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New data disproves a big concern about Covid-19 lockdowns

March 25, 2022 | News | No Comments

Last year, as then-President Donald Trump railed against Covid-19 lockdowns and called on states to reopen their economies, he claimed the shutdowns would lead to a spike in suicides: “You’re going to lose more people by putting a country into a massive recession or depression. You’re going to lose people. You’re going to have suicides by the thousands.”

But new data suggests that the number of suicides actually decreased in the US last year. According to the National Center for Health Statistics, suicides totaled fewer than 45,000 in 2020, down from about 47,500 in 2019 and more than 48,000 in 2018.

So far, this seems to be true globally. England saw no increase in suicides in the aftermath of lockdowns, Louis Appleby, a researcher on suicide and self-harm at the University of Manchester, wrote for the medical journal BMJ. The same seems to be true in other nations, including Australia, Canada, New Zealand, Norway, Peru, and Sweden, based on data for the first few months of lockdowns around the globe.

“Our conclusions at this stage, however, should be cautious. These are early findings and may change,” Appleby wrote in BMJ. “Beneath the overall numbers there may be variations between demographic groups or geographical areas. After all, the impact of covid-19 itself has not been uniform across communities.”

Still, the news overall seems good.

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Trump wasn’t alone in his concerns. For much of 2020, this was a popular argument among opponents of lockdowns — that the measures would lead to an increase in suicides. Various news articles have echoed the claim in some form, exemplified by the recent New York Times headline, “Suicide and Self-Harm: Bereaved Families Count the Costs of Lockdowns.”

It’s all wrapped up in an argument that lockdowns weren’t worth the costs. As Trump put it, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”

The reality is lockdowns worked to contain the spread of Covid-19, based on studies from Health Affairs, The Lancet, the Centers for Disease Control and Prevention, and others. And experts now widely agree that it was the US’s move to reopen too quickly, fueled in part by Trump’s claims, that made the country one of the worst in the world for Covid-19 deaths.

That’s not to say the lockdowns were costless. The emotional anguish brought by isolation and lack of social contact, as well as the economic calamity of the last year, are both clear examples of the downsides to lockdowns — even if the measures were ultimately worth it in the face of a deadly pandemic.

According to one CDC study, self-reported mental distress increased in the early months of the pandemic (though it’s not clear if lockdowns were the cause).

Another category of “deaths of despair” — drug overdoses — also appeared to increase dramatically last year: The latest data shows there were more than 88,000 overdose deaths in the year through August 2020, up from nearly 70,000 in the same time period of 2019. It’s plausible that lockdowns fueled overdoses as people turned to drugs during isolation or as addiction treatment and harm reduction services closed down, though it’s also possible that the increase was driven by something else, like the continued spread of the dangerous synthetic opioid fentanyl in illicit drug markets.

There’s also genuine debate about how the lockdowns worked. Based on the more recent evidence, it seems like mass closings of schools were ultimately misguided — as children and schools ended up not being major vectors of the coronavirus’s spread. Meanwhile, the risky indoor spaces many states pushed to reopen quickly, like bars and restaurants, have proven to be significant sources of outbreaks. All of that suggests the US may have closed down the wrong places, while reopening the wrong places too.

At the very least, though, it seems lockdowns didn’t produce one of the bad effects people initially feared.

If you or anyone you know in the US is considering suicide or self-harm, or is anxious, depressed, upset, or needs to talk, you can call the National Suicide Prevention Hotline at 1-800-273-8255, or text CRISIS to 741741 for free, confidential crisis counseling. Outside the US, the International Association for Suicide Prevention maintains a list of crisis hotlines and their respective phone numbers around the world.

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By Tncse

Where billions of cicadas will emerge this spring (and over the next decade), in one map

March 23, 2022 | News | No Comments

For 17 years, cicadas do very little. They hang out in the ground, sucking sugar out of tree roots. Then, following this absurdly long hibernation, they emerge from the ground, sprout wings, make a ton of noise, have sex, and die within a few weeks. Their orphan progeny will then return to the ground and live the next 17 years in silence.

Over the next several weeks, billions of mid-Atlantic cicadas will hear the call of spring and emerge from their cozy bunkers. This year’s group, born in 2004, is known as Brood X. They’ll start their journey to the surface when soil temperatures reach around 64 degrees Fahrenheit.

While they’ll emerge in biblical numbers, they’ll be blanketing only a small slice of the country.

Cicadas appear every year on the East Coast, but it’s a different 17-year crew that wakes up each time. (There are some 13-year broods of cicadas in the Southeast, too.) Emerging in these humongous annual batches is likely an evolutionary strategy. There are so many cicadas all at once, predators (such as birds and small mammals) can’t make a meaningful dent in their numbers.

In sum, the broods lay claim to much of the eastern United States, stretching from New England to Oklahoma. You can see all of the US broods on the US Forest Service map below.

Brood X (shown in yellow) will be seen in Maryland, Delaware, Pennsylvania, Indiana, Ohio, and eastern Tennessee.

And while their mating calls are loud and annoying, cicadas are one of nature’s beautiful mysteries: No one — not even Sir David Attenborough — knows how the cicadas are able to count to 17 years underground.

Click play on the video below to watch Attenborough seduce a male cicada by imitating the clicks a female makes. Enjoy!

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By Tncse

Why you can’t compare Covid-19 vaccines

March 23, 2022 | News | No Comments

In the US, the first two available Covid-19 vaccines were those from Pfizer/BioNTech and Moderna. Both vaccines have very high “efficacy rates” of around 95 percent. But the third vaccine introduced in the US, from Johnson & Johnson, has a much lower efficacy rate: just 66 percent.

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Look at those numbers next to each other, and it’s natural to conclude that one of them is considerably worse. Why settle for 66 percent when you can have 95 percent? But that isn’t the right way to understand a vaccine’s efficacy rate, or to even understand what a vaccine does. And public health experts say that if you really want to know which vaccine is the best one, efficacy isn’t actually the most important number at all.

Watch the video above to learn more about how these numbers were calculated and why the “best” vaccine is the first one you can get. And read more from Vox’s Umair Irfan on why these efficacy numbers can be misleading.

You can find this video and all of Vox’s videos on YouTube. Subscribe for more.

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By Tncse

How to make this winter not totally suck, according to psychologists

March 23, 2022 | News | No Comments

This winter is brutal. The cold weather has made it hard to socialize outdoors, coronavirus variants are spreading, and the US is about to surpass half a million Covid-19 deaths. Many of us are feeling anxious about how we’re going to make it through the lonely, bleak weeks ahead.

I see a lot of people trying to cope with this anxiety by drumming up one-off solutions. Buy a fire pit! Better yet, buy a whole house! Those may be perfectly fine ideas, as far as they go — but I’d like to suggest a more effective way to think about reducing your suffering and increasing your happiness this winter.

Instead of thinking about the myriad negative feelings you want to avoid and the myriad things you can buy or do in service of that, think about a single organizing principle that is highly effective at generating positive feelings across the board: Shift your focus outward.

“Studies show that anything we can do to direct our attention off of ourselves and onto other people or other things is usually productive and makes us happier,” said Sonja Lyubomirsky, a psychology professor at the University of California Riverside and author of The How of Happiness: A Scientific Approach to Getting the Life You Want. “A lot of life’s problems are caused by too much self-focus and self-absorption, and we often focus too much on the negatives about ourselves.”

Rather than fixating on our inner worlds and woes, we can strive to promote what some psychologists call “small self.” Virginia Sturm, who directs the Clinical Affective Neuroscience lab at the University of California San Francisco, defines this as “a healthy sense of proportion between your own self and the bigger picture of the world around you.”

This easy-to-remember principle is like an emotional Swiss Army knife: Open it up and you’ll find a bunch of different practices that research shows can cut through mental distress. They’re useful anytime, and might be especially helpful during this difficult winter (though they’re certainly no panacea for broader problems like mass unemployment or a failed national pandemic response).

The practices involve cultivating different states — social connectedness, a clear purpose, inspiration — but all have one thing in common: They get you to focus on something outside yourself.

A sense of social connectedness

Some of the practices are about cultivating a sense of social connectedness. Decades of psychology research have taught us that this is a key to happiness.

In fact, Lyubomirsky said, “I think it is the key to happiness.”

That’s what Harvard’s Study of Adult Development discovered by following the lives of hundreds of people over 80 years, from the time they were teenagers all the way into their 90s. The massive longitudinal study revealed that the people who ended up happiest were the ones who really leaned into good relationships with family, friends, and community. Close relationships were better predictors of long and pleasant lives than money, IQ, or fame.

Psychiatrist George Vaillant, who led the study from 1972 to 2004, summed it up like so: “The key to healthy aging is relationships, relationships, relationships.”

Other studies have found evidence that social connections boost not only our mental health but also our physical health, helping to combat everything from memory loss to fatal heart attacks.

During our pandemic winter, you can socialize in person by, yes, gathering around a fire pit or maybe doubling your bubble. But there are other ways to make you feel you’re connected to others in a wider web. A great option is to perform an act of kindness — like donating to charity, or volunteering to read to a child or an older person online.

“I do a lot of research on kindness, and it turns out people who help others end up feeling more connected and become happier,” Lyubomirsky told me.

