At the height of the coronavirus pandemic, as lines of ambulances roared down the streets and freezer vans packed into parking lots, the pediatric emergency department at Our Lady of the Lake Children’s Hospital, in Baton Rouge, Louisiana, was quiet. It was an eerie juxtaposition, says Chris Woodward, a pediatric-emergency-medicine specialist at the hospital, given what was happening just a few doors down. While adult emergency departments were being inundated, his team was so low on work that he worried positions might be cut. A small proportion of kids were getting very sick with COVID-19—some still are—but most weren’t. And due to school closures and scrupulous hygiene, they weren’t really catching other infections—flu, RSV, and the like—that might have sent them to the hospital in pre-pandemic years. Woodward and his colleagues couldn’t help but wonder if the brunt of the crisis had skipped them by. “It was, like, the least patients I saw in my career,” he told me. That is no longer the case. Across the country, children have for weeks been slammed with a massive, early wave of viral infections—driven largely by RSV, but also flu, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive-care units are now at or past capacity, and resorting to extreme measures. At Johns Hopkins Children’s Center, in Maryland, staff has pitched a tent outside the emergency department to accommodate overflow; Connecticut Children’s Hospital mulled calling in the National Guard. It’s already the largest surge of infectious illnesses that some pediatricians have seen in their decades-long careers, and many worry that the worst is yet to come. “It is a crisis,” Sapna Kudchadkar, a pediatric-intensive-care specialist and anesthesiologist at Johns Hopkins, told me. “It’s bananas; it’s been full to the gills since September,” says Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health. “Every night I turn away a patient, or tell the emergency department they have to have a PICU-level kid there for the foreseeable future.” I asked Chris Carroll, a pediatric-intensive-care specialist at Connecticut Children’s, how bad things were on a scale of 1 to 10. “Can I use a Spinal Tap reference?” he asked me back. “This is our 2020. This is as bad as it gets.” [Read: The strongest signal that Americans should worry about flu this winter] The autumn crush, experts told me, is fueled by dual factors: the disappearance of COVID mitigations and low population immunity. For much of the pandemic, some combination of masking, distancing, remote learning, and other tactics tamped down on the transmission of nearly all the respiratory viruses that normally come knocking during the colder months. This fall, though, as kids have flocked back into day cares and classrooms with almost no precautions in place, those microbes have made a catastrophic comeback. Rhinovirus and enterovirus were two of the first to overrun hospitals late this summer; now they’re being joined by RSV, all while SARS-CoV-2 remains in play. Also on the horizon is flu, which has begun to pick up in the South and the mid-Atlantic, triggering school closures or switches to remote learning. During the summer of 2021, when Delta swept across the nation, “we thought that was busy,” Woodward said. “We were wrong.” Children, on the whole, are more susceptible to these microbes than they have been in years. Infants already have a rough time with viruses like RSV: The virus infiltrates the airways, causing them to swell and flood with mucus that their tiny lungs may struggle to expel. “It’s almost like breathing through a straw,” says Marietta Vazquez, a pediatric-infectious-disease specialist at Yale. The more narrow and clogged the tubes get, “the less room you have to move air in and out.” Immunity accumulated from prior exposures can blunt that severity. But with the pandemic’s great viral vanishing, kids missed out on early encounters that would have trained up their bodies’ defensive cavalry. Hospitals are now caring for their usual RSV cohort—infants—as well as toddlers, many of whom are sicker than expected. Infections that might, in other years, have produced a trifling cold are progressing to pneumonia severe enough to require respiratory support. “The kids are just not handling it well,” says Stacy Williams, a PICU nurse at UVA Health. Coinfections, too, have always posed a threat—but they’ve grown more common with SARS-CoV-2 in the mix. “There’s just one more virus they’re susceptible to,” Vazquez told me. Each additional bug can burden a child “with a bigger hill to climb, in terms of recovery,” says Shelby Lighton, a nurse at UVA Health. Some patients are leaving the hospital healthy, only to come right back. There are kids who “have had four respiratory viral illnesses since the start of September,” Woodward told me. Pediatric care capacity in many parts of the country actually shrank after COVID hit, Sallie Permar, a pediatrician at NewYork-Presbyterian and Weill Cornell Medicine, whose hospital was among those that cut beds from its PICU, told me. A mass exodus of health-care workers--nurses in particular—has also left the system ill-equipped to meet the fresh wave of demand. At UVA Health, the pediatric ICU is operating with maybe two-thirds of the core staff it needs, Williams said. Many hospitals have been trying to call in reinforcements from inside and outside their institutions. But “you can’t just train a bunch of people quickly to take care of a two-month-old,” Kudchadkar said. To make do, some hospitals are doubling up patients in rooms; others have diverted parts of other care units to pediatrics, or are sending specialists across buildings to stabilize children who can’t get a bed in the ICU. In Baton Rouge, Woodward is regularly visiting the patients who have just been admitted to the hospital and are still being held in the emergency department, trying to figure out who’s healthy enough to go home so more space can be cleared. His emergency department used to take in, on average, about 130 patients a day; lately, that number has been closer to 250. “They can’t stay,” he told me. “We need this room for somebody else.” Experts are also grappling with how to strike the right balance between raising awareness among caregivers and managing fears that may morph into overconcern. On the one hand, with all the talk of SARS-CoV-2 being “mild” in kids, some parents might ignore the signs of RSV, which can initially resemble those of COVID, then get much more serious, says Ashley Joffrion, a respiratory therapist at Baton Rouge General Medical Center. On the other hand, if families swamp already overstretched hospitals with illnesses that are truly mild enough to resolve at home, the system could fracture even further. “We definitely don’t want parents bringing kids in for every cold,” Williams told me. The key signs of severe respiratory sickness in children include wheezing, grunting, rapid or labored breaths, trouble drinking or swallowing, and bluing of the lips or fingernails. When in doubt, experts told me, parents should call their pediatrician for an assist. [Read: The great pandemic hand-washing blooper] With winter still ahead, the situation could take an even darker turn, especially as flu rates climb, and new SARS-CoV-2 subvariants loom. In most years, the chilly viral churn doesn’t abate until late winter, which means hospitals may be only at the start of a grueling few months. And still-spotty uptake of COVID vaccines among little kids, coupled with a recent dip in flu-shot uptake and the widespread abandonment of infection-prevention measures, could make things even worse, says Abdallah Dalabih, a pediatric-intensive-care specialist at Arkansas Children’s. The spike in respiratory illness marks a jarring departure from a comforting narrative that’s dominated the intersection of infectious disease and little children’s health for nearly three years. When it comes to respiratory viruses, little children have always been a vulnerable group. This fall may force Americans to reset their expectations around young people’s resilience and recall, Lighton told me, “just how bad a ‘common cold’ can get.” from https://ift.tt/vGTxf9X Check out http://natthash.tumblr.com
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A version of this article was originally published in Undark Magazine. On a late April afternoon, the Ngor Health Center in Dakar, Senegal, is serene. Sunlight spills through architectural gaps in the ceiling and lush plants line cream-colored corridors. In a patient waiting area on the second floor, a staff member gently rolls a ball back and forth with a toddler. The calm belies the chaos at the health center eight months prior, in the summer of 2021, when COVID-19 struck the West African nation in its third and deadliest wave. The only reminder exists high up on the walls: slim copper pipes trained through roughly drilled holes. The pipes were built as Ngor frantically retrofitted its waiting area with extra beds in a bid to extend the center’s limited oxygen network to treat the influx of COVID patients. But to the pediatrician Idrissa Demba Ba, the scramble for oxygen—which, in many countries, came to symbolize the pandemic—was nothing new. In fact, it’s a hallmark of another scourge he’s been battling for 18 years, childhood pneumonia. The disease, caused by an infection of the lungs that disrupts breathing, killed 2,400 Senegalese children under the age of 5 in 2019. Pneumonia can be triggered when a pathogen—for instance, a virus, bacteria, or fungus—enters the lungs, where it inflames the air sacs, causing them to fill with fluid or pus and making it hard to breathe. Children are more vulnerable to the disease because their lungs and immune systems are still developing. To treat the condition, there are three main options: antibiotics, antivirals, and oxygen. Every day, there are children who need to be connected to an oxygen supply, says Ba, who is head of pediatric pulmonology at Dakar’s Albert Royer National Children’s Hospital. The World Health Organization lists oxygen as an essential medicine, which seems intuitive for a vital, life-sustaining gas. Yet in Senegal and many other developing countries, providing oxygen in its medical form can be fraught: The medical-grade oxygen is expensive, getting it from one place to another requires the construction of pipelines and other infrastructure, and medical personnel must be trained to administer it. These supply-chain obstacles threaten, per one estimate, more than 7 million children in low- and middle-income countries who are infected with pneumonia each year and need oxygen to survive. Limited supplies are part of the reason the disease remains the most common infectious cause of death in children worldwide, claiming the lives of more than 740,000 under the age of 5 in 2019. Younger children are more vulnerable--29 percent of pneumonia deaths occur within the first month of life, and three-quarters within the first year. Most of those affected live in lower- and middle-income countries like Senegal, where the risk of pneumonia is exacerbated by malnutrition and other issues, says Papa Birane Mbodji, the head of newborn health at the Department of Mother and Child Health in Senegal’s Ministry of Health and Social Action. Another threat is the nearby Sahara Desert, which sweeps in huge amounts of dust that contribute to the region’s outsize global burden of young patients. When there isn’t enough oxygen to treat these children, their lungs fail, eliciting grunts as they try desperately to rake in more oxygen from the air, Ba says—a symptom that echoes the devastating effects of COVID-19. While the world’s attention has been trained on COVID, “you could basically say there is an ongoing pandemic of pneumonia mortality,” says Keith Klugman, an infectious-disease expert who heads the pneumonia program