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NINE GAA GAMES are live on TV this week as part of a hectic week of action.
Mayo and Tyrone face off next Saturday night.
Source: Laszlo Geczo/INPHO
On Saturday the inter-county action commences with the football league tie involving Tyrone against Mayo, a repeat of last year’s All-Ireland decider, and the hurling league clash of Down against Kerry.
There’s also a ladies football league semi-final double-header with Dublin taking on Donegal and Meath facing Mayo.
Then Sunday’s league games involving Kilkenny against Waterford in hurling, while a pair of football games take place with Armagh playing Kerry and Dublin meeting Donegal.
Dublin meet Donegal on Saturday.
Source: John McVitty/INPHO
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On Sunday, TG4 will trial a ‘picture in picture’ feature during their live coverage of Kilkenny v Waterford. These will show cutaways that feature the major moments from two key other Division 1 hurling matches, Limerick v Offaly and Laois v Dublin.
Before that Croke Park is the focus on Thursday for the All-Ireland senior colleges football and hurling finals, with the prestigious Hogan Cup and Croke Cup titles on offer. There are Kerry, Kildare, Limerick and Kilkenny sides all chasing glory in the deciders as St Brendan’s Killarney take on Naas CBS, before Ardscoil Rís play St Kieran’s Kilkenny.
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Here’s what’s in store:
Thursday
- 2pm: TG4 – St Brendan’s Killarney v Naas CBS – Hogan Cup final.
- 4pm: TG4 – St Kieran’s Kilkenny v Ardscoil Rís – Croke Cup final.
Saturday
- 1pm: TG4 – Dublin v Donegal – Division 1 ladies football league semi-final.
- 2pm: BBC Sport NI site – Down v Kerry – Division 2 hurling league.
- 3pm: TG4 – Meath v Mayo – Division 1 ladies football league semi-final.
- 5.45pm: RTÉ 2 – Tyrone v Mayo – Division 1 football league.
Sunday
- 1.45pm: TG4 – Kilkenny v Waterford – Division 1 hurling league.
- 2pm: TG4 app – Armagh v Kerry – Division 1 football league…(Deferred coverage on TG4 at 5.35pm)
- 3.45pm: TG4 – Dublin v Donegal – Division 1 football league.
– Originally published at 12:37
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Last year, as then-President Donald Trump railed against Covid-19 lockdowns and called on states to reopen their economies, he claimed the shutdowns would lead to a spike in suicides: “You’re going to lose more people by putting a country into a massive recession or depression. You’re going to lose people. You’re going to have suicides by the thousands.”
But new data suggests that the number of suicides actually decreased in the US last year. According to the National Center for Health Statistics, suicides totaled fewer than 45,000 in 2020, down from about 47,500 in 2019 and more than 48,000 in 2018.
So far, this seems to be true globally. England saw no increase in suicides in the aftermath of lockdowns, Louis Appleby, a researcher on suicide and self-harm at the University of Manchester, wrote for the medical journal BMJ. The same seems to be true in other nations, including Australia, Canada, New Zealand, Norway, Peru, and Sweden, based on data for the first few months of lockdowns around the globe.
“Our conclusions at this stage, however, should be cautious. These are early findings and may change,” Appleby wrote in BMJ. “Beneath the overall numbers there may be variations between demographic groups or geographical areas. After all, the impact of covid-19 itself has not been uniform across communities.”
Still, the news overall seems good.
Trump wasn’t alone in his concerns. For much of 2020, this was a popular argument among opponents of lockdowns — that the measures would lead to an increase in suicides. Various news articles have echoed the claim in some form, exemplified by the recent New York Times headline, “Suicide and Self-Harm: Bereaved Families Count the Costs of Lockdowns.”
It’s all wrapped up in an argument that lockdowns weren’t worth the costs. As Trump put it, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”
The reality is lockdowns worked to contain the spread of Covid-19, based on studies from Health Affairs, The Lancet, the Centers for Disease Control and Prevention, and others. And experts now widely agree that it was the US’s move to reopen too quickly, fueled in part by Trump’s claims, that made the country one of the worst in the world for Covid-19 deaths.
That’s not to say the lockdowns were costless. The emotional anguish brought by isolation and lack of social contact, as well as the economic calamity of the last year, are both clear examples of the downsides to lockdowns — even if the measures were ultimately worth it in the face of a deadly pandemic.
According to one CDC study, self-reported mental distress increased in the early months of the pandemic (though it’s not clear if lockdowns were the cause).
Another category of “deaths of despair” — drug overdoses — also appeared to increase dramatically last year: The latest data shows there were more than 88,000 overdose deaths in the year through August 2020, up from nearly 70,000 in the same time period of 2019. It’s plausible that lockdowns fueled overdoses as people turned to drugs during isolation or as addiction treatment and harm reduction services closed down, though it’s also possible that the increase was driven by something else, like the continued spread of the dangerous synthetic opioid fentanyl in illicit drug markets.
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There’s also genuine debate about how the lockdowns worked. Based on the more recent evidence, it seems like mass closings of schools were ultimately misguided — as children and schools ended up not being major vectors of the coronavirus’s spread. Meanwhile, the risky indoor spaces many states pushed to reopen quickly, like bars and restaurants, have proven to be significant sources of outbreaks. All of that suggests the US may have closed down the wrong places, while reopening the wrong places too.
At the very least, though, it seems lockdowns didn’t produce one of the bad effects people initially feared.
If you or anyone you know in the US is considering suicide or self-harm, or is anxious, depressed, upset, or needs to talk, you can call the National Suicide Prevention Hotline at 1-800-273-8255, or text CRISIS to 741741 for free, confidential crisis counseling. Outside the US, the International Association for Suicide Prevention maintains a list of crisis hotlines and their respective phone numbers around the world.
It’s an exciting time in particle physics. The results of a new experiment out of Fermilab in Illinois — involving a subatomic particle wobbling weirdly — could lead to new ways of understanding our universe.
To understand why physicists are so excited, consider the ambitious task they’ve set for themselves: decoding the fundamental building blocks of everything in the universe. For decades, they’ve been trying to do that by building a big, overarching theory known as the standard model.
The standard model is like a glossary, describing all the building blocks of the universe that we’ve found so far: subatomic particles like electrons, neutrinos, and quarks that make up everything around us, and three of the four fundamental forces (electromagnetic, weak, and strong) that hold things together.
But, as Jessica Esquivel, a particle physicist at Fermilab, tells Vox, scientists suspect this model is incomplete.
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“One of the big reasons why we know it’s incomplete is because of gravity. We know it exists because apples fall from trees and I’m not floating off my seat,” Esquivel says. But they haven’t yet found a fundamental particle that conveys gravity’s force, so it’s not in the standard model.
Esquivel says the model also doesn’t explain two of the biggest mysteries in the universe: dark matter, an elusive substance that holds galaxies together, and dark energy, an even more poorly understood force that is accelerating the universe’s expansion. And since the overwhelming majority of the universe might be made up of dark matter and dark energy, that’s a pretty big oversight.
The problem is, the standard model works really well on its own. It describes the matter and energy we’re most familiar with, and how it all works together, superbly. Yet, as physicists have tried to expand the model to account for gravity, dark matter, and dark energy, they’ve always come up short.
That’s why Esquivel and the many other particle physicists we’ve spoken to are so excited about the results of a new experiment at Fermilab. It involves muons — subatomic particles that are like electrons’ heavier, less stable cousins. This experiment might, finally, have confirmed a crack in the standard model for particle physicists to explore. It’s possible that crack could lead them to find new, fundamental building blocks of nature.
Esquivel worked on the experiment, so we asked her to walk us through it for the Unexplainable podcast. What follows is a transcript of that conversation, edited for clarity and length.
Noam Hassenfeld
What was this muon experiment?
Jessica Esquivel
So at Fermilab, we can create particle beams of muons — a very, very intense beam. You can imagine it like a laser beam of particles. And we shoot them into detectors. And then by taking a super, super close measurement of those muons, we can use that as kind of a probe into physics beyond our standard model.
Noam Hassenfeld
So how, exactly, does this muon experiment point to a hole in the model, or to a new particle to fill that gap?
Jessica Esquivel
So the muon g-2 experiment is actually taking a very precise measurement of this thing that we call the precession frequency. And what that means is that we shoot a whole bunch of muons into a very, very precise magnetic field and we watch them dance.
Noam Hassenfeld
They dance?
Jessica Esquivel
Yeah! When muons go into a magnetic field, they precess, or they spin like a spinning top.
One of the really weird quantum-y, sci-fi things that happens is that when you are in a vacuum or an empty space, it actually isn’t empty. It’s filled with this roiling, bubbling sea of virtual particles that just pop in and out of existence whenever they want, spontaneously. So when we shoot muons into this vacuum, there are not just muons going around our magnet. These virtual particles are popping in and out and changing how the muon wobbles.
Noam Hassenfeld
Wait, sorry … what exactly are these virtual particles popping in and out?
