Walter Barker has, since the fall of 2020, had five doses of COVID-19 vaccine. He’s already starting to ponder when he might need a sixth. Barker, a 38-year-old office worker in New York, received his first two doses a year ago, as part of an AstraZeneca vaccine trial. But the shots, which haven’t been authorized by the FDA, couldn’t get him into some venues. Sick of having to test every time he went to a Yankees game, Barker nabbed a pair of Moderna injections in the spring. Then, when the government urged boosters, he figured he’d “rather be safe than sorry,” especially because of his Type 2 diabetes—a risk factor for severe COVID. That was vaccine No. 5. Plus, he told me, he’d also caught the actual virus between his AstraZeneca and Moderna shots. Now Barker’s steeling himself for the possibility of “a new booster or two every year.” Inklings of such a policy are already starting to appear. Israel is debating whether to offer fourth shots to higher-risk groups, including people over 60 and health-care workers. Some physicians are arguing that certain Americans should dose up again as well. And vaccine makers have long insisted that we’ll likely need annual shots at least. Given the clip at which the coronavirus seems to change, “I do think we’ll have to keep updating the vaccine,” Katie Gostic, an infectious-disease modeler at the University of Chicago, told me. [Read: Omicron has created a whole new booster logic] At this point in the pandemic, though, there’s no consensus on the number of shots we’ll need in the long term; plenty of the world’s leading COVID-vaccine experts have shifted their stance in just the past few weeks. Back in the summer, Ali Ellebedy, an immunologist at Washington University in St. Louis, thought, “There is no way we will need annual vaccinations,” he told me. “I am [at] 50 percent now.” A future of annual vaccinations would almost be a relief. In the past year, the U.S. government has recommended that almost everyone eligible be COVID-vaccinated three times over, and the possibility of an Omicron-focused shot now looms. But the sweet spot for boosting frequency isn’t all that easy to find—both undervaccinating and overvaccinating have downsides—and the narrative is definitely not as simple as more is more. Maybe we’ll luck out, and finagle some truly durable protection out of our current shots. Or perhaps we’re just at the start of what could be the world’s most intense and widespread repeat-vaccination campaign to date. There are two main reasons to vaccinate the already vaccinated: a substantial drop in our body’s defenses or a huge hike in the virus’s offenses. We’re still, for instance, working to understand how well our immune systems cling to the intel offered by our shots. For months, scientists have been monitoring the lift and drop in protection from asymptomatic infection and milder forms of COVID-19, dynamics that seem tightly tethered to antibodies, the molecules that can waylay viruses outside of cells. Antibodies always decline in the months after infection or vaccination, for any pathogen, Rafi Ahmed, an immunologist at Emory University, told me. But boosters can lift their levels back up, sometimes to new heights; the triply dosed are better at fending off the virus, even dueling new variants that they’ve never encountered before. (Protection against severe disease and death is less capricious, thanks to defenders such as B and T cells, which stick around long-term.) [Read: A better name for booster shots] After people’s first two mRNA shots, levels of neutralizing antibodies ticked down about five- to tenfold from their peak in about six months. Now immunologists are monitoring what happens after the third dose—where antibody levels will stabilize, and how long reaching that plateau will take. The lower it is, or the steeper the downslope, the sooner we might be asked to vaccinate again. In a nonideal scenario, we’d see something of an up-and-down “sawtooth” trend, John Moore, a vaccine expert at Cornell University, told me, with a similarly steep decay after every dose. (Some researchers are starting to wonder whether we’re seeing the beginnings of this now—and durability may differ by vaccine brand.) Then again, maybe the drop will be less pronounced, or at least more gradual, after the third shot. There’s reason to hope that might be the case. Post-boost, we pump out more antibodies than we did after the first shots; they’ll naturally take longer to dip below a protective threshold. Repeat exposures to a vaccine can also up the quality of antibodies, which get iteratively better at sniping SARS-CoV-2 down. “That means it takes way fewer of them to protect you,” Deepta Bhattacharya, an immunologist at the University of Arizona, told me. If that process keeps chugging along after the third shot, or perhaps the fourth, we might be able to get away with vaccinating much less often than we are now. The final pace of vaccination will also depend on what we want our shots to achieve. Blocking severe disease requires fewer shots; trying to suppress most infections and transmission means more. And we’ll need to set our expectations reasonably. Indefinitely preventing infections “is a bar that vaccinology, historically, has not been able to really meet,” Kizzmekia Corbett, an immunologist and COVID-vaccine developer at Harvard, told me recently. All this gets more complicated, though, if the coronavirus itself keeps metamorphosing. Solid protection against one variant might not be enough to thwart another. Already, Omicron is so heavily mutated that many of our vaccine-trained antibodies don’t recognize it very well. That puts people who are far out from their first doses in a more vulnerable spot: Their defensive walls are low, and the variant’s genetically primed to jump extra high. Our current boosters still help in this scenario—the original virus and Omicron are similar enough that, given a glut of antibodies, some will still meet their mark. But even weirder versions of the virus are almost certainly on their way. Viral switcheroos are a huge part of why we offer annual flu vaccines. Coronaviruses don’t shape-shift as swiftly, but experts such as David Martinez, a vaccinologist at the University of North Carolina at Chapel Hill, think “our policy to boost is going to be driven by how much the virus is changing.” The more variants we’re troubled by, and the more often we collide with them, the more doses we’ll need. Just as important as sussing out our need for shots is determining how many our immune systems (and psyches) can handle. At a certain point, yet another exposure to the exact same vaccine just won’t do the body’s defenses much good. Our current vaccination regimens aren’t running this risk yet. But repeatedly dosing every few months may rack up unnecessary costs. Some are logistical. The more vaccines we need, the more we’ll have to manufacture, and the more often public-health officials will have to convince communities to accept them. Side effects can keep people out of school or work, and researchers don’t yet know to what extent boosting might raise the risk of rare, serious events such as heart inflammation. Faced with an unending series of shots, some people might stop getting them, or never start the vaccine series at all. Cumbersome dosing regimens could also exacerbate vaccine inequities, as countries with fewer resources struggle to administer repeat shots. There’s good reason to wait between doses, too. A stretched-out interval can give antibodies more time to mature. Ellebedy’s team, which has been tracking this prolonged antibody coming-of-age, has found that, half a year out from the second mRNA dose, many molecules are still on their self-improvement kick. Waiting at least a few months could help ensure that the mediocre antibodies get weeded out, leaving only the best to be called into action. “If you wait to boost, the antibodies should be more durable, and peak at a higher level,” Martinez told me. And redosing prematurely, into a body still teeming with antibodies, might also mean that the molecules “wipe out the vaccine” before it can teach cells anything new, Marion Pepper, an immunologist at the University of Washington, told me. [Read: Fully vaccinated is about to mean something else] Right now, though, case rates are shattering records; people can’t afford to wait very long for immune cells to stew, or for antibodies to chill. Even super-strong immune defenses can be overwhelmed by sheer quantity of virus. The United Kingdom and Israel recently halved the dosing interval between second and third injections, from five or six months to three, so more people could shore up their defenses sooner. “The TL;DR is for everyone to get a booster now,” the University of Chicago’s Gostic told me. If cases drop to less worrisome levels in a few months, maybe most of us can take our time with dose No. 4. And someday there probably will be a fourth dose, if not more, experts told me. (Many immunocompromised people, who don’t respond well to vaccines, already need them.) We might, for instance, pivot to an Omicron-specific vaccine in a few months. If Delta’s still around in the spring, though, we’ll have to verify that Omi-vax works against both variants, especially for people who haven’t yet gotten shots. We’ll also need to prepare for the possibility of a new variant that could oust Delta, Omicron, or both. No matter what, our next dose probably shouldn’t be an exact repeat of the ones we’ve been getting, modeled on the original SARS-CoV-2’s spike. It might not be ideal for the immune system to be told, yet again, This is the version of spike to pay attention to. That spike’s pretty much defunct; such a tactic would be like asking students to study a decades-out-of-date textbook before a grueling final exam. Immune cells could, in a sense, get hung up on ideas that are no longer terribly useful. A version of this phenomenon, called imprinting, happens with flu viruses. It’s not necessarily catastrophic, but Gostic and her colleagues have recorded some instances of people’s bodies getting so distracted by old flu strains that they don’t steel themselves properly against new ones, even when given updated vaccines. But SARS-CoV-2’s biology is very different from that of flu viruses, and this new coronavirus just hasn’t been around that long. Experts think that this sort of skew is quite unlikely to dent our defenses anytime soon. Even if a few people’s bodies do get stuck on old variants because they’ve been vaccinated or infected multiple times with the same thing, there’s probably a fix, Ahmed said. Bodies might let go of their biases if we dose them a couple of times with new, unfamiliar recipes—effectively persuading them to overcome their inertia, and reinvest in the foreign matter they see. “We should definitely get boosted right now, but that’s a short-term strategy,” he told me. “Hopefully, the next boost we get matches the circulating strain.” [Read: Omicron won’t ruin your booster] Martinez agrees—and is trying to think big. His team at UNC is one of several groups chasing a universal coronavirus vaccine that might fend off a panoply of variants (and perhaps, in certain cases, some of their more distant cousins—SARS-1, MERS, and the like). That way, we’re not just “playing whack-a-mole with variants,” Martinez told me. Other researchers are feeling optimistic about nasal-spray vaccines that could tickle out airway-specific immune responses. Even if these newfangled formulations are better at kicking the virus to the curb, they won’t necessarily be panaceas. We’d still have to figure out a way to coax the body into remembering the doses long-term, and maybe stay flush with enough antibodies to keep most sickness at bay. But the hope is that they’d keep vaccine regimens trimmer and, by extension, more practical for the people running them and receiving them. Such a strategy could pay dividends: Durable vaccine protection might mean fewer infections among the inoculated, and fewer opportunities for SARS-CoV-2 to further mutate. More people might get the shots. Population immunity would grow. Our vaccines would gain an even stronger edge; they could reinforce their own success. from https://ift.tt/3FCDXb7 Check out http://natthash.tumblr.com