at the Bill and Melinda Gates Foundation. But there may be an upside: The crisis of the coronavirus pandemic drew the world’s attention to the crucial importance of oxygen. Seeing how quickly countries galvanized to tackle COVID, Klugman and other experts wrote a Lancet article in November 2020, calling for them to build on the pandemic’s rare gains—such as increasing oxygen infrastructure—to help curb childhood pneumonia. The authors wrote: “The COVID-19 response provides opportunities to increase diagnostic and treatment services for respiratory infections.” Ba and other experts on the ground share the sentiment. More and more, they see COVID as an opportunity to get the essential resource to more children, to tackle this forgotten epidemic. Against this backdrop, Senegal offered fertile ground for improvement. Even before the pandemic, and in the midst of it, the country was interrogating its medical-oxygen infrastructure. “The government of Senegal established an ambitious scale-up strategy for oxygen as early as 2013,” wrote Lisa Smith, the access-to-medical-devices portfolio director for the market-dynamics program at the public-health nonprofit PATH, in an email to Undark. Then in 2017, she wrote, members of the Senegalese government attended a PATH-led meeting focused on widening oxygen access. There, the government highlighted its work with a private contractor to install and maintain pressure-swing adsorption, or PSA, plants—which produce purified oxygen from ambient air on-site—at a number of hospitals. After this event, Smith said, PATH started working with the government to offer additional support to close other gaps in Senegal’s oxygen-supply chain. A year into the pandemic, PATH published a report based on a nationwide survey of medical equipment, focused on oxygen infrastructure, noting where it was available and where it was most lacking. Key among the findings of the resulting report was that oxygen was heavily concentrated at emergency centers in large urban areas, but much scarcer at smaller health centers and posts that serve the majority of the population. For instance, of 29 COVID-treatment centers surveyed across 13 regions, Dakar, Senegal’s capital, had the highest concentration of key medical tools—62 percent of pulse oximeters, which estimate blood oxygen levels, and 84 percent of functional ventilators—despite the city making up less than a quarter of the country’s population. The equipment survey also revealed stark disparities in the distribution of PSA plants, which provide a reliable supply of oxygen. Nearly half of the treatment centers with access to a PSA plant, which cost upwards of $100,000 apiece, were concentrated in Dakar to meet the needs of the city’s dense population—such as the Ngor Health Center’s PSA plant, which was built there before COVID hit and became a boon during the pandemic. Within a large, sun-drenched courtyard on the hospital grounds, the PSA plant hums inside a locked concrete enclosure. As part of the setup, there is a black box called a compressor, which sucks in external air and pressurizes it. From there, the pressurized air is scrubbed as it runs through a filtration device to remove nitrogen and allow oxygen to pass through. The oxygen is then transferred to holding tanks, ready to be piped into the wards. In contrast, at most other health-care facilities where PSA plants are in short supply, health-care workers rely on smaller pieces of equipment such as oxygen concentrators and cylinders to supply the crucial gas. These come with their own challenges: Most concentrators, which are portable, suitcase-size machines, deliver oxygen at a rate that’s too slow for severe COVID patients, and cylinders can be refilled with new oxygen only at centralized plants, which means that supply can be disrupted because of unreliable transport. Maintaining this piecemeal infrastructure can also be impractical. At another health facility across town, this was evidenced by a pile of discarded concentrators strewn amongst other items—unused respirators in water-logged boxes, mosquito nets, and an old mat and metal bed frame stripped bare—stacked under a zinc roof just outside the entry ramp for emergency patients. [Read: Think 168,000 ventilators is too few? Try three.] Such infrastructural challenges aren’t unique to Senegal. A 2021 WHO technical consultation revealed that before the pandemic, the majority of low- and middle-income countries struggled to obtain medical oxygen. In sub-Saharan countries, 31 percent of facilities had interrupted access, while 25 percent had none at all. These wider findings on oxygen and COVID also helped inform child-pneumonia initiatives, including a clinical trial designed to test the value of pulse oximeters in these patients. The trial, part of a project called Tools for Integrated Management of Childhood Illness, or TIMCI—jointly run by PATH, Unitaid, and the Swiss Tropical and Public Health Institute—launched in August 2021 in multiple facilities in three countries, including the arid baobab-studded region of Thiès, an hour’s drive into the countryside beyond Dakar. Here, TIMCI supplied pulse oximeters to doctors at 59 health posts to diagnose incoming patients. As of September 2022, TIMCI has screened almost 17,000 sick children in Thiès. The devices work by attaching to a patient’s finger and painlessly measuring the level of oxygen in their blood. It’s a quick and inexpensive way of detecting a condition in which oxygen saturation levels dip dangerously below 90 percent, called hypoxemia. Hypoxemia increases the risk of death by pneumonia up to five times. The Senegalese trial—part of a larger multicountry initiative also involving Kenya, Tanzania, India, and Myanmar—intends to evaluate the effectiveness of pulse oximeters in more accurately and swiftly diagnosing hypoxemia, in order to then help children get the urgent oxygen treatment that they need and save lives. But such initiatives will only ultimately be effective if the essential oxygen supplies are on hand nearby. On a tree-lined street in downtown Dakar, Ndèye Astou Badiane sits inside the PATH regional headquarters contemplating the pandemic’s legacy. In Senegal, although the health system struggled with a real “increase in demand [for] oxygen,” says Badiane, who is a respiratory-care coordinator at the nonprofit, some good came out of it. The clear and urgent need, she adds, injected new momentum into national efforts to tackle oxygen shortages. For instance, the government, together with PATH, is now finalizing another assessment of its oxygen infrastructure, maintenance, and long-term sustainability. The overarching aim is “to improve oxygen availability and utilization in each health facility,” Badiane wrote in a follow-up email. This evolving assessment laid the foundation for the government’s most significant move: the plan to roll out dozens of new PSA plants, the units that produce oxygen on-site at hospitals, says Amad Diouf, the director of the Department of Infrastructure, Equipment, and Maintenance at Senegal’s Ministry of Health and Social Action. These crucial new oxygen plants, five of which are funded by UNICEF, are due to be installed by the end of 2022, with a focus on health centers across the country. At the start of the pandemic, with support from PATH and Unitaid, Senegal was able to acquire 175 oxygen concentrators, 1,000 oxygen masks, and 250 pulse oximeters. There are early indications that the effort to strengthen Senegal’s oxygen gaps is translating into gains in the fight against childhood pneumonia. A 2021 review study found that bolstering oxygen infrastructure in lower- and middle-income countries could cut child-pneumonia deaths in hospitals by almost half. And in Senegal, the pediatrician Mbodji says there has been a notable increase in the availability of oxygen at health facilities. Though it’s difficult to attribute solely to this change, Mbodji says, pneumonia deaths in children have declined over the past two years. The pandemic has also given pneumonia initiatives like TIMCI special resonance. COVID-19 was “an opportunity” for the Ministry of Health to recognize the importance of oxygen infrastructure and accelerate the spread of lifesaving tools like pulse oximeters through more health facilities, says Maymouna Ba, who leads the TIMCI project in Senegal. “Before TIMCI, before COVID-19, such equipment, such tools, were just available at higher levels like in hospitals, in health centers. But not in health posts where providers also need these kind of equipment, these kind of tools to better detect severe illness in the early stage,” Ba says. With the TIMCI trial ongoing, she adds, there are plans to eventually provide even more pulse oximeters to health posts across the whole country. Other pneumonia interventions have received a similar boost in recognition—such as the SPRINT project, or Scaling Pneumonia Response InnovaTions, a program run by UNICEF to expand access to antibiotics and oxygen treatment for pneumonia. The program was originally confined to certain regions, but since the pandemic began, Mbodji says, the government has been working on plans to extend it to the entire country. Senegal’s oxygen response is emblematic of changes unfolding elsewhere. COVID made plain that “you can’t wait for disaster to happen for the equipment to be here,” says Fatima Diaban, a critical-care physician and member of the Every Breath Counts Coalition, an initiative by the nonprofit JustActions focused on supporting national governments in reducing pneumonia deaths by the end of the decade. In May 2021, Senegal was among nine African nations to begin receiving help from PATH and the Clinton Health Access Initiative to procure new oxygen equipment, funded by $20 million from Unitaid. The Global Fund, an international health-care-focused funding organization, with support from government and private-sector donors, also provided $475 million to 66 lower- and middle-income countries for a similar purpose. [Read: One of long COVID’s worst symptoms is also its most misunderstood] Now that the pandemic has eased, some of these resources can be redeployed to treat childhood pneumonia—something that’s already under way in other countries such as Ethiopia, where the government announced plans in 2021 to redistribute the pulse oximeters and oxygen therapies it used for COVID elsewhere in its health-care system. Large aid donations often come with questions about whether such funding reaches the intended recipients in its entirety. PATH’s Smith said there are safeguards in place to ensure it does. “Each donor has unique requirements for accountability and responsible use of funds,” she wrote in an email. For instance, her organization worked closely with Senegal’s Ministry of Health and the Department of Infrastructure, Equipment, and Maintenance to distribute donated oxygen equipment to facilities in need. Overall, such initiatives could fast-track progress on pneumonia, a disease that’s still “very much neglected” in the global health discourse, despite its global burden, says Klugman of the Bill and Melinda Gates Foundation. Pneumonia is still chronically underfunded, taking just 5 percent of the money devoted to fighting infectious disease globally, and just 3 percent of the research funding allocated to infectious diseases from 2000 to 2017 by public and philanthropic funders in G20 countries. Prevention will be crucial—and progress is under way to develop new, targeted vaccines, which protect better against pneumonia compared with existing vaccines, Klugman says. But for now, oxygen remains a uniquely efficient way to save lives. As such, the pandemic responses that many countries have drawn up provide an ideal framework for action—a “foundation for continued declines in deaths from all-cause respiratory infections over the next decade,” according