Jessica Esquivel
So, virtual particles, I … see them as like ghosts of actual particles. We have photons that kind of pop in and out and they’re just kind of like there, but not really there. I think a really good depiction of this, the weirdness of quantum mechanics, is Ant-Man. There’s this scene where he shrinks down to the quantum realm, and he gets stuck and everything is kind of like wibbly-wobbling and something’s there, but it’s really not there.
That’s kind of like what virtual particles are. It’s just hints of particles that we’re used to seeing. But they’re not actually there. They just pop in and out and mess with things.
Noam Hassenfeld
So quantum mechanics says that there are virtual particles, sort of like ghosts of particles we already know about in our standard model, popping in and out of existence. And they’re bumping into muons and making them wobble?
Jessica Esquivel
Yes. But again, theoretical physicists know this, and they’ve come up with a really good theory of how the muon will change with regards to which particles are popping in and out. So we know specifically how every single one of these particles interacts with each other and within the magnetic field, and they build their theories based on what we already know — what is in the standard model.
Noam Hassenfeld
Got it. So even though there are these virtual ghost particles popping in and out, as long as they’re versions of particles we know, then physicists can predict exactly how the muons are going to wobble. So were the predictions off?
Jessica Esquivel
So what we just unveiled is that precise measurement doesn’t align with the theoretical predictions of how the muons are supposed to wobble in a magnetic field. It wobbled differently.
Noam Hassenfeld
And the idea is that you have no idea what’s making it do that extra wobble, so it might be something that hasn’t been discovered yet? Something outside the standard model?
Jessica Esquivel
Yeah, exactly. It’s not considered new physics yet because we as physicists give ourselves a very high bar to reach before we say something is potentially new physics. And that’s 5 sigma [a measure of the probability that this finding wasn’t a statistical error or a random accident.] And right now, we’re at 4.2 sigma. But it’s pretty exciting.
Noam Hassenfeld
So if it clears that bar, would this break the standard model? Because I’ve seen that framing in a bunch of headlines.
Jessica Esquivel
No, I don’t think I would say the standard model is broken. I mean, we’ve known for a long time that it’s missing stuff. So it’s not that what’s there doesn’t work as it’s supposed to work.
It’s just that we’re adding more stuff to the standard model, potentially. Just like back in the day when scientists were adding more elements to the periodic table … even back then, they had spots where they knew an element should go, but they hadn’t been able to see it yet. That’s essentially where we’re at now. We know we have the standard model, but we’re missing things. So we have holes that we’re trying to fill.
Noam Hassenfeld
How exciting does all of this feel?
Jessica Esquivel
I think it’s like a career-defining moment. It’s a once-in-a-lifetime. We’re chasing new physics and we’re so close, we can taste it.
What I’m studying isn’t in any textbook that I’ve read or peeked through before, and the fact that the work that I’m doing could potentially be in textbooks in the future … that people can be learning about the dark matter particle that g-2 had a role in finding … it gives me chills just thinking about it!
Over the past few months, the Centers for Disease Control and Prevention (CDC) was criticized for playing it too cautiously with its Covid-19 guidance. The agency had recommended people wear masks outdoors, even kids in the outdoor heat of summer camp. It has overestimated the risk of outdoor spread and surface transmission. It was too slow to tell the fully vaccinated that they can go about their lives, living closer to normal.
So experts argued that the CDC was failing to seize on a moment of victory: Vaccines are triumphing over the virus. The US needs more people to get the shots — and needs to encourage them to do so with the promise of a light at the end of the tunnel.
But on Thursday, the CDC leaped ahead of the criticisms — announcing that it no longer recommends the vaccinated mask up, even in most indoor settings. The agency named a few specific exceptions for health care settings, public transportation, prisons, jails, and homeless shelters. And people should continue to follow local and state laws. But the overall message was unambiguous: Vaccinated Americans can start getting back to normal.
“The science is clear: If you are fully vaccinated, you are protected, and you can start doing the things that you stopped doing because of the pandemic,” the CDC said in a statement.
With the news, the CDC snapped out of its cautious ways, moving faster than widely expected, given that the majority of Americans still aren’t fully vaccinated. And it finally embraced the power of the Covid-19 vaccines.
For months, some experts have lamented that the vaccines were being undersold. Clinical trials and real-world evidence have found the shots are very effective, nearly eliminating the risk of severe disease, hospitalization, and death. Recent research, including from the CDC, also found that the shots seem to stop the vaccinated from transmitting the virus to others. And data from Israel, as well as early signs in the US, suggests that mass vaccination truly causes Covid-19 cases and deaths to plummet.
As vaccination rates in America began to plateau then fall, it seemed more urgent for the agency to signal that vaccines will let people return to normal by dangling a huge incentive — a normal post-pandemic life — in front of unvaccinated people. It’s that pressure, along with the mounting evidence of vaccines’ effectiveness, that seems to have led the CDC to change course.
A big question with the CDC’s new guidance is how it will be carried out in the real world. In public settings, are people simply supposed to trust that the maskless are vaccinated? Will businesses start asking for proof of vaccination before someone can shed the mask? Will there be any enforcement at all, or will the assumption be that the unvaccinated are left to fend for themselves? All of that remains to be seen.
Still, this is a big step for America toward a post-pandemic normal. As CDC director Rochelle Walensky told reporters on Thursday, “We have all longed for this moment — when we can get back to some sense of normalcy. Based on the continuing downward trajectory of cases, the scientific data on the performance of our vaccines, and our understanding of how the virus spreads, that moment has come for those who are fully vaccinated.”
Yes, the Covid-19 vaccines are that amazing
The CDC is acting on mounting evidence that the vaccines are truly effective, including against variants.
The initial clinical trials put the efficacy of the two-shot Moderna and Pfizer/BioNTech vaccines at 95-plus percent and the one-shot Johnson & Johnson vaccine at more than 70 percent. All three vaccines also drove the risk of hospitalization and death to nearly zero.
The real-world evidence backed this up, too. Data from Israel, which has the most advanced vaccination campaign in the world, found that the Pfizer/BioNTech vaccine was 90 percent effective at preventing Covid-19, with better rates for symptomatic disease, hospitalization, and death. Israel has seen this effectiveness firsthand: Since reopening in March, after most people in the country got at least one dose, daily new Covid-19 cases have fallen by more than 95 percent and daily deaths now number in the single digits or zero.
A hint of these results is visible in the US figures, too. As the country has vaccinated more people, daily new Covid-19 cases in America have dropped by nearly 50 percent since mid-April, with hospitalizations and deaths trending down as well. The remaining serious cases are also all among the unvaccinated, with the Cleveland Clinic estimating 99.75 percent of its Covid-19 patients between January and mid-April weren’t vaccinated.
One lingering concern is that the vaccines might be less effective against the coronavirus variants that have popped up across the world, some of which seem to be better at evading existing immunity. But the research has shown that the vaccines approved in the US are really effective against the variants, too, preventing the risk of serious illness and death.
There have been some breakthrough cases of Covid-19 among the vaccinated. But these tend to be milder infections, less likely to transmit, and far from common. “This is less than 0.01 percent of the vaccinated,” Akiko Iwasaki, an immunologist at Yale, previously told me, citing CDC data. “So extremely rare!”
There were also some concerns that a vaccinated person could spread the virus. But over the past few weeks, some studies have indicated that the vaccines also stop vaccinated people from spreading the virus. The CDC summarized one such real-world study for the Pfizer/BioNTech and Moderna vaccines, showing the vaccines stop not just symptoms but overall infections and, therefore, transmission:
Results showed that following the second dose of vaccine (the recommended number of doses), risk of infection was reduced by 90 percent two or more weeks after vaccination. Following a single dose of either vaccine, the participants’ risk of infection with SARS-CoV-2 was reduced by 80 percent two or more weeks after vaccination.
Some experts have recently cited this growing evidence to embrace old freedoms after getting vaccinated.
“I am fully vaccinated and have resumed normal activities,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, previously told me. “I have gone indoor dining, went to my first movie theater, and would go to a bar if there was an opportunity!”
The CDC is now adopting this attitude. On top of its change to its mask guidance, the agency said it will review its other recommendations to make sure they line up with the current understanding of the evidence. Overall, it’s signaling the vaccinated should be confident they are safe.
“The science demonstrates that if you are fully vaccinated, you are protected,” Walensky said. “It is the people who are not fully vaccinated in those settings who are not protected.”
US policy now focuses on getting more people vaccinated
With the news, America has entered a new phase in its Covid-19 response, in which it’s all-in on the vaccines.
It’s a reflection of the current reality: Now that the vaccines are widely available and more than half of US adults have gotten at least one dose, it’s less tenable to continue asking the vaccinated to make huge sacrifices. At the same time, the unvaccinated remain at risk of a deadly virus, and policymakers should do everything they can to make sure as many people as possible get the shot.
Much of the country had already moved to reopen, with 14 states already doing away with mask mandates entirely. The CDC’s guidance will likely nudge states further, perhaps causing them to, at the very least, find ways to let the vaccinated evade mask mandates.
