In 2020, and again in 2021, the dreaded twindemic never came. The worry among experts was that a winter COVID surge layered on top of flu season—or even, in worst-case scenarios, a flu outbreak of pandemic proportions—would push already strained hospitals to the brink. Thankfully, we got lucky. Flu season simply didn’t materialize in 2020: The United States recorded only about 2,000 cases, a jaw-dropping 110 times fewer than it had the season prior. Similar trends held for other respiratory viruses. In 2021, cases were way up from 2020, but still way down from typical pre-pandemic years. Now our luck seems finally to have run out. Flu season has only just begun, and already the U.S. has recorded an explosion of cases. A massive wave of RSV is hitting the country, along with smaller parallel surges in rhinovirus and enterovirus. The result of all this is what my colleague Katherine J. Wu has called “the worst pediatric-care crisis in decades.” Meanwhile, COVID cases and hospitalizations remain low around the country relative to earlier stages of the pandemic, but the coronavirus continues to kill about 350 Americans daily. The worry now is not a twindemic but a “tripledemic.” What this means for you is that your body is likely to encounter multiple different virological foes this season—perhaps even at the same time. When you board a plane, or see a show, or eat out, you’re facing a more varied swirl of viruses than in recent years. How should you expect your body to cope? [Read: Hundreds of Americans will die from COVID today] Before delving into immunological arcana, it’s worth making one thing perfectly clear, at the risk of stating the obvious: Having a cold will not protect you from COVID. COVID will not protect you from the flu. Nor the flu from RSV. Different viruses penetrate the body’s defenses in different ways, and unfortunately, as impressive as our immune system is, it doesn’t have some universal ability to fend off all seasonal pathogens simply because it detects one. The same goes for vaccinations. A flu vaccine will not inoculate you against COVID, and a COVID vaccine will not inoculate you against flu; defending against both viruses requires both vaccines. The immune system is famously complicated, however. As my colleague Ed Yong has written, immunology is where intuition goes to die. When people’s bodies face two different pathogens, whether simultaneously or in quick succession, all sorts of dynamics factor in. And more confusing still, these dynamics can differ drastically from one person to the next. Some people have conditions that leave them immunocompromised. Others must take immunosuppressive medications. Genetics come into play. Factors that no one yet understands come into play. When a pathogen finds its way into your body, the initial stages of the response are part of what’s called the innate immune system—a constellation of cells, barriers such as our skin, and reflexes such as coughing that work in concert to ward off foreign invaders. The innate immune system is not particularly discerning. It distinguishes only between what is part of the body and what is not, then attacks the latter. Infection by one pathogen is unlikely to boost the innate immune system’s response to another in anything but the most marginal way. “You might be a little bit revved up, and your immune system might work a little bit faster, but there’s no specific protection,” Cindy Leifer, an immunologist at Cornell University, told me. “You’re still going to get the whole infection. It just might be a little less severe.” These minor benefits, if you get them at all, will likely last only a week or two, she said. And even they are far from a given. In fact, infection with one pathogen can sometimes leave you more vulnerable to infection with another, Annabelle de St. Maurice, a pediatric-infectious-disease specialist at UCLA Health, told me. Flu, for example, can increase your risk of certain bacterial infections. COVID can increase your risk of certain fungal infections. At this point, it’s hard to say how COVID will interact with other respiratory viruses. Because we’ve seen so few cases of these other viruses over the past few years, we don’t have much of a sample from which to make inferences. [Read: Are we really getting COVID boosters every year forever?] While the innate immune system hammers away, the body musters B cells and T cells, which, unlike the cells involved in the innate immune response, come in many varieties specialized to fight many different pathogens. These cells are part of the adaptive immune system, distinguished from the innate response both by this specificity and by its capacity for memory. Once they’ve cleared a pathogen, a fraction of the B and T cells called into action stick around, so that if the