to a 2021 report on pneumonia and the coronavirus pandemic produced by JustActions. Indeed, it’s not just children with pneumonia who stand to benefit from this spread: Wider oxygen provisions will aid people with infectious diseases, cardiovascular diseases, and asthma. This larger importance, laid bare and elevated by the pandemic, is behind the recent September 2022 launch of the Lancet Global Health Commission on medical oxygen security, a new partnership of academics and NGOs, which will reportedly include strong representation from lower- and middle-income countries. The Commission seeks to build on the pandemic’s gains and provide policy makers with information and tools to close the crucial gaps in global oxygen-supply chains. Already, the benefits of expanded oxygen access are evident at the Ngor health center, where the copper pipes are reminders of a traumatic time but now stretch beyond the emergency room, ferrying oxygen to those who need it most. Just off the main corridor of the second floor, those pipes have been trained into a room with walls decorated with cheerful stickers of Dora the Explorer, flowers, and birds—a children’s ward. As Badiane puts it: “In 2022, really oxygen should be available and affordable in every health facility.” from https://ift.tt/X1K9ueJ Check out http://natthash.tumblr.com For the first couple of years of the coronavirus pandemic, the crisis was marked by a succession of variants that pummeled us one at a time. The original virus rapidly gave way to D614G, before ceding the stage to Alpha, Delta, Omicron, and then Omicron’s many offshoots. But as our next COVID winter looms, it seems that SARS-CoV-2 may be swapping its lead-antagonist approach for an ensemble cast: Several subvariants are now vying for top billing. In the United States, BA.5—dominant since the end of spring—is slowly yielding to a slew of its siblings, among them BA.4.6, BF.7, BQ.1, and BQ.1.1; another subvariant, XBB, threatens to steal the spotlight from overseas. Whether all of these will divvy up infections in the next few months, or whether they’ll be pushed aside by something new, is still anyone’s guess. Either way, the forecast looks a little grim. None of the new variants will completely circumvent the full set of immune defenses that human bodies, schooled by vaccines or past infections, can launch. Yet all of them seem pretty good at dodging a hefty subset of our existing antibodies. For anyone who gets infected, such evasions could make the difference between asymptomatic and feeling pretty terrible. And for the subset of people who become sick enough to need clinical care, the consequences could get even worse. Some of our best COVID treatments are made from single antibodies tailored to the virus, which may simply cease to work as SARS-CoV-2 switches up its form. Past variants have already knocked out three such concoctions—REGEN-COV, sotrovimab, and bamlanivimab/etesevimab—from the U.S. arsenal. The only two left are bebtelovimab, a treatment for people who have already been infected, and Evusheld, a crucial supplement to vaccination for those who are moderately or severely immunocompromised; both are still deployed in hospitals countrywide. But should another swarm of variants take over, these two lone antibody therapies could also be obsolete within months, if not weeks. “It seems like the writing is on the wall,” says Erin McCreary, an infectious-disease pharmacist at the University of Pittsburgh Medical Center. “I live constantly low-key worried that I’m not going to have an active therapy for my patients, and I won’t be able to help them.” All of this bodes poorly for this winter and beyond. In the near term, millions of immunocompromised people could be left without viable options either to keep SARS-CoV-2 at bay or to temper its blaze once an infection begins to burn. And that loss would set a troubling precedent for seasons to come. The business end of the virus “is now adapting so rapidly that I don’t know how it’s going to be possible for monoclonals to keep up,” says Jeanne Marrazzo, an infectious-disease physician at the University of Alabama at Birmingham. Experts may need to revamp the strategies they use to bring new therapies to market—or find themselves, once again, in a serious bind. “I worry,” Marrazzo told me, “that we’re on a razor’s edge.” Whatever happens this winter, doctors will still have some options to treat COVID patients. Experts don’t think the virus will develop widespread resistance to our antiviral drugs—molnupiravir, remdesivir, and Paxlovid—“anytime soon,” Marrazzo said. But the vanishing of effective antibody therapies would still leave a massive hole that other treatments can’t fill. The benefits of molnupiravir seem lackluster at best; remdesivir offers a few more perks but is a hassle to administer, requiring several days of infusions. And although Paxlovid has worked wonders for people in high-risk groups, one of its ingredients can screw with a long list of other drugs. McCreary has seen many patients hospitalized, she told me, because their physicians prescribed Paxlovid without properly adjusting their regular meds. “Plus,” she added, “Paxlovid tastes awful.” [Read: Paxlovid mouth is real—and gross] Monoclonal antibodies aren’t perfect. But at their best, they’re astoundingly effective and safe, and often the first thing McCreary reaches for when caring for newly infected people. Some patients are also “just more comfortable with monoclonal antibodies than they are with antivirals,” says Mari Nakamura, an infectious-disease specialist at Boston Children’s Hospital. And Evusheld remains the only COVID treatment that is authorized to guard people before they encounter the virus at all. People who don’t mount much of a response to vaccines can sign up for a pair of injections—one into each gluteal muscle—and expect to have their defenses buoyed for a good six months. “I see it as an extension of vaccines for those who are vulnerable,” says Jonathan Abraham, an immunologist and physician at Harvard Medical School. The greatest strength of these treatments, however, also happens to be their most glaring weakness. Monoclonal antibodies work their magic by glomming so tightly onto SARS-CoV-2’s surface that the virus can’t dock onto our cells. Their grip is ultra precise—enough so that it can be nullified by just one viral mutation in exactly the right spot. Those genetic changes have already booted antibody treatments from our lineup. Now the data hint that bebtelovimab might not work against BQ.1 or BQ1.1. The list of subvariants that might be able to resist Evusheld is even longer: BQ.1, BQ.1.1, BA.4.6, BA.2.75.2, BF.7, and XBB. Soon health-care providers will have to start making tough calls about when to retire these two antibody treatments—and with few hard rules to guide them. Resistance can be a pretty murky concept: Viral mutations sometimes soften an antibody’s grasp without totally obliterating it. With antibiotics, for example, doctors can respond to some forms of low-level drug resistance just by increasing the dose, McCreary told me. But COVID monoclonal antibodies are still new to the scene. Even when an antibody cocktail has clearly become functionally useless against a given set of variants, there’s no universal standard for deciding when those variants have become so common that the cocktail should be shelved. (When I asked the FDA about this, it declined to comment on specifics.) So the choice is often left up to individual hospitals, Nakamura told me, which can create a bit of a patchwork in how experts are approaching COVID treatment—and put a burden on surveillance efforts to deliver hyperlocal data in real time. In Pittsburgh, McCreary’s team has, in prior seasons, pulled monoclonals when they stop working against just 20 to 30 percent of the reported variant milieu. Alpana Waghmare, a physician at the Fred Hutchinson Cancer Center and Seattle Children’s Hospital, told me her threshold may be closer to about 50 percent, though she pointed out that the more the options dwindle, the more willing health-care workers may be to keep using a variant-mismatched antibody. Alfred Kim, a rheumatologist at Washington University in St. Louis, told me he’d need to see resistant variants make up “the majority in a region” before he’d even consider putting an antibody out to pasture. There’s little downside to administering the treatments, he said, and for his patients, the potential cost of withholding them is just too immense. Should bebtelovimab and Evusheld be forced from the stage in the coming months, they might, at least, have a few understudies waiting in the wings. Regeneron, the maker of the late REGEN-COV, has two antibody treatments in Phase 1 trials, according to a spokesperson; AstraZeneca, Evusheld’s parent, also has replacements in development, though a spokesperson declined to provide more details on where in the pipeline they sat. Eli Lilly, which manufactures bebtelovimab and the now-gone bamlanivimab/etesevimab, didn’t respond to my questions about whether they were cooking up new recipes for future use. Vir, which makes sotrovimab—still available overseas—is working on “several highly potent” new antibodies “that have shown activity against all COVID-19 variants tested to date including BQ1.1,” according to a spokesperson. Clearing drugs for human use remains a plodding process; all of those options could be months away from regular use. “The virus may have moved on” by then, Abraham told me. Already, experts are grappling with whether once-a-year shots will be enough to keep pace with coronavirus evolution; updates on the treatment side may have to come much faster. The problem could get worse as SARS-CoV-2 lineages continue to jockey for control. For the moment, at least, the leading variants are invalidating antibody treatments in relatively similar ways. But if variants diverge further, pharmaceutical companies could have an even tougher time devising broadly effective antibody therapies. Some experts are also concerned that the market for monoclonals may be going dry. Antibodies are expensive to produce, and with a turnover rate this high, the industry may not have much incentive to stay involved, McCreary told me. Marrazzo, too, thinks the urgency may have lessened with the advent of oral antivirals, and the rush to return to “normal.” If anything, though, the need for good monoclonal options may be growing in urgency. Treatments such as REGEN-COV and bamlanivimab/etesevimab once had clearance to be used in people right after they were exposed to SARS-CoV-2—a sort of emergency antiviral contraceptive. Now no monoclonals are available for so-called postexposure prophylactic use. Kids, too, could use more treatment options. Children under 12 are eligible for three-day courses of remdesivir, given by IV infusion—but those are a tough ask for many families who don’t have the time or means to make such frequent trips to the hospital, Nakamura told me. “And that’s pretty much it.” Yet no one would feel the loss of antibody-based COVID treatments more than the immunocompromised, Waghmare told me. “It’s this horrible nexus,” Marrazzo said: The most vulnerable people will lose their best options first. Many of those who received Evusheld in the spring will soon be due for their second set of injections, scheduled six months after the first. As of right now, “we’re still telling patients to come in,” McCreary told me. But that may not be the advice she gives next month, or the next. Robyn Ruth, of Augusta County, Virginia, is at that decision point now. Her first experience with the treatment, in April, was momentous: “I had my first hug since the beginning of the pandemic,” Ruth told me. “I just remember my knees buckled, because I hadn’t touched another human being in so long.” In the weeks after, Ruth felt safe enough to go to a