Meanwhile, President Biden’s administration has emphasized that it’s now focused on vaccinating as many people as possible, adopting strategies to boost access, encourage the skeptical to get the shot, and reward those who do get inoculated. The administration has set a goal of vaccinating 70 percent of adults by July 4 — with the promise that at that point, much of the country can truly return to normal.
Ohio is a recent example of this kind of shift. This week, Gov. Mike DeWine (R) announced the state will rescind Covid-related health orders, including its mask mandate, in June. At the same time, he unveiled a lottery in which five vaccinated people will have a chance to win $1 million each.
The CDC’s announcement offers yet another incentive, with the promise that if you are vaccinated, in most cases you no longer have to worry about the risk to your health and can shed the mask.
This is what a return to normal looks like. By embracing the vaccines, America is now able to slowly but surely put Covid-19 — and all the changes it forced on our lives — behind us.
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The future of America’s Covid-19 epidemic can now be distilled into this: long-term confidence and hope, but short-term uncertainty and, perhaps, even despair.
Vaccines are rolling out quickly, setting up the country to crush the outbreaks that have warped our lives for the past year.
But in the short term, perhaps the next month, the US faces a few potential paths. The worst scenario: A fourth surge of the coronavirus outpaces vaccinations and kills thousands more people even as the country nears the finish line with Covid-19. The best possibility: The accelerating vaccine rollout and continued vigilance keep the virus at its current level or, hopefully, results in fewer infections — letting the US cross the finish line safely and with more lives saved. Then there’s a middle path: Cases rise, but vaccines shield the country from more hospitalizations and deaths.
The path the US takes, though, will be decided by one of the most unpredictable things of all: human behavior.
The public could loosen up on Covid-19 precautions too quickly, discarding masks and failing to social distance before enough people are vaccinated. As has already been done in some areas, policymakers could push the country in this direction by ending restrictions before the vaccine rollout is truly at critical mass. Either of those things, or a combination of both, could lead to a fourth surge.
But if Americans hold out just a bit longer, and vaccination rates continue to pick up, the US could reach the end of the current large outbreaks — as cases dwindle down close to zero — before that happens.
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The good news is, an end seems to be in sight. At current vaccination rates, the country could inoculate its entire adult population by July, leaving us ample time over the summer to start getting our lives back to normal and, hopefully, celebrate with others. One country that has vaccinated the bulk of its population, Israel, has shown this is possible, reopening its economy and crushing the Covid-19 curve at the same time.
“Yes, there are some near-term concerns,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “But so far we’re — cautiously — on the other side of it. … If we push ahead and really accelerate vaccination, by the summer we’ll be in a much, much better place.”
The question now is what lies between here and there.
The worst short-term scenario: Cases, hospitalizations, and deaths rise in a fourth surge
This is the worst-case scenario — the one that CDC Director Rochelle Walensky said fills her with a feeling of “impending doom.”
Here’s how it could play out: In the next few weeks, states continue to loosen the restrictions they put in place to combat Covid-19, opening up businesses (particularly indoor locations) and revoking their mask mandates. The public follows suit, embracing the near-end of Covid-19 by going out and engaging in close-contact activities with family, friends, and strangers, even if they’re not yet fully vaccinated. The vaccine campaign can’t keep up with all of this new social activity, and more people catch the virus than are inoculated.
So the coronavirus spreads, jumping between all these vulnerable people mingling together again, while more-infectious coronavirus variants spread rapidly at the same time, pushing the wave even higher. (B.1.1.7, the variant that appears to have originated in the UK, is now the dominant cause of new infections in the US, Walensky said Wednesday.)
That said, it doesn’t seem like the US overall is heading toward the worst-case scenario, at least not yet. A recent uptick in Covid-19 cases might have hit a plateau. The US still has a lot of daily new Covid-19 cases — nearly 500 times that of Australia after controlling for population — but it may not be getting worse.
The concern is that could all change — and quickly — due to exponential spread, which causes infections to pick up at an accelerating pace. During the US’s third surge in the fall, it took roughly a month for daily new cases to double from about 40,000 to 80,000. But it took only around two weeks for daily new cases to double once again, from 80,000 to 160,000.
This might already be happening in Michigan, which has been hit hard by Covid-19 in the past few weeks. The state’s current surge isn’t quite as bad yet as its previous one, but it’s still leading to more hospitalizations and deaths. If it’s already happening there, it could happen elsewhere.
The middle short-term path: Covid-19 cases rise, but not hospitalizations and deaths
Throughout the pandemic, Covid-19 deniers have claimed rises in cases were only a “casedemic,” meaning that cases rose but hospitalizations and deaths didn’t, and therefore there was nothing to worry about.
That was nonsense for much of the past year, fueled by a crucial misunderstanding: Increases in hospitalizations and deaths tend to lag behind increases in cases because it takes time for people to get sick, land at the hospital, and die after getting infected.
But something like this could happen now, thanks to the vaccines. So far, the populations more vulnerable to Covid-19, based on age, have gotten more of the vaccine. The result is that more than 76 percent of adults 65 and older have gotten at least one dose, and more than 57 percent have been fully vaccinated (either by the one-shot Johnson & Johnson vaccine or a two-shot vaccine from Moderna or Pfizer). Over the past year, this age group represented around 80 percent of all Covid-19 deaths in the US.
With much of the vulnerable vaccinated, a rise in Covid-19 cases may not translate to a significant rise in hospitalizations and deaths. Younger people may contract the virus, but they won’t show up at the hospital or die at the same rates as older individuals. The virus would lose the race to the vaccines.
So the US may still see a fourth surge in cases. But, as Amesh Adalja at the Johns Hopkins Center for Health Security told me, “It’s going to be of a different flavor than prior waves” because the vaccines “have defanged the virus,” including the variants that have been discovered so far.
This is still speculative.
“I think it’s a bit too early to tell,” George Mason University epidemiologist Saskia Popescu said about that scenario. Reducing a fourth surge to a “casedemic” still requires action — ensuring vaccines continue to go out quickly, especially to vulnerable populations.
The best short-term scenario: No fourth surge at all
This scenario — where cases, hospitalizations, and deaths all hold steady or continue to fall — is contingent on policymakers not reopening their states too quickly, the American people continuing to follow public health guidelines such as social distancing and masking, and the vaccine rollout improving, or at the very least, maintaining its current pace.
It could also be helped along by warmer weather in most of the country in the coming weeks, pushing Americans to do more in outdoor spaces where the virus doesn’t spread as easily.
History might not give much reason for optimism. America has generally done a bad job with its policy approach and public adherence throughout the pandemic (hence America’s high death toll relative to many of its developed peers). As Popescu put it, “The US has really struggled when it comes to maintaining vigilance when the finish line is in sight.”
But the country could do it. If Americans hold out a little while longer — possibly just several weeks — we could suddenly find ourselves in a world where most US adults have gotten at least one shot of the vaccine. If we get there and avoid the first scenario on this list, it could translate to tens of thousands more of us being around to celebrate.
The longer-term scenario is more certain — and hopeful
For all the uncertainty surrounding the short term, there’s a longer-term scenario that seems very likely: Thanks to the vaccines, the US will reach the end of the large outbreaks, and the summer will be the beginning of our return to normal.
There’s a real-world example that should fill Americans with hope: Israel. Thanks to good planning and flexibility, Israel has fully vaccinated more than 56 percent of its population, including the vast majority of older demographics. That’s allowed it to almost fully open its economy again as Covid-19 cases plummet to levels not seen since summer 2020.
This is incredibly encouraging. It shows that the vaccines work and are truly a way out of the pandemic. “It’s there,” Adalja said. “The real-world data shows what future we’ll eventually achieve if everything stays on track and we continue to vaccinate.”
The US is well on its way to that point. Already, more than 19 percent of the US population is fully vaccinated. With more than 3 million doses being administered a day, the country will be able to fully inoculate the majority of its population in a little more than a month — and all adults within three months. If that trend continues, the US could reproduce Israel’s crushed curve in just months or even weeks.
Then it will finally happen. We’ll find ourselves back at parties with family, at dinners with friends, and in movie theaters with strangers. What was considered too risky just months ago will be the normal we’ve desired for a year.
“I reckon that point will become apparent in retrospect,” Bill Hanage, an epidemiologist at Harvard, previously told me. “We will suddenly realize that we are laughing, indoors, with people we don’t know and whose vaccine status is unknown, and we will think, ‘Wow, this would have been unimaginable back when …’”
There are still major challenges ahead. Avoiding the deadliest of the short-term scenarios could save tens of thousands of lives. Ensuring enough people get vaccinated — by both improving access and addressing vaccine hesitancy — will be crucial. And it’s a race against time: The possibility that worse variants will emerge increases as the virus continues to spread and mutate.
It’s important to help the rest of the world in its efforts too — not simply for humanitarian reasons, but because the coronavirus and its variants could creep back into the US from other countries.
Still, the happier future now looks like a matter of when, not if. After a year of our futures constantly seeming so uncertain, we now have this respite to look forward to — and it’s likely just a matter of time.
