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Sunday, April 10, 2022

A new COVID wave is probably coming, and America just doesn’t seem to care

BY ERIN PRATER     |    April 9, 2022 11:25 AM AST

It was a viral moment that elicited both nervous laughs and tears of joy from a pandemic-weary nation: Colorado Gov. Jared Polis awaiting his state's first COVID vaccine shipment in December 2020, staring at a delivery door like a child stares at a fireplace on Christmas Eve.

“Any minute now we’re going to hear a doorbell,” Polis says with childlike glee, his words muffled by a surgical mask. 

“And then we’re going to ….” He dramatically pauses before saying, “of course, let the vaccine in.”

Before he finishes his sentence, a bell shrieks.

“Ope, there we go!” Polis exclaims, making a rapid rotation to hit a button and open the warehouse door. 

“This is the Pfizer vaccine, arriving here in Colorado, to end the pandemic!” he exclaims as the door opens slowly, awkwardly revealing a delivery man who perhaps wasn’t aware he’d been chosen to save mankind—or at least Coloradans.

Polis’ giddy anticipation mirrored the mental state of so many Americans in those weeks before Christmas 2020. The potential side effects were unnerving, maybe, but the vaccine was coming.

To end the pandemic and nine months of isolation and tragedy.

That was the hope. But it wasn’t reality.

“I think some of it is just human nature, that you want to believe there will be a quick technological fix,” Fractal Therapeutics CEO Arijit Chakravarty told Fortune. His position is summed up by the headline of his searing new article published to Lancet-affiliated preprint journal medRxiv: “Endemicity is not a victory: the unmitigated downside risks of widespread SARS-COV2 transmission.”

Scenarios under which the U.S. sees surges of a variant more deadly than any seen before are plausible, Chakravarty and his colleagues contend.

Hundreds of thousands of deaths could ensue annually, they say. COVID could become the No. 1 cause of death in the U.S., beating out the most common maladies like heart disease and cancer.

“It’s not a specific prediction about the future,” Chakravarty hedged. “We’re not saying the world will end on Tuesday, April 7, 2024. But the goal is to make people say, ‘Gee, some scenarios out there are really quite ugly.’”

A ‘one-way ceasefire’

Chakravarty isn’t alone in worrying about what happens next. He has good company in Dr. Anthony Fauci, the infectious disease expert who has become the face of America’s COVID response. He said this week that a surge of COVID is likely this fall, and an increase in cases over even the next few weeks would not be surprising.

Fauci’s remarks contrast with a sudden vanishing of the Omicron wave that gripped the country in December and January (and ruined many people’s holiday plans). Cases fell so far so fast that big cities like New York relaxed mandates that had been in place for nearly two years. In New York’s case, famously unvaccinated celebrities like basketball star Kyrie Irving are free to play indoors again, and masks are off at most restaurants and retail outlets, bringing it in line with the rest of the country.

March is seeing cases creep back up again as bosses consider a widespread return to the office.

When it comes to the blissful oblivion of many to the pandemic’s continued existence, “motivated reasoning” is to blame, says psychologist Paul Thagard, a philosopher and cognitive scientist who authored the paper “The cognitive science of COVID-19: Acceptance, denial, and belief change.”

Another term for motivated reasoning: “a complicated version of wishful thinking.”

“People look at what makes them happy instead of evidence,” Thagard says. “This virus has been very unpredictable. People want to believe it’s going to get better and better. It’s not based on solid knowledge of the biology of the virus.”

If another severe wave of COVID were to hit the U.S., Thagard predicts the country would see a similarly large wave of denial, “one more application of motivated reasoning.”

“Right now things don’t look that bad in North America, generally, because hospitals aren’t that full. That could change fairly quickly.”

Vaccines aren't enough

Current vaccines have failed to end the pandemic.

That’s a key argument Chakravarty and his coauthors make in their new paper.

It’s a reality, they say, that so many are failing to recognize as they buy into the scenario that the pandemic is becoming milder and will continue to, and that the pandemic is shrinking to endemicity and will continue to shrink in scale.

“Public-health authorities in many countries have advocated for a strategy of using the vaccines to limit morbidity and mortality while permitting unchecked SARS-CoV-2 spread (‘learning to live with the disease’),” Chakravarty’s team writes. 

But that strategy seems to rely on future waves of COVID being less deadly, either due to weaker but more transmissible strains of the virus taking hold, or due to population immunity that is inevitably temporary, the authors write. And it ignores the fact infection fatality rates of future COVID variants may wax and wane.