couple of doctor appointments and visit a few friends, even garden in their company—activities she hadn’t engaged in since the start of 2020. But as variants continue to chip away at Evusheld’s efficacy, Ruth is steeling herself for the possibility that another dose won’t bring the same relief. Caregivers and patients alike must now strategize for what could be a very difficult winter stretch. Many immunocompromised people can still benefit from vaccines, even if not as much as others. Marrazzo also cautiously pointed out that if things get bad enough, some providers might go back to convalescent plasma—a treatment with just so-so effectiveness that’s hard to roll out in large quantities, and that doesn’t deliver consistent results—as a desperate stopgap. Other than that, though, it’ll come down to the behavioral measures that many Americans have long since abandoned: isolation, quarantine, masking, distancing. [Read: It’s gotten awkward to wear a mask] Nakamura told me she’s been struggling to deliver optimistic advice. “All they can do is try not to get the virus,” she said. She also worries about what might happen should her young patients actually fall ill. “Our hospitals are already overflowing,” she said, amid an early seasonal surge of respiratory viruses, including RSV, and a massive mental-health crisis. McCreary, too, knows many tough conversations are ahead. “There’s nothing worse than one day having something safe and highly effective,” she told me, “and the next day, it’s, ‘Sorry, we don’t have that anymore.’” For some, the simultaneous disappearance of bebtelovimab and Evusheld could almost rewind the clock to the pandemic’s start. Sara Anne Willette, a data analyst in Ames, Iowa, has a condition called common variable immunodeficiency that keeps her from making certain types of protective antibodies. She also has a history of anaphylaxis to antivirals, potentially making bebtelovimab her only postinfection treatment option should she fall ill. Willette’s second dose of Evusheld is scheduled for December, but she’s not sure whether, by that point, risking the trip will even be practical. “It feels like we’re back at square one,” she told me. “I get COVID, and it’s ‘go it alone.’” from https://ift.tt/nZvc0O6 Check out http://natthash.tumblr.com When I attended a Washington Wizards open practice at D.C.’s Capital One Arena earlier this month, the focus was more on spectator entertainment than Rocky-style workouts. The season opener was a week away, and the players ran drills at half speed and engaged in silly skills competitions for fans, including a basketball version of Connect Four. But as a lifelong Wiz devotee, I was having an awestruck, love-you-man moment. Here I was posing for a photo with Phil freakin Chenier. Franchise royalty. My childhood idol. Back in the 1970s, when Chenier was draining jumpers and sporting a Richard Pryor mustache, the team routinely chased titles. These days? Not so much. Being an NBA fan who loves the Wizards is a little like being a foodie who adores turnips: It just doesn’t make sense. Since the 2000–01 season, only the Knicks and Timberwolves have lost more games. The franchise last advanced beyond the second round of the playoffs in 1979 (back when they were called the Bullets), and they’ve missed the playoffs 16 of the past 25 years. We fans have endured 40-plus years of frustration and disappointment, mainly from the typical issues—bad defense, bad draft picks, bad trades—but sometimes from … weirder ones: One All-Star player was charged with a gun felony involving a teammate, and another was once suspended without pay for being overweight. It’s all #SoWizards, to use a Twitter hashtag. And yet, I made it out to the open practice with a few hundred fans on a Tuesday night, wearing a Wizards T-shirt and feeling the faint, irrational warmth of preseason hope. Anyone can root for a winner. That’s easy. Last season, the NFL teams with the top-selling merchandise were the Cowboys, 49ers, Patriots, Steelers, and Chiefs. Each team finished with a winning record. In Philadelphia, the currently undefeated Eagles and the World Series–bound Phillies have generated a 20 percent or more increase in business for local restaurants, sports bars, and memorabilia stores. But rooting for the middling Wizards takes guts at best and is downright masochism at worst. Still, even though the team is more likely to bring me agony than elation, I can’t fathom supporting any other franchise. The same is surely true of my fellow Wizards fans—and many fans of other perennial losers (hey, the Detroit Lions somehow still have fans). So why do we stay hooked? My Wizards fandom began in the D.C. suburbs in the ’70s, when I was a Bullets-crazed kid devouring box scores on the sports page, shooting jumpers on a backyard dirt court, and pretending to be Chenier. I was 12 when the Bullets paraded down Pennsylvania Avenue to celebrate their only title, and the subsequent 44 years have brought lots of bad memories: Last season, the Wizards somehow blew a 35-point lead against the L.A. Clippers. The worst part? I wasn’t surprised. Recent pain should feel stronger than childhood joy, I would think—even for fans like me, whose support was passed down geographically. But these deep, die-hard roots can influence our adult behavior. “Early learning is incredibly powerful and hard to erase,” Chris Crandall, a psychology professor at the University of Kansas who has studied fan allegiance, told me. The team’s success 50 years ago may have boosted my childhood loyalty, Crandall explained, and their subsequent failures did not remove it. A new attitude (“Wow, these guys stink”) essentially “lays over the old one, but the old one is still there,” Crandall said. “And it’s very difficult to get rid of it.” I’m at least old enough to remember the team’s lone championship. The top memory for Wizards fans in their 30s is probably John Wall’s dramatic game-winning three-pointer in Game 6 of the Eastern Conference semifinals. The Wizards, of course, then lost Game 7. But one reason fans stick around is the perverse pride they have in their fandom, Edward Hirt, a professor at the University of Indiana who has studied sports-fan psychology, told me. Rooting for the Lakers or the Dallas Cowboys is like wearing khakis: You hardly stand out in a crowd. Loving the Wizards gives me a defiant sense of individuality. “Do you want to be like everybody else, or do you want to be different?” Hirt said. “The answer is neither. We want to be a little bit of both. We like feeling like we belong, but we don’t want to be seen as a clone of everybody else, either.” Supporting a loser satisfies both of those desires. I can commune with fellow fans at a sports bar or game, but when I walk through an airport, even in D.C., I’m often the only guy wearing a Wizards cap. And honestly, I like that. My Wiz fandom, Andrew Billings, a sports-media professor at the University of Alabama, told me, sends a message to the world: “How loyal am I? I root for the Washington Wizards.” (Which, let’s be real, would be a great T-shirt). In a 2015 study of students from seven universities, football fans were 55 percent less likely to wear team apparel following a defeat compared with a win. But those who do are making a statement: I’m not a fair-weather fan; I’m dedicated and trustworthy. Those noble qualities explain why fans of lousy teams despise fair-weather fans, Hirt added. Bandwagon fans skip the suffering but embrace the glory. If the Wizards somehow reached the NBA Finals this year, I’d be both thrilled and infuriated by the mobs of rapturous fans at downtown watch parties. Where were these bandwagon yahoos in 2001, when the team finished 19–63? But maybe winning matters less than we think—even for die-hard fans who react to each loss with a primal scream. In one 2019 study, fans of a college football team felt a two-day rise in self-esteem after a victory. But self-esteem levels didn’t drop significantly among losing fans. One of the reasons: Even if your team loses, you can raise your self-esteem simply by commiserating with friends, Billings, a co-author, said. Yes, suffering sucks, but suffering together has some upsides. It can be a social glue that intensifies bonds with the team and fellow fans. “Going through this hardship with your sports team makes you much more likely to stick with them,” Omri Gillath, a psychology professor at the University of Kansas, told me. Fans don’t just bask in reflected glory, or BIRG, as psychologists call it; they also BIRF—bask in reflected failure. “It’s about having a community of people that understand you and like the same thing that you do,” Gillath said. Last season, a friend and I attended the Wizards’ home finale, and they got shellacked by the equally lousy Knicks. But my friend and I enjoyed laughs over pregame beers. We made sarcastic comments as the Wiz turned a 10–0 lead into a 22-point deficit. I bought an end-of-the-season discounted T-shirt at the team store. Listening to Knicks fans hoot about their victory was annoying, but we had fun. And we bonded. But rooting for a losing team may be a dying phenomenon. Sports betting and streaming have made sports more solitary and less tied to where you live—undercutting some of the reasons fans endure their god-awful teams. “Geographic loyalty is particularly powerful for older generations, partly because they weren’t nearly as mobile with their jobs or their careers as younger people are,” Billings said. “I live in Alabama. If I wanted to be a Golden State Warriors fan, I could access all 82 of their regular-season games in a way that was not possible for older generations when they built their fandom.” Younger fans may also be more likely to follow a single player than a particular team, Billings believes. Let’s be clear: Winning is way better than losing. A 2013 study found that on the Monday after NFL games, fans of losing teams were more likely to consume saturated fats and sugars compared with fans of winning teams. But I truly believe—and maybe this is loser talk—that my decades of Wizards fandom have made me a better human. I have well-developed coping skills. My friends and I are like Statler and Waldorf, the crusty hecklers on The Muppet Show: We manage head-smacking losses with well-timed quips. I don’t get too elated after a victory—although victories mean more when they’re rare—or too down after a defeat. Hell, maybe it’s even made me more empathetic to people’s challenges. After all, most of us in life can relate more like the constantly struggling Wizards than the trophy-hoisting Warriors. Even though I know better, I’m optimistic this season won’t be a #SoWizards year. Maybe the team will jell. Maybe the young players will develop. Maybe the veterans will stay healthy. Or, you know, maybe not. A struggling sports franchise, I’ve decided, is like your idiot brother or jackass uncle. Despite all their obvious flaws, you still love them. And so I’ll cherish disco-era Bullets memories, celebrate the unexpected victories, cling to foolish hope, and brace myself for the worst. If they miss the playoffs—again—well, there’s always next year. from https://ift.tt/6iS5hDv Check out http://natthash.tumblr.com And just like that, with the passing of Labor Day, fall was upon us. Seemingly overnight, six-packs of pumpkin beer materialized on grocery shelves, hordes of city dwellers descended upon apple orchards—and America rolled out new COVID boosters. The timing wasn’t a coincidence. Since the beginning of the pandemic, cases in North America and Europe have risen during the fall and winter, and there was no reason to expect anything different this year. Spreading during colder weather is simply what respiratory diseases like COVID do. The hope for the fall booster rollout was that Americans would take it as an opportunity to supercharge their immunological