Month: March 2022

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The number of confirmed Covid-19 deaths in the United States has now surpassed 400,000, and that devastating toll is set to grow in the coming weeks with the US still averaging more than 3,300 deaths every single day.

In just the 11 months since the country’s first confirmed death from Covid-19, the disease has killed as many Americans as US soldiers who died during four years of World War II.

That figure is also almost surely an undercount. The number of excess deaths during the Covid-19 pandemic (the number of deaths that have occurred in excess of what would ordinarily be expected based on long-running trends) is closer to 500,000, according to some recent estimates. Some of the additional 100,000 deaths may not be from the coronavirus — they could, instead, be people who couldn’t get adequate medical care because health systems have been strained by the pandemic — but experts think a substantial portion probably are uncounted Covid-19 deaths.

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Regardless, the loss of human life over the past year has been extraordinary. The US has by far the most confirmed Covid-19 deaths in the world and nearly doubles the toll in Brazil, the second-hardest-hit country. Even when adjusting for population, America ranks 11th in the world in Covid-19 deaths per million people.

And even now, nearly a year into the pandemic, deaths are piling up faster and faster, rather than slowing down. It took about three months from the first confirmed Covid-19 death in the US in late February for the country to hit 100,000 deaths. Another four months elapsed before the country reached 200,000 deaths in late September. But then things picked up speed during the winter surge: The US added 100,000 more deaths in less than two months, and from there, it took a little more than a month to go from 300,000 to 400,000 deaths.

What went so wrong? Vox’s German Lopez explained at the beginning of this month:

The primary answer lies in President Donald Trump and Republican leaders in Congress, who have collectively abdicated the federal government’s role in addressing the outbreak or even acknowledging its severity. From Trump’s borderline denialist messaging on Covid-19 to Congress’s inability to pass broader economic relief, the country has been left in a place where states, local governments, and the public have to fend for themselves — and none of them have the resources to deal with the coronavirus on their own.

Trump and his allies have also actively worked to sideline the Centers for Disease Control and Prevention, crippling the agency’s ability to provide guidance to states and others that have now been left out on their own.

At the same time, there are serious structural issues that hindered states’ and the public’s ability to act. Experts have long argued that the US’s public health infrastructure is underresourced and ill prepared for a serious crisis, and the pandemic has exposed this many times over: Nearly a year into the pandemic, no state has capacities for testing and contact tracing that most experts would consider adequate.

President-elect Joe Biden is coming into the White House promising to pass a big bill allocating more funding for the Covid-19 response and to fix the nation’s troubled vaccine rollout. More precautions and more vaccinations could help reduce the loss of life going forward.

But America’s failures in the pandemic have already exacted an awful cost: at least 400,000 lives lost.

People who are pregnant are now eligible to get the coronavirus vaccine in more than 40 states — typically ahead of their lower-risk peers. And more than 60,000 of them have already rolled up their sleeves, according to the Centers for Disease Control and Prevention.

Although the Covid-19 vaccines authorized in the US were not studied in pregnancy, early data is now starting to emerge suggesting — as researchers expected — that the vaccines are likely safe during pregnancy and confer protection not only to the recipient but also, potentially, the baby.

“It’s all very positive,” says Stephanie Gaw, a maternal-fetal medicine specialist at the University of California San Francisco Medical Center, of the findings so far.

There have been many reasons to suspect the vaccines should be safe in pregnancy, including the lack of major adverse events reported so far, solid studies in animals, and a good understanding of how the vaccines work in the body (they don’t contain live virus, and they are quickly broken down). “The data that we’re collecting on it so far has no red flags,” Anthony Fauci, the top US infectious disease doctor, said in February.

Meanwhile, new research, published March 25 in the American Journal of Obstetrics and Gynecology, found that the vaccines offer strong immune protection for people who are pregnant, just like their non-pregnant peers.

Preliminary research also suggests vaccines might provide some protection to newborns, who are unlikely to have their own approved Covid-19 vaccine anytime soon (and are also vulnerable to more severe illness). The new AJOG paper joins other early findings that antibodies to Covid-19 generated by pregnant mothers after receiving their vaccines were passed through the placenta to the fetus.

But Covid-19 vaccine rollout to the pregnant population has been inconsistent around the globe.

For months, the US and many national medical groups — including the American College of Obstetrics and Gynecology, the Society for Maternal-Fetal Medicine, and the Academy of Breastfeeding Medicine — say the vaccine should be offered to this group, in large part because there’s strong evidence that pregnancy elevates the risk for severe Covid-19 and death. (Given this data, the American Society for Reproductive Medicine goes so far as to say the vaccine is “recommended” for those who are pregnant or considering pregnancy.)

“If a pregnant patient gets infected during pregnancy, her risk of intensive care admission is around 5 percent,” says David Baud, chief of obstetrics at Le Centre hospitalier universitaire vaudois in Switzerland, where he studies infections during pregnancy. “I do not know of any disease that put a 30-year-old woman at such high risk to be admitted to the ICU.” Furthermore, if the infection happens late in pregnancy, it increases the risk of preterm birth and the baby needing intensive care.

Israel went as far as adding pregnant women to its vaccine priority list in January. But other countries, such as the UK and Germany, and the World Health Organization are still saying most people who are pregnant should wait.

Why the disagreement? The clinical trials of the new Covid-19 vaccines explicitly excluded pregnant people, and we don’t yet have enough follow-up data from individuals who have opted to get the shots to say for sure they are safe for everyone during pregnancy.

Add to this muddled landscape the persistent misinformation swirling around the Covid-19 vaccines and pregnancy and fertility, and it is little wonder some people are still confused or worried. And most organizations still stop short of advising all pregnant people to definitely get the vaccine.

Thankfully, these information gaps are starting to fill in. Numerous studies are underway following the outcomes of pregnant and breastfeeding people and their offspring after immunization. And a handful of them are now starting to report early, reassuring results.

In the meantime, however, a growing number of people have had to come to their own decision, with the optional help of their care provider, with some uncertainty. And no one needs an extra thing to stress about during a pandemic pregnancy.

So more information about the coronavirus vaccines in pregnancy can’t come soon enough.

4 reasons the coronavirus vaccine should be okay to get while pregnant — but why not everyone is recommending it yet

One of the big reasons why, despite Covid-19’s known risks in pregnancy, not everyone has unequivocally recommended the vaccines that currently have emergency approval in the US for pregnant people is that the way they work is fairly new. But we do have some key pieces of information already:

1) These vaccines don’t contain live coronavirus. The only types of vaccines that are contraindicated in pregnancy contain live virus that has been weakened, such as the chickenpox vaccine. (Even fewer immunizations, such as the smallpox vaccine, are not recommended during lactation.) While these vaccines don’t pose a risk to most people, there is a small, theoretical chance they could cross the placenta and infect the fetus.

The Pfizer/BioNTech and Moderna vaccines, on the other hand, contain just a fragment of genetic material, called messenger RNA, that can tell human cells to build a tiny part of the virus’s outer shell, which the immune system learns to recognize and fight off. The Johnson & Johnson vaccine uses a different method, known as a viral vector (the same platform as the already-used Zika and Ebola vaccines), to get the body to build part of the virus’s shell.

In either case, there is no way the vaccine can cause a Covid-19 infection.