“Omicron was mild. Maybe if there’s a BA.3, it will be mild too,” Chakravarty says. “But just because it was named Omicron 3 doesn’t mean it couldn’t be its own beast.”

Writing the paper wasn’t easy, Chakravarty says. 

“We, as a team, went back and forth—this took months to write,” he says. “Emotionally, it’s a difficult conclusion to come to. It doesn’t help you sleep well at night.”

Regarding COVID, “You have to mitigate the risk of the worst thing without having a big debate about whether or not it’s going to happen today. People aren’t really having that conversation.”

He and his colleagues realize an approach like China’s zero COVID policy isn’t sustainable. The team recommends an approach of “subtle changes” that “don’t require endless amounts of personal sacrifice,” and that “slow down evolution and work on limiting the spread.”

Among their proposals: upgrading air quality and ventilation in buildings, since most transmission occurs indoors; widespread surveillance of virus transmission; and focusing on the development of preventative medicines and next-generation vaccines that can reduce the spread.

But with Congress bickering over a $10 billion COVID aid bill and the U.S. running out of funds for things like vaccines and research, the U.S. is quickly losing its ability to “see what’s happening and react nimbly.”

“We’re more and more flying blind,” he says.

A World Health Organization official recently aid we may be entering a "period of ceasefire" with the virus, but Chakravarty says "it takes two parties to agree to a ceasefire. Another word for a one-way ceasefire? Surrender.”

'We get comfortable with what happens'

Chakravarty says America is now rolling the dice with its COVID strategy.

Dr. Georges Benjamin, executive director of the American Public Health Association, says it’s the no-plan plan.

In short: The American approach to COVID seems to be “ignore it and hope it goes away, and hope the interventions we have right now are functional enough to make it tolerable,” he says.

“And the answer is, not yet. We have good tools. We’re better than we were two years ago, but this virus is pretty tricky. It’s fooled us every time we thought we understood something.

“In many ways, we were unprepared and playing catch-up.”

COVID isn’t the only public health crisis about which Americans have become complacent, Benjamin says. 

“We get tired of an issue,” he says. “We park it. We get comfortable with what happens. Thousands of people die from gun violence every year. That’s something that, when it happens, particularly mass shootings, everyone says, ‘It’s terrible. We must do something.’ 

“But the political will to do something about it quickly fades.”

He worries the most about politicians getting COVID fatigue and potentially failing to pass another COVID aid bill to fund, among other things, surveillance of the virus and research on new variants.

“Resource allocators have a tendency to, when something happens, throw a lot of money at it—usually not quite enough, never for long enough,” he says. “Then they withdraw funding, and their expectation of performance far exceeds the money put into it.

“We’re seeing that happen right now.”

A cautionary tale

This isn’t the first time Americans have turned a blind eye toward disease, says John M. Barry, author of “The Great Influenza: The story of the deadliest pandemic in history.”

The 1918 flu pandemic “killed young people and children, and the elderly largely escaped it—despite that, people grew tired of taking precautions.”

The flu, an H1N1 virus thought to have originated in birds, was first identified in the U.S. in the spring of 1918. It spread worldwide in waves, infecting about a third of the world’s population and killing at least 50 million, with about 675,000 deaths in the U.S. alone, according to the U.S. Centers for Disease Control and Prevention. Many were previously healthy young adults and young children.

When it comes to America’s collective memory, the flu pandemic was left out, a seeming historical amnesia.

“That’s the single question I was asked most when my book came out in 2004: ‘How come I never heard of this?’” he says.

He’s not entirely sure, though it might have something to do with people at the time being more accustomed to death by infectious disease, World War I, and historians writing about “what people did to people,” but not about what nature did to people.

Thagard offers a cautionary tale: a fourth wave of the 1918 flu pandemic that came in 1920 at a time when the public was weary.

“They pretty much entirely ignored it—and the fourth wave, in some cities, was the deadliest yet,” Barry says.

“People just didn’t want to deal with it, just as we don’t want to deal with it.”

Source: https://fortune.com/2022/04/09/new-covid-wave-return-to-office-fauci-omicron-subvariant/

Sunday, April 3, 2022

A New Wave of Covid-19 Is Coming. Here’s How to Prepare.

Taking these seven steps now can lower your risk and minimize the disruption to your family’s life.

By Tara Parker-Pope and Knvul Sheikh

Published March 30, 2022 | Updated April 1, 2022

John Macdougall/Agence France-Presse — Getty Images

The next wave of Covid-19 is coming, and in some parts of the United States, it’s already here. Are you ready?

