Bad Reason For Good News

Shitty-Attitude Mike wants to say thanks to a whole big bunch of dumbass rubes who gave up the ghost because they were convinced to put more stock in their political fantasies than they did in what real-world clinicians with real-world expertise told them.

Not-Such-An-Asshole Mike regrets being unable to convince people not to fuck around.

Understanding the Red State Death Trip - Paul Krugman

Last Friday the Medicare trustees released their latest report on the system’s finances, and it contained some unexpected good news: Expenditures are running below projections, and the Hospital Insurance Trust Fund won’t be exhausted as soon as previously predicted.

But one important reason for this financial improvement was grisly: Covid killed a substantial number of Medicare beneficiaries. And the victims were disproportionately seniors already suffering from severe — and expensive — health problems. “As a result, the surviving population had spending that was lower than average.”

Now, Covid killed a lot of people around the world, so wasn’t this just an act of God? Not exactly. You see, America experienced a bigger decline in life expectancy when Covid struck than any other wealthy country. Furthermore, while life expectancy recovered in many countries in 2021, here it continued to fall.

And America’s dismal Covid performance was part of a larger story. I don’t know how many Americans are aware that over the past four decades, our life expectancy has been lagging ever further that of other advanced nations — even nations whose economic performance has been poor by conventional measures. Italy, for example, has experienced a generation of economic stagnation, with basically no growth in real G.D.P. per capita since 2000, compared with a 29 percent rise here. Yet Italians can expect to live about five years longer than Americans, a gap that has widened even as the Italian economy flounders.

What explains the American way of death? A large part of the answer seems to be political.

One important clue is that the problem of premature death isn’t evenly distributed across the country. Life expectancy is hugely unequal across U.S. regions, with major coastal cities not looking much worse than Europe but the South and the eastern heartland doing far worse.

But wasn’t it always thus? No. Geographic health disparities have surged in recent decades. According to the U.S. mortality database, as recently as 1990, Ohio had slightly higher life expectancy than New York. Since then, New York’s life expectancy has risen rapidly, nearly converging with that of other rich countries, while Ohio’s has hardly risen at all and is now four years less than New York’s.

There has been considerable research into the causes of these growing disparities. A 2021 paper published in The Journal of Economic Perspectives examined various possible causes, like the increasing concentration of highly educated Americans (who tend to be healthier than those with less education) in states that are already highly educated and the widening per capita income gaps among states. The authors found that these factors can’t explain more than a small fraction of the growing mortality gap.

Instead, they argued, the best explanation lay in policy: “The most promising explanation for our findings involve efforts by high-income states to adopt specific health-improving policies and behaviors since at least the early 1990s. Over time, these efforts reduced mortality in high-income states more rapidly than in low-income states, leading to widening spatial disparities in health.”

That sounds right. But did high-income states adopt health-improving policies because they were rich and could afford to? Or was it because in 21st-century America, high-income states tend to be politically progressive and politics, rather than money per se, account for the difference?

There is, in fact, a strong correlation between how much a state’s life expectancy rose from 1990 to 2019 and its political lean, as measured by Joe Biden’s margin over Donald Trump in the 2020 election — a correlation slightly stronger, by my estimates, than the correlation with income.

There are several reasons to believe that America’s death trip is largely political rather than economic. One is the comparison with European nations, which have had much better health trends even when, as in Italy, their economies have performed badly.

Another is the fact that some of the poorest states in America, with the lowest life expectancy, are still refusing to expand Medicaid, even though the federal government would cover the bulk of the cost (and the failure to expand Medicaid is killing many hospitals). This suggests that they’re failing to improve health because they don’t want to, not because they can’t afford to.

Finally, since Covid struck, residents of Republican-leaning counties have been far less likely to get vaccinated and far more likely to die of it than residents of Democratic-leaning counties — even though vaccines are free.

All of this seems relevant to our current era of culture war, with many Republican politicians praising rural and red-state values while denigrating those of coastal elites. Gov. Ron DeSantis of Florida, for example, claims that although he grew up around Tampa Bay, he’s culturally a product of western Pennsylvania and northeastern Ohio. It’s worth noting, then, that the culture these politicians want all of America to emulate seems to have a problem with one of society’s most important functions: keeping people from dying early.

COVID-19 Update

NYT finally got around to explaining an item that they must've known they had reported badly.

Here’s Why the Science Is Clear That Masks Work

The debate over masks’ effectiveness in fighting the spread of the coronavirus intensified recently when a respected scientific nonprofit said its review of studies assessing measures to impede the spread of viral illnesses found it was “uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.”

Now the organization, Cochrane, says the way it summarized the review was unclear and imprecise, and that the way some people interpreted it was wrong.

“Many commentators have claimed that a recently updated Cochrane Review shows that ‘masks don’t work’, which is an inaccurate and misleading interpretation,” Karla Soares-Weiser, the editor in chief of The Cochrane Library, said in a statement.

“The review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses,” Soares-Weiser said, adding, “given the limitations in the primary evidence, the review is not able to address the question of whether mask wearing itself reduces people’s risk of contracting or spreading respiratory viruses.”

She said that “this wording was open to misinterpretation, for which we apologize,” and that Cochrane would revise the summary.

Soares-Weiser also said, though, that one of the lead authors of the review even more seriously misinterpreted its finding on masks by saying in an interview that it proved “there is just no evidence that they make any difference.” In fact, Soares-Weiser said, “that statement is not an accurate representation of what the review found.”

Cochrane reviews are often referred to as gold standard evidence in medicine because they aggregate results from many randomized trials to reach an overall conclusion — a great method for evaluating drugs, for example, which often are subjected to rigorous but small trials. Combining their results can lead to more confident conclusions.

Masks and mask mandates have been a hot controversy during the pandemic. The flawed summary — and further misinterpretation of it — set off a debate between those who said the study showed there was no basis for relying on masks or mask mandates and those who said it did nothing to diminish the need for them.

Michael D. Brown, a doctor and academic who serves on the Cochrane editorial board and made the final decision on the review, told me the review couldn’t arrive at a firm conclusion because there weren’t enough high-quality randomized trials with high rates of mask adherence.

While the review assessed 78 studies, only 10 of those focused on what happens when people wear masks versus when they don’t, and a further five looked at how effective different types of masks were at blocking transmission, usually for health care workers. The remainder involved other measures aimed at lowering transmission, like hand washing or disinfection, while a few studies also considered masks in combination with other measures. Of those 10 studies that looked at masking, the two done since the start of the Covid pandemic both found that masks helped.