2) The main coronavirus vaccines are very fragile. Once the mRNA enters the body, it likely only reaches local arm muscle cells before the body breaks it down. This means it is unlikely to enter the bloodstream, and even less likely to make it as far as the placenta. Even if it does get that far, “one of the placenta’s main functions is to be an immune barrier to the fetus,” which adds another layer of protection, says Gaw. And although it contains genetic material, it doesn’t enter our cells’ nuclei, meaning that it can’t cause any mutations to our cells — or those of a developing fetus. This mRNA is so fragile, vaccine developers had to wrap it in nanolipids (which are also presumed to be safe for pregnancy) just to keep it intact long enough to reach muscle cells in the arm.

Experts also expect it is unlikely for the mRNA to make its way intact into breast milk. Preliminary research from Gaw and her team, which is in the process of being peer-reviewed, found no trace of the vaccine itself in breast milk samples from hours and days post-vaccination. And even if a small amount of it were to be transferred to a feeding baby, researchers say it (and any lipid nanoparticles) would get broken down by the baby’s stomach acids.

3) Animal studies look promising. Before any shots were given to pregnant humans, vaccine companies gathered safety data in other pregnant mammals. None of these developmental and reproductive toxicity (DART) studies from Pfizer/BioNTech, Moderna, or Johnson & Johnson suggest any safety concerns for use during pregnancy.

Rats, of course, are not humans, and DART study results do not always translate identically into humans. “Some results are similar to humans, and some are very different,“ Gaw says. Nevertheless, they are a good starting point — when combined with strong safety data in the clinical trials and public vaccinations so far.

4) We haven’t seen adverse events in pregnant people who have gotten it so far. For the Covid-19 vaccine trials, those of “childbearing potential” were screened for pregnancy before each shot, and those with positive tests were removed from the studies. However, a handful of people (12 who got the vaccine in Pfizer/BioNTech’s study and six who got the vaccine in Moderna’s study) ended up having been pregnant at the time of vaccination — and companies haven’t reported any negative outcomes from these individuals.

A newer and much larger data set is emerging from the Centers for Disease Control and Prevention, which is following pregnant people who sign up for its tracking platform V-safe after being vaccinated — and allowing them to sign up for a more targeted pregnancy-specific vaccine registry.

At the beginning of March, the CDC reported data from more than 1,800 pregnant people in the registry who had received Covid-19 vaccines. Among these individuals, there was not a statistically significant increase in adverse pregnancy or birth outcomes. Nor have they found any significant differences in side effects from the vaccine (such as fatigue or fever).

“From a scientific perspective, there’s no specific reason to think that pregnant individuals would have more adverse reactions to the vaccine or that there would be a risk to the fetus with the vaccine, while we know that there is risk with the Covid infection,” says Alisa Kachikis, an assistant professor of obstetrics and gynecology at the University of Washington.

A January study published in JAMA Internal Medicine, for example, analyzed the outcomes of more than 406,000 people who gave birth in hospitals between April and November 2020 and found that a significantly higher rate of those with Covid-19 had major complications. “The higher rates of preterm birth, preeclampsia, thrombotic [blood clotting] events, and death in women giving birth with Covid-19 highlight the need for strategies to minimize risk,” noted the authors.

So why are some, such as the WHO and the UK, still saying most pregnant people should not get the coronavirus vaccine yet? They are waiting for more data.

There are also, of course, other types of coronavirus vaccines in the works, such as protein-based vaccines (which is the basis for Novavax’s shots). This model of shot has been used for years — including for pertussis and hepatitis B — “and we are very comfortable with [their] safety profile,” Gaw says. Viral vector vaccines (which is how the Johnson & Johnson and AstraZeneca/Oxford shots work) have also been used safely in pregnancy, such as for the Ebola and Zika vaccines, although there is less historical data on these.

So, says Kachikis, if what’s hanging people up about getting a Covid-19 vaccine in pregnancy is mostly the novelty of the mRNA vaccines, having other types to choose from — as long as they’re just as effective — could be a good option.

What studies are happening, and what will they help us learn about the Covid-19 vaccine in pregnancy?

The CDC continues to monitor for any adverse outcomes and side effects through its V-safe program — and related pregnancy registry (which will check in with participants in each trimester, after delivery, and when the baby is 3 months old).

Pfizer/BioNTech started giving vaccine doses in their pregnancy-focused, placebo-controlled clinical trial this February. They are first running a smaller safety study of just 350 healthy pregnant participants before scaling up to give the vaccine to a total of about 4,000 people who are at between 24 and 34 weeks gestation. (This study design, however, will still leave some questions about the safety and efficacy of the vaccine, especially earlier in pregnancy.)

Moderna has created a registry that people can sign up for after receiving their vaccine while pregnant. For its part, Johnson & Johnson plans to conduct trials of its vaccine in pregnant participants later (likely after it studies the vaccine in children).

In the meantime, other researchers are racing to collect and study data from the natural experiment that started in December, when many pregnant people began electing to get vaccines as they became eligible because of their high-risk work in hospitals or long-term care centers.

At the University of Washington, Kachikis is leading a study to also follow vaccination in people who are pregnant. Thousands of people from around the US and the world who have received the vaccine while pregnant have already signed up for the registry, she says. (People who are pregnant or lactating but have not yet gotten vaccinated can also sign up, as can people who are considering becoming pregnant within the next two years.) This research will help them track any adverse outcomes, as well as gather additional data, such as whether any vaccinated individuals (or their newborns) later get Covid-19.

An additional large-scale clinical trial, which has not started enrolling participants, aims to track 5,000 women and their offspring over the course of 21 months. Other smaller studies are in the works as well, such as one at Duke University.

At UCSF, Gaw and her team are in the midst of separate observational studies. They will more closely follow a smaller group of participants — 100 or so of whom are pregnant and roughly 50 of whom are lactating — “to determine whether the Covid vaccines are equally effective in pregnant and lactating women, how long antibody responses last, and whether immunity is transferred to the baby,” Gaw explains.

Other vaccines are routinely given in pregnancy, such as pertussis, in large part to provide protective antibodies to the fetus and protect the newborn until they are old enough to get the vaccine themselves.

Covid-19 antibodies have been shown to transfer across the placenta in women who were positive for the virus at delivery. The new AJOG study found that even higher levels of antibodies were present in the umbilical cord after Covid-19 vaccination than after natural infection. “The research shows really promising results,” Kachikis says.

If these antibodies prove to be protective, it could be especially helpful, as newborns and infants will likely be among the last to have an authorized vaccine — and have the highest rates for complications and death from the virus among children. “There is still a lot of data that needs to be assessed, but for individuals who are thinking of ways that the vaccine may benefit their newborn, this is really encouraging,” Kachikis says.

More nuanced research might also eventually help advise on optimal timing for the Covid-19 vaccine during pregnancy. For example, Gaw notes, “there needs to be sufficient time for the mom to develop a robust antibody response, and then pass [this] to the baby.” After extensive research, the Tdap vaccine is recommended around 27 weeks of gestation so as to provide the best protection for the infant after birth. Without such information for the Covid-19 vaccine, many experts are recommending that those who decide to get the shot treat it like the flu shot — getting it as soon as it’s available to them, regardless of where they are in their pregnancy.

People who are lactating were also excluded from the vaccine trials. So researchers at a number of institutions are now working to study how the vaccine might impact breast milk contents and a nursing child. A study from October 2020 showed that most people who had recovered from Covid-19, as well as those suspected of being infected, passed on antibodies to the virus in their breast milk.

