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Tag: last year

  • Are Colds Really Worse, or Are We All Just Weak Babies Now?

    Are Colds Really Worse, or Are We All Just Weak Babies Now?

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    For the past few weeks, my daily existence has been scored by the melodies of late winter: the drip of melting ice, the soft rustling of freshly sprouted leaves—and, of course, the nonstop racket of sneezes and coughs.

    The lobby of my apartment building is alive with the sounds of sniffles and throats being cleared. Every time I walk down the street, I’m treated to the sight of watery eyes and red noses. Even my work Slack is rife with illness emoji, and the telltale pings of miserable colleagues asking each other why they feel like absolute garbage. “It’s not COVID,” they say. “I tested, like, a million times.” Something else, they insist, is making them feel like a stuffed and cooked goose.

    That something else might be the once-overlooked common cold. After three years of largely being punted out of the limelight, a glut of airway pathogens—among them, adenovirus, RSV, metapneumovirus, parainfluenza, common-cold coronaviruses, and rhinoviruses galore—are awfully common again. And they’re really laying some people out. The good news is that there’s no evidence that colds are actually, objectively worse now than they were before the pandemic started. The less-good news is that after years of respite from a bunch of viral nuisances, a lot of us have forgotten that colds can be a real drag.

    Read: The pandemic broke the flu … again

    Once upon a time—before 2020, to be precise—most of us were very, very used to colds. Every year, adults, on average, catch two to three of the more than 200 viral strains that are known to cause the illnesses; young kids may contract half a dozen or more as they toddle in and out of the germ incubators that we call “day cares” and “schools.” The sicknesses are especially common during the winter months, when many viruses thrive amid cooler temps, and people tend to flock indoors to exchange gifts and breath. When the pandemic began, masks and distancing drove several of those microbes into hiding—but as mitigations have eased in the time since, they’ve begun their slow creep back.

    For the majority of people, that’s not really a big deal. Common-cold symptoms tend to be pretty mild and usually resolve on their own after a few days of nuisance. The virus infiltrates the nose and throat, but isn’t able to do much damage and gets quickly swept out. Some people may not even notice they’re infected at all, or may mistake the illness for an allergy—snottiness, drippiness, and not much more. Most of us know the drill: “Sometimes, it’s just congestion for a few days and feeling a bit tired for a while, but otherwise you’ll be just fine,” says Emily Landon, an infectious-disease physician at the University of Chicago. As a culture, we’ve long been in the habit of dismissing these symptoms as just a cold, not enough of an inconvenience to skip work or school, or to put on a mask. (Spoiler: The experts I spoke with were adamant that we all really should be doing those things when we have a cold.)

    The general infectious-disease dogma has always been that colds are a big nothing, at least compared with the flu. But gentler than the flu is not saying much. The flu is a legitimately dangerous disease that hospitalizes hundreds of thousands of Americans each year, and, like COVID, can sometimes saddle people with long-term symptoms. Even if colds are generally less severe, people can end up totally clobbered by headaches, exhaustion, and a burning sore throat; their eyes will tear up; their sinuses will clog; they’ll wake up feeling like they’ve swallowed serrated razor blades, or like their heads have been pumped full of fast-hardening concrete. It’s also common for cold symptoms to stretch out beyond a week, occasionally even two; coughs, especially, can linger long after the runny nose and headache resolve. At their worst, colds can lead to serious complications, especially in the very young, very old, and immunocompromised. Sometimes, cold sufferers end up catching a bacterial infection on top of their viral disease, a one-two punch that can warrant a trip to the ER. “The fact of the matter is, it’s pretty miserable to have a cold,” Landon told me. “And that’s how it’s always been.”

    Read: Don’t worry, it’s not COVID

    As far as experts can tell, the average severity of cold symptoms hasn’t changed. “It’s about perception,” says Jasmine Marcelin, an infectious-disease physician at the University of Nebraska Medical Center. After skipping colds for several years, “experiencing them now feels worse than usual,” she told me. Frankly, this was sort of a problem even before COVID came onto the scene. “Every year, I have patients who call me with ‘the worst cold they’ve ever had,’” Landon told me. “And it’s basically the same thing they had last year.” Now, though, the catastrophizing might be even worse, especially since pandemic-brain started prompting people to scrutinize every sniffle and cough.

    There’s still a chance that some colds this season might be a shade more unpleasant than usual. Many people falling sick right now are just coming off of bouts with COVID, flu, or RSV, each of which infected Americans (especially kids) by the millions this past fall and winter. Their already damaged tissues may not fare as well against another onslaught from a cold-causing virus.

    It’s also possible that immunity, or lack thereof, could be playing a small role. Many people are now getting their first colds in three-plus years, which means population-level vulnerability might be higher than it normally is this time of year, speeding the rate at which viruses spread and potentially making some infections more gnarly than they’d otherwise be. But higher-than-usual susceptibility seems unlikely to be driving uglier symptoms en masse, says Roby Bhattacharyya, an infectious-disease physician and microbiologist at Massachusetts General Hospital. Not all cold-causing viruses leave behind good immunity—but many of those that do are thought to prompt the body to mount relatively durable defenses against truly severe infections, lasting several years or more.

    Plus, for a lot of viruses going around right now, the immunity question is largely moot, Landon told me. So many different pathogens cause colds that a recent exposure to one is unlikely to do much against the next. A person could catch half a dozen colds in a five-year time frame and not even encounter the same type of virus twice.

    Read: Maybe consider not kissing that baby

    It’s also worth noting that what some people are categorizing as the worst cold they’ve ever had might actually be a far more menacing virus, such as SARS-CoV-2 or a flu virus. At-home rapid tests for the coronavirus often churn out false-negative results in the early days of infection, even after symptoms start. And although the flu can sometimes be distinguished from a cold by its symptoms, they’re often pretty similar. The illnesses can only be definitively diagnosed with a test, which can be difficult to come by.