defenses against the coronavirus in advance of a winter wave that we know is going to come. So far, reality isn’t living up to that hope. Since the new booster became available in early September, fewer than 20 million Americans have gotten the shot, according to the CDC—just 8.5 percent of those who are eligible. The White House COVID-19 response coordinator, Ashish Jha, said at a press conference earlier this month that he expects booster uptake to increase in October as the temperatures drop and people start taking winter diseases more seriously. That doesn’t seem to be happening yet. America’s booster campaign is going so badly that by late September, only half of Americans had heard even “some” information about the bivalent boosters, according to a recent survey. The low numbers are especially unfortunate because the remaining 91.5 percent of booster-eligible people have already shown that they’re open to vaccines by getting at least their first two shots—if not already at least one booster. Now the bungled booster rollout could soon run headfirst into the winter wave. The virus is not yet surging in the United States—at least as far as we can tell—but as the weather cools down, cases have been on the rise in Western Europe, which has previously foreshadowed what happens in the U.S. At the same time, new Omicron offshoots such as BQ.1 and BQ.1.1 are gaining traction in the U.S., and others, including XBB, are creating problems in Singapore. Boosters are our best chance at protecting ourselves from getting swept up in whatever this virus throws at us next, but too few of us are getting them. What will happen if that doesn’t change? The whole reason for new shots is that though the protection conferred by the original vaccines is tremendous, it has waned over time and with new variants. The latest booster, which is called “bivalent” because it targets both the original SARS-CoV-2 virus and BA.5, is meant to kick-start the production of more neutralizing antibodies, which in turn should prevent new infection in the short term, Katelyn Jetelina, a public-health expert who writes the newsletter Your Local Epidemiologist, told me. The other two goals for the vaccine are still being studied: The hope is that it will also broaden protection by teaching the immune system to recognize other aspects of the virus, and that it will make protection longer-lasting. In theory, this souped-up booster would make a big difference heading into another wave. In September, a forecast presented by the Advisory Committee on Immunization Practices (ACIP), which advises the CDC, showed that if people get the bivalent booster at the same rate as they do the flu vaccine—optimistic, given that about 50 percent of people have gotten the flu vaccine in recent years—roughly 25 million infections, 1 million hospitalizations, and 100,000 deaths could be averted by the end of March 2023. But these numbers shouldn’t be taken as gospel, because protection across the population varies widely and modeling can’t account for all of the nuance that happens in real life. Gaming out exactly what our dreadful booster rates mean going forward is not a simple endeavor “given that the immune landscape is becoming more and more complex,” Jetelina told me. People received their first shots and boosters at different times, if they got them at all. And the same is true of infections over the past year, with the added wrinkle that those who fell sick all didn’t get the same type of Omicron. All of these factors play a role in how much America’s immunological guardrails will hold up in the coming months. “But it’s very clear that a high booster rate would certainly help this winter,” Jetelina said. At this point in the pandemic, getting COVID is far less daunting for healthy people than it was a year or two ago (although the prospect of developing long COVID still looms). The biggest concerns are hospitalizations and deaths, which make low booster uptake among vulnerable groups such as the elderly and immunocompromised especially worrying. That said, everyone ages 5 and up who has received their primary vaccine is encouraged to get the new booster. It bears repeating that vaccination not only protects against severe illness and death but has the secondary effect of preventing transmission, thereby reducing the chances of infecting the vulnerable. What will happen next is hard to predict, Michael Osterholm, an epidemiologist at the University of Minnesota, told me, but now is a bad time for booster rates to be this low. Conditions are ripe for COVID’s spread. Protection is waning among the unboosted, immunity-dodging variants are emerging, and Americans just don’t seem to care about COVID anymore, Osterholm explained. The combination of these factors, he said, is “not a pretty picture.” By skipping boosters, people are missing out on the chance to offset these risks, though non-vaccine interventions such as masking and ventilation improvements can help too. That’s not to say that the immunity conferred by vaccination and the initial boosters is moot. Earlier doses still offer “pretty substantial protection,” Saad Omer, a Yale epidemiologist, told me. Not only are eligible Americans slacking on booster uptake, but lately vaccine uptake among the unvaccinated hasn’t risen much either. Before the new bivalent shots came around, less than half of eligible Americans had gotten a booster. “That means we are, as a population, much more vulnerable going into this fall,” James Lawler, an infectious-diseases expert at the University of Nebraska Medical Center, told me. If booster uptake—and vaccine uptake overall—remains low, expecting more illness, particularly among the vulnerable, would be reasonable, William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, told me. Hospitalizations will rise more than they would otherwise, and with them the stress on the health-care system, which will also be grappling with the hundreds of thousands of people likely to be hospitalized for flu. While Omicron causes relatively minor symptoms, “it’s quite capable of producing severe disease,” Schaffner said. Since August, it has killed an average of 300 to 400 people each day. All of this assumes that we won’t get a completely new variant, of course. So far, the BA.5 subvariant targeted by the bivalent booster is still dominating cases around the world. Newer ones, such as XBB, BQ.1.1, and BQ.1, are steadily gaining traction, but they’re still offshoots of Omicron. “We’re still very hopeful that the booster will be effective,” Jetelina said. But the odds of what she called an “Omicron-like event,” in which a completely new SARS-CoV-2 lineage—one that warrants a new Greek letter—emerges out of left field, are about 20 to 30 percent, she estimated. Even in this case, the bivalent nature of the booster would come in handy, helping protect against a wider crop of potential variants. The effectiveness of our shots against a brand-new variant depends on its mutations, and how much they overlap with those we’ve already seen, so “we’ll see,” Omer said. Just as it isn’t too late to get boosted, there’s still time to improve uptake in advance of a wave. If you’re three to six months out from an infection or your last shot, the best thing you can do for your immune system right now is to get another dose, and do it soon. Though there’s no perfect and easy solution that can overcome widespread vaccine fatigue, that doesn’t mean trying isn’t worthwhile. “Right now, we don’t have a lot of people that feel the pandemic is that big of a problem,” and people are more likely to get vaccinated if they feel their health is challenged, Osterholm said. There’s also plenty of room to crank the volume on the messaging in general: Not long ago, the initial vaccine campaign involved blasting social media with celebrity endorsers such as Dolly Parton and Olivia Rodrigo. Where is that now? Lots of pharmacies are swimming in vaccines, but making getting boosted even easier and more convenient can go a long way too. “We need to catch them where they come,” said Omer, who thinks boosters should be offered at workplaces, in churches and community centers, and at specialty clinics such as dialysis centers where patients are vulnerable by default. After more than two years of covering and living through the pandemic, believe me: I get that people are over it. It’s easy not to care when the risks of COVID seem to be negligible. But while shedding masks is one thing, taking a blasé attitude toward boosters is another. Shots alone can’t solve all of our pandemic problems, but their unrivaled protective effects are fading. Without a re-up, when the winter wave reaches U.S. shores and more people start getting sick, the risks may no longer be so easy to ignore. from https://ift.tt/OgHCj8P Check out http://natthash.tumblr.com Long, long ago—five years, to be precise—Jeff Owens accepted that his calls to the vet would tax his fortitude. When the person on the other end asks his name, Owens, a test scorer in Albuquerque, says, “Jeff.” When they ask for his cat’s name, he has to tell them, “Baby Jeff.” The black exotic shorthair, a wheezy female with a squashed face and soulful orange eyes, is named for Owens, says his partner, Brittany Means, whose tweet about Jeff and Baby Jeff went viral this past spring. The whole thing started as a joke several years ago, when Means started calling every newcomer to their home—the car, the couch—“Baby Jeff.” Faced with blank adoption paperwork in 2017, the couple realized that only one name would do. Baby Jeff is a weird (albeit very good!) name, but it’s not as weird as it would have been a century or two ago. In the U.S., and much of the rest of the Western world, we’re officially living in an era of bequeathing unto our pets some rather human names. It’s one of the most prominent reminders that these animals have become “members of the family,” says Shelly Volsche, an anthropologist at Boise State University, to the point where they’re ascribed “agency and personhood.” The animals in our homes commonly receive so many of the acts of love people shower on the tiny humans under their care; pets share our beds, our diets, our clothes. So why not our names, too? The names and nature of the human-animal bond weren’t always this way. Kathleen Walker-Meikle, a medieval historian at the Science Museum Group and the author of Medieval Pets, has found records from the Middle Ages describing dogs with names that alluded to some part of their physical appearance (Sturdy or Whitefoot), or an object that appealed to their human (a 16th-century Swiss wagoner once owned a dog named Speichli, or “Little Spoke”). Details on cats are sparser, Walker-Meikle told me, but some Old Irish legal texts make mention of a few felines, among them Cruibne (“little paws”) and Bréone (“little flame”). Even when people-ish names did appear during this era, and the few centuries following, they trended zany, cheeky, cutesy, even pop-cultural—nothing that would be easily mistaken for a child’s given name. The 18th-century English painter William Hogarth named his pug Trump—perhaps an anglicization of a Dutch admiral called Tromp, according to Stephanie Howard-Smith, a pet historian at King’s College London. Catherine Parr, the last of King Henry VIII’s six wives, had a dog called Gardiner, after the anti-Protestant Bishop of Winchester. “This was her enemy, who wanted to destroy her,” Walker-Meikle told me. The idea was “to take the piss out of” him. Then, as the Victorian era ushered in the rise of official dog breeds, people began to reconceptualize the roles that canines could play in their homes. Once largely relegated to working roles, dogs more often became status symbols, and items of luxury—and as their status grew, so did the list of names they could acceptably bear. People no longer considered it such “a