Month: March 2022

As confirmed coronavirus cases rise to their highest levels since the pandemic began, hospitals across the country are reporting critical staff shortages. And those shortages may only grow worse in the weeks to come, as thousands of the 1 million Americans diagnosed with Covid-19 in the past week begin to require hospitalization.

According to an NPR analysis of data released by the Department of Health and Human Services (HHS) this week, more than 1,000 hospitals across the country have been identified as “critically” short on staff as they face a dramatic third wave of Covid-19 infections.

That amounts to about 18 percent of all hospitals that report to HHS. In all, 21 percent of hospitals, representing 40 states and Puerto Rico, expect their staffing needs to increase in coming days. Seven states report shortages in 30 percent or more of their hospitals. North Dakota — which has one of the most severe coronavirus outbreaks in the US — is the worst hit, with 51 percent of hospitals reporting shortages.

Nebraska, Virginia, and Missouri report expecting the largest upticks they’ve faced during the pandemic in the next week.

According to NPR, the HHS data is incomplete because many hospitals do not share staffing numbers with HHS. The agency has been collecting this data since July, but this is the first time it has released it to the public.

These staff shortages translate to exhausted and overworked doctors, nurses, and other hospital employees, and also pose a risk that, as employees become sick themselves, there will be no one to cover for them.

Fear of overwhelming hospital systems was a large part of the “flatten the curve” messaging that accompanied the start of the outbreak in the United States in March. By keeping caseloads to reasonable numbers and admitting only the sickest patients to hospitals, medical experts explained, there was less risk of running out of bed space, ventilators, and other equipment central to the care of Covid-19 patients. It also meant that resources would be available for non-Covid patients as well.

With hospitalization and case rates at record highs, hospitals could soon be out of staff and space

Ultimately, the curve was flattened — but with cases worse than they have ever been, hospitals are again in danger of running out of space, and of health care professionals.

As of November 20, 82,178 people were hospitalized with Covid-19, according to the Covid Tracking Project — far more than the previous records of nearly 60,000 reached in the spring and summer. And on November 20, the US hit a record high of 192,805 confirmed coronavirus cases, breaking the record of the previous day: 182,832 confirmed cases.

As Vox’s Dylan Scott has explained, hospitalization is what is known as a lagging indicator. This means the number of people hospitalized rises after, rather than alongside, an increase in infections: It can take days, or longer, for an infected person to need hospitalization after receiving a positive test result.

This means already burdened hospitals will likely begin to see an increase in patients infected last week in the weeks to come, and providers struggling with those new patients could be overwhelmed in mid- to late December should cases increase sharply following Thanksgiving.

At the moment, hospitals are nearing capacity. HHS estimates that as of November 20, 73.66 percent of all US inpatient beds are full (counting both Covid-19 patients and those seeking treatment for other illnesses), and that 60.62 percent of all ICU beds are occupied.

When the virus was more contained to several hot spots earlier in the year — in New York and New Jersey, for example — medical professionals from elsewhere, as well as from the US military, were also able to travel and provide short-term staffing support.

Now, with the virus so widespread, there are fewer health care providers able to leave one community and support another.

This has led to dramatic reports from local media across the country, as communities that previously saw few coronavirus cases begin to experience strain on their medical systems.

In North Dakota, where hospitals are at capacity, hospital workers have been told they may continue reporting to work even after testing positive for the coronavirus, so long as they are not exhibiting symptoms. (Covid-19 is contagious even in asymptomatic hosts.)

The University of Utah Hospital in Salt Lake City opened an overflow ICU two weeks ago, and officials there said it would be staffed by doctors and nurses working overtime. In Muskegon, Michigan, a recently-closed hospital has been reopened, and licensed nurses are being asked to come out of retirement to meet staffing and infrastructural demands.

And as the pandemic has begun surging in previously untouched parts of the country, rural hospitals, many of which lacked resources to begin with, have been especially hard-hit.

Rural hospitals reaching their capacity can have a ripple effect if nearby urban hospitals also become overwhelmed. As the Kansas City Star’s Jonathan Shorman, Sarah Ritter, and Matthew Kelly reported, Kansas City hospitals have “reached a tipping point where additional COVID admissions could trigger a crisis,” and may have to stop accepting patients from rural hospitals, leaving those patients with nowhere to go and without access to care.

Overwhelmed hospitals will almost certainly lead to more deaths. As Vox’s Julia Belluz has explained, medical professionals have become far better at treating Covid-19 patients than they once were, and the mortality rate has fallen:

Now, there’s strong evidence that common steroids like dexamethasone can reduce the risk of mortality in severely sick inpatients. Putting patients to rest on their stomachs instead of their backs (a practice known as proning) also seems to help.

Though there’s still a lot of progress to be made, the treatment approach has become more standardized over time, said Jen Manne-Goehler, an infectious disease doctor at Brigham and Women’s and Massachusetts General hospitals. When she started treating Covid-19 patients in the spring, it felt like practice was changing every few days. Now it’s more streamlined — and that’s undoubtedly helping with survival, too.

But to receive those improved treatments, patients must have access to doctors. And increasingly, it appears that access may be severely — and perhaps dangerously — limited in the weeks to come. HHS has plans to coordinate between hospitals to make up for staff shortages, according to NPR. However, if hospitals are overwhelmed throughout the country, finding the staff needed to save lives may not be possible, for hospital systems or for the federal government.

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Joe Biden will become the US president during an extraordinary moment in history, one that could very well prove to be the calm before the storm, a brief prelude to dissolution and illiberalism. Trump’s bid to become a full-on authoritarian failed, but Democrats could easily lose the House in a 2022 backlash. Biden could face total congressional opposition, even impeachment — as the recent baseless “stolen election” narrative has shown, if Republicans don’t have any evidence, they’ll just make something up.

Or maybe Democrats will keep the House and take the Senate in 2022, and legislation will become possible! Who knows? (The Georgia Senate runoffs are another big question mark.) If there’s one thing I’ve learned over the past five years, it’s that I definitely don’t know what is going to happen next, and it doesn’t seem like anyone else does either.

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What we do know is that Republicans will wage full-on war on Biden from the second he takes office. They will generate fake conspiracies and controversies through right-wing media and social media. Conservative voters will be told again and again that Biden and Kamala Harris are uniquely dangerous traitors engaged in all sorts of elaborate evil plots. The entire conservative movement, from top to bottom, will view limiting Biden to one term as its primary strategic objective. And the movement will engage in misinformation, norm violation, procedural fuckery, and outright lawbreaking, if necessary, to achieve that objective.

The right will be what it is, what it has been becoming for decades now; expecting anything else would be madness. The question is how the Biden administration should behave, knowing all this.

It would be foolish for anyone to claim to have all the answers, or any of the answers really, but in my mind the most pointed lesson about how to behave in a hopelessly partisan environment comes from Donald Trump himself.

Before getting to that (suspense!), it’s instructive to take a look back at some of the experiences of the administration for which Biden was vice president.

Obama’s efforts to collect and spend “political capital” were mostly for naught

When Barack Obama took office in 2009 in a deepening recession, he expected to receive some Republican help bailing out the economy. It’s easy today to look back on that expectation as naive, but at the time it wasn’t unreasonable. The economy was on the brink of disaster, the need was clear, and the depth of conservative backlash was not yet as evident as it would become later.

What happened instead was a wall of opposition from Republicans, built on bad-faith objections about deficit spending and government waste. With so little room to maneuver, Democrats were forced to negotiate with the tiny handful of moderate Republicans and the large handful of conservative Democrats in the Senate, holding the stimulus bill down to their arbitrary spending caps. In the end, the stimulus bill passed with zero Republican votes in the House and just three in the Senate. The result was an inadequate economic boost and a sluggish recovery that hobbled the rest of Obama’s presidency.

Since it was widely agreed that “political capital” was limited and Democrats could only take on one fight at a time, the question then became what to tackle next. The answer proved to be health care reform, perceived as a policy better developed and more widely supported in the Democratic caucus.

In July 2009, Democrats in the House introduced a health care plan based on a system that had been road-tested by Mitt Romney in his recent tenure as governor in Massachusetts. Many Democrats thought the process would take a few months, and then Congress could move on to climate change. Instead, again and again, Republicans lured Democrats into extended negotiations, only to withdraw support at the last minute over some new bad-faith objection (see: “death panels”). That left Democrats negotiating with their most conservative members, who did much the same thing (Joe Lieberman, may his name live in infamy).

In the end, talks dragged on until March 2010, when Obama finally signed the Affordable Care Act. It got no Republican votes, in the Senate or the House.

Then it was finally time for climate change, and the strategy there was yet more clever sequencing. Obama told Republicans that if they didn’t cooperate on climate change legislation, he would regulate greenhouse gases via the Environmental Protection Agency, which would offer less flexibility and less ability to compensate hard-hit communities. The idea was that the threat of EPA regulations — made inevitable by the Supreme Court’s 2007 Massachusetts v. EPA judgment that carbon dioxide is a pollutant subject to the Clean Air Act — would frighten Republicans to the legislative table, where they could better defend their interests.

Instead, Republicans vowed implacable opposition to all of it. They would fight furiously against legislation when it was on the table and then fight regulations just as furiously when they came up.

To a cool Vulcan mind like Obama’s, it seemed entirely irrational, against Republicans’ own best interests. At that point, he had not fully internalized the extent to which the conservative movement has become unleashed id, driven more by right-wing media than by Republican politicians, fueled by resentment and organized purely to defeat the libs.

In June 2009, when the climate bill passed the House, it got eight Republican votes. By mid-2010, it was dead in the water, with no hope of any Republican votes in the Senate. Democrats no longer had their filibuster-proof 60 seats, and there was nothing like the same support in the caucus that health care reform generated, so it never came to a Senate vote. It ended with a whimper, not a bang.