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You know that moment, just after you get a batch of cookies in the oven, when you take off your apron, place the mixing bowl neatly in the sink, fill it with water, and wash your hands to celebrate a job well done? Well, congratulations if you do. I’ve certainly never experienced it. As soon as I’ve formed the last reasonably sized cookie, my grubby little paws go straight for the dough that’s sticking to the side of the bowl. Does one raw cookie look runty compared with its pan-fellows? Problem solved! It’s already in my belly. Cookie dough, pancake batter, pie crust, brownie batter, bread dough, custard—you name it, I’ve eaten it raw. The CDC estimates that one in six Americans gets a foodborne disease every year. And you know what? I’m probably two or three of them. I can’t remember a time in my life before I licked the beaters clean. Tempting a stomachache for the sweet, gritty satisfaction of a licked beater has always been a game of roulette that I’m willing to play. And after spending nearly two years mapping out the consequences of every risk I take, that carefree moment when batter meets tongue feels more precious than ever. Plenty of people agree with me. In one consumer survey published earlier this year, two-thirds of those who bake with flour admitted to eating raw cookie dough. Betty Feng, the food scientist at Purdue University who led the survey, told me that her colleagues in other countries are sometimes surprised to hear about this habit. “It’s not something worldwide,” she said. [Read: The creation myth of chocolate-chip cookies] For those with strong American values, who do know the incomparable goodness of a spatula coated in cake batter or a spoonful of raw brownie, three elements are likely at play: taste, texture, and psychology. Batters and doughs tend to be sweeter than their baked counterparts, Jaime Schick, a pastry and dessert expert at Johnson & Wales University, told me. During baking, the sugar crystals dissolve into the eggs, butter, and oil that surround them, and some caramelize. That makes for a less sweet but more complex flavor when something finally comes out of the oven. Undissolved sugars also add a grittiness to raw batter that’s hard to replicate in other foods, Schick explained. If you don’t have a bowl of brownie batter on hand, just try to imagine the last time you snuck a spoonful: It’s mostly smooth, but speckled with delicious, sandy grains that might even crunch between your teeth. That right there is textural nirvana. “Contrast is really, really pleasing,” Schick said. You can find similar perfection on a larger scale in raw chocolate-chip-cookie dough, which, with your eyes closed, sort of feels like pebbles mixed into Play-Doh, in a good way. Once the cookies are baked, the chips melt, and you lose that sharp pleasure. And even without the contrast, the texture of batter and dough is exquisitely diverse: a spectrum ranging from semiliquid (brownie) to semisolid (shortbread). Its in-betweenness is “something that you don’t find in baked products or in other products,” Schick said; the nearest comparison she could think of was chocolate lava cake (arguably just a cake filled with cake batter), or the liquid center in a chocolate truffle. This taste-and-texture profile makes raw batter a treat. But the context in which people eat it distinguishes it from other indulgent foods, says Lisa Duizer, the chair of food science at the University of Guelph, in Canada. If you’ve made a recipe from scratch, scraping the bowl is “the reward at the end of the job,” she told me. Nostalgia, too, could make the practice harder to resist for people who have fond memories of parents or loved ones passing them the beaters as a kid. Also, Duizer said, it feels rebellious. “Our brain tells us that we shouldn’t be doing it. But there’s that little devil on our shoulder that says, Oh, do it anyway. It’s not going to hurt you.” The little devil is, as usual, not entirely correct. Eggs and flour can carry E. coli and salmonella. “Most people are going to get diarrhea and get over it” if they do encounter these pathogens, Cynthia Sears, an expert in foodborne illnesses at the Johns Hopkins University School of Medicine, told me. But if you’re very young, very old, pregnant, immunocompromised, or living with diabetes, the bugs pose a real risk. Even otherwise healthy people, Sears said, can occasionally develop complications beyond stomach discomfort, including reactive arthritis. Salmonella, in particular, can stick around in your gut for a long time. And if you work in a setting such as a day care or hospital, you might have to prove that you’ve cleared the infection before going back to work. Felicia Wu, a food-safety professor at Michigan State University, told me that when it comes to raw batters, she worries about a strain of E. coli, O157:H7, which can in rare cases lead to kidney disease and death. In general, she would advise people against such eating habits. Still, she sees it as a personal decision: “Each one of us knows how much benefit or pleasure we get from eating raw cookie dough,” she said. Oh, we know alright. For me, a hit of raw cookie dough might make me almost as happy as, say, going to a concert. But if I go to a concert these days, I’ll be ratcheting up the risk for myself, the other fans, and everyone I interact with after. When I scrape the side of a bowl and let the resulting dollop melt in my mouth, it’s easier to feel in control, like the risks I take are mine alone. The rules don’t change, either: Today’s raw chocolate-chip cookie dough isn’t likely to be any more or less dangerous than the peanut-butter variant I mix up next Tuesday. I don’t need to plan to eat cookie dough in June, then spend six months fretting over whether or not I will actually be able to eat it when the time comes. It’s instantaneous, a fleeting joy; there’s no time to agonize over what it means. A blink, a swallow, and it’s over. At this point, I’m starting to wonder if I have any boundaries when it comes to raw eggs and flour. Picture this: It’s November, and I’ve decided to make an Earl Grey custard pie for Friendsgiving. To make the filling, I’ve steeped the tea in milk and heavy cream, then mixed that with sugar, vanilla, cornstarch, and eggs. That’s absolutely foul, I think. Basically egg-and-bergamot soup. And then I take a sip. After all, I have a reputation to uphold. from https://ift.tt/3HnVC6S Check out http://natthash.tumblr.com “I do not see a scenario for any kind of shutdown,” New York City Mayor Bill de Blasio declared this week, as parts of New York were in fact shutting down all around him. Broadway canceled show after show. Restaurants closed their kitchens. De Blasio’s successor, Eric Adams, who will take office January 1, nixed his inauguration gala. There has been no March 2020–style universal shutdown, but New York is not back anymore, baby. For Brent Young, who runs a butcher shop and two restaurants in Brooklyn, it began last week when, one by one, staff members tested positive. “It’s more or less decimated our workforce,” he says. One of his restaurants had been booked solid with parties for a week—the holidays are one of the busiest times of the year for restaurants—but people started canceling those parties too. At this point it’s not worth trying to stay open, Young says, “because the anxiety’s so high no one’s wanting to eat.” For most vaccinated people, Omicron will be mild. But even a mild cold, sufficiently widespread, can disrupt a city. A voluntary suspension of activity—a soft lockdown, essentially—will help dampen transmission of the coronavirus. This happened all over the country in spring 2020, when people began staying at home before official stay-at-home orders came down, says Saad Omer, an epidemiologist at Yale and a co-author of a paper that studied the phenomenon using anonymized cellphone data. It’s intuitive, really. “Things become more salient; you react on that,” Omer says. This feedback loop, which conventional epidemiological models entirely ignore, can help determine the shape and duration of the Omicron wave—but exactly how is hard to predict. [Read: The liberals who can’t quit lockdown] The classic “epi curve” shows cases rising exponentially until so many people are immune that the spread of the virus has to slow. Then cases fall exponentially. But if soft lockdowns help suppress that viral spread, then cases will drop off sooner, while many people are still susceptible. In other words, “when you see a peak and see it go down, it doesn’t mean the risk has abated,” says Joshua Weitz, who studies viral dynamics at Georgia Tech. According to work by Weitz and his colleagues, this helps explain why COVID cases have peaked and plateaued multiple times over the course of the pandemic. Those peaks also tend to be asymmetrical, with steeper rises than falls. This too may be related to behavior: People might become more careful when they see an initial surge in cases but let their guard down when pandemic fatigue sets in. Just as our voluntary actions can act as a brake on rising cases, they can also slow a wave’s decline. Omicron is surging at a time when Americans are already weary of the pandemic, so this soft lockdown may not last very long. And in communities where people are very over COVID, it may not happen at all. Predicting how humans behave has been one of the biggest challenges of the pandemic. It’s easier to look at the impact of official policies that have start and end dates, like last year’s school or business closures. Now the shutdowns are much more of a patchwork, with some businesses closing and some events canceled, says Micaela Martinez, an infectious-disease ecologist at Emory University. Case trends will be hard to interpret over the next few weeks. In London, where the Omicron-fueled growth of cases already seems to be slowing, a number of factors may be at the root: behavior changes, maxed-out testing capacity, or the virus running into a wall of immunity. [Read: Omicron is the beginning of the end] Whatever the effect of a soft lockdown on the spread of Omicron, it will affect the economy too. Even if customers remain willing to go out, businesses will have to close when too many employees end up sick or get stuck in quarantine. It’s why the NHL has canceled its games through Christmas and why several museums in London have closed their doors. Shortening isolation periods in light of Omicron might help minimize these disruptions. The U.K. is now allowing sick people to test out of isolation at day seven, and the U.S. is considering a shorter period for vaccinated people with breakthrough cases. In a soft lockdown, businesses are also on their own. Last spring’s stay-at-home orders came with unemployment assistance and emergency loans. None of that is coming this time. “All of the decision making is put on the small-business owners,” Brent Young says. He’ll have to shoulder the cost of closing his businesses, and then just hope they can reopen soon. In the meantime, he says, he’s buying all the rapid tests he can. from https://ift.tt/3pr1oP1 Check out http://natthash.tumblr.com With Omicron, everything is sped up. The new variant is spreading fast and far. At a time when Delta was already sprinting around the country, Omicron not only caught up but overtook it, jumping from an estimated 13 to 73 percent of U.S. cases in a single week. We have less time to make decisions and less room to course-correct when they are wrong. Whereas we had months to prepare for Delta in the U.S., we’ve had only weeks for Omicron. Every mistake gets amplified; every consequence hits us sooner. We should have learned after living through multiple waves and multiple variants of COVID, but we haven’t, at least not enough. We keep making the same pandemic mistakes over and over again. This is not March 2020. We have masks. We have better treatments. Our immune systems are much more prepared to fight off the virus, thanks to vaccines. But as a society, we are still not prepared. Here are the six traps that we keep falling into, each consequence made all the more acute because of Omicron’s speed. We rush to dismiss it as “mild.”In February 2020, when the then-novel coronavirus still seemed far away, a reassuring statistic emerged: 82 percent of cases were mild—milder than SARS, certainly milder than Ebola. This notion would haunt our response: What’s the big deal? Worry about the flu! Since then, we’ve learned what mild in “most” people can mean when the virus spreads to infect hundreds of millions: 5.4 million dead around the world, with 800,000 in just the U.S. This coronavirus has caused far more damage than viruses that are deadlier to individuals, because it’s more transmissible. A milder but more transmissible virus can spread so aggressively that it ultimately causes more hospitalizations and deaths. Mild initial infections can also lead to persistent, debilitating symptoms, as people with long COVID have learned. The notion of a mostly mild disease became entrenched so rapidly that the experience of many long-haulers was dismissed. We’ve seen how such early concepts can lead us astray, and still the idea of Omicron as an intrinsically mild variant has already taken hold. We don’t know yet if Omicron is less virulent than Delta. We do know it’s far more transmissible in highly immune places. That’s enough for worry. We can expect Omicron cases to be milder in vaccinated people than unvaccinated. And because the variant is able to infect many vaccinated people that Delta cannot, the proportion of infected people who need to be hospitalized will look lower than Delta’s. What’s less clear is if Omicron is intrinsically any less virulent in unvaccinated people. Some early data from South Africa and the U.K. suggest that it might be, but confounding factors like previous immunity are hard to disentangle. In any case, Omicron does not appear so mild that we can dismiss the hospitalization burden of a huge wave. That burden will depend largely on how many unvaccinated and undervaccinated people Omicron reaches. The U.S. simply has too many people who are entirely unvaccinated (27 percent) and people over 65—the age group most vulnerable to COVID—who are unboosted (44 percent). In a country of 330 million, that’s tens of millions of people. Omicron will find them. Because this variant is so fast, the window for vaccinating or boosting people in time is smaller. And although vaccines remain very good at protecting against hospitalization, we make a mistake when … We treat vaccines as all-or-nothing shields against infection.When the COVID-19 vaccines first started rolling out this time last year, they were billed as near-perfect shots that could block not only severe disease, but almost all infections—absolute wonders that would bring the pandemic to a screeching halt. The stakes some prominent experts laid out seemed to be: Get vaccinated, or get infected. The summer of Delta made it clear that the options were not binary. Vaccinated people were getting infected. Their antibody levels were dropping (as they always do after vaccination), and the new variant was super transmissible and slightly immune-dodging. Infections among the vaccinated very, very rarely turned severe, and the vaccines had never been designed to stave off all infections. But every positive test among the immunized was still labeled a breakthrough, and carried a whiff of failure. Our COVID shots were never going to stop infections forever--that’s not really what any vaccines do, especially when they’re fighting swiftly shape-shifting respiratory viruses. Think of disease as a tug-of-war on a field with death and asymptomatic infection at opposite ends, and symptomatic disease and transmission in between. The vaccines are pulling in one direction, the virus in the other. A jacked vaccine can force the virus to yield ground: People who would have been seriously ill might get only an irksome cold; people who would have been laid up for a week might now feel nothing at all. When the virus shifts and gains strength, it will first make gains in the zone of infection. But it would have to pull really hard to completely usurp the stretch of field that denotes severe sickness, the vaccines’ most durable stronghold. With the highly mutated Omicron, the