    The pandemic has steered our perception of illness into a false binary: Oh no, it’s COVID or Phew, it’s not. COVID is undoubtedly still more serious than a run-of-the-mill cold—more likely to spark severe disease or chronic, debilitating symptoms that can last months or years. But the range of severity between them overlaps more than the binary implies. Plus, Marcelin points out, what truly is “just” a cold for one person might be an awful, weeks-long slog for someone else, or worse—which is why, no matter what’s turning your face into a snot factory, it’s still important to keep your germs to yourself. The current outbreak of colds may not be any more severe than usual. But there’s no need to make it bigger than it needs to be.

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    Katherine J. Wu

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  • So Are Nonstick Pans Safe or What?

    So Are Nonstick Pans Safe or What?

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    I grew up in a nonstick-pan home. No matter what was on the menu, my dad would reach for the Teflon-coated pan first: nonstick for stir-fried vegetables, for reheating takeout, for the sunny-side-up eggs, garlic fried rice, and crisped Spam slices that constituted breakfast. Nowadays, I’m a much fussier cook: A stainless-steel pan is my kitchen workhorse. Still, when I’m looking to make something delicate, such as a golden pancake or a classic omelet, I can’t help but turn back to that time-tested fave.

    And what a dream it is to use. Nonstick surfaces are so frictionless that fragile crepes and scallops practically lift themselves off the pan; cleaning up sticky foods, such as oozing grilled-cheese sandwiches, becomes no more strenuous than rinsing a plate. No wonder 70 percent of skillets sold in the U.S. are nonstick. Who can afford to mangle a dainty snapper fillet or spend time scrubbing away crisped rice?

    All of this convenience, however, comes with a cost: the unsettling feeling that cooking with a nonstick pan is somehow bad for you. My dad had a rule that we could only use a soft, silicon-edged spatula with the pan, born of his hazy intuition that any scratches on the coating would cause it to leach into our food and make us sick. Many home cooks have lived with these fears since at least the early 2000s, when we first began to hear about problems with Teflon, the substance that makes pans nonstick. Teflon is produced from chemicals that are part of an enormous family of chemicals known as perfluoroalkyl and polyfluoroakyl substances, or PFAS, and research has linked exposure to them to many health conditions, including certain cancers, reproductive issues, and high cholesterol. And that is about all we know: In kitchens over the past two decades, the same questions around safety have lingered unanswered amid the aromas of sizzling foods and, perhaps, invisible clouds of Teflon fumes.

    It is objectively ridiculous that the safety of one of the most common household items in America remains such a mystery. But the reality is that it is nearly impossible to measure the risks of PFAS from nonstick cookware—and more important, it’s probably pointless to try. That’s because PFAS have for many decades imparted a valuable stain- and water-resistance to many types of surfaces, including carpets, car seats, and raincoats.

    At this point, the chemicals are also ubiquitous in the environment, particularly in the water supply. Last June, the Environmental Protection Agency established new safety guidelines for the level of certain PFAS in drinking water; a study published around the same time showed that millions of deaths are correlated with PFAS exposure. By the Environmental Working Group’s latest count, PFAS have contaminated more than 2,850 sites in 50 states and two territories—an “alarming” level of pervasiveness, researchers wrote in a National Academies of Sciences, Engineering, and Medicine report last year. But something about nonstick pans has generated the biggest freak-out. This is not surprising, given their exposure to food and open flames. After all, people do not heat up and consume raincoats (as far as I know).

    Since research into their health effects began, certain types of PFAS have been flagged as more dangerous than others. Two of them, PFOA and PFOS, were voluntarily phased out by manufacturers for several reasons, including the fact that they were deemed dangerous to the immune system; now many nonstick pans specify that their coatings are PFOA free. (If you’re confused by all the acronyms, you aren’t the only one.) But other types of PFAS are still used in these coatings, and their risks to humans aren’t clear. Teflon claims that any flakes of nonstick coating you might ingest are inert, but public studies backing up that claim are difficult to find.

    In the absence of relevant data, everyone seems to have a different take on nonstick pans. The FDA, for example, allows PFAS to be used in nonstick cookware, but the EPA says that exposure to them can lead to adverse health effects, and last year proposed labeling certain members of the group as “hazardous substances.” According to the CDC, the health effects of low exposure to these chemicals are “uncertain.” Food experts are similarly undecided on nonstick pans: A writer for the culinary site Serious Eats said he “wouldn’t assume they’re totally safe,” whereas a Wirecutter review said they “seem to be safe”—if used correctly.

    That’s about the firmest answer you’re going to get regarding the safety of nonstick cookware. “In no study has it been shown that people who use nonstick pans have higher levels” of PFAS, says Jane Hoppin, a North Carolina State University epidemiologist and a member of a National Academies of Sciences, Engineering, and Medicine committee to study PFAS. But she also told me that, with regard to the broader research on PFAS-related health risks, “I haven’t seen anybody say it’s safe to use.”

    Certainly, more research could be done on PFAS, given the lack of relevant studies. There is no research, for example, showing that people who use nonstick pans are more likely to get sick. The one study on exposure from nonstick pans mentioned in the report that Hoppin and others published last year found inconclusive results after measuring gaseous PFAS released from heated nonstick pans, though the researchers tested only a few pans. Another study in which scientists used nonstick pans to cook beef and pork—and an assortment of more glamorous meats including chicken nuggets—and then measured the PFAS levels likewise failed to reach a conclusion, because too few meat samples were used.

    More scientists could probably be convinced to pursue rigorous research in this field if PFAS exposure came only from nonstick pans. Investigating the risks would be tough, perhaps impossible: Designing a rigorous study to test the risks of PFAS exposure would likely involve forcing unwitting test subjects to breathe in PFAS fumes or eat from flaking pans. But given that we are exposed to PFAS in so many other ways—drinking water being chief among them—what would be the point? “They’re in dental floss, and they’re in your Gore-Tex jacket, and they’re in your shoes,” Hoppin said. “The relative contribution of any one of those things is minor.”