slight, necessarily, to share your name with a dog,” Howard-Smith told me. Diminutive names for animals—Jack or Fanny rather than John or Frances—became more common, too, paving the path for even more overlap down the line. [Read: Humans can’t quit a basic myth about dog breeds] The big boom happened in the 20th century, and by its latter half, lists of the most popular dog and baby names were getting awfully hard to tell apart. Nowadays, you could probably “go to a playground and shout ‘Alice!,’ and perhaps both dogs and girls would come rushing to you,” says Katharina Leibring, an expert in language and dialect at Uppsala University, in Sweden. Cats, meanwhile, seem to “have been kind of behind the curve in getting human names,” or perhaps receiving any names at all, Volsche told me. Even in 19th-century texts, Howard-Smith has spotted accounts from families who named their dogs, but would refer to “the cat” as only that. Findings such as these have held true across several countries, but pet naming trends have never been universal. In Taiwan, for example, dogs and cats might get food names, onomatopoeic names, or even English human names, such as Jasper or Bill. They don’t, however, “get Chinese human names,” which hold particular significance, says Lindsey Chen, a linguist at National Taiwan Normal University. “We love them, but they’re not humans.” In Togo, the Kabre people sometimes name their dogs with pointed phrases—such as Paféifééri, or “they are shameless”—that, when spoken aloud, communicate their frustrations with other humans without confronting them directly.b American animals who lack human-esque names aren’t loved any less, but the degree of intimacy we have with modern companion animals may almost demand anthropomorphism. Joann Biondi, a photographer in Miami, does not view her Maine coon as a “pet”; a frequent model for her artwork, he is her travel companion, her roommate, her business partner—“a creature who shares my life,” she told me. When she adopted him 13 years ago, she wanted a name befitting of his dignified features. But he also “looked like a hairy Italian soccer player,” Biondi told me, so she chose Lorenzo, sometimes tacking “Il Magnifico” on to the end. Several experts told me they’d feel a bit uncomfortable if a close family member decided to name a new pet after them. “There is still a reluctance to call animals things that really make them sound indistinguishable from a human,” Walker-Meikle told me. But some pet owners are downright inspired by that uncanny valley, including Sean O’Brien, an enterprise-software salesperson in Iowa, who deliberately sought out a very human name for his cockapoo, Kyle. “It’s just funny to see people’s reactions, like, ‘Did you say Kyle?’” he told me. [Read: Why so many Millennials are obsessed with dogs] A smidge of the species barrier can still be found in the ways some owners play with their pets’ names. Howard-Smith’s family dogs, Winnie and Arabella, have been gifted some unhuman monikers: Babby Ween, the Weenerator; Bubs, Bubski, Ballubbers, Ballubber-lubbers. Volsche’s pug, Lucy, is frequently dubbed Pug Nugget, Chunky Monkey, and Lucy, Devourer of Snackies, Demander of Attention. My own cats, Calvin and Hobbes, enjoy titles such as Chumbowumbo, Chino Vatican, Fatticus Finch, Herbal Gerbil, and Classic Herbs. Children with nicknames this unhinged would suffer all kinds of public humiliation. But with pets, “I think we can be a bit freer,” Howard-Smith told me. It’s funny; it’s embarrassing; it’s “a snapshot into someone’s relationship with their pet.” These are the impromptu names that are offered up in private, and the animals can’t complain. Means and Owens, Baby Jeff’s people, plan to keep giving their animals starkly human names. In addition to the cat, their home is also shared by a quartet of chickens: Ludwing van Beaktoven; Johenn Sebastian Bawk; Brittany, Jr. (named for Means, of course—“it was my turn,” she told me); and Little Rachel (named for their human roommate). The next bird they adopt will be named Henjamin, in honor of Means’s brother Ben. But Means and Owens, too, have a sense for which names just don’t feel quite right. “I knew this guy with a cat named Michael,” Means said. “Every time I think of it, it blows me away.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic. from https://ift.tt/VBaRpNJ Check out http://natthash.tumblr.com Way back in the early, whirlwind days of the pandemic, surfaces were the thing to worry about. The prevailing scientific wisdom was that the coronavirus spread mainly via large droplets, which fell onto surfaces, which we then touched with our hands, with which we then touched our faces. (Masks, back then, were said by public health authorities to be unnecessary for the general public.) So we washed our hands until they were raw. We contorted ourselves to avoid touching doorknobs. We went through industrial quantities of hand sanitizer, and pressed elevator buttons with keys and pens, and disinfected our groceries and takeout orders and mail. And then we learned we’d had it all backwards. The virus didn’t spread much via surfaces; it spread through the air. We came to understand the danger of indoor spaces, the importance of ventilation, and the difference between a cloth mask and an N95. Meanwhile, we mostly stopped talking about hand-washing. The days when you could hear people humming “Happy Birthday” in public restrooms quickly disappeared. And wiping down packages and ostentatious workplace-disinfection protocols became a matter of lingering hygiene theater. This whole episode was among the stranger and more disorienting shifts of the pandemic. Sanitization, that great bastion of public health, saved lives; actually, no, it didn’t matter that much for COVID. On one level, this about-face should be seen as a marker of good scientific progress, but it also raises a question about the sorts of acts we briefly thought were our best available defense against the virus. If hand-washing isn’t as important as we thought it was in March 2020, how important is it? [Read: Don’t worry, it’s not COVID] Any public-health expert will be quick to tell you that, please, yes, you should still wash your hands. Emanuel Goldman, a microbiologist at Rutgers New Jersey Medical School, considers it “commonsense hygiene” for protecting us against a range of viruses spread through close contact and touch, such as gastrointestinal viruses. Also, let’s be honest: It’s gross to use the bathroom and then refuse to wash, whether or not you’re going to give someone COVID. Even so, the pandemic has piled on evidence that the transmission of the coronavirus via fomites—that is, inanimate contaminated objects or surfaces—plays a much smaller role, and airborne transmission a much larger one, than we once thought. And the same likely goes for other respiratory pathogens, such as influenza and the coronaviruses that cause the common cold, Linsey Marr, an environmental engineer and aerosols expert at Virginia Tech, told me. This realization is not an entirely new one: A 1987 study by researchers at the University of Wisconsin found that a group of men playing poker with “soggy,” rhinovirus-contaminated cards were not infected, while a group playing with other sick players were. Now Goldman intends to push this point even further. At a conference in December, he is going to present a paper arguing that, with rare exceptions, such as RSV, all respiratory pathogens are transmitted predominantly through the air. The reason we’ve long thought otherwise, he told me, is that our understanding has been founded on faulty assumptions. Generally speaking, the studies pointing toward fomite-centric theories of transmission were virus-survival studies, which measure how long a virus can survive on a surface. Many of them either used unrealistically large amounts of virus or measured only the presence of the virus’s genetic material, not whether it remained infectious. “The design” of these experiments, he said, “was not appropriate for being able to extrapolate to real-life conditions.” The upshot, for Goldman, is that surface transmission of respiratory pathogens is “negligible,” probably accounting for less than .01 percent of all infections. If correct, this would mean that your chance of catching the flu or a cold by touching something in the course of daily life is virtually nonexistent. Goldman acknowledged that there’s a “spectrum of opinion” on the matter. Marr, for one, would not go quite so far: She’s confident that more than half of respiratory-pathogen transmission is airborne, though she said she wouldn’t be surprised if the proportion is much, much higher—the only number she would rule out is 100 percent. [Read: The very real lessons America has learned from COVID] For now, it’s important to avoid binary thinking on the matter, Saskia Popescu, an epidemiologist at George Mason University, told me. Fomites, airborne droplets, smaller aerosol particles—all modes of transmission are possible. And the proportional breakdown will not be the same in every setting, Seema Lakdawa, a flu-transmission expert at Emory University, told me. Fomite transmission might be negligible at a grocery store, but that doesn’t mean it’s negligible at a day care, where kids are constantly touching things and sneezing on things and sticking things in their mouths. The corollary to this idea is that certain infection-prevention strategies prove highly effective in one context but not in another: Frequently disinfecting a table in a preschool classroom might make a lot of sense; frequently disinfecting the desk in your own private cubicle, less so. Much of the conspicuous cleaning we did early in the pandemic was excessive, Popescu said, but she worries that we may have slightly overcorrected, lumping some useful behaviors—targeted disinfection, even hand-washing in some cases—into the category of hygiene theater. Whatever the setting, the experts I spoke with all agreed that these behaviors remain important for contending with non-respiratory pathogens. Recently, when several members of Marr’s family came down with norovirus, an extremely unpleasant stomach bug that causes vomiting, diarrhea, and stomach cramping, she disinfected a number of high-touch surfaces around the house. Picture that: one of the country’s foremost experts on airborne transmission wiping down doorknobs and light switches. Marr isn’t convinced we’ve overcorrected. Hand sanitizer still abounds, businesses still tout their surface-cleaning protocols, and air quality still gets comparatively little attention. Recently, she watched a person use their shirt to open the door of a visitor center without touching the handle … then proceed inside unmasked. There’s nothing wrong with taking certain precautions to prevent fomite transmission, she said—these should not all be dismissed en masse as hygiene theater—as long as they don’t come at the expense of efforts to block airborne transmission. “If you’re doing extra hand washing ... then you should also be wearing a good mask in crowded indoor environments,” Marr said. “If you’re bothering to clean the surfaces, then you should be bothering to clean the air.” On Friday, with respiratory-virus season looming, CDC Director Rochelle Walensky tweeted out three pieces of advice for staying healthy: “Get an updated COVID-19 vaccine & get your annual flu vaccine,” “Stay home if you are sick,” and—not to be forgotten—“Practice good hand hygiene.” She made no mention of masks or ventilation. from https://ift.tt/NmV85Rq Check out http://natthash.tumblr.com For as long as my marriage lasts, my household will be divided by reactions to vaccines. I am, fortunately, speaking of physical reactions rather than ideological ones; my partner and I are both shot enthusiasts, a fact we verified on our first date. But if my immune system is a bashful wallflower, rarely