes when I stand up too quickly. But now, instead of fainting once or twice a year, I feel that woozy fade from light to dark daily, sometimes even hourly. A few weeks ago, I stood up to make a smoothie and my heart rate zoomed from lying-in-a-hammock to booming-bass-drum. The official name for my new heart troubles, as I’ve recently been diagnosed, is postural orthostatic tachycardia syndrome, or POTS. The condition, a puzzling dysfunction of both the heart and the nervous system, messes with how the body regulates involuntary functions, including pulse. POTS is known to affect approximately 500,000 people in the U.S., typically young women in their late teens or early 20s. But now, several cardiologists with whom I’ve spoken say they’re noticing an unsettling trend. Previously fit and healthy women of all ages who have had COVID-19 are showing up at their offices, complaining of inexplicably racing hearts. [Read: COVID-19 can last for several months.] The more we learn about COVID-19, the stranger its effects appear to be. Beyond its telltale fever and cough, troubling early evidence has been mounting that the disease can damage many organs in the body, including the lungs, the brain, and—yes, you guessed it—the heart. An array of cardiac dysfunctions has cropped up, confounding researchers and revealing that COVID-19 is a far more complicated and potentially long-lasting disease than people initially expected. These heart ailments have especially gained attention from sports: Some college football players who have had COVID-19 are sitting out this season with myocarditis, a rare condition that can be fatal if untreated. The Red Sox pitcher Eduardo Rodriguez is doing the same. In a strange way, I feel lucky. POTS is not life-threatening—at least, aside from the risk of head trauma from blacking out. But it is destabilizing, both physically and mentally, to wander around not knowing what my body has in store for me from one minute to the next. Like so many other aspects of this pandemic, this latest syndrome in my parade of illness is mysterious, disruptive, and scarily indefinite. After my smoothie incident, I called my cousin Emily Wessler, a pediatric cardiologist at Stanford, and asked her what was going on in my body whenever I felt like I was going to pass out. “You’re not getting enough blood to the brain,” she told me, “so the brain says, ‘Shut down! Shut down! Emergency!’” She’d been reading more and more professional chatter about cases of POTS and other cardiovascular disorders post-COVID, so she urged me to make an appointment with a cardiologist. She added that I also might want to speak with a neurologist. There are a lot of doctors to call if your whole body feels like it’s malfunctioning, which is not ideal at a time when millions of Americans are losing their health insurance. I started with a cardiologist. At NYU Langone, Seol Young Han Hwang hooked me up to an EKG that immediately spit out bad news. “Sinus tachycardia,” it read. “Abnormal ECG.” In other words, my heart was beating much faster than it should have been, given that I was reclining on an exam table. Han asked me to wear a Holter monitor for a week to trace my heart’s vagaries. It showed abrupt daily spikes, during which my heart rate would jump from as low as 51 beats per minute, while at rest, to as high as 163. I returned to the hospital for a cardiac ultrasound and a test of my heart’s ability to deal with exercise. The echocardiogram was normal. The stress test was not. Susan Polizzi, another Langone cardiologist, had me slowly build up my heart rate to 161 beats per minute on a gradually steepening treadmill. The test confirmed that I’m in good shape for my age (54) and gender, but when Polizzi then had me sit down and rest, my heart rate remained elevated well above 100 bpm for the next four minutes, instead of quickly slowing down as it should have. When it was finally within the normal range, Polizzi told me to stand. My heart rate immediately shot back up, and I felt on the verge of fainting. “Yup, that’s POTS,” Polizzi said. In layperson’s terms, having POTS means that blood pools too rapidly in your pelvis and legs when you stand up, and your heart goes nuts to compensate. This bodily response is actually an exaggerated version of the system that allows us to walk on two feet. But knowing that doesn’t make the condition any more tolerable. It just makes me jealous of dogs. POTS has been recognized under different names by doctors for more than 160 years, but the syndrome’s root cause is still poorly understood. Its apparent link to COVID-19 is even more of a mystery, in the most nascent stage of research. “We know much more about POTS in general than we do about post-COVID POTS,” says Matthew Tomey, the director of the cardiac intensive-care unit at Mount Sinai Morningside and one of a growing number of cardiologists who have begun studying the lingering effects of COVID-19 on the heart. “In a series of patients who do have POTS, over 40 percent describe symptoms of a preceding viral illness. And so while we’re still learning more and more about COVID-19 specifically, we have good reason to believe that it is yet another viral illness that could precede the onset of POTS.” [Read: The coronavirus is never going away.] Tomey is in the middle of gathering data on COVID-19 survivors stricken with all manner of symptoms, so he wasn’t able to share any specific numbers on those with POTS that might hint at exactly how widespread the overlapping conditions are. For now, the evidence is anecdotal. But Tomey and the other