body encounters the same pathogen again, it can mobilize more swiftly and more robustly than it did the first time. In certain cases, the adaptive immunity conferred by one pathogen can end up protecting us from another. This is called cross-reactive immunity. If two pathogens are sufficiently similar, the immune system might build protection against the one by fighting the other. We sometimes see this with different strains of the flu. Or different COVID variants. This is why smallpox vaccines can inoculate against monkeypox. Early on in the pandemic, some scientists hypothesized that past infections with the common-cold coronaviruses so familiar to us all might provide a degree of protection against COVID. Some studies have offered modest support for this theory, but the real-world results—millions of deaths from COVID-19—suggest that whatever protection we had wasn’t terribly strong, Donna Farber, an immunologist at Columbia, told me. How cross-reactivity plays out can differ drastically from person to person. The response relies on the adaptive immune system recognizing a part of pathogen A that pathogen B shares. It is this matching that allows the body to mount an immune response to pathogen B, despite having never encountered it before. If the body instead recognizes a part of pathogen A that pathogen B does not share, the body won’t mount a cross-reactive response. Researchers are trying to understand why these dynamics occur one way in one person and differently in another, but for the moment, Leifer told me, “I don’t think we really have a good handle on that.” When the body happens to strike upon a near-perfect match between parts of two viruses that otherwise aren’t all that similar, she said, it’s “like winning the lottery.” Unless you like those odds, you probably shouldn’t bank on cross-reactive immunity bailing you out this flu season. Instead, the reality is that you’re more likely to get sick with multiple different things this winter than you were in either the last one or the one before. Be safe out there. Your immunological superpowers can only offer so much protection. from https://ift.tt/Ivjfqkc Check out http://natthash.tumblr.com
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A couple of weeks ago, a friend asked me how many COVID shots I’d gotten so far. And for a brief, wonderful moment, I forgot. “Three,” I told them, before shaking my head. “No, actually, four.” I had no trouble recalling when I’d received my most recent shot (September). But it took me a moment to tabulate all the doses that had preceded it. By this point in the pandemic, a lot of people must be losing track. “I actually think this is a good thing,” says Grace Lee, a pediatrician at Stanford, and the chair of the CDC’s Advisory Committee on Immunization Practices. Now that so many Americans have racked up several shots or infections, she told me, the question is no longer “‘How many doses have you gotten cumulatively?’ It’s ‘Are you up to date for the season?’” The flip is subtle, but it marks a rethink of the COVID-vaccination paradigm. We’re at a define-the-relationship moment with these shots, when people are trying to commit—to normalize them as a routine part of our lives. At a September ACIP meeting, CDC officials noted that “we are changing the way we are thinking about these vaccines,” and trying to “get on a more regular schedule.” If COVID shots are here for good, then at least we can be rid of the bother of counting them. [Read: It’s a bad time to be a booster slacker] Counting doses was more apt early in the vaccine rollout, when it seemed that two jabs (or even one) would be enough to get Americans “fully vaccinated” and out of the danger zone. When more shots followed, they were often advertised with confusing finality: What some initially described as the booster was later retconned as the first booster after a second one was recommended for certain groups. But with immunity against infection more fragile than some hoped, and a virus that quickly shapeshifts out of antibodies’ grasp, those ordinal adjectives have stopped making sense. Until our vaccine tech becomes much more durable or variant-proof, repeat doses will be, for most of us, a fixture of the future—and it won’t do anyone much good to say, “‘I’m on shot 15’ or ‘I’m on shot 16,’” Angela Shen, a vaccine expert at Children’s Hospital of Philadelphia, told me. The numbers certainly matter when they’re small: It will continue to be important for people to count off their first few shots, for instance, especially those without a history of infections. But after that initial set of viral-spike-protein exposures, the total count is moot. In most cases, about three vaccinations or infections—preferably vaccinations, which are both safer and easier to accurately