(emphasis is mine)

The calculations the review used to reach a conclusion were dominated by prepandemic studies that were not very informative about how well masks blocked the transmission of respiratory viruses.

For example, in one study of hajj pilgrims in Mecca, only 24.7 percent of those assigned to wear masks reported using one daily, but not all the time (while 14.3 percent in the no-mask group wore one anyway). The pilgrims then slept together, generally in tents with 50 or 100 people. Not surprisingly, given there was little difference between the two groups, researchers found no difference from mask wearing and declared their results “inconclusive.”

In another prepandemic study, college students were asked to wear masks for at least six hours a day while in their dormitories, but they were not obligated to wear them elsewhere. Researchers found no difference in infection rates between those who wore masks and those who did not. The authors noted this might be because “the amount of time masks were worn was not sufficient” — obviously, college students also go to classes and socialize where they may not wear masks.

Yet despite their inconclusiveness, the data from just these two studies accounted for roughly half of the calculations for evaluating the impact of mask wearing on transmission. The other six prepandemic studies similarly suffered from low masking adherence, limited time wearing them and, often, small sample sizes.

The only prepandemic study reviewed by Cochrane reporting high rates of mask adherence started during the worrying H1N1 season in 2009 in Germany, and found mask wearing reduced spread if started quickly after diagnosis and if a mask was worn consistently (though its sample size, too, was small).

So what we learn from the Cochrane review is that, especially before the pandemic, distributing masks didn’t lead people to wear them, which is why their effect on transmission couldn’t be confidently evaluated.

Soares-Weiser told me the review should be seen as a call for more data, and said she worried that misinterpretations of it could undermine preparedness for future outbreaks.

So let’s look more broadly at what we know about masks.

Crucially, the question of whether a mask reduces a wearer’s risk of infection is not the same as whether wearing masks slows the spread of respiratory viruses in a community.

To use randomized trials to study whether masks reduce a virus’s spread by keeping infected people from transmitting a pathogen, we need randomized comparisons of large groups, like having people in one city assigned to wear masks and not to in another. As ethically and logistically difficult as that might seem, there was one study during the pandemic in which masks were distributed, but not mandated, in some Bangladeshi villages and not others before masks were widely used in the country. Mask use increased from 10 percent to 40 percent over a two-month period in the villages where free masks were distributed. Researchers found an 11 percent reduction in Covid cases in the villages given surgical masks, with a 35 percent reduction for people over age 60.

Another pandemic study randomly distributed masks to people in Denmark over a month. About half the participants wore the masks as recommended. Of those assigned to wear masks, 1.8 percent became infected, compared to 2.1 percent in the no-mask group — a 14 percent reduction. But researchers could not reach a firm conclusion about whether masks were protective because there were few infections in either group and fewer than half the people assigned masks wore them.

Why aren’t there more randomized studies on masks? We could have started some in early 2020, distributing masks in some towns when they weren’t widely available. It’s a shame we didn’t. But it would have been hard and unethical to deny masks to some people once they were available to all.

Scientists routinely use other kinds of data besides randomized reviews, including lab studies, natural experiments, real-life data and observational studies. All these should be taken into account to evaluate masks.

Lab studies, many of which were done during the pandemic, show that masks, particularly N95 respirators, can block viral particles. Linsey Marr, an aerosol scientist who has long studied airborne viral transmission, told me even cloth masks that fit well and use appropriate materials can help.

Real-life data can be complicated by variables that aren’t controlled for, but it’s worth examining even if studying it isn’t conclusive.

Japan, which emphasized wearing masks and mitigating airborne transmission, had a remarkably low death rate in 2020 even though it did not have any shutdowns and rarely tested and traced widely outside of clusters.

David Lazer, a political scientist at Northeastern University, calculated that before vaccines were available, U.S. states without mask mandates had 30 percent higher Covid death rates than those with mandates.

Perhaps the best evidence comes from natural experiments, which study how things change after an event or intervention.

Researchers at Mass General Brigham, one of Harvard’s teaching hospital groups, found that in early 2020, before mask mandates were introduced, the infection rate among health care workers doubled every 3.6 days and rose to 21.3 percent. After universal masking was required, the rate stopped increasing, and then quickly declined to 11.4 percent.

In Germany, 401 regions introduced mask mandates at various times over three months in the spring of 2020. By carefully comparing otherwise similar places before and after mask mandates, researchers concluded that “face masks reduce the daily growth rate of reported infections by around 47 percent,” with the effect more pronounced in large cities and among older people.

Brown, who led the review’s approval process, told me that mask mandates may not be tenable now, but he has a starkly different feeling about their effects in the first year of a pandemic.

“Mask mandates, social distancing, the other shutdowns we had in terms of even restaurants and things like that — if places like New York City didn’t do that, the number of deaths would have been much higher,” he told me. “I’m very confident of that statement.”

So the evidence is relatively straightforward: Consistently wearing a mask, preferably a high-quality, well-fitting one, provides protection against the coronavirus.

It’s also true that the highly contagious Omicron variant is much harder to avoid, especially because even people masking consistently can catch it from others in their social circle. Fortunately, Omicron arrived after vaccines and treatments were available.

Then why all the fuss?

Masks have become a symbol of frustration over shortcomings in the pandemic response. Some see a lack of mask mandates or a failure to wear masks as an abandonment of the clinically vulnerable. The pandemic’s burden has indeed fallen disproportionately on them.

Others have come to think mandates represent illogical rules. To be sure, we did have many illogical rules: mandating masks outdoors and even at beaches, or wearing them to enter a restaurant but not at the table, or requiring children as young as 2 to mask in day care but not during nap time (presumably, the virus also took a nap). Some mask proponents and public health authorities have also used weak studies to make overblown or imprecise claims about masks’ effectiveness.

So how should we evaluate an interview in which the lead author of the Cochrane review, Tom Jefferson, said of masks that the review determined “there is just no evidence that they make any difference”? As for whether N95s are better than surgical masks, Jefferson said, “makes no difference — none of it.”

It’s no surprise that Jefferson says he has no faith in masks’ ability to stop the spread of Covid.

In that interview, he said there is no basis to say the coronavirus is spread by airborne transmission — despite the fact that major public health agencies have long said otherwise. He has long doubted well-accepted claims about the virus. In an article he co-wrote in April 2020, Jefferson questioned whether the Covid outbreak was a pandemic at all, rather than just a long respiratory illness season. At that point, New York City schools had been closed for a month and Covid had killed thousands of New Yorkers. When New York was preparing “M*A*S*H”-like mobile hospitals in Central Park, he said there was no point in mitigations to slow the spread.