In the coming months, America could reach a point when it has more Covid-19 vaccines than people want.
Between efforts from the federal government and drug companies to step up manufacturing and distribution, the US’s vaccine supply is truly increasing: At least 150 million doses are expected through March — a rate of more than 3 million shots a day, the kind of speed the country needs to reach herd immunity, when enough people are protected against the virus to stop its spread, this summer.
But public health experts are increasingly warning of what may come as America inches closer to the finish line in its vaccine campaign: After the majority of people who want a vaccine get one, there’s a large minority of people who have voiced skepticism in public surveys. And if these people don’t change their minds in the coming months, they could doom any chance the US has of reaching herd immunity.
“There’s going to be a point … where there’s going to be vaccine available, and getting people to take it will be the primary issue,” Emily Brunson, a medical anthropologist at Texas State University, told me.
To reach herd immunity, experts generally estimate that we’ll need to vaccinate at least 70 to 80 percent of the population — though it could be more or less, because we don’t really know for sure with a new virus. Yet according to a recent AP-NORC survey, 32 percent of Americans say they definitely or probably won’t get a Covid-19 vaccine. If that holds and the herd immunity estimates are correct, it would make herd immunity impossible.
Public health experts say there are ways to make people more willing to get vaccinated, but such efforts have to be flexible to match the different concerns about a vaccine different communities and individuals may hold. What might sway skeptical white Republicans who don’t see Covid-19 as a threat won’t necessarily work for Black communities that are distrustful of a medical establishment that has long neglected and even abused them.
Whatever anti-hesitancy campaigns take shape, though, must happen quickly. With every day the coronavirus continues to spread across America, the country sets itself up for hundreds if not thousands more deaths a day — not to mention the constant need for social distancing, a weakened economy, and potentially harsher restrictions on daily life. Each day of uncontrolled spread also brings the risk of new, more dangerous coronavirus variants, as each replication of the virus carries the risk of a mutation that catches on more widely.
Now, the days when hesitancy becomes the top vaccine problem may still be up to months away. But if the pandemic should have taught us anything, it’s that it’s better to be proactive than reactive. It’s not too late to get ahead of this problem before it becomes the next major bottleneck in America’s efforts to end its outbreak.
The US’s vaccine supply problem is getting better
The past few weeks have brought a lot of genuinely good news on the vaccine front.
The number of shots delivered has increased dramatically, from less than 1 million a day in mid-January to around 1.7 million in mid-February. (Though recent snowstorms likely slowed that down.) As bad as America’s initial rollout was, the US is still ahead of all countries except Israel, Seychelles, the United Arab Emirates, and the United Kingdom in vaccination rates — and it’s improving quickly enough, so far, to sustain that lead.
There have also recently been fewer mishaps at the state level. There were some alarming reports during the first few weeks of the rollout — machines breaking down, staffing issues, doses going unused. These problems still pop up (the US is big, and someone is always causing trouble here), but they seem to be happening less frequently as states and localities get the hang of the process. To this end, states are using much more of their vaccines: While it was rare for a state to report administering more than 60 percent of vaccine doses in January, it’s now pretty common for them to report using more than 80 or 90 percent.
Meanwhile, President Joe Biden’s administration has made some strides to improve both the supply of vaccines sent to states and communication with states on what supplies they can expect. The latter is particularly important because it lets states plan for the doses they’re getting — something they weren’t often able to do in the early stages of the vaccine rollout, as they would find out how many vaccines they were getting as late as the day they got the doses. That might help explain why states have been doing better.
There are still plenty of problems. The current rate of 1.7 million shots a day is still too slow; experts would like the country to get to 2 million or 3 million to get through the bulk of vaccine efforts this summer. While the country seems to be on track to get enough doses to do that next month, the question then becomes whether it has the distribution capacity to actually turn those doses into shots in arms — and the logistical challenges there will be immense.
Still, a world where there are enough vaccines to go around is rapidly approaching. Biden said vaccines will be available to all Americans by the end of July, while Anthony Fauci, the top federal infectious disease expert, took a slightly more optimistic outlook in saying it would be “open season” in late May or early June.
At that point, vaccine hesitancy may make supply less of a problem than demand.
America has a hesitancy problem
The views of one-third of Americans may not always amount to a national crisis, but those views matter a lot when the country needs to do something that requires nearly everybody on board. That’s the case with the Covid-19 vaccination campaign, where 70 or 80 percent — or more — of the country will need to get vaccinated to reach herd immunity. So surveys that show as many as one-third of Americans are skeptical amount to a real public health crisis.
Compounding that is the reality that a Covid-19 vaccine still hasn’t been approved for children — and that might not happen until later this summer or even 2022. Given that kids make up 22 percent of the population, herd immunity probably can’t happen without them. But even if herd immunity only requires the lower estimate of 70 percent of Americans, that still will be impossible if more than 30 percent of adults refuse a vaccine.
Based on public surveys, particularly in-depth ones from the Kaiser Family Foundation, the skeptical report a variety of concerns regarding the Covid-19 vaccine.
A major one is concerns about side effects, particularly long-term health consequences. The Covid-19 vaccines do have side effects, but they’re almost entirely minor — temporary aches, fever, and cold-like symptoms — aside from rare allergic reactions, which require monitoring but are treatable. Still, people worry about the risks.
Some of the skeptics worry that the vaccine approval process, given its record speed, was rushed. But the Covid-19 vaccines still went through the three-phase clinical trial process required by the Food and Drug Administration, testing for safety and efficacy. The vaccines have also been out in the real world for months now, with still no reports of previously unknown and serious effects.
Some people of color also distrust the health care system, based on their experiences with a system that’s often discriminatory and a history of experimentation on Black bodies, such as the Tuskegee study. Surveys show that Latinos and Black people, in particular, are less likely to trust doctors and hospitals in general. That’s likely fed into distrust toward the vaccine, too.
A segment of the population, particularly on the right of the political spectrum, is also skeptical they even need a Covid-19 vaccine. Encouraged by people like former President Donald Trump, they tend to believe the threat of the coronavirus has long been overplayed in the media. Given other potential concerns, for instance about side effects and a rushed process, they question whether they should get a vaccine, believing that Covid-19 isn’t really a threat to them. The reality is it’s a threat to everyone — killing more people under 55 alone than all murders in a typical year — but the perception remains.
Then there are the concerns that fall more in the conspiracy theory camp, whether about certain wealthy people’s involvement in the vaccine process or more traditional (and debunked) anti-vaxxer concerns. But those tend to make up a very small minority of the US public and even Covid-19 vaccine skeptics.
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There’s no one-size-fits-all solution
As the list above demonstrates, concerns about vaccines tend to vary and can differ significantly from community to community. Some concerns may not even show up in national surveys at all — they might be too localized to ever appear. This is a critical fact of public health, but it especially applies here: Local problems require local solutions, meaning messaging to combat vaccine hesitancy will have to be tailored differently from community to community.
“There will be similarities, and I think there will be some overlapping issues,” Brunson said. “But there will be local iterations of this that can vary quite widely.”
That doesn’t mean states or federal governments have no role to play. To the contrary, a big federal campaign about the basic facts, particularly the benefits, of the vaccines could be really helpful — and, in fact, experts have repeatedly told me such a campaign should have started months ago. Federal and state governments can also provide support, with money, personnel, guidance, and expertise, that local governments will need to execute on their plans.
The underlying theme of these campaigns, experts say, should be to meet people where they are. That begins with really hearing the community’s concerns, then transparently and honestly walking through why the vaccines’ benefits still dramatically outweigh any downsides. Doing that could require, at some points, acknowledging that people have a point — for example, the US health care system really does have a history of racism — but making the case that the evidence for vaccines is still strong and they’re still worth taking.
The messaging will have to be tested, and what works best will, again, likely differ from place to place and person to person. But experts pointed to several ideas: Campaigns can point to the evidence that the vaccines are very effective, particularly that they, based on the clinical trials, drive Covid-19 deaths down to zero and hospitalizations to almost zero. They can highlight the importance of everyone getting vaccinated to reach herd immunity and, subsequently, protect not just yourself but your friends, family, and community. They can tap into trusted or beloved sources, including doctors but also potentially celebrities.
A more controversial idea is to tell people about the personal benefits of the vaccines. Some of the public health messaging in the US has actually obscured this — telling people that even if they get a vaccine, they won’t be able to go back to their normal, pre-coronavirus lives right away.
Still, some experts argue that the restrained messaging can drive people to ask, “Why bother?” Masking and social distancing should be encouraged until America reaches herd immunity or close to it because we don’t yet know how effective vaccines are in driving down transmission. But people should be trusted with factual information about how vaccines will make certain activities less risky for them and others who get inoculated — and maybe they could safely enjoy some of those activities with their vaccinated friends and family once again.
“People undersell the vaccine,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “They don’t understand that if you tell people nothing changes when they get a vaccine — which I don’t think is true — then they’re not going to have an incentive to get the vaccine.”