As promised, Obama’s EPA began slowly rolling out regulations, one at a time. It wasn’t until late in his first term that auto mileage standards were finalized and into his second term before EPA got to power plants. Republicans were able to keep Obama’s Clean Power Plan tied up in court through the end of his second term. Then Trump took power and began a simultaneous all-fronts assault on Obama’s regulations, unrolling them so fast it was difficult to even keep track.

Two-party partisan politics really is a zero-sum game

The theme of these stories is that Democrats relied on clever sequencing over and over again, imagining some amount of political capital (“credibility”) that they could husband and spend strategically to get assistance across the aisle, at every juncture underestimating the ferocity and unanimity of Republican opposition. They kept behaving as though they would find good-faith negotiating partners, as though they were still in the postwar American era of relatively low (or at least manageable) polarization.

What too few of them realized was that they were already in a new era of near-total polarization, with the population sorted into like-minded enclaves, a bifurcated media ecosystem nurturing stacked (and diametrically opposed) “mega-identities,” and voters motivated primarily by “negative partisanship,” which is to say, hatred of the other side.

A fully polarized two-party system really is a zero-sum game. Any victories or gains by one side come at the other side’s expense, even if the victory secures shared goals. The rational course for the party out of power is to fight with full intensity against everything, always, and that’s what Republicans did under Obama. With scarcely any exceptions, from 2010 through 2020, they pushed in every case for maximal partisan advantage, no matter the stakes or possible cost.

The GOP has failed to repeal the Affordable Care Act, despite a few close calls, but otherwise, its unprincipled pursuit of raw power has paid off handsomely. The party captured state legislatures in 2010 and was able to gerrymander itself minority rule in several states. It practically shut down Congress as a legislative body for six years of Obama’s term. It blocked Merrick Garland’s nomination to the Supreme Court and for its efforts got Neil Gorsuch. It ignored Ruth Bader Ginsburg’s dying wishes and for its efforts got a 6-3 conservative Court majority that could last for generations.

Republicans blocked so many Democratic judicial nominations that Senate leader Harry Reid had to get rid of the judicial filibuster to keep the courts staffed. Then, when the GOP took control of the presidency and Senate, it used the absence of the filibuster to pack the federal courts full of hyper-ideological, young, often woefully unqualified judges.

Rather than paying any price for total partisan warfare, Republicans were rewarded in 2016 with the presidency and both houses of Congress. After carrying the country to the brink of authoritarian crisis, it has now lost the House and the presidency. But Joe Biden has been left to tackle a virtually uncontrolled pandemic and millions of people out of work and on the verge of homelessness or food insecurity.

The GOP will likely retain control of the Senate, which means there will be no adequate economic recovery package and none of Biden’s ambitious campaign plans will come to fruition. It has kept control of key state legislatures, so it will be able to gerrymander itself an advantage for another decade.

The elections of 2022 will be another partisan brawl, and the odds are stacked against Democrats; the president’s party has lost seats in every first-term midterm in the past 100 years, save three. If Republicans gain full control of Congress, impeachment becomes a real possibility, even if conviction is very unlikely.

It’s a grim situation, and Biden is starting out behind the eight-ball. How should he proceed?

Biden should run a blitz

Here we return to the lesson that Trump has to teach Biden about life in hyperpolarized politics.

To wit: blitz. Do everything at once.

No matter what the Biden administration does, it will be accused of socialism and corruption by the right. And the past several years have richly demonstrated that conservative parts of the country, particularly rural areas and low-density suburbs, are almost completely captured by right-wing media, from Fox on the TV to AM conservative radio to Sinclair-owned local news to the profusion of shady Facebook sources and groups, where misinformation is rapid and rampant.

Democrats badly need to address this media asymmetry. Despite what conservatives have convinced themselves, mainstream media outlets like CNN are not analogous to Fox, and Democrats have no comparable radio, local TV, or social media operations to carry their messages and narratives straight to voters where they live.

But that is long-term work, and 2022 is right around the corner.

The only thing Biden will have real control over is his administration and what it does. And his North Star, his organizing principle, should be doing as much good on as many fronts as fast as possible. Blitz.

By constantly blundering forward, Trump has helped chart which US institutions and norms provide real resistance and which don’t. The courts have tangibly restrained Trump; they have been the primary bulwark against him. But the chattering of the media and the political classes? Moral outrage? Precedent and tradition? Civil protest?

All of these have proven gossamer. Trump charged right through them like they were cotton candy. By constantly acting, being on the offensive, generating new stories and controversies, he simply overwhelmed the ability of the system to fasten on any one thing.

Biden should learn the lesson. All that matters is what gets done, put on paper and into law. The rest is vapor.

The administration should staff up as rapidly as possible with ambitious young progressives and tell every single civil servant that the next two years are going to be a full sprint. Start immediately rewriting and reimplementing the environmental, public health, and worker safety regulations Trump has weakened. Reverse his immigration policies. Drop his lawsuits.

Reassess the social cost of carbon. Replace Trump’s weak Affordable Clean Energy rule with more stringent carbon rules for the power sector. Ditch EPA’s “secret science” rule and restock scientific advisory boards with actual scientists. Put a moratorium on new oil and gas drilling leases on public land. Pledge the purchasing power of the federal government — around $500 billion a year — toward clean energy technology.

Through the Office of Management and Budget (OMB), direct federal financing toward carbon reduction and clean energy across agencies. Use the Office of Information and Regulatory Affairs (OIRA) to reject regulations from any agency that do not include both a climate and equity “screen” to ensure that they reduce emissions and help the most vulnerable. Use the powers conferred by the Dodd-Frank financial reform bill to integrate climate risks into the financial system.

I’ve written more about what Biden can do on climate change without Congress. Vox’s Dylan Matthews took a wider policy view with 10 big things Biden can do with executive powers, from forgiving student loan debt to reigning in factory farming. More ideas can be found here, here, here, and here, among other places. There’s no shortage of ways for Biden to deploy the powers of the presidency, and he should maximize every one of them.

The new rule of partisan politics is to act, not react

All of these moves will elicit howls of outrage and court challenges from the right. Many will also infuriate the left, since they will inevitably fall short of Biden’s grand campaign promises.

Biden can’t control any of that. Doing less, negotiating more, relying on clever sequencing, chasing after receding promises of cooperation — none of that will solve anything, any more than it did for Obama. He can reach across the aisle, make it clear his door is open, but he shouldn’t wait around for anyone to walk in.

Biden’s best chance is to try to overwhelm the system the way Trump did, by doing so much that it’s impossible to make any one thing into a lasting story. He should launch so many simultaneous reforms that there’s no time for right-wing media to make up lies about all of them or for the Supreme Court to hear them all. He should ignore bad-faith attacks and stay relentlessly on message about what’s gotten done and what’s getting done next. He should, at every juncture, get caught trying to make government work better for ordinary people.

To succeed, all this must happen alongside Democratic Party efforts to improve messaging and media, get persistent party infrastructure on the ground in communities the party has neglected, and innovate on voter outreach and persuasion. (Aaron Strauss has some good ideas on that front.)

But Biden has something the rest of the party at the federal level does not have: the power to improve Americans’ lives in a visible way. More than anything else, cynicism about government’s ability to do that is corroding US politics. The best thing Biden can do, morally and politically, is act, as much and as fast as possible, and then talk about it, and do more of it, and talk about it more. (And he should be clear about exactly who stands in the way of bigger, better changes, and why his name is Mitch McConnell.)

The rest of it, he should ignore: the Washington chatter about the latest Republican accusations or catty infighting among Democratic factions, the cable news story or Twitter drama of the day, the latest offensive thing Trump or some Trump surrogate said, all of it. Bulldoze through it.

The president has limited ability to control political discourse and drama, but he has an enormous capacity to change policy and direct resources. Biden should use that power while he has it, without hesitation or apology.

When the Covid-19 pandemic forced much of the US to lock down in the spring of 2020, officials and experts worried the necessary social distancing measures would make another public health crisis — the opioid epidemic — worse. Addiction treatment is traditionally done in person, and restrictions on gatherings and closed businesses would make it much less accessible.

So the federal government responded by easing rules for getting into treatment virtually — making it easier for treatment providers to retain patients and attract new ones. Even before the pandemic, experts had been calling for making treatment easier to get in the US, and the new rules were a big step forward.

But with vaccines for the coronavirus moving through clinical trials and the end of the pandemic in sight, advocates are worried that the old rules will snap back into place — making it harder, once again, to get people into addiction treatment.

Officials relaxed federal rules in several ways. They allowed doctors to prescribe buprenorphine, an evidence-based medication for opioid addiction, over video or audio calls without requiring an in-person evaluation. They also made it easier to prescribe the medication across state lines, which previously required prescribers to be licensed in both states. And they eased rules for take-home doses of methadone, another proven opioid addiction medication, which traditionally is administered daily to patients at an in-person clinic.

State and federal officials also made it possible for public health insurance programs, like Medicare and Medicaid, to pay for telemedicine addiction treatment services. And some places received permission to go further — for example, delivering methadone to patients rather than requiring they pick it up in person.

Providers say the changes really helped. Many of them had to go virtual almost overnight, as the threat of the coronavirus became clear to much of the country. But they had feared they wouldn’t be able to prescribe necessary medications at all, given the arduous rules on such drugs, possibly putting their patients at risk of relapse, overdose, and death.

Things haven’t gone perfectly, but the relaxed rules, providers and experts say, have helped avoid the worst of it.

“It was incredibly challenging [for us], as it was for all providers,” Alexis Geier-Horan, vice president of government relations at the addiction treatment provider CleanSlate, told me. “Thankfully, we really didn’t lose many patients. … That was only possible because of what the federal government did in response to public health emergencies.”