In an editorial accompanying a 2020 version of the review — the review is in its sixth update since 2006 — Soares-Wiser noted a lack of “robust, high-quality evidence for any behavioral measure or policy” and said that “when protecting the public from harm is the objective, public health officials must act in a precautionary manner to take action even when evidence is uncertain (or not of the highest quality).”

Jefferson, however, said in the interview that “the purpose of the editorial was to undermine our work.” Soares-Wiser strongly denied this, and asserted that her warning in that editorial would apply to this update as well.

Jefferson has not responded to emailed requests for comment.

As Marr notes, a respiratory virus outbreak with even higher death rates would cut these arguments tragically short. We need to be better prepared in many ways for the next pandemic, and one way is to continue to collect data on mask wearing, despite the challenges.

That, along with an honest assessment of what was done right and what might have been done better, could go a long way in resolving people’s questions and doubts.

Masks are a tool, not a talisman or a magic wand. They have a role to play when used appropriately and consistently at the right times. They should not be dismissed or demonized.

COVID-19 Update

(From 12-08-2020)

USC research showed that people born during or just after the 1918 flu pandemic faced increased heart disease risk more than 60 years later.

The legacy of the novel coronavirus could be worse.

For nearly a year, the novel coronavirus and the resulting COVID-19 pandemic have dominated headlines across the world, and justifiably so. With nearly 68 million cases reported and more than 1.5 million deaths worldwide as of December 7, 2020, the short-term impact of this disease has been stark and devastating.

But as health care providers, researchers and public health professionals across the globe grapple with the immediate challenges presented by the COVID-19 pandemic — preventing viral transmission, identifying cases, successfully treating the disease and creating an effective vaccine — scientists’ thoughts also turn to the future and the long-term health issues the pandemic might present to the more than 43 million people who have survived SARS-CoV-2 infection.

Many COVID-19 survivors will face sequelae, or the aftereffects of infection, predicts Pinchas Cohen, dean of the USC Leonard Davis School. Damage to the lungs, brain and heart has already been observed in survivors, and “our medical system is going to be highly impacted,” he says. However, the true extent of any long-term effects will likely take years to measure accurately.

While many questions remain about what the aftermath of the pandemic will look like, we can take a few clues from history, say USC University Professors Eileen Crimmins and Caleb Finch.

“I think that COVID is setting us up for a hundred years of problems,” predicted Crimmins, who holds the AARP Chair in Gerontology at the USC Leonard Davis School.

Looking to the past

A little more than 100 years ago, the world faced another pandemic that gripped the world’s attention. The culprit then was an H1N1 influenza virus that became known as the “Spanish flu.”

In total, the 1918–1919 pandemic claimed at least 50 million lives, after having infected around half a billion people—one-third of the world’s population at the time. Approximately 675,000 people died in the U.S., with the flu first identified in this country in soldiers stationed at an Army base in Kansas during the spring of 1918.

The mortality patterns of the 1918 flu differed from COVID-19, Crimmins says. In both pandemics, individuals over age 65 were at particular risk, but children younger than 5 and adults between 20 and 40 years of age also faced a high rate of death from the 1918 flu.

“1918 was particularly hard on young adults, those in the childbearing years, [while] COVID-19 is particularly hard on older adults,” Crimmins says.

But beyond the high death toll, the full impact of the 1918–1919 pandemic wouldn’t be realized until more than 60 years later. In 2009, Finch and Crimmins published a study examining epidemiological data on individuals born in 1919, who were newborns or second- or third-trimester fetuses during the height of the pandemic. The data revealed that these individuals had approximately 25% more heart disease after age 60, as well as increased diabetes risk, compared to a similar cohort of individuals not born in 1919, including those who were older infants during the pandemic.

While the researchers didn’t have data on exactly which people were exposed to the flu either in utero or as infants in 1918–1919, the results were nevertheless strikingly different between the two age cohorts. In addition to higher levels of ischemic heart disease as well as diabetes in those who could have been exposed prenatally, U.S. census data indicated that the cohort of children born in early 1919 attained less education and had lower economic productivity over their lifetime, suggesting a higher level of developmental impairment or other long-term health issues in those with prenatal flu exposure at the height of the outbreak. Adult height (as recorded at World War II enlistment) was also slightly lower for the 1919 birth cohort than for those born in adjacent years, which suggests that overall growth was also negatively affected.

“The fact that this cohort of people had elevated risks of disease even more than six decades after the pandemic indicates that maternal exposure to the influenza virus appears to have had wide-ranging and long-lasting health effects on offspring,” Crimmins says. Subsequent studies have shed further light on the potential for inflammation to cause indelible damage, especially to the heart.

Crimmins and Finch hypothesize that one mechanism of this could be the increase in inflammatory response, including an increase in the protein interleukin-6 (IL-6), resulting in developmental changes affecting the fetus. An increase in IL-6, which can cross the blood-brain barrier, has been observed with COVID-19, with such an increase part of the dangerous “cytokine storms” seen in severely ill patients. But there are other mechanisms linked to the novel coronavirus that provide additional cause for concern, says Finch, who holds the ARCO/William F. Kieschnick Chair in the Neurobiology of Aging at the Leonard Davis School.

Effects could be widespread and long term

While the most well-known hallmark of COVID-19 is a marked deterioration in lung function, health care providers and COVID-19 survivors have reported many other startling and dangerous effects of the illness, including heart damage, blood clotting that results in strokes, cognitive difficulty, general debilitation and weakness. A number of survivors report being among those known as “long-haulers” — individuals who continue to suffer from ill effects long after the virus is no longer detectable in their bodies.

This array of wide-ranging effects throughout the body may be due to the affinity of the virus for the angiotensin-converting enzyme-2, or ACE2, receptor, Finch says. ACE2 receptors are widely present in cells of the alveoli—tiny, saclike structures in the lungs that play a key role in the exchange of oxygen and carbon dioxide as we breathe. The receptors are also found on cells in many tissue types throughout the body, including within the heart, blood vessels, kidneys, liver and gastrointestinal tract.

“[ACE2 receptors] are found in cells everywhere,” he says. “You can anticipate a very broad number of consequences.”