The recently released AJOG paper found a high level of antibodies in breast milk from women who had received the Covid-19 vaccine. Gaw’s team also has new findings, which are currently in peer review, that show a solid dose of Covid-19 antibodies in breast milk samples after vaccination. This, they hope, will provide some protection from the virus for babies.

“It’s all reassuring,” Gaw says. But “all the studies have been small…[so] we can’t 100 percent determine safety until a lot more people have been vaccinated and it’s been reported on.”

Wait, why weren’t pregnant people included in the early research to begin with?

Pregnancy has, for decades, been considered a “vulnerable” condition when it comes to researching new medical treatments and preventions, meaning people who are pregnant have been excluded from general trials in much the same way as have those who are unable to give informed consent, like children and those with severe mental disabilities.

Part of the reason for this might be due to the damaging legacy of thalidomide. This drug was given to pregnant women around the world starting in the 1950s as a way to ease nausea (although it was never approved specifically for use in pregnancy in the US). Soon, thousands of these babies were being born with devastating birth defects. This hammered home for scientists and the public that, when it comes to pregnant women and their fetuses, much more care ought to be taken in giving medications or vaccines.

But this conclusion, many are now saying, has it backward, as the oft-repeated phrase indicates: Protect pregnant people “through research, not from research.” If thalidomide had been carefully and systematically studied for pregnancy, it likely never would have been approved for use (or used unofficially) in this population, preventing the majority of these tragic outcomes.

“It can’t be emphasized enough that pregnant women should be included in vaccine trials from the get-go,” Kachikis says.

Gaw agrees: “We actually cause harm by not including [pregnant people] in early research, as they have to wait longer for good data to be published.”

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So when will we have more data about the coronavirus vaccine in pregnancy and lactation?

One big challenge with researching anything to do with pregnancy is that it takes a long time: nine months, plus follow-up time to monitor infant outcomes. And subsequent study during lactation while you’re at it, and maybe preconception research, too.

Consider that it took vaccine makers just 10 months to develop the Covid-19 vaccines and ensure they were safe and effective in adults. But with formal studies in pregnant people just getting underway (and with many having not yet started, and others, like Pfizer’s, currently limited to late pregnancy), it could be late 2021 or beyond until we have comprehensive, robust safety data for all stages of pregnancy. And even later to assess long-term outcomes for babies.

Follow-up to the early work Gaw and colleagues are doing at UCSF will take “at least six to nine months, as we have to wait for a sufficient number of babies to deliver,” Gaw says.

Kachikis and her team at the University of Washington plan to follow the outcomes of people who sign up for their list for about a year, with hopes to continue more long-term follow-up. For example, they plan to test babies months after birth to see how long antibodies from vaccines given during gestation persist — and if these antibodies are equally as effective at fighting off the coronavirus as those found in the vaccinated adults.

But they aren’t waiting that long to start sharing what they learn. “The focus is on getting any data out,” Kachikis says. And “if multiple groups can get some data out, that will be better than having absolutely nothing,” which has been the situation, she notes.

For now, much of the official guidance in the US stresses the need for people to conduct their own analysis of the known increased risks of Covid-19 in pregnancy with the remaining unknowns of the vaccine. And this calculus is not the same for everyone.

“As more evidence is coming out, it’s tilting to more benefit of getting the vaccine,” Gaw says. “But every individual has a different level of risk they’re willing to take” — as well as the amount of risk they might have of contracting the virus or getting extremely sick from it. The bottom line, based on the latest Covid-19 vaccine research in pregnancy, she says, is that “it’s looking more and more like it does work, it does pass antibodies to the baby (although we don’t know yet how protective they are), and there doesn’t look like there’s any harm at this moment.”

Additionally, even those who are reluctant to advocate the vaccine for all pregnant people just yet, such as the WHO, do suggest it should be available to those at high risk of exposure to the virus or underlying health conditions that increase their risk of severe Covid-19.

And some might elect to wait until there is more solid data. So to help move along the plodding process, people who are pregnant and have gotten the vaccine — or are considering it — can contribute to getting more and better guidance sooner by opting in to registries and studies.

Katherine Harmon Courage is a freelance science journalist and author of Cultured and and Octopus! Find her on Twitter at @KHCourage.

President Joe Biden on Thursday set a new goal for Covid-19 vaccines in the US: 200 million shots in his first 100 days in office. That’s up from Biden’s original goal of 100 million in 100 days. “I know it is ambitious — twice our original goal,” Biden said.

But the goal of 200 million shots in 100 days is really not that ambitious; it’s achievable if absolutely nothing changes with America’s current vaccine rollout.

That’s a testament to how much America’s vaccine campaign has improved since Biden took office. Before Inauguration Day, the country administered less than 1 million shots a day. Today, the US is at 2.5 million shots a day, on average.

At the current rate, the country could hit Biden’s goal of 200 million shots in 100 days — hitting the goal as soon as April 28, a couple days before Biden’s 100th day in office.

Things stand to improve beyond the current rate. As vaccine manufacturers ramp up production, they’ve already made deals with the federal government to deliver enough vaccines for every adult in the summer. At the very least, that should address questions about the supply of vaccines, though not about distribution or willingness to take them.

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Biden previously pledged that the US will have enough vaccines for every adult in the US by the end of May. Getting all of those vaccines into arms will require a distribution boost: At the current rate of 2.5 million shots a day, only about 180 million adults, of roughly 255 million, will be fully vaccinated by the end of May. The US has to do more than 4 million shots a day, on average, by then to fully vaccinate every adult in the US before June.

That will be a challenge, with lots of potential factors involved: whether drug companies can ramping up manufacturing, whether the federal government can ship those vaccines out, whether local and state governments can turn those doses into shots in arms, and whether vaccine hesitancy is sufficiently addressed to get all adults to want the vaccine.

That’s a lot that could go wrong. Biden, for his part, has vowed to get ahead of these issues, dedicating more money to vaccine distribution and public education and awareness efforts, funded in part by the recently enacted Covid-19 relief package.

Now Americans waiting for a shot will have to wait and see if Biden can turn those promises into reality.

THE TWO SIDES beaten in the 2021 All-Ireland series by the eventual champions Tyrone, met in Tralee on Saturday night.

Kerry and Mayo both entered the game unbeaten in the league to date, and while the spoils went to the home team, both remain in the top two spots in Division 1.

Part of the current leading football group, what can either take from the mid-March meeting on a night of torrential rain?

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Kerry dig deep for victory

There were clear parallels that could be drawn between Kerry’s Round 5 tie on Saturday and their Round 1 game in late January in Newbridge. They were in front 1-10 to 0-9 in the 58th minute against Kildare and were ahead of Mayo 1-10 to 0-10 in the 55th minute in Tralee.

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Kerry didn’t move the scoreboard thereafter against Kildare, hauled back for a draw as they leaked the last four points of the match. On Saturday something similar looked set to happen as three Mayo points on the spin drew them level but Kerry found the wherewithal to push ahead twice through David Clifford frees, the last proving the match-winner.

In a bruising battle on a sodden night, it was easy to understand why Jack O’Connor was so satisfied afterwards. He cannot influence how lopsided Munster football has become in his team’s favour, they are standout favourites to add another provincial title to their collection by late May.