Lyubomirsky’s research shows that committing any type of kind act can make you happier, though you should choose something that fits your personality (for example, if you don’t like kids, then reading to them might not be for you). You may also want to vary what you do, because once you get used to doing something, you start taking it for granted and don’t get as much of a boost from it. By contrast, people who vary their kind acts show an increase in happiness immediately afterward and up to one month later. So you might call to check up on a lonely friend one day, deliver groceries to an older neighbor the next day, and make a donation the day after that.

A sense of purpose

Other practices are about cultivating a sense of purpose. Psychologists have found that having a clear purpose is one of the most effective ways to cope with isolation.

Steve Cole, a researcher at the University of California Los Angeles, studies interventions designed to help people cope with loneliness. He’s found that the ones that work tend to focus not on decreasing loneliness, but on increasing people’s sense of purpose. Recalling one pilot program that paired isolated older people with elementary school kids whom they’re asked to tutor and look out for, Cole told Vox, “Secretly, this is an intervention for the older people.”

Philosophers have long noted the fortifying effects of a clear sense of purpose. “Nietzsche said if you find purpose in your suffering, you can tolerate all the pain that comes with it,” Jack Fong, a sociologist who researches solitude at California State Polytechnic University, Pomona, told me. “It’s when people don’t see a purpose in their suffering that they freak out.”

Experienced solitaries confirm this. Billy Barr, who’s been living alone in an abandoned mining shack high up in the Rocky Mountains for almost 50 years, says we should all keep track of something. In his case, it’s the environment. How high is the snow today? What animals appeared this month? For decades, he’s been tracking the answers to these questions, and his records have actually influenced climate change science.

Now, he suggests that people get through the pandemic by participating in a citizen science project such as CoCoRaHS, which tracks rainfall.

“I would definitely recommend people doing that,” he told WAMU. “You get a little rain gauge, put it outside, and you’re part of a network where there’s thousands of other people doing the same thing as you, the same time of the day as you’re doing it.” (Notice, again, that this is really about sensing you’re part of the larger world around you.)

Other citizen science projects are looking for laypeople to classify wild animals caught on camera or predict the spread of Covid-19.

If citizen science isn’t your jam, find something else that gives you a sense of purpose, whether it’s writing that novel you’ve been kicking around for years, signing up to volunteer with a mutual aid group, or whatever else.

A sense of inspiration

Finally, some practices are about cultivating a sense of inspiration — which can take the form of gratitude, curiosity, or awe.

Regularly feeling gratitude helps protect us from stress and depression.

“When you feel grateful, your mind turns its attention to what is perhaps the greatest source of resilience for most humans: other humans,” David DeSteno, a psychology professor at Northeastern University and the author of Emotional Success, told me. “By reminding you that you’re not alone — that others have contributed to your well-being — it reduces stress.”

So one thing you can do this winter is try gratitude journaling. This simple practice — jotting down things you’re grateful for once or twice a week — has gained popularity over the past few years. But studies show there are more and less effective ways to do it. Researchers say it’s better to write in detail about one particular thing, really savoring it, than to dash off a superficial list of things. They recommend that you try to focus on people you’re grateful to, because that’s more impactful than focusing on things, and that you focus on events that surprised you, because they generally elicit stronger feelings of thankfulness.

Another practice is to write a letter of gratitude to someone. Research shows it significantly increases your levels of gratitude, even if you never actually send the letter. And the effects on the brain can last for months. In one study, subjects who participated in gratitude letter writing expressed more thankfulness and showed more activity in their pregenual anterior cingulate cortex — an area involved in predicting the outcomes of our actions — three months later.

Feeling a sense of curiosity or awe about the world around you is likewise shown to boost emotional well-being.

“Awe makes us feel like our problems are very trivial in the big scheme of things,” Lyubomirsky said. “The idea that you are this tiny speck in the universe gives you this bigger-picture perspective, which is really helpful when you’re too self-focused over your problems.”

For example, a study recently published in the journal Emotion investigated the effects of “awe walks.” Over a period of eight weeks, 60 participants took weekly 15-minute walks outdoors. Those who were encouraged to seek out moments of awe during their walks ended up showing more of the “small self” mindset, greater increases in daily positive emotions, and greater decreases in daily distress over time, compared to a control group who walked without being primed to seek out awe.

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“What we show here is that a very simple intervention — essentially a reminder to occasionally shift our energy and attention outward instead of inward — can lead to significant improvements in emotional wellbeing,” said Sturm, the lead author.

So, bottom line: When the world between your two ears is as bleak as the howling winter outside, shifting your attention outward can be powerfully beneficial for your mental health. And hey, even in the dead of winter, a 15-minute awe walk outdoors is probably something you can do.

If you or anyone you know is anxious, depressed, upset, or needs to talk, there are people who want to help. Text CRISIS to 741741 for free, confidential crisis counseling.

Sign up for the Future Perfect newsletter. Twice a week, you’ll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and — to put it simply — getting better at doing good.

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By Tncse

What it’s like to die from Covid-19

March 23, 2022 | News | No Comments

We’ve reached half a million deaths from the coronavirus in the US. But most of these deaths — and the grueling medical ordeals leading up to them — have remained largely hidden from view. The majority of terminally ill Covid-19 patients typically spend their last days or weeks isolated in ICUs to keep the virus from spreading.

“Most of what I’m seeing is behind closed curtains, and the general public isn’t seeing this side of it,” says Todd Rice, a critical care and pulmonology specialist at Vanderbilt University Medical Center. Even “families are only seeing a little bit of it,” he says. As a result, most of us have been “protected and sheltered from seeing the worst of this disease.”

So what have these 500,000 people endured as the infection took over and their bodies failed? The terrible details have been strikingly absent from most of our personal and national discussions about the virus. But if we have been thus far (perhaps somewhat willfully) blind to the excruciating ways Covid-19 takes lives, this milestone is an opportunity to open our eyes.

Four physicians, who collectively have cared for more than 100 dying Covid-19 patients over the past 11 months, shared with Vox what their patients have gone through physically and mentally as the virus killed them. Their experiences reveal the isolating and invasive realities of what it is typically like for someone to die from Covid-19.

Lungs “full of bees” and a “sense of impending doom”

The torture of Covid-19 can begin long before someone is sick enough to be admitted to a hospital intensive care unit.

Since the coronavirus attacks the lungs, it hampers the intake of oxygen. People with worsening Covid-19 typically show up in the emergency room because they are having trouble breathing.

As their lungs deteriorate further, they have a harder and harder time getting enough oxygen with each breath, meaning they need to breathe faster and faster — up from an average of about 14 times per minute to 30 or 40. Such gasping can bring about a very real sense of panic.

Imagine trying to breathe through a very narrow straw, says Jess Mandel, chief of pulmonary, critical care, and sleep medicine at UC San Diego Health. “You can do that for 15 to 20 seconds, but try doing it for two hours.” Or for days or weeks.

Patients struggling through low oxygen levels like this have told Kenneth Remy, an assistant professor of critical care medicine at Washington University School of Medicine in St. Louis, that it feels like a band across their chest or that their lungs are on fire. Or like a thousand bees stinging them inside their chest. Others might have thick secretions in their lungs that make it feel like they are trying to breathe through muck. Many people say it feels like they’re being smothered.

The ordeal is so taxing that many wish for death. “You hear the patients say, ‘I just want to die because this is so excruciating,’” Remy says. “That’s what this virus does.”

Others feel that death is coming no matter what they do. Rice notes that is much more so for his Covid-19 patients than others he has treated. There seems to be something about Covid-19, he says, “that makes people prone to having a feeling of, ‘I really believe I’m going to die.’”

Meilinh Thi, who specializes in critical care and pulmonology at the University of Nebraska Medical Center, has witnessed the same thing. “A lot of patients, regardless of age, have this sense of impending doom,” Thi says. Many have told her outright they felt like they were going to die. Eerily, “Everyone who has told me that has passed away,” she says.

Isolated

The agony of being critically ill with Covid-19 isn’t just borne by the body but also by the mind. “It doesn’t only put your lungs on fire or give you a horrible headache or make you feel miserable or make you breathe really fast,” Remy says. “It also wreaks havoc on your mental state.”

For one, from the time anyone with Covid-19 is admitted to the hospital, they are essentially cut off from almost everything that is familiar. Most Covid-19 deaths have occurred in hospitals, but Centers for Disease Control and Prevention data shows that some are also dying in long-term care facilities (about 10 percent) or at home (about 6 percent).

“A lot of patients have told me how isolating and how lonely it is,” Thi says. And many get depressed. It is also incredibly scary to reach that point of illness with a disease that we know has already killed so many people, she and others point out.

All of these challenges have a cumulative effect. “If you can understand being in the hospital for two, three weeks, continuously breathing that fast, not having good interactions with your family because they can’t come and visit you — it’s extremely anxiety-provoking. It’s scary,” Remy says.

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Being in the ICU for any reason also vastly increases a person’s risk for delirium, a state of confusion that can result in agitation, fear, and anger. Medications used to sedate people or relieve pain (both common in Covid-19 treatment) are part of the reason for this risk, as are the constant monitoring and physical disturbances — and subsequent sleep disruption.

Being a Covid-19 patient increases this likelihood of disorientation even more. Some estimates put the rate of delirium among adult ICU Covid-19 patients at about 65 percent.

One reason for this extra risk is that the only people patients see are covered in head-to-toe PPE, often with only their eye area visible behind a shield or goggles, rendering them even more anonymous and unfamiliar. (ICU nurses have described working alongside the same people for decades and now not recognizing them due to all the protective gear.) “That for sure increases the risk of delirium,” Thi says.