Under healthy circumstances, ACE2 plays an important role in modulating the activity of the protein angiotensin II in the renin-angiotensin-aldosterone system (RAAS) pathway, a process regulating body functions such as blood pressure, wound healing and inflammation. However, the “spike” proteins of SARS-CoV-2 bind to a cell’s ACE2 receptors like a key into a lock, granting the virus access to the cell, enabling the virus to replicate itself and subverting normal ACE2 function in the process. This allows angiotensin II activity to go unchecked, which likely contributes to tissue injury, especially in the heart and lungs.

“It creates cell death and a fibrous response,” Finch explains, “so the lung tissue is displaced by scar tissue, in effect. This also has a clotting consequence that’s been unknown for the influenza series.”

“What’s happening to people’s lungs now seems totally different [than with the 1918 flu],” Crimmins says, explaining that people who died from the 1918 flu tended to die of secondary infections following the illness, including bacterial pneumonia. In comparison, COVID-19 deaths appear to be more directly attributable to deterioration of lung function. “The lungs just fall apart,” she says.

According to a recent study published in JAMA, even asymptomatic people who have tested positive for SARS-CoV-2 infection have been found to have signs of tissue damage, including myocarditis, or inflammation of the heart. Could this be a precursor to an increased risk of heart disease or other health issues in the future, such as those seen with people born in 1919?

With people of all ages affected, “We may have a century of COVID damage,” Finch warns.

An epidemic of mistrust

Amid the ongoing threat to health, the current pandemic also echoes the 1918–1919 influenza in the debates surrounding societal responses to the illness, increasing the risk for more infection and thus more long-term impact.

The sound bites are familiar, according to news articles from 1918 and 1919. Scientists and public health officials urged the shutdown of crowded gathering spaces; supported mandates to wear masks; and promoted isolation, quarantine and hygiene as the main weapons in the battle against the illness. Those opposing such public health measures made assertions about the futility of or harm caused by wearing masks, as well as the economic risks of shutting down businesses. People fought against the idea that the pandemic was a serious threat—even though there was not yet a vaccine for influenza, nor were there antibiotics to treat resulting secondary infections. However, the media landscape was not nearly as varied, nor as constant and pervasive, as it is today.

In 2020, individuals’ behavior in response to the pandemic has closely correlated with the kinds of mass media outlets they trust, according to a study published in BMJ Global Health by USC PhD in gerontology students Erfei Zhao and Qiao Wu and co-authored by Crimmins and associate professor of gerontology and sociology Jennifer Ailshire.

Zhao, Wu and colleagues analyzed response data from the Understanding America Study’s COVID-19 panel on how often participants performed five virus-mitigating behaviors during the coronavirus pandemic: (1) wearing a face mask, (2) washing hands with soap or using hand sanitizer several times per day, (3) canceling or postponing personal or social activities, (4) avoiding eating at restaurants, (5) and avoiding public spaces, gatherings or crowds. In addition, the team also looked at risky health behaviors, including going out to a bar, club or other place where people gather; going to another person’s residence; having outside visitors such as friends, neighbors or relatives at one’s home; attending a gathering with more than 10 people, such as a party, concert or religious service; or having close contact (within six feet) with someone who doesn’t live with the respondent.

Using CNN as an example of a left-leaning news source and Fox News as a news source on the right side of the political spectrum, the study identified the relative amount of trust participants reported in either news source with the risky or positive behaviors they engaged in. Risky behaviors were highest among participants who reported more trust in Fox News, followed closely by those who reported trusting neither outlet. Positive behaviors were more frequently reported among those who trusted CNN more than Fox News.

The results imply that behavior sharply differs along media bias lines, indicating that partisan narratives are likely getting in the way of solid health messaging that encourages healthy behavior change.

“In such a highly partisan environment, false information can be easily disseminated. Health messaging, which is one of the few effective ways to slow down the spread of the virus in the absence of a vaccine, is being damaged by politically biased and economically focused narratives,” say Zhao and Wu.

Prevention today for a better tomorrow

Looking beyond the scientific unknowns or misinformation in popular media, one thing is clear, according to Crimmins and Finch: Preventing as much further infection as possible will be our best bet for staving off the worst long-term outcomes.

In addition to personal health behaviors, public policy changes and increased research support can help identify other ways to help those most at risk of infection and complications. More basic science research is needed to understand how viruses such as SARS-CoV-2 affect people of different ages and health histories, which could provide insight on how to better address COVID-19 and any future pandemics. And new policies and programs at both the local and national levels could help older people as well as people of lower socioeconomic status, who often face increased risk due to denser living conditions or more exposure to the public through their work.

“Biological factors may strongly affect how people respond to infection with COVID-19, but social rather than biological factors primarily determine the likelihood that people of different ages get infected with COVID-19, get diagnosed with the disease, and get treated in a timely fashion,” Crimmins wrote in a paper published in Public Policy & Aging Report.

In an analysis of positive health behaviors by age, Crimmins and her team found that older adults in the U.S., though slow to adopt preventive measures when the pandemic first started, have now improved their rate of mask-wearing, hand-washing and maintaining physical distance from others. Until an effective vaccine is released, much of the immediate power to prevent further infection lies with individuals and their health behaviors. Keeping the possibility of long-term complications in mind, people of all ages should learn from history and take fighting the virus seriously, Crimmins and Finch say.

Why does COVID-19 cause ongoing health problems?

Organ damage could play a role. People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen. It isn't clear how long these effects might last. The effects also could lead to the development of new conditions, such as diabetes or a heart or nervous system condition.

The experience of having severe COVID-19 might be another factor. People with severe symptoms of COVID-19 often need to be treated in a hospital intensive care unit. This can result in extreme weakness and post-traumatic stress disorder, a mental health condition triggered by a terrifying event.

What are the risk factors for post-COVID-19 syndrome?

You might be more likely to have post-COVID-19 syndrome if:

• You had severe illness with COVID-19, especially if you were hospitalized or needed intensive care.
• You had certain medical conditions before getting the COVID-19 virus.
• You had a condition affecting your organs and tissues (multisystem inflammatory syndrome) while sick with COVID-19 or afterward.
• Post-COVID-19 syndrome also appears to be more common in adults than in children and teens. However, anyone who gets COVID-19 can have long-term effects, including people with no symptoms or mild illness with COVID-19.

What should you do if you have post-COVID-19 syndrome symptoms?