    As long as PFAS keep proliferating in the environment, we might never fully know exactly what nonstick pans are doing to us. The best we can do for now is decide what level of risk we’re willing to accept in exchange for a slippery pan, based on the information available. And that information is frustratingly vague: Most nonstick products come with a disclosure of the types of PFAS they contain and the types they do not. Sometimes they also include instructions to avoid high heat, especially above 500 degrees Fahrenheit. Hoppin recommends throwing nonstick pans away once they start flaking; in general, it seems worth it to use the pans only when essential. There is likewise a dearth of guidance on breathing in the fumes from an overheated pan, though breathing in PFAS fumes in industrial settings has been known to cause flulike symptoms. If you’re concerned, Hoppin said, you could use any of the growing number of nonstick alternatives, including ceramic and carbon-steel cookware. (Her preference is well-seasoned cast iron.)

    Still, perhaps it’s time to accept that exposure to PFAS is inevitable, much like exposure to microplastics and other carcinogens. At this point, so many harmful substances are all around us that there doesn’t seem to be any point in trying to limit them in individual products, though such efforts are underway for raincoats and period underwear. “What we really need to do is remove these chemicals from production,” Hoppin said. The hope is that doing so would broadly reduce our exposure to PFAS, and there’s evidence that it would work: After PFOS was phased out in the early 2000s, its levels in human blood declined significantly. But until PFAS are more tightly regulated, we’ll continue our endless slide through nonstick limbo, with our grasp of the cookware’s safety remaining slippery at best.

    I’ve tried to cut down on my nonstick-pan use for sheer peace of mind. Many professional chefs reject nonstick pans as unnecessary if you know the proper technique; French chefs, after all, were flipping omelets long before the first Teflon pan was invented—by a French engineer—in 1954. Fancying myself a purist, I recently attempted to cook an omelet using All-Clad stainless steel, following a set of demanding instructions involving ungodly amounts of butter and a moderate amount of heat. Unlike my resolve to avoid nonstick pans, the eggs stuck.

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    Yasmin Tayag

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  • How Moderate Republicans Became an Endangered Species

    How Moderate Republicans Became an Endangered Species

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    Early this summer, the federal government will, in all likelihood, exhaust the “extraordinary measures” it is now employing to keep paying the nation’s bills. As the country careens toward that fiscal abyss, Congress will face a now-familiar stalemate: Republicans will refuse to raise the debt ceiling unless Democrats agree to cut spending. Democrats will balk. Markets will slide—perhaps precipitously—and the economy will swiftly turn south.

    When that moment arrives, the most important people in Washington won’t be those who work in the White House, or even the party leaders who occupy the Capitol’s most palatial offices. They will be the House Republicans who sit closest to the political center: the so-called moderates. The GOP’s majority is narrow enough that any five Republicans could dash Speaker Kevin McCarthy’s plan to demand a ransom for the debt ceiling. They will have to decide whether to stand with him or join with Democrats to avert a first-ever default on the nation’s debt.

    “Those guys will be called on to save the day,” says former Representative Charlie Dent, a Pennsylvania Republican who, until his retirement in 2018, was one of the House’s most prominent moderates.

    Yascha Mounk: How moderates won the midterms

    Dent is talking about Republicans such as Representative Don Bacon of Nebraska, whose Omaha district voted for Joe Biden over Donald Trump in 2020. Bacon is a leader of the faction of Republicans hoping to serve as a counterweight to the House Freedom Caucus and the far-right hard-liners who extracted all manner of concessions from McCarthy earlier this month in exchange for allowing him to become speaker. During the four days of voting that McCarthy endured, Bacon regularly held court with reporters outside the House chamber, castigating the holdouts as the “chaos caucus” and comparing them to the Taliban.

    Bacon, a 59-year-old former Air Force commander first elected in 2016, styles himself as a pragmatist and a realist, and he is keenly aware of the sway that he and other like-minded Republicans could have. Indeed, he and his allies have already blocked two bills backed by some on the far right—including a measure to replace the federal income tax with a 30 percent sales tax—from coming up for a vote. But don’t call him a moderate. “I’d rather be called a conservative who gets things done,” Bacon told me.

    In rejecting the moderate label, Bacon is no different than the other 221 Republicans now serving in the House, virtually all of whom describe themselves as some version of conservative. As the party has moved to the right, so, too, has its leftmost flank. The decline of the GOP moderate is a story more than two decades in the making, but it carries particular significance at a moment when centrist lawmakers could wield so much power. If they choose to use it. If they exist at all anymore.

    Two years ago, Bacon picked up the discarded flag of a dormant GOP group called the Main Street Caucus. The caucus is the House extension of the Republican Main Street Partnership, a political organization founded 25 years ago by then-Representative Amo Houghton of New York. The original Main Street Partnership was explicitly, and proudly, moderate; Houghton called himself a “militant moderate,” and the group’s aim was to “serve as a voice for centrist Republicans,” as well as to soften the GOP’s harsh rhetoric and policies on abortion, gay rights, and the environment, among other issues.

    The Partnership remains active—it spent $25 million in support of Republican candidates last year—but it has rebranded itself to stay relevant in today’s GOP. Searching through its website history on the Internet Archive, I found that the Partnership dropped the words moderate and centrist from its mission statement sometime in the fall of 2011, shortly after the last new Republican House majority forced a confrontation over the debt ceiling with a Democratic president. They’ve since been replaced by more generic descriptors, such as common sense and pragmatic.

    “We used to be called moderate. We are not moderate,” says Sarah Chamberlain, the Partnership’s CEO and a former aide to Houghton (who retired from Congress in 2004 and died in 2020). Its members now identify as “pragmatic conservatives.” “The entity from day one has the same name, but it looks very different,” Chamberlain told me.