coronavirus has once again yanked on the line. This should prompt a heave from us in response: an additional dose of vaccine. But no number of boosts can be expected to make bodies totally impermeable to infection. That means the vaccinated, who can still carry and pass on the virus, cannot exempt themselves from the pandemic, despite what the White House has implied. None of our tools, in fact, is sufficient on its own for this situation, which makes it extra dicey when … We still try to use testing as a one-stop solution.For tests to fulfill their very essential role in the pandemic toolkit, they need to be accessible, reliable, and fast. Nearly two years into the pandemic, that’s still not an option for most people in the United States. PCR-based tests, while great at detecting the virus early on in infection, take a long time to run and deliver results. Laboratory personnel remain overstretched and underfunded, and the supply shortages they battled early on never truly disappeared. Rapid at-home tests, although more abundant now, still frequently go out of stock; when people can find them, they’re still paying exorbitant prices. The Biden administration has pledged to make more free tests available, and reimburse some of the ones people nab off shelves. But those benefits won’t kick in until after the new year, leapfrogging the holidays. And only people with private insurance will qualify for reimbursements, which are not always easy to finagle. If anything, the gross inequities in American testing are only poised to grow. Even at their best, test results offer only a snapshot in time—they just tell you if they detected the virus at the moment you swabbed your nose. And yet, days-old negatives are still being used as passports to travel and party. That left plenty of time for Delta to sneak through; with the speedy, antibody-dodging Omicron, the gaps feel even wider. It’s a particular worry now because Omicron seems to rocket up to transmissible levels on a faster timeline than its predecessors—possibly within the first couple of days after people are infected. That leaves a dangerously tight window in which to detect the virus before it has a chance to spread. Test results were never a great proxy for infectiousness; now people will need to be even more careful when acting on results. Already there have been reports of people spreading Omicron at parties, despite receiving negative test results shortly before the events. Omicron cases are growing so quickly that they’re already stressing the United States’ frayed testing infrastructure. In many parts of the country, PCR testing sites are choked with hours-long lines and won’t deliver answers in time for holiday gatherings; a negative result from a rapid antigen test, although speedier, might not hold from morning to afternoon. (Some experts are also starting to worry that certain rapid tests might not detect Omicron as well as they did its predecessors, though some others, like the very-popular BinaxNOW, will probably be just fine; the FDA, which has already identified some PCR tests that are flummoxed by the variant, is investigating.) Our testing problem is only going to get worse, even as … We pretend the virus won’t be everywhere soon.By now, this story should sound familiar: A new virus causes an outbreak in a country far away. Then cases skyrocket in Europe, then in major U.S. cities—and then in the rest of the country. Travel bans are enacted too late and, in any case, are incredibly porous, banning travel by foreigners but not Americans (as if the virus cared about passports). This is what happened with the original virus and China, and this is what has happened again now with Omicron and southern Africa. Then and now, the experience of other places should have been a warning about how fast this virus can spread. How Omicron cases will translate into hospitalizations will be harder to discern from trends abroad. Whereas everyone started from the same baseline of zero COVID immunity in early 2020, now every country—and even every state in the U.S.—has a unique mix of immunity from different vaccines, different levels of uptake, different booster schemes, or different numbers of previous infections. Americans’ current mix of immunity is not very good at heading off Omicron infections—hence the rapid rise in cases everywhere—but it should be more durable against hospitalizations. We’ll have to keep all of this in mind as we try to divine Omicron’s future in the U.S. from hospitalizations in South Africa and Europe. Could we see differences simply because a country used AstraZeneca’s vaccine, which is slightly less effective than the mRNA ones? Or boosted more of its elderly population? Or had a large previous wave of the Beta variant, which never took hold elsewhere? And some communities remain especially vulnerable to the virus for the same reasons they were in March 2020. Just like at the beginning of the pandemic … We fail to prioritize the most vulnerable groups.As Omicron tears through the U.S., it will likely repeat the inequities of the past two years. Elderly people, whose immune systems are naturally weaker, are especially reliant on the extra protection of a booster. But on top of the 44 percent who haven’t had their boosters yet, 12 percent of Americans 65 and over aren’t even “fully vaccinated” under the soon-to-be-updated definition. Boosters might not even be enough, which is why the most vulnerable elderly people—those packed into nursing homes—must be surrounded by a shield of immunity. But Joe Biden’s vaccine mandate for nursing-home staff has faced legal opposition, and almost a quarter of such workers still aren’t vaccinated, let alone boosted. Even if they all got their first shots today, Omicron is spreading faster than their immune defenses could conceivably accrue. Without other defenses, including better ventilation, masking for both staff and visitors, and rapid testing (but … see above), nursing homes will become grim hot spots, as they were in the early pandemic and the first Delta surge. Working-class Americans are vulnerable too. In the pandemic’s first year, they were five times as likely to die of COVID-19 as college-educated people. Working-age people of color were hit even harder: 89 percent fewer would have lost their lives if they’d had the same COVID death rates as white college graduates. These galling disparities will likely recur, because the U.S. has done little to address their root causes. The White House has stressed that “we know how to protect people and we have the tools to do it,” but although America might have said tools, many Americans do not. Airborne viruses are simply more likely to infect people who live in crowded homes, or have jobs that don’t allow them to work remotely. Making vaccines “available at convenient locations and for no cost,” as the White House said it has done, doesn’t account for the time it takes to book and attend an appointment or recover from side effects, and the 53 million Americans—44 percent of the workforce—who are paid low wages, at an hourly median of $10, can ill-afford to take that time off. Nor can they afford to wait in long testing lines or to blow through rapid tests at $25 a pair. Making said tests reimbursable is little help to those who can’t pay out of pocket, or to the millions who lack health insurance altogether. Once infected, low-income people are also less likely to have places in which to isolate, or paid sick leave that would let them miss work. To make it feasible for vulnerable people to protect those around them, New York City is providing several free services for people with COVID, including hotel rooms, meal deliveries, and medical check-ins. But neither the Trump nor Biden administration pushed such social solutions, focusing instead on biomedical countermeasures such as therapeutics and vaccines that, to reiterate, cannot exempt people from the pandemic’s collective problem. Unsurprisingly, people with low incomes, food insecurity, eviction risk, and jobs in grocery stores and agricultural settings are overrepresented among the unvaccinated. The vaccine inequities of the summer will become the booster inequities of the winter, as the most privileged Americans once again have the easiest access to life-saving shots, while the more vulnerable ones are left to keep the economy running. Ultimately, the weight of all these failures will come to rest on the hospital system and the people who work in it, because, even now … We let health-care workers bear the pandemic’s brunt.Health-care workers have been described as the pandemic’s front line, but the metaphor is inexact. Hospitals are really the rear guard, tasked with healing people who were failed by means of prevention. And America’s continuing laxity around prevention has repeatedly forced its health-care workers to take the brunt of each pandemic surge. Delta was already on its second go at sending hospitalizations climbing. Omicron, with its extreme transmissibility, could accelerate that rise. If so, many of the trends from the early pandemic will likely recur at rapid speed. Omicron’s global spread could cause shortages of vital equipment. Hospitals will struggle to recruit enough staff, and rural hospitals especially so. (Biden’s plan to send 1,000 military personnel to hospitals might help, but most of them won’t be deployed until January.) Nonessential surgeries will be deferred, and many patients will come in sicker after the surge is over, creating crushing catch-up workloads for already tired health-care workers. Many Americans have mistakenly assumed that the health-care system recovers in the lulls between surges. In truth, that system has continually eroded. Droves of nurses, doctors, respiratory therapists, lab technicians, and other health-care workers have quit, leaving even more work for those left behind. COVID patients are struggling to get care, but so are patients of all kinds. In this specific way, the U.S. is in a worse state than in March 2020. As the doctors Megan Ranney and Joseph Sakran wrote, “We are on the verge of a collapse that will leave us unable to provide even a basic standard of care.” Being overwhelmed is no longer an acute condition that American hospitals might conceivably experience, but a chronic state into which it is now locked. Omicron is dangerous not just in itself, but also because it adds to the damage done by all the previous variants—and at speed. And the U.S. has consistently underestimated the cumulative toll of the pandemic, lowering its guard at the first hint of calm instead of using those moments to prepare for the future. That is why it keeps making the same mistakes. American immune systems are holding on to their memories for dear life, but American minds seem bent on forgetting the past years’ lessons. from https://ift.tt/3JeB2Yn Check out http://natthash.tumblr.com “MARIA MADE A LIST of things she would never do. She would never: walk through the Sands or Caesar’s alone after midnight. She would never: ball at a party, do S-M unless she wanted to, borrow furs from Abe Lipsey, deal. She would never: carry a Yorkshire in Beverly Hills.” I came across Play It as It Lays in my high-school library when I was 16, and I cut two or possibly three classes to read it. God, I hated high school. I wanted to read, but they wanted me to sit at a desk and talk about “side, angle, side.” I found Joan Didion’s novel electric, bleak, ravishing. More than that: essential. There I was, on the cusp of womanhood, of being a sexual creature—and in the nick of time, I had stumbled across this invaluable guidebook. In the girls’ magazines, all you ever read about was “boys who only wanted one thing” and how you should be grateful for strict parents, because imagine what would happen to you if they didn’t care enough to give you a curfew? But Play It as It Lays introduced me to what were obviously the real perils, the important ones that the adults were keeping from us. Bad, terrible, unspeakable things that I’d never even considered. Balling at parties! S-M! Yorkshire terriers! I can remember whole passages from the book, but more than anything that series of she-would-nevers. Over the years, I have come up with my own list, as square and tame as I am: Caitlin would never call a boy unless he had called her first. She would never change into or out of a bathing suit in a communal dressing room. She would never watch Star Wars or any of its sequels, cut a dinner roll with a knife, become an alcoholic. And, for the past 20 years, the list would include one extremely important never: Caitlin would never write in detail about the painful, unacceptable things that she has had to endure in two decades of cancer treatment. At the time of my diagnosis, I was just beginning my career as a writer, and for some reason I thought no one would ever hire me if they knew I was sick. I was also superstitious, and felt that writing about the disease during a period of remission was tempting the gods. Plus there was the problem of sadists: Letting personal information like that out into the world gives cruel people a loaded gun. Lately, though, I’ve begun to see that no matter how much I have tried to pretend that cancer is an aberration in my life, an interruption after which life will return to normal, it never has and it never will. When I turned 60 last month, I had a sorrowful realization, one that might have come sooner if I’d spent more time plowing the cold fields of “side, angle, side” and its attendant concerns. I realized that I’d had cancer for a third of my life. It never went away, it’s never going away, and I will be on chemotherapy for as long as I live. [Caitlin Flanagan: I’ll tell you the secret of cancer] It’s bracing to face those truths, but I rarely spend much time dwelling on them, because I’ve known—and known of—so many women who have died of breast cancer. I had the strange good luck of getting diagnosed with what was once a particularly dangerous strain of the disease at the moment that scientists were beginning to break its code. So long as I keep my mind on that fact, I’m okay. But a few weeks ago something happened that finally broke my spirit. For the first time in this endless war, I felt like deserting. What happened is I lost some teeth. It was a