triggering more than a sore arm in the hours after I get a vaccine, then my spouse’s is a party animal. Every immunization I’ve watched him receive—among them, four doses of Moderna’s COVID-19 vaccine—has absolutely clobbered him with fevers, chills, fatigue, and headaches for about a full day. When he got the flu shot and the bivalent COVID jab together a few weeks ago, he ended up taking his first day off work in more than a decade. As usual, the same injections caused me so few symptoms that I wondered if I was truly dead inside. “Why don’t you feel anything?” my spouse howled at me from the bedroom, where his sweat was soaking through the sheets. “Sorry,” I yelled back from the kitchen, where I was prepping four days’ worth of meals between work calls after returning from an eight-mile run. If this is how every autumn will go from now on, so be it: A few hours of discomfort is still worth the rev-up in defenses that vaccines offer against serious disease and death. But it’s not hard to see that gnarly side effects will only add to the many other factors that work against COVID-vaccine uptake, including lack of awareness, sloppy messaging, dwindling access, and spotty community outreach. Back in the spring, when I spoke with several people who hadn’t gotten boosters despite being eligible for many, many months, several of them cited the post-shot discomfort as a reason. Now I’m getting texts and calls from family members and friends—all up to date on their previous COVID vaccines—admitting they’ve been dillydallying on the bivalent to avoid those symptoms too. “I don’t know if we’re going to continue to get strong buy-in from the public if they have this sort of reaction every year,” says Cindy Leifer, an immunologist at Cornell University. [Read: America created its own booster problems] The good news, at least, is that experts told me they don’t expect this bivalent recipe—or future autumn COVID shots, for that matter—to be worse, side-effect-wise, than the ones we’ve received before. It’ll take a while for data to confirm that, especially considering that more than a month into this fall’s rollout, fewer than 15 million Americans have received the updated shot. But Kathleen Neuzil, a vaccinologist at the University of Maryland School of Medicine who has studied the performance of COVID vaccines in clinical trials, pointed out to me that the mRNA shots’ ingredients have been swapped out before without altering the rate of side effects. As the alphabet soup of variants began to sweep the world in early 2021, she told me, vaccine makers started to tinker with alternate formulations, sometimes combining multiple versions of the spike protein into a single shot—“and they’re all comparable.” (If anything, early data suggest that bivalent shots containing an Omicron variant spike may be easier to take.) The same goes for flu vaccines, which are also retooled each year: When measured across the population, the frequency and intensity of side effects remain more or less the same. On average, then, mRNA-vaxxed people can probably expect to have an annual experience that’s pretty similar to the one they had with their first COVID booster. As studies have shown, that one was actually better for most people than dose No. 2, the most unpleasant of the injections so far. (The math, of course, becomes tougher for people getting another vaccine, such as the flu shot, at the same time.) There are probably two main reasons why side effects have lessened overall, experts told me. First, the spacing: Most people received the second dose in their Pfizer or Moderna primary series just three or four weeks after the first. That’s an efficient way to get a lot of people “fully vaccinated” in a short period of time, but it means that many of the immune system’s defensive cells and molecules will still be on high alert. The second shot could end up fanning a blaze of inflammation that was never quite put out. In line with that, researchers have found that spacing out the primary-series doses to eight weeks, 12 weeks, or even longer can prune some side effects. Dose matters a lot too: Vaccines are, in a way, stimulants meant to goad the immune system into reacting; bigger servings should induce bigger jolts. When vaccine makers were tinkering with their recipes in early trials, higher doses—including ones that were deemed too large for further testing—produced more side effects. Each injection in Moderna’s primary series contains more than three times the mRNA packaged into Pfizer’s, and Moderna has, on average, caused more intense side effects. But Moderna’s booster and bivalent doses contain a smaller scoop of the stimulating material: People 12 and older, for instance, get 50 micrograms instead of the 100 micrograms in each primary dose; kids 6 to 11 years old get 25 micrograms instead of 50. (All of Pfizer’s doses stay the same size across primaries and boosters, as long as people stay in the same age group.) People who switch between brands, then, may also notice a difference in symptoms. It’s a tricky balance, though. Sometimes, the immune system adjusts the magnitude of its protection to match the danger posed by a pathogen (or shot), a bit like titrating a crisis response to the severity of a threat—so it’s important that vaccine makers don’t undershoot. For better or worse, the mRNA-based COVID vaccines do seem to cause a rougher response than most other vaccines, including annual flu shots. One of the offending ingredients might be the mRNA itself, which codes for SARS-CoV-2’s spike protein. But Michela Locci, an immunologist at the University of Pennsylvania, told me that the mRNA’s packaging—a greasy fat bubble called a lipid nanoparticle—may be the more likely culprit. For some people, in any case, the side effects of COVID shots might be on par with those of the two-dose Shingrix vaccine, one of the most infamously reactogenic immunizations in our roster. Leifer, who has received both, told me the second dose of each “floored” her to about the same extent. The fact that I get fewer side effects than my spouse does not imply that I’m any less protected. A ton of factors—genetics, hormone levels, age, diet, sleep, stress, pain tolerance, and more—could potentially influence how someone experiences a shot. Women tend to have more reactive bodies, as do younger people. But there are exceptions to those trends: I’m one of them. The whole topic is understudied, Locci told me. Her own recent experience with the bivalent threw her for a loop. After her first, second, and third dose of Moderna each ratcheted up in side-effect severity, she cleared her calendar for the couple of days following her bivalent, “afraid I was going to be in bed with a fever again,” she said: “But it was a light headache for a morning, and then it was over.” She has no idea what next year will bring. Either way, side effects such as fevers and chills tend to be short-lived. “Very few side effects are severe,” Neuzil told me, “and COVID continues to be a severe disease.” Still, Grace Lee, a pediatrician at Stanford and the chair of the CDC’s Advisory Committee on Immunization Practices, hopes that scientists will keep developing new COVID vaccines that might come with fewer post-shot issues—including the very rare ones, such as myocarditis—without sacrificing immune protection. Lee doesn’t tend to react much to vaccines, but her daughter “always misses school the next day,” she told me. “I plan her shots for a Friday afternoon so she can lay out all Saturday.” Early on, when hardly anyone had immunity to the virus, signing everyone up for somewhat reactogenic shots was a no-brainer—especially given the hope that two doses would yield many, many years of protection. Now that we know it’s a repeated need, Neuzil said, “the equation changes a bit.” People aren’t totally helpless against side effects. Deepta Bhattacharya, an immunologist at the University of Arizona, had an “awful, terrible” experience with his second and third doses, which slammed him with 102- and 103-degree fevers, respectively. He weathered the side effects without intervention, worried that a painkiller would curb not just the agony, but also his protective immune response. This time, though, armed with new knowledge from his own lab that anti-inflammatory and pain-relieving drugs don’t blunt antibody levels, “the first sign I feel even the slightest bit shitty,” he told me, “I’m dosing up.” I’ll probably do the same for my spouse the next time he’s due for a vaccine of any kind … likely while I chill on the sidelines. Bhattacharya’s spouse, too, is kind of an immune introvert, a fact that he bemoans. “Her only side effect was she felt thirsty,” he said. “It’s just not fair.” from https://ift.tt/lgKYk7I Check out http://natthash.tumblr.com Winter is coming. Again. For the past two years, colder temperatures have brought seasonal COVID upticks, which turned into massive waves when ill-timed new variants emerged. In Western Europe, the first part of that story certainly seems to be playing out again. Cases and hospitalizations started going up last month. No new variant has become dominant yet, but experts are monitoring a pair of potentially troubling viral offshoots called BQ.1 and XBB. “We have the seasonal rise that’s in motion already,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland. If one of these new variants comes in on top of that, Europe could end up with yet another double whammy. The U.S. may not be far behind. America’s COVID numbers are falling when aggregated across the country, but this isn’t true in every region. The decline is largely driven by trends in California, says Samuel Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundation’s Pandemic Prevention Initiative. In chillier New England, hospitalization numbers have already ticked up by as much as nearly 30 percent, and more virus is showing up in wastewater, too. There are a couple of reasons to be more optimistic about this winter compared with last. The U.S. is just exiting a long and high COVID plateau, which means there is a lot of immunity in the population that could blunt the virus’s spread. An estimated 80 percent of Americans have had Omicron in the past year. And BQ.1 and XBB are not overtaking previous versions as quickly as Omicron did last winter. They seem unlikely to cause a winter surge as overwhelming for hospitals as the original Omicron wave, though a full picture of their severity and ability to reinfect is still emerging. (Both of these new variants are descended from Omicron: BQ.1 comes from BA.5, and XBB comes from two different BA.2 lineages that recombined into one. Confused by all these letters and numbers? Here’s a guide to understanding lineage names.) [Read: The COVID data that are actually useful now] Lab data tell us that both subvariants are capable of substantial immune evasion. XBB is already driving a surge in Singapore. BQ.1, and its closely related descendant BQ.1.1, are rising in Western European countries and now account for about 8 to 10 percent of cases, according to Hodcroft—but they are probably not widespread enough to explain why COVID rates were already going up. Several countries in the region may have already hit a peak for now, but as BQ.1 and BQ.1.1 become more prevalent, they could jump-start another wave. The variant situation this winter could look different from past ones. Unlike previous winters, when Alpha and Omicron took clear paths to domination, now “there is this soup of variants,” says Tom Peacock, a virologist at Imperial College London. One of these might come to monopolize infections in certain parts of the world, another elsewhere. BQ.1 and XBB are distinct enough from each other, Peacock says, that they could end up co-circulating, or not. It’s too early to say for sure. We could also get another unwelcome surprise, he adds—just as Omicron