    David A. Graham: Kevin McCarthy’s predicament is a warning

    The Main Street Caucus isn’t the only congressional group whose members once might have identified as moderate. Others include the Republican Governance Group (formerly known as the Tuesday Group) and the bipartisan Problem Solvers Caucus. A couple dozen Republicans, including Bacon, are members of all three groups. But they each eschew the word, in part, Bacon explained to me, because in primaries “it’s used as a cudgel.”

    Another reason is they are simply more conservative than their predecessors. As Republicans who embraced the moderate label, including Dent, have left Congress over the past 20 years, the Republicans replacing them have moved ever further from the political center. Many of the original members of the Tuesday Group and the Main Street Partnership, for example, backed abortion rights; Dent, who left the House five years ago, told me he believed he was either the last, or one of the last, House Republicans to hold that position.

    Earlier this month, the Main Street Caucus—the largest of the three groups, with about 60 members—elected as its chair a Republican even more conservative than Bacon, Representative Dusty Johnson of South Dakota. When I spoke with him by phone, Johnson eagerly volunteered that both he and the group’s new vice chair, Representative Stephanie Bice of Oklahoma, earned higher ratings than the average House Republican on the scorecard kept by Heritage Action, the conservative activist group that has warred with GOP moderates for years. “We are members who overwhelmingly want to deliver policy wins—conservative policy wins,” Johnson told me.

    The big question now is whether the GOP’s self-identified pragmatists will stand up to—or simply behind—the party leadership in the fiscal battles to come. During the speakership fight, Johnson, Bacon, and other pragmatists served as McCarthy’s protective guard, staring down the GOP holdouts by declaring that they would vote for no one other than McCarthy. Yet, with only a few complaints, they largely blessed the concessions the new speaker made to empower the far right at his own expense.

    Bacon assured me that he and his fellow pragmatists will use the leverage they have, noting the two bills that they had already prevented from coming for a vote. On the debt-ceiling debate, however, many of the deal-seeking Republicans are sounding like McCarthy, who has said the president must endorse spending cuts in order to lift the borrowing limit. “We’re not going to raise the debt ceiling until we have some additional fiscal responsibility returned to spending in this town,” Johnson told me. He put the onus on Biden and the Democrats to negotiate, equating their refusal to do so with “choosing the path of legislative terrorism.” Other members of the Main Street Caucus struck a slightly more malleable tone. “We have to be aggressive on spending, and it’s something I ran for Congress on, so I’m comfortable with that,” Representative Kelly Armstrong of North Dakota told me. “But we also have to continue to be able to govern.”

    The primary mechanism that the pragmatic Republicans could use to bypass McCarthy is a discharge petition, which would force a vote on increasing the debt limit. Given the GOP’s narrow lead in the House, only five Republicans would need to join Democrats to get the requisite support. (One GOP leader of the Problem Solvers Caucus, Representative Brian Fitzpatrick of Pennsylvania, mentioned this as a possibility when the hard-liners were blocking McCarthy’s path to speaker.) “It would be very difficult for me to sign a discharge petition against leadership,” Armstrong told me. “I would never say never, but I would be very, very skeptical that I would ever sign that.” Yet in the next breath, Armstrong suggested that if the stock market were crashing, that could change his mind: “I’m not cratering every senior in my district’s 401(k). I’m not doing it.”

    Annie Lowrey: The trillion-dollar coin might be the least bad option

    A discharge petition is an imperfect vehicle for resolving a debt-ceiling crisis; because of the House’s procedural rules, gathering signatures would have to begin weeks or even months in advance. In 2015, Dent helped lead a bipartisan coalition in using a discharge petition to go around the GOP leadership to pass legislation reviving the Export-Import Bank, a federal credit agency that conservatives wanted to let die. Then-Speaker John Boehner had already announced his departure, having been ushered into retirement by a far-right revolt. “Ordinarily, the speaker would be pretty upset about it. I can assure you he was not,” Dent recalled.

    A dozen years ago, it was Boehner leading a House GOP majority bent on securing spending cuts in exchange for lifting the debt ceiling. After several rounds of negotiations failed—including an attempted “grand bargain” on taxes and entitlement programs with then-President Barack Obama—Congress agreed to form a “super committee” to put in place budget caps that became known as sequestration. (Congress would later prevent many of these caps from being put in place.)

    Dent predicted that Republicans would win few if any concessions from Democrats for raising the borrowing limit this time around. “You’re going to get something close to a clean debt-ceiling bill,” he told me. Perhaps Biden will agree to form a fiscal commission to propose possible spending cuts, Washington’s favorite face-saving punt. A fig leaf, in other words. Bacon told me he’s hoping for something more, such as a commitment to keep increases in federal spending below inflation. “I’d like to see more than a fig leaf. I’d like to at least see some underwear on.”

    What’s all but certain is that a significant chunk of the House Republican conference won’t go for that kind of deal. Republicans told me that they doubt the party could pass any debt-ceiling increase on its own, and many conservatives might reject any deal that McCarthy could get Democrats to endorse, if he can get Democrats to negotiate at all. That will put the pressure once again on the GOP’s pragmatists, the Republicans who pass for moderate in 2023 but won’t dare use that word. If and when the debt crisis comes, they could well be the ones deciding between, well, moderation and default.

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    Russell Berman

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  • Is the Worst of Winter Over for COVID?

    Is the Worst of Winter Over for COVID?

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    For months, the winter forecast in the United States seemed to be nothing but viral storm clouds. A gale of RSV swept in at the start of autumn, sickening infants and children in droves and flooding ICUs. After a multiyear hiatus, flu, too, returned in force, before many Americans received their annual shot. And a new set of fast-spreading SARS-CoV-2 subvariants had begun its creep around the world. Experts braced for impact: “My biggest concern was hospital capacity,” says Katelyn Jetelina, who writes the popular public-health-focused Substack Your Local Epidemiologist. “If flu, RSV, and COVID were all surging at the same time—given how burned out, how understaffed our hospital systems are right now—how would that pan out?”