Whatever form a pro-vaccine effort takes, experts are in agreement — and they have been for a long time — that some kind of big anti-hesitancy campaign needs to get going soon. Really, it should have started yesterday or last year. But there’s still time to act before the country gets to the point where supply is outstripping demand.
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This winter is brutal. The cold weather has made it hard to socialize outdoors, coronavirus variants are spreading, and the US is about to surpass half a million Covid-19 deaths. Many of us are feeling anxious about how we’re going to make it through the lonely, bleak weeks ahead.
I see a lot of people trying to cope with this anxiety by drumming up one-off solutions. Buy a fire pit! Better yet, buy a whole house! Those may be perfectly fine ideas, as far as they go — but I’d like to suggest a more effective way to think about reducing your suffering and increasing your happiness this winter.
Instead of thinking about the myriad negative feelings you want to avoid and the myriad things you can buy or do in service of that, think about a single organizing principle that is highly effective at generating positive feelings across the board: Shift your focus outward.
“Studies show that anything we can do to direct our attention off of ourselves and onto other people or other things is usually productive and makes us happier,” said Sonja Lyubomirsky, a psychology professor at the University of California Riverside and author of The How of Happiness: A Scientific Approach to Getting the Life You Want. “A lot of life’s problems are caused by too much self-focus and self-absorption, and we often focus too much on the negatives about ourselves.”
Rather than fixating on our inner worlds and woes, we can strive to promote what some psychologists call “small self.” Virginia Sturm, who directs the Clinical Affective Neuroscience lab at the University of California San Francisco, defines this as “a healthy sense of proportion between your own self and the bigger picture of the world around you.”
This easy-to-remember principle is like an emotional Swiss Army knife: Open it up and you’ll find a bunch of different practices that research shows can cut through mental distress. They’re useful anytime, and might be especially helpful during this difficult winter (though they’re certainly no panacea for broader problems like mass unemployment or a failed national pandemic response).
The practices involve cultivating different states — social connectedness, a clear purpose, inspiration — but all have one thing in common: They get you to focus on something outside yourself.
A sense of social connectedness
Some of the practices are about cultivating a sense of social connectedness. Decades of psychology research have taught us that this is a key to happiness.
In fact, Lyubomirsky said, “I think it is the key to happiness.”
That’s what Harvard’s Study of Adult Development discovered by following the lives of hundreds of people over 80 years, from the time they were teenagers all the way into their 90s. The massive longitudinal study revealed that the people who ended up happiest were the ones who really leaned into good relationships with family, friends, and community. Close relationships were better predictors of long and pleasant lives than money, IQ, or fame.
Psychiatrist George Vaillant, who led the study from 1972 to 2004, summed it up like so: “The key to healthy aging is relationships, relationships, relationships.”
Other studies have found evidence that social connections boost not only our mental health but also our physical health, helping to combat everything from memory loss to fatal heart attacks.
During our pandemic winter, you can socialize in person by, yes, gathering around a fire pit or maybe doubling your bubble. But there are other ways to make you feel you’re connected to others in a wider web. A great option is to perform an act of kindness — like donating to charity, or volunteering to read to a child or an older person online.
“I do a lot of research on kindness, and it turns out people who help others end up feeling more connected and become happier,” Lyubomirsky told me.
Lyubomirsky’s research shows that committing any type of kind act can make you happier, though you should choose something that fits your personality (for example, if you don’t like kids, then reading to them might not be for you). You may also want to vary what you do, because once you get used to doing something, you start taking it for granted and don’t get as much of a boost from it. By contrast, people who vary their kind acts show an increase in happiness immediately afterward and up to one month later. So you might call to check up on a lonely friend one day, deliver groceries to an older neighbor the next day, and make a donation the day after that.
A sense of purpose
Other practices are about cultivating a sense of purpose. Psychologists have found that having a clear purpose is one of the most effective ways to cope with isolation.
Steve Cole, a researcher at the University of California Los Angeles, studies interventions designed to help people cope with loneliness. He’s found that the ones that work tend to focus not on decreasing loneliness, but on increasing people’s sense of purpose. Recalling one pilot program that paired isolated older people with elementary school kids whom they’re asked to tutor and look out for, Cole told Vox, “Secretly, this is an intervention for the older people.”
Philosophers have long noted the fortifying effects of a clear sense of purpose. “Nietzsche said if you find purpose in your suffering, you can tolerate all the pain that comes with it,” Jack Fong, a sociologist who researches solitude at California State Polytechnic University, Pomona, told me. “It’s when people don’t see a purpose in their suffering that they freak out.”
Experienced solitaries confirm this. Billy Barr, who’s been living alone in an abandoned mining shack high up in the Rocky Mountains for almost 50 years, says we should all keep track of something. In his case, it’s the environment. How high is the snow today? What animals appeared this month? For decades, he’s been tracking the answers to these questions, and his records have actually influenced climate change science.
Now, he suggests that people get through the pandemic by participating in a citizen science project such as CoCoRaHS, which tracks rainfall.
“I would definitely recommend people doing that,” he told WAMU. “You get a little rain gauge, put it outside, and you’re part of a network where there’s thousands of other people doing the same thing as you, the same time of the day as you’re doing it.” (Notice, again, that this is really about sensing you’re part of the larger world around you.)
Other citizen science projects are looking for laypeople to classify wild animals caught on camera or predict the spread of Covid-19.
If citizen science isn’t your jam, find something else that gives you a sense of purpose, whether it’s writing that novel you’ve been kicking around for years, signing up to volunteer with a mutual aid group, or whatever else.
A sense of inspiration
Finally, some practices are about cultivating a sense of inspiration — which can take the form of gratitude, curiosity, or awe.
Regularly feeling gratitude helps protect us from stress and depression.
“When you feel grateful, your mind turns its attention to what is perhaps the greatest source of resilience for most humans: other humans,” David DeSteno, a psychology professor at Northeastern University and the author of Emotional Success, told me. “By reminding you that you’re not alone — that others have contributed to your well-being — it reduces stress.”
So one thing you can do this winter is try gratitude journaling. This simple practice — jotting down things you’re grateful for once or twice a week — has gained popularity over the past few years. But studies show there are more and less effective ways to do it. Researchers say it’s better to write in detail about one particular thing, really savoring it, than to dash off a superficial list of things. They recommend that you try to focus on people you’re grateful to, because that’s more impactful than focusing on things, and that you focus on events that surprised you, because they generally elicit stronger feelings of thankfulness.
Another practice is to write a letter of gratitude to someone. Research shows it significantly increases your levels of gratitude, even if you never actually send the letter. And the effects on the brain can last for months. In one study, subjects who participated in gratitude letter writing expressed more thankfulness and showed more activity in their pregenual anterior cingulate cortex — an area involved in predicting the outcomes of our actions — three months later.
Feeling a sense of curiosity or awe about the world around you is likewise shown to boost emotional well-being.
“Awe makes us feel like our problems are very trivial in the big scheme of things,” Lyubomirsky said. “The idea that you are this tiny speck in the universe gives you this bigger-picture perspective, which is really helpful when you’re too self-focused over your problems.”
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For example, a study recently published in the journal Emotion investigated the effects of “awe walks.” Over a period of eight weeks, 60 participants took weekly 15-minute walks outdoors. Those who were encouraged to seek out moments of awe during their walks ended up showing more of the “small self” mindset, greater increases in daily positive emotions, and greater decreases in daily distress over time, compared to a control group who walked without being primed to seek out awe.
“What we show here is that a very simple intervention — essentially a reminder to occasionally shift our energy and attention outward instead of inward — can lead to significant improvements in emotional wellbeing,” said Sturm, the lead author.
So, bottom line: When the world between your two ears is as bleak as the howling winter outside, shifting your attention outward can be powerfully beneficial for your mental health. And hey, even in the dead of winter, a 15-minute awe walk outdoors is probably something you can do.
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We’ve reached half a million deaths from the coronavirus in the US. But most of these deaths — and the grueling medical ordeals leading up to them — have remained largely hidden from view. The majority of terminally ill Covid-19 patients typically spend their last days or weeks isolated in ICUs to keep the virus from spreading.
“Most of what I’m seeing is behind closed curtains, and the general public isn’t seeing this side of it,” says Todd Rice, a critical care and pulmonology specialist at Vanderbilt University Medical Center. Even “families are only seeing a little bit of it,” he says. As a result, most of us have been “protected and sheltered from seeing the worst of this disease.”
So what have these 500,000 people endured as the infection took over and their bodies failed? The terrible details have been strikingly absent from most of our personal and national discussions about the virus. But if we have been thus far (perhaps somewhat willfully) blind to the excruciating ways Covid-19 takes lives, this milestone is an opportunity to open our eyes.
Four physicians, who collectively have cared for more than 100 dying Covid-19 patients over the past 11 months, shared with Vox what their patients have gone through physically and mentally as the virus killed them. Their experiences reveal the isolating and invasive realities of what it is typically like for someone to die from Covid-19.
Lungs “full of bees” and a “sense of impending doom”
The torture of Covid-19 can begin long before someone is sick enough to be admitted to a hospital intensive care unit.