Addiction treatment has long been difficult to access in the US. According to federal data, only 1 in 10 people with a drug use disorder get specialty treatment. Multiple problems play into that treatment gap, including a lack of local providers, high costs, and poor insurance coverage. Much of the treatment provided lacks evidence, or even rejects evidence-based modalities, and can even be downright fraudulent — leaving potential patients resistant to getting care in a broken system.

That’s why, even before the Covid-19 pandemic, activists and providers were calling for making it easier to prescribe addiction medications. Pandemic or not, some patients have always struggled with transportation, or lived in underserved areas that would require a lengthy trip to get treatment. For these patients, getting prescriptions by telemedicine or phone, or simply having to go to a clinic less often for medication, would help.

On the flip side, the patients who now rely on these services to get treatment, regardless of the pandemic, could stand to lose if the relaxed regulations expire. That’s what those in the field are now worried about: If those patients lose their means to treatment, they might give up on it altogether.

That would come at a particularly calamitous time for the opioid epidemic. Even before the pandemic, drug overdose deaths were trending up. But with the pandemic and continuing spread of the potent opioid fentanyl, overdose deaths have skyrocketed this year: On April 2020 (the latest month of data), there were nearly 78,000 drug overdose deaths, based on preliminary federal data — a 13 percent increase from the same time last year, setting up 2020 to be the worst year for overdose deaths ever.

That’s not, advocates and experts say, a sign that the measures easing access to addiction treatment failed, but rather that the measures didn’t and couldn’t go far enough to address a rapidly worsening overdose crisis. While the measures likely helped ease some of the pain brought on by Covid-19, they couldn’t resolve all the hurdles to treatment in America. That’s a case for building on the relaxed rules, not taking them away when the pandemic subsides.

“The stakes are life and death,” Kelly Clark, president of the advocacy group Addiction Crisis Solutions, told me. “We know, absolutely, that people who are taking their maintenance medications like buprenorphine for opioid addiction have a decreased chance of dying prematurely because of their addiction compared to those who aren’t on medications. This is very clear.”

Providers now worry the lax rules could go away soon

Two of the three federally approved medications for opioid addiction, methadone and buprenorphine, are among the most regulated drugs in the country. Methadone is only administered at specialized clinics — requiring patients to go to a clinic as often as daily to get it, and only letting them earn the ability to take some doses home over time. Buprenorphine can be prescribed by a doctor and picked up at a pharmacy, like other medications, but it still requires the prescriber to go through a special certification, and starting a patient required an in-person medical evaluation.

Then the Covid-19 pandemic came, almost immediately making these requirements unfeasible for patients and providers who now had to get and do treatment virtually.

So federal agencies took advantage of the federal public health emergency declared to combat Covid-19 to ease the rules — making telemedicine, including video and audio calls, more feasible for buprenorphine, and easing rules for methadone take-home doses. Local and state agencies followed suit.

But the changes are only in effect until the public health emergency expires. That’s left advocates and providers worried, and they’re increasingly sounding the alarm — as early as possible — to get Congress or other officials to act. They’ve called on federal lawmakers to pass the TREATS Act, which would make many of the rule changes permanent, as soon as possible.

“Speaking for [the American Society of Addiction Medicine], ASAM would love to see the TREATS Act passed with any kind of legislation that goes through during this lame-duck [period], so that we don’t have to face this other unknown coming into the year,” Clark, former president of ASAM and vice chair of the group’s Covid-19 task force, told me.

The typical argument for keeping the old rules comes down to fears of diversion: that the medications will be diverted to a black market for recreational uses. Buprenorphine and methadone are opioids, and, though they’re very effective for treating addiction, they can be misused. So loosening access to either too much, the argument goes, could lead to the drugs ending up in the wrong hands.

As the Drug Enforcement Administration put it, “Under normal circumstances, DEA would not consider the initiation of treatment with a controlled substance based on a mere phone call to be consistent with the framework of the [Controlled Substance Act] given that doing so creates a high risk of diversion.”

Providers take these concerns very seriously, and have adopted a range of practices, such as regular urine screenings, to make sure people are actually taking their medications and not relapsing. Many providers are concerned that loosening the rules too much, and simply doing treatment virtually, could make it harder to prevent diversion.

At the same time, some experts argue that concerns about diversion are overblown. For one, some research suggests that diversion is a result of people not being able to legally obtain buprenorphine or other treatment, forcing them to resort to illegal means of getting the medication. So the stricter regulations could be causing more diversion, not preventing it.

That indicates a balancing act is needed. If it turns out, in the pandemic, that expanding telemedicine for buprenorphine increases access without much more, if any, diversion, then maybe the right balance is more toward a laxer regime than the longstanding laws and rules suggest.

“These agencies are trying to balance the public safety side of making these changes with the public health side,” Geier-Horan, who previously worked on addiction treatment under the Obama administration, said. “From a CleanSlate perspective, the benefit of these things far outweighs those [diversion] concerns.”

Some researchers are working to find out if that’s the case, studying how virtual treatment has worked throughout the pandemic. A JAMA Psychiatry article noted there’s a dearth of research on the role of telemedicine in addiction treatment, including whether it improves access and can be done without significantly increasing diversion.

“That could be really helpful in getting people on board,” Allison Lin, lead author of the JAMA Psychiatry article and an addiction psychiatrist and researcher at the University of Michigan and the VA Center for Clinical Management Research, told me. “We do need more research to provide that data. We don’t have those kinds of answers just yet.”

Short of that, providers are sharing their own experiences, arguing that they’ve been able to maintain a level of care, and even gain some patients, throughout the pandemic despite the obvious disruptions Covid-19 has brought on. But they also worry that losing the new tools they have now could lead to the opposite result once the pandemic is over, fueling a drug overdose crisis that’s already getting worse.

Effective addiction treatment is inaccessible to many Americans

Although the Covid-19 pandemic has in some ways overshadowed it, America’s opioid epidemic is still in full force. It’s in fact gotten worse this year, based on the data we have. The widespread sense of isolation and despair that many people have felt this year, coupled with greater difficulty finding help for such problems as many places close down, has contributed to more drug overdose deaths. Paired with that, the powerful synthetic opioid fentanyl has continued to supplant heroin in more of the illicit market — and in part because it’s so potent, it’s more likely to cause overdoses and deaths.

“While our attention has gone to Covid, and rightly so, our overdose deaths have skyrocketed,” Clark said. “We have to keep overdose deaths on the map.”

One of the key contributors to this crisis all along has been lack of access to evidence-based treatment. Good treatment remains very difficult to get in the US — it can cost tens of thousands of dollars out of pocket, and despite those high costs, it’s still frequently of bad to mediocre quality. One family I spoke to last year told me that they spent $200,000 on treatment before they found something that worked. That’s an extreme example, but it’s not rare, based on the thousands of responses to Vox’s survey about the issue, for people to spend an exorbitant amount on treatment and end up with little to nothing to show for it.

That’s not because evidence-based treatment doesn’t exist. For opioid addiction, the medications are truly proven to work well. Studies show buprenorphine and methadone reduce all-cause mortality among opioid addiction patients by half or more, and they do a far better job of keeping people in treatment than non-medication approaches. There are all sorts of other good treatment modalities for other kinds of addiction, including medications and paying people to stay in treatment (known as contingency management).

But these evidence-based approaches are dramatically underutilized. According to federal data, only 42 percent of the nearly 15,000 facilities tracked by the Substance Abuse and Mental Health Services Administration (SAMHSA) provide any type of medication for opioid addiction. This is largely driven by stigma — the faulty notion that medications replace one drug for another, even though the medications are proven to improve outcomes compared to continuing to use illicit drugs.

So there’s a dearth of providers for evidence-based treatment. When those providers are available, they might not be covered by insurance, and cost thousands out of pocket. If someone has gone to a treatment facility before and ended up with a bad experience due to shoddy, evidence-less care, they also might be skeptical that there’s good help out there at all. That all makes treatment less accessible, and people less receptive to it.

That’s why much of the work to combat the opioid epidemic, from legislation passed by Congress to state efforts to more localized approaches to lawsuits, has gone to expanding access to treatment: If truly effective treatment exists, then it’s just a matter of making sure it’s available to the public.

Along those lines, activists had pushed for more access to telemedicine for years. Of particular concern were underserved areas with few providers — like rural West Virginia, which has a massive overdose crisis and not enough addiction treatment providers to handle demand from patients. Telemedicine can make it easier for existing providers to serve other areas in the state, or even people in other states entirely.

It’s also about expanding the spectrum of care. Every person dealing with addiction is different. Some people are fine with being on medications; some people aren’t. Some will like treatment through Zoom or phone; some won’t. Some have a car; some have no reliable transportation. By offering a variety of options for what care is delivered and how, the hope is fewer people won’t get into treatment because there’s not an option for them.

“It’s not to say everybody should get telehealth, or everybody should get in-person [treatment],” Lin said. “It was just that, before, everybody was in person because that was the only option available.”

Covid-19 has made a lot of things worse, including the opioid crisis. A silver lining to all of this is it’s also given us a big, ongoing experiment to see if a telemedicine model can work for addiction care.

Some providers are now hoping that the eventual end of the pandemic isn’t the end of that experiment — given that it may be helping stave off what’s already the worst drug overdose crisis in American history.

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THE GPA HAVE released a detailed statement this evening as the dispute with the GAA over player expenses continues.

Written by Wexford hurler and GPA National Executive Committee Co-Chair Matthew O’Hanlon, the GPA chief insists it is false to suggest that the group would be happy to allow over training continue.

The statement also questions whether the GAA pursued an honest way to negotiate over the recent charter and that if the GAA allows unlimited training, the players would be financially penalised.