    But the season’s worst-case scenario—what some called a “tripledemic,” bad enough to make health-care systems crumble—has not yet come to pass. Unlike last year, and the year before, a hurricane of COVID hospitalizations and deaths did not slam the country during the first month of winter; flu and RSV now appear to be in sustained retreat. Even pediatric hospitals, fresh off what many described as their most harrowing respiratory season in memory, finally have some respite, says Mary Beth Miotto, a pediatrician and the president of the Massachusetts chapter of the American Academy of Pediatrics. After a horrific stint, “we are, right now, doing okay.” With two months to go until spring, there is plenty of time for another crisis to emerge: Certain types of influenza, in particular, can be prone to delivering late-season second peaks. “We need to be careful and recognize we’re still in the middle,” Jetelina told me. But so far, this winter “has not been as bad as I expected it to be.”

    No matter what’s ahead, this respiratory season certainly won’t go down in history as a good one. Children across the country have fallen sick in overwhelming numbers, many of them with multiple respiratory viruses at once, amid a nationwide shortage of pediatric meds. SARS-CoV-2 remains a top cause of mortality, with its daily death count still in the hundreds, and long COVID continues to be difficult to prevent or treat. And enthusiasm for new vaccines and virus-blocking mitigations seems to be at an all-time low. Any sense of relief people might be feeling at this juncture must be tempered by what’s in the rearview: three years of an ongoing pandemic that has left more than 1 million people dead in the U.S. alone, and countless others sick, many chronically so. The winter may be going better than it could have. But that shouldn’t hold us back from tackling what’s ahead this season, and in others yet to come.

    Not all of this past autumn’s gloomy predictions were off base. RSV and flu each rushed in on the early side of the season and led to a steep rise in cases. But both viruses made rather hasty exits: RSV hit an apparent apex in mid-November, and flu bent into its own decline the following month. The staggered peaks “helped us quite a bit, in terms of hospitals being stressed,” says Sam Scarpino, the director of AI and life sciences at the Institute for Experiential AI at Northeastern University. In recent days, coronavirus cases and hospitalizations have been tilting downward, too—and severe-disease rates seem to be holding at a relative low. Just under 5 percent of hospital beds are currently occupied by COVID patients, compared with more than four times that fraction this time last year. And weekly COVID deaths are down by almost 75 percent from January 2022. (Death, though, has always been a lagging indicator, and the mortality numbers could still shift upward soon.) Despite some dire predictions to the contrary, the fast-spreading XBB.1.5 subvariant didn’t spark “some giant Omicron-type wave and crush everything,” says Justin Lessler, an infectious-disease modeler at the University of North Carolina at Chapel Hill. “In that sense, I feel good.”

    Read: How worried should we be about XBB.1.5?

    No one can say for sure why we dodged winter’s deadliest bullets, but the population-level immunity that Americans have built up over the past three years clearly played a major role. “That’s a testament to how vaccination has made the disease less dangerous for most people,” says Cedric Dark, an emergency physician at Baylor College of Medicine. Widespread immunization, combined with the fact that most Americans have now been infected, and many of them reinfected, has caused severe-disease rates to plunge, and the virus to move less quickly than it otherwise would have. Antiviral drugs, too, have been slashing hospitalization rates, at least for the meager fraction of recently infected people who use them. The gargantuan asterisk of long COVID still applies to new infections, but the short-term effects of the disease are now more on par with those of other respiratory illnesses, reducing the number of resources that health-care workers must marshal for each case.

    The virus, too, was more merciful than it could have been. XBB.1.5, despite its high transmissibility and penchant for dodging antibodies, doesn’t so far seem more capable of causing severe disease. And the fall’s bivalent shots, though not a perfect match for the newcomer, still improve the body’s response to viruses in the Omicron clan. Competition among respiratory viruses may have also helped soften COVID’s recent blows. In the days and weeks after one infection, bodies can become more resilient to another—a phenomenon known as viral interference that can reduce the risk of simultaneous or back-to-back infections. On population scales, interference can push down surges’ peaks, or at the very least, separate them, potentially keeping hospitals from being hit by a medley of microbes all at once. It’s hard to say for sure: “Many things go into when an epidemic wave happens—human behavior, temperature, humidity, the biology of the virus, the biology of the host,” says Ellen Foxman, an immunologist at Yale. That said, “I do think viral interference probably does play a role that has not been appreciated.”

    None of the experts I spoke with was ready to issue a blanket phew. Overlapping waves of respiratory illness have already led to nonstop sickness, especially among children, draining resources at every point in the pediatric caregiving chain. Kids were kept out of school, and parents stayed home from work; after a glut of COVID-related closures in New Mexico, schools and day cares running low on teachers had to call in the National Guard. Inundated with illnesses, pediatric emergency rooms overflowed; adult-care units had to be repurposed for children, and some hospitals pitched tents on their front lawns to accommodate overflow. Local stopgaps weren’t always enough: At one point, a colleague of Miotto’s in Boston told her that the closest available pediatric ICU bed was in Washington, D.C.

    Read: The worst pediatric-care crisis in decades

    By any metric, for the pediatric community, “it’s been a horrible season, the worst,” says Yvonne Maldonado, a pediatrician at Stanford. “The hospitals were bursting, bursting at the seams.” The flow of fevers has ebbed somewhat in recent weeks, but remains more flood than trickle. “It’s not over: We still don’t have amoxicillin in general, and we still struggle to get fever medication for people,” Miotto said. A parent recently told her that they’d gone to almost 10 pharmacies to try to fill an antibiotic prescription for their child. And pediatric providers across the country are steeling themselves for what the coming weeks could bring. “I think we could still see another surge,” says Joelle Simpson, the division chief of emergency medicine at Children’s National Hospital. “In prior years, February has been one of the worst months.”