That system will prompt concerns of them being undercooked by the time they reach the All-Ireland series. O’Connor’s awareness of that explains why he stressed after Saturday night’s game, that this was one they had explicitly targeted to collect a win.

Hitting the net and missing the target

A core strength of Mayo teams is their defensive prowess, specialist markers at the back allow them to push on further upfield. Padraig O’Hora and Oisin Mullin were principally detailed to protect the goalmouth on Saturday night, both taking up position next to David Clifford at different stages.

They were really only unlocked once, but it was a critical moment. Tony Brosnan skipped through in the 21st minute after a move he started himself, that availed of Lee Keegan slipping, with the swift passing of Clifford and Adrian Spillane also integral, before the Dr Crokes man slammed his shot to the net.

Kerry forward Tony Brosnan (file photo).

Source: Ben Brady/INPHO

Kerry were clinical when the first-half chance presented itself, Mayo in contrast were not. Aiden Orme’s connection was poor as he dragged a shot wide and Diarmuid O’Connor was denied by Shane Murphy’s intervention, both in the second quarter when raising a green flag would have boosted Mayo’s prospects.

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If it seems a simplistic analysis, it’s worth thinking back to that aspect of last year’s All-Ireland final and how this can be a recurring issue for Mayo. Kerry have seven goals in this year’s league to date, joint highest in Division 1 with Armagh, and only bettered by Galway’s tally of nine across the top two tiers.

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Absent attackers

Shortly before throw-in, there was a row of seats filled in the main stand at Austin Stack Park. David Moran, Dan O’Donoghue, Gavin White and Sean O’Shea amongst the group that filed in, a reminder of how Kerry’s depth had been tested. The absence of O’Shea, instrumental to Kerry’s progress this spring, was a reminder of how his playmaking talents at 11 will be central to Kingdom aspirations this year. Paul Geaney, a late withdrawal through illness, is another valuable option closer to goal.

Ryan O’Donoghue in action for Mayo against Kerry.

Source: Lorraine O’Sullivan/INPHO

Mayo lacked their own big-name forwards. Tommy Conroy’s season-ending knee problem will continue to be a source of regret for their camp. There has yet to be a sign of Cillian O’Connor in action since his Achilles tendon injury last June brought his year to a halt. Much of Mayo’s attacking strategy on Saturday night revolved around Ryan O’Donoghue as a focal point and if he didn’t score from play, he was a constant menace in winning frees, which he nervelessly converted. Fergal Boland weighed in with three impressive points but Mayo’s forward line lacked the necessary output to win this.

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The rapid spread of new variants of the coronavirus, some of which seem to be more contagious than older versions, has experts in the US calling for stricter social distancing and better masking to avoid yet another big surge of new Covid-19 cases and deaths.

Health advocates and epidemiologists are particularly concerned about what will happen once the new variants find their way into prisons, jails, and immigration detention facilities.

Across the US, at least one in five incarcerated individuals has already been infected with Covid-19, and a disproportionate number of them have died. One study found that the 2.3 million Americans living behind bars have twice the risk of dying from Covid-19 as a similar person who is not.

Jaimie Meyer is an associate professor at Yale School of Medicine and a researcher and clinician who specializes in the spread of infectious diseases behind bars. The pandemic “has laid bare [and] exposed the issues around conditions in confinement,” she told Vox, including how difficult or impossible it is to truly safeguard those held behind bars. In its quest to survive, Covid-19 will find “all of the holes [in our public health strategy] … all of the weaknesses, and pressure test them” she added. “If facilities have not done something to keep people safe, a more highly transmissible strain will spread like wildfire.”

An epidemiological nightmare

Prisoners are at an increased risk of Covid-19 for a simple reason: how the virus spreads. Scientists now know that the illness is mostly passed from person to person through respiratory droplets and sometimes through the air, which is why being in sustained, close proximity to others is so risky — and why crowded prisons and jails are especially dangerous. Contagion also frequently happens even before someone has symptoms, making it impossible to know who to isolate without frequent, rapid, near-universal testing.

“Congregate settings in general, and prisons in particular, are places where physical distancing is impossible,” said Meyer. Moreover, she added, people in prisons are more likely to have certain medical conditions, including obesity and diabetes, that put them at greater risk of infectious diseases.

The epidemiological realities of Covid-19 have been exacerbated by the failures of elected officials and institutions whose job it is to protect those who are incarcerated. Chris Beyrer, a professor of public health and human rights at Johns Hopkins, has been a vocal critic of Maryland’s approach to managing the crisis. In December, cases of the virus in the state’s prisons more than doubled.

“The single most important thing you have to do to deal with Covid in prison is to [reduce] overcrowding,” he told Vox. “We failed at that.” Although prison and jail populations dropped at the outset of the pandemic — mostly because fewer people entered the system due to virus concerns, rather than early release pushes — these populations are now on the rise again.

The second most important thing is to implement policies that can stem the spread of the disease, including social distancing and giving prisoners and staff masks and other essential supplies. “That, too, has been slow, inadequate, and insufficient,” Beyrer said. The Maryland Department of Corrections, he told Vox, isn’t providing free, unlimited bars of soap to people locked up in the state, leaving prisoners unable to do something as fundamental as wash their hands.

And the concerns don’t stop there. In facilities across the country, incarcerated people have reported a range of serious safety issues during the pandemic: correctional officers who refuse, or are not required, to wear masks; insufficient or failed efforts to test staff and incarcerated people; and the creation of new outbreaks by transferring Covid-positive prisoners to new facilities.

Meanwhile, vaccination has not even begun in most of the country’s prisons and jails, while those in other congregate settings — including nursing homes and homeless shelters — have been among the first in line to receive the shot.

“We are living through the failure of the basics of Covid prevention,” said Beyrer.

With all of these systemic shortcomings, many are extremely worried prisons and jails will be even harder hit when more contagious strains breach their walls. Early research has indicated that people infected with the new strain may carry higher viral loads, meaning that engaging in the same conduct — spending extended periods of time indoors without distancing — poses an even greater risk of spreading the virus than it did previously. For prisoners, that means that the worst outbreaks may be yet to come.

“A more infectious virus is only going to infect more people,” Beyrer said. “If more people are going to get infected, more people are going to die.”

“Scared as hell”

With so few resources to protect themselves and, in most places, no vaccine in sight, many prisoners are worried about the future. Jabriel Lewis is incarcerated at Allenwood federal prison in Pennsylvania. “That new strain got everybody in here scared as hell,” he said. “[I]f it gets into the federal institutions it could possibly mean a death sentence.”

For Michelle Angelina, a woman locked up in New Jersey’s Edna Mann facility, the threat posed by the new variants isn’t limited to the virus. The steps the prison system has taken to protect prisoners — shutting down all visitation, ending academic and substance abuse programming, and canceling religious services — will only be extended even further. “It’s putting an immense strain on all of us.”

Her concerns were echoed by Shebri Dillon, a woman incarcerated at Fluvanna Correctional Center at Virginia, who described the difficulty of spending “hours upon hours in a concrete cage, without seeing or hugging our children and family.”

“This new variant means an extension of all that pains us,” Dillon told Vox. “It is not a matter of if it will get in, but when.”

A matter of equity and public health

There are basic ways, however, to protect this large, vulnerable segment of the population — and the rest of the public at the same time.