The statement, in full, reads:

“I, like many players, read what GAA Director General Tom Ryan had to say to county boards this week with interest. I have read the reaction to what he had to say and what GPA CEO Tom Parsons has had to say this week too, and I find some of it hard to fathom. So, I want to make some points for clarity.

“Last weekend players took a stand that we would not engage in match day media activity around games. It was a small gesture to highlight player frustration over the ongoing issues around squad charters. It had minimal impact on fans, if any. The GAA’s response was to unilaterally, without the agreement of players, try to impose a squad charter on their terms.

“The GAA have designed this charter, by their account, with player welfare in mind. Again, let’s be clear on this. Last December through to March the GAA came to the negotiating table wanting to retain the cost saving measures players had agreed to during the Covid crisis. Now however, language around player welfare had been conveniently added in.

“At the time the GAA negotiating team put forward a case that 50 cent per mile for 3 sessions a week and a cap of 32 players was all they could afford. Two months later they posted a profit for 2021 of €13.5 million. Was that an honest way to negotiate?

“That brings me specifically to player welfare. The GAA are now willing to cover 4 sessions per week at 65c. That came about because last week the GPA let them know we would be communicating with all players. 3 sessions were then moved to 4 over the course of 24 hours. Surely if player welfare was the concern here such a move, adding 33% to a training load, would be unthinkable.

“Following on from that, the GAA now want to enforce a charter where 4 sessions are agreed at 65c per mile and then anything above that will need to be negotiated locally by players with county boards. In other words, county boards can allow as many sessions as they want – the GAA would be openly allowing unlimited training, but players would be financially penalised because the GAA accept a reduced mileage rate for sessions above 4.

“This is what some commentators are accusing the GPA of wanting. It’s hard to believe that when Tom Parsons refers to training once or ten times a week to emphasise a point, it is being portrayed that the GPA would be happy to allow such over training. It’s spreading and creating a false picture – deliberately.

“To put an end to that I’ll say this. Back as far as January, separate to the charter negotiations, the GPA’s Player Welfare Manager Colm Begley discussed a working document with the GAA’s Sports Science Group looking at the area of contact hours. In it, recommendations are made on the required number of sessions a player would train at each stage of the season. Colm will be presenting to the GAA group on March 30th on this matter, an arrangement again made back in January. This is with a view to getting expert scientific and medical input to add to that already gathered by the GPA.

“This policy concept was proposed to the GAA charter negotiating team on December 16th via a memo as a means of using sports science to identify the required number of sessions per week as it varies from pre-season to in-season and from Rookie to late career players. It would not just be done by picking an arbitrary number like 3 out of the air and then moving that to 4 at a whim last week.

Statement on behalf of Matthew O'Hanlon, GPA National Executive Co-Chair and Wexford hurler, on Player Charter situation with GAA.https://t.co/HxODXDC6Fp

— GPA (@gaelicplayers) March 16, 2022

“For clarity, the working document outlines situations where 5 sessions a week might be needed in pre-season. During the playing season and a de-load week for example, sports science indicates 3 sessions a week is adequate for performance.

“As part of the negotiations with the GAA, the GPA proposed that this is the policy that should be used as the means of regulating sessions, rooted in sports science and with player welfare actually to the fore. It’s our view that all parties, players, managers and county boards, should then sign off on a Contact Hours Policy that indicates the optimum number of sessions allowable for all players on the squad. The mileage rate and claimable expenses by players cannot be the mechanism to do this; it’s a point of principle.

“Players are not looking to be paid expenses for unlimited sessions; they are just looking for all squad members (not just the 32) to be reimbursed for all the sessions they take part in at the same rate of 65c. Players, through the GPA, have proposed how to properly regulate sessions using scientific expertise. That should be signed off by all and policed by the GAA to ensure County Boards and managers are adhering to it.

“Players are still open and willing to go back to the negotiating table based on the above. It would be fair, based on expertise and would likely not cost the GAA anything more than what they are trying to impose.

“The key difference – players would not be used by the GAA as a cost control measure. If they actually have player welfare in mind, then it’s a no-brainer to use a Contact Hours Policy.

“Revert to the 2019 charter and let’s sort this out with a Contact Hours Policy initiative as proposed by the players body in December of 2021.”

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With two Covid-19 vaccine candidates expected to be approved for the US market in the coming weeks, a group of experts met Tuesday to advise on which Americans should be immunized first. In a 13-1 vote, they put health care personnel and staff and residents of long-term care facilities at the front of the line.

The Advisory Committee on Immunization Practices (ACIP), a panel of independent medical and public health experts, has been meeting for months to think through the question of whom to prioritize during a pandemic while vaccine supplies are still limited.

ACIP is highly influential in the US. It makes recommendations on vaccination policy to the Centers for Disease Control and Prevention, which overwhelmingly accepts the committee’s guidance. States aren’t obliged to follow it, however. It’s up to governors — and individual hospitals and vaccine sites — to make their own vaccine prioritization plans.

But with coronavirus hospitalizations and deaths rising exponentially, the meeting was another stark reminder that vaccine rationing will be a painful reality for months while supplies remain short.

“There is an average of one Covid death per minute right now,” said Dr. Beth Bell of the University of Washington, who chairs ACIP’s Work Groups, at the meeting’s opening. “In the time it takes us to have this ACIP meeting, 180 people will have died of Covid-19.”

And that’s one reason why, vaccine and public health experts told Vox, ACIP should have weighed in sooner. Major health groups like the World Health Organization (WHO) and the National Academies of Sciences, Engineering, and Medicine (NASEM) have published advice on how countries and other decision-making bodies can set their prioritization plans for Covid-19 vaccines.

“It would have been helpful to have this a week ago,” said Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics, since states, which have been waiting on the guidance, must place their first orders of Covid-19 vaccines with the government and share their initial distribution plans by Friday. “States were not caught completely unaware here,” Faden added — since ACIP had signaled in previous meetings the direction they were likely to go — but Tuesday’s guidance could have been more specific, particularly when it comes to how to immunize America’s health workforce.

The advice is not specific enough

ACIP’s primary task on Tuesday was to vote for phase 1a of the rollout for two priority groups: health care personnel and long-term care facility staff and residents, comprising about 24 million people.

According to CDC officials, there will only be 5 million to 10 million doses of the vaccines available per week for these groups once vaccines are approved, which should happen before the end of the year. The two manufacturers that are expected to have vaccines approved first, Moderna and Pfizer/BioNTech, will have enough doses to vaccinate only around 20 million people by the end of December.

Long-term care facility residents and staff are a top priority because they have accounted for 40 percent of US Covid-19 deaths, according to the committee. And it makes sense to prioritize health care workers — they’ve also been among the groups hardest hit by the virus, and we need them healthy and working to keep the health system functioning.

But the gap between the priority groups and the expected supply is a problem ACIP should have addressed, experts say.

It’s not clear from the guidance who among the health workers should go first, said Jason Schwartz, assistant professor of public health at Yale School of Public Health. “This matters because states might have 20,000 or 100,000 doses and figuring out where to use them in a priority group is going to be a hard question.”

ACIP has only said that “individuals with direct patient contact,” personnel working in residential care and long-term care facilities, and workers without coronavirus infection in the last 90 days should go first.

“Direct patient care is often interpreted as physicians and nurses and clinicians,” said Saad Omer, director at the Yale Institute for Global Health, who is part of both the WHO and NASEM Covid-19 vaccine prioritization committees. “But you have to go beyond that to explicitly say that includes cleaning workers, others who are doing housekeeping, etc.”

These groups are potentially just as exposed to the coronavirus as ICU doctors or nurses since they’re working in the same high-risk spaces.

“There’s a huge difference between say a dermatologist that’s doing cosmetic surgery in a private office and somebody who’s in a Covid-19 ward in a large inner-city hospital,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, added. “It would be enormously helpful if there could be a greater stratification based upon risk of the health worker.”

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What’s more, had ACIP been more specific about which health workers are high risk, “you leave open a strategy of prioritizing them then going to other high-risk groups rather than [immunizing] the entirety of the health system workforce,” said Faden — who also advises the WHO on vaccine prioritization.

The next challenge: How to prioritize the elderly

Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said most states are planning to be able to immunize their entire health care workforce within three weeks of getting the first Covid-19 vaccine shipments. If that’s true, “issues here regarding sub-prioritization will be very short-lived and the need for more detailed guidance is reduced,” Schwartz said.

ACIP typically sets recommendations for vaccine policy based on specific vaccines, and they’ll reconvene and potentially shift their advice as soon as Covid-19 vaccines are approved by the Food and Drug Administration. They’ll also need to vote on which groups come after phase 1a of the rollout.

If ACIP follows through with what they’ve been telegraphing so far, the committee will prioritize essential workers (such as teachers, food and agriculture workers, police, and firefighters) in phase 1b, and adults 65 and older and with high-risk medical conditions in phase 1c.

ACIP would deviate from other international expert groups with this plan, Omer said. The WHO and NASEM vaccine frameworks have both prioritized older adults and adults with underlying health conditions alongside or immediately after health workers, instead of essential workers.

“The reason everyone is prioritizing the elderly — compared to people 18 to 29 years of age — is that even at ages 65 to 74, they have a 90 times higher risk of death,” Omer explained. “My hope is [ACIP] will revisit some of the assumptions that were driving the considerations for the trade-off between essential workers and older age populations.”

The United Kingdom on Wednesday granted temporary authorization for emergency use of the Covid-19 vaccine developed by Pfizer and BioNTech to adults age 16 and older, with the first 800,000 doses of the two-dose vaccine slated to be offered in the country next week.

This makes the UK the first country to approve the Pfizer/BioNTech mRNA-based vaccine and the first government approval of a vaccine backed by a clinical trial. (Some countries like Russia and China began administering their Covid-19 vaccines before completing large-scale trials.) It’s also the fastest a vaccine has ever gained approval, albeit on a temporary basis.

