Why healthcare workers are quitting in droves

‘About one in five health-care workers has left their job since the pandemic started. This is their story—and the story of those left behind...

‘Health-care workers aren't quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise...

‘Several health-care workers told me that, amid the most grueling working conditions of their careers, their hospitals cut salaries, reduced benefits, and canceled raises; forced staff to work more shifts with longer hours; offered trite wellness tips, such as keeping gratitude journals, while denying paid time off or reduced hours; failed to provide adequate personal protective equipment; and downplayed the severity of their experiences.’

Read here (The Atlantic, Nov 16, 2021)

America has lost the plot on Covid

‘We know how this ends: The coronavirus becomes endemic, and we live with it forever. But what we don’t know—and what the U.S. seems to have no coherent plan for—is how we are supposed to get there. We’ve avoided the hard questions whose answers will determine what life looks like in the next weeks, months, and years: How do we manage the transition to endemicity? When are restrictions lifted? And what long-term measures do we keep, if any, when we reach endemicity?

‘The answers were simpler when we thought we could vaccinate our way to herd immunity. But vaccinations in the U.S. have plateaued. The Delta variant and waning immunity against transmission mean herd immunity may well be impossible even if every single American gets a shot. So when COVID-related restrictions came back with the Delta wave, we no longer had an obvious off-ramp to return to normal—are we still trying to get a certain percentage of people vaccinated? Or are we waiting until all kids are eligible? Or for hospitalizations to fall and stay steady? The path ahead is not just unclear; it’s nonexistent. We are meandering around the woods because we don’t know where to go.’

Read here (The Atlantic, Nov 1, 2021)

‘Maybe the coronavirus was lower-hanging fruit’

‘Emerging mRNA technology proved excellent for COVID vaccines. BioNTech’s founders preview what that could mean for cancer and other mysteries...

‘The fact that mRNA technology had never delivered an authorized therapy before the coronavirus pandemic could tell us one of two things. Perhaps synthetic mRNA is like a miraculous key that humankind pulled out of our pockets in this pandemic, but it was so perfectly shaped for the coronavirus that we shouldn’t expect it to unlock other scientific mysteries any time soon.

‘Or perhaps mRNA is merely in the first chapter of a more extraordinary story. This month, BioNTech announced that it had initiated Phase 2 trials of personalized cancer vaccines for patients with colorectal cancer. It is working on other personalized cancer vaccines and exploring possible therapies for malaria using a version of the mRNA technology that had its breakout moment in 2020.’

Read here (The Atlantic, Oct 18, 2021)

What even counts as science writing anymore? Ed Yong

‘The pandemic made it clear that science touches everything, and everything touches science...

‘To the extent that the pandemic has been a science story, it’s also been a story about the limitations of what science has become. Perverse academic incentives that reward researchers primarily for publishing papers in high-impact journals have long pushed entire fields toward sloppy, irreproducible work; during the pandemic, scientists have flooded the literature with similarly half-baked and misleading research. Pundits have urged people to “listen to the science,” as if “the science” is a tome of facts and not an amorphous, dynamic entity, born from the collective minds of thousands of individual people who argue and disagree about data that can be interpreted in a range of ways. The long-standing disregard for chronic illnesses such as dysautonomia and myalgic encephalomyelitis meant that when thousands of COVID-19 “long-haulers” kept experiencing symptoms for months, science had almost nothing to offer them. The naive desire for science to remain above politics meant that many researchers were unprepared to cope with a global crisis that was both scientific and political to its core. “There’s an ongoing conversation about whether we should do advocacy work or ‘stick to the science,’” Whitney Robinson, a social epidemiologist, told me. “We always talk about how these magic people will take our findings and implement them. We send those findings out, and knowledge has increased! But with Covid, that’s a lie!”

https://www.theatlantic.com/science/archive/2021/10/how-pandemic-changed-science-writing/620271/

Read here (The Atlantic, Oct 2, 2021)

We’re already barreling toward the next pandemic: Ed Yong

‘This one is far from over, but the window to prepare for future threats is closing fast...