For epidemiologists, advocates, and incarcerated people, the answer is to implement the policies they’ve recommended all along. “The implications of a more rapidly spreading Covid-19 variant in jails are clear,” said Robert Cohen, a physician who previously worked on Rikers Island and now serves on the Board of Corrections that oversees New York City’s jails. In addition to providing better access to basic PPE, sanitizing supplies, and testing, as many people as possible need to be released from prisons, jails, and other detention facilities, stressed Cohen, and all remaining incarcerated people and staff must be inoculated against the virus sooner rather than later.

In a handful of states, including Massachusetts and California, the vaccinations of prisoners have already begun — but in many places, including New York, they aren’t being prioritized for the vaccine.

Advocates say this reality is just another example of the inequitable impact of the virus on poor people and people of color, given that Black and Latinx individuals are locked up at many times the rate of their white peers. “Despite calling for equity in vaccine distribution, [New York’s] Gov. Cuomo has neglected incarcerated people even while rolling out vaccines to other congregate settings,” including homeless shelters, said Katie Schaffer, director of advocacy and organizing at Center for Community Alternatives, which provides programming and policy work to reduce incarceration across New York state.

While many incarcerated individuals are eager to be inoculated, vaccine hesitancy does exist inside prisons and jails, in no small part due to the long history of medical experimentation inside these facilities. Some agencies are providing incentives to encourage prisoners to participate, including video visits with family members and slightly shortened sentences, while outside initiatives have sought to educate prisoners about the vaccine and its safety. Since the two coronavirus vaccines in the US currently only have emergency approval from the FDA, it’s likely unlawful for correctional authorities to mandate that prisoners or staff receive the shot.

Releasing more prisoners and accelerating the vaccination of those left inside is not only a matter of human rights, say public health officials — it’s also a necessary step to protect the public at large.

There are indications that widespread infection inside these sorts of facilities easily spreads to the community and beyond. One study found that the March outbreak in Chicago’s Cook County jail contributed to about one in seven of the state’s total cases in the following month. Prisons have also incubated especially deadly variants of other illnesses, including strains of multi-drug-resistant tuberculosis.

“This is part of our public health,” said Meyer. “We should all want people who are in any congregate setting to have the best chance of preventing exposure and infection” — for their own health and safety as well as that of everyone else in the country.

Aviva Stahl is an award-winning investigative reporter who writes about how health care policy and scientific debates play out in the prison context. She’s written for a variety of outlets including Vox, the Guardian, and the New York Times, and can be followed at @stahlidarity.

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The pandemic is becoming a grief crisis

March 25, 2022 | News | No Comments

It’s been nearly a year since Julie Horowitz-Jackson’s mother, Arlene, died of Covid-19 in a nursing facility in Philadelphia. “What hit me recently is that the world is opening back up, and my mom’s still dead,” Horowitz-Jackson says.

At this point in the Covid-19 pandemic, as vaccines get rolled out in the United States and around the globe, there is a glimmer of hope that life will safely start shifting back to “normal” in the coming months. But so many people, like Horowitz-Jackson, are still working through their grief, and it won’t just disappear when the virus does. Horowitz-Jackson, 51, says she was coping well with the loss of her mom until recently, when, in Chicago, where she lives, she saw many people out and about, celebrating St. Patrick’s Day in large crowds. “I get angry,” she says. “I get angry that people aren’t taking it seriously.”

With over 550,000 reported Covid-19 deaths in the US and 2.8 million worldwide, a massive grief crisis is upon us — with large, unaddressed mental health and economic implications.

“For a large share of people, these [losses] lead to bouts of prolonged grief disorder and depression,” says Ashton Verdery, a Penn State sociologist who studies the societal costs of bereavement. “But also they have huge impacts on their finances, on their employment, on their relationships, and on all kinds of aspects of thriving in the world.”

And new research here provides a broad window onto the lasting scope of our national tragedy.

“These losses that are felt now will be felt for some time to come — even individuals who aren’t born yet will potentially be missing these relatives who might have been alive during their formative years,” says Mallika Snyder, a graduate researcher at UC Berkeley who is also working on estimates with colleagues of the “excess bereavement” felt in the United States and other countries this year.

There’s no exact figure on the amount of “excess bereavement,” but it’s likely very large, and very devastating.

So many more people are grieving this year than normal

Lately, I’ve been trying to understand the long-term consequences of the Covid-related death — the blank spaces and shadows it leaves behind. Death is not a one-dimensional statistic. It ripples across time, leaving holes in people’s present and future where their loved ones would have been. So, so many people are sensing these holes in their lives right now.

Recently, Verdery and colleagues estimated that, roughly, every person who dies from Covid-19 in the United States leaves nine grieving people behind. Since more than 550,000 people have died of Covid-19 here, then there are nearly 5 million people who’ve suffered the loss of someone close to them.

Verdery’s work is based on a statistical model of the personal connections people typically have. The Centers for Disease Control and Prevention collects data on who is dying of Covid-19, but not the survivors they leave behind.

That said, Verdery says his team’s work suggests a huge swath of people are dealing with loss. “Each death [regardless of their age at death] is going to leave a 4-year-old, a 50-year-old, a 60-year-old, a 10-year-old bereaved, on average,” he says.

And researchers know from past disasters that those losses can leave a lasting mark.

Meghan Zacher, a sociology researcher at Brown, has recently re-analyzed some mental health and wellness data collected from survivors of Hurricane Katrina, in an attempt to predict some of the long-term consequences of the pandemic. “Katrina and Covid are different in really important ways,” she stresses. “This isn’t an apples-to-apples comparison. But there really isn’t an apples-to-apples comparison to the pandemic, at least in modern history.”

She and her co-authors found that the experience of losing a relative or a friend during the storm and its aftermath had the “largest effects on mental and physical health, one year after the storm,” she says. “Also things like fearing for your loved ones’ safety had sizable impacts, as did unmet medical needs. And those are all things that people have experienced during the pandemic.”

Many people experiencing loss from death could benefit from counseling. Covid-19 swells their numbers.

The loss of a loved one is really hard, and not everyone copes in the same way. But there’s some research into the broad buckets of need grieving people fall into. And that helps us understand the immediate impact this bereavement crisis is having in the country — and around the world.

Survey research suggests that, at least in Western contexts, around 60 percent of people dealing with a loss cope by relying on friends and family to support them. “They handle it in their own way,” says Catriona Mayland, a physician and researcher at the University of Sheffield who studies end-of-life issues. It’s not necessarily easy for this group to deal with loss. But they manage.

A further 30 percent might need some more structured help. “So that might be group bereavement support from a faith-based or community-based group,” Mayland says.

And then around 10 percent of those who lose someone close to them experience symptoms qualifying them for a prolonged grief disorder, a diagnosis that soon will be included in the DSM (the psychology/psychiatry official diagnostic manual).

The diagnosis recognizes that sometimes grief rises to the level of severely interfering with the normal function of life, and that people experiencing prolonged grief could benefit from mental health care.

That 10 percent figure is both small and large. It means that, yes, most people cope with loss in their own time. But it’s also not uncommon for someone to need extra help.

And then consider the Covid-19 pandemic. Again, there could be 5 million people grieving losses due to the pandemic. If 10 percent of those people qualify for this diagnosis, that’s half a million people.

