Covid-19 is different now: Our response to Covid-21 cannot be myopic

‘We are at an inflection point that will change the reality of this disease. The most insidious future is one in which we fail to change our moral benchmarks, and end up measuring the danger of COVID-21 by the standards of 2020. If wealthy countries with early access to vaccines abandon continued, global coronavirus-vaccination efforts as their cases fall or when the disease becomes milder for them, a still-severe disease could haunt the world indefinitely—and lead to rebounds everywhere.

‘Avoiding this myopia is the central challenge of COVID-21. It extends to the systemic problems highlighted by this pandemic. Much of the damage the virus has wrought has come indirectly, by exacerbating food and housing insecurity, for example, or restricting access to medical care. The Biden administration has elevated science and begun to focus on comprehensive approaches to prevention. No longer is federal leadership hawking hydroxychloroquine, suggesting injections with “disinfectant,” or stoking xenophobic sentiment. But this sudden sense of order is a beginning, not an end.’

Read here (The Atlantic, Mar 27, 2021)

Why the pandemic experts failed: We’re still thinking about pandemic data in the wrong ways

‘Not until early May, when the CDC published its own deeply inadequate data dashboard, did we realize the depth of its ignorance. And when the White House reproduced one of our charts, it confirmed our fears: The government was using our data. For months, the American government had no idea how many people were sick with COVID-19, how many were lying in hospitals, or how many had died. And the COVID Tracking Project at The Atlantic, started as a temporary volunteer effort, had become a de facto source of pandemic data for the United States.

‘After spending a year building one of the only U.S. pandemic-data sources, we have come to see the government’s initial failure here as the fault on which the entire catastrophe pivots. The government has made progress since May; it is finally able to track pandemic data. Yet some underlying failures remain unfixed. The same calamity could happen again.

‘Data might seem like an overly technical obsession, an oddly nerdy scapegoat on which to hang the deaths of half a million Americans. But data are how our leaders apprehend reality. In a sense, data are the federal government’s reality. As a gap opened between the data that leaders imagined should exist and the data that actually did exist, it swallowed the country’s pandemic planning and response.’

Read here (The Atlantic, Mar 16, 2021)

There is no one pandemic anniversary

‘Disaster anniversaries are powerful in part because they’re communal. The bomb went off in an instant. The tornado tore through town in an afternoon. The earthquake rocked the whole region at once. The pandemic, though, did not come to everyone on the same day, or even in the same month, and nor will its anniversary. In this way, as in so many others, this is not an ordinary disaster.

‘For each of the country’s more than 526,000 dead, nine people grieve. Hundreds of thousands have spent time in the ICU, an experience that can bring its own unique trauma. And then there are the smaller losses, the ones that did not threaten lives but still changed them. Today is the day I missed my mother’s funeral. The day I would have gone to prom. Met my grandson. Gotten married.’

Read here (The Atlantic, Mar 12, 2021)

The differences between the vaccines matter

‘It’s certainly true that all three of the FDA-authorized vaccines are very good—amazing, even—at protecting people’s health. No one should refrain from seeking vaccination on the theory that any might be second-rate. But it’s also true that the COVID-19 vaccines aren’t all the same: Some are more effective than others at preventing illness, for example; some cause fewer adverse reactions; some are more convenient; some were made using more familiar methods and technologies. As for the claim that the vaccines have proved perfectly and equally effective at preventing hospitalization and death? It’s just not right.

‘These differences among the options could matter quite a bit, in different ways to different people, and they should not be minimized or covered over. Especially not now: Vaccine supplies in the U.S. will soon surpass demand, even as more contagious viral variants spread throughout the country. In the meantime, governors are revoking their rules on face masks, or taking other steps to loosen their restrictions. It’s tempting to believe that a simple, decisive message—even one that verges on hype—is what’s most needed at this crucial moment. But if the message could be wrong, that has consequences.’