    The season’s ongoing woes have been compounded by preexisting health-care shortages. Amid a dearth of funds, some hospitals have reduced their number of pediatric beds; a mass exodus of workers has also limited the resources that can be doled out, even as SARS-CoV-2 testing and isolation protocols continue to stretch the admission and discharge timeline. “Hospitals are in a weaker position than they were before the pandemic,” says Joseph Kanter, Louisiana’s state health officer and medical director. “If that’s the environment in which we are experiencing this year’s respiratory-virus season, it makes everything feel more acute.” Those issues are not limited to pediatrics: Now that COVID is a regular part of the disease roster, workloads have increased for a contingent of beleaguered clinicians that, across the board, seems likely to continue to shrink. In many hospitals, patients are getting stuck in emergency departments for several hours, even multiple days—sometimes never making it to a bed before being sent home. “It seems like hospitals everywhere are full,” Dark told me, not just because of COVID, but because of everything. “The vast majority of the work I do, and that I bet you what most of my colleagues are doing, is taking place in waiting rooms.”

    The U.S. has come a long way in the past three years. But still, “the cumulative toll of these winter surges has been higher than it needs to be,” says Julia Raifman, a health-policy researcher at Boston University. Had more people gone into winter up to date on their COVID vaccines, the virus’s mortality rate could have been driven down further; had more antiviral drugs and other protections been prioritized for the elderly and immunocompromised, fewer people might have been imperiled at all. If relief is percolating across the country right now, that says more about a shift in standards than anything else. “Our threshold for what ‘bad’ looks like has just gotten so out of whack,” Simpson told me. This winter could have been as grim as recent ones, Scarpino told me, with body-filled freezer trucks in parking lots and hospitals on the brink of collapse. But an improvement from those horrific lows isn’t much to brag about. And this winter—three years into combatting a coronavirus for which we have shots, drugs, masks, and more—has been nowhere close to the best one imaginable.

    The concern now, experts told me, is that the U.S. might accept a winter like this one as simply good enough. Regular vaccine uptake could dwindle even further; another wild-card SARS-CoV-2 variant could ignite another conflagration of cases. If that did happen, some researchers worry that we’d be slow to notice: Genomic surveillance is down, and many tests are being taken, unreported, at home. And with so many different immune histories now scattered across the globe, it’s getting tougher for modelers like Lessler to predict where and how quickly new variants might take over.

    The country does have a few factors working in its favor. By next winter, at least one RSV vaccine will almost certainly be available to protect the population’s youngest, eldest, or both. mRNA-based flu vaccines, which are expected to be far faster to develop than currently available shots, are also in the works, and will likely make it easier to match doses to circulating strains. And if, as Foxman hopes, SARS-CoV-2 eventually settles into a more predictable, seasonal pattern, infections will be less of a concern for most of the year and season-specific immunizations could be easier to design.

    Read: Should everyone be masking again?

    But no vaccine will do much unless enough people are willing and able to take it—and the public-health infrastructure that’s led many outreach efforts remains underfunded and understaffed. Kanter worries that the nation may not be terribly willing to invest. “We’ve fallen into this complacency trap where we just accept a given amount of mortality every year as unavoidable,” he told me. It doesn’t have to be that way, as the past few years have shown: Treatments, vaccines, clean indoor air, and other measures can lower a respiratory virus’s toll.

    By the middle of spring, the U.S. will be in a position to let the public-health-emergency declaration on COVID lapse—a decision that could roll back protections for the uninsured, and ratchet up price points on shots and antivirals. This winter’s retrospective is likely to influence that decision, Scarpino told me. But relief can breed complacency, and complacency further slows a sluggish public-health response. The fate of next winter—and of every winter after that—will depend on whether the U.S. decides to view this season as a success, or to recognize it as a shaky template for well-being that can and should be improved.

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    Katherine J. Wu

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  • How Worried Should We Be About XBB.1.5?

    How Worried Should We Be About XBB.1.5?

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    After months and months of SARS-CoV-2 subvariant soup, one ingredient has emerged in the United States with a flavor pungent enough to overwhelm the rest: XBB.1.5, an Omicron offshoot that now accounts for an estimated 75 percent of cases in the Northeast. A crafty dodger of antibodies that is able to grip extra tightly onto the surface of our cells, XBB.1.5 is now officially the country’s fastest-spreading coronavirus subvariant. In the last week of December alone, it zoomed from 20 percent of estimated infections nationwide to 40 percent; soon, it’s expected to be all that’s left, or at least very close. “That’s the big thing everybody looks for—how quickly it takes over from existing variants,” says Shaun Truelove, an infectious-disease modeler at Johns Hopkins University. “And that’s a really quick rise.”

    All of this raises familiar worries: more illness, more long COVID, more hospitalizations, more health-care system strain. With holiday cheer and chilly temperatures crowding people indoors, and the uptake of bivalent vaccines at an abysmal low, a winter wave was already brewing in the U.S. The impending dominance of an especially speedy, immune-evasive variant, Truelove told me, could ratchet up that swell.

    But the American public has heard that warning many, many, many times before—and by and large, the situation has not changed. The world has come a long way since early 2020, when it lacked vaccines and drugs to combat the coronavirus; now, with immunity from shots and past infections slathered across the planet—porous and uneven though that layer may be—the population is no longer nearly so vulnerable to COVID’s worst effects. Nor is XBB.1.5 a doomsday-caliber threat. So far, no evidence suggests that the subvariant is inherently more severe than its predecessors. When its close sibling, XBB, swamped Singapore a few months ago, pushing case counts up, hospitalizations didn’t undergo a disproportionately massive spike (though XBB.1.5 is more transmissible, and the U.S. is less well vaccinated). Compared with the original Omicron surge that pummeled the nation this time last year, “I think there’s less to be worried about,” especially for people who are up to date on their vaccines, says Mehul Suthar, a viral immunologist at Emory University who’s been studying how the immune system reacts to new variants. “My previous exposures are probably going to help against any XBB infection I have.”