There’s even some limited research from the Netherlands suggesting losses due to Covid-19 are harder to take, resulting in more grief, compared to deaths from more typical natural causes.

Talking with people who have experienced loss, it’s easy to see why. Horowitz-Jackson’s family is Jewish, and it’s custom for the family and surrounding community of the deceased to hold a week-long open house “shiva” period, where there’s near-constant company in the home.

“Shiva Zoom was about the worst thing I’ve ever experienced,” she says. Particularly, she remembers how her father, hard of hearing, struggled with the technology. “The ritual of seeing each other and leaning on one another,” she says, just couldn’t be facilitated as well over the internet.

Mayland worries, too, that “there actually could be an upward shift” in the number of people needing more than informal support after a loss, since due to the social distancing restrictions of the pandemic, “normal support” from family and friends may be limited.

Which is all to say: More people than usual may need support to deal with their loss.

Bereavement can impact health and well-being differently at different ages

A person older than 65 who loses a spouse has a “shockingly elevated” increased risk of dying over the next year, Verdery says — estimates range from 15 to 30 percent higher risk of dying. There are many reasons: Our loved ones take care of us when we’re sick, they prod us to get checked out by a doctor, they provide emotional and sometimes financial support. When a loved one gets taken out of the picture, so many cracks can form in the foundations of our lives.

There is, quite literally, a condition called “broken heart syndrome,” or takotsubo cardiomyopathy. It’s when, in reaction to a sudden surge in stress, the heart’s left ventricle weakens.

The experience of loss can be particularly impactful on the trajectory of a life when it comes to young people: When a person under the age of 18 loses a parent, they become less likely to finish high school or college. “Because we know that education is so strongly linked to all manner of life course outcomes — like involvement in the prison system, socioeconomic status in adulthood, unemployment spells, early pregnancy, all sorts of stuff — this does suggest that some of these bereavement events might be really derailing,” Verdery says.

The impact of these deaths is so powerful that bereavement is thought to be a source of racial disparities in health and education in America. By age 20, a Black child is twice as likely to experience the death of a mother and 50 percent more likely to experience the death of a father. The pandemic is likely to make this trend worse — as we know Covid-19 has been taking minorities at younger ages than white people dying from it.

And American society doesn’t do well to protect these grieving kids. It’s estimated that less than 50 percent of children who experience the loss of a parent receive Social Security survivors benefits (which they may be entitled to). “This is one of the most staggering statistics that I found,” Verdery says. “The kids are already dealing with so much. And we’re not even getting them in touch with the benefits they’re entitled to.”

What should we do about this?

After experiencing the loss of her child, Joyal Mulheron, a former adviser to Michelle Obama’s “Let’s Move” campaign, felt the extreme, life-altering pain bereavement can bring. “I basically drove to work every day for 18 months and cried to and from work,” she says. And it wasn’t just her personal pain that was horrible — she also realized that society often overlooks bereavement issues.

Now Mulheron runs Evermore, a bereavement-focused nonprofit, and hopes the pandemic will be a wake-up call for the country to start paying closer attention to the societal strain bereavement puts on the country. “The challenge is no one is thinking about it as an event that can change the course of an individual’s life,” she says.

For instance, she points out that “bereavement is not part of the FMLA” — the Family and Medical Leave Act, which provides time off for those caring for sick family members, but not to cope with their loss. She calls for better housing protections for those who lose financial support after losing a loved one, more transparent funeral pricing, and better Social Security assistance for kids who lose parents.

She also simply would like to see this issue be studied more thoroughly. “We’ve not had the data to really contextualize this,” Mulheron says. “We’ve really thought of a death event as a personal tragedy, rather than a family or a community experience.” At the very least, Mulheron would like to see the White House establish an Office of Bereavement Care, to set a national agenda on this issue.

On a smaller scale, Mayland, the physician who studies end-of-life issues, says it can be helpful just to find spaces to talk about grief, and more helpful still if friends and family reach out with an ear to listen. “Sometimes it’s therapeutic to be able to tell a story,” she says.

“Each time I talk about it, I feel like I’m honoring her memory,” Horowitz-Jackson, the Chicago woman who lost her mother, says.

And don’t forget, Mayland stresses, “Individual kindness can have an impact. It often is the small things that actually can make a difference.”

If you’re reading this, having lost someone to Covid-19, know that you are not alone. So many people are experiencing loss in the country right now, and the pain might not go away when life appears to return to normal.

For some additional resources on bereavement, check out Refuge in Grief, a website and online community with worksheets and courses for processing grief. And you can read more about therapies designed to help people with complicated grief here.

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July 4 this year could also be America’s Independence Day from Covid-19.

At current rates, America is administering nearly 2.8 million Covid-19 vaccine doses a day — roughly enough to vaccinate every adult (18 and older) in the country by July 4.

That would mean 80 percent of the population would be able to get a vaccine. We don’t know for certain if that’s enough for herd immunity, when enough of the population is immune to the disease, through vaccines or natural infection, that the virus can no longer sustain its spread. But it’s in the range that experts typically mention.

Since a vaccine isn’t yet approved for children younger than 16, this is also close to the highest level of vaccination we can expect for the time being. (The estimates in this story don’t include 16- and 17-year-olds who are eligible for vaccines.)

As of Tuesday, March 30, about 96 million adults in the US have received at least one shot. More than 53 million, around 21 percent of adults, have been fully vaccinated, according to the Centers for Disease Control and Prevention.

At current rates, then, America could fully vaccinate up to 255 million people by July 4 — covering the entire adult population. (This is assuming about one-third of doses are the Johnson & Johnson vaccine, which, unlike the Moderna and Pfizer vaccines, requires one shot instead of two.)

The rollout is likely to speed up even more. In the coming weeks, drug companies are expected to deliver as many as 4 million doses a day to the federal government. If the companies deliver and states can turn those doses into shots in arms, it’d be enough to meet President Joe Biden’s goal to have enough vaccine supply for all adults by the end of May and, potentially, vaccinate all adults by June.

That would leave the rest of the summer to, hopefully, live life closer to the pre-pandemic normal, without worrying about the coronavirus.

None of this seemed very likely before Biden took office, when the US was administering fewer than 1 million shots a day. But local, state, and federal governments, along with the health care system, have worked around the clock since then to improve the rollout. We’re now seeing the results, with the rate of vaccinations improving steadily from day to day.

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A lot can still go wrong. Maybe the drug companies won’t be able to deliver on the supply they’ve promised. Maybe cities, states, and the feds won’t clear all the logistical hurdles to get shots in arms. Maybe something else will break in a fairly complicated supply chain.

And as supply increases, it’s likely vaccine hesitancy will become a bigger issue as more adults simply refuse a vaccine. Overcoming that — to continue increasing the nationwide rate of vaccinations — will require creative education and awareness campaigns, focused on local pockets of resistance. That will pose its own logistical challenges.

The country is also seeing a recent increase in Covid-19 cases. If that marks the beginning of a fourth surge, it could lead to another wave of illness, hospitalizations, and deaths. It could also give the virus the room it needs, through millions more replications as it jumps from host to host, to mutate into another variant. So far, the current vaccines seem to work well against the variants, but that could change if the virus is allowed to mutate once again — and upend the US’s vaccination efforts.

At the very least, though, the country can see a likely finish line just a few months away. After more than a year of dealing with the coronavirus, America is so close to potentially breaking free.