As a Covid-19 patient, “You’re just devoid of human contact to a large degree,” Mandel says.

And that is no small thing. With loved ones relegated to video calls, personal connection through in-person visits — typically a mainstay during an intensive hospital stay — is gone.

“If your mom or dad or spouse was in the hospital and was very sick, you would be at their bedside holding their hand,” Remy says. With fatal Covid-19, your last meaningful contact with family, before your final hours, might be as you get admitted into the ER, days or weeks before.

Doctors often have to use many invasive procedures to try to save lives

Anyone unwell enough to be in the ICU for any reason will be hooked up to lots of machines. But people with severe Covid-19 face a particularly grueling and invasive experience.

When people can no longer breathe for themselves and still aren’t getting enough oxygen from external sources (like short nose tubes or a BiPap machine, like those some people wear for sleep apnea), the next step is usually putting them on a ventilator.

To do this, patients are put on IV-based sedation and pain medication so they can tolerate the procedure. A tube is inserted into the mouth and down the airway so the machine can pump air into the lungs. The tube can remain there for days or weeks, during which time that person will remain heavily sedated and unable to talk. (This sedation can also mask other problems that arise during their illness, such as major strokes.)

Those who have survived the ordeal often don’t even remember the day leading up to being put on ventilation, Thi says. “They say they really just lost that portion of their life.”

The ventilator itself is not without risks. For example, if the machine is set to deliver too much air, it can cause additional lung damage. And the breathing tube only tends to be safe to keep in place for about two to three weeks, Thi notes. After that, it can start to deteriorate. At that point, doctors might surgically insert a tube into the patient’s neck — a procedure known as a tracheostomy — to connect them to the ventilator.

For some, even mechanical ventilation can’t get them enough oxygen. These patients often get put on “heart-lung” machines, which pump blood out of the body, through a machine that oxygenates it, and back in. (These are also sometimes used for people who have suffered a heart attack, and are known to have numerous side effects, such as increased risk for strokes as well as for agitation and delirium.) This process requires two large catheters (long tubes) inserted into a major artery or vein, so the machine can effectively pump enough blood in and out of the body.

Flipping people onto their stomachs has also helped get more air into their systems. During this practice, called proning, the sick individual is typically put on a medication to paralyze them so they cannot move. (Medical staff also turn incapacitated patients in bed every couple of hours “to make sure their skin doesn’t break down,” Thi says.)

A significant proportion of people — somewhere between about 1 in 5 and 1 in 3 — who get very sick with Covid-19 also end up with kidney failure. To prevent this from killing them, they’re put on dialysis machines, which take blood out of the body and filter it before returning it to the body. This procedure can cause nausea, cramping, and chronic itching. Anyone getting dialysis will need two additional large catheters put into another major blood vessel.

But these aren’t all of the tubes critically ill Covid-19 patients need. They also have a central venous catheter to administer medication. This long tube usually gets inserted into a major vein in the clavicle or groin, then is pushed through the vein until it reaches the heart, where it will stay until that person recovers or dies. Another catheter, sometimes put in near the groin, will take the person’s blood for analysis.

Other catheters will be inserted into the urethra to drain urine (which is monitored closely) and the rectum to frequently evacuate their feces (which is especially important because Covid-19 often causes diarrhea). Additional IVs, such as for hydration and medications, will poke patients in smaller vessels as well. People this ill with Covid-19 will also have a tube put into their mouth or nose and down into their stomach, to deliver a nutritious slurry to prevent malnutrition.

On top of all of these tubes and needles, a number of other beeping and humming devices monitor a person’s vitals. Leads attached to the chest track heart function, and a pulse oximeter on the finger keeps tabs on oxygen saturation. A standard cuff monitors blood pressure, but people often get an additional catheter into yet another vessel to measure blood pressure from within that artery.

All of these incredibly invasive interventions have a goal of sustaining the body simply so that it can try to fight off the virus and heal. “The technology we have is very powerful in terms of keeping people alive but less powerful at turning things around,” Mandel says. “It’s always a race.”

But even all of these procedures — alongside treatments like dexamethasone and remdesivir — are not enough to save everyone with Covid-19. Some people decline to go through some or all of this, or at least to endure it indefinitely, but that does not guarantee a lack of suffering. And for those most unlucky 1.8 percent of people confirmed to have Covid-19 in the US, death will then be imminent.

The end

Once someone is sick enough with Covid-19 that they need a ventilator, their chance of survival is somewhere between 40 and 60 percent, notes Remy. “You flip a coin, and you may be one of those people who die,” he says.

Remy recalls one particularly difficult week during the fall surge when he cared for a number of people in their 40s and 50s who ultimately died. Most of them were obese but otherwise healthy when they caught Covid-19 by not wearing a mask.

“One of the[se] patients specifically told me before I put the breathing tube in, ‘Let everyone know that this is real, my lungs are on fire. It’s like there’s bees stinging me. I can’t breathe. Please let them know to wear a mask … because I wouldn’t wish this on my worst enemy.’”

Right after that patient died, Remy made a precautionary video that he posted on Twitter.

If a patient’s breathing deteriorates slowly, hospitals can often arrange a way for them to talk with family members before they get intubated. Because after the tube goes in, they might not be conscious or able to talk again before they die. Regardless, the last person they have conscious contact with is typically a member of the medical staff before they are heavily sedated to receive the ventilator tube. In essence, “It could be anybody,” Rice says.

Despite the strict isolation for Covid-19 patients, “We try to make sure patients don’t die alone,” Thi says. For those who quickly nosedive, there often isn’t time to bring in family. Those people die surrounded by medical staff, either receiving CPR or, if they had do not resuscitate orders, with staff standing by.

For those who fall toward death, family — in full PPE — are now typically allowed in (which wasn’t usually the case at the beginning of the pandemic). At that point, “We would proceed with comfort measures only,” Thi says. In this scenario, the dying person will be on heavy medication as the ventilator tube is removed. Even still, once it gets taken out, people often gasp or cough as the body fights for air before they die.

Despite the palliative care and the possibility for family to now be present for a person’s actual death, doctors describe Covid-19 as a uniquely terrible way to die. “Covid is just so different,” Thi says. “I don’t think anything could be comparable to it. … I don’t wish it on my worst enemy.”

Remy agrees. After having cared for patients dying from infectious diseases all over the world, he says, “I don’t know a disease that wreaks such havoc on the body and on the mind.” Which is perhaps why his dying patient was pleading with him so desperately just before being intubated to tell people to wear their masks and take the virus seriously.

Because otherwise, it will continue to take thousands of lives this way each day in the US until we can get vaccines to almost everyone.

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

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By Tncse

The Texan dream of going it alone was never real

March 23, 2022 | News | No Comments

The power was still out in my Dallas housing complex early last Tuesday, so I grabbed the survival hatchet from my emergency bag to chop up a couple of fallen trees, which were covered with six inches of down-soft snow dropped by Winter Storm Uri.

The trees broke easily, and after 30 minutes of hacking, I’d cut enough for two small blazes. I divided the wood — one half for my apartment, the other for my neighbor.

My wife Joy and I cooked beans over the fireplace and burned some old clothing to keep the temperature in the apartment above 40 degrees. After our fire died, our complex issued an “Important Message For Residents” warning that Dallas might ration water as treatment plants froze: “Please take action NOW to fill pots/pitchers, bathtubs and other storage containers … use this water to flush toilets.”

Joy, who had recently moved here from Bolivia, had seen her WhatsApp fill up with worried messages from loved ones who’ve watched America’s panoply of recent crises unfold. They asked if she was safe from the horrors on their televisions: the world’s worst Covid-19 numbers, horned defectors with assault weapons, and now infrastructure that abandons people during natural disasters.

After reading the hoard-water note, she turned to me and joked, “I thought the United States was a first-world country?”

In her eyes, a developed country and its state leaders should take care of its citizens. Millions of Texans have seen their electricity cut out for hours and days at a time in a deadly rolling crisis that began with snowfall on Valentine’s Day. Though most power is now restored, millions of Texans are still without water as treatment plants recover. The crisis has been a burden, not just for the state or the power company at fault, but for its residents to bear.

You see, we’re individuals, and, like one Texas mayor wrote on Facebook, we shouldn’t expect state institutions to help. “No one owes you or your family anything; nor is it the local government’s responsibility to support you during trying times like this! Sink or swim, it’s your choice!” then-Mayor Tim Boyd of Colorado City, a town of fewer than 5,000 people a four-hour drive west of Dallas, told constituents in a typo-laden Facebook post. (That same day, he announced his resignation, but he didn’t say whether his exit stemmed from the backlash.)

We were on our own.

We lost power for most of Monday and Tuesday, but luckily, we never lost water. Many Texans fared worse. Houston firefighters had to deal with low water pressure when dousing residential fires started by candles, displacing dozens of Houstonians. Prison inmates had to live with overflowing, unusable toilets for days. Exotic animals, including a chimpanzee and other primates, froze to death in a San Antonio rescue. By last Tuesday, hospitals had treated more than 50 people for carbon monoxide poisoning; desperate to get warm, they’d heated their homes with gas stoves and running cars. A woman near Houston filed a wrongful death lawsuit against power utilities after her 11-year-old son froze to death in his bed.