The culprit this time is BA.2, a subvariant of the highly infectious Omicron variant. Nobody knows for sure how much havoc it will cause, but BA.2 has already led to a surge of cases in Europe and is now the dominant version of the coronavirus in the United States and around the world.

Researchers are tracking an uptick in cases in the United States, and they’ve detected a rise in the viral particles recovered from nearly 150 wastewater-surveillance sites. Because people can shed the coronavirus even if they never develop symptoms, pieces of the virus collected in wastewater can serve as advance warning several days before official case counts rise, said Bronwyn MacInnis, who directs pathogen genomic surveillance at the Broad Institute in Cambridge, Mass. Over the past two weeks, Dr. MacInnis’s group has seen a rapid increase in levels of the BA.2 subvariant in the Northeast.

“I don’t think we’re looking at a crazy lockdown scenario in this part of the world with BA.2,” Dr. MacInnis said. “But we can’t be sure that we won’t have another curveball from this virus in the future.”

American health officials have said they are hopeful that BA.2 won’t cause another major surge, in part because so many people were infected by the original Omicron wave this winter and most likely have at least some natural or vaccine immunity to protect them against severe illness and hospitalization.

But other variables could turn the BA.2 wave into a more damaging surge. One concern is that less than 70 percent of Americans over 65 have had a first booster shot, leaving a large group vulnerable, said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in La Jolla, Calif. And for many people who got their booster shots in the fall, immune protection may be waning. Unvaccinated people who are counting on natural immunity from a previous infection by a different variant should know that BA.2 can easily sidestep those fading immune defenses.

And then there’s the question of whether pandemic fatigue will prevent some people from taking reasonable precautions, like wearing masks and social distancing, when Covid numbers start to rise in their area.

“We know how to manage it,” said Dr. Robert Wachter, a professor and the chair of the medicine department at the University of California, San Francisco. “But the big caveat will be that there are lots of parts of the country that will not go back into careful mode. It’s wishful thinking to believe we’re going to stay in a situation as good as we are in now.”

While the virus is unpredictable, there are clear ways to protect yourself. The plans you make now can lower your risk of exposure, minimize the disruption to the lives of your family and friends and help to assure you have access to treatments if you or someone you know becomes seriously ill.

Here’s what you can do to prepare.

Pay attention to Covid indicators in your community

Don’t wait for public health officials to issue warnings. Keep an eye on Covid-19 statistics for your county or region. An easy way to do this is to check the color-coded map from the Centers for Disease Control and Prevention that shows community levels of Covid-19 around the country. The map is mostly a welcoming green right now, which means there are relatively low rates of new cases and hospital admissions. But there is a growing number of yellow spots, showing medium risk, in Texas, the Northeast and other areas, and orange-colored hot spots are cropping up in Montana, the Dakotas and other states, indicating high rates of community spread.

As the map shifts to yellow and eventually orange in your area, it’s time to take extra precautions, including donning masks in public spaces and rethinking large indoor gatherings where you don’t know the vaccination status of others.

If you want even earlier warning of Covid trends, you can bookmark the C.D.C.’s wastewater data tracker map.

Another useful indicator is your community’s positive test rate. Experts advise taking more precautions as you see positive test rates start to rise above 5 percent. The Johns Hopkins coronavirus resource center shows daily U.S. and state-by-state testing trends.

Have high-quality masks on hand

Even if you’re not wearing a mask now, check your mask supply and make sure you have plenty of high-quality medical-style masks on hand. A limited number of free N95 respirator masks are available at pharmacies and community centers. Enter your ZIP code on the C.D.C.’s mask locator to find a participating distributor near you. If you want to buy additional masks, use our guide to find a reliable supply of N95, KN95 or KF94 masks and avoid counterfeits.

Since many communities have lifted mask mandates, when and how often you use a mask is probably going to be up to you.

“The mask needs to go on when you start seeing case numbers going back up,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading experts on viral transmission.

Dr. Marr said she knows people are tired of masks, but wearing one is only a minor inconvenience and is a proven way to lower your risk. “I’m not into fear mongering, but there’s still so much we don’t know about long Covid that I don’t want to get Covid, and I don’t want anyone else to, either,” she said.

And the more people who wear masks as cases start to rise, the sooner the next wave will be over.