cardiologists with whom I spoke all are alarmed by the uptick in POTS and other forms of dysautonomia—the dysfunction of the nerves regulating involuntary body functions—in their practices. This is frustrating for everyone involved. POTS’s unclear origins and wide range of symptoms vex doctors. And they make it easy for patients to be dismissed. Many teens and young women who develop POTS grow out of the condition. But the apparent surge in cases across a wider age range has made it harder for cardiologists to speculate about how long these symptoms might persist or what the lasting consequences could be. POTS’s greatest danger, according to Tomey, is not a heart attack today, but a downward spiral in physical activity that could eventually lead to heart failure in the future. If cases linked to COVID-19 are not an urgent crisis, in other words, they could perhaps be more subtly pernicious. The most significant health damages could be difficult to trace and could arrive far down the road, well after the pandemic ends. Before leaving my stress test, I asked Polizzi how best to manage POTS. She suggested I buy a pair of compression socks and pants to keep the blood from pooling in my lower half, eat more salt and drink more liquids with electrolytes, and follow a recumbent exercise regime developed for POTS patients. (Swimming, rowing machine, recumbent bike—none of which I have access to during a pandemic.) I walked out of her office more confused than ever. Although the diagnosis was a helpful validation, it mostly raised more questions. When would I be able to walk up stairs again? Was this the new normal for the rest of my life? After months of anxieties and baffling ailments, how could it be that two of the best solutions available to me were merely … Gatorade and Spanx? “Some of my POTS patients take frequent shots of pickle juice,” Han later told me at a follow-up visit. Yeah, no thanks. I was not surprised by the dearth of either cures or data. Like so many others, I’ve come to rely on confusion as the one constant I can expect in this pandemic. Studies have found that most COVID-19 patients produce antibodies that stick around in the body for months, if not longer. Yet when I was finally able to get an antibody test two months after I got sick, I tested negative—twice. Testing can’t confirm that I even had COVID-19 in the first place. But nothing about this disease is simple. As Ed Yong has pointed out in The Atlantic, “most existing antibody studies have focused on either hospitalized patients or those with mild symptoms and swift recoveries.” David Putrino, a physical therapist at Mount Sinai Hospital who has surveyed more than 1,000 people with long-lasting symptoms consistent with COVID-19, has found that about two-thirds of these “long-haulers” who’ve had antibody tests received negative results. (Putrino hasn’t tracked when in the course of their illness they were tested.) [Read: Long-haulers are redefining COVID-19.] It feels important to note here that I’m not prone to hypochondria. In fact, I’m used to ignoring and pushing through illness and recovery. I once hiked the foothills of the Himalayas two weeks after emergency surgery. I put the finishing touches on a TV news story while in active labor with my daughter. This time, however, I feel both annoyed and limited. I’m stuck in post-COVID limbo, waiting until I can magically walk up the stairs again without feeling like I swallowed Dave Grohl’s drum. Last month, on a long-anticipated family trip to rural Maine, instead of hiking Acadia with my kids, as planned, I had to wave them off into the wild while I stayed back at our Airbnb, reading. It’s probably going to be a while until research has any new solutions for me. “Right now the emphasis is almost entirely on coming up with a vaccine and testing and mechanisms of the viral disease, and these are obviously all key,” says David S. Goldstein, the chief of autonomic medicine at the National Institutes of Health and the discoverer of the chemical imbalance that leads to fainting. But Goldstein does believe that this focus will shift toward the virus’s lasting effects once we can tame its global rampage. “My guess is that it won’t be long before the main public-health threat from this pandemic won’t be acute critical illness or death,” he told me. “Instead, it will be a post-COVID syndrome, like chronic fatigue syndrome but drastically amplified.” That future already seems to be arriving. COVID-19 long-haulers have launched their own online support groups and research projects to call attention to lasting symptoms that were at first widely dismissed. Survivor Corps, one of the largest of these groups, has identified 98 different symptoms self-reported by long-haulers, such as brain fog, chronic shortness of breath, digestive issues, dry eyes, fatigue, and depression, along with diagnoses of lupus, diabetes, and tachycardia. Goldstein himself caught COVID-19 and now has mild post-COVID symptoms, such as shortness of breath and fatigue, which he referred to as a “sense that if I don’t have anything else to do, I’m going to go to sleep.” With POTS, at least, I do have some hope for a less heart-wrenching future. Both Goldstein and Tomey were quick to point out that many astronauts—including, they said, every female astronaut who has ever blasted off into space and spent extended time in zero gravity––have come home with cases of POTS-like orthostatic intolerance. All recovered relatively quickly. As strange as it sounds, a link between space travel and COVID-19 might actually exist: The physical