The disaster worsened existing crises in average Texans’ lives. My neighbor, a nurse who underwent several major surgeries this year amid the pandemic, began to seem less social and more withdrawn. My boss’s mother suffered a stroke just before the storm, and his energies were split between caring for her and making sure his water pipes didn’t freeze. I was depressed and disagreeable.

I draw a line from this catastrophe to America’s fetishized individualism for which Texas, home to a fierce secessionist movement, is the poster child. Texas is where the West starts, home of high-riding cowboys and oilmen who project an image of self-reliance — all they needed to prosper was a government that stayed out of their way.

I work for a manufacturer that makes devices for the power industry, and I can’t conjure a better example of the Texas government’s light touch than its relationship to the electric grid. As electricity infrastructure evolved in the 1930s, the federal government regulated energy across state lines. But Texas had its own grid network, the Texas Interconnected System, and a flourishing oil trade. So the state shrewdly spurned interstate grids.

In the 1970s, the Electric Reliability Council of Texas, or ERCOT, was formed to manage the state’s electricity distribution. But in 2002, Texas deregulated its energy market, creating an environment in which electricity retailers compete for business. The lowest bidder would win customers in the marketplace, but that encouraged power generators to delay or neglect weatherizing critical equipment. In 2011, the Federal Energy Regulatory Commission warned ERCOT that power plants must winterize their equipment. Electricity providers, beholden only to the market, largely ignored the advice.

Put simply, this market created a larger disaster when the freezing weather hit. Because the function of the Texas power industry is to provide cheap electricity, it has no incentive to make costly preparations to its infrastructure for comparatively rare cold weather.

As Uri intensified, enough people were using electric heaters and enough generation equipment had frozen that demand outpaced supply, and the grid’s frequency began to destabilize. Officials told the Texas Tribune Thursday the grid was “minutes” from a full crash, which would’ve taken weeks to restore. ERCOT then mandated statewide “rolling blackouts” to reconcile the grid’s burden with power generation.

It initially said the outages would last less than 45 minutes, but when I woke up that morning, the lights and heat were out. I spent an hour on a dying cellphone navigating overwhelmed service hotlines for any nugget pointing to restored power. I learned the outage could, in fact, last hours, and I gave up calling. Local officials gave suggestions on how to make do. The city of Fort Worth told constituents to close their blinds and stuff towels in cracks to retain heat.

This disaster doesn’t appear to have inspired sober reflection among many of our politicians. On Fox News last week, Republican Gov. Greg Abbott blamed wind turbines for the crisis; in fact, natural gas equipment is responsible for the bulk of the losses. Cranking up the invective, Abbott fingered as a culprit the Green New Deal, a policy framework to address climate change that Congress rejected in 2019. And, of course, our climate-change-denying Republican Sen. Ted Cruz famously jetted off from Houston to Cancun with his family mid-crisis as Texans froze to death.

Individualist thinking justifies this mentality. It says that states and individuals should marshal and deploy their own resources, a notion as American as apple pie. If you lack the resources to get to a Mexican beach resort, hike your sleeves, chop firewood, and don’t burn down your home.

I ended up chopping wood. I’m lucky that I had the option to — it allowed us to stay warm for part of Tuesday morning, and it was better than huddling in a darkened bedroom. But not everyone lives in a forested apartment complex, and others were forced to turn to potentially deadly methods, like a grandmother who spent a night in her car to keep warm.

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The fact that I even had a survival hatchet feels ironic. I’m mostly skeptical of prepper culture, partly because it reeks of that individualism. Yet Joy and I frantically built our emergency bags in January after Trump supporters attacked the US Capitol. A friend who works in logistics told me corporations were preparing for a doomsday scenario after the DC raid — cutting emergency credit cards for employees, making extraction plans. Our form of government forces us to prep, and when you’re on your own, it pays to have the tools.

Still, during Uri, ordinary Texans didn’t just help themselves. They distributed food, donated and organized mutual aid funds, and, if they had electricity, took shivering strangers into their homes. A coworker ran errands for neighbors who can’t drive in snow. An acquaintance brought an elderly woman coolers full of water so she could flush the loo.

Tuesday night, our neighbor knocked on our door with an Ikea tote full of more black willow. “They cut this firewood, you want some?”

It was sweet to be cared for by our community. But it’d be better if our government looked after us instead.

Aaron Hedge is a Dallas-based writer and a reader at Longform.org.

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By Tncse

FDA advisers unanimously recommend Johnson & Johnson’s Covid-19 vaccine

March 23, 2022 | News | No Comments

A panel of expert advisers to the Food and Drug Administration (FDA) voted unanimously on Friday afternoon to recommend the one-dose Covid-19 vaccine developed by Johnson & Johnson for an emergency use authorization. The next step is for the FDA to accept the recommendation, which could happen as soon as this weekend, clearing the way for distribution.

Earlier this week, the FDA posted a briefing going over the results of the phase 3 clinical trials of the Johnson & Johnson vaccine, which included 40,000 participants in several countries divided randomly into placebo and treatment groups.

The most important finding: The vaccine was 100 percent effective after 28 days at preventing deaths and hospitalizations from Covid-19 among the clinical trial participants who received the treatment. (Two vaccine recipients were hospitalized with Covid-19 two weeks after receiving the injection.)

The vaccine was also 66.1 percent effective at preventing symptomatic Covid-19 illness after four weeks, with consistent results across all age groups. When looking at blocking severe and critical cases of Covid-19, the Johnson & Johnson vaccine was 85.4 percent effective.

Mathai Mammen, global head of research and development for Janssen Pharmaceutical Companies, said during a press conference last month that the vaccine also had “plain vanilla safety results,” with the vast majority of recipients experiencing no problems. Most of the reported symptoms were mild, including fatigue, arm pain, and fever.

The efficacy levels against severe to critical Covid-19 changed depending on where the vaccine was tested. It was 85.9 percent in the United States after four weeks, while in South Africa, where a coronavirus variant with worrisome mutations that help it escape vaccines has been spreading widely, efficacy against severe disease was reduced to 81.7 percent.

Health officials say that while the Johnson & Johnson efficacy results are not as high as those from Moderna and Pfizer/BioNTech, the two vaccines that have already received emergency use authorizations from the FDA, the new vaccine’s performance is still superb.

“If this had occurred in the absence of a prior announcement and implementation of a 94, 95 percent efficacy [vaccine], one would have said this is an absolutely spectacular result,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during the press conference last month. The vaccine was developed by Janssen Pharmaceuticals, a division of Johnson & Johnson based in Belgium, together with Boston’s Beth Israel Deaconess Medical Center.

But unlike the vaccines from Moderna and Pfizer/BioNTech, Johnson & Johnson’s doesn’t require a booster shot, circumventing the two-dose problems posed by its competitors. There’s no need to track people down for their second dose, which means more people could be vaccinated faster. The shots also don’t require deep-cold storage, which means they’re less costly and somewhat easier to distribute.

“It’s a complete game changer,” said Georgetown University health law professor Lawrence Gostin. “It completely changes the equation.”

The Johnson & Johnson vaccine is also different in another way. It uses an adenovirus vector to deliver instructions for making the spike protein of the coronavirus, which is also less expensive to manufacture than the mRNA platform used for the other vaccines. (It’s estimated to cost around $10 per vaccine dose — roughly half the cost of the Pfizer/BioNTech vaccine.)

Johnson & Johnson has promised enough vaccines for 20 million Americans by the end of March and 100 million Americans by the end of June despite production challenges. It would be a huge boost to the 65 million Covid-19 vaccine doses that have been administered in the US so far.

So even with an overall efficacy level that’s lower than the two other vaccines on the US market, the Johnson & Johnson vaccine could become a major player. It’s the vaccine that “can increase equity,” said Saad Omer, the director of the Yale Institute for Global Health, particularly “if it’s deployed strategically in nations that are hard to reach and where that would be a particular challenge under a two-dose schedule.” Johnson & Johnson expects to distribute a billion doses of its vaccine worldwide this year.

But as amazing as it is to see several effective Covid-19 vaccines developed in record time, it’s now clear that the technology alone won’t save the day. An orchestra of supply chains, manufacturing, logistics, staff, and public trust needs to harmonize in order to actually get billions of shots into arms around the world and finally draw the pandemic to a close. And we also have other hurdles to overcome: controlling the spread of variants that seem to be threatening the effectiveness of all the vaccines we have.

What we learned about the safety and efficacy of the Johnson & Johnson Covid-19 vaccine

Johnson & Johnson launched separate clinical trials testing both a one-dose and a two-dose regimen to see how well these strategies provided long-term protection against Covid-19. The one-dose phase 3 trial arm yielded efficacy results first.

But hints that this vaccine could be safe and effective have been trickling out for months. The company published some of its early phase 1 and phase 2 trial data in a preprint paper in September, and the final version of the paper in January, in the New England Journal of Medicine. The papers showed the vaccine was well tolerated among the participants, and seemingly very effective: With one dose, after 29 days, the vaccine ensured that 90 percent of participants had enough antibodies required to neutralize the virus. After 57 days, that number reached 100 percent.

“When I looked at that, I thought, wow, this Johnson & Johnson product is very powerful after the first dose in terms of immunogenicity,” said Monica Gandhi, a professor of global medicine at the University of California San Francisco. “The Pfizer and Moderna vaccines needed two doses to get that level of [virus] neutralization.”