“To be ready for the next pandemic, we need to make sure that there’s an even footing in our societal structures,” Seema Mohapatra, a health-law expert at Southern Methodist University, in Dallas, told me. That vision of preparedness is closer to what 19th-century thinkers lobbied for, and what the 20th century swept aside. It means shifting the spotlight away from pathogens themselves and onto the living and working conditions that allow pathogens to flourish. It means measuring preparedness not just in terms of syringes, sequencers, and supply chains but also in terms of paid sick leave, safe public housing, eviction moratoriums, decarceration, food assistance, and universal health care. It means accompanying mandates for social distancing and the like with financial assistance for those who might lose work, or free accommodation where exposed people can quarantine from their family. It means rebuilding the health policies that Reagan began shredding in the 1980s and that later administrations further frayed. It means restoring trust in government and community through public services. “It’s very hard to achieve effective containment when the people you’re working with don’t think you care about them,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me. 

Read here (The Atlantic, Sept 29, 2021)

Six rules that will define our second pandemic winter

The pandemic keeps changing, but these principles can guide your thinking through the seasons to come.

• The role of vaccines has changed (again)
• The proportion of vaccinated people matters, but who they are and how they cluster also matters
• The people at greatest risk from the virus will keep changing
• As vaccination increases, a higher proportion of cases will appear in vaccinated people—and that’s what should happen
• Rare events are common at scale
• There is no single “worst” version of the coronavirus

Read here (The Atlantic, Sept 20, 2021)

The plan to stop every respiratory virus at once

‘The benefits of ventilation reach far beyond the coronavirus. What if we stop taking colds and flus for granted, too?

‘The challenge ahead is cost. Piping more outdoor air into a building or adding air filters both require more energy and money to run the HVAC system. (Outdoor air needs to be cooled, heated, humidified, or dehumidified based on the system; adding filters is less energy intensive but it could still require more powerful fans to push the air through.) For decades, engineers have focused on making buildings more energy efficient, and it’s “hard to find a lot of professionals who are really pushing indoor air quality,” Bahnfleth said. He has been helping set COVID-19 ventilation guidelines as chair of the ASHRAE Epidemic Task Force. The pushback based on energy usage, he said, was immediate. In addition to energy costs, retrofitting existing buildings might require significant modifications. For example, if you add air filters but your fans aren’t powerful enough, you’re on the hook for replacing the fans too.

‘The question boils down to: How much disease are we willing to tolerate before we act? When London built its sewage system, its cholera outbreaks were killing thousands of people. What finally spurred Parliament to act was the stench coming off the River Thames during the Great Stink of 1858. At the time, Victorians believed that foul air caused disease, and this was an emergency. (They were wrong about exactly how cholera was spreading from the river—it was through contaminated water—but they had ironically stumbled upon the right solution.)’

Read here (The Atlantic, Sept 8, 2021) 

What we actually know about waning immunity

‘Vaccines don’t last forever. This is by design: Like many of the microbes they mimic, the contents of the shots stick around only as long as it takes the body to eliminate them, a tenure on the order of days, perhaps a few weeks.

‘What does have staying power, though, is the immunological impression that vaccines leave behind. Defensive cells study decoy pathogens even as they purge them; the recollections that they form can last for years or decades after an injection. The learned response becomes a reflex, ingrained and automatic, a “robust immune memory” that far outlives the shot itself, Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. That’s what happens with the COVID-19 vaccines, and Ellebedy and others told me they expect the memory to remain with us for a while yet, staving off severe disease and death from the virus at extraordinary 

‘That prediction might sound incompatible with recent reports of the “declining” effectiveness of COVID-19 vaccines, and the “waning” of immunity. According to the White House, we’ll all need boosters very, very soon to fortify our crumbling defenses. The past few weeks of news have made it seem as though we’re doomed to chase SARS-CoV-2 with shot after shot after shot, as if vaccine protections were slipping through our fingers like so much sand.’