If you're having symptoms of post-COVID-19 syndrome, talk to your health care provider. To prepare for your appointment, write down:

• When your symptoms started
• What makes your symptoms worse
• How often you experience symptoms
• How your symptoms affect your activities

Your health care provider might do lab tests, such as a complete blood count or liver function test. You might have other tests or procedures, such as chest X-rays, based on your symptoms. The information you provide and any test results will help your health care provider come up with a treatment plan.

In addition, you might benefit from connecting with others in a support group and sharing resources.

The Frankenstein Effect

We're never without some weird shit floating around way down deep in our brains that makes us feel uneasy about what's going on in the world because we think someone we may not like, or trust - or even know about - is doing something that threatens our security, or upsets our sense of how things should be.

Call it a variation on Type 1 / Type 2 Logic Errors which have been programmed into our firmware over 3 million years of homonin evolution.

1. We hear a rustling in the bushes, we conclude it's a predator, and we run away. It turns out to be the wind, but we've survived long enough to have a shot at getting our DNA into subsequent generations.
2. We hear a rustling in the bushes, we conclude it's nothing, and we just keep going on our merry little ape-like way. It turns out to be predator, and we're lunch, which means our DNA is left in a pile of leopard shit on the plains of Africa.

That paranoia regarding the unknown has been selected for us by a seemingly random, but very efficient process of evolution.

We're hard-wired to be cautious, which is a good thing, but it can be exploited by cynical manipulators to keep us frightened enough to knee-jerk our way into full-blown authoritarian rule if we're not really careful.

Enter COVID-19, and take a close look at how Rand Paul plays on that paranoia by pimping the bullshit about "gain of function" and "vaccination hysteria" etc, until he's whipped the wingnuts into a rich creamy lather, and has enough people doubting every aspect of science that they just fall in line and follow along with whatever The Daddy State tells them.

Anyway, back to Rational World, where we know there are real threats regarding the use of scientific discovery, and where we hopefully can get a better handle on the pluses and minuses by calmly and un-politically assessing situations as they arise, and before assholes like Rand Paul can exploit them so he can drum up a good old-fashioned torch-n-pitchfork mob just to score a few points with the rubes.

Biology Is Dangerously Outpacing Policy

The original source of the coronavirus pandemic remains unconfirmed. While it was likely the result of a spillover from animals to humans, a lab origin cannot be ruled out. Given the uncertainty, additional scrutiny on research with pathogens that are engineered to be more transmissible or dangerous is warranted to prevent any future devastating pandemics.

In response to that risk, the United States recently took an important step toward strengthening the government’s oversight of research with viruses and other pathogens. An expert panel known as the National Science Advisory Board for Biosecurity voted unanimously in January to recommend a major overhaul of how the United States supervises what’s called dual-use research. Research is considered dual use if the intended use of the work is for peaceful purposes but there is concern it could result in a more dangerous pathogen or information that could be used maliciously.

As experts with four decades of combined experience studying biosecurity and the risks of dual-use research, we think the board’s proposals pave the way for welcome and needed changes. We hope the Biden administration will codify many of these recommendations into policy and work with Congress to secure the funding and legislation needed to implement the more far-reaching reforms.

Historically, the United States has taken a reactive and haphazard approach to preventing lab accidents and the misuse of high-risk science. A patchwork of regulations, guidance and policies exists based on the specific pathogen being researched, the type of research being conducted and the source of funding. But some research doesn’t fall under any agency, leaving an oversight vacuum.

This fragmented system has not kept pace with the evolving risk landscape. There are now more powerful tools for genetic engineering, and these tools are easier to use and more widely available than ever before. There are also more researchers interested in conducting research with engineered pathogens for scientific and medical purposes. According to the Global Biolabs Initiative, of which Dr. Koblentz is a co-director, there are more than 100 high and maximum containment labs around the world conducting high-risk research, with more planned. The United States has more such labs than any other country. Failure to update bio-risk-management policies is too great a concern.

When will the pandemic end? We asked three experts — two immunologists and an epidemiologist — to weigh in on this and some of the hundreds of other questions we’ve gathered from readers recently, including how to make sense of booster and test timing, recommendations for children, whether getting covid is just inevitable and other pressing queries.

How concerning are things like long covid and reinfections? That’s a difficult question to answer definitely, writes the Opinion columnist Zeynep Tufekci, because of the lack of adequate research and support for sufferers, as well as confusion about what the condition even is. She has suggestions for how to approach the problem. Regarding another ongoing Covid danger, that of reinfections, a virologist sets the record straight: “There has yet to be a variant that negates the benefits of vaccines.”

How will the virus continue to change?

As a group of scientists who study viruses explains, “There’s no reason, at least biologically, that the virus won’t continue to evolve.” From a different angle, the science writer David Quammen surveys some of the highly effective tools and techniques that are now available for studying Covid and other viruses, but notes that such knowledge alone won’t blunt the danger.

What could endemic Covid look like?

David Wallace Wells writes that by one estimate, 100,000 Americans could die each year from the coronavirus. Stopping that will require a creative effort to increase and sustain high levels of vaccination. The immunobiologist Akiko Iwasaki writes that new vaccines, particular those delivered through the nose, may be part of the answer.

The board has recommended far-reaching changes that would greatly extend oversight of research that could be misused to cause harm. The proposal would expand the range of pathogens subject to oversight to include those currently considered less dangerous, and include privately funded research as well. It would also lower the threshold for genetic engineering experiments that could trigger extra scrutiny. The board also recommended this strengthened oversight system be administered by a government office that can provide guidance to researchers and transparency to the public.

The Biden administration has the authority to implement many of these recommendations, such as expanding current oversight over more pathogens and providing more transparent guidance to researchers and the public. These reforms are consistent with the administration’s biodefense strategy and should be implemented immediately. The administration has already requested $1.8 billion to strengthen biosafety and biosecurity, some of which could be used for this purpose.

But funding and implementing some of the board’s more far-reaching recommendations will likely require congressional action. Pathogens don’t care about politics, and efforts to strengthen biosafety and biosecurity should receive bipartisan support.

Currently, only a small number of private labs need to seek approval for dual-use research with a short list of pathogens. This creates a loophole that allows scientists with private funding — from a foundation, a corporation or even a crowdfunding site — to conduct unsupervised research with potential pandemic pathogens that are not on this list. For example, scientists at Boston University were able to create a chimera version of the coronavirus with enhanced properties without seeking government review because they did not use government funding to conduct the experiment. Given the potential consequences of a misstep, any institutions or researchers who work with such pathogens, regardless of their source of funding, should have their research reviewed to make sure it is being conducted safely, securely and responsibly.