Order home Covid tests sooner rather than later

Each U.S. household is eligible for two sets of four home Covid tests free from the government; if you haven’t ordered them yet, get them now before the weather turns warm. The tests can be damaged by heat, and you don’t want yours sitting for hours in a mail truck on a hot day.

“Now is better than a month from now, especially for people in hot locations,” said Dr. Michael Mina, chief science officer for eMed, a company that verifies at-home test results. “Just take advantage of the program, get them and put them in your cupboard for when you need them.”

People with insurance can also be reimbursed for eight free tests a month. If you develop respiratory symptoms, have a fever or just feel unusually fatigued, use a test on the first day of symptoms. If symptoms persist and you still test negative at home a few days later, you may want to get a lab-based PCR test to be sure.

“If you can afford it, test when you think you have allergies, test when you think you have a cold,” said Kelly Hills, a bioethicist and risk expert and co-founder of the consulting firm Rogue Bioethics. “This is one of those things I think people need to get in the habit of setting aside money for because tests provide important data for making decisions.”

Get a booster (when you’re eligible)

Federal regulators have authorized a second booster shot for everyone 50 and older. The agency also authorized a second booster for people 12 and older with certain immune deficiencies.

While scientists are still debating the value of another booster, most say that people 65 and older and the immune compromised are likely to benefit. If you haven’t gotten your first booster shot, experts agree you should get one now. If you’ve recently had Covid, you most likely have as much natural protection as you’d get from a booster shot — at least for a while.

The protective antibodies from a vaccine or an infection tend to wane in four or five months. A well-timed booster shot tells the body to bump up its antibody defenses and helps other parts of the immune system — like B cells and T cells — become better at remembering how to fight the virus, said Theodora Hatziioannou, a virologist at Rockefeller University in New York City.

Get a pulse oximeter

A pulse oximeter is a small device that clips on your finger and measures your blood oxygen levels. When levels drop to 92 or lower, patients should see a doctor. Low oxygen can be a sign of Covid pneumonia and may raise your risk for serious complications from Covid-19. The devices can be less reliable for people with darker skin, so pay attention to downward trends as well as the number.

A study from South Africa found that the risk of dying from Covid-19 was about 50 percent lower among patients who had been instructed to monitor their oxygen saturation at home. You can find the devices for about $30 in pharmacies and online. (Researchers say the pulse oximetry reading on your Apple watch probably is less reliable than the fingertip device.)

Make a plan for antiviral drug treatment

Two oral antiviral therapies are available to treat Covid-19 in the United States, though they require a doctor’s prescription and are authorized only for people who may be at high risk of severe disease. One, called Paxlovid, developed by Pfizer, is taken as three pills twice a day for five days. It is available for high-risk patients 12 and older.

The second drug, called molnupiravir, was developed by Merck in partnership with Ridgeback Biotherapeutics. It is taken as four pills twice a day for five days, and is available for high-risk adults 18 and older.

For the pills to be most effective, you need to start taking them within five days of the start of your symptoms, so it’s important to have a plan for getting a prescription and knowing which pharmacy can fill it, said Kuldip Patel, the senior associate chief pharmacy officer at Duke University Hospital in North Carolina.

You can use the Covid-19 therapeutics locator to track local supply of the drugs and check with your doctor to make sure you can receive the medication should you fall ill. (Some doctors are still declining to prescribe the drugs.) You can also look up qualified pharmacy-based clinics near you, as well as community health centers and long-term care facilities that have an authorized medical provider so you can get tested and, if positive, receive antiviral medication on the spot.

People who are immune compromised should also talk to their doctor about Evusheld, a drug from AstraZeneca that can be given by injection to provide an additional layer of protection on top of vaccines.

Have backup plans for social events and travel

If you have plans for a graduation party, wedding or other large event, it’s a good idea to have an outdoor backup plan if your community’s case numbers spike. If you’re planning to travel, do a little advance research into clinics and pharmacies at your destination so you know whether you can get antiviral drugs if you catch Covid-19 on your trip. Make sure you have extra funds or plenty of room on your credit card in case you need to extend your trip to recover from Covid. (You still need proof of a negative Covid test for international travel.)

Health experts said planning for the next wave of Covid shouldn’t disrupt your life or prompt you to cancel travel plans or time with friends and family. In fact, being prepared for the unexpected will allow you to keep living your life as normally as possible.

“A lot of people feel it’s a terrible inconvenience and they are sick of it, and I understand that,” said Dr. Topol, of Scripps Research. “We’ve had a time out, and it’s been good. But people should be ready to gear up if need be.”

Source: https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html

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