Read here (The Atlantic, Mar 8, 2021)

Unlocking the mysteries of Long Covid

‘A growing number of clinicians are on an urgent quest to find treatments for a frighteningly pervasive problem. They’ve had surprising early success...

‘The unlucky remainder—more than 90 percent of the patients the center has seen—was a puzzling group “where we couldn’t see what was wrong,” Chen said. These tended to be the patients who had originally had mild to moderate symptoms. They were overwhelmingly women, even though men are typically hit harder by acute COVID‑19. (Acute COVID‑19 refers to the distinct period of infection during which the immune system fights off the virus; the acute phase can range from mild to severe.) And they tended to be young, between the ages of 20 and 50—not an age group that, doctors had thought, suffered the worst effects of the disease. Most of the patients were white and relatively well-off, raising concern among clinicians that many people of color with ongoing symptoms were not getting the care they needed.

‘These patients’ tests usually showed nothing obviously the matter with them. “Everything was coming back negative,” says Dayna McCarthy, a rehabilitation-medicine physician and a lead clinician at the center. “So of course Western medicine wants to say, ‘You’re fine.’ ”

‘But the patients were self-evidently not fine. An international survey by Patient-Led Research for COVID‑19, one of various groups drawing attention to persisting problems, asked nearly 3,800 patients with ongoing illness to describe their symptoms. A significant number—85.9 percent—reported having relapses in the months after their initial infection, usually triggered by mental or physical exertion. (Not all patients in this group had confirmed cases of COVID‑19, given that tests were hard to come by last March and April.) Many patients were experiencing severe fatigue and brain fog. Other patients suffered from chest tightness and tachycardia—a condition in which the heart beats more than 100 times a minute—when they stood up or walked. Others had diarrhea and lost their appetite; some had terrible bone pain. Nearly a quarter said they were still unable to work; many had gone on disability or taken medical leave. Patient groups of COVID‑19 “long-haulers” were springing up on Facebook and elsewhere online, where people shared data and compared notes about what they began to call “long COVID.”’

Read here (The Atlantic, Mar 8, 2021)

Late-stage pandemic is messing with your brain

‘This is the fog of late pandemic, and it is brutal. In the spring, we joked about the Before Times, but they were still within reach, easily accessible in our shorter-term memories. In the summer and fall, with restrictions loosening and temperatures rising, we were able to replicate some of what life used to be like, at least in an adulterated form: outdoor drinks, a day at the beach. But now, in the cold, dark, featureless middle of our pandemic winter, we can neither remember what life was like before nor imagine what it’ll be like after.

‘To some degree, this is a natural adaptation. The sunniest optimist would point out that all this forgetting is evidence of the resilience of our species. Humans forget a great deal of what happens to us, and we tend to do it pretty quickly—after the first 24 hours or so. “Our brains are very good at learning different things and forgetting the things that are not a priority,” Tina Franklin, a neuroscientist at Georgia Tech, told me. As the pandemic has taught us new habits and made old ones obsolete, our brains have essentially put actions like taking the bus and going to restaurants in deep storage, and placed social distancing and coughing into our elbows near the front of the closet. When our habits change back, presumably so will our recall.’

Read here (The Atlantic, Mar 8, 2021)

We’re just rediscovering a 19th-century pandemic strategy

‘The first way to fight a new virus would once have been opening the windows...

‘Miasma theory—discredited, of course, by the rise of germ theory—held that disease came from “bad air” emanating from decomposing matter and filth. This idea peaked in the 19th century, when doctors, architects, and one particularly influential nurse, Florence Nightingale, became fixated on ventilation’s importance for health. It manifested in the physical layout of buildings: windows, many of them, but also towers erected for the sole purpose of ventilation and elaborate ductwork to move contaminated air outdoors. Historic buildings still bear the vestigial mark of these public-health strategies, long after the scientific thinking has moved on.