Like Pfizer/BioNTech, Johnson & Johnson “didn’t rush to phase 3 [trials],” said Hilda Bastian, a scientist who has been tracking the global vaccine race. Instead, it tested multiple vaccine doses and candidates at the outset to figure out which might perform the best in humans, and then proceeded through clinical trials.

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The vaccine was also tested in nine countries — the largest single international phase 3 trial in the world, with more than 60,000 participants — meaning many ethnic groups were represented in the data, Bastian said. “As if all that’s not enough, it’s one of the ones that could be manufactured in South Africa and other places,” since Johnson & Johnson has manufacturing capacity around the world, even in countries hard-hit by the pandemic that have been waiting for vaccine supplies, she added.

The day this vaccine gets approval “is going to be a big day for the future of this pandemic [and] a ticket out of this disease for a larger part of the world,” said Nicholas Lusiani, a senior adviser at Oxfam America.

How adenovirus vector vaccines work

Part of the appeal of this vaccine lies in the technology behind it. Adenoviruses are a family of viruses that can cause a range of illnesses in humans, including the common cold. They’re very efficient at getting their DNA into a cell’s nucleus. Scientists reasoned that if they could snip out the right sections of an adenovirus’s genome and insert another piece of DNA code (in this case, for a fragment of the new coronavirus), they could have a powerful system to deliver instructions to cells.

For decades, scientists have experimented with adenovirus vectors as a platform for gene therapy and to treat certain cancers, using the virus to modify or replace genes in host cells. More recently, researchers have found success using adenoviruses as vaccines. Already, an adenovirus vector vaccine has been developed for the Ebola virus.

In addition to Johnson & Johnson and AstraZeneca/Oxford, CanSino Biologics of China is also developing an adenovirus vector Covid-19 vaccine; Russia’s Sputnik V Covid-19 vaccine uses this platform, too.

To make one of these vaccines, the adenovirus is modified so that it can’t reproduce but can carry the instructions for making a component of a virus. In the case of Covid-19, most adenovirus vector vaccines code for the spike protein of SARS-CoV-2, the part the virus uses to begin an infection.

Human cells then read those instructions delivered by the adenovirus and begin manufacturing the spike protein. The immune system recognizes the spike proteins as a threat and begins to build up its defenses.

Since adenoviruses exist naturally, they tend to be more temperature-stable than the synthetic lipid nanoparticles that are used to deliver the mRNA in the Moderna and Pfizer/BioNTech vaccines.

“The nice thing about the adenovirus vector vaccines is that they’re a little more tolerant to a longer shelf life, to the conditions of storage,” said Angela Rasmussen, a virologist at Georgetown University. Adenovirus vector vaccines can be stored at refrigerator temperatures, while mRNA vaccines need freezers, with Pfizer/BioNTech’s vaccine requiring temperatures of minus 80 degrees Celsius.

This helps lower the cost and complexity of manufacturing, distribution, and administration of adenovirus vector vaccines compared to other platforms. And simply having another vaccine on the market, made by a major pharmaceutical company with its own manufacturing infrastructure, is a big step forward. “The more vaccine doses we can have, the better,” Rasmussen said.

What comes next

The next challenge for Johnson & Johnson, after getting a green light from the FDA, is actually delivering doses to millions of arms.

But with three vaccines eventually on the market, should people hold out for any one vaccine in particular?

“Right now when people ask me, which, you know, which vaccine should I get? It’s pretty easy to answer that question because it’s whichever one you get offered,” said Paul Sax, a professor of medicine at Harvard Medical School. Vaccine supplies are limited, the transmission of the virus is high, and hospitals are close to capacity, so few people can be picky about what they get.

On the other hand, once vaccine supplies stabilize, having multiple vaccines with different characteristics could allow doctors and public health officials to optimize how the shots are distributed. “If the efficacy [of a given vaccine] is lower but still pretty good, there may be a scenario that one vaccine is recommended for low-risk populations and another one is for a high-risk population,” Omer said.

Though the Johnson & Johnson vaccine does have some key advantages over its competitors, it could face some of the same distribution snags that have hit other vaccines, like miscommunication between the government and hospitals, and production hurdles.

Researchers say that all the manufacturers also need to start working to get vaccines to the rest of the world. The new variants that have emerged in the UK, Brazil, and South Africa and have been detected in other parts of the world are reminders that the virus continues to evolve, and that a partially vaccinated population could exert more selection pressures that accelerate these mutations. So vaccination has to happen fast, and globally — and Johnson & Johnson’s vaccine may be a critical tool to do this.

“Long term, we need to be thinking about getting vaccines out equitably to the entire world, and having vaccines that are easier to distribute in terms of the cold chain requirements is going to be huge in that regard,” Rasmussen said.

But even as these vaccines roll out, there’s still more to learn: how long protection from vaccines last, whether there are any rare complications to consider, whether they prevent transmission as well as disease, and how well these vaccines work against the new variants. There are already some troubling signs of how these variants might eventually be able to evade vaccines. Continuing clinical trials will be critical, Sax said.

“You know, we’ve got millions of people who’ve received these vaccines already, which is exciting,” he added. “We’re on our way.”

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By Tncse

Even if you’re vaccinated, indoor dining is still complicated

March 23, 2022 | News | No Comments

When many Americans talk about returning to “normal life” after the pandemic, they might mean going back to the office, resuming in-person school or child care, or preparing for the best summer ever. For plenty of other people, though, their true barometer is the simple ability to once again eat indoors at restaurants.

The past year completely overhauled countless lives, essentially asking each and every one of us to pare down our social selves if we want to protect our health and that of others. And like some demented curse, it turned out strangers eating together inside a restaurant is actually one of the ideal settings where the coronavirus absolutely thrives. Indoor dining was one of the first things to go in many states’ efforts to curb the pandemic, and the decision to keep restaurants open sparked national conversations about larger issues such as freedom, safety, and the economy.

And now, while indoor dining at restaurants has largely returned (or, in some cases, never went away), restaurants aren’t the same. Neither are we.

According to the National Restaurant Association’s 2021 state of the industry report, restaurant sales in 2020 were $240 billion lower than what was forecasted, thanks to the pandemic, and over 110,000 eating and drinking establishments shut their doors at least temporarily. The organization estimated that at one point, around 8 million employees were laid off or furloughed. Restaurant employees who kept their jobs risked their health to work during the pandemic. And, according to the results of a Morning Consult poll published April 21, only 55 percent of the public would feel comfortable eating indoors right now.

Faced with this new reality, I asked public health experts if it’s natural to be hesitant about our new dining normal (it is) and whether eating at restaurants indoors is still risky (you probably shouldn’t if you’re not fully vaccinated, and you should still mask indoors if you are).

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But at the heart of this debate, and of my hesitance, is the question of how we navigate our newfound freedom, what we need to relearn, and whether we should be doing so in the first place. Despite the restaurant reopenings and general excitement, the answer might not be one we’re ready to hear.

Indoor dining is inherently very risky when it comes to Covid-19

The way epidemiologists currently look at dining — indoor dining specifically — is different from the way most of us probably look at it. They see a full dining room and think about the prolonged amount of time people are spending together unmasked, eating and talking and laughing and sending tiny particles into the air. They remember that a little over half of all American adults have had at least one vaccine dose, which means unvaccinated people may be among those who are eating and talking and laughing in that dining room. They also look at the number of windows in the dining room and whether they’re open.

All of these factors combine to make indoor dining a coronavirus hazard.

“It’s not just that indoor dining checks one box, it’s that it checks many of them,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University. “All of those things make it higher risk.”

These risks make decisions such as fully opening restaurants without any safety protocols — see Texas and Mississippi — concerning for Popescu and her public health colleagues. According to a study released by the Centers for Disease Control and Prevention on March 5, counties that opened restaurants for on-premises dining saw a rise in daily infections roughly six weeks later and an increase in death rates about three weeks after that. The findings were in line with those of a July 2020 study, which found that “going to locations that offer on-site eating and drinking options were associated with COVID-19 positivity.”

While the CDC study doesn’t assert a cause-and-effect connection, the agency has emphasized that the risk is present. Public health experts have been urging lawmakers and diners to use extreme caution since the pandemic began.

The complicated new wrinkle in these warnings is that Americans now have access to very effective vaccines that protect against both hospitalization and the most serious Covid-19 symptoms. The messaging about risk becomes cloudy when combined with the extremely positive messaging about vaccines, especially when people have been waiting to resume their normal lives.

In response, public health experts have had to thread the needle about maintaining caution without compromising the positive messaging about vaccines, and vice versa.

Popescu said she’s focused on vaccination status. Current health advisories from the government and the CDC suggest that people who are fully vaccinated can go and mingle with others who are also fully vaccinated. And people who are fully vaccinated can visit an unvaccinated household, provided no one is at high risk for severe disease.

“You don’t know any of that information in a restaurant,” Popescu told me, explaining the CDC currently estimates that around 30 percent of the American population and 38 percent of Americans older than 18 are fully vaccinated. She also said we have to keep in mind that scientists are still studying the efficacy of vaccines against new variants, and that while the vaccines we have are safe and effective, a small number of breakthrough infections, where vaccinated people still catch Covid-19, have occurred.

“You don’t know the vaccination status of other people in a restaurant, and to start requiring that, I think, would be a huge issue in terms of equity. I can’t even imagine going down that route,” Popescu said.

Marissa Baker, an assistant professor in the Department of Environmental and Occupational Health Sciences at the University of Washington, echoed Popescu’s sentiments: In indoor restaurants where not everyone is fully vaccinated, the risk isn’t zero — and the risk to unvaccinated or partially vaccinated individuals is one of her main concerns.