Since the coronavirus attacks the lungs, it hampers the intake of oxygen. People with worsening Covid-19 typically show up in the emergency room because they are having trouble breathing.
As their lungs deteriorate further, they have a harder and harder time getting enough oxygen with each breath, meaning they need to breathe faster and faster — up from an average of about 14 times per minute to 30 or 40. Such gasping can bring about a very real sense of panic.
Imagine trying to breathe through a very narrow straw, says Jess Mandel, chief of pulmonary, critical care, and sleep medicine at UC San Diego Health. “You can do that for 15 to 20 seconds, but try doing it for two hours.” Or for days or weeks.
Patients struggling through low oxygen levels like this have told Kenneth Remy, an assistant professor of critical care medicine at Washington University School of Medicine in St. Louis, that it feels like a band across their chest or that their lungs are on fire. Or like a thousand bees stinging them inside their chest. Others might have thick secretions in their lungs that make it feel like they are trying to breathe through muck. Many people say it feels like they’re being smothered.
The ordeal is so taxing that many wish for death. “You hear the patients say, ‘I just want to die because this is so excruciating,’” Remy says. “That’s what this virus does.”
Others feel that death is coming no matter what they do. Rice notes that is much more so for his Covid-19 patients than others he has treated. There seems to be something about Covid-19, he says, “that makes people prone to having a feeling of, ‘I really believe I’m going to die.’”
Meilinh Thi, who specializes in critical care and pulmonology at the University of Nebraska Medical Center, has witnessed the same thing. “A lot of patients, regardless of age, have this sense of impending doom,” Thi says. Many have told her outright they felt like they were going to die. Eerily, “Everyone who has told me that has passed away,” she says.
Isolated
The agony of being critically ill with Covid-19 isn’t just borne by the body but also by the mind. “It doesn’t only put your lungs on fire or give you a horrible headache or make you feel miserable or make you breathe really fast,” Remy says. “It also wreaks havoc on your mental state.”
For one, from the time anyone with Covid-19 is admitted to the hospital, they are essentially cut off from almost everything that is familiar. Most Covid-19 deaths have occurred in hospitals, but Centers for Disease Control and Prevention data shows that some are also dying in long-term care facilities (about 10 percent) or at home (about 6 percent).
“A lot of patients have told me how isolating and how lonely it is,” Thi says. And many get depressed. It is also incredibly scary to reach that point of illness with a disease that we know has already killed so many people, she and others point out.
All of these challenges have a cumulative effect. “If you can understand being in the hospital for two, three weeks, continuously breathing that fast, not having good interactions with your family because they can’t come and visit you — it’s extremely anxiety-provoking. It’s scary,” Remy says.
Being in the ICU for any reason also vastly increases a person’s risk for delirium, a state of confusion that can result in agitation, fear, and anger. Medications used to sedate people or relieve pain (both common in Covid-19 treatment) are part of the reason for this risk, as are the constant monitoring and physical disturbances — and subsequent sleep disruption.
Being a Covid-19 patient increases this likelihood of disorientation even more. Some estimates put the rate of delirium among adult ICU Covid-19 patients at about 65 percent.
One reason for this extra risk is that the only people patients see are covered in head-to-toe PPE, often with only their eye area visible behind a shield or goggles, rendering them even more anonymous and unfamiliar. (ICU nurses have described working alongside the same people for decades and now not recognizing them due to all the protective gear.) “That for sure increases the risk of delirium,” Thi says.
As a Covid-19 patient, “You’re just devoid of human contact to a large degree,” Mandel says.
And that is no small thing. With loved ones relegated to video calls, personal connection through in-person visits — typically a mainstay during an intensive hospital stay — is gone.
“If your mom or dad or spouse was in the hospital and was very sick, you would be at their bedside holding their hand,” Remy says. With fatal Covid-19, your last meaningful contact with family, before your final hours, might be as you get admitted into the ER, days or weeks before.
Doctors often have to use many invasive procedures to try to save lives
Anyone unwell enough to be in the ICU for any reason will be hooked up to lots of machines. But people with severe Covid-19 face a particularly grueling and invasive experience.
When people can no longer breathe for themselves and still aren’t getting enough oxygen from external sources (like short nose tubes or a BiPap machine, like those some people wear for sleep apnea), the next step is usually putting them on a ventilator.
To do this, patients are put on IV-based sedation and pain medication so they can tolerate the procedure. A tube is inserted into the mouth and down the airway so the machine can pump air into the lungs. The tube can remain there for days or weeks, during which time that person will remain heavily sedated and unable to talk. (This sedation can also mask other problems that arise during their illness, such as major strokes.)
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Those who have survived the ordeal often don’t even remember the day leading up to being put on ventilation, Thi says. “They say they really just lost that portion of their life.”
The ventilator itself is not without risks. For example, if the machine is set to deliver too much air, it can cause additional lung damage. And the breathing tube only tends to be safe to keep in place for about two to three weeks, Thi notes. After that, it can start to deteriorate. At that point, doctors might surgically insert a tube into the patient’s neck — a procedure known as a tracheostomy — to connect them to the ventilator.
For some, even mechanical ventilation can’t get them enough oxygen. These patients often get put on “heart-lung” machines, which pump blood out of the body, through a machine that oxygenates it, and back in. (These are also sometimes used for people who have suffered a heart attack, and are known to have numerous side effects, such as increased risk for strokes as well as for agitation and delirium.) This process requires two large catheters (long tubes) inserted into a major artery or vein, so the machine can effectively pump enough blood in and out of the body.
Flipping people onto their stomachs has also helped get more air into their systems. During this practice, called proning, the sick individual is typically put on a medication to paralyze them so they cannot move. (Medical staff also turn incapacitated patients in bed every couple of hours “to make sure their skin doesn’t break down,” Thi says.)
A significant proportion of people — somewhere between about 1 in 5 and 1 in 3 — who get very sick with Covid-19 also end up with kidney failure. To prevent this from killing them, they’re put on dialysis machines, which take blood out of the body and filter it before returning it to the body. This procedure can cause nausea, cramping, and chronic itching. Anyone getting dialysis will need two additional large catheters put into another major blood vessel.
But these aren’t all of the tubes critically ill Covid-19 patients need. They also have a central venous catheter to administer medication. This long tube usually gets inserted into a major vein in the clavicle or groin, then is pushed through the vein until it reaches the heart, where it will stay until that person recovers or dies. Another catheter, sometimes put in near the groin, will take the person’s blood for analysis.
Other catheters will be inserted into the urethra to drain urine (which is monitored closely) and the rectum to frequently evacuate their feces (which is especially important because Covid-19 often causes diarrhea). Additional IVs, such as for hydration and medications, will poke patients in smaller vessels as well. People this ill with Covid-19 will also have a tube put into their mouth or nose and down into their stomach, to deliver a nutritious slurry to prevent malnutrition.
On top of all of these tubes and needles, a number of other beeping and humming devices monitor a person’s vitals. Leads attached to the chest track heart function, and a pulse oximeter on the finger keeps tabs on oxygen saturation. A standard cuff monitors blood pressure, but people often get an additional catheter into yet another vessel to measure blood pressure from within that artery.
All of these incredibly invasive interventions have a goal of sustaining the body simply so that it can try to fight off the virus and heal. “The technology we have is very powerful in terms of keeping people alive but less powerful at turning things around,” Mandel says. “It’s always a race.”
But even all of these procedures — alongside treatments like dexamethasone and remdesivir — are not enough to save everyone with Covid-19. Some people decline to go through some or all of this, or at least to endure it indefinitely, but that does not guarantee a lack of suffering. And for those most unlucky 1.8 percent of people confirmed to have Covid-19 in the US, death will then be imminent.
The end
Once someone is sick enough with Covid-19 that they need a ventilator, their chance of survival is somewhere between 40 and 60 percent, notes Remy. “You flip a coin, and you may be one of those people who die,” he says.
Remy recalls one particularly difficult week during the fall surge when he cared for a number of people in their 40s and 50s who ultimately died. Most of them were obese but otherwise healthy when they caught Covid-19 by not wearing a mask.
“One of the[se] patients specifically told me before I put the breathing tube in, ‘Let everyone know that this is real, my lungs are on fire. It’s like there’s bees stinging me. I can’t breathe. Please let them know to wear a mask … because I wouldn’t wish this on my worst enemy.’”
Right after that patient died, Remy made a precautionary video that he posted on Twitter.
If a patient’s breathing deteriorates slowly, hospitals can often arrange a way for them to talk with family members before they get intubated. Because after the tube goes in, they might not be conscious or able to talk again before they die. Regardless, the last person they have conscious contact with is typically a member of the medical staff before they are heavily sedated to receive the ventilator tube. In essence, “It could be anybody,” Rice says.
Despite the strict isolation for Covid-19 patients, “We try to make sure patients don’t die alone,” Thi says. For those who quickly nosedive, there often isn’t time to bring in family. Those people die surrounded by medical staff, either receiving CPR or, if they had do not resuscitate orders, with staff standing by.