    SARS-CoV-2’s evolution is still worth tracking closely through genomic surveillance—which is only getting harder as testing efforts continue to be pared back. But “variants mean something a little different now for most of the world than they did earlier in the pandemic,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, who’s been tracking the proportions of SARS-Cov-2 variants around the world. Versions of the virus that can elude a subset of our immune defenses are, after all, going to keep on coming, for as long as SARS-CoV-2 is with us—likely forever, as my colleague Sarah Zhang has written. It’s the classic host-pathogen arms race: Viruses infect us; our bodies, hoping to avoid a similarly severe reinfection, build up defenses, goading the invader into modifying its features so it can infiltrate us anew.

    Read: How long can the coronavirus keep infecting us?

    But the virus is not evolving toward the point where it’s unstoppable; it’s only switching up its fencing stance to sidestep our latest parries as we do the same for it. A version of the virus that succeeds in one place may flop in another, depending on the context: local vaccination and infection histories, for instance, or how many elderly and immunocompromised individuals are around, and the degree to which everyone avoids trading public air. With the world’s immune landscape now so uneven, “it’s getting harder for the virus to do that synchronized wave that Omicron did this time last year,” says Verity Hill, an evolutionary virologist at Yale. It will keep trying to creep around our defenses, says Pavitra Roychoudhury, who’s monitoring SARS-CoV-2 variants at the University of Washington, but “I don’t think we need to have alarm-bell emojis for every variant that comes out.”

    Read: The coronavirus’s next move

    Some particularly worrying variants and subvariants will continue to arise, with telltale signs, Roychoudhury told me: a steep increase in wastewater surveillance, followed by a catastrophic climb in hospitalizations; a superfast takeover that kicks other coronavirus strains off the stage in a matter of days or weeks. Omens such as these hint at a variant that’s probably so good at circumventing existing immune defenses that it will easily sicken just about everyone again—and cause enough illness overall that a large number of cases turn severe. Also possible is a future variant that is inherently more virulent, adding risk to every new case. In extreme versions of these scenarios, tests, treatments, and masks might need to come back into mass use; researchers may need to concoct a new vaccine recipe  at an accelerated pace. But that’s a threshold that most variations of SARS-CoV-2 will not clear—including, it seems so far, XBB.1.5. Right now, Hodcroft told me, “it’s hard to imagine that anything we’ve been seeing in the last few months would really cause a rush to do a vaccine update,” or anything else similarly extreme. “We don’t make a new flu vaccine every time we see a new variant, and we see those all through the year.” Our current crop of BA.5-focused shots is not a great match for XBB.1.5, as Suthar and his colleagues have found, at least on the antibody front. But antibodies aren’t the only defenses at play—and Suthar told me it’s still far better to have the new vaccine than not.

    In the U.S., wastewater counts and hospitalizations are ticking upward, and XBB.1.5 is quickly elbowing out its peers. But the estimated infection rise doesn’t seem nearly as steep as the ascension of the original Omicron variant, BA.1 (though our tracking is now poorer). XBB.1.5 also isn’t dominating equally in different parts of the country—and Truelove points out that it doesn’t yet seem tightly linked to hospitalizations in the places where it’s gained traction so far. As tempting as it may be to blame any rise in cases and hospitalizations on the latest subvariant, our own behaviors are at least as important. Drop-offs in vaccine uptake or big jumps in mitigation-free mingling can drive spikes in illness on their own. “We were expecting a wave already, this time of year,” Hill told me. Travel is up, masking is down. And just 15 percent of Americans over the age of 5 have received a bivalent shot.

    The pace at which new SARS-CoV-2 variants and subvariants take over could eventually slow, but the experts I spoke with weren’t sure this would happen. Immunity across the globe remains patchy; only a subset of countries have access to updated bivalent vaccines, while some countries are still struggling to get first doses into millions of arms. And with nearly all COVID-dampening mitigations “pretty much gone” on a global scale, Hodcroft told me, it’s gotten awfully easy for the coronavirus to keep experimenting with new ways to stump our immune defenses. XBB.1.5 is both the product and the catalyst of unfettered spread—and should that continue, the virus will take advantage again.

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    Katherine J. Wu

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  • The Inflated Risk of Vaccine-Induced Cardiac Arrest

    The Inflated Risk of Vaccine-Induced Cardiac Arrest

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    During this week’s Monday Night Football game, the 24-year-old Buffalo Bills safety Damar Hamlin collapsed moments after making a routine defensive play. Hamlin seemed to have suffered a blow to his chest shortly before losing consciousness from cardiac arrest, and his condition is grave. The source of his illness remains unclear. A study of sudden cardiac events in U.S. athletes from 2014 to 2016 found that structural abnormalities of the heart muscle or arteries and faulty electric rhythms were the most common causes; traumatic chest injuries have also been linked to such incidents, in a rare condition called commotio cordis. Still, the availability of these hypotheses did not stop online activists from blaming Hamlin’s health crisis on vaccines.

    Anti-vaccine influencers have been fomenting fear about a supposed rise in COVID-shot-induced athletic deaths for a while. Fact-checkers have repeatedly assessed these claims and found them to be without merit. Jonathan Drezner, a sports-medicine physician who studies sudden deaths in athletes, told media outlets last year that he was “not aware of any COVID-19 vaccine-related athletic death.” The National Center for Catastrophic Sport Injury Research, which systematically tracks sports-related fatalities, identified 13 medical deaths during football-related activities in 2021 among players participating at all levels of competition, eight of which were caused by cardiac arrest. The same researchers had found 14 medical deaths two years earlier, 10 of which were heart-related. These incidents remain tragic and scarce.