The higher the fully vaccinated percentage rises, the more comfortable Baker, Popescu, and their public health colleagues are with indoor dining. What troubles them is the number of restaurants that are open without any restrictions while vaccination numbers remain where they are, and that there are still states where Covid-19 cases are high.

Figuring out a vaccination percentage that public health officials feel is safe and considered herd immunity is what Baker calls the “billion-dollar question” of the moment.

“All I can say is that we definitely aren’t there yet,” she said, urging patience and pointing out that each day means more people vaccinated, one step closer to herd immunity, and one step closer to possibly eating at The Cheesecake Factory indoors, unmasked, with friends. The problem is that America’s track record with the pandemic and patience hasn’t been stellar.

When it comes to risk, everything is personal

In separate interviews, Popescu and Baker both said they weren’t personally comfortable yet with indoor dining. They also said that someone’s risk tolerance is a personal, individual decision. They can’t stop anyone from dining out and, say, enjoying burgers if that is what the person’s heart desires.

What they urge, though, is that everyone considers these risks and how to mitigate them before making their decisions.

“I try to be mindful of teetering that line about really reminding people that vaccines are the best tool we have. They’re really amazing and efficacious. But they’re also not sterilizing immunity,” Popescu explained. “They’re close but not perfect. They’re a risk reducer, not an eliminator. And that is even that much more of an important nuance when we’re not at herd immunity when we don’t have global equitable distribution.”

Instead of thinking about vaccines as magic bullets, public health experts urge us to think about them in conjunction with other tools in our repertoire — tools that we’ve been using for the past year, like maintaining distance, socializing in pods, ventilation, and masking.

“People should be looking for restaurants that have really good airflow, that their waitstaff is consistently wearing masks, and that they’re expecting their patrons to wear masks, and that they’re conscientious about their Covid controls as well,” Baker said.

While some of this can seem superfluous, especially to those feeling confident about their fully vaccinated status, these precautions help with the bigger picture of reducing transmission and achieving herd immunity. Herd immunity isn’t thinking about our individual selves, but what we can do for our communities.

“When thinking about going out to eat or going to a restaurant or a bar, it’s important to keep in mind that there’s, of course, you and the other patrons in those spaces. But there’s also the workers in those spaces,” Baker said.

Baker urges that when we eat out, we should really think about if we are keeping servers, runners, bussers, cooks, and restaurant staff safe. There’s a chance some waitstaff might not be fully vaccinated, and regardless, they’re likely interacting with many people a day and therefore have a higher risk for exposure. By taking individual precautions, diners can make it safer for those serving them.

But that isn’t often the reality.

“I don’t mean to overuse this word or use it lightly, but the past year was pretty traumatic working in the restaurant and dealing with customers,” Amanda Cohen, the James Beard-nominated chef and owner of Dirt Candy, a restaurant in Manhattan’s Lower East Side, told me.

She explained that in addition to the stress of keeping her restaurant afloat, she often had to tell customers to put on their masks, maintain distancing, and often repeat and remind customers of her restaurant’s Covid-19 protocols and rules.

“I certainly felt like I was the Covid police. And in a way — and I get it — nobody was prepared for the pandemic,” she said. “But I wish the city, and I think most people in most cities felt like this, had really stepped up and put the onus on the customers who are going out to eat, to follow the rules and not the restaurant to have to be the one to implement them. You know, I don’t like being the Covid police.”

Dirt Candy hasn’t yet resumed indoor dining because Cohen is still figuring out the best way to implement protocols to keep her customers and her staff safe.

Cohen’s experience isn’t unique. Servers and restaurant staff often have to remind customers about masking and protocols and are put into uncomfortable situations for having to do so. Dirt Candy has a no-tipping policy (which existed pre-pandemic) and aims to pay its staff a living wage. In restaurants where reprimanding someone about masking could adversely affect tips, it becomes even more difficult for servers and staffers to remind patrons of the rules.

“As the people frequenting those spaces, we can make it so the server doesn’t have to make that choice and just be conscientious and wear a mask as much as we can,” Baker said, explaining that eating and drinking unmasked is fine but to think about wearing a mask when interacting with servers (during ordering, during bussing, paying the bill, etc.) and moving about the restaurant.

“It’s the conscientious thing to do. And it’s kind of a show of respect, as a way of saying ‘we don’t know each other’s vaccination status, so we’re doing what we can to take care of each other.’”

Patience is key

That narrative about caring and supporting each other extends to the relationship between diners and the restaurants they love — even beyond Covid-19 protocols.

The pandemic has seismically ravaged the dining industry, permanently shutting down many restaurants. That doesn’t just affect owners and chefs, but all the staff — the US Bureau of Labor Statistics reports that in 2020, food and beverage servers make a median of $11.63 per hour, or $24,190 per year. Instead of coming to their aid, the federal government has, in your correspondent’s blunt opinion, done barely anything, and for the past year has left the fate of restaurants in diners’ wallets and the delivery companies that stack surcharge upon surcharge on restaurants.

“There were times when I certainly felt like, I’m only gonna be able to rely on my customers to get me through this. And I felt like so much of the burden all of a sudden was put on the population and not the government,” Cohen told me.

Restaurants that did survive are facing a new and not-improved financial reality. They’re making less money. That money goes to procuring ingredients, yes, but it also goes to paying all the staffers, the rent, the insurance, the electric bills, the everything, Cohen explains. And because capacity is reduced and tourism is down — depending on city or state restrictions — it’ll be a long time before many restaurants will make the kind of money they were making before the pandemic.

As we’ve learned to think about our own relationship to supporting restaurants and how fragile and important restaurants are to us, thinking about the health of the people who keeping them running is just as important.

“We’re all a little worried about serving indoors and what that’s going to be like. Because while we’re vaccinated, we’re still indoors, and not everybody who’s eating in the restaurant may be vaccinated. The risk isn’t zero,” Cohen said. “I think people forget that, and I get it. It’s been a really hard year — I’m still processing the fact that this has gone on for over a year. But you can see everybody relaxing their guard a lot, and that makes me nervous.”

Cohen urges diners to be flexible, patient, and empathetic. Restaurant staffers want to get back to “normal” life as much as, if not more than, diners do. And it helps to keep in mind that chefs and owners like Cohen as well as her colleagues and everyone in the restaurant industry are trying to hit a moving target of keeping their businesses alive, keeping their customers happy, and keeping everyone safe at the same time.

That might mean being more patient when it comes to indoor dining and waiting just a little longer for case numbers to go down and vaccination rates to go up. Each day that passes, more Americans are vaccinated. And in many parts of the country, the weather is, thankfully, allowing for safer outdoor dining.

“It’s still going to be much safer to eat outdoors,” Baker told me, explaining that distancing and crowding protocols should still be maintained outdoors. “And to the extent that you can do that and will do that, you’re not only protecting yourself and the people you’re eating with, but you’re also protecting the folks who work in those establishments — people who have had a lot of ups and downs in the last year in terms of their employment.”

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By Tncse

Biden agreed to waive vaccine patents. But will that help get doses out faster?

March 23, 2022 | News | No Comments

The Biden administration has announced that it will work with the World Trade Organization (WTO) to negotiate a deal to suspend intellectual property rights associated with the Covid-19 vaccines — a surprise move for the administration, which had initially resisted taking such a step.

The reversal came as Covid-19 deaths are mounting in India and elsewhere. The vaccination program in the US is going well, but much of the world is still waiting for vaccines, which has made the role of pharmaceutical companies and intellectual property in the global vaccine effort the subject of intense debate.

There is unanimous agreement on one thing: There is a lot of work to be done to speed up vaccine manufacturing and vaccinate the world. As the WTO’s General Council meets this week, patents have risen to the top of the agenda. India and South Africa have asked the WTO to waive intellectual property (IP) rules relating to the vaccines so that more organizations can make them.

The case for waivers is simple: Waiving IP rights might enable more companies to get into the vaccine-manufacturing business, easing supply shortages and helping with the monumental task of vaccinating the whole world. The case against them: Taking IP rights from vaccine makers punishes them for work that society should eagerly reward and disincentivizes similar future investment. Opponents have also argued this step would do very little to address the vaccine supply problem, which has largely been the result of factors such as raw material shortages and the incredible complexity and tight requirements of the vaccine-manufacturing process.

The debate has raged for the past several weeks — with Bill Gates as a notably outspoken defender of IP rights — but recently intensified as the Covid-19 crisis in low-income countries worsens.

Wednesday’s announcement unambiguously puts the US on record in support of such a waiver, a reversal from its previous position. “The Administration believes strongly in intellectual property protections, but in service of ending this pandemic, supports the waiver of those protections for COVID-19 vaccines,” US trade representative Katherine Tai said in an announcement.

Done correctly, making the IP associated with these vaccines available to the world can be a good first step — the more information-sharing here, the better. But it’s a small thing to do at a time when bigger commitments are needed. Waivers might help, but ending the pandemic worldwide is going to require so much more.

While the Biden administration’s decision is a positive development, but debates over intellectual property can also distract the world from the policy measures that could really end the pandemic: building our vaccine-manufacturing capacity, committing to purchase the doses the rest of the world needs, and working directly with manufacturers to remove every obstacle in their path.