‘That era saw the rise of well-ventilated “Nightingale pavilions,” named after Florence Nightingale, who popularized the design in her 1859 book, Notes on Hospitals. As a nurse in the Crimean War, she saw 10 times more soldiers die of disease than of battle wounds. Nightingale began a massive hygiene campaign in the overcrowded hospitals, and she collected statistics, which she presented in pioneering infographics. Chief among her concerns was air. Notes even laid out exact proportions for 20-patient pavilions that could allow 1,600 cubic feet of air per bed.’

Read here (The Atlantic, Feb 22, 2021)

A quite possibly wonderful summer

‘The summer of 2021 is shaping up to be historic... After months of soaring deaths and infections, COVID-19 cases across the United States are declining even more sharply than experts anticipated. This is expected to continue, and rates of serious illness and death will plummet even faster than cases, as high-risk populations are vaccinated. Even academics who have spent the pandemic delivering ominous warnings have shifted their tone to cautiously optimistic now that vaccination rates are exploding.’

Read here (The Atlantic, Feb 19, 2021)

Covid-19 cases are dropping fast. Why?

‘One month ago, the CDC published the results of more than 20 pandemic forecasting models. Most projected that COVID-19 cases would continue to grow through February, or at least plateau. Instead, COVID-19 is in retreat in America. New daily cases have plunged, and hospitalizations are down almost 50 percent in the past month. This is not an artifact of infrequent testing, since the share of regional daily tests that are coming back positive has declined even more than the number of cases. Some pandemic statistics are foggy, but the current decline of COVID-19 is crystal clear.

**Four reasons: social distancing, seasonality, seroprevalence, and shots.’

Read here (The Atlantic, Feb 17, 2021) 

Bhutan: The unlikeliest pandemic success story

‘On January 7, a 34-year-old man who had been admitted to a hospital in Bhutan’s capital, Thimphu, with preexisting liver and kidney problems died of COVID-19. His was the country’s first death from the coronavirus. Not the first death that day, that week, or that month: the very first coronavirus death since the pandemic began.

‘How is this possible? Since the novel coronavirus was first identified more than a year ago, health systems in rich and poor countries have approached collapse, economies worldwide have been devastated, millions of lives have been lost. How has Bhutan—a tiny, poor nation best known for its guiding policy of Gross National Happiness, which balances economic development with environmental conservation and cultural values—managed such a feat? And what can we in the United States, which has so tragically mismanaged the crisis, learn from its success?’

Read here (The Atlantic, Feb 10, 2021)

The second Covid-19 shot is a rude reawakening for immune cells

‘Side effects are just a sign that protection is kicking in as it should...

‘At about 2 a.m. on Thursday morning, I woke to find my husband shivering beside me. For hours, he had been tossing in bed, exhausted but unable to sleep, nursing chills, a fever, and an agonizingly sore left arm. His teeth chattered. His forehead was freckled with sweat. And as I lay next to him, cinching blanket after blanket around his arms, I felt an immense sense of relief. All this misery was a sign that the immune cells in his body had been riled up by the second shot of a COVID-19 vaccine, and were well on their way to guarding him from future disease.

‘Side effects are a natural part of the vaccination process, as my colleague Sarah Zhang has written. Not everyone will experience them. But the two COVID-19 vaccines cleared for emergency use in the United States, made by Pfizer/BioNTech and Moderna, already have reputations for raising the hackles of the immune system: In both companies’ clinical trials, at least a third of the volunteers ended up with symptoms such as headaches and fatigue; fevers like my husband’s were less common.

‘Dose No. 2 is more likely to pack a punch—in large part because the effects of the second shot build iteratively on the first. My husband, who’s a neurologist at Yale New Haven Hospital, is one of many who had a worse experience with his second shot than his first.’