shocking event, one that had nothing to do with a cancer recurrence or with my overall health; it was just far downstream from some of the endless treatments I’ve had over 20 years, a side effect I’d never considered. I was finally ready to give up. Game, set, match: cancer. This is the horrible part of the essay where I have to give you some dental information. Believe me, I tried to keep it out, but the story doesn’t add up without it. Decades ago, when the world and I were young, I had to get a dental bridge. Basically that’s what they give you if you have a missing or—in my case—funky tooth. It’s sort of a fake tooth anchored to the two teeth on either side of it. Let’s skip why I needed it. (No, full disclosure! Exposure dream! The reason I needed the bridge was that the middle tooth was a baby tooth. There was a time when I thought that was an adorable little fact about me, although now I realize it’s just more evidence that I have lived my life in a Ford Pinto of a body. Nothing has ever worked right.) Back to our story, already in progress. Over the summer, I had a pain underneath my bridge. That can’t be good, I thought. It wasn’t just that it suggested some nasty procedure; it was also that for many years I’ve been on a powerful drug called Zometa, which has a rare but ghastly side effect: It can lead to a hideous thing called osteonecrosis of the jaw—so you have to take excellent care of your teeth. Thankfully, it turned out I did not have osteonecrosis of the jaw, or anything like it. I had a cavity. The dentist took an X-ray and said she would just need to remove the bridge, fill the cavity, and then make a new bridge. This sounded straightforward enough, but I delayed doing it for a couple of months because my husband and I immediately set to work creating some new material on the subject of “on-plan dentists” versus “off-plan dentists.” He wanted an on-plan dentist to curb the cost, and I wanted a dentist who had nitrous oxide so that I could open the doors of perception. In the end we compromised, and I went to an off-plan dentist without nitrous oxide. By the time I was finally in the chair, not only did the tooth really hurt, but it was also the most absurd time to have a dental procedure. We were moving to a different city—just an hour away, but still a move--that very day. The assistant clipped on the little drool bib; the nice, young dentist gave me a shot of novocaine; and we were off to the races. At first, a lucky break: The bridge came off easily. The dentist started drilling and I started listening to a friend’s podcast. It was nice to feel that she was there with me. But then something strange happened: I got all the way to the end of the podcast, but the drilling continued. We kept having to stop for more novocaine. I listened to another episode and got to the end of that one too. More novocaine. The appointment seemed to be taking a really long time. Finally, in the words of the very long note the dentist wrote in my file, which I had to later take around town, showing it to different experts, she “sat patient up and told her it was hopeless.” Hopeless? There was a big television on the wall, which had previously shown a calming image of bamboo shoots beside a babbling stream. That image came down and was replaced by an enormous photograph of the place in my mouth where my teeth should have been. The middle tooth was gone, the one to the left of it was a small stump, and the one to the right wasn’t any bigger. There’s a reason that dreams about losing teeth are so common; I felt that some elemental part of me, something I couldn’t live without, was gone. The dentist put a temporary bridge on my teeth and scheduled another appointment with an expert. My son came to pick me up, and I did what I always do when my kids collide headfirst with my health problems: I joked around and assured him that everything was going to be fine. But I was out of my mind with shock. It took forever to fill my prescription for pain medication, and as we drove and the novocaine wore off, I felt I was in a frantic race against some terrible kind of suffering. (Though in the end I didn’t need the pain meds at all. My teeth hurt less than they had before the drilling.) At last I got to the new house. The moving truck had just arrived and all I wanted to do was lie down and weep, but there weren’t any beds yet. I didn’t know anyone in the neighborhood, and I was in no condition to go to a coffee shop. It felt like the whole family was moving into an exciting new chapter—one that had been my idea—but I was being left behind. I holed up in my empty bedroom and began calling the group—the women who have been with me this whole, long experience. Everyone was extremely sympathetic, but none of them seemed alarmed. This had nothing directly to do with cancer, and my life wasn’t in any danger. These are people who get in cars and book flights whenever bad cancer news arrives; my older sister just teleports into my kitchen before I’ve even picked up the phone to call her. Nothing I said could convince them that this was more than a setback. What people don’t realize is that all of the treatments I’ve been through these 20 years have added and added and added up. It’s as though each one is a porcelain cup, and each of those cups has been stacked one on top of another. One more piece of bad news could bring them crashing down. The teeth hadn’t broken my spirit; it was all of the things that had come before. The surgeries and the radiation and the gallons—literal gallons—of chemotherapy that have been poured into me, and all of the vomiting that came with it. (Had stomach acid gotten under the bridge and eroded my teeth? That was the horrible supposition of one of the doctors I saw.) It was crossing the Styx: from Stage 3 to Stage 4, and watching the boat return to the other shore without me. It was finding out that I would be on chemotherapy for the rest of my life. It was the ports that brought powerful drugs straight to the vein to my heart; the uncountable hours I’ve sat in chairs hooked up to machines; the waiting for blood counts, scan results, biopsies, bronchoscopies. It was finding out that there was cancer in my spine and in my lungs and in my liver. It was losing my hair—twice. It was all of the times—50? Could it be 100?—that my body has slid slowly in and then out of PET/CT scans while I’ve lain flat, with my arms raised above my head in a posture of pure surrender. It was all of that and more. And on top of that—my teeth? No. My oncologist sent me to one of the foremost authorities on my weird situation, a doctor who works at the UCLA School of Dentistry and who has an M.D., a D.D.S., a Ph.D., and a long list of publications. I drove from Pasadena to Westwood, the kind of overland passage described by the early settlers, and I wasn’t myself. Now I understand stories that start with things like “I saw her that afternoon! She seemed perfectly fine!” It wasn’t that I was suicidal. But I wasn’t right, and my thoughts were dark. All of the garages were full, so I just drove brazenly into a parking lot marked with signs saying no one could park there unless they had some very rare, very particular kind of permit. My only concern was that someone would stop me from getting out of the car, but no one did. What was the worst that could happen? I’d get a ticket? The car would get towed? I was at high altitude and dropping ballast. I could do without the car. I was led to an exam room, and the very expert person walked in. Never have I been given the facts of a medical situation so succinctly, so definitively, and so dispassionately. I felt as though we were colleagues looking down at an anesthetized patient. She said: My dentist would need to make a four-tooth bridge instead of a three-tooth bridge, but it might not work, because these are notoriously problematic. I could have had one of the bad teeth extracted, which for some reason would have been helpful, but extraction was too dangerous because of the Zometa. And then she said the thing that brought the tower of porcelain cups crashing down: If the bridge didn’t work, I would have two crowns with a two-tooth gap in between. I sat quietly waiting to hear what was going to replace the teeth, but she wasn’t saying anything so I nudged her helpfully along—implants? No, no—I could never have implants, because of the Zometa. “But what about the space?” I asked, mystified. Well, she said, maybe your dentist could make you a plate with two teeth on it. [Caitlin Flanagan: Tell children the truth] Many years ago, I had a terrible habit of wasting my valuable time with doctors by getting overwhelmed, by crying, by needing to be comforted. Doctors are busy; doctors expect you to do your part and behave like a normal patient. Cry too much and you’re a problem, and there’s another downside: If they see you’re someone who can’t handle bad news, they won’t talk as freely with you as they might. They will still tell you the truth, but they won’t elaborate. If you can handle your shit—and I can—they’ll let you know what they’re thinking before the test result arrives. So with the expert dentist I carefully continued behaving like a normal patient, without giving any cues that I was slipping past her, that part of me wasn’t in the room anymore. I tried to look like someone who would willingly go through life with two teeth on a dental plate. I am not that person. The dark thoughts got darker. When I got outside, the car was still there, with no ticket, and let that be a lesson about the randomness of the universe. No one can tell you why you got cancer or why your teeth fell out or why the eagle-eyed parking patrol of UCLA didn’t notice that you’d parked in the most conspicuously forbidden spot on campus. There’s no underlying pattern. I am not a person who would ever do anything drastic or horrible to her family. Caitlin would never: commit suicide. Caitlin would never: leave a mess. But I was in a state of extreme distress, and for the first time in my life, I wasn’t able to explain myself to people. No one really understood the extent of my emotional crisis. Somehow I needed to register to myself that what was happening was unacceptable and would not be tolerated. Someone needed to stand up on my behalf, someone needed to tell me that all of this was really beyond the pale, and there was no one but me to do it. I had not touched the pain meds—Tylenol had done the trick. But now I took out the bottle and opened it. All of America—scarred by the opioid epidemic and by all of the people who have started with one pill and ended up dead—screamed, “Don’t do it, Caitlin!” but I didn’t look up from the child-proof cap. I swallowed one pill with a cup of water, lay down on my bed, and waited for it to take effect, wondering if it would have an answer to my problems. It didn’t have the answers, because it obliterated the problems. It produced the kind of warm, dreamy euphoria that can never be described in words. Even now I don’t really remember how I felt, only that at last everything was all right. After 20 years of hideous drugs, I was finally taking one for no other reason than the pleasure it might offer me. What was the worst thing that could happen? I would immediately become dependent on them, accidentally overdose, and die? For some reason, I was confident that it wouldn’t happen. It wasn’t until six hours later, after I’d taken the second pill, that I realized why. It’s because I am violently, wildly, incredibly intolerant of opioid medications. The first dose had been small enough to push my boat out from shore a little bit, but the second one brought on the storm. I threw up all night, and scared myself enough to throw out all the pills the next morning, which I did by following the directions on the CDC website: to mix them into a bag of used coffee grounds or kitty litter, both of which are never in short supply at my house. For extra punishment, I used the kitty litter and created a concoction so loathsome that I felt the bile rising again. Then I stuck the barf bomb in the bottom of the trash. And with that, I came to my senses, and my mood downgraded from despair to depression. A couple of teary weeks went by, and soon enough, it was time for a Christmas tree. Somehow the rest of the household understood that they should go out and get it and bring the ornaments up from the garage and put up the outside lights. I still felt very raw and desperate, but now the men in the house had picked up on the fact that I was really struggling, and they began to look after me. We regressed into watching The Great British Bake Off after dinner, and it was nice to sit in the new kitchen—all my life I’ve wanted a kitchen with a couch and a television, and now I have one—with the family, shit-talking Paul Hollywood and taking a personal, almost tender interest in each of the bakers. Every night, when one of them was eliminated, we would shout, “No!” and it would seem impossible to imagine the show continuing without that person, but by the next night, we couldn’t even remember who had left. The program moved steadily forward, and whatever space the missing person had left was more than filled by the people who were still there. And let that be a lesson too. [Caitlin Flanagan: The day I got old] Watching those episodes, in the warmth of the kitchen, I couldn’t deny that everyone in the room would love me just as much if I didn’t have a tooth in my head. For the past few years, I’ve wondered why I keep doing all of these crazy treatments now that my children are grown. But I realized that I’m still a necessary person, and what’s necessary is not screwing up their good lives with any drama or anguish. Since I started writing about cancer, I’ve heard from many people who lost their mothers to the disease when they were in their late teens or their 20s, and how much they grieve for them and for how long. It’s not right for me to complain and give up hope when I’m the one to whom the random universe has given the miraculous treatments. The four-tooth bridge has arrived at the dentist’s office, and after the holidays I’ll go for the appointment to see if it will work. And I found out—get this—that it wasn’t necessarily cancer treatment that caused the problem. Apparently teeth under bridges go bad all the