Patents, trade secrets, and what you need to know to make a vaccine

To unpack what the Biden administration’s move means, it’s important to understand the role patents play in vaccine manufacturing.

When a pharmaceutical company makes a drug, it applies for a patent. The patent protects its intellectual property for a fixed amount of time, typically 20 years, after which others can make “generic” versions of the drug, which are generally a lot cheaper.

Simple enough, right?

When it comes to Covid-19 vaccines — and many modern pharmaceutical products — the situation is much more complicated than that.

First, a modern vaccine is often in a web of different intellectual property rights, with the vaccine manufacturer having purchased the rights to some elements of its vaccine from either other pharmaceutical companies or researchers.

The lipids (shells that contain the mRNA molecules) used for mRNA vaccines, for example, are licensed to Pfizer and Moderna, but other companies have the rights to them. Patents held by the vaccine companies are actually a fairly small share of what’s going on in this IP web. It’s better to talk more broadly about all of the intellectual property that goes into a vaccine: licensing deals, copyrights, industrial designs, and laws protecting trade secrets.

The other complication is that, while there are legal barriers to copying the existing vaccines, that’s not what’s really making them impossible for other companies to start manufacturing. Experts I spoke with emphasized that, generally speaking, the world’s entire supply of critical raw materials is already going into vaccines, and there are no factories “sitting idle” waiting for permission to start making them. What’s more, changing a factory’s processes to produce a new kind of vaccine is a difficult, error-prone process — which went wrong, for example, when a plant converted to make Johnson & Johnson vaccines spoiled millions of doses.

Moderna is an instructive example here. The pharmaceutical company made a splashy announcement in the fall that it would not enforce its Covid-19 vaccine patents. Despite that move, there is still no generic Moderna vaccine, and none of the experts I talked to believed one was on the horizon. (It turned out well for Moderna — get the PR bump from the announcement without suffering the financial drawbacks.)

In the long run, though, a world where everything Moderna, Pfizer, Novavax, AstraZeneca, and Johnson & Johnson know about manufacturing their vaccines was freely available online would make vaccines easier for other manufacturers to make. It would also make them cheaper and more accessible to countries that have had trouble getting them.

At a meeting this week, the WTO is considering requests from India and South Africa to waive the patents for the duration of the emergency. Most countries have their own patent laws, but international agreements about how they enforce each other’s patents — and disputes when countries suspect each other of ignoring IP concerns — tend to be mediated by the WTO.

Although the Biden administration’s announcement is a win for the pro-waiver side, the US isn’t the only country that needs to be persuaded for the WTO to agree on a patent waiver. For their part, the EU, the UK, Japan, and Switzerland have expressed opposition. But the US is influential in these debates, and the Biden administration’s about-face may well be decisive.

The case against IP waivers

Many global health researchers, Bill Gates (and the Bill and Melinda Gates Foundation), and some within the Biden administration have vocally opposed waiving IP rights on the Covid-19 vaccines, generally with two arguments.

First, they argue society should want pharma companies to invent vaccines like the ones they did for Covid-19, and waiving rights will make that less likely in the future by making similar projects less appealing targets for investment. Second, they contend that patent waivers will set that precedent without even speeding up vaccine manufacturing.

“For the industry, this would be a terrible, terrible precedent,” Geoffrey Porges, a research analyst at SVB Leerink, an investment bank, told the New York Times. “It would be intensively counterproductive, in the extreme, because what it would say to the industry is: ‘Don’t work on anything that we really care about, because if you do, we’re just going to take it away from you.’”

Perhaps most prominent among those who’ve taken this stance is Bill Gates. “The thing that’s holding things back, in this case, is not intellectual property,” Gates said in a controversial interview on Sky News. “It’s not like there’s some idle vaccine factory with regulatory approval that makes magically safe vaccines. You’ve got to do the trials on these things, and every manufacturing process has to be looked at in a very careful way.”

Instead of intellectual property, Gates’s argument goes, the problem is deep technical know-how: the important details of the process that goes into making a vaccine. This is an especially critical problem for the mRNA vaccines Pfizer and Moderna created because they use a new technique. (The mRNA vaccines give the body instructions it can use to make the spike protein on the coronavirus. From there, the body can recognize it and fight it off. This is different from the vaccines we’re all familiar with, which expose a patient to a dead or weak virus, or a chunk of a virus, to help prime the immune system.)

Moderna and Pfizer know not only the exact formula of their vaccines but also countless procedural details about making them successfully: equipment modification, temperature settings, how to troubleshoot common problems, different kinds of failure and what problems they indicate, and so on. Waiving IP protections won’t make this information available.

This isn’t an instance of Bill Gates going off message; it has consistently been the stance of his foundation. Last year, it worked to convince Oxford to partner with AstraZeneca on vaccine production, a partnership that has come under heavy criticism for having held back the Oxford vaccine’s potential for wider, cheaper sharing as AstraZeneca scaled up production slower than was hoped.

Why would advocates for global health want partnerships with for-profit pharmaceutical companies?

They contend that, if the world predictably waives patents for sufficiently critical medications and vaccines, companies will find it harder to attract investment when they work on those problems. And vaccines developed without a pharmaceutical partner — say, by a university — might have no luck being manufactured at the needed scale. “At our foundation, we believe that IP fundamentally underpins innovation, including the work that has helped create vaccines so quickly,” Mark Suzman, CEO of the Bill and Melinda Gates Foundation, wrote in February.

“From early in the pandemic, there were lots of smart people at the Gates Foundation thinking about how to structure financing and incentives for accelerating vaccine development,” Justin Sandefur, senior fellow at the Center for Global Development, a nonprofit think tank based in London and Washington, DC, told me. “To their credit, they worked on this really early on. They convinced themselves that IP was important.”

(In May, after the Biden administration’s reversal, the Gates Foundation actually reversed course, too, expressing support for a limited waiver.)

Many other global health experts have also made the case that waivers would be a bad idea. Vaccine makers “are already cooperating widely with competitors and generic manufacturers, including via voluntary licenses, contracted production, and proactive technology transfer,” the CGD’s Rachel Silverman argued in a CGD-hosted debate about whether to waive IP. “Diluting that commercial incentive may reduce their interest in pursuing the voluntary horizontal collaborations that are already driving scale.”

The case for IP waivers

The case for IP waivers is that, while there are definitely many other barriers to getting the world vaccinated, removing even one is better than letting it remain in place. As part of a no-holds-barred effort to get the vaccine to everyone, the world should do everything in its power to cut through some of the restrictions delaying vaccines, even if it will take additional steps for this particular action to make a big difference.

“There’s a question of where the onus of proof lies in this situation,” Sandefur told me. “The standard line you hear is, ‘Well, there aren’t that many factories that can do this.’ And I can’t point you to the [specific] factory that’s ready to produce AstraZeneca, but we want to free up the market to let the discovery happen.”

If you really want to get something done, it makes sense to address every possible thing standing in the way of getting it done, even if it’s not the biggest or most significant barrier. And while the vaccines genuinely are incredibly difficult to manufacture, those from Novavax, Johnson & Johnson, and AstraZeneca aren’t quite as out of reach as the mRNA vaccines from Pfizer and Moderna, and years of this fight are still ahead — time during which some company could, perhaps, pull off what has been dismissed as too difficult or even impossible and get generics off the ground a little faster.

What’s implicit in that argument is there’s actually only a small chance of seeing benefits from waivers. But, proponents of waivers argue, there’s also not much chance of harm. If it’s true other companies can’t make the vaccines easily, the IP waivers won’t undercut sales for the existing companies or disincentivize future R&D. Conversely, the only way the IP waivers could actually cut into existing companies’ profits is if they successfully incentivize more vaccine development. If that actually happened, the thinking goes, that’d be worth it.

Some supporters of IP waivers have argued the debate is essentially a matter of class warfare: Gates and Big Pharma against the global poor. But there are passionate defenders of the interests of low-income people on both sides of the IP waiver debate: Many experts who’ve spent their careers fighting for the world’s poor also see IP waivers as a counterproductive step. Smart people disagree on whether this approach does, in fact, increase vaccine access where it’s needed most, and whether it damages our preparedness for the next pandemic.

What the intense focus on IP waivers misses

Regardless of whether they were for or against IP waivers, everyone I spoke to agreed on one thing: IP waivers are much less important than just directly funding poor countries’ access to the vaccine.

Many people who aren’t opposed to IP waivers nonetheless caution against advocating for them because it could distract from better solutions. Silverman called waiver advocacy “an inefficient use of limited global advocacy/political capital for vaccine access.” IP is “not the point in the medium term,” Amanda Glassman, director of global health policy at CGD, tweeted Wednesday.

Her focus: urging governments to give money to Covax so there’s clear demand for increased manufacturing. Covax is supposed to purchase vaccines for the world but has found them scarce; the overwhelming majority of vaccines have been distributed in rich countries. Despite the devastating consequences of letting the pandemic rip through poorer nations, richer countries have been stingy with Covax, and it needs more resources to succeed.

“I think [waiving IP protections] is almost as much of a PR move as anything else,” Derek Lowe, a medicinal chemist who works on drug discovery in the pharmaceutical industry, told me. “There are a lot of people who are convinced that the only thing that’s holding back the generic vaccine is the patents, so the Biden administration said, ‘Okay, let’s see.’”