“I’m confident now, with the news today, that from spring, from Easter onward, things are going to be better,” said UK Health Secretary Matt Hancock during a press conference. “And we’re going to have summer next year that everyone can enjoy.”

The UK’s health regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), granted the temporary authorization shortly after Pfizer and BioNTech reported in November that their Covid-19 vaccine was 95 percent effective. Though this is a temporary authorization, the MHRA is conducting a rolling review of vaccine trial data as it comes in and may grant full approval at a later date. In contrast, the US Food and Drug Administration is evaluating vaccines based on completed studies, which increases the length of the approval process.

The UK government reached a deal with Pfizer and BioNTech to purchase 40 million doses of the vaccine through 2021 — enough for 20 million people — mainly shipped from Pfizer’s manufacturing plant in Puurs, Belgium.

“This authorization is a goal we have been working toward since we first declared that science will win, and we applaud the MHRA for their ability to conduct a careful assessment and take timely action to help protect the people of the U.K.,” said Pfizer CEO Albert Bourla, in a statement.

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The UK has been one of the most severely afflicted countries during the Covid-19 pandemic, with 1.6 million reported infections and almost 60,000 deaths in a population of 66 million. The government recently imposed a second national lockdown as cases spiked; restrictions on movement and which businesses can stay open may begin to relax this week as the number of new cases declines. But with winter approaching, the risk of more Covid-19 spread in the UK remains high.

The UK is prioritizing older adults to receive a Covid-19 vaccine

With limited doses of the Pfizer/BioNTech vaccine to give out for the time being, the UK is establishing several priority tiers for Covid-19 immunization.

The country’s Joint Committee on Vaccination and Immunisation (JCVI) on Wednesday laid out guidelines for administering the vaccine based mainly on age. The top priority is residents and workers at care homes for older adults, a ranking based on the number of vaccinations that would be needed in each tier to prevent one death, not necessarily risk of exposure.

That’s why health workers, who will be at the front of the line in the US, are not in the top tier in the UK, even though they may be encountering the virus more frequently. “As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age,” according to the guidelines.

The committee divided its overall priority list into nine groups. “It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19,” according to the JCVI guidelines.

But the guidelines also note that vaccine deployment strategies may have to shift to address concerns like mitigating health inequalities and logistical challenges. The latter is particularly important for the Pfizer/BioNTech vaccine because it has some of the most stringent cold storage requirements of any Covid-19 vaccine candidate: temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit) or lower. While Pfizer and BioNTech are developing shipping containers that can maintain these temperatures for 30 days, it’s likely that the first facilities to receive it will be major health facilities that already have freezers.

Recipients will have to receive the vaccine as two doses spaced 21 days apart, so rigorous patient tracking will be needed as well.

The US is now waiting on emergency approval for two Covid-19 vaccines

Advisers to the Centers for Disease Control and Prevention this week voted on US guidelines for vaccine approval. The recommendations from the Advisory Committee for Immunization Practices stated that health workers and residents of long-term care facilities should be up first for a Covid-19 vaccine. That health workers are in the top tier stands in contrast to the guidelines issued by the UK.

Establishing these priorities is all the more critical now that a vaccine is poised to begin distribution in the US in weeks. Pfizer and BioNTech have also applied for an emergency use authorization (EUA) in the US from the FDA for their Covid-19 vaccine. The FDA is meeting on December 10 to discuss their vaccine. This week, Moderna, another mRNA Covid-19 vaccine developer, also applied for an EUA.

If granted, these emergency approvals would mark the fastest vaccine development timeline ever, an amazing feat against an unprecedented pandemic. But Covid-19 cases are continuing to rise across the US, and it will still be a few more months before there is widespread access to a vaccine.

As if the Covid-19 pandemic wasn’t bad enough, America is also seeing a surge in homicides this year.

A new report, by the Council on Criminal Justice, found homicides have increased sharply this year across 21 US cities with relevant data: “Homicide rates increased by 42% during the summer and 34% in the fall over the summer and fall of 2019.” Other data, from crime analyst Jeff Asher, found murder is up 36 percent throughout the year so far, compared to the same period in 2019, in a sample of 51 US cities. A preliminary FBI report also found murders up 15 percent nationwide in the first half of 2020.

The increase in homicides is large and widespread enough to raise serious alarms for criminologists and other experts. So what’s going on?

Some experts have cited the protests this summer over the police killings of George Floyd and others — which could’ve had a range of effects, from officers pulling back from their duties to greater community distrust in police, leading to more unchecked violence. Others point to the bad economy. Another potential factor is a huge increase in gun purchases this year. Still others posit boredom and social displacement as a result of physical distancing leading people to cause more trouble.

Above all, though, experts caution it’s simply been a very unusual year with the Covid-19 pandemic. That makes it difficult to say what, exactly, is happening with crime rates. “The current year, 2020, is an extreme deviation from baseline — extreme,” Tracey Meares, founding director at the Justice Collaboratory at Yale Law School, previously told me.

That offers a bit of good news: It’s possible that the end of the pandemic will come and homicide rates will fall again, as they generally have for the past few decades in the US. But no one knows for sure if that will happen, or if we’re now seeing a shift in long-term trends.

Uncertainty about what’s going on isn’t exactly new in the field of criminal justice. Rates of crime and violence have plummeted over the past few decades in the US, yet there is no agreed-upon explanation for why. There are theories applying the best evidence, research, and data available, ranging from changes in policing to a drop in lead exposure to the rise of video games. But there’s no consensus.

That a decades-long phenomenon is still so hard to explain shows the need for humility before jumping to conclusions about the current trends.

“We don’t know nearly enough to know what’s going on at the given moment,” Jennifer Doleac, director of the Justice Tech Lab, previously told me. “The current moment is so unusual for so many different reasons that … it’s really hard to speculate about broad phenomena that are driving these trends when we’re not even sure if there’s a trend yet.”

All of that said, here’s what we do know.

Homicides are up in the US this year

There are several good sources, from criminologists, economists, and other data analysts, for what’s happened with crime and violence so far this year: an analysis by Jeff Asher; a Council on Criminal Justice report written by Richard Rosenfeld and Ernesto Lopez; City Crime Stats, a website from the University of Pennsylvania set up by David Abrams, Priyanka Goonetilleke, Elizabeth Holmdahl, and Kathy Qian; and a preliminary report from the FBI.

Crime analyst Jeff Asher offers the most recent data, looking at crime trends in 51 US cities in 2020 so far compared to 2019. He found murders are up 36 percent. Despite previous comments by President Donald Trump blaming the increase on Democrat-run cities, Asher found murders are up about 36 percent in both cities with Democratic mayors and those with Republican mayors. In a smaller sample of US cities, he found violent crime overall is flat and property crimes are down.

The Council on Criminal Justice report, updated in November, analyzed crime in 28 US cities, ranging in size from Los Angeles to St. Petersburg, Florida, through October. The authors looked for “structural breaks,” in which reported crime increased or decreased more than would be expected, based on data from previous years.

They found structural breaks in homicide, aggravated assault, and gun assault increases, particularly starting in the summer. There weren’t significant increases in domestic assault (although the data for domestic violence is fairly limited), and robbery was actually down. Other kinds of crime, including larceny and drug offenses, largely decreased.

Here’s the graph for homicide increases:

“There were 610 more homicides in the 21 cities in the summer and fall of 2020 than during the same period in 2019,” the report found.

City Crime Stats’ data complicates matters a bit, comparing the 2020 crime trends in 28 major cities to a five-year baseline. With this approach, the homicide increases don’t seem quite as dramatic in many cities, and other types of crime appear to be mostly down as well. Still, homicides do seem to be significantly up in many of the cities included in the City Crime Stats data set.

Here, for example, is Chicago’s homicide trend, which shows this year’s rate (the red line) rising above the five-year baseline (the gray line and shading) at several points throughout the year:

There’s a lot of variation from city to city. Minneapolis, Milwaukee, New York City, and Philadelphia are on the high end of homicides or seeing a flat-out increase. Baltimore, Boston, and Columbus are close to historical trends or actually down.

Overall, though, Abrams said that his data suggests there was a significant increase in homicides from May to June: “We did find a statistically significant increase in homicides — about 21 percent — in aggregate in the cities we looked at in the month after versus before those protests,” he previously told me, cautioning we can’t say with any confidence if the protests were the cause. “Same for shootings, but that’s from a smaller number of cities.”

A preliminary FBI report confirmed these other reports’ findings for the first half of 2020. It found a 15 percent increase in murders, a 5 percent increase in aggravated assaults, and an 8 percent decrease in property crime nationwide from January through June, compared to the same time period in 2019. The FBI will likely release a report for all of 2020 later in 2021.

In Chicago, as well as some other cities, the apparent increase in homicides began before the protests over the police killing of George Floyd. And in some cases, as in Chicago, the spike abruptly ended almost as quickly as it started, only to surge again weeks later, after the protests had calmed. So it’s hard to blame only the protests for a spike — especially because we know that other factors likely played a role, such as the start of summer, when crime tends to go up, and the end of stay-at-home orders.

City-by-city variation isn’t unique to 2020. It’s expected, even when talking about national crime waves or declines, to see some places go up and others go down for different kinds of crime. The US is a big country, and a range of local factors can affect different kinds of crime.

Still, there’s enough in the four data sets to draw some conclusions: Homicides are up significantly this year. But other kinds of crime, including violent crime overall, aren’t up and may actually have decreased so far this year. There was also a brief spike in burglaries in major cities starting in late May — an increase that was so brief and contained to specific cities that experts told me it was almost certainly due to the riots and looting surrounding some Black Lives Matter protests.