time, for all kinds of reasons. Not only that, but as I talked about my situation with more women my age, it turned out people were losing teeth left and right. One friend had a front tooth fall out of her mouth when she was eating dinner. Apparently, incredibly, I’ve been alive so long that I’m getting old. Look at me over here, “aging.” I’m okay, fine—I’m good. The house is nice and I love my new town, and I finally remembered to get the poinsettias early, before they’re all sold out, and my husband went with me and we filled the back seat of his car with them. But still, so much has happened to me, and now those teeth are gone. And ever since that morning at the dentist’s office, two lines of poetry have been with me almost every day. They’re the last lines of a Robert Frost poem, “The Oven Bird”: The question that he frames in all but words Is what to make of a diminished thing. from https://ift.tt/3EphoFJ Check out http://natthash.tumblr.com You’ve probably seen the shoplifting stories, if only because there are a lot of them. On local news and in national publications, they paint a shocking picture: Across the United States, retail stores are fighting a war against large, violent, highly organized criminal gangs. The attacks are common, and they’re escalating in severity. Thieves smash windows at luxury clothing stores, go full-on Supermarket Sweep in the aisles of drugstores, and sell their wares undetected on Amazon or eBay or Facebook Marketplace. In the process, they’re endangering people’s lives and sapping corporate profits. The stores are losing the war. According to the retail executives, industry advocacy groups, and law-enforcement officers who have described their failing battles against these attacks, the problem has been building for years, but a spate of recent changes in laws and attitudes has threatened to tip American shopping into chaos: Felony-theft laws, they say, are now too permissive. Bail reform means that thieves are roaming the streets before they stand trial. Internet platforms where criminals profit are indifferent to pleas to shut down illegal storefronts. Employees don’t feel safe in stores, and understaffing makes theft even easier. To stabilize their businesses and make their communities safe, these executives, advocates, and officers say, they need different changes in both local and federal law. The incidents these stories use to illustrate the problem are genuine mayhem: At a Bay Area Nordstrom, police say, as many as 80 thieves executed a coordinated attack on the store. At another Nordstrom, this one in Southern California, thieves were caught on video assaulting workers with bear spray. At a Louis Vuitton boutique in an Illinois mall, more than a dozen robbers overwhelmed sales clerks and made off with $120,000 in loot. Before dawn on a November day in New York City, thieves used a hammer to smash their way into a closed Givenchy boutique and left with $80,000 in designer duds. But wait. Are we still talking about shoplifting? No, we’re not. Recent news stories describe a shoplifting surge, but this narrative conflates an array of very different offenses into a single crime wave said to be cresting right now, all over the country, in a frenzy of naked avarice and shocking violence. Smash-and-grabs are awful, but they’re pretty rare (and already very much felonies). Nevertheless, a handful of viral videos and some troubling statistics from retailers and industry groups have set Americans on edge during the year’s most economically essential shopping season, wondering if the mall where they buy their Christmas presents might be next. The deeper you search for real, objective evidence of an accelerating retail crime wave, the more difficult it is to be sure that you know anything at all. To determine what, if anything, is up with shoplifting in America, we have to answer two questions: Is theft really more common than it was in the recent past, and is current theft really more severe or harmful? You would think that answers to both of these questions would be readily available, if only because the topic has been discussed so much, but the reality of the situation is not quite so clear-cut. The first indicator that the theft-wave narrative may not hold water is that stories about it tend to garble terms and numbers. They pair broad statistics about the commonness of shoplifting or larceny of any kind with lurid descriptions of brazen armed robberies (which aren’t included in any shoplifting stats, because they are a different crime entirely) to illustrate a narrowly defined problem: organized retail crime. This is identified as repetitive, mostly nonconfrontational theft for profit, whose perpetrators strive to evade detection and keep each theft strategically below local dollar thresholds for felony larceny. Misdemeanors don’t attract law-enforcement attention, the theory goes, so criminals are able to strike again and again and flip their hauls to fences, who consolidate millions of dollars of stolen goods into inventory for online storefronts, where Amazon and Etsy and eBay shield them from detection and punishment. Whether any of these offenses—simple shoplifting, organized theft, or violent smash-and-grabs—are actually happening more frequently overall is, at best, ambiguous. If we look closely at crime statistics in San Francisco, which news stories paint as the epicenter of this crime wave and whose crime stats are often used to illustrate these stories, the idea doesn’t seem immediately ridiculous. Robberies, which is where smash-and-grabs generally fall, are slightly down citywide from 2020, according to the San Francisco Police Department, but larceny theft, which is where shoplifting would fall, is indeed up more than 19 percent. In the city’s central district, where expensive fashion boutiques and other kinds of retail outlets are clustered together, larceny theft was up 88 percent from 2020 as of early December, when CNN used the number to demonstrate the dire nature of San Francisco’s crime problem. You’ve gotta admit, that’s a worrying number. Except, as you might remember, 2020 was kind of a weird year—people stayed home and many stores were closed for months at a time, which helped make the year’s crime statistics, to put it mildly, unique. In San Francisco, the murder rate was (and still is) up, but recorded larceny thefts were way, way down compared with 2019. Robberies were also down by almost a quarter. This year, the 88 percent increase in the central district’s larceny reports is still not enough to bring the area’s theft rate back up to pre-pandemic levels, which themselves had been dropping for decades. So far, this dynamic holds true for much of the country, according to FBI statistics. In 2020, the most recent year for which data are available, reports of robbery and larceny fell off a cliff. If we see a big jump in the near future, especially in violent smash-and-grabs, it’s worth asking how much the recent media attention itself contributed to the spike. Research has shown that sensational news coverage can influence potential offenders to adopt highly publicized tactics in copycat crimes. Retail theft, organized or not, affects some kinds of stores more than others. Big-box stores, discount stores, and drugstores—which tend to be thinly staffed and stock lots of small, easy-to-steal, easy-to-flip products—experience more losses from sales-floor theft than, say, furniture stores do, and it makes sense that those types of retailers would be particularly outspoken about it. Questioning how much things have really changed doesn’t mean denying that a problem exists. If you’ve worked on a big-box sales floor, as I have, then you know that people attempting to steal large quantities of stuff that they probably intend to resell never has been particularly rare. The question is whether the way the problem is now being talked about matches reality. When I asked retailers how they squared falling property-crime rates with their own assertions that theft has skyrocketed, they weren’t exactly forthcoming. A spokesperson for Walgreens, which announced over the summer that it was closing some San Francisco locations because of high theft rates—a claim that has prompted skepticism in local media—declined to discuss the topic with me in any specifics. A spokesperson for CVS Health, which has been vociferous about organized theft and the need for new laws, told me that shoplifting has increased 300 percent in its stores since the beginning of the pandemic, and that the increase isn’t reflected in police data, because police were less responsive to reports of property crime when criminal courts were closed. The company would not say what that change represents in absolute numbers, elaborate on its theft-tracking methodology, or explain whether the rate has fluctuated significantly in the nearly two-year period since the pandemic began. As with San Francisco’s shopping-district larceny jump, a change of 300 percent is alarming at face value, as are other rates of change commonly cited in media reports on shoplifting. For example, a survey conducted in early 2020 by the National Retail Federation (NRF), a trade association and advocacy group, found that of surveyed retailers that reported being victims of organized retail crime, three-quarters said that the crime had increased in their stores at least slightly in the previous 12 months. But according to Anita Lavorgna, a criminologist at the University of Southampton, in England, who specializes in organized crime, those numbers are not especially meaningful if we do not know what data are being compared or the methodology that produced them. Without more transparency, accounting for all of the variables that could have affected the results is hard. If store managers receive the message from corporate that documenting theft is of the utmost importance, for instance, one could easily imagine a spike in reported incidents of theft much more significant than any actual spike in theft itself. (The NRF surveys dozens of retailers, but it does not disclose which retailers participate in its surveys, which makes checking its work impossible for third parties.) This type of fuzzy data is a common problem, Lavorgna told me. Another common problem is one of semantics: She’s not convinced that, from a criminological perspective, the “organized” label fits much of the theft that these retailers are describing. There’s just not much empirical evidence that flipping stolen makeup or baby formula or designer handbags online is primarily the province of huge, violent criminal-conspiracy organizations, she said. Meanwhile, certain states with specific statutes about organized theft define the act so broadly that it loses its usual meaning. In some places, two or more people conspiring together to steal anything a store might carry meets the legal definition of organized retail crime. Just because a type of offense isn’t organized crime doesn’t mean it isn’t serious or worth trying to stop, Lavorgna was careful to stipulate. But, she said, people or organizations that want to elicit fear in service of some goal—harsher laws, greater surveillance capabilities, access to increased funding—tend to stretch the “organized” label to fit all kinds of group crimes. This can create a gap between the scale of a problem and the scale or severity of the measures adopted to address it, according to Lavorgna’s research—a sign of a moral panic. In the U.S., states are already responding to widespread concern: Many have either already created organized-retail-crime task forces or are in the process of doing so. In California, Governor Gavin Newsome has proposed $255 million in additional law-enforcement funding to address retail theft. The INFORM Consumers Act, which would require online marketplaces to verify state-issued IDs for millions of sellers, has bipartisan support in Congress. Large brick-and-mortar retailers stand to benefit greatly from these measures, which encourage people to see even the pettiest property crime as a mortal sin, allocate public funding to help companies shore up their inventory issues, and weaken the competitive advantage of large-scale online-shopping platforms, whose success is a much larger existential threat to their bottom line than thieves could ever be. If you’ve made it this far and still feel unsure whether you understand how big of a problem “organized” retail theft is, well, take a number. Trying to quantify it means wading through a morass of slippery terms, questionably reliable estimates, and statistical sleights of hand. When you make it to the other side, you find a significant discrepancy between the enormity of organized retail crime as described by the retail industry and the actual dollar losses it attribute to the problem. Consider “shrink.” That’s the term retailers use to describe inventory losses from any cause—shoplifting, sloppy checkout practices, shipping errors, warehouse mistakes, or simple misplacement—usually expressed as a percentage of total sales. It can be very difficult for stores to determine how any particular piece of inventory was lost, so they are forced to estimate how much different kinds of losses contribute to their bottom line. In both 2019 and 2020, annual surveys of NRF members pegged the industry’s average overall shrink rate at 1.6 percent—for every $100 in sales, an average of $1.60 in inventory was lost. The NRF’s estimate of how much organized retail crime contributes to shrink is $700,000 for every $1 billion in sales, or $0.07 for every $100. Even by the estimates of groups lobbying lawmakers and the public to take the problem seriously, these types of crimes account for a tiny proportion of overall losses, on average. Paperwork errors and self-checkout machines are both far graver threats to inventory management. Consider, too, that organized retail crime and organized retail theft do not refer to the same phenomenon, even though they are sometimes used interchangeably. Theft of goods from sales floors is only one part of that seven cents of shrink. Returns fraud, gift-card schemes, and cargo theft are all also significant factors, but they’re rarely discussed in news reports about criminal threats to businesses. The stories just aren’t as good—there are no terrifying viral