The United States also needs to establish an independent government agency that has the authority and resources to regulate this research. This agency would serve a similar purpose as the National Transportation Safety Board or the Nuclear Regulatory Commission, and be dedicated to understanding the cause of accidents and mitigating risk anywhere in the United States. This would provide a central place for scientists to receive guidance about their work or to raise concerns. Such an agency could develop and promote policies so that all institutions doing this work would be held to the same standards.

Some researchers argue that these recommendations are too far-reaching and will inhibit science. But many of these measures would align the regulatory environment of the United States with those of its peers, such as Canada, Switzerland, the Netherlands, the United Kingdom and Germany. Fears that more oversight will have a chilling effect on research are belied by the robust research programs found in each of these countries. Still, the implementation of these recommendations will require a careful balancing act: fostering innovation in the life sciences while minimizing the safety and security risks.

As longtime participants in the debate about how to achieve this balance between science and security, we have been frustrated by the lack of progress for so long. Notably, the recommendations put forward by the National Science Advisory Board for Biosecurity are not substantively different from those offered by the same board in 2007. We sincerely hope it doesn’t take another 16 years, or another pandemic, to seize this opportunity for reducing the risks posed by dual-use research with viruses and other pathogens.

COVID-19 Update

Even though numbers are "pretty low" right now, in the time since Jan 2020, we've averaged more than 1,000 dead Americans every day for 3 years.

Utah doctor charged with destroying COVID-19 vaccines, giving fake shots to children at their parents' request

Dr. Michael Kirk Moore, three others accused of administering bogus CDC vaccine cards in exchange for $50 'donations'

A Utah plastic surgeon has been accused of destroying COVID-19 vaccines -- and giving saline shots to children upon their parents’ request – as part of an alleged scheme to peddle fraudulent CDC cards.

Dr. Michael Kirk Moore Jr., 58, of Salt Lake County, Utah, was indicted by a federal grand jury this month on charges alleging he disposed of more than $28,000 worth of COVID-19 vaccines and fraudulently completed and distributed hundreds of vaccination record cards.

Prosecutors say Moore and his three co-defendants, including his neighbor, allegedly ran a scheme Plastic Surgery Institute of Utah Inc. to "defraud the United States and the Centers for Disease Control and Prevention (CDC)."

The doctor and co-defendants Kari Dee Burgoyne, 52, Kristin Jackson Andersen, 59, and Sandra Flores, 31, destroyed at least $28,028.50 worth of government-provided COVID-19 vaccines and distributed at least 1,937 doses’ worth of fraudulently completed vaccination record cards to others in exchange for either direct cash payments or required "donations" to a specified charitable organization, without administering a COVID-19 vaccine to the card recipient, U.S. Attorney Trina A. Higgins for the District of Utah announced on Wednesday.

As charged in court documents, the defendants also allegedly administered saline shots to minors – at the request of their parents – so children would think they were receiving a COVID-19 vaccine.

The indictment, obtained by Fox News Digital Sunday, says Moore, a then-board-certified surgeon, and his neighbor, Andersen, belong to a secret organization that aims to "‘liberate’ the medical profession from government and industry conflicts of interest." They joined forces with Burgoyne, the office manager, and Flores, the receptionist, to pour the legitimate vaccines down the drain with syringes, according to the indictment. They allegedly charged a $50 "donation" per fake vaccination card.

The American Board of Plastic Surgery tells Fox News Digital that Moore is no longer certified as of Dec. 31.

"By allegedly falsifying vaccine cards and administering saline shots to children instead of COVID-19 vaccines, not only did this provider endanger the health and well-being of a vulnerable population but also undermined public trust and the integrity of federal health care programs," Curt L. Muller, Special Agent in Charge with the Department of Health and Human Services, Office of the Inspector General, said in a statement. "HHS-OIG remains committed to working with our law enforcement partners to hold accountable bad actors who attempt to illegally profit from the pandemic."

"This defendant allegedly used his medical profession to administer bogus vaccines to unsuspecting people, to include children falsifying a sense of security," Acting Special Agent in Charge Chris Miller, HSI Las Vegas added. "HSI remains committed to working with our partners to bring those who seek to take advantage of the pandemic to deliberately harm and deceive others for their own profit to justice."

The quartet was indicted by a federal grand jury on Jan. 11.

Moore, his medical corporation, and the three co-defendants are charged with conspiracy to defraud the United States; conspiracy to convert, sell, convey, and dispose of government property; and conversion, sale, conveyance, and disposal of government property and aiding and abetting.

Today's Death Of Irony, Part ∞

Just let me state the obvious: I think these flim-flammers care nothing about bad shit that happens because of their flim-flammery.

And they sure as hell don't care that they look like idiots or assholes after they've been killed by the thing they insisted wasn't real, and anyway the gubmint cain't make me take a shot or wear a mask and blah blah fucking blah...

... and FREEDOM!!!

Conservative Activist Dies of COVID Complications After Attending Anti-Vax ‘Symposium’

Kelly Canon had celebrated her vaccine exemption a few weeks before she fell ill with the virus and wound up on a ventilator.

A well-known conservative activist in Arlington, Texas, who peddled COVID-19 vaccine misinformation has died of complications caused by the virus—just a few weeks after attending a “symposium” against the shots.

The Arlington Republican Party confirmed the passing of Kelly Canon on Facebook.

“Another tragedy and loss for our Republican family. Our dear friend Kelly Canon lost her battle with pneumonia today. Kelly will be forever in our hearts as a loyal and beloved friend and Patriot. Gone way too soon We will keep her family in our prayers,” the Arlington Republican Club said in a statement.

Friends and colleagues of the Republican figure flooded social media with tributes on Tuesday, lamenting what they said was her death “from COVID-related pneumonia.”

“I Had just texted with her yesterday and she said she was doing well, fighting off this damn Covid in both of her lungs that turned into double pneumonia, so I am quite shocked to get this news,” wrote one friend who identified herself as Jennifer Talbert Frank.

“I am truly heartbroken to learn that my dear friend Kelly Canon has passed away from complications from Covid pneumonia. Just yesterday around 4pm she told a group of friends that she definitely felt better and that the docs had told her she had ‘turned the corner’ with improved blood test results. She was talking about wanting to come home. Later last night she developed an acute abdominal issue, was given pain meds and put on the ventilator,” wrote Maggie Clopton Wright.