track—should be “enough to fully charge up the immune system’s battery” for the first time, says Rishi Goel, an immunologist at the University of Pennsylvania. Further COVID shots will help only insofar as they can recharge the battery toward max capacity when it starts to lose its juice. Scheduling a vaccine, then, becomes a matter of “how long it’s been since your last immunity-conferring event,” regardless of how many exposures a body has racked up, says Avnika Amin, a vaccine epidemiologist at Emory University. People who are immunocompromised may need four or more shots to establish that initial immunity charge, and their own (maybe smaller) peak capacity. But ultimately, the threshold effect they experience—a point of “diminishing returns”—is similar, says Marion Pepper, an immunologist at the University of Washington. Given how many vaccinations and infections the U.S. has now logged, the majority of Americans “can be done with counting,” she told me. If we’re going to shift our focus to timing shots, instead of counting them, we’ll have to schedule our shots smartly. Several prominent figures have already come out and said that yearly doses are a top choice. Albert Bourla, Pfizer’s CEO, has been pushing that idea since early 2021; Peter Marks, who heads the FDA’s Center for Biologics Evaluation and Research, has been delivering a similar line for several months. Even President Joe Biden has endorsed the annual approach, noting in a September statement that the debut of the bivalent shot heralded a new phase in COVID vaccination, in which Americans would receive a dose “once a year, each fall.” That plan is not unreasonable. Shots will have to come with at least some regularity, as variants keep rolling in and immunity against infection ebbs. But re-dose prematurely with a shot with similar ingredients, and the body--still hopped up from the previous dose—may destroy the vaccine before it has much effect, making it about as useful as charging a battery that’s already at 95 percent. SARS-CoV-2 antibody levels drop off steeply in the first six months following a vaccine dose, and then, the rate of drain slows down. It’s as if the immune system goes into “power-saver mode,” Goel told me, which means there might not be a huge difference between revaccinating twice a year or only once. Plus, living out much of the year with lower antibody levels is not as worrisome as it might sound. Although antibodies can be a rather useful proxy for our level of protection, especially against infection, they don’t paint the whole defensive picture: T cells and other fighters tend to stick around for far longer, maintaining safeguards against severe disease. (The immunocompromised and older people may still need more frequent COVID-immunity top-offs.) [Read: Are we really getting COVID boosters every year forever?] The optimal pace for COVID vaccination will also depend on the speed at which the virus spews out variants. A yearly schedule works for influenza, Shen told me, but “we know flu’s cadence.” SARS-CoV-2 hasn’t yet settled down into a predictable, seasonal pattern; its waves aren’t relegated to the chilliest months. The degree to which we, as the coronavirus’s hosts, tamp down transmission also matters quite a bit. Having more virus around puts more pressure on vaccines to perform, especially when there aren’t many other mitigation measures in place. If all this talk of “once a year, each fall” turns out to be another red-herring recommendation, Amin told me, it could undermine any messaging that follows. All of that said, the autumn regimen may yet stick around because it’s the easiest approach. Flu-shot uptake is far from perfect, but the messaging around it is “simple and clean,” says Rupali Limaye, a behavioral scientist and vaccine-attitudes researcher at Johns Hopkins. After dosing up twice in four weeks as infants, people are asked to get a yearly shot, and that’s it. Compare that with the most convoluted days of COVID vaccination, when people couldn’t dose up without accounting for their age, health status, number of previous doses, vaccine brand, time since last dose, and more. “That’s absolute overload,” Limaye told me. Complicated schedules burn people out—or dissuade them from showing up at all. This fall, when the bivalent shot debuted, a troubling proportion of Americans didn’t even know they were eligible. Encouraging COVID vaccines at the same, straightforward pace as flu shots would make it easy for people to sign up for both at once, and maybe, eventually, to get them in the same syringe. Vaccines tend to ride one another’s coattails, Shen told me. “In the fall, there’s a bump in other routine vaccines,” she said, because people “are already there for their flu shot.” It would also make a big difference if the COVID-vaccine recipes changed for everyone at the same time, as they do for flu. [Read: When’s the perfect time to get a flu shot?] If we’re going to pivot from numbering doses to timing them, we might as well take the opportunity to discard the term booster as well. Some people don’t understand what it means, Limaye told me, or they default to a logical question--How many more boosters will I need? Plus, booster may no longer fit the science. “When we start updating formulas, it’s not really a booster anymore,” Amin told me. That’s not how we generally talk about flu shots: I certainly couldn’t tell you how many “boosters” of that vaccine I’ve had. (I don’t know, maybe 14? 