As Asher noted on Twitter, a disconnect between murders and other crimes would be odd: “Violent crime and murder almost always move in the same direction and they are never this far apart nationally.”

One way to reconcile this may be the nature of crime reporting. All of this data is based on reports to governments, typically local police departments. But with people stuck at home, and no government agency operating normally this year, perhaps these reports are just less likely to happen or get picked up, especially lower-level crimes involving drugs or stolen property.

At the same time, it’s far harder for a homicide to go completely unreported — it’s difficult to ignore a dead person. This is why, for much of US history, the homicide rate has been used as a proxy for violent crime overall: The nature of homicide made it a more reliable metric than others for crime.

In other words, it’s possible that other kinds of crime are up this year, but they’re simply going unreported. At any rate, homicides are up significantly.

One note on domestic violence: Some activists and experts worried it would increase this year as people were forced to stay home more often. The Council on Criminal Justice report and City Crime Stats’ analysis suggest that’s not the case, showing no significant change or a drop in some places. But there’s reason for skepticism: Both sources are pulling data from a limited number of cities. And reporting limitations may especially apply to domestic violence, since this year victims are potentially more likely to be trapped with their abusers and unable to make a phone call for help.

There are plenty of caveats to all this data. Much of it only represents trends in large US cities, which means it might not be representative of the country as a whole. And it only covers 2020 through November at the latest.

But the trends, particularly with homicides, are very alarming.

We know less about why there’s a spike, but there are some theories

So why are homicides up?

When I posed this question to experts, they again cautioned that no one can say with certainty what’s going on. That said, they offered some possible explanations, based on the limited information we have so far:

1) The pandemic has really messed things up: Looming over absolutely every discussion about 2020 is the Covid-19 pandemic. That’s no different for discussions about crime and violence. This year is very unusual, with many forced to stay at home and living in fear of a new, deadly virus. That could lead to all sorts of unpredictable behaviors that experts don’t understand yet and might take years to explain.

2) Depolicing led to more violence: In response to the 2014 and 2015 waves of Black Lives Matter protests against police brutality, officers in some cities pulled back, either out of fear that any act of aggressive policing could get them in trouble or in a counterprotest against Black Lives Matter. While protesters have challenged the crime-fighting effectiveness of police, there is a sizable body of evidence that more, and certain kinds of, policing do lead to less crime. Given that, some experts said that depolicing in response to protests could have led to more violence — what some in years past called the “Ferguson effect,” after the 2014 protests in Ferguson, Missouri, over the police shooting of Michael Brown, and also seen in Baltimore after the 2015 killing of Freddie Gray.

3) Lack of trust in police led to more violence: In response to the “Ferguson effect” in 2015, some experts offered a different view of what was happening: Maybe people had lost trust in the police and, as a result, they relied more on street justice and other illegal activities to resolve interpersonal disputes — an interpretation of “legal cynicism,” explained well in Jill Leovy’s Ghettoside and supported by some empirical research. Perhaps Floyd’s killing and the ensuing protests led to a similar phenomenon this year.

4) More guns led to more gun violence: There’s been a big surge in gun buying this year, seemingly in response to concerns about personal safety during a pandemic. And as the research has shown time and time again, more guns mean more gun violence. A recent, preliminary study from researchers at UC Davis already concluded that gun purchases led to more gun violence than there would be otherwise through May this year. That could have further exacerbated homicide increases.

5) Overwhelmed hospitals led to more deaths: One way to explain a flat or dropping violent crime rate as homicides rise is that the violent crime was deadlier than usual. With health care systems across the US at times close to capacity or at capacity due to Covid-19, maybe hospitals and their staff couldn’t treat violent crime victims as well — increasing the chances they died this year. That could translate to more deaths, and homicides, even if violent crime remained flat or declined.

6) Idle hands led to more violence: Throughout the pandemic, a lot of people have been bored — with forms of entertainment, from restaurants to movie theaters, closed down. Schools are limited or closed too, and millions have been newly unemployed. Other support programs that can prevent violence were shuttered due to the closures. All of that could have led to conflict, and possibly more crime and violence. But, experts cautioned, this is speculative, with little evidence so far to support it.

7) A bad economy led to more violence: With the economy tanking this year, some people may have been pushed to desperate acts to make ends meet. Disruptions in the drug market, as product and customers dried up in a bad economy, may have led to more violent competition over what’s left. The bad economy also left local and state governments with less funding for social supports that can keep people out of trouble. All of that, and more, could have contributed to more crime and violence — but this, too, is still very speculative.

Another possibility: None of these explanations is right. With limited data in strange times, it wouldn’t be surprising if it turns out we have no idea what’s going on right now. “We can bet on it being unpredictable,” Doleac said.

Again, there’s still no consensus about what’s caused crime to decline since the 1990s. In that context, it’s no surprise there’s nowhere near a consensus as to why a homicide spike has occurred so far this year.

The trends could change after a strange 2020

It’s possible that before we understand why it’s happening, the year’s alarming homicide trends could recede. It’s happened before: In 2005 and 2006, the homicide rate briefly increased, only to start declining again before hitting record lows in 2014. In 2015 and 2016, the rates also spiked again only to start to dip after. In both instances, these years were effectively blips and the overall crime decline America has seen for the past three decades continued.

Maybe after this very weird year ends, crime and violence trends will, similarly, go back to the previous normal.

But that’s not a guarantee — and it’s not something we should rely on, experts said. “We don’t really understand why crime and violence went down,” John Roman, a criminal justice expert at NORC at the University of Chicago, previously told me. “Being able to say we should expect this unexplained phenomenon to continue strikes me as sort of irrational.”

Even if we can’t explain what may be causing a homicide spike, there are certain strategies that might help fight crime in the short term — such as deploying police in crime hot spots (though that would have to be done carefully and with reforms, given the current political climate around policing), a “focused deterrence” program that targets the few people in a community engaging in violence with a mix of support and sanctions, and using civilian “interrupters” to personally intervene in cases in which violence seems likely to break out.

Notably, a lot of this work is done at the local and state level, where the vast majority of police departments are based. The federal government can incentivize certain practices, like President-elect Joe Biden has proposed doing, but it ultimately falls on cities, counties, and states to carry out new or revised approaches.

Many of the evidence-based approaches rely on in-person contact, which requires ending the pandemic. “The police, public health, and community approaches to violence reduction require that people meet face-to-face; they cannot be replaced by Zoom,” Rosenfeld and Lopez wrote in one of their reports. “An underappreciated consequence of the pandemic is how social-distancing requirements have affected outreach to high-risk individuals.”

So the first priority should be to end the pandemic — ending its potential ripple effects on crime and enabling evidence-based approaches that can help reduce crime. But to do that, the US public and governments will need to truly embrace strategies that have worked for countries like South Korea and Germany against Covid-19: physical distancing, masking, and testing, tracing, and isolating the sick. In this sense, Trump’s failures to address Covid-19 may be leading to more violence.

“Seeing what’s happening with these [crime] numbers can point us to or at least get us thinking about what potential policy levers we could employ that would be helpful,” Doleac said. “Otherwise, our attention is probably better focused on making sure we’re all wearing masks.”

Beyond the pandemic, police are going to have more trouble fighting crime — including any current or future spikes — if large segments of the community don’t trust them. That’s where police reform comes into play. It’s a complicated topic, separate from a possible spike in violence this year. But, in short, experts say police should, at a minimum, show the communities they serve that they understand the concerns, acknowledge mistakes, and will change how officers are trained and deployed.

Otherwise, there’s a good chance that protests against police will flare up, just as they did from 2014 to 2016 and have again this year. If protests lead to more violence — whether by leading to depolicing, or sowing and exposing distrust in law enforcement — that’s going to create public safety problems.

To put it another way: There’s a lot we don’t know about crime, why it happens, and how to stop it. But it’s going to be much easier to wrap our heads around these issues once things get closer to how they should be — and that means seriously addressing the pandemic and protests against police brutality.

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Unfortunately, the US is going in the opposite direction, with a surge of Covid-19 this fall and winter and Trump exacerbating police-community tensions with his rhetoric and push to deploy unsolicited federal agents in some US cities.

“How optimistic should we be for the rest of the summer?” Roman said. “I think the answer is not terribly optimistic, because none of these factors seem to be abating with the return of Covid.”

The Centers for Disease Control and Prevention suggested on Wednesday that some people who have been exposed to Covid-19 can quarantine for less than two weeks.

The agency said a 14-day quarantine, in which people stay home and avoid interacting with others, is still the safest option if they come into close contact — within 6 feet for at least 15 minutes — with someone who has Covid-19. Anyone who actually contracts the disease should self-isolate until at least 10 days after symptoms begin, and not leave isolation until their fever is gone for at least 24 hours.

But the CDC updated its guidelines — which are recommendations, not legal requirements — to offer “alternatives.” People who’ve been in close contact with someone with Covid-19 should still quarantine. But that quarantine can end after 10 days without a coronavirus test. Or it can last seven days if someone obtains a negative test result, which they’re advised to get as early as day five of quarantine. People should watch out for symptoms for 14 days after quarantine.

Public health experts described the change as a harm reduction move: It’s not ideal for people to cut their quarantine time short. But if the change lets more people quarantine for some period of time, that could be better overall.

“The new guidelines are an example of a harm reduction approach, or one that takes into account the challenges individuals might face in reducing risks,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “My main concern, however, is about potential confusion, and the need for strong, clear messaging. CDC is still recommending 14-day quarantine — that should not be lost here.”

The CDC hinted at that, citing the possibilities of “economic hardship” and “stress on the public health system” due to 14-day quarantines.

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“CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus,” the agency said.

The incubation period for Covid-19 can be up to two weeks — perhaps even longer in rare cases — suggesting that people can’t say they’re fully in the clear until a 14-day quarantine is up.