Read here (The Atlantic, Sept 3, 2021)

The coronavirus could get worse

‘In the worst-case scenario, a variant could arise that would “make it like the vaccines did not exist,” Hanage [Bill Hanage, an epidemiologist at the Harvard School of Public Health] said. But at the moment, “there is no such variant like that.” And it would probably be extraordinarily difficult for one to manifest. Even the most evasive variants we know of—the ones that have stumped certain antibodies—aren’t fully duping vaccinated bodies, which harbor a slew of other immunological guards. Hanage also pointed out that many people’s immune systems have been trained on different triggers—distinct brands of vaccines, unique variants, or some combination thereof. A new version of SARS-CoV-2 would find skirting all of those blockades at once to be nearly impossible.

‘Viruses aren’t infinitely mutable; sometimes, to keep themselves in contention, they must make sacrifices. Several experts told me they’re hopeful that the coronavirus might struggle to max out both transmission and immune evasion at once, requiring some sort of trade-off between the two. Some of the most powerful anti-coronavirus antibodies target SARS-CoV-2’s spike protein, which the virus uses to unlock and enter our cells. If the virus altered the protein to sidestep those antibodies, it might make itself less recognizable to the immune system. But it could also hurt its ability to infect us at all.’

Read here (The Atlantic, Aug 25, 2021)

Delta has changed the pandemic risk calculus

‘Vaccination was a reprieve from this calculus of personal danger, at least for a while—get vaccinated, get your family and friends vaccinated, get back to a far more normal version of life. To a certain extent, that logic holds: The vaccines are still doing a fantastic job preventing hospitalization and death from the coronavirus’s far-more-transmissible Delta variant. But as COVID-19 cases and hospitalizations have roared back, concerns about breakthrough cases among the vaccinated and increased transmissibility among kids have muddied a lot of people’s ability to gauge their own day-to-day risk, just as they’d begun to venture back out into the world and hug, eat, and laugh in the same airspace together again. In some ways, pandemic life is more confusing than ever.’

Read here (The Atlantic, August 19, 2021)

How the pandemic now ends: Ed Yong

‘Pandemics end. But this one is not yet over, and especially not globally. Just 16 percent of the world’s population is fully vaccinated. Many countries, where barely 1 percent of people have received a single dose, are “in for a tough year of either lockdowns or catastrophic epidemics,” Adam Kucharski, the infectious-disease modeler, told me. The U.S. and the U.K. are further along the path to endemicity, “but they’re not there yet, and that last slog is often the toughest,” he added. “I have limited sympathy for people who are arguing over small measures in rich countries when we have uncontrolled epidemics in large parts of the world.”

‘Eventually, humanity will enter into a tenuous peace with the coronavirus. COVID-19 outbreaks will be rarer and smaller, but could still occur once enough immunologically naive babies are born. Adults might need boosters once immunity wanes substantially, but based on current data, that won’t happen for at least two years. And even then, “I have a lot of faith in the immune system,” Marion Pepper, the immunologist, said. “People may get colds, but we’ll have enough redundancies that we’ll still be largely protected against severe disease.” The bigger concern is that new variants might evolve that can escape our current immune defenses—an event that becomes more likely the more the coronavirus is allowed to spread. “That’s what keeps me up at night,” Georgetown’s Shweta Bansal told me.

‘To guard against that possibility, the world needs to stay alert. Regular testing of healthy people can tell us where the virus might be surging back.’

Read here (The Atlantic, August 12, 2021)

Millions are saying no to the vaccines. What are they thinking?

‘So what will change their minds? I cannot imagine that any amount of hectoring or shaming, or proclamations from the public-health or Democratic communities, will make much of a difference for this group. “I’ve lost all faith in the media and public-health officials,” Myles Pindus, a 24-year-old in Brooklyn, said. “It might sound crazy, but I’d rather go to Twitter and check out a few people I trust than take guidance from the CDC, or WHO, or Fauci,” Baca, the Colorado truck driver, told me. Other no-vaxxers offered similar appraisals of various Democrats and liberals, but they were typically less printable.

‘From my conversations, I see three ways to persuade no-vaxxers: make it more convenient to get a shot; make it less convenient to not get a shot; or encourage them to think more socially.’

Read here (The Atlantic, May 3, 2021)

The hot-person vaccine

‘The internet has decided that Pfizer is significantly cooler than Moderna—but why?...