15?) Pivoting to a terminology of “seasonal shots” could make COVID vaccination that much more routine. So, fine, if anyone should ask: I’ve had (count ’em: one, two, three) four doses of the vaccine so far. But more important, I’ve gotten the shot most recently available to me. from https://ift.tt/PMDjFLu Check out http://natthash.tumblr.com This weekend, I’ll be waking up to one of my favorite days of the year: a government-sanctioned 25-hour Sunday. Forget birthdays, forget my anniversary; heck, forget the magic of Christmas. On Sunday, I’ll get to do a bit of time traveling as most of the United States transitions out of daylight saving time back into glorious, glorious standard time. I may be a standard-time stan, but I’m no monster. I feel for the die-hard fans of DST. With the push of a button, or the turn of a dial, most Americans will be cleaving an hour of brightness out of their afternoons, at a time of year when days are already fast-dimming. Leaving work to a dusky sky is a bummer; a pre-dinner stroll cut short by darkness can really be the pits. But if we all put aside our differences for just a moment, we can celebrate the fact that this weekend, nearly all Americans—regardless of where they sit on the DST love-hate spectrum—will be blessed with a 25-hour day, and that freaking rocks. If we must live in a dumb world where the dumb clocks shift twice a dumb year, let’s at least come together on the objective greatness of falling back. [Read: The family that always lives on daylight saving time] I don’t want to minimize the nuisance of the time shift. Toggling back and forth twice a year is an absolute pain, and many Americans cheered when the Senate unanimously passed a proposal earlier this year to move the entire U.S. to permanent daylight saving time. But Katy Milkman, a behavioral scientist at the University of Pennsylvania and the host of the podcast Choiceology—who, by the way, loathes the end of DST—told me we can all reframe the autumn clock change “as a windfall.” Sunday will contain a freebie hour to do whatever we like. Rafael Pelayo, a sleep specialist at Stanford, will be spending his at the farmers’ market; Ken Carter, a psychologist and self-described morning person at Emory University, told me he might chill with an extra cup of coffee and his cats. I’m planning to split my minutes between a nap and Paper Girls (the graphic novel, not the show). An hour isn’t enough time to learn a new language or cure cancer, or even to watch the entire season finale of The Rings of Power. But a little wiggle room could help kick-start a new habit, such as a gym routine, Milkman said, especially if you make a plan, tell a friend, and stick to it. Above all, she said, “do something to bring you joy.” Falling back, to me, is its own joy: It recoups a springtime loss, and resets the clocks to the time that’s always suited me best. It’s wicked hard to fall asleep when the light lingers past 8 or 9 p.m. I also struggle to get out of bed without a hefty dose of morning light, which has been scarce in the past few weeks. Going out for my prework run has meant a lot of stumbling around and using my phone as a crummy flashlight. If and, God willing, when we ditch the status quo, I maintain that permanent standard time >>>> permanent daylight saving time. (So maybe it’s not terrible that the DST-forever bill is now stalled in the House.) And I gotta say, the science (pushes glasses up nose) largely backs me and my fellow standardians up. Several organizations, including the American Academy of Sleep Medicine, have for years wanted to do away with DST for good. “Standard time is a more natural cycle,” Pelayo told me. “In nature we fall asleep to darkness and we wake up to light.” When people spend most of their year out of sync with these rhythms, “it reduces sleep duration and quality,” says Carleara Weiss, a behavioral-sleep-medicine expert at the University at Buffalo. The onset of DST has been linked to a bump in heart attacks and strokes, and Denise Rodriguez Esquivel, a psychologist at the University of Arizona College of Medicine, told me that our bodies