upended our winter expectations last Thanksgiving. With a few more weeks of data, the real-world severity and reinfection rate of BQ.1 and XBB will be clearer. Still, our window into COVID reality is foggier than ever. As governments have ramped down COVID mitigations, they’ve also ramped down surveillance. “The data going into these models is far poorer because we aren’t sequencing as much,” Peacock says. In the U.S., the data we do have suggest that BQ.1 and BQ.1.1 account for about 10 percent of cases. Case numbers are also less reliable because of the rise of at-home testing, which generally doesn’t get officially reported. Comparing across regions is becoming harder too. Back in March 2020, every country started with virtually the same amount of immunity against COVID: none. Since then, we’ve all been diverging immunologically from one another. South Africa, for example, had a large Beta wave that didn’t hit Europe. Europe saw a large and distinct BA.2 wave that never materialized in the U.S. And now countries are administering a mix of BA.1 and BA.5 bivalent boosters, depending on availability, and offering boosters to different segments of their populations. As we’re already seeing in the U.S., even different parts of the same country are likely to experience this COVID winter differently. “What’s happening in Boston is not what’s happening in L.A.,” Scarpino says. For communities to respond to the situation on the ground, “we have to have more real-time, locally relevant information.” from https://ift.tt/9Gt2cAq Check out http://natthash.tumblr.com Last week, just a couple of hours into a house-sitting stint in Massachusetts for my cousin and his wife, I received from them a flummoxed text: “Dude,” it read. “We are the only people in masks.” Upon arriving at the airport, and then boarding their flight, they’d been shocked to find themselves virtually alone in wearing masks of any kind. On another trip they’d taken to Hawaii in July, they told me, long after coverings became optional on planes, some 80 percent of people on their flight had been masking up. This time, though? “We are like the odd man out.” Being outside of the current norm “does not bother us,” my cousin’s wife said in another text, despite stares from some of the other passengers. But the about-face my cousin and his wife identified does mark a new phase of the pandemic, even if it’s one that has long been playing out in fits and starts. Months after the vanishing of most masking mandates, mask wearing has been relegated to a sharply shrinking sector of society. It has become, once again, a peculiar thing to do. “If you notice, no one’s wearing masks,” President Joe Biden declared last month on 60 Minutes. That’s an overstatement, but not by much: According to the COVID States Project, a large-scale national survey on pandemic-mitigation behaviors, the masking rate among Americans bounced between around 50 and 80 percent over the first two years of the pandemic. But since this past winter, it’s been in a slide; the project’s most recent data, collected in September, found that just 29 percent have been wearing masks outside the home. This trend may be long-standing on the population level, but for individuals—and particularly for those who still wear masks, such as my cousin and his wife—it can lead to moments of abrupt self-consciousness. “It feels like it’s something that now needs an explanation,” Fiona Lowenstein, a journalist and COVID long-hauler based in Los Angeles, told me. “It’s like showing up in a weird hat, and you have to explain why you’re wearing it.” Now that most Americans can access COVID vaccines and treatments that slash the risk of severe disease and death, plenty of people have made informed decisions to relax on masking—and feel totally at ease with their behavior while paying others’ little mind. Some are no longer masking all the time but will do so if it makes others feel more comfortable; others are still navigating new patterns, trying to stay flexible amid fluctuating risk. Saskia Popescu, an infectious-disease epidemiologist at George Mason University, told me that she’s now more likely to doff her mask while dining or working out indoors, but that she leaves it on when she travels. And when she does decide to cover up, she said, she’s “definitely felt like more of an outlier.” For some, like my cousin and his wife, that shift feels slightly jarring. For others, though, it feels more momentous. High-filtration masks are one of the few measures that can reliably tamp down on infection and transmission across populations, and they’re still embraced by many parents of newborns too young for vaccines, by people who are immunocompromised and those who care for them, and by those who want to minimize their risk of developing long COVID, which can’t be staved off by vaccines and treatments alone. Theresa Chapple-McGruder, the public-health director for Oak Park, Illinois, plans to keep her family masking at least until her baby son is old enough to receive his first COVID shots. In the meantime, though, they’ve certainly been feeling the pressure to conform. “People often tell me, ‘It’s okay, you can take your mask off here,’” Chapple-McGruder told me; teachers at the local elementary school have said similar things to her young daughters. Meghan McCoy, a former doctor in New Hampshire who takes immunosuppressive medications for psoriatic arthritis and has ME/CFS, has also been feeling “the pressure to take the mask off,” she told me—at her kid’s Girl Scout troop meetings, during trips to the eye doctor. “You can feel when you’re the only one doing something,” McCoy said. “It’s noticeable.” [Read: Mask mandates are illogical. So what?] For Chapple-McGruder, McCoy, and plenty of others, the gradual decline in masking creates new challenges. For one thing, the rarer the practice, the tougher it is for still-masking individuals to minimize their exposures. “One-way masking is a lot less effective,” says Gabriel San Emeterio, a social worker at Hunter College who is living with HIV and ME/CFS. And the less common masking gets, the more conspicuous it becomes. “If most people met me, they wouldn’t know I was immunocompromised,” McCoy told me. “There’s no big sign on our foreheads that says ‘this person doesn’t have a functioning immune system.’” But now, she said, “masks have kind of become that sign.” Aparna Nair, a historian and disability scholar at the University of Oklahoma who has epilepsy, told me that she thinks masks are becoming somewhat analogous to wheelchairs, prosthetics, hearing aids, and her own seizure-alert dog, Charlie: visible tools and technologies that invite compassion, but also skepticism, condescension, and invasive questions. During a recent rideshare, she told me, her driver started ranting that her mask was unnecessary and ineffective—just part of a “conspiracy.” His tone was so angry, Nair said, that she began to be afraid. She tried to make him understand her situation: I’ve been chronically ill for three decades; I’d rather not fall sick; better to be safe than sorry. But she said that her driver seemed unswayed and continued to mutter furiously under his breath for the duration of the ride. Situations of that kind—where she has to litigate her right to wear a mask—have been getting more common, Nair told me. Masking has been weighed down with symbolic meaning since the start of the pandemic, with some calling it a sign of weakness and others a vehicle for state control. Americans have been violently attacked for wearing masks and also for not wearing them. But for a long time, these tensions were set against the backdrop of majority masking nationwide. Local mask mandates were in place, and most scientific experts wore and championed them in public. With many of those infrastructural supports and signals now gone, masking has rapidly become a minority behavior—and people who are still masking told me that that inversion only makes the tension worse. San Emeterio, who wears a vented respirator when they travel, recently experienced a round of heckling from a group of men at an airport, who started to stare, laugh, and point. Oh my god, look at what he’s wearing, San Emeterio recalls the strangers saying. “They clearly meant for me to hear it,” San Emeterio told me. “It didn’t make me feel great.” Alex Mawdsley, the 14-year-old son of an immunocompromised physician in Chicago, is one of just a handful of kids at his middle school who are still masking up. Since the start of the academic year, he’s been getting flak from several of his classmates “at least once a week,” he told me: “They’re like ‘You’re not gonna get COVID from me’ and ‘Why are you still wearing that? You don’t need it anymore.’” Alex’s mother, Emily Landon, told me she’s been shaken by the gawks and leers she now receives for masking. Even prior to the pandemic, and before she was diagnosed with rheumatoid arthritis and began taking immunosuppressive drugs, she considered herself something of a hygiene stan; she always took care to step back from the sneezy and sniffy, and to wipe down tray tables on planes. “And it was never a big deal,” she said. [Read: Put your face in airplane mode] It hasn’t helped that the donning of masks has been repeatedly linked to chaos and crisis—and their removal, to triumph. Early messaging about vaccines strongly implied that the casting away of masks could be a kind of post-immunization reward. In February, CDC Director Rochelle Walensky described masks as “the scarlet letter of this pandemic.” Two months later, when the administration lifted its requirements for masking on public transportation, passengers on planes ripped off their coverings mid-flight and cheered. To reclaim a mask-free version of “normalcy,” then, may seem like reverting to a past that was safer, more peaceful. The past few years “have been mentally and emotionally exhausting,” Linda Tropp, a social psychologist at the University of Massachusetts at Amherst, told me. Discarding masks may feel like jettisoning a bad memory, whereas clinging to them reminds people of an experience they desperately want to leave behind. For some members of the maskless majority, feeling like “the normal ones” again could even serve to legitimize insulting, dismissive, or aggressive behavior toward others, says Markus Kemmelmeier, a social psychologist at the University of Nevada at Reno. It’s unclear how the masking discourse might evolve from here. Kemmelmeier told me he’s optimistic that the vitriol will fade as people settle into a new chapter of their coexistence with COVID. Many others, though, aren’t so hopeful, given the way the situation has unfolded thus far. “There’s this feeling of being left behind while everyone else moves on,” Lowenstein, the Los Angeles journalist and long-hauler, told me. Lowenstein and others are now missing out on opportunities, they told me, that others are easily reintegrating back into their lives: social gatherings, doctor’s appointments, trips to visit family they haven’t seen in months or more than a year. “I’d feel like I could go on longer this way,” Lowenstein said, if more of society were in it together. Americans’ fraught relationship with masks “didn’t have to be like this,” Tropp told me—perhaps if the country had avoided politicizing the practice early on, perhaps if there had been more emphasis on collective acts of good. Other parts of the world, certainly, have weathered shifting masking norms with less strife. A couple of weeks ago, my mother got in touch with me from one such place: Taiwan, where she grew up. Masking was still quite common in public spaces, she told me in a text message, even where it wasn’t mandated. When I asked her why, she seemed almost surprised: Why not? from https://ift.tt/xFDIHlg Check out http://natthash.tumblr.com |
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