Canon had announced on Facebook in November that her employer granted her a religious exemption for the COVID-19 vaccine.

“No jabby-jabby for me! Praise GOD!” she wrote at the time.

Canon was prominent in Republican circles for her grassroots organizing and campaign to ban red light cameras in Arlington. She also made headlines in 2017 for going public about sexually explicit photos allegedly sent to her by then-GOP Rep. Joe Barton, a scandal which ultimately ended in Barton stepping down.

More recently, Canon had been an outspoken critic of COVID-19 vaccine mandates and pandemic-related restrictions. In one of her final Facebook posts, Canon shared several links to speeches she attended at a “COVID symposium” in Burleson in early December devoted to dissuading people from getting the COVID-19 vaccines that are currently available. The event was organized by God Save Our Children, which bills itself as “a conservative group that is fighting against the use of experimental vaccines on our children.”

Canon had shared similar content on Twitter, where her most recent post was a YouTube video featuring claims that the coronavirus pandemic was “planned” in advance and part of a global conspiracy.

As news of her death spread Tuesday, pro-vaccine commentators flooded her Facebook page with cruel comments and mocking memes, while her supporters unironically praised her for being a “warrior for liberty” to the very end.

Today's Tweet

The least you can do.

Tom Hanks Says He Has No Respect For People Who Will Not Wear Masks pic.twitter.com/VktCsuGtPR

— James Cintolo, RN FN CPT (@healthbyjames) January 20, 2023

COVID-19 Update

We should never celebrate the destruction of a fellow human being.

But being closely in touch with my Inner Asshole, I have to admit a smile will flash briefly across my psyche when this kind of news presents itself.

“Proud boy” leading member, Aaron Laigaie, died from Covid

Aaron Laigaie, one of the founders of the Proud Boys and a Covid denier and anti vaxxer has died of Covid.

ANTI-VAXXER Aaron Laigaie, who declared “covid is over”, said it was “a problem for the elderly” and said he didn’t need the vaccine because he previously had Covid-19 and “it sucked for 2 days and it was over”, has reportedly died from Covid-19.

According to a post that was published online by Geoff Guenther, Aaron Laigaie has unfortunately passed away. Coronavirus was the cause of death for Aaron Laigaie. According to the reports, Aaron Laigaie was a Trumpzi who asserted that he had “natural resistance” to COVID.

He was infected with COVID. Aaron was a COVID denier all the way through. The SARS-CoV-2 virus is the infectious agent that causes the disease known as coronavirus disease (COVID-19).

According to Google, the majority of people who become ill with COVID-19 will have symptoms that range from mild to moderate and will recover without the need for any special therapy. On the other hand, some of them will become gravely ill and call for medical assistance.

Aaron Laigaie’s refusal to get the COVID19 shot has come to light thanks to a number of people on social media. He was one of the original members of the MT Baker Proud Boys. The Proud Boys are an all-male, neo-fascist, far-right organization with its headquarters in the United States. They are known for their participation in political violence and for encouraging others to do the same. It has also been called a street gang, although the governments of Canada and New Zealand have classified it as a terrorist organization.

The Proud Boys are a well-known organization that criticizes left-wing and progressive groups and is well-known for its backing of former US President Donald Trump. Another Trumpzi who claimed to be “naturally immune” (from brains, I should guess) has passed away with COVID, Geoff Guenther said on Facebook. Aaron Laigaie, a proud boy, is no longer with us.

Review finds hybrid immunity provides best protection against Omicron

A review and meta-regression of 26 studies shows that hybrid SARS-CoV-2 immunity provides the highest level of protection against the Omicron variant, researchers reported yesterday in The Lancet Infectious Diseases.

The authors say the finding of the study, the first to estimate the durability of protection conferred by hybrid immunity—the antibody response developed through a combination of SARS-CoV-2 infection and vaccination—could provide guidance on vaccine timing at both the individual and public health level.

Hybrid immunity highly protective against severe outcomes
Of the 26 studies reviewed by a team led by researchers from the University of Toronto and the World Health Organization, 11 reported on the protective effectiveness of previous infection, and 15 reported on protection from hybrid immunity; 7 reported on both. The studies looked at protection against reinfection, hospitalization, and severe disease caused by Omicron.

The effectiveness of previous infection against hospital admission or severe disease at 12 months was 74.6% (95% confidence interval [CI], 63.1% to 85.3%], with effectiveness against reinfection waning to 24.7% (95% CI, 16.4% to 35.5%) at 12 months. For hybrid immunity, protection against hospital admission or severe disease was 97.4% (95% CI, 91.4% to 99.2%) at 12 months with primary series vaccination and 95.3% (95% CI, 81.9% to 98.9%) at 6 months with the first booster shot. The effectiveness of hybrid immunity against reinfection waned to 41.8% (95% CI, 31.5% to 52.8%) at 12 months, and to 46.5% (95% CI, 36.0% to 57.3%) following the first booster shot at 6 months.

Further analysis of the 7 studies that reported on both types of protection showed that hybrid immunity conferred a significant gain in protection compared with previous infection alone—whether subjects with hybrid immunity had received the partial primary vaccine series, the full vaccine series, or the first booster shot.

The authors say the findings indicate that the protection conferred by previous infection should not detract from the need for vaccination, because infection-induced immunity wanes rapidly and vaccines increase the durability of protection. In addition, they suggest the results can be used to tailor guidance on the number and timing of SARS-CoV-2 vaccinations.

'Substantial durability' of hybrid immunity

"Our findings make clear the substantial durability of hybrid immunity and could help inform the timing and prioritisation of vaccination programmes in populations with high rates of past infection," the study authors wrote. "Policy makers can use these findings to project population protection from local vaccination and seroprevalence rates, helping to inform the use and timing of COVID-19 vaccination as an important public health tool."

They add that further analysis is needed to determine effectiveness of hybrid immunity against hospitalization or severe disease over a longer duration.

"A first-generation vaccine is still an excellent option when offered as a primary series in areas with a high rate of previous infection."

In an accompanying commentary, researchers with Brazil's Universidad Federal de Bahia say the findings demonstrate that the focus of first-generation vaccines should be prevention of severe disease.

"For this purpose, a first-generation vaccine is still an excellent option when offered as a primary series in areas with a high rate of previous infection, or with boosters, if a low infection rate has been observed," they wrote.