videos of people entering Home Depot, picking up a brand new drill, walking it up to customer service, and returning the unbought drill for store credit, which is then sold for half of its cash value on Craigslist. The CVS Health spokesperson I talked with argued that the company’s alarming shoplifting statistics during the pandemic failed to match police data because the cops themselves were showing up less to document theft. There is likely some truth to that theory. Read Hayes, the founder of the Loss Prevention Research Council, which conducts research on behalf of retail-industry clients, says that retirement and turnover trends in local police forces have led to fewer patrol officers available to respond to reports of petty crimes, which in turn has made retail workers less likely to bother reporting low-level offenses to the police. Hayes sees shoplifting and organized retail crime as big threats to the industry, but according to Jay Kennedy, a criminologist at Michigan State University, police declining to get involved in low-level offenses doesn’t necessarily signal a crisis. Kennedy echoed Hayes’s explanation for the sometimes scant police response to small thefts, but told me that his research has found that people tend to be fine with police and prosecutors prioritizing more serious or violent crimes over petty offenses. Where to draw the line between a misdemeanor and a felony has become central to how shoplifting is discussed, thanks in large part to the advocacy of the retail industry itself. The NRF, for example, blames states’ increases in the felony-theft threshold—the value of goods that must be stolen in order to charge a thief with a more serious crime—for stores’ increased losses, and argues that the thresholds should be brought back down to combat theft. Kennedy doesn’t buy it. Increasing penalties for lesser offenses “would make some people feel comfortable and happy, but in reality it’s not going to have any substantial impact on the crimes,” he said. “It doesn’t hold up empirically, and it just doesn’t hold up practically.” This is War on Drugs logic, and it hasn’t panned out there either. Indeed, research on dozens of states that have increased their felony-theft thresholds since 2001 suggests that doing so presents no threat to public safety. And felony thresholds don’t map neatly onto how liberal a state’s government tends to be, or how “progressive” its prosecutors are. Even after loosening its law, California’s $950 minimum is still more conservative than most other states’. South Carolina and Texas, by comparison, set theirs at $2,000 and $2,500, respectively, but as far as I can tell, they are not being widely accused of legalizing theft. This year, when the NRF asked the retailers in its survey which problems had become more of a priority for them in the past five years, organized retail crime wasn’t the most popular answer. It was in-store violence, specifically shootings. Retail stores are the site of a tremendous amount of violence in American life, and have been for a long time. When I worked at Best Buy in the late 2000s, there was plenty of shoplifting, both recreational and professional, but the incidents I remember most vividly had nothing to do with theft. They involved people putting their hands on me or my co-workers, or, in one case, trying to run over one of us in the parking lot. The situation has deteriorated since then. At their most extreme, malls, grocery stores, and big-box stores have been the scene of scores of mass shootings in the past two decades, including atrocities such as the 2019 Walmart shooting in El Paso, Texas, that left 23 people dead. More recently—and far more commonly—retail workers and sometimes patrons have had to put up with a wave of assaults during the pandemic, including a number of murders. Many of these attacks have been provoked by simple safety protocols, and this violence, combined with the industry’s low pay, has helped make retail-job openings particularly difficult to fill this year. Understaffed stores can invite more theft, as can stores where existing employees hate their job. How many people who make $12 an hour to get screamed at by strangers for 31 hours a week (any more and the company would have to give them health insurance) are going to interrupt someone dumping bottles of shampoo into a garbage bag so that they can save their corporate overlords a rounding error’s worth of losses? Is it worth finding out if that guy has a gun? If we’re concerned with the types of crime that destroy lives and businesses, endanger retail workers on the job, and discourage people from going out to enjoy themselves, then shoplifting is the wrong crime to focus on. The problem is violence, which frequently has nothing to do with shoplifting at all. But shoplifting is an easier conversation for the retail industry to have, and one that plenty of people—journalists included—are keen to get in on. It’s a thousand other zeitgeisty arguments in one: about the role of police and prison in society, about the efficacy of tough-on-crime politicians or “Defund the police” as a slogan, about how serious property crime is relative to other types of harm, about whether liberal local governments are actually inept, about why there’s so much open human misery on the streets of San Francisco. Good old thieves, that is to say, are a palatable common enemy. Better to fear them than the other types of casual violence that have seeped into everyday life in America, and the rot that may have created it. from https://ift.tt/3JozWcW Check out http://natthash.tumblr.com Just a few minutes before tip-off on Wednesday, March 11, 2020, the PA announcer for the Oklahoma City Thunder broke the news to the gathered fans: That night’s NBA game between the Thunder and the visiting Utah Jazz was canceled “due to unforeseen circumstances.” A Jazz player, it would soon come out, had tested positive for the novel coronavirus. “You are all safe,” the announcer assured the apprehensive crowd. “Take your time leaving the arena tonight and do so in an orderly fashion.” Twenty minutes later, the NBA suspended its season, and a classic form of American escapism became an unwitting emissary of a reality Americans could no longer escape. By the weekend, the president had declared a national state of emergency. Twenty-one months later, here we go again: Once more, COVID chaos has descended upon the world of sports. And once more, sports leagues are foreshadowing our pandemic future. In just the past two weeks, hundreds of professional athletes in the NFL, NBA, NHL, and English Premier League have tested positive for the virus. Outbreaks have left some teams with so few healthy players that they’ve been unable to take the field (or court, or ice). Dozens of games have been postponed. Of the 10 Premier League matches scheduled for this past weekend, only four were played. At times the situation has verged on farce. Today the NFL’s Cleveland Browns suited up for their game against the Las Vegas Raiders without their starting quarterback, backup quarterback, or head coach. A cornerback for the Cincinnati Bengals has been added to the league’s COVID list twice in the space of five weeks. With nearly half their roster subject to the NBA’s COVID protocols, the Brooklyn Nets found themselves in such dire straits that they recalled exiled all-star Kyrie Irving, who has been sitting the season out—and forgoing nearly half his $35 million salary—because he refuses to comply with New York City’s vaccine mandate. The team announced Irving’s return as a part-time player on Friday … only only to lose him to COVID protocols the next day. What makes these outbreaks all the more worrisome is that they’re tearing through some of the healthiest, most closely monitored, and most highly vaccinated communities in the country, if not the world. The NHL has a vaccination rate north of 99 percent; the NBA’s stands at 97 percent; and the NFL trails just behind, at a little less than 95 percent vaccinated. With all that immunity, seasonal patterns alone are unlikely to explain the recent outbreaks, Nita Bharti, an epidemiologist at Penn State University, told me: “It has to be some element of immune escape, which gives us Omicron.” [Read: Our first preview of how vaccines will fare against Omicron] The nonstop news alerts about infected stars and delayed games can give the impression that sports are uniquely COVID-afflicted. And it’s true, Bharti told me, that athletes’ jobs—with all the travel and physical contact and packed arenas—may entail greater-than-usual exposure to the virus. But it’s also true, she said, that players are tested far more often than the average American. The NFL tests vaccinated players weekly and unvaccinated players daily. The NHL has required even more frequent tests for the vaccinated: at least one every 72 hours for much of the season, and one per day as of Sunday. Meanwhile, testing for people who aren’t professional athletes in the U.S. remains slow, expensive, and hard to access. Because of their strict testing regimens, the leagues are detecting asymptomatic cases that would almost certainly go undiagnosed in the general population. So too are universities, many of which have similarly high vaccination rates and similarly frequent testing; last week, Cornell shut down its main campus after more than 900 students tested positive in the space of a week. Brian Wasik, a virologist there, told me that both campuses and sports leagues serve as an “early-warning system for trends that may hit at population levels.” If so, the message is not good. America’s population at large is older, less healthy, and less vaccinated than professional athletes, and the virus is unlikely to spare us as it has them. “The fact that we’re still seeing transmission means that it’s moving even faster than we’re testing,” Samuel Scarpino, a network scientist at the Rockefeller Foundation’s Pandemic Prevention Institute, told me. “That should be a real warning to the broader population about how serious the situation is.” Heading into the winter, the country was already primed for a major Delta-driven surge. Now, on top of that, we must reckon with Omicron, a variant that, early data suggest, is both more transmissible and more adept at penetrating the protection conferred by vaccines (though they still excel at staving off severe illness). Experts remain unsure of just how bad things might get, but COVID cases in the Northeast and Midwest are already surging to record highs. At this rate, Wasik doesn’t think there will be many unvaccinated, uninfected people left by early 2022. The virus will peak simultaneously in multiple parts of the country, further straining a hospital system that, Scarpino said, is “essentially already at capacity.” He expects this wave to be by far the worst yet. In 2020, the NBA did eventually manage to finish its season. The league embarked on a nearly $200 million public-health experiment, convening 22 teams at Disney World, in Orlando, Florida, to play out the remainder of the regular season and the playoffs in strict isolation. The “bubble,” as it came to be known, was a roaring success: Not a single player tested positive for the virus. For public-health experts, this was early proof that masking, distancing, and frequent testing really could thwart the virus. “We learned a lot about what types of public-health interventions you need to prevent outbreaks,” Brandon Ogbunu, an evolutionary and computational biologist at Yale who has studied COVID’s effects on sports, told me. How leagues handle the virus “ends up being a nice model for our public-health decision making.” With Omicron surging around the world, sports are once more having to adapt. In Germany, many soccer matches are again being played in empty stadiums. The NBA has ramped up testing, and generally seems to be taking something of a wait-and-see approach. The NFL, meanwhile, has gone a different route, eliminating weekly testing for players who are vaccinated and asymptomatic. Whatever happens next, Ogbunu said, “the world will watch what sports leagues do.” from https://ift.tt/3Ef4Nor Check out http://natthash.tumblr.com Variants are a little bit like breakups: There’s never a great time for one to strike, but there absolutely are terrible times. With Omicron, it’s hard to imagine a worse possible moment. The promise of this holiday season has long been that Americans would finally get to make up for all the getaways and family reunions that didn’t happen last winter. That’s exactly what Americans have been banking on: The country is entering its biggest travel moment of the entire pandemic. Omicron introduced itself to the world only a few weeks ago, but it’s made quite an impression. In the United Kingdom, COVID-19 cases hit an all-time record on Thursday. And Friday. There’s much we still don’t know about the new strain, but as my colleague Sarah Zhang has written, we know enough to see that Omicron is about to tear through the United States. Here, Omicron cases are now doubling every two days, and the variant’s contagiousness—and knack for duping our vaccines—is ratcheting up breakthrough infections. Sports leagues have started rescheduling games, restaurants are closing for a little while, and some schools are going remote. All of this has left many would-be travelers nervously glancing at their calendar and asking themselves another round of terrible pandemic questions: How bad will things be by Christmas? By New Year’s? And when do things get so bad that I need to cancel my holiday plans? Whether you should travel over the next couple of weeks is not something Americans are getting an easy answer to at the moment. So far, the CDC is plowing forward with the same old guidelines: If you’re fully vaccinated and not experiencing any COVID symptoms, mask up and off you go. Anthony Fauci and other public-health figures, while urging caution with Omicron, have been reluctant to tell people to stay home. Unlike last year, when virtually no one was vaccinated and the CDC point-blank told Americans not to travel, the fuzzy messaging comes in part from the fact that so much now depends on people’s individual situations—whether they’re vaccinated, what precautions they’re taking, and whom they’re going to see. This year, everyone