THERE’S A STRONG Galway contingent in this year’s Hurling Team of the Year selection, awarded after the recent Fitzgibbon Cup and Ryan Cup finals.

Six Galway players are included, the same number as champions UL. Beaten finalists NUIG have four players included, with beaten Fitzgibbon Cup semi-finalists GMIT and IT Carlow having two representatives each.

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Kerry’s Fionán Mackessy is included, from the Ryan Cup winning MTU Kerry side. Limerick star Cian Lynch, Waterford goalscoring hero Mikey Kiely and Tipperary’s brilliant defender Bryan O’Mara are some of the main names in the selection.

Galway, Laois, Tipperary, Kilkenny, Kerry, Limerick, Waterford and Clare are the counties with players honoured.

The equivalent football awards will be unveiled on Monday 21 March with the Rising Star Hurling and Football Player of the Year announced on 4 April.

2022 Electric Ireland HE GAA Rising Stars Hurling Team of the Year

  • 1. Darach Fahy – GMIT – Ardrahan, Galway.
  • 2. Podge Delaney – IT Carlow – The Harps, Laois.
  • 3. TJ Brennan – UL – Clarinbridge, Galway.
  • 4. Jack Fitzpatrick – NUIG – Killimordaly, Galway.
  • 5. Cianán Fahy – GMIT – Ardrahan, Galway.
  • 6. Bryan O Mara – UL – Holycross/Ballycahill, Tipperary.
  • 7. Niall Brassil – IT Carlow – James Stephens, Kilkenny.
  • 8. Ciaran Connolly – UL – Loughmore/Casteleiney, Tipperary.
  • 9. Fionán Mackessy – MTU Kerry – St Brendan’s, Kerry.
  • 10. Cian Lynch – NUIG – Patrickswell, Limerick.
  • 11. Gearóid O’Connor – UL – Moyne/Templetuohy, Tipperary.
  • 12. John Fleming – NUIG – Meelick Eyrecourt, Galway.
  • 13. Mikey Kiely – UL – Abbeyside/Ballinacourty, Waterford.
  • 14. Mark Rodgers – UL – Scariff, Clare.
  • 15. Evan Niland – NUIG – Clarinbridge, Galway.
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Over the past few days, Covid-19 cases have taken an upward turn — a trend that led Centers for Disease Control and Prevention Director Rochelle Walensky to say she has a sense of “impending doom.”

The increase might seem small; the US is still better off than it was in January. And news about America’s Covid-19 vaccine rollout keeps getting better and better. But there’s a reason Walensky and other public health officials and experts are still so worried about the uptick in cases: exponential spread.

With Covid-19, as well as other infectious pathogens, the start of new waves of disease comes slowly. But as more people get infected with the virus, the surge starts to pick up. Pretty soon, daily new cases can start doubling in a matter of days or weeks — and by then, any reaction from the public or policymakers is doomed to be too little, too late. It’s made even worse by the possibility of coronavirus variants: As the virus spreads and replicates exponentially, it gets more chances to mutate, potentially leading to another new, possibly more infectious variant.

So now is the time to redouble efforts against the coronavirus — before things get out of control. That means continuing the basic precautions that have long worked against Covid-19: social distancing, masking, and testing and tracing. It also means speeding up America’s vaccine rollout.

The good news: This could be the last threat of a Covid-19 surge that the US has to deal with, at least in the near future. With the vaccine rollout picking up nationally, America is now on track to vaccinate every adult by July 4. Once that happens, the threat of the coronavirus could very well be behind us — barring any new variants or needed refreshers in immunity if the vaccines’ effects prove to be temporary.

But with the end so close, experts say now is not the time to ease up. Every single infection, hospitalization, and death that’s avoided now is an infection, hospitalization, and death that truly might never happen. The finish line is near, and the goal should be ensuring more people make it across.

“Summer will be great,” Brown University School of Public Health dean Ashish Jha wrote. “How many get infected now, sick or die next month is up to us.”

Covid-19 cases have picked up across the US

According to the CDC’s tracker, Covid-19 cases have ticked up a bit over the past couple of weeks. On March 14, the country reported a recent low below 53,000 cases a day, on a weekly average. Most recently, as of March 29, the country neared 62,000 cases a day.

That has not yet translated to a significant increase in hospitalizations or deaths nationally. But hospitalizations and deaths tend to be a lagging indicator — people can take days or even weeks to land in the hospital once they’re infected, and then deaths can occur a few weeks after that.

The increase seems to be driven by surges in a few states, including Michigan, New York, New Jersey, and Connecticut. Notably, Covid-19 hospitalizations and deaths in Michigan — which has seen one of the worst recent surges — have already trended up.

The national increase in cases is likely tied to a variety of factors: the public easing up on precautions, policymakers relaxing restrictions, and more infectious coronavirus variants reaching the US.

Now that increase is causing concern among health officials that America could be seeing the sparks of a fourth surge. Covid-19, like other epidemics, tends to start slowly, with the spread of the virus rapidly picking up as more people get infected.

For example: During the US’s third surge, in the fall, the country took about one month to double from around 40,000 to 80,000 cases. But then it took only around two weeks for cases to double once again, from 80,000 to 160,000 cases. That’s exponential spread.

The goal of public health is to avoid letting the situation get this bad to begin with. In fact, with Covid-19 cases still so high — the US’s recent plateau of around 50,000 cases is still higher than its plateau before the fall surge — the preference would be to bring cases lower, as close to zero as possible. That’s why Walensky is sounding the alarm now.

Instead, states are moving in the opposite direction. Over the past few weeks, state leaders have eased their Covid-19 restrictions — with some, like Texas, ending their mask mandates entirely. There’s good evidence that the restrictions, including mask mandates, work, so the states’ moves could help cause the fourth surge the CDC’s director is now worried about.

It’s particularly alarming, though, because these states may only have to hold out a little while longer to avoid any more surges.

The end of the pandemic is near. Let’s make sure more people make it.

America’s Covid-19 vaccine campaign is truly getting better. The country has gone from administering fewer than 1 million shots a day before President Joe Biden’s inauguration to nearly 2.8 million a day as of March 30. At the current rates, every adult in the US could be fully vaccinated by July 4 — a new kind of Independence Day.

We’re probably already feeling some of the effects of these vaccine efforts. According to the CDC, about 73 percent of adults 65 and older, the group that represents roughly 80 percent of Covid-19 deaths, have gotten at least one shot, and nearly 50 percent are fully vaccinated. It’s likely that the high vaccination rate for older Americans is already saving a lot of lives — and may prevent a potential fourth surge from being as deadly as past waves.

But that’s not to say the end is here; it’s merely near. More than half of the very vulnerable 65-plus population still isn’t fully vaccinated, and around 80 percent of the rest of the adult population still isn’t fully vaccinated. There are also big racial disparities, with white people more likely to have received their vaccine so far than their Black or Hispanic peers, even as Covid-19 has hit Black and Hispanic communities harder. That leaves hundreds of millions of people in vulnerable populations still susceptible to the virus.

The known coronavirus variants, and the possibility that more might emerge, are also a reason for concern. Some known variants are more infectious and can partly overcome immunity — not enough to nullify vaccine-induced immunity, based on the evidence so far, but still a concerning sign. There’s a lot of anxiety within public health circles that the coronavirus could find the right set of mutations to completely overcome the current vaccines, putting us all back to square one in fighting the pandemic.