deconditioning that occurs both during prolonged time in zero gravity and while lying in bed battling a virus may play a key role in triggering the syndrome. As for why women are disproportionately affected, Goldstein has what he calls a “pet theory”: Women’s larger pelvises, where blood pools too rapidly in POTS, need to be more vascularly “stretchy” than men’s to grow a baby, so “some women might simply be too stretchy,” he said. No one, to his knowledge, has been given a grant to study this. “It’s a women’s-health issue,” he said, clearly pained by the lack of scientific resources appropriated to half the human species. For the sake of furthering post-COVID science, I’ve volunteered my own female body to join Tomey’s study sometime this fall. This will require extra trips up and down my stairs. I asked Tomey if I should change apartments. “No,” he said. “As difficult as those stairs are for you right now, they may be the salvation to the problem.” Such is the damning catch-22 of POTS. A racing heart limits physical activity. But to recuperate, one must be active. The point, however, may be moot. Less than a week after my conversation with Tomey, a process server showed up at the bottom of my Everest stairs with a letter announcing that my landlord would not be renewing our lease once it ends on November 30. “Is this a joke?” I asked when I walked down to receive it. “Nope,” the process server said, then left. We’ve since gotten permission to stay through the end of the school year. Still, because no one will tell us why we can’t stay even longer, it’s all just more confusion. The answers to seemingly basic questions––Why are you kicking out a family from their home during a pandemic? Why am I still sick? When will I get better?––are somehow maddeningly elusive. Clutching the letter in one hand and the banister in the other, I climbed the 53 stairs, one by one, pausing on each landing to lie down and catch my breath between ascents. from https://ift.tt/356WDAK Check out http://natthash.tumblr.com One of the pandemic’s most insidious misconceptions is getting closer to explicit national policy. On Monday, The Washington Post reported that a top Trump medical adviser, Scott Atlas, has been “urging the White House to embrace a controversial ‘herd immunity’ strategy.” Atlas subsequently denied the report, though during his time as a Fox News commentator he consistently argued in favor of fringe approaches that go hand in hand with the idea: namely that city and state shutdowns are deadlier than the coronavirus itself. The idea of abandoning preventive measures and letting the virus infect people has already gotten traction in the administration. Just last week, Atlas moved to ease up on the most important strategy to fight the virus—widespread testing—by telling the Centers for Disease Control and Prevention to change their guidelines to advise against testing asymptomatic people. On Monday night, the president referenced the concept in an appearance on Fox News, explaining, “Once you get to a certain number—we use the word herd—once you get to a certain number, it’s going to go away.” But“herd immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy. Herd immunity is an important public-health concept, developed and used to guide vaccination policy. It involves a calculation of the percentage of people in a population who would need to achieve immunity in order to prevent an outbreak. The same concept offers little such guidance during an ongoing pandemic without a vaccine. If it were a military strategy, it would mean letting the enemy tear through you until they stop because there’s no one left to attack. [Read: A new understanding of herd immunity] We may hear even more talk of herd immunity as the election nears, when Trump has an incentive to claim that the pandemic is almost over. So now is a good time to revisit exactly what herd immunity means and, perhaps more important, what it doesn’t. I talked with Howard Forman, a health-policy professor at Yale University who has followed the data on how “herd-immunity strategies” have gone in various countries. The full conversation appears on the latest episode of Social Distance, which I host with Katherine Wells, The Atlantic’s executive producer of podcasts. This transcript has been edited for length and clarity. Listen to the interview here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. James Hamblin: What do you make of news about a “herd-immunity strategy” reportedly being discussed in the White House? Howard Forman: This is one of these topics that very few people understand. [People] use the term “herd immunity” flippantly. Some talk about it as a policy prescription without knowing what it even means. And I think that there’s a lot of nuance here. In a situation like this where we’ve already lost 180,000 lives, we shouldn’t be flippant about things. We should be thinking about how to avoid as much death as possible, and resume life as well as possible. Whenever people talk about herd immunity, whenever they talk about ‘ripping the Band-Aid off’ or any of those things, it is an absolutely dangerous idea. Now, I think there are lessons to be learned from Sweden, and no one should be flippant about saying Sweden was horrific or the worst thing that could have happened. But Sweden ultimately did not pursue the policy that we seem to be pursuing right now. Katherine Wells: I thought they did? Hamblin: Sweden became this reportedly textbook case of using a “herd immunity” approach, or at least, they initially said they were going to. Forman: It started