‘Large differences in access aren’t limited to certain brands, and some degree of “us versus them” applies across all of the available shots. White Americans continue to have higher vaccination rates than Black and Hispanic Americans, for example. And according to a vaccine-equity project run out of Duke University’s Global Health Innovation Center, high-income countries have already purchased more than half of the world’s available vaccine doses.

‘Seen in that context, ironic Pfizer elitism may feel uncomfortably close to actual elitism. Another vaccine-culture TikTok that went viral paired each brand with its equivalent cellphone—the iPhone for Pfizer, a recent-looking Android model for Moderna, an early 2010s pay-as-you-go Firefly phone for Johnson & Johnson, and a truly ancient Nokia for AstraZeneca. The video compared the slim but tangible differences between Pfizer and Moderna to the silly, perennial debate over whether iPhone users are snobby and judgmental toward people whose texts show up as “green bubbles.” For some commenters, this was a step too far. “Classism is disgusting,” one responded. “Not westerners fighting over which vaccine is best,” another wrote with a sobbing emoji.’

Read here (The Atlantic, Apr 30, 2021)

Why the world should worry about India

‘The world’s largest vaccine producer is struggling to overcome its latest COVID-19 surge—and that’s everyone’s problem...

‘None of the Indian government’s missteps absolve the world from caring about what happens to the country, nor should they. Beyond the obvious moral reasons are practical ones too. As I have repeatedly written before, uncontrolled outbreaks anywhere pose a threat everywhere, including vaccine-rich countries such as the United States. Perhaps the biggest concern right now, in India and elsewhere, is the threat posed by more transmissible variants and their potential ability to overcome vaccine immunity. Though virtually every known variant, including those from Britain, Brazil, and South Africa, has been identified in India, in some states the Indian strain has become the most prevalent.

“It’s very similar to what we saw in Manaus,” Christina Pagel, the director of clinical operational research at University College London, told me, referring to the badly hit Brazilian city. She noted that “it’s not a coincidence that these variants are arising in populations that have developed immunity through infection.”

Read here (The Atlantic, Apr 26, 2021)

The blood-clot problem is multiplying

‘Whether the blood issues are ultimately linked to only one vaccine, or two vaccines, or more, it’s absolutely crucial to remember the unrelenting death toll from the coronavirus itself—and the fact that COVID-19 can set off its own chaos in the circulatory system, with blood clots showing up in “almost every organ.” That effect of the disease is just one of many reasons the European Medicines Agency has emphasized that the “overall benefits of the [AstraZeneca] vaccine in preventing COVID-19 outweigh the risks of side effects.” The same is true of Johnson & Johnson’s. These vaccines are saving countless lives across multiple continents.

‘But it’s also crucial to determine the biological cause of any vaccine-related blood conditions. This global immunization project presents a lot of firsts: the first authorized use of mRNA vaccines like the ones from Pfizer and Moderna; the first worldwide use of adenovirus vectors for vaccines like AstraZeneca’s, Johnson & Johnson’s, and Sputnik V; and the first attempt to immunize against a coronavirus. Which, if any, of these new frontiers might be linked to serious side effects? Which, if any, of the other vaccines could be drawn into this story, too? How can a tiny but disturbing risk be mitigated as we fight our way out of this pandemic? And what might be the implications for vaccine design in the years to come?

‘To answer these questions, scientists will have to figure out the biology behind this rare blood condition: what exactly causes it; when and why it happens. This is not an easy task. While the evidence available so far is fairly limited, some useful theories have emerged...

• Theory 1: Platelet problems
• Theory 2: The spike’s the problem
• Theory 3: A suspect sequence
• Theory 4: The mixed bag

Read here (The Atlantic, Apr 17, 2021)

Three different futures for the Johnson & Johnson vaccine

‘Based on what we know so far, the future of the J&J vaccine can fork in at least three different directions. In one, the vaccine flames out; unless many, many more cases come to light soon, this seems unlikely. Either of the other two—in which officials end the pause and return the nation to its regularly scheduled vaccine programming, with or without restrictions on who gets J&J next—are more likely. No matter the outcome, though, today’s announcement won’t quickly be forgotten. Pauses in clinical trials, sprinkled through the past year, have already stoked vaccine hesitancy, skepticism, and outright denialism in many circles. The Johnson & Johnson vaccine, previously stigmatized for being “less effective,” now risks a second label: “less safe.” It’s on the precipice of becoming our country’s grody vaccine; maybe it’s already toppled over the edge. An altered reputation in the U.S. will reverberate throughout the world, and set back the global struggle to contain the coronavirus.