The one way to prevent the development of new variants is by slowing the spread of the coronavirus. Every time the coronavirus infects another host, it quickly replicates so it can continue spreading. With each of these replications, there’s a chance that the virus will mutate. If that mutation proves beneficial to the virus and catches on more broadly, that could develop into yet another variant of concern. The best way to prevent all of this is by ensuring the coronavirus doesn’t find new hosts to replicate in and spread through to begin with.

This has to be done globally — a variant that shows up in another country could easily end up in the US, as we’ve seen with the variants first found in the UK, South Africa, and Brazil already. But Americans can begin this work at home.

For the public, stopping a fourth wave and discouraging the growth of new variants means taking the usual precautions against the virus, like social distancing and masking, and getting a vaccine when it’s available. For lawmakers and the health care system, it means holding steady on restrictions for now and speeding up the vaccination campaign.

The US can finally see the end of the pandemic. But between now and then, possibly tens or hundreds of thousands of people could die to Covid-19, depending on how bad we let things get. Making sure a fourth surge never comes is the one way we can guarantee that more of our family, friends, and neighbors make it to that finish line. The history of Covid-19 shows that to really do that, though, the country will have to take action sooner rather than later.

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About 2 percent of new cars on US roads right now run on electricity. The auto industry expects that by 2030, half of new car sales will be electric. And President Joe Biden is stepping on the gas pedal to make that happen.

Among the many provisions of the White House’s $2 trillion infrastructure and jobs plan released last week is $174 billion to support electric vehicles, the single largest item in the proposal’s transportation section.

That money will help pay for 500,000 electric vehicle chargers over the next decade, an idea from Senate Majority Leader Chuck Schumer. It also covers modifying factories to build electric vehicles (EVs), grants and tax incentives to encourage buyers, and shoring up a domestic supply chain to make electric cars and trucks.

Electrifying transportation is a major component of how the Biden administration plans to tackle climate change. The transportation sector is the largest source of greenhouse gases in the US. Cars and light trucks account for 60 percent of these emissions. So EVs would be a huge step toward meeting Biden’s goal of decarbonizing the US economy by 2050, alongside a decarbonization of the power sector.

These ideas are an abrupt turn from Biden’s predecessor. The Trump administration moved to weaken federal fuel economy rules for cars and light trucks, going as far as to sue the state of California for reaching a voluntary agreement with several automakers to impose its own stricter standards.

Getting a significant share of the US’s 270 million vehicles electrified by 2030 would be a massive leap. And US automakers, despite their insistence on an electric future, have so far been lackadaisical in their electric offerings, while continuing to crank out fuel-thirsty SUVs, crossovers, and even larger pickup trucks.

The effort to switch to EVs is a microcosm of the broader effort to fight climate change — any shift to a carbon-neutral economy requires everyone to act, but the federal government only has so many levers. Short of direct mandates, the government will need to use a system of nudges and prods to get everyone from companies to car buyers to homeowners to make the requisite investments in clean energy.

But if the US can pull off electrification of its greatest contributor to climate change, it bodes well for decarbonizing the rest of the economy.

Biden’s plan requires the government to lead by example — with big fleets of electric vehicles

One of the big challenges with switching over to EVs is that a lot of people have to choose to buy them. It’s tricky to convince finicky consumers to buy something without a mandate, but Biden does have the massive purchasing power of the government at his disposal.

He has already pledged to replace the federal government’s 650,000 vehicle motor pool with electrics. “The federal government also owns an enormous fleet of vehicles, which we’re going to replace with clean electric vehicles made right here in America made by American workers,” Biden said in a January press conference. Currently, the US government’s fleet has just over 3,000 electric vehicles.

The new infrastructure proposal also calls for electrifying 20 percent of the nearly 500,000 US school buses with a grant program administered through the Environmental Protection Agency.

Some Democratic lawmakers are also pushing to halt a $6 billion contract to build the next generation of US Postal Service delivery vehicles. The contract, awarded in February, calls for up to 165,000 vehicles from a mix of gasoline and electric variants. Democrats want those vehicles to be entirely electric.

Delivery vehicle fleets are a ripe target for electrification because purchasers like USPS can take advantage of bulk discounts. Mail trucks also return to a central location at the end of their rounds, meaning less charging infrastructure is needed.

“Squandering this once-in-a-generation opportunity by spending billions of dollars on vehicles that will be custom built for obsolescence — indeed, by the end of their operating lives they will be the last internal combustion fleet vehicles on the road — and defying President Biden’s Executive Order is utterly unacceptable,” 13 House Democrats wrote in a letter to the Postal Service’s Board of Governors last month.

Private delivery fleets are already investing in electric delivery, with FedEx vowing to run a 100 percent electric fleet by 2040.

While big purchases of delivery trucks and buses aren’t likely to sway car buyers, ordinary drivers considering EVs could still benefit from the supply chain boost for components like batteries and the buildup of charging infrastructure.

Another upside of electrifying trucks, buses, and delivery vehicles is the opportunity to get many of them off of diesel fuel. Diesel pollution accounts for 180,000 deaths around the world each year. So the transition to cleaner fleets doesn’t just have a benefit to the climate over the long term but yields an immediate health benefit.

The government and the auto industry still need to do more to meet their electric goals

Bulk purchases and a massive expansion of EV charging are important steps, but they aren’t enough on their own to convince wary car buyers to give up the rumble of a gasoline engine.

A YouGov poll from October 2020 found that half of Americans would support a mandate to end fossil fuel-powered vehicle sales, similar to California’s plan to limit auto sales to zero-emissions vehicles by 2035.

However, the main deterrent to buying EVs for most Americans isn’t the number of charging stations. According to the poll, the highest-ranking concern was charging time, followed by a higher upfront cost for EVs, the hassle of charging, and the cost of charging at home. Subsidies and tax credits can offset some of the cost concerns, but the other hurdles may require technological advances that aren’t here yet.

Carmakers, for their part, have put out plans for more electric vehicles over the coming decade. Volkswagen recently joked that it was changing its name to Voltswagen. Even Ford is working on an electric version of its F-150 pickup truck, one of the best-selling vehicles in the US.

But car companies will also have to put more marketing muscle behind their electric vehicles. Environmental groups have observed that automakers spend much less when advertising their cleaner vehicles than their larger, more expensive trucks and SUVs. These larger vehicles tend to have bigger profit margins than EVs.

Switching over to EVs would also require an incentive to take some of the oldest, dirtiest cars off the road at a faster rate, something that isn’t addressed in the current plan. During the Covid-19 pandemic, new car sales dropped, and used car sales shot up. Schumer has called for a “cash for clunkers” program, based on a similar idea from 2009, where people could trade in their gas guzzlers for discounts on EVs.

And while running an electric car is as clean as the electricity that charges it up, making EVs to begin with can have a higher carbon footprint, so better sourcing of critical components (like lithium for batteries) and more efficient manufacturing are also needed.

Automakers will need to prepare for even bigger changes on the horizon: How people drive today may not be how they drive tomorrow. With the advent of ride-hail apps, the push for greater urban density, more options for short trips like electric scooters, and the potential for autonomous vehicles, there is less need for everyone to have their own car. So while car companies may grumble about switching gears to cleaner cars, they still have to keep their eyes on the road ahead.

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