For those who fall toward death, family — in full PPE — are now typically allowed in (which wasn’t usually the case at the beginning of the pandemic). At that point, “We would proceed with comfort measures only,” Thi says. In this scenario, the dying person will be on heavy medication as the ventilator tube is removed. Even still, once it gets taken out, people often gasp or cough as the body fights for air before they die.
Despite the palliative care and the possibility for family to now be present for a person’s actual death, doctors describe Covid-19 as a uniquely terrible way to die. “Covid is just so different,” Thi says. “I don’t think anything could be comparable to it. … I don’t wish it on my worst enemy.”
Remy agrees. After having cared for patients dying from infectious diseases all over the world, he says, “I don’t know a disease that wreaks such havoc on the body and on the mind.” Which is perhaps why his dying patient was pleading with him so desperately just before being intubated to tell people to wear their masks and take the virus seriously.
Because otherwise, it will continue to take thousands of lives this way each day in the US until we can get vaccines to almost everyone.
Katherine Harmon Courage is a freelance science journalist and author of Cultured and and Octopus! Find her on Twitter at @KHCourage.
The power was still out in my Dallas housing complex early last Tuesday, so I grabbed the survival hatchet from my emergency bag to chop up a couple of fallen trees, which were covered with six inches of down-soft snow dropped by Winter Storm Uri.
The trees broke easily, and after 30 minutes of hacking, I’d cut enough for two small blazes. I divided the wood — one half for my apartment, the other for my neighbor.
My wife Joy and I cooked beans over the fireplace and burned some old clothing to keep the temperature in the apartment above 40 degrees. After our fire died, our complex issued an “Important Message For Residents” warning that Dallas might ration water as treatment plants froze: “Please take action NOW to fill pots/pitchers, bathtubs and other storage containers … use this water to flush toilets.”
Joy, who had recently moved here from Bolivia, had seen her WhatsApp fill up with worried messages from loved ones who’ve watched America’s panoply of recent crises unfold. They asked if she was safe from the horrors on their televisions: the world’s worst Covid-19 numbers, horned defectors with assault weapons, and now infrastructure that abandons people during natural disasters.
After reading the hoard-water note, she turned to me and joked, “I thought the United States was a first-world country?”
In her eyes, a developed country and its state leaders should take care of its citizens. Millions of Texans have seen their electricity cut out for hours and days at a time in a deadly rolling crisis that began with snowfall on Valentine’s Day. Though most power is now restored, millions of Texans are still without water as treatment plants recover. The crisis has been a burden, not just for the state or the power company at fault, but for its residents to bear.
You see, we’re individuals, and, like one Texas mayor wrote on Facebook, we shouldn’t expect state institutions to help. “No one owes you or your family anything; nor is it the local government’s responsibility to support you during trying times like this! Sink or swim, it’s your choice!” then-Mayor Tim Boyd of Colorado City, a town of fewer than 5,000 people a four-hour drive west of Dallas, told constituents in a typo-laden Facebook post. (That same day, he announced his resignation, but he didn’t say whether his exit stemmed from the backlash.)
We were on our own.
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We lost power for most of Monday and Tuesday, but luckily, we never lost water. Many Texans fared worse. Houston firefighters had to deal with low water pressure when dousing residential fires started by candles, displacing dozens of Houstonians. Prison inmates had to live with overflowing, unusable toilets for days. Exotic animals, including a chimpanzee and other primates, froze to death in a San Antonio rescue. By last Tuesday, hospitals had treated more than 50 people for carbon monoxide poisoning; desperate to get warm, they’d heated their homes with gas stoves and running cars. A woman near Houston filed a wrongful death lawsuit against power utilities after her 11-year-old son froze to death in his bed.
The disaster worsened existing crises in average Texans’ lives. My neighbor, a nurse who underwent several major surgeries this year amid the pandemic, began to seem less social and more withdrawn. My boss’s mother suffered a stroke just before the storm, and his energies were split between caring for her and making sure his water pipes didn’t freeze. I was depressed and disagreeable.
I draw a line from this catastrophe to America’s fetishized individualism for which Texas, home to a fierce secessionist movement, is the poster child. Texas is where the West starts, home of high-riding cowboys and oilmen who project an image of self-reliance — all they needed to prosper was a government that stayed out of their way.
I work for a manufacturer that makes devices for the power industry, and I can’t conjure a better example of the Texas government’s light touch than its relationship to the electric grid. As electricity infrastructure evolved in the 1930s, the federal government regulated energy across state lines. But Texas had its own grid network, the Texas Interconnected System, and a flourishing oil trade. So the state shrewdly spurned interstate grids.
In the 1970s, the Electric Reliability Council of Texas, or ERCOT, was formed to manage the state’s electricity distribution. But in 2002, Texas deregulated its energy market, creating an environment in which electricity retailers compete for business. The lowest bidder would win customers in the marketplace, but that encouraged power generators to delay or neglect weatherizing critical equipment. In 2011, the Federal Energy Regulatory Commission warned ERCOT that power plants must winterize their equipment. Electricity providers, beholden only to the market, largely ignored the advice.
Put simply, this market created a larger disaster when the freezing weather hit. Because the function of the Texas power industry is to provide cheap electricity, it has no incentive to make costly preparations to its infrastructure for comparatively rare cold weather.
As Uri intensified, enough people were using electric heaters and enough generation equipment had frozen that demand outpaced supply, and the grid’s frequency began to destabilize. Officials told the Texas Tribune Thursday the grid was “minutes” from a full crash, which would’ve taken weeks to restore. ERCOT then mandated statewide “rolling blackouts” to reconcile the grid’s burden with power generation.
It initially said the outages would last less than 45 minutes, but when I woke up that morning, the lights and heat were out. I spent an hour on a dying cellphone navigating overwhelmed service hotlines for any nugget pointing to restored power. I learned the outage could, in fact, last hours, and I gave up calling. Local officials gave suggestions on how to make do. The city of Fort Worth told constituents to close their blinds and stuff towels in cracks to retain heat.
This disaster doesn’t appear to have inspired sober reflection among many of our politicians. On Fox News last week, Republican Gov. Greg Abbott blamed wind turbines for the crisis; in fact, natural gas equipment is responsible for the bulk of the losses. Cranking up the invective, Abbott fingered as a culprit the Green New Deal, a policy framework to address climate change that Congress rejected in 2019. And, of course, our climate-change-denying Republican Sen. Ted Cruz famously jetted off from Houston to Cancun with his family mid-crisis as Texans froze to death.
Individualist thinking justifies this mentality. It says that states and individuals should marshal and deploy their own resources, a notion as American as apple pie. If you lack the resources to get to a Mexican beach resort, hike your sleeves, chop firewood, and don’t burn down your home.
I ended up chopping wood. I’m lucky that I had the option to — it allowed us to stay warm for part of Tuesday morning, and it was better than huddling in a darkened bedroom. But not everyone lives in a forested apartment complex, and others were forced to turn to potentially deadly methods, like a grandmother who spent a night in her car to keep warm.
The fact that I even had a survival hatchet feels ironic. I’m mostly skeptical of prepper culture, partly because it reeks of that individualism. Yet Joy and I frantically built our emergency bags in January after Trump supporters attacked the US Capitol. A friend who works in logistics told me corporations were preparing for a doomsday scenario after the DC raid — cutting emergency credit cards for employees, making extraction plans. Our form of government forces us to prep, and when you’re on your own, it pays to have the tools.
Still, during Uri, ordinary Texans didn’t just help themselves. They distributed food, donated and organized mutual aid funds, and, if they had electricity, took shivering strangers into their homes. A coworker ran errands for neighbors who can’t drive in snow. An acquaintance brought an elderly woman coolers full of water so she could flush the loo.
Tuesday night, our neighbor knocked on our door with an Ikea tote full of more black willow. “They cut this firewood, you want some?”
It was sweet to be cared for by our community. But it’d be better if our government looked after us instead.
Aaron Hedge is a Dallas-based writer and a reader at Longform.org.
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A panel of expert advisers to the Food and Drug Administration (FDA) voted unanimously on Friday afternoon to recommend the one-dose Covid-19 vaccine developed by Johnson & Johnson for an emergency use authorization. The next step is for the FDA to accept the recommendation, which could happen as soon as this weekend, clearing the way for distribution.
Earlier this week, the FDA posted a briefing going over the results of the phase 3 clinical trials of the Johnson & Johnson vaccine, which included 40,000 participants in several countries divided randomly into placebo and treatment groups.
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The most important finding: The vaccine was 100 percent effective after 28 days at preventing deaths and hospitalizations from Covid-19 among the clinical trial participants who received the treatment. (Two vaccine recipients were hospitalized with Covid-19 two weeks after receiving the injection.)
The vaccine was also 66.1 percent effective at preventing symptomatic Covid-19 illness after four weeks, with consistent results across all age groups. When looking at blocking severe and critical cases of Covid-19, the Johnson & Johnson vaccine was 85.4 percent effective.