may never fully adjust to DST. We’re just off-kilter for eight months. [Read: Daylight saving is a trap] For years, some researchers have argued that perma-DST would cut down on other societal woes: crime, traffic accidents, energy costs, even deer collisions. But research on the matter has produced mixed or contested results, showing that several of those benefits are modest or perhaps even nonexistent. And although sticking with DST might boost late-afternoon commerce, people might hate the shift more than they think. In the 1970s, the U.S. did a trial run of year-round DST … and it flopped. (Most of Arizona, where Rodriguez Esquivel lives, exists in permanent standard time; she told me it’s “really nice.”) Returning to the proper state of things won’t be without its troubles. Next week will have its missed meetings, fumbled phone calls, and general grumpiness. Although springing forward is usually tougher, “fallback blues,” Weiss told me, are absolutely a thing. The change-up may be extra hard on parents of very young kids, overnight workers, and people who don’t have a safe place to sleep. “It’s a very confusing time for our brain,” Rodriguez Esquivel told me. “Just be kind to yourself.” That’s why I’ll be having two breakfasts on Sunday: one when my body says it’s time, and one when the clock does. Carter told me it doesn’t hurt to be extra accommodating of others, too. “I try to keep quiet this time of year,” he said. “It doesn’t annoy me very much. But I’m secretly amused by people like you.” Realistically, many of us will just end up snoozing right through the bonus hour. Which is totally fine. I’m considering that plan, too. The only losers in that scenario will, alas, be my cats. They do not follow the clock changes, legislation be damned; a 25-hour day is to them a scourge if it means that I sleep in, and breakfast arrives a full hour late. In that event, they, unlike me, will eat when the clock decrees, and not a minute sooner. from https://ift.tt/89XaFR0 Check out http://natthash.tumblr.com You never forget the first time a doctor gives up: when they tell you that they don’t know what to do—they have no further tests to run, no treatments to offer—and that you’re on your own. It happened to me at the age of 27, and it happens to many others with chronic pain.
I don’t remember what film I’d gone to see, but I know I was at The Oaks Theater, an old arts cinema on the outskirts of Pittsburgh, when pain stabbed me in the side. This was followed by an urgent need to urinate; after bolting to the bathroom, I felt better, but a band of tension ran through my groin. As the hours went by, the pain resolved into a need to pee again, which woke me up at 1 or 2 a.m. I went to the bathroom—but, as if I was in some bad dream, urinating made no difference. The band of sensation remained, insusceptible to feedback from my body. I spent a night of hallucinatory sleeplessness sprawled on the bathroom floor, peeing from time to time in a vain attempt to snooze the somatic alarm.
My primary-care doctor guessed that I had a urinary-tract infection. But the test came back negative—as did more elaborate tests, including a cystoscopy in which an apparently teenage urologist inserted an old-fashioned cystoscope through my urethra in agonizing increments, like a telescopic radio antenna. It certainly felt like something was wrong, but the doctor found no visible lesion or infection. [Read: The enduring mystery of pain measurement] What followed were years of fruitless consultations, the last of which produced a label, chronic pelvic pain—which means what it sounds like and explains very little—and a discouraging prognosis. The condition is not well understood, and there is no reliable treatment. I live with the hum of pain as background noise, flare-ups decimating sleep from time to time.
That pain is bad for you may seem too obvious to warrant scrutiny. But as a philosopher, I find myself asking why it is so bad—especially in a case like mine, where the pain I feel from day to day is not debilitating. To my relief, I am able to function pretty well; sleep deprivation is the worst of it. What more is there to say about the harm of being in pain?
Virginia Woolf may have invented the commonplace that language struggles to communicate pain. “English, which can express the thoughts of Hamlet and the tragedy of Lear,” she wrote, “has no words for the shiver and the headache.” Woolf’s maxim was developed by the literary and cultural critic Elaine Scarry in The Body in Pain, a book that has become a classic. “Physical pain—unlike any other state of consciousness—has no referential content,” she wrote. “It is not of or for anything. It is precisely because it takes no object that it, more than any other phenomenon, resists objectification in language.”