Read here (The Atlantic, Feb 2, 2021)

The pandemic has erased entire categories of friendship

‘Close relationships were long thought to be the essential component of humans’ social well-being, but Granovetter’s research led him to a conclusion that was at the time groundbreaking and is still, to many people, counterintuitive: Casual friends and acquaintances can be as important to well-being as family, romantic partners, and your closest friends...[this is the group of friends the pandemic has erased].

[At this point]...there’s cause for optimism. As more Americans are vaccinated in the coming months, more people will be able to return confidently to more types of interactions. If the best historical analogue for the coronavirus outbreak is the 1918 flu pandemic, the Roaring ’20s suggest we’ll indulge in some wild parties. In any case, Rawlins doubts that many of the moderate and weak ties people lost touch with in the past year will be hurt that they didn’t get many check-in texts. Mostly, he predicts, people will just be so happy to see one another again.

‘All of the researchers I spoke with were hopeful that this extended pause would give people a deeper understanding of just how vital friendships of all types are to our well-being, and how all the people around us contribute to our lives—even if they occupy positions that the country’s culture doesn’t respect very much, such as service workers or store clerks. “My hope is that people will realize that there’s more people in their social networks that matter and provide some kind of value than just those few people that you spend time with, and have probably managed to keep up with during the break,” Sandstrom said. America, even before the pandemic, was a lonely country. It doesn’t have to be. The end of our isolation could be the beginning of some beautiful friendships.’

Read here (The Atlantic, Jan 28, 2021)

Why kids might be key to reaching herd immunity

‘Vaccinating kids, however, is often not just about the direct and immediate benefits to them. It’s also meant to protect children against diseases that would otherwise become more dangerous for them as adults—measles, mumps, and chicken pox are three common examples—and dampen the overall spread of these diseases. In the short term, the primary reason to vaccinate children against COVID-19 may be that the U.S. will have a hard time reaching herd immunity otherwise.‘

Read here (The Atlantic, Jan 21, 2021)

The coronavirus is evolving before our eyes

‘Even if we cannot contain this particular variant, we’re learning from its spread. Preventing more virulent strains from becoming dominant—when they inevitably do arise—may be possible if we can track genomic patterns more widely, so that we have the context needed to determine whether a strain is indeed uniquely dangerous. If we can take steps to contain a new threat early enough, it may never become widespread. If we miss these opportunities, we risk repeating the kind of mistake that allowed the original SARS-CoV-2 strain to escape China in the first place.

‘Last week, Eddie Holmes reflected on the fateful moment when he tweeted the virus’s original genetic code. It was a moment of triumph for collaborative science, but the work was just beginning. The triumph must be repeated daily. “What worries me most of all is if politics gets in the way of data sharing and science,” he told Medscape. “Step one has to be immediate, rapid, open data sharing. Speed is of the essence in a pandemic. Any barrier to working together makes this a much less safe world. That should be the lesson of this outbreak.”

Read here (The Atlantic, Jan 15, 2021) 

The mutated virus is a ticking time bomb

‘There is much we don’t know about the new COVID-19 variant—but everything we know so far suggests a huge danger.

‘A more transmissible variant of COVID-19 is a potential catastrophe in and of itself. If anything, given the stage in the pandemic we are at, a more transmissible variant is in some ways much more dangerous than a more severe variant. That’s because higher transmissibility subjects us to a more contagious virus spreading with exponential growth, whereas the risk from increased severity would have increased in a linear manner, affecting only those infected.’

Read here (The Atlantic, Jan 1, 2021) 

Longform podcast: Ed Yong of The Atlantic

‘Ed Yong spent 2020 covering the pandemic for The Atlantic. His latest feature is "How Science Beat the Virus." He says: “I am trying to give readers a platform that they can stand on to observe this raging torrent that is the pandemic, this cascade of information that is threatening to sweep us all away. I’m trying to give people a rock on which they can stand so that they can observe what is happening without themselves being submerged by it. But I am trying to construct that platform while also being submerged in it.”