Indeed, the attention the debate over patent waivers has generated in the past week has obscured an important point: There’s no one trick to making vaccines widely available. Doing so is going to require commitments to buy billions of doses once companies make them, and months of hard work easing the supply bottlenecks that slow down production. Even if companies can manufacture generic versions of vaccines, they won’t do so without committed buyers — and that’s where committing to help poor countries purchase them really becomes essential.

In other words, it would be a mistake to take a victory lap following the Biden administration’s announcement. Even if legal barriers are addressed, countless practical barriers remain between here and vaccinating the world. If the IP waiver is a first step, great. But there are many steps to go if we’re to conquer Covid-19 in every corner of the globe.

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How the world missed more than half of all Covid-19 deaths

March 23, 2022 | News | No Comments

The world may have undercounted Covid-19 deaths by a staggering margin, according to an analysis released Thursday by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine. The actual count may actually be 6.9 million deaths, more than double official tolls.

The United States alone is estimated to have had 905,000 Covid-19 fatalities, vastly more than the 579,000 deaths officially reported, and more than any other country. The calculation is based on modeling of excess mortality that has occurred during the pandemic.

The drastic difference highlights how difficult it is to keep track of even basic metrics like deaths when a deadly disease is raging. The higher toll also means the ripples of the pandemic have spread wider than realized, particularly for health workers on the front lines who have repeatedly faced the onslaught with limited medical resources and personal protection. And the undercounts have important consequences for how countries allocate resources, anticipate future hot spots, and address health inequities.

Researchers who weren’t involved with the analysis say it confirms what many already presumed: that official death counts were far, far off.

“Big picture, it’s not really surprising,” said Jennifer Nuzzo, an epidemiologist and a senior scholar at the Johns Hopkins Center for Health Security. “We’ve long suspected that the tolls of Covid are undercounted for a number of reasons, but probably a big part is having capacity to diagnose infections and count them.”

Now, with the number of reported cases around the world reaching new highs, the findings should serve as a stark reminder that disease surveillance and tracking remain dangerously inadequate, and that the world may have already overlooked some of the greatest tragedies of the pandemic. Preventing deaths going forward demands a coordinated international effort to contain Covid-19, vaccinate as many people as possible, and monitor the spread of the virus, led by countries with the most resources helping those with the fewest.

Otherwise, an even greater toll may lie ahead.

Almost every part of the world is underreporting Covid-19 deaths

To come up with the new estimate of 6.9 million total Covid-19 deaths so far around the world, the IHME team constructed a model that incorporated observations about the pandemic. They also constructed a baseline estimate of how many deaths there would have been in a world without Covid-19. The team drew on weekly and monthly death records from 56 countries and 198 sub-national locations — city, state, and provincial records — from places like the US and Brazil.

Researchers also drew on previously published death estimates. They then subtracted the anticipated deaths from the actual number of deaths to find the excess mortality stemming specifically from the disease.

Excess mortality is mostly due to deaths directly from Covid-19, but it also includes deaths indirectly caused by the pandemic like people unable or unwilling to receive medical care, a decline in vaccination rates for other diseases, an increase in drug use, and a rise in depression. So researchers tried to correct for these factors to get their Covid-19 death estimate.

It’s a well-worn approach in public health circles and has been used to calculate other health indicators like the global burden of disease.

The model showed that, around the world, more than half of Covid-19-related deaths are not labeled in the official tallies. And the actual number could still be higher.

According to Christopher Murray, the director of IHME, while just about every part of the world missed cases of Covid-19, some countries missed more than others.

“In many parts of the world — sub-Saharan Africa, India, Latin America, differences by state in Brazil and Mexico — you can account for much of the under-reporting because of lower testing rates,” Murray said during a press conference. “But there is this phenomenon — Egypt stands out, as do a number of different countries in Eastern Europe and Central Asia — where these excess mortality rate numbers suggest dramatically larger epidemics than have been reported that cannot be accounted for through testing.”

Egypt has officially reported just over 13,000 Covid-19 deaths, but IHME found its estimated death toll was more than 170,000. It’s not clear why the discrepancy is so large, but it shows Covid-19 epidemics in different countries can be far worse than the death reports reveal.

“We are absolutely, absolutely undercounting deaths,” said Ruth Etzioni, a professor and biostatistician at the Fred Hutchinson Cancer Research Center who was not involved in the study.

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IHME’s Covid-19 models missed the mark before, but researchers say they’ve improved

Scientists have also been critical of IHME’s past modeling work during the Covid-19 pandemic.

IHME’s forecasts last spring were criticized for projecting many fewer deaths than actually occurred. In March 2020, the organization projected fewer than 161,000 deaths total in the US. Then in April 2020, the group revised their death toll projections through August to be 60,415, with an uncertainty range between between 31,221 and 126,703 deaths. The projections were out of step with other epidemiological models, which were anticipating far more casualties from Covid-19.

The Trump White House, however, was eager to use the rosy IHME projections as the basis for planning for the pandemic and lifting public health restrictions, as well as a political tool to downplay the severity of Covid-19. “I was furious with [IHME], and I’m still kind of getting over it,” Etzioni said. “In the beginning, it was unacceptably un-rigorous.”

By the end of August 2020, more than 180,000 Americans had died of the disease.

“So far as I can tell, IHME has substantially improved their modeling from the early days of the pandemic,” said Alexey J. Merz, a professor of biochemistry at the University of Washington, in an email. “My major criticisms pertain to those early efforts, and IHME’s ongoing failure to address what went wrong, or to assess the (in my opinion, considerable) damage arising from those flawed estimates.”

Asked about IHME’s track record, Murray explained how his team’s Covid-19 forecasting improved and even outperformed other models. “For example, if you go back to August last year, we were forecasting the winter surge, and nobody else thought there was going to be a winter surge in the United States,” he said. “We spend a lot of time on our model trying to look at what are the long-term drivers so we have been able to pick up these long-term trends quite a bit sooner than others.”

Why the US official count is so low compared to the new analysis

It makes sense that countries with less robust health care systems and fewer resources would struggle to keep track of how many people are dying of Covid-19. But the US, a wealthy country that has a national Covid-19 death reporting system, also missed almost 40 percent of Covid-19 deaths, according to the IHME model.

That’s because while death can seem like a pretty obvious health indicator, the causes of death can be mercurial.

The problems start with the death certificate. Ivor Douglas, chief of the Pulmonary Sciences and Critical Medicine division at the Denver Health Medical Center, explained that death certificates emphasize the primary cause of death, which is the most immediate condition leading to the fatality. Death certificates also have space for secondary and indirect causes.

As the Covid-19 pandemic has revealed, the disease can manifest in myriad ways and leave lasting damage, even in people who had a mild illness.

So a Covid-19 death certificate could list something like a blood clot in the lungs as the primary cause of death, with Covid-19 as a secondary or indirect cause. Whether that specific death is then coded as a Covid-19 fatality could differ depending on the state. That local-level reporting has sometimes become politicized and led to discrepancies in death tolls.

And when Covid-19 first arrived in the US, many health workers didn’t realize what they were dealing with and thus didn’t include it in their paperwork. “I think the preponderance of missed cases were early on in the pandemic,” Douglas said. “Often, certainly early in the pandemic, there was the primary diagnosis without Covid-19 attribution.”

The missing Covid-19 deaths are also another manifestation of the inequities in US society. “If you’re poor, don’t have access [to health care], and die at home, you’re much less likely to have an attribution of Covid pneumonia as a cause of your death than ‘oh, you’re a sad old person with diabetes’ and that was the cause of death,” Douglas said.

That means that the groups that are being most severely harmed by Covid-19 may also be underrepresented in the official numbers. That makes it harder to properly allocate resources like tests, vaccines, and treatment to the most vulnerable people, forcing them to bear an even greater health burden.

“There’s real policy implications, it has political implications, and social justice implications, in my mind,” Douglas said. On the other hand, accurate monitoring could help mitigate the harms of the Covid-19 pandemic, helping health officials figure out not just where to deploy vaccines and treatments, but other factors driving transmission, like crowded living conditions. Intervening before infections begin to spread is what will yield the greatest dividends in containing the disease. “You cannot simply vaccinate your way out of this problem,” Douglas said.

Finding the true toll of Covid-19 is more urgent than ever

Regardless of how high the actual number of deaths is, the devastation of Covid-19 is clear. “Even the reported numbers are so utterly staggering that I’m not even sure doubling it should make us even more horrified,” Nuzzo said.

Still, the fact that Covid-19 deaths appear so vastly underreported should be a warning that the virus can still take millions more lives, and why containing Covid-19 is imperative for every country in the world. “We should feel more personally threatened by these numbers. And we should recognize it as a societal threat,” Etzioni said.

The devastating Covid-19 outbreak in India is all the more urgent now that multiple variants of Covid-19 that are more transmissible and better able to evade immunity are spreading around the world. As the virus continues to spread, the likelihood of even more dangerous variants arising will grow.

What’s more, the countries that have been reporting lower deaths so far deserve more attention. “Many of us contend that sub-Saharan Africa has been extensively devastated by the pandemic but because of lack of testing medical reporting, it appears as if there has been a relatively minor event there,” Douglas said.

As for countries that have so far been genuinely spared from Covid-19, they must remain vigilant and take active measures to keep the disease at bay. “It may be that they haven’t yet been hit or it could be that we don’t fully understand how they’ve been hit, but I want to put to bed this idea that any country has simply escaped the worst of it,” Nuzzo said. “The countries that have done the best are ones that have been very, very aggressive in responding to it.”

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