But for most people, the incubation period is now believed to be “skewed toward the shorter end of that” 14-day window, Harvard epidemiologist William Hanage said. So most people likely can cut their quarantine time short without posing a risk to others.

The change comes at a particularly calamitous time. Cases in the US are continuing to rise, regularly breaking records. Hospitalizations surpassed 100,000 for the first time this week. The daily death toll is now regularly above 2,000 — levels of death not seen since the initial spring outbreaks.

And things are bound to get worse. Thanks to the virus’s incubation period, and the fact that most people are sick for potentially weeks before hospitalization or death, we still haven’t seen the effects of Thanksgiving gatherings last week. The US could have record-breaking levels of Covid-19 cases, hospitalizations, and deaths, right as people go on to gather for Christmas and New Year’s — further spreading the virus in sustained, intimate settings. Meanwhile, a vaccine is likely still months away for most Americans.

The CDC’s new quarantine guidance is an attempt to get Americans to do something, even as many of them resist taking the other steps the agency has called for. If it works, it could help combat just how bad things get in the next few weeks.

The shortened quarantine time is all about harm reduction

In public health, “harm reduction” means acknowledging that people are going to take risks, but still trying to make their behavior as safe as possible. People could eliminate their risk of sexually transmitted infections, for example, by never having sex at all — but given that people are going to have sex, public health officials try to encourage people to do it safely, by using condoms and having fewer partners.

As we’ve gotten more evidence on how the coronavirus spreads, and as the public has become fatigued with the pandemic and more resistant to tougher measures, health officials have increasingly taken a harm reduction approach to fighting Covid-19.

“While we might like to imagine we can instantaneously halt all transmission, in reality we are working to prevent as much as possible, which can sometimes involve trade-offs,” Hanage said.

While it’s better if people from different households don’t socialize — since any interaction carries a risk of transmission — officials have tried to push people toward safer interactions in outdoor environments where the virus can’t spread as easily. The same impulse drives the push to wear masks: Maybe people shouldn’t get their hair cut at all if they want to eliminate the risk of Covid-19, but if they’re going to, they can at least mitigate the risk of transmission with masks.

At a press conference announcing the new recommendations, CDC officials were clear that they would still prefer people quarantine for a full 14 days after exposure. But given the constraints people can face, including the need to work, and the more recent evidence that the incubation period may not be two weeks for most people, the CDC is now trying to offer some flexibility.

“We can safely reduce the length of quarantine, but accepting that there is a small residual risk that a person who is leaving quarantine early could transmit to someone else if they became infected,” John Brooks, chief medical officer for the CDC’s Covid-19 response, said.

It’s not perfect. With the CDC’s new guidance, some coronavirus infections will likely sneak through that could have been prevented by a 14-day quarantine. But if the guidance stops more infections overall by getting more people to quarantine, even for a less-than-perfect amount of time, that’s still a net benefit in reducing transmission.

This is, in other words, about striking a balance between the ideal steps to stop Covid-19 and people’s willingness to actually follow those steps.

There are still risks with a shortened quarantine

A big risk with the CDC’s guidance is there’s still a lot we don’t know about Covid-19. We’re still learning a lot of the basics about the coronavirus and the disease it causes, from how long incubation lasts to the wide range of symptoms to its long-term effects. It’s still not certain how much transmission is driven by people who never experience symptoms, and that could pose a challenge for the CDC’s guidance if it turns out a lot of people leave their quarantine early — at the new 10-day cutoff, for example — but are able to spread the virus, unknowingly, to others.

On the other hand, there are also studies showing that people may not be infectious for as long as previously thought. So it could turn out that the CDC’s new guidance is too lax, just like it could also be that the agency’s guidelines are still generally too strict.

Some experts were critical about the CDC’s guidance, calling for more clarity or tweaks to the recommendations. Saskia Popescu, an infectious disease epidemiologist, told me she’s concerned that the agency said people can get a test as early as day five of quarantine and use test results to stop quarantining after day seven. “I would’ve liked to see testing on day six or seven and then end of quarantine when the result comes back negative,” Popescu said.

Still, experts were overall receptive to the change, with Popescu noting that “it can help get more compliance for quarantine.” But, she cautioned, the CDC and other officials should be clear about the limitations and a continued need for other steps, like social distancing when possible and masking.

The big risk, for now, is the US is still in the middle of a massive Covid-19 outbreak — one of the worst in the world. In that environment, every single interaction outside of your home is a potential risk for transmission. There’s simply too much virus out there, making it easy for people to spread it.

Despite these circumstances, public health officials have also had to wrestle with the fact that people aren’t listening. For weeks, experts and officials were advising people not to travel for Thanksgiving. Then the country set records for pandemic-era airline travel last week.

The same now seems likely to happen again with Christmas and New Year’s, bringing new superspreading events as the country deals with record highs for cases, hospitalizations, and deaths.

Given that reality, the CDC is trying to meet people where they are: If individuals are going to do things officials prefer they don’t do, they can at least take some measures — even a reduced quarantine time period — to help slow spread as much as possible. It’s not perfect, but it’s where the country is at.

If someone told you in March, when the World Health Organization finally called the Covid-19 outbreak a pandemic, that we’d have three strong coronavirus vaccine candidates by mid-November, you might have called that person delusional.

Yet with Monday’s news from AstraZeneca and University of Oxford that early results from their phase 3 trial demonstrate their vaccine’s effectiveness, that’s exactly the scenario we’re in.

In a press release, the pharmaceutical giant and its Oxford co-developers reported interim findings from two groups in their ongoing trials — one in the UK and one in Brazil. The trials used different approaches to inoculating the people who participated, and found two levels of efficacy, which they averaged to 70 percent. The researchers also found no severe cases or hospitalizations in the study participants who got the vaccine.

In the UK trial group AztraZeneca reported on, the vaccine — known as AZD1222 — was given as a half dose, followed by a full dose around one month later, resulting in 90 percent efficacy. In the Brazil group, study participants were given two full doses at least one month apart, and the efficacy was 62 percent.

The researchers aren’t sure why there was this striking gap in vaccine performance — and in a press conference, said that the half dose may better prime the immune system to respond to the second full vaccine. But while the company framed the reason for the half dose was “serendipity” — in reality, the trial participants were given a smaller dose in error. And while it appears the accidental dosing regimen may have outperformed two full doses, independent researchers wondered about whether it was administered to enough people to know for sure. (More on that in a moment.)

Either way, 50 percent efficacy is the floor set by the US Food and Drug Administration and the European Medicines Agency (the FDA equivalent in Europe) for approval. The AstraZeneca-Oxford research team will “immediately” submit their findings to regulatory agencies around the world, seeking early approval.

While the efficacy outcome falls short of the 95 percent preliminary result recently reported by both Moderna and Pfizer/BioNTech, the results, if real, could be promising. At around $3 to $4 per dose, the AstraZeneca-Oxford shot is the cheapest of the three current options and should be easier to distribute globally (since it can be stored in regular refrigerators). That’s why lower-income countries around the world have been pre-purchasing access.

But, as with all the new coronavirus vaccine candidates, there are some big caveats to consider. And since the results came via press release and lacked detailed data, they raise questions we don’t yet have answers to. Here’s the rundown.

The Oxford-AstraZeneca vaccine could be a game changer for low- and middle-income countries

Among the Covid-19 vaccines furthest along in development, the AstraZeneca-Oxford candidate is among the most likely to be affordable to low- and middle-income countries. And considering much of the world’s population currently lives in low- and middle-income settings, it’s the jab that — with a 90 percent efficacy result — could make a big dent in the pandemic worldwide.

It also uses a novel approach to inoculation, one that’s different from Pfizer-BioNTech and Moderna — and from conventional vaccines.

Vaccine makers have typically used the virus itself or a fragment of the virus, often in a weakened or inactivated form, to inoculate recipients. But this new generation of vaccines uses genetic instructions for making parts of the SARS-CoV-2 virus that causes Covid-19. All three candidates — Pfizer, Moderna, and AstraZeneca-Oxford — deliver the instructions for making the SARS-CoV-2 spike protein, or the part of the virus that lets it enter human cells. And it’s these instructions, which human cells then use to manufacture parts of the virus, that are injected into vaccine recipients, essentially coaching the immune system to fight off the invader should it arrive.

The Moderna and Pfizer-BioNTech vaccines both use mRNA as their platform for delivering the genetic instructions. AstraZeneca-Oxford’s uses DNA instead, and the DNA is delivered to cells with the help of another virus known as an adenovirus. (Other Covid-19 vaccine developers, like CanSino Biologics and Johnson & Johnson, are also using adenovirus vectors.)

AstraZeneca, unlike Moderna and Pfizer/BioNTech, has promised to sell its shot at cost — around $3 to $4 — and not to profit from the vaccine while the pandemic is ongoing (though public money has gone into funding its research effort). According to the FT, that price is “a fraction” of the expense of the other vaccine candidates, which are expected to cost between $15 and $25 per dose.

Also unlike the two other leading vaccine candidates, it doesn’t require extremely cold temperatures for storage. That’s the distribution hurdle Moderna and Pfizer-BioNTech are working to overcome.

Moderna’s vaccine requires long-term storage at minus 20 degrees Celsius (minus 4 degrees Fahrenheit) and is stable for 30 days at refrigerator temperatures between 2 and 8 degrees Celsius (36 to 46 degrees Fahrenheit). Meanwhile, the Pfizer-BioNTech vaccine demands ultra-cold temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit) or lower, with about five days of shelf life at refrigerator temperatures. The AstraZeneca-Oxford vaccine can be stored in a normal refrigerator for at least six months.