Listen to the podcast here (Longform, Dec 23, 2020)

The mysterious link between Covid-19 and sleep

‘The coronavirus can cause insomnia and long-term changes in our nervous systems. But sleep could also be a key to ending the pandemic... 

‘The newly discovered coronavirus had killed only a few dozen people when Feixiong Cheng started looking for a treatment. He knew time was of the essence: Cheng, a data analyst at the Cleveland Clinic, had seen similar coronaviruses tear through China and Saudi Arabia before, sickening thousands and shaking the global economy. So, in January, his lab used artificial intelligence to search for hidden clues in the structure of the virus to predict how it invaded human cells, and what might stop it. One observation stood out: The virus could potentially be blocked by melatonin...

‘After he published his research, though, Cheng heard from scientists around the world who thought there might be something to it. They noted that, in addition to melatonin’s well-known effects on sleep, it plays a part in calibrating the immune system. Essentially, it acts as a moderator to help keep our self-protective responses from going haywire—which happens to be the basic problem that can quickly turn a mild case of COVID-19 into a life-threatening scenario.’

Read here (The Atlantic, Dec 22, 2020)

Hang on for 3 more months

‘Some simple advice for anyone contemplating a holiday gathering: Wait until March...The fight against the coronavirus has been called a “national marshmallow test” [for the United States] that we’re failing. In a famous study, children were left alone with a marshmallow for 15 minutes, and promised a second if they didn’t eat the first. Kids who were better at delaying gratification were found to be more successful later in life. At first, this correlation was explained as demonstrating the importance of willpower and executive function.

‘Later, a team of researchers set out to replicate this study and uncovered something profound. Once they adjusted for factors such as household income, mother’s education, and home environment at age 3, the effect disappeared...

‘If we failed our national marshmallow test this summer and fall, perhaps that says something about how little reason the public was given for optimism. Hope can’t just be a slogan or a pep talk; it must be justified by facts, experiences, and trustworthy promises. And in fairness, until last month, it was less clear when and how this would all end... But hope is justified today.’

Read here (The Atlantic, Dec 17, 2020)

How science beat the virus... And what it lost in the process

“To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”

‘The scientific community spent the pre-pandemic years designing faster ways of doing experiments, sharing data, and developing vaccines, allowing it to mobilize quickly when COVID‑19 emerged. Its goal now should be to address its many lingering weaknesses. Warped incentives, wasteful practices, overconfidence, inequality, a biomedical bias—COVID‑19 has exposed them all. And in doing so, it offers the world of science a chance to practice one of its most important qualities: self-correction.’

Read here (The Atlantic, Dec 14, 2020)

The end of the pandemic is now in sight

‘Both vaccines, from Moderna and from Pfizer’s collaboration with the smaller German company BioNTech, package slightly modified spike-protein mRNA inside a tiny protective bubble of fat. Human cells take up this bubble and simply follow the directions to make spike protein. The cells then display these spike proteins, presenting them as strange baubles to the immune system. Recognizing these viral proteins as foreign, the immune system begins building an arsenal to prepare for the moment a virus bearing this spike protein appears... This overall process mimics the steps of infection better than some traditional vaccines, which suggests that mRNA vaccines may provoke a better immune response for certain diseases...

‘All of this is how mRNA vaccines should work in theory. But no one on Earth, until last week, knew whether mRNA vaccines actually do work in humans for COVID-19. Although scientists had prototyped other mRNA vaccines before the pandemic, the technology was still new. None had been put through the paces of a large clinical trial. And the human immune system is notoriously complicated and unpredictable. Immunology is, as my colleague Ed Yong has written, where intuition goes to die. Vaccines can even make diseases more severe, rather than less. The data from these large clinical trials from Pfizer/BioNTech and Moderna are the first, real-world proof that mRNA vaccines protect against disease as expected. The hope, in the many years when mRNA vaccine research flew under the radar, was that the technology would deliver results quickly in a pandemic. And now it has.’

Read here (The Atlantic, Nov 19, 2020)