But as someone who has lived with pain for 19 years, I think Woolf and Scarry are wrong. Physical pain has “referential content”: It represents a part of the body as being damaged or imperiled even when, as in my case, it isn’t really. Pain can be deceptive. And we have many words for it: Pulsing, burning, and contracting are all good words for mine.
That pain represents the body in distress, bringing it into focus, helps us better understand why it is bad. Pain disrupts what the philosopher and physician Drew Leder calls the “transparency” of the healthy body. We don’t normally attend to the bodies itself; instead, we interact with the world “through” it, as if it was a transparent medium. Being in pain blurs the corporeal glass. That’s why pain is not just bad in itself: It impedes one’s access to anything good.
This accounts for one of pain’s illusions. Sometimes, I think I want nothing more than to be pain free—but as soon as pain is gone, the body recedes into the background, unappreciated. The joy of being free of pain is like a picture that vanishes when you try to look at it, like turning on the lights to see the dark.
Philosophy illuminates another side of pain—in a way that has practical upshots. This has to do with understanding persistent pain as more than just a sequence of atomized sensations. The temporality of pain transforms its character.
Although I am not always in notable pain, I’m never aware of pain’s onset or relief. By the time I realize it has vanished from the radar of attention, it has been quiet for a while. When the pain is unignorable, it seems like it’s been there forever and will never go away. I can’t project into a future free of pain: I will never be physically at ease. Leder, who also suffers from chronic pain, traces its effects on memory and anticipation: “With chronic suffering a painless past is all but forgotten. While knowing intellectually that we were once not in pain we have lost the bodily memory of how this felt. Similarly, a painless future may be unimaginable.”
We can draw two lessons from this. The first is that we have to focus on the present, not on what is coming in the future: If you can treat pain as a series of self-contained episodes, you can diminish its power. I try to live by what I call the “Kimmy Schmidt rule,” after the sitcom heroine who endured 15 years in an underground bunker with the mantra “You can stand anything for 10 seconds.” My units of time are longer, but I do my imperfect best not to project beyond them. You can have a good day while experiencing pelvic pain. And life is just one day after another. [Read: The long history of discrimination in pain medicine] The second lesson is that there’s less to what philosophers call “the separateness of persons” than might appear. Moral philosophers have argued that concern for others does not simply aggregate their harms. If you have to choose between agony for one person or mild headaches for many others, you should choose the headaches, no matter the number. The relief of minor pain for many cannot offset the agony of one, because the pains afflict distinct and separate people. They don’t add up.
Do trade-offs like this make sense within a single life? Philosophers often say they do, but I’ve come to believe that’s wrong. If what I was experiencing was just a sequence of atomized pains, without effects on memory or anticipation, I don’t think it would make sense to trade them for short-lived agony—a three-hour surgery performed without anesthetic, say—any more than it would make sense to trade a million mild headaches for the agony of one person. If I would choose to undergo that surgery, it would be because of the temporal effects of chronic pain, the shadow it casts over past and future.
A lot has been made of pain’s unshareability, how it divides us from one another. In fact, pain is no more shareable over time. My mother-in-law once asked, rhetorically, “Why can one man not piss for another man?” But you can’t piss for your past or future self either. And as we bridge the gulf between now and then to sympathize with ourselves at other times, we sympathize too with the suffering of others. Self-compassion is not the same as compassion for other people, but they are not as different as they seem. There is solace in solidarity, in sharing the experience of chronic pain, in compassion’s power to breach the boundaries that separate us from other people, and ourselves. This article has been excerpted from Kieran Setiya’s new book, Life Is Hard: How Philosophy Can Help Us Find Our Way. 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/RIfrx5M Check out http://natthash.tumblr.com |
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