has to make a choice all on their own. And yet all the signs make it clear that many Americans have already made up their mind. While some number of people might cancel, no matter what happens between now and the thick of the holidays, Omicron almost definitely will not compel a critical mass of people to change their travel plans. So if you are traveling, you can take several steps to make it as safe for everyone as possible. [Read: We know enough about Omicron to know that we’re in trouble] Thanks to Omicron, international jet-setters now have to navigate more travel restrictions, quarantine mandates, and testing rules. But beyond that, almost no evidence shows that Americans are rushing to change any plans. I fired up the TSA’s tracker of how many travelers are passing through its checkpoints each day, and airports are even busier now than pre-Omicron. “If you decide today that you want to travel in the U.S. for Christmas, you’re going to be seeing eye-popping airfares almost everywhere,” Henry Harteveldt, a travel-industry analyst at Atmosphere Research Group, told me. “Depending on where you’re going, the hotel prices or the rental-car rates may be through the roof. All of that is a sign that people really, really want to travel right now.” United Airlines has said that it ferried 400,000 passengers a day during the Thanksgiving rush, and now it’s planning on even more for the year-end holidays. Meanwhile, the flight-search site Kayak saw a slight Omicron dip in searches within the U.S. when we first learned about the variant, but while the news has gotten only more worrying, searches are already back to where they were in late November. For anyone who has been persuaded by Omicron to forgo holiday gatherings, airlines have stuck with the more flexible cancellation policies that popped up at the start of the pandemic, Harteveldt said. Most airlines won’t refund your money, but they’ll give you a voucher to use sometime in the future. That at least gives people some wiggle room if Omicron takes a turn for the worse and the CDC makes a last-minute plea for everyone to stay at home. (When I reached out to the CDC for comment on what would need to happen for the agency to come out against holiday travel, a spokesperson sent me back to the travel guidelines on the CDC website.) Even so, Omicron is making its charge precisely at the moment when many Americans are heading off on their trips—and exactly when they’re least likely to endure the headache of fiddling with their plans. “Very few people are going to cancel the day before the flight,” says Scott Keyes, the founder of the travel website Scott’s Cheap Flights. “At this point, if we haven’t seen a wave of cancellations yet for Christmas—which we haven’t—I would expect that most people are still going to continue to take whatever holiday travel plans they already have on the books." The same goes for people who are planning on driving to their gatherings—which is how the overwhelming majority of Americans travel. Of everyone who travels at least 50 miles during the holiday season, the Bureau of Transportation Statistics estimates that just 5 percent fly. Paula Twidale, a senior vice president of AAA travel, told me that AAA is expecting 100 million travelers on the road during the holidays, just a sliver less than in 2019, which she called a “banner year” for travel. Let’s be clear: That so many Americans seem poised to travel doesn’t mean it’s the right call. “I rather suspect that Omicron will take over from Delta across much if not most of the country during the Christmas period,” Bill Hanage, a Harvard epidemiologist, told me in an email. “And in January we will reap whatever whirlwind got seeded along with the eggnog.” Just like before Omicron, however, the risk of travel has less to do with the act itself and more to do with how people from different households behave before they all meet up. You could take every precaution possible in getting to your grandma’s house halfway across the country, but if you packed into a bar the night before the trip and don’t plan on getting tested before you see her, you’re missing the point. Before you head out for the holidays, says Saskia Popescu, an epidemiologist at George Mason University, give yourself a cool-down period—a week, if still possible—by pulling back on activities that are especially prone to spreading COVID, such as indoor dining. If you work in person, wear a high-quality, non-cloth mask, and stick to wearing it as best as you can. A. Marm Kilpatrick, a disease ecologist at UC Santa Cruz, is having his mom and sister over for the holidays, and he just made the unenviable decision of forgoing a sauna party that his friend was throwing. (Kilpatrick has cooler friends than I do.) “We were going to be tightly packed enough that I didn’t want to do that with three or four other households,” he told me. Kilpatrick reiterated the basics of Omicron 101: Get boosted! If you haven’t yet, it’s not too late. Since a booster shot kicks in more quickly than initial doses, you can get a shot today and receive the best Christmas present ever: a tangible immunity bump. [Read: Fully vaccinated is about to mean something else] How you travel also is less important than what you do en route. Driving gives you some control over your environment, but be wary of making pit stops to eat indoors and bringing along people from outside your household. Thanks to ventilation in airplanes, flying hasn’t been so risky throughout the pandemic. “But that doesn’t mean we should overcorrect and feel like the risk of being on an airplane is zero,” Popescu told me. “You still want to be mindful of the people right next to you.” That’s especially true now that planes are as full as they were pre-pandemic. If the passenger next to you has their mask off to eat or drink, Popescu said, wait a few minutes until after they’re done to do the same. Turning the overhead AC on full blast and pointing it toward your face can help disperse any bits of the virus that are floating around. And particularly with a more transmissible variant, it’s worth being even more cautious in less ventilated areas, such as when you’re sitting by the gate or lingering on the jet bridge. Think hard about who you’ll be seeing once you arrive, especially if your plans include older, immunocompromised, or unvaccinated people. Conversations about pandemic risk can sometimes be awkward, but they can be a good place to start: “A lot of this comes down to: Is the person you’re visiting vulnerable, and how do you feel about that?” Popescu said. “How do they feel about that?” If you’re going to be spending a lot of time indoors with someone who is vulnerable, Kilpatrick said it’s best to bring along at-home rapid tests—the ones you can buy at the pharmacy—for each day of your visit, especially if you have any inklings of COVID symptoms. Since Omicron appears to make people sick even more quickly than previous forms of the coronavirus did, don’t bank on a test result from a few days ago. “If I had a dinner party to go to on Christmas and took a rapid test 15 minutes before the party,” Kilpatrick said, “that’s going to catch a huge fraction of infections.” (Unfortunately, these tests don’t come cheap, and they’re in serious short supply right now.) Even if Omicron had come at a less terrible time, it wouldn’t have changed the fatigue that Americans are feeling right now. Over time, the link between what’s going on with COVID and how we act about it is weakening, says David Lazer, a political scientist at Northeastern University who’s involved with the COVID States Project. “The problem is that we’ve become habituated,” he told me. When the Delta wave tore through the South, it led to only an incremental bump in protective measures such as mask wearing. Now, Lazer said, Omicron could potentially lead to even tinier changes. But the pandemic is still here—more than 800,000 Americans are dead—and it is not ending anytime soon. Relish the holiday season, but don’t use it as an excuse to let your guard down going forward as Omicron gears up for its next twist and turn. Americans might be over the pandemic, but the pandemic is certainly not over us. from https://ift.tt/3mo4gum Check out http://natthash.tumblr.com It certainly might not seem like it given the pandemic mayhem we’ve had, but the original form of SARS-CoV-2 was a bit of a slowpoke. After infiltrating our bodies, the virus would typically brew for about five or six days before symptoms kicked in. In the many months since that now-defunct version of the virus emerged, new variants have arrived to speed the timeline up. Estimates for this exposure-to-symptom gap, called the incubation period, clocked in at about five days for Alpha and four days for Delta. Now word has it that the newest kid on the pandemic block, Omicron, may have ratcheted it down to as little as three. If that number holds, it’s probably bad news. These trimmed-down cook times are thought to play a major part in helping coronavirus variants spread: In all likelihood, the shorter the incubation period, the faster someone becomes contagious—and the quicker an outbreak spreads. A truncated incubation “makes a virus much, much, much harder to control,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told me. Already, that’s what this variant seems to be. In less than a month, Omicron has blazed into dozens of countries, sending case rates to record-breaking heights. If, as some scientists suspect, this variant is so primed to xerox itself more quickly inside us—including, it seems, in many people with at least some immunity—that leaves punishingly little time in which to detect the virus, intervene with antivirals, and hamper its spread. [Read: America is not ready for Omicron] A pause here. We are still just weeks into our fight against Omicron, and it’s not easy to gather data on incubation periods, which might differ among populations, or suss out exactly how the virus is tangoing with our cells. But the early warning signs are here—and as my colleague Sarah Zhang has reported, we know enough to act. All of this, then, ups the urgency on having tests that can quickly and reliably pinpoint Omicron. “If Omicron has a shorter incubation period, that’s going to wreak havoc on how we test for it and deal with it,” Omai Garner, a clinical microbiologist in the UCLA Health system, told me. But testing in the United States remains slow, expensive, and, for many, infuriatingly out of reach. We’re ill-prepared for the incoming Omicron surge not just because it’s a new version of the coronavirus, but because it’s poised to exploit one of the greatest vulnerabilities in our infection-prevention toolkit. The coronavirus is getting faster, which means it’s also getting harder to catch. Since the World Health Organization designated Omicron as a variant of concern at the end of November, the virus seems to have popped up just about everywhere. Researchers are tracing cases of it back to schools, child-care centers, hotels, universities, weddings, and bars. And they’re finding it at office holiday parties, like the one at a restaurant in Oslo, Norway, where about 80 people may have caught or transmitted Omicron. In a research paper describing the Oslo outbreak, scientists noted that, after the event, symptoms seemed to come on quickly—typically in about three days. More troubling, nearly every person who reported catching Omicron said that they were vaccinated, and had received a negative antigen-test result sometime in the two days prior to the party. It was a clue that perhaps the microbe had multiplied inside of people so briskly that rapid-test results had rapidly been rendered obsolete. The time lines described by the Norwegian researchers are preliminary, and might not be representative of the rest of us. But they appear to match up with early, sometimes-anecdotal reports, including some out of South Africa, one of the first countries to detect and report Omicron’s existence. Shorter incubation periods generally lead to more infections happening in less time, because people are becoming more contagious sooner, making onward transmission harder to prevent. Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me he still wants more data on Omicron before he touts a trim incubation. But “it does make sense,” he said, considering the variant’s explosive growth in pretty much every country it’s collided with. In many places, Omicron cases are doubling every two to three days. [Read: Omicron’s explosive growth is a warning sign] Nailing the incubation interval really is tough. Researchers have to track down sizable outbreaks, such as the Oslo Christmas party; try to figure out who infected whom; wait for people to report when they start feeling sick—always a fickle thing, because symptoms are subjective—then, ideally, track whether the newly infected are spreading the virus too. The numbers will vary depending on who was involved: SARS-CoV-2-incubation periods could differ by vaccination status, underlying health conditions, infection history, age, and even the dose of the virus people get blasted with. To complicate things further, the start of symptoms tends to lag behind the start of contagiousness by, on average, a couple of days; when symptoms begin earlier, transmission might not follow to exactly the same degree. If Omicron’s incubation period turns out to be conclusively shorter, we would still have to figure out how it got winnowed down. Some of it could be inherent to the virus itself. Omicron’s spike protein is freckled with more than 30 mutations, some of which, based on previous variants, could help it grip more tightly onto cells and wriggle more efficiently into their interiors. Two recent laboratory studies, neither yet published in scientific journals, may be hinting at these trends. One, from a team at Harvard University, showed that a harmless virus, engineered to display Omicron’s spike on its surface, more easily penetrated human cells in a dish; another, out of Hong Kong University, found that Omicron multiplied dozens of times faster than Delta in tissue extracted from the upper airway. The findings won’t necessarily translate into what goes on in actual bodies, but they support the idea that Omicron is turbocharging the rate at which it accumulates to contagiousness. The faster that happens, the more quickly the virus can spill out of one person and into the next. If the data pan out, “this could go a long way in explaining the rapid transmission,” Lisa Gralinski, a virologist at the University of North Carolina at Chapel Hill, told me. The unvaccinated remain most at risk, but this trend would have troubling consequences for the vaccinated and previously infected too, especially if they’re unboosted. Many of the antibodies we marshaled against previous versions of the coronavirus don’t recognize Omicron very well, and won’t be able to sequester it before it foists itself into cells. Eventually, a vaccine- or infection-trained immune system will “catch up,” Ryan McNamara, a virologist at Harvard Medical School, told me, churning out more antibodies and launching an army of T cells that can quell the virus before it begets serious disease. But those defenses take a few days to kick in and might not arrive in time to forestall the early, and often most potent, stages of transmission. The faster Omicron sprints, the more of a head start it gets against the body’s defenses. The picture on Omicron is coalescing both microscopically within us and broadly in communities—steep, steep, steep slopes in growth. The two phenomena are linked: A shorter incubation period means there’s less time to pinpoint an infection before it becomes infectious. With Omicron, people who think they’ve been exposed may need to test themselves sooner, and more often, to catch a virus on the upswing. And the negative results they get might have even less longevity than they did with other variants, Melissa Miller, a clinical microbiologist at UNC, told me. Tests offer just a snapshot of the past, not a forecast of the future; a fast-replicating virus can go from not detectable to very, very detectable in a matter of hours—morning to evening, negatives may not hold. This, especially, could be bad news for PCR tests, which have been the gold standard throughout the pandemic and essential for diagnosing the very sick. (Thankfully, most PCR tests do seem to be detecting Omicron well.) These tests have to be processed in a laboratory before they can ping back results—a process that usually takes at least a few hours but, when resources are stretched thin as they are now, can balloon out to many days. In that time, Omicron could have hopped out of one person’s body and into the next, and into the next. It’s a particular gamble for people who don’t have symptoms and who are still out and about while they await their results. The more swiftly the virus becomes infectious, the more important testing speed becomes too. Rapid at-home antigen tests—which can be purchased over the counter, and can return results in about 15 minutes—could fill some of the gaps. Their results would also come with quick expiration dates, but they’d also manifest faster, and, potentially, offer a better representation of what’s happening in the body right now. [Read: COVID tests weren’t designed for this] But rapid antigen tests aren’t a perfect solution. Compared with PCR tests, they are less able to pick up on the virus when it’s present at pretty low levels—which means they might have a harder time homing in on the virus while it’s simmering early in infection, or might even fail to detect it in people who are already contagious. A few experts told me that they’re worried some antigen tests will struggle to pinpoint the highly mutated Omicron at all, something still being monitored by the FDA. People could test themselves repeatedly to lower the chances that they miss the microbe, but a strategy like that quickly starts to verge on impractical. You can’t reasonably ask people to test themselves every 12 hours, Nuzzo said. And the products still aren’t available in high enough numbers to meet anywhere near that kind of demand. They’re also wildly expensive, keeping them out of the hands of many of the vulnerable communities that need them most. Some states are passing out rapid tests for free, but they’re still in the minority. And the Biden administration’s limited reimbursement plan won’t take effect until next year. On grand scales, American supply is still massively, massively falling short. That fact, married with Omicron’s probable pace, means “we’re not going to catch everybody who has it,” Nuzzo said. [Read: Coronavirus variants have nowhere to hide] The variant’s fleet-footedness is likely to have big ripple effects in clinical settings too. Garner and Miller, who both run clinical labs, are worried that the coming testing surge will delay results for patients who have to be screened before going into surgery, or who need a diagnosis for treatment. That could be especially problematic for doling out the much-anticipated antiviral pills to treat COVID, which need to be taken very early in the course of illness to effectively halt the progression of disease. Stretched laboratory capacity could also compromise testing for other pathogens, including the flu, which is creeping back into the population just as health-care systems are starting to buckle once more. Nationwide, Garner said, “we are as unprepared for a surge as we were a year ago.” People shouldn’t give up on tests, experts told me; they’ll still make a big difference when and where they’re used, especially for diagnosing the sick. But Omicron’s speed is a sharp reminder of humanity’s own sluggishness during this pandemic. Until now, tests offered only a porous safety net; in the era of Omicron, the holes are even wider. We’ll need to close the gaps by doubling down further on preventive measures: masking, vaccination, ventilation, and, unfortunately, cutting back on travel and socializing. Viruses don’t actually move that fast on their own—they need human hosts to carry them. If things stay as they are, though, we’ll keep giving this one the ride of a lifetime. from https://ift.tt/3qjxH1U Check out http://natthash.tumblr.com I turn 40 today, and I was planning to have a party. The Delta surge made me nervous about it. The arrival of Omicron made me cancel it. The plan was to have an extended house party, with a couple dozen people popping by over the weekend. On the one hand, it would have been an unmasked, indoor event—the kind in which the coronavirus, in all its incarnations, spreads most easily. On the other hand, everyone who was going to be there is fully vaccinated, and most of them, myself included, have been boosted. A month ago, I would have felt comfortable about that trade-off, especially if people got tested in the preceding days, as eight friends did when they came over for Thanksgiving. Omicron didn’t much shift the way I weighed my personal risk. Although the new variant can evade some of our immune defenses, early data suggest that boosted people are roughly as protected against Omicron infection as people with two vaccine doses are against Delta. That protection isn’t foolproof, but even if immune systems can’t block the virus from gaining an initial foothold, they should still be able to stop it from causing too much damage. If I got the virus on my birthday, I’d expect to be knocked down for a time but okay by Christmas—and I’d expect the same to be true for everyone who was meant to come. I don’t know the odds that this would happen. But I know that said odds are rising with every passing day, given how quickly and easily Omicron is spreading, even among highly vaccinated populations. I know that many of my friends, like many vaccinated Americans, have been going out to restaurants, bars, gyms, and movie theaters. I know that Omicron’s incubation period—the gap between infection and symptoms—seems unusually short, so that even people who tested negative a few days ago might still be infected and infectious. I know that even mild infections can lead to long COVID. If someone got sick, I know others could too. A week later, many of my friends will spend Christmas with their own families. At best, a cluster of infections at the birthday party would derail those plans, creating days of anxious quarantine or isolation, and forcing the people I love to spend time away from their loved ones. At worst, people might unknowingly carry the virus to their respective families, which might include elderly, immunocompromised, unvaccinated, partially vaccinated, or otherwise vulnerable people. Being born eight days before Christmas creates almost the perfect conditions for one potential super-spreader event to set off many more. My friends, of course, are adults who can make informed decisions about their own risks and their own loved ones’ risks. But the logic of personal responsibility goes only so far. Omicron is spreading so rapidly that if someone got infected at my party, my decision to host it could easily affect people who don’t know me, and who had no say in the risks that I unwittingly imposed upon them. Omicron is unlikely to land me in the hospital, but it could send my guests’ grandparents or parents to one. I also know the state of those hospitals. Over the past two years, especially while I was reporting a new article last month, hundreds of nurses, doctors, and other health-care workers have told me that they, and the system they work in, are utterly broken. Some have quit jobs or careers that they thought they would keep for life. Others spoke of a system in the midst of collapse, in which the dwindling workforce can no longer provide a normal level of care for its growing pool of patients—not just COVID patients, but all patients. Several said that they’re struggling to hold on to empathy for people who are putting themselves at risk. Many cried down the phone during our interview. Many just sounded hollow. I feel haunted by their words when I make decisions about the pandemic. When I stare out my window, the world looks normal, but I know through my reporting that it is not. This has already changed the way I behave, and not just to avoid getting COVID. I’ve been trying to drive more carefully, in the knowledge that if I got into an accident, I wouldn’t get the same care that I would have two years ago. I feel that the medical system in this country is at a tipping point—a fragile vase balanced so precariously on an edge that even a fly could knock it over. Omicron is a bullet. It’s one that we can each choose whether to fire. For many people, this will all sound like a lot of melodrama. Surely the odds are still low that anyone at the party would have Omicron at all, let alone that any resulting infections would be severe enough to bother a hospital? Even if that wasn’t true, with people widely partying and traveling, surely canceling any one event would be an impossibly small drop in an impossibly large bucket? I sympathize with those arguments. But I’ve tried to take to heart the lesson I keep writing about—that the pandemic is a collective problem that cannot be solved if people (or governments) act in their own self-interest. I’ve tried to consider how my actions cascade to affect those with less privilege, immune or otherwise. Instead of asking “What’s my risk?,” I’ve tried to ask “What’s my contribution to everyone’s risk?” I’ve done things that personally inconvenience me to avoid contributing to the much greater societal inconvenience of, say, a collapsed health-care system. I still mask indoors. I still eat outdoors at restaurants. I still avoid large gatherings. I’m still writing articles that take a toll on my own resilience, to help our readers make sense of a crisis that I desperately want to never think about again. I’ve tried to put we over me. A birthday party is almost the antithesis of that ethic—an asymmetric gathering in which we celebrate me. I talked with my wife, Liz, and two of my colleagues about ways of mitigating the risks—could we ask people to do a rapid test just before coming?—but, ultimately, simply canceling felt easier and safer. The growing number of anecdotes about outbreaks within boosted parties has only made me feel more confident about that choice. These decisions are hard. Plans and hopes have their own inertia, and canceling things is a pain. A birthday party isn’t ultimately a big deal, but I’m still sad about not seeing my friends, and a celebration would certainly have improved my fraying mental health. Those trade-offs, which we’ve been asked to make now for almost two years, have an erosive power as they add up. Our Christmas will also be quiet. I don’t know how to think about everyone else’s. For two straight years, America’s leaders have largely punted the responsibility for controlling the pandemic to individuals, and now Omicron leaves said people with few options beyond boosting, masking, and—the one nobody wants to hear—avoiding social gatherings. If people really hunker down over the next week, eschewing the kinds of exposures that they would have felt comfortable with a mere month ago, they might be in a more secure position to gather by Christmas. But as my colleague Ian Bogost has written, to have to wrangle with these choices again, just as the holiday season begins, feels like a cruel joke. It is easy to despair, but we cannot afford the luxury of nihilism. Grim though the stories I’ve written may be, I have tried to infuse every one with some hope—with the acknowledgment that a better future is at least possible, if not probable. And despite everything, I firmly believe that it is. Failed systems constrain us, but we still have agency, and our small choices matter immensely. The infectious nature of a virus means that a tiny bad decision can cause exponential harm, but also that a tiny wise decision can do exponential good. This time last year, with effective vaccines and a new administration on the horizon, I tweeted that I was “gently hopeful about being able to have a party.” That wasn’t to be. But canceling doesn’t mean that I can’t have a joyful weekend, or that I can’t have a party again, or even a 40th-birthday party again. I can imagine reviving the idea if transmission falls back to a gentle simmer. The cost of waiting for such a moment feels low, and certainly much lower than the consequences of reckless impatience. And I know, despite the relentless nature of the past two years, that pandemics do eventually end.
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