More Good Stuff From CIDRAP:

• First-wave COVID patients had much higher risk of death for 18 months
• More than 65 million people around the world may have long COVID
• Feds probe possible stroke link to new Pfizer COVID booster
• Spanish hospitals spent $1.33 billion on COVID patients in 2020
• Convalescent plasma may cut risk of death in immune-impaired COVID patients
• Almost a fourth of air passengers screened from China had COVID-19, report reveals
• Paying people to take COVID vaccine worked well, study finds

COVID-19 Update

VAX UP

MASK UP

KEEP YOUR DISTANCE

WASH YOUR HANDS

be smart - this could get bad again

‘People aren’t taking this seriously’: experts say US Covid surge is big risk

Fewer precautions, recent holidays and subvariants have driven rise but boosters, masks and other precautions are still effective

In the fourth year of the pandemic, Covid-19 is once again spreading across America and being driven by the recent holidays, fewer precautions and the continuing evolution of Omicron subvariants of the virus.

New sub-variants are causing concern for their increased transmissibility and ability to evade some antibodies, but the same tools continue to curtail the spread of Covid, especially bivalent boosters, masks, ventilation, antivirals and other precautions, experts said.

Yet booster uptake has been “pitiful”, said Neil Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health. Antiviral uptake has been low, and few mandates on masking, vaccination and testing have resumed in the face of the winter surge, which is once again putting pressure on health systems.

New Covid hospital admissions are now at the fourth-highest rate of the pandemic, according to the US Centers for Disease Control and Prevention (CDC). Covid hospitalizations declined somewhat after the summer wave, but never dropped to the low levels seen after previous spikes, persisting through the fall and rising again with the winter holidays.

“Hospitals are at maximum capacity,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association, of his region’s current rates. “I’m not sure what the trajectory of this thing’s going to be, but I am worried.”

The majority of Covid hospitalizations are among those 65 and older, although the share for children under four roughly doubled in 2022.

In the past week, Covid deaths rose by 44%, from 2,705 in the week ending 4 January to 3,907 in the week ending 11 January.

This is one of the greatest surges of Covid cases in the entire pandemic, according to wastewater analyses of the virus. It’s much lower than the peak in January 2022, but similar to the summer 2022 surge, which was the second biggest.

And it’s not done yet. “Certainly it does not appear that we are peaking yet,” Sehgal said.

The Omicron subvariants BQ.1.1 and BQ.1 as well as the quickly expanding XBB.1.5 make up the majority of cases, according to CDC estimates. The north-east, where more than 80% of cases are estimated to be from the XBB.1.5 subvariant, has the highest proportion of cases, according to wastewater data.

“With XBB, there’s such a significant transmission advantage that exposure is really risky – it’s riskier now than it’s ever been” in terms of transmissibility, Sehgal said.

Official case counts have been slower to rise, because of the prevalence of at-home tests and because of a general reluctance to test at all, experts say. Of the tests that are reported, however, positivity rates have been very high, with about one in six tests (16%) turning positive.

Despite the high rates of Covid spread, hospitalizations have not yet reached previous peaks seen earlier in the pandemic, probably due to immunity from vaccinations and prior cases, said Stuart Ray, a professor of medicine and infectious diseases at the Johns Hopkins University School of Medicine.

But that protection should not be taken for granted, he said, particularly because immunity wanes.

Boosters, especially the updated bivalent boosters, are highly effective at reducing the risk of severe disease and death. Yet only 15.4% of Americans over the age of five have received the new boosters.

“You’re just fighting a lot of misinformation and also some political missteps when it comes to the vaccines,” Williams said. When Joe Biden declared the pandemic was “over” in September, he said, it probably stalled public enthusiasm for the new booster and spurred further inaction from Congress on more funding to address the pandemic.

“It’s challenging to strike that parallel narrative that you shouldn’t worry about Covid but also go get a shot,” said Sehgal, calling the declaration “another unforced error”.

While vaccines are very important, other precautions also help prevent infection, disease, and death, Sehgal said – particularly important during a surge like this. Yet because of poor messaging from officials, many people may not even realize the US is experiencing a surge and precautions are still necessary, he added.

“I think the majority of people who aren’t masking today, just don’t know that they should.”

Even if the US reaches the point where surges do not cause a corresponding increase in hospitalizations and death, they will still increase the number of people sickened and disabled by long Covid, experts said.

“There’s accumulating data that repeated Covid accumulates risk for short- and long-term complications, including cardiovascular, mental health and other problems,” Ray said. “We will only know in retrospect exactly how big this cost is. But evolving data suggests that there is a cost that’s incremental as we accumulate infections.”

Williams is worried that hospitals are reaching maximum capacity even as long-term care facilities see outbreaks among residents and staff, after years of worker shortages.

“In New Hampshire, nursing homes will not admit those that they feel that they cannot staff to care for, which I think is admirable, but the consequence of that is that the hospitals are jammed up,” he said. Hospitals that might release patients to care facilities for transitional or long-term care will see beds filled for longer, putting even more pressure on the hospitals, patients and health workers.

“It’s a continuum, but right now the continuum is broken,” Williams said.

Health workers have experienced three years of burnout, disability and death, and some have needed to exit the workforce. Others have been alarmed by unsafe working conditions and the continued crises caused by the pandemic. Nurses in New York reached a tentative agreement this week after striking for safer working conditions.

Nursing homes and residential care facilities have roughly 300,000 fewer workers today than there were in March 2020, Williams said. “It’s hard to see how it’s going to get better,” he said.

In the meantime, Covid continues circulating, with nursing home residents and staff seeing one of the biggest rises in cases of the pandemic.

“The first key to keeping people healthy in a nursing home is to keep people in the community healthy,” Williams said. But “it just doesn’t seem like people are wearing masks and getting boosted – people aren’t taking any of this seriously. We just seemed to declare that when it comes to Covid mortality, we’re number one, and that’s a title that we’re not going to relinquish to any other country.”

Sehgal calls it a “collective forgetting” about how and why we need to protect ourselves and one another. “There are people for whom a mild infection actually isn’t so mild, either because of their underlying health, or because of social factors in their life,” he said. “It’s just a tremendous self-inflicted wound.”

And the more the virus spreads, the more opportunities it has to evolve, potentially picking up mutations that make it easier to overcome immunity.

Yet the same measures that helped curb previous surges still work today. And they don’t just prevent illness and death – they also minimize social disruption, like lost hours at work and school. “Those steps that we can take to protect ourselves and protect other people – they don’t seem onerous in the face of a Covid infection,” Sehgal said.

As Ray put it: “When we could be wearing a mask, why aren’t we?”