So these are the reasons why the AstraZeneca-Oxford vaccine has become a leading contender lower-income countries are relying on to end their epidemics. For now, the shot “accounts for more than 40% of the supplies” going to low- and middle-income countries, according to Bloomberg. AstraZeneca said the company has the capacity to supply 3 billion doses of the vaccine in 2021.

“[T]he vaccine’s simple supply chain and our no-profit pledge and commitment to broad, equitable and timely access means it will be affordable and globally available supplying hundreds of millions of doses on approval,” said Pascal Soriot, CEO of AstraZeneca, in a statement.

The US is also poised to benefit. In May, the Biomedical Advanced Research and Development Authority (BARDA) under the Department of Health and Human Services pledged up to $1.2 billion to back the AstraZeneca-Oxford vaccine, aiming to secure 300 million doses for Americans.

Of course, if the shot only has around 70 percent efficacy, officials will have to grapple with how and where it’s used at all. “If it’s 70%, then we’ve got a dilemma,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Stat. “Because what are you going to do with the 70% when you’ve got two [vaccines] that are 95%? Who are you going to give a vaccine like that to?”

The caveats

That’s not the only caveat to consider. The AstraZeneca-Oxford results so far came via press release, and gloss over nuances we’d need to understand to know how the vaccine works in people. AstraZeneca-Oxford also released fewer details about their research than the other two companies, and reported their results in a way that made drawing comparisons among the three candidates difficult. Let’s go over what we know.

• Before clinical trials begin, research groups are supposed to publicly share a plan — called a protocol — for how they’ll run the studies and analyze and share the results, and they’re supposed to stick to it. That helps ensure experimenters don’t move the goalposts to come to more favorable conclusions.

But AztraZeneca and Oxford have only shared two of the protocols for their phase 3 studies after the trials began. We have the protocol for their US phase 3 study, and as writer and meta-scientist Hilda Bastian points out in Wired, a UK protocol published in a Lancet study appendix, also shared after the trial started.

“The appendix doesn’t say when this became the plan. We don’t even know if the Oxford-AstraZeneca team followed it,” Bastian writes. Again, in the press release, AstraZeneca also only disclosed data for subgroups in two of the trials, not the four specified in the UK protocol, she told Vox. “We do know [what’s in the protocol] is not what they reported.” “Transparency can increase confidence in the trials and are essential for establishing the quality of the science. [Six companies or research groups] have released protocols for their phase 3 studies — why not Oxford?” asked Peter Doshi, who has been a prominent critic of Covid-19 vaccine trials.

• The press release doesn’t report details of what side effects the study participants experienced. The company only reported there were no serious safety events confirmed to date, and that the vaccine “was well tolerated across both dosing regimens.” We do know that the UK trial for AZD1222 was paused in July and again in September after two volunteers reported neurological problems. Investigations later found no link between the vaccine and these symptoms, and regulators allowed the trial to resume in October.
• While we know the number of participants included in each in the UK and Brazil trials (2,741 in the UK versus 8,895 in Brazil), we don’t know how many got the vaccine (versus a placebo or meningococcal vaccine), which raised a statistical question about how many people were infected with the virus in the UK group that saw 90 percent efficacy. Some statisticians have suggested the number may be very small — and potentially unreliable:

• The press releases also lack details about the demographics of people participating in the trials. AstraZeneca said its trial participants come from “diverse racial and geographic groups who are healthy or have stable underlying medical conditions,” but without knowing the exact numbers, it’s hard to gauge how well they reflected the groups most at risk of severe disease (including older adults and people of color).
• The trials also didn’t use a simple placebo to measure efficacy. In the UK arm of the trial, volunteers were randomly assigned to receive the AZD1222 vaccine or the meningococcal vaccine. In the Brazil arm, the comparison group was given the meningococcal for the first dose and a saline placebo for the second dose.
• Another factor to consider: AstraZeneca-Oxford measured their results in a different way from their two major competitors. The Moderna and Pfizer/BioNTech trials only captured Covid-19 infections in their trial pool that advanced far enough to produce symptoms, while the AstraZeneca trials conducted weekly swab tests among their participants, allowing them to detect much less severe cases — including potential asymptomatic infections — among their volunteers. These differences make it trickier to draw apples-to-apples comparisons of the efficacy of the different vaccines.

Together, these factors highlight that there’s still a lot to learn about the new vaccines, even as they’re all set to roll out imminently. The Moderna, Pfizer-BioNTech, and Oxford-AstraZeneca teams have all vowed to publish their trial results in peer-reviewed journals. But distribution on a limited emergency use basis may begin as soon as next month, pending approval from regulators.

For now, it’s worth pausing over how remarkable it is that there are several SARS-CoV-2 vaccine candidates that have reported high levels of efficacy, featuring technologies that have never been deployed at a large scale in humans before.

If the AstraZeneca-Oxford, Moderna, and Pfizer-BioNTech groups pass regulators, the coronavirus vaccines may be the beginning of an entirely new approach to inoculating people against disease.

Clarification, December 4: An earlier version of this story stated that AstraZeneca/Oxford only shared the protocol for their US study. While that was the only phase 3 protocol registered on their clinical trials database, the researchers also shared the protocol for the UK trial in an appendix in a journal article.

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DeepMind, an AI research lab that was bought by Google and is now an independent part of Google’s parent company Alphabet, announced a major breakthrough this week that one evolutionary biologist called “a game changer.”

“This will change medicine,” the biologist, Andrei Lupas, told Nature. “It will change research. It will change bioengineering. It will change everything.”

The breakthrough: DeepMind says its AI system, AlphaFold, has solved the “protein folding problem” — a grand challenge of biology that has vexed scientists for 50 years.

Proteins are the basic machines that get work done in your cells. They start out as strings of amino acids (imagine the beads on a necklace) but they soon fold up into a unique three-dimensional shape (imagine scrunching up the beaded necklace in your hand).

That 3D shape is crucial because it determines how the protein works. If you’re a scientist developing a new drug, you want to know the protein’s shape because that will help you come up with a molecule that can bind to it, fitting into it to alter its behavior. The trouble is, predicting which shape a protein will take is incredibly hard.

Every two years, researchers who work on this problem try to prove how good their predictive powers are by submitting a prediction about the shapes that certain proteins will take. Their entries are judged at the Critical Assessment of Structure Prediction (CASP) conference, which is basically a fancy science contest for grown-ups.

By 2018, DeepMind’s AI was already outperforming everyone at CASP, provoking some melancholic feelings among the human researchers. DeepMind took home the win that year, but it still hadn’t solved the protein folding problem. Not even close.

This year, though, its AlphaFold system was able to predict — with impressive speed and accuracy — what shapes given strings of amino acids would fold up into. The AI is not perfect, but it’s pretty great: When it makes mistakes, it’s generally only off by the width of an atom. That’s comparable to the mistakes you get when you do physical experiments in a lab, except that those experiments are much slower and much more expensive.

“This is a big deal,” John Moult, who co-founded and oversees CASP, told Nature. “In some sense the problem is solved.”

Why this is a big deal for biology

The AlphaFold technology still needs to be refined, but assuming the researchers can pull that off, this breakthrough will likely speed up and improve our ability to develop new drugs.

Let’s start with the speed. To get a sense of how much AlphaFold can accelerate scientists’ work, consider the experience of Andrei Lupas, an evolutionary biologist at the Max Planck Institute in Germany. He spent a decade — a decade! — trying to figure out the shape of one protein. But no matter what he tried in the lab, the answer eluded him. Then he tried out AlphaFold and he had the answer in half an hour.

AlphaFold has implications for everything from Alzheimer’s disease to future pandemics. It can help us understand diseases, since many (like Alzheimer’s) are caused by misfolded proteins. It can help us find new treatments, and also help us quickly determine which existing drugs can be usefully applied to, for example, a new virus. When another pandemic comes along, it could be very helpful to have a system like AlphaFold in our back pocket.

“We could start screening every compound that is licensed for use in humans,” Lupas told the New York Times. “We could face the next pandemic with the drugs we already have.”

But for this to be possible, DeepMind would have to share its technology with scientists. The lab says it’s exploring ways to do that.

Why this is a big deal for artificial intelligence

Over the past few years, DeepMind has made a name for itself by playing games. It has built AI systems that crushed pro gamers at strategy games like StarCraft and Go. Much like the chess matches between IBM’s Deep Blue and Garry Kasparov, these matches mostly served to prove that DeepMind can make an AI that surpasses human abilities.

Now, DeepMind is proving that it has grown up. It has graduated from playing video games to addressing scientific problems with real-world significance — problems that can be life-or-death.

The protein folding problem was a perfect thing to tackle. DeepMind is a world leader in building neural networks, a type of artificial intelligence loosely inspired by the neurons in a human brain. The beauty of this type of AI is that it doesn’t require you to preprogram it with a lot of rules. Just feed a neural network enough examples of something, and it can learn to detect patterns in the data, then draw inferences based on that.

So, for example, you can present it with many thousands of strings of amino acids and show it what shape they folded into. Gradually, it detects patterns in the way given strings tend to shape up — patterns that human experts may not have detected. From there, it can make predictions about how other strings will fold.

This is exactly the sort of problem at which neural networks excel, and DeepMind recognized that, marrying the right type of AI to the right type of puzzle. (It also integrated some more complex knowledge — about physics and evolutionarily related amino acid sequences, for example — though the details remain scant as DeepMind is still preparing a peer-reviewed paper for publication.)

Other labs have already harnessed the power of neural networks to make breakthroughs in biology. At the beginning of this year, AI researchers trained a neural network by feeding it data on 2,335 molecules known to have antibacterial properties. Then they used it to predict which other molecules — out of 107 million possibilities — would also have these properties. In this way, they managed to identify brand-new types of antibiotics.

DeepMind researchers are capping the year with another achievement that shows just how much AI has matured. It’s genuinely great news for a generally terrible 2020.

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