‘If the J&J vaccine does return with the FDA’s blessing, we’ll need to rehabilitate it with clear and nuanced messaging, Gounder and many others told me. A vaccine can be excellent. A vaccine can also carry risks. Both can be true; both have been true, for other shots we’ve used. In this case, the gamble could be very small—and still be well worth it.’

Read here (The Atlantic, Apr 13, 2021)

The threat that Covid-19 poses now

‘After a year of waves and surges, the pandemic is entering a “tornado” phase in America...

‘The United States is entering a new phase of the pandemic. Although we’ve previously described the most devastating periods as “waves” and “surges,” the more proper metaphor now is a tornado: Some communities won’t see the storm, others will be well fortified against disaster, and the most at-risk places will be crushed. The virus has never hit all places equally, but the remarkable protection of the vaccines, combined with the new attributes of the variants, has created a situation where the pandemic will disappear, but only in some places. The pandemic is or will soon be over for a lot of people in well-resourced, heavily vaccinated communities. In places where vaccination rates are low and risk remains high, more people will join the 550,000 who have already died.’

Read here (The Atlantic, Apr 6, 2021)

The hidden toll of remote work

‘Switching to Zoom forever might be convenient, but it’s a recipe for loneliness.

‘Between one-third and one-half of American employees worked in person throughout the pandemic, with or without a say in the matter, and some at great personal risk. Most of the rest of us were forced to work from home, also without necessarily wanting to. And in fact, almost two-thirds of people in a poll last fall felt that the cons of working from home outweighed the pros, and nearly a third said they had considered quitting their jobs since being banned from the workplace. In another poll, about 70 percent said that mixing work and other responsibilities had become a source of stress, and about three in four American workers in the early days of the pandemic confessed to being “burned out”.’

Read here (The Atlantic, Apr 1, 2021) 

The pandemic’s wrongest man [in the US]

‘In this crowded field of wrongness, one voice stands out. The voice of Alex Berenson: the former New York Times reporter, Yale-educated novelist, avid tweeter, online essayist, and all-around pandemic gadfly. Berenson has been serving up COVID-19 hot takes for the past year, blithely predicting that the United States would not reach 500,000 deaths (we’ve surpassed 550,000) and arguing that cloth and surgical masks can’t protect against the coronavirus (yes, they can).

‘Berenson has a big megaphone. He has more than 200,000 followers on Twitter and millions of viewers for his frequent appearances on Fox News’ most-watched shows. On Laura Ingraham’s show, he downplayed the vaccines, suggesting that Israel’s experience proved they were considerably less effective than initially claimed. On Tucker Carlson Tonight, he predicted that the vaccines would cause an uptick in cases of COVID-related illness and death in the U.S...’

Read here (The Atlantic, Apr 1, 2021)

How mRNA technology could change the world

‘mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic...

‘But mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic. This year, a team at Yale patented a similar RNA-based technology to vaccinate against malaria, perhaps the world’s most devastating disease. Because mRNA is so easy to edit, Pfizer says that it is planning to use it against seasonal flu, which mutates constantly and kills hundreds of thousands of people around the world every year. The company that partnered with Pfizer last year, BioNTech, is developing individualized therapies that would create on-demand proteins associated with specific tumors to teach the body to fight off advanced cancer. In mouse trials, synthetic-mRNA therapies have been shown to slow and reverse the effects of multiple sclerosis. “I’m fully convinced now even more than before that mRNA can be broadly transformational,” Özlem Türeci, BioNTech’s chief medical officer, told me. “In principle, everything you can do with protein can be substituted by mRNA”.’

Read here (The Atlantic, Mar 29, 2021)