off with Sweden and the United Kingdom talking about pursuing herd immunity. Then England got cold feet and Sweden supposedly proceeded with this, but they didn’t. Sweden did a lot of things to curtail the spread. What people seem to not understand is that we do things in our country, even in some areas that are “still shut down” that would not be tolerated in Sweden. They still have a ban on gatherings of 50 people or more. [Read: The U.K.’s coronavirus ‘herd immunity’ debacle] Wells: Oh! I feel like the picture of Sweden I have in my mind is everyone outside without masks enjoying the summer, all together. Forman: For the most part, they are without masks. But they still have a complete ban on visiting retirement homes. They still have a ban on public gatherings of 50 people. Gatherings for religious practice? Banned. Theatrical and cinema performances? Banned. Concerts? Banned. And this is what bothers me. Our president did a rally in Tulsa. That would have been banned in Sweden. Hamblin: So if anything, we’re the country that’s maybe closest to this “herd immunity” approach? I don’t even want to use that term because we’re doing a lot as well. But no one is honestly just letting the thing run wild, as the idea might suggest. Forman: That’s absolutely correct. If you have a good understanding of herd immunity, then you know that it means that if we achieve a certain percent of immunity in the population then you cannot get an epidemic outbreak in that community. You can still get spread. You could still have a person come to our country with measles and go into a classroom and somebody will get measles from that person, but you will not have a measles outbreak because there are sufficient numbers of people that are immune to measles that in the process of trying to spread, the virus will extinguish itself. You might get two or three people infected, but it will never take off again. That’s herd immunity. That requires individuals to be truly immune to the virus, which means that the virus not only doesn’t affect you and cause you to get sick, but you actually can’t get infected. You can’t spread the virus if somebody comes in proximity to you. Wells: And we should mention, just always keeping in mind that herd immunity, while maybe a relief now, would have come at the cost of many lives. Forman: At the cost of many lives, and potentially, morbidity that we don’t know about yet. I say this with a lot of caution, but we have no idea whether having had this infection means that, ten years from now, you have an elevated risk of lymphoma. There’s not any indication that it would, but we just don't know. We know that hepatitis C leads to liver cancer. We know that human papillomavirus leads to cervical cancer. We know that HIV leads to certain cancers. I don't want people to panic over that possibility because I think that’s unnecessary, but just to make the point that we don’t know. So even if you thought you could get to a vaccination-equivalent immunity through infection, you still run risks beyond the immediate mortality and the immediate morbidity. Hamblin: Right, there are things we’re not seeing that we need to consider. And so, without suggesting specifically that this virus is causing cancer, we have no idea what the long-term effects will turn out to be and so we don't want to mess around with infecting anyone who doesn’t need to be infected. Forman: Right. And by the way, there’s never been a real case of herd immunity through infection. Wells: For any disease ever? Forman: Correct. In fact, the term itself didn’t arise until just a few decades ago when we had vaccination programs. There are cases where, as large waves of infection passed through communities, you had lower levels of outbreak in most years, and then you would have epidemic outbreaks other years. That probably is the closest thing, but that’s not herd immunity. You’re still having outbreaks all the time. You’re just having bigger waves and smaller waves. Wells: The term “herd-immunity strategy” makes even less sense to me than it did before. Forman: We know how much testing alone could do to help us here. Combine massive testing with things like masking and social distancing, and then you have to ask yourself: Why would you allow people to just die in such large numbers when you have these alternatives that are readily available to us? And that, quite frankly, could allow us to get much closer to a normal life than we are right now. Wells: Well, what’s the answer? Forman: Honestly, I am at a loss. I’m hoping, by the end of November, the entrepreneurs who have been developing these cheap tests are going to allow us to test at such a massive scale at such a low cost that we’ll be able to substantially impact this in a way that we haven’t so far. But I’m also 100 percent convinced that if our federal government had thought about this back in February and March and decided that they were going to commit even one tenth of the amount of money that they have committed to a vaccine to a cheap testing initiative, that we would have already saved tens of thousands of lives and certainly would have saved tens of thousands more going forward. I co-wrote an op-ed two months ago where we said that testing is the vaccine. And at that time, I was quarreling about whether we should say $10 or $20 per test as being achievable. Now we’re talking about $1 to $5 for these tests. This is the way out until we have a vaccine. from https://ift.tt/2EL5zB0 Check out http://natthash.tumblr.com |
Authorhttp://natthash.tumblr.com Archives
April 2023
Categories |