Mathai Mammen, global head of research and development for Janssen Pharmaceutical Companies, said during a press conference last month that the vaccine also had “plain vanilla safety results,” with the vast majority of recipients experiencing no problems. Most of the reported symptoms were mild, including fatigue, arm pain, and fever.
The efficacy levels against severe to critical Covid-19 changed depending on where the vaccine was tested. It was 85.9 percent in the United States after four weeks, while in South Africa, where a coronavirus variant with worrisome mutations that help it escape vaccines has been spreading widely, efficacy against severe disease was reduced to 81.7 percent.
Health officials say that while the Johnson & Johnson efficacy results are not as high as those from Moderna and Pfizer/BioNTech, the two vaccines that have already received emergency use authorizations from the FDA, the new vaccine’s performance is still superb.
“If this had occurred in the absence of a prior announcement and implementation of a 94, 95 percent efficacy [vaccine], one would have said this is an absolutely spectacular result,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during the press conference last month. The vaccine was developed by Janssen Pharmaceuticals, a division of Johnson & Johnson based in Belgium, together with Boston’s Beth Israel Deaconess Medical Center.
But unlike the vaccines from Moderna and Pfizer/BioNTech, Johnson & Johnson’s doesn’t require a booster shot, circumventing the two-dose problems posed by its competitors. There’s no need to track people down for their second dose, which means more people could be vaccinated faster. The shots also don’t require deep-cold storage, which means they’re less costly and somewhat easier to distribute.
“It’s a complete game changer,” said Georgetown University health law professor Lawrence Gostin. “It completely changes the equation.”
The Johnson & Johnson vaccine is also different in another way. It uses an adenovirus vector to deliver instructions for making the spike protein of the coronavirus, which is also less expensive to manufacture than the mRNA platform used for the other vaccines. (It’s estimated to cost around $10 per vaccine dose — roughly half the cost of the Pfizer/BioNTech vaccine.)
Johnson & Johnson has promised enough vaccines for 20 million Americans by the end of March and 100 million Americans by the end of June despite production challenges. It would be a huge boost to the 65 million Covid-19 vaccine doses that have been administered in the US so far.
So even with an overall efficacy level that’s lower than the two other vaccines on the US market, the Johnson & Johnson vaccine could become a major player. It’s the vaccine that “can increase equity,” said Saad Omer, the director of the Yale Institute for Global Health, particularly “if it’s deployed strategically in nations that are hard to reach and where that would be a particular challenge under a two-dose schedule.” Johnson & Johnson expects to distribute a billion doses of its vaccine worldwide this year.
But as amazing as it is to see several effective Covid-19 vaccines developed in record time, it’s now clear that the technology alone won’t save the day. An orchestra of supply chains, manufacturing, logistics, staff, and public trust needs to harmonize in order to actually get billions of shots into arms around the world and finally draw the pandemic to a close. And we also have other hurdles to overcome: controlling the spread of variants that seem to be threatening the effectiveness of all the vaccines we have.
What we learned about the safety and efficacy of the Johnson & Johnson Covid-19 vaccine
Johnson & Johnson launched separate clinical trials testing both a one-dose and a two-dose regimen to see how well these strategies provided long-term protection against Covid-19. The one-dose phase 3 trial arm yielded efficacy results first.
But hints that this vaccine could be safe and effective have been trickling out for months. The company published some of its early phase 1 and phase 2 trial data in a preprint paper in September, and the final version of the paper in January, in the New England Journal of Medicine. The papers showed the vaccine was well tolerated among the participants, and seemingly very effective: With one dose, after 29 days, the vaccine ensured that 90 percent of participants had enough antibodies required to neutralize the virus. After 57 days, that number reached 100 percent.
“When I looked at that, I thought, wow, this Johnson & Johnson product is very powerful after the first dose in terms of immunogenicity,” said Monica Gandhi, a professor of global medicine at the University of California San Francisco. “The Pfizer and Moderna vaccines needed two doses to get that level of [virus] neutralization.”
Like Pfizer/BioNTech, Johnson & Johnson “didn’t rush to phase 3 [trials],” said Hilda Bastian, a scientist who has been tracking the global vaccine race. Instead, it tested multiple vaccine doses and candidates at the outset to figure out which might perform the best in humans, and then proceeded through clinical trials.
The vaccine was also tested in nine countries — the largest single international phase 3 trial in the world, with more than 60,000 participants — meaning many ethnic groups were represented in the data, Bastian said. “As if all that’s not enough, it’s one of the ones that could be manufactured in South Africa and other places,” since Johnson & Johnson has manufacturing capacity around the world, even in countries hard-hit by the pandemic that have been waiting for vaccine supplies, she added.
The day this vaccine gets approval “is going to be a big day for the future of this pandemic [and] a ticket out of this disease for a larger part of the world,” said Nicholas Lusiani, a senior adviser at Oxfam America.
How adenovirus vector vaccines work
Part of the appeal of this vaccine lies in the technology behind it. Adenoviruses are a family of viruses that can cause a range of illnesses in humans, including the common cold. They’re very efficient at getting their DNA into a cell’s nucleus. Scientists reasoned that if they could snip out the right sections of an adenovirus’s genome and insert another piece of DNA code (in this case, for a fragment of the new coronavirus), they could have a powerful system to deliver instructions to cells.
For decades, scientists have experimented with adenovirus vectors as a platform for gene therapy and to treat certain cancers, using the virus to modify or replace genes in host cells. More recently, researchers have found success using adenoviruses as vaccines. Already, an adenovirus vector vaccine has been developed for the Ebola virus.
In addition to Johnson & Johnson and AstraZeneca/Oxford, CanSino Biologics of China is also developing an adenovirus vector Covid-19 vaccine; Russia’s Sputnik V Covid-19 vaccine uses this platform, too.
To make one of these vaccines, the adenovirus is modified so that it can’t reproduce but can carry the instructions for making a component of a virus. In the case of Covid-19, most adenovirus vector vaccines code for the spike protein of SARS-CoV-2, the part the virus uses to begin an infection.
Human cells then read those instructions delivered by the adenovirus and begin manufacturing the spike protein. The immune system recognizes the spike proteins as a threat and begins to build up its defenses.
Since adenoviruses exist naturally, they tend to be more temperature-stable than the synthetic lipid nanoparticles that are used to deliver the mRNA in the Moderna and Pfizer/BioNTech vaccines.
“The nice thing about the adenovirus vector vaccines is that they’re a little more tolerant to a longer shelf life, to the conditions of storage,” said Angela Rasmussen, a virologist at Georgetown University. Adenovirus vector vaccines can be stored at refrigerator temperatures, while mRNA vaccines need freezers, with Pfizer/BioNTech’s vaccine requiring temperatures of minus 80 degrees Celsius.
This helps lower the cost and complexity of manufacturing, distribution, and administration of adenovirus vector vaccines compared to other platforms. And simply having another vaccine on the market, made by a major pharmaceutical company with its own manufacturing infrastructure, is a big step forward. “The more vaccine doses we can have, the better,” Rasmussen said.
What comes next
The next challenge for Johnson & Johnson, after getting a green light from the FDA, is actually delivering doses to millions of arms.
But with three vaccines eventually on the market, should people hold out for any one vaccine in particular?
“Right now when people ask me, which, you know, which vaccine should I get? It’s pretty easy to answer that question because it’s whichever one you get offered,” said Paul Sax, a professor of medicine at Harvard Medical School. Vaccine supplies are limited, the transmission of the virus is high, and hospitals are close to capacity, so few people can be picky about what they get.
On the other hand, once vaccine supplies stabilize, having multiple vaccines with different characteristics could allow doctors and public health officials to optimize how the shots are distributed. “If the efficacy [of a given vaccine] is lower but still pretty good, there may be a scenario that one vaccine is recommended for low-risk populations and another one is for a high-risk population,” Omer said.
Though the Johnson & Johnson vaccine does have some key advantages over its competitors, it could face some of the same distribution snags that have hit other vaccines, like miscommunication between the government and hospitals, and production hurdles.
Researchers say that all the manufacturers also need to start working to get vaccines to the rest of the world. The new variants that have emerged in the UK, Brazil, and South Africa and have been detected in other parts of the world are reminders that the virus continues to evolve, and that a partially vaccinated population could exert more selection pressures that accelerate these mutations. So vaccination has to happen fast, and globally — and Johnson & Johnson’s vaccine may be a critical tool to do this.
“Long term, we need to be thinking about getting vaccines out equitably to the entire world, and having vaccines that are easier to distribute in terms of the cold chain requirements is going to be huge in that regard,” Rasmussen said.
But even as these vaccines roll out, there’s still more to learn: how long protection from vaccines last, whether there are any rare complications to consider, whether they prevent transmission as well as disease, and how well these vaccines work against the new variants. There are already some troubling signs of how these variants might eventually be able to evade vaccines. Continuing clinical trials will be critical, Sax said.
“You know, we’ve got millions of people who’ve received these vaccines already, which is exciting,” he added. “We’re on our way.”