    The mRNA shots by Pfizer and Moderna are associated with a very small risk of heart inflammation, called myocarditis, which can lead to cardiac arrest. This risk is most pronounced in teenage boys receiving a second dose of the vaccine, but even in that scenario only about one in 10,000 recipients is affected. (Most professional athletes are in their 20s, not teens, so the risk to them is lower.) Myocarditis is a potentially fatal condition, but the version that occurs after vaccination is much less deadly than the heart inflammation induced by many viruses, including SARS-CoV-2. A recent analysis identified only a single death in 104 cases of vaccine-induced myocarditis. In comparison, for every 100 people who get myocarditis from a virus, about 11 will die.

    Read: The selfishness of Novak Djokovic

    The mere fact that mRNA shots can lead to heart problems has been exploited by conservative commentators and politicians to exaggerate the risks to young people. Last month, per a news release, Florida Governor Ron DeSantis promised to look into “sudden deaths of individuals that received the COVID-19 vaccine,” and called for a grand jury to investigate alleged wrongdoing by the vaccine manufacturers. His petition to the Florida Supreme Court justified the investigation by pointing out that “excess mortality from heart attacks rose significantly during the COVID-19 pandemic, especially among individuals ages 25 to 44.” Yet the rise in youth heart attacks actually began in 2020, before vaccines were available. That’s because increased cardiac fatalities during the pandemic have mostly been due to the coronavirus itself. Heart-disease deaths in the United States have been observed to rise and fall in near lockstep with waves of COVID deaths, suggesting that most of these cases—97 percent, according to one estimate—are the result of undocumented SARS-CoV-2 infection.

    DeSantis’s crusade against vaccines is backed by his surgeon general, Joseph Ladapo, who is a staunch opponent of inoculating young people against COVID. (He has encouraged the use of ineffective therapies such as hydroxychloroquine and ivermectin, though.) In October, Ladapo’s department produced an anonymous, non-peer-reviewed analysis suggesting that COVID shots were causing an increase in cardiac fatalities in young men. This report was modeled on a study by the U.K. government, which came to the opposite conclusion about vaccines but did find that COVID infection was associated with a sixfold increase in youth cardiac death. Given the lack of detail provided in the Florida study, it’s hard to know how to reconcile its contradictory result. This week, a group of University of Florida physicians and scientists released a report that strongly criticized the work’s methodology.

    The COVID vaccines are among the most widely used medical interventions. More than 13 billion doses have been administered, at least 1 billion of which relied on mRNA technology. In analyzing this trove of real-world data, researchers have occasionally identified potential safety issues. A lack of perfect consistency across their studies is expected, and only confirms that the scientific dialogue about this new technology has been transparent. Scientists know that findings made outside a clinical trial are prone to spurious associations, so they examine how well each analysis has been performed and interpret it in the context of prior research.

    Read: The core lesson of the COVID-19 heart debate

    Vaccine skeptics prefer to cherry-pick supportive studies while ignoring others that contradict them. Ladapo, for example, has cited a Scandinavian report showing a potential increase in post-vaccine blood clots and heart attacks. Yet the study authors themselves cautioned readers against relying too heavily on their results, because the finding was observed in only some age groups and time periods but not others. Ladapo also failed to mention that similar studies out of the U.K., France, Scotland, and elsewhere had not found a meaningful increase in blood clots or heart attacks with mRNA shots.

    A careful recitation of facts can take one only so far in combatting anti-vaccine claims. Activists use ambiguous anecdotes such as Hamlin’s cardiac arrest and the sudden death of the soccer journalist Grant Wahl during last month’s World Cup to make the alleged risks of the shots more visceral. Sports are much less dangerous than SARS-CoV-2, but when unexpected tragedies do occur, they lead to an outpouring of mourning and reflection. Collective trauma can easily give way to collective speculation, and partisans on all sides will be happy to tell us what really happened. Yet convenient scapegoats will not be enough to mend our grief.

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    Benjamin Mazer

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  • It’s Beginning to Look a Lot Like Another COVID Surge

    It’s Beginning to Look a Lot Like Another COVID Surge

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    When I called the epidemiologist Denis Nash this week to discuss the country’s worsening COVID numbers, he was about to take a rapid test. “I came in on the subway to work this morning, and I got a text from home,” Nash, a professor at the City University of New York, told me. “My daughter tested positive for COVID.”

    Here we go again: For the first time in several months, another wave seems to be on the horizon in the United States. In the past two weeks, reported cases have increased by 53 percent, and hospitalizations have risen by 31 percent. Virus levels in wastewater, which can provide an advance warning of spread, are following a similar trajectory. After the past two years, a winter surge “was always expected,” Nash said. Respiratory illnesses thrive in colder weather, when people tend to spend more time indoors. Thanksgiving travel and gatherings were likewise predicted to drive cases, Anne Rimoin, an epidemiologist at UCLA, told me. If people were infected then, their illnesses will probably start showing up in the data around now. “We’re going to see a surge [that is] likely going to start really increasing in velocity,” she said.

    Winter has ushered in some of the pandemic’s worst moments. Last year, Omicron’s unwanted arrival led to a level of mass infection across the country that we had not previously seen. The good news this year is that the current rise will almost certainly not be as bad as last year’s. But beyond that, experts told me, we don’t know much about what will happen next. We could be in for any type of surge—big or small, long or short, national or regional. The only certain thing is that cases and hospitalizations are rising, and that’s not good.

    The pandemic numbers are ticking upward across the country, but so far the recent increases seem especially sharp in the South and West. The daily average of reported cases in Mississippi, Georgia, Texas, South Carolina, and Alabama has doubled in the past two weeks. Hospitalizations have been slower to rise, but over the same time frame, daily hospitalizations in California have jumped 57 percent and are now higher than anywhere else in the United States. Other areas of the country, such as New York City, have also seen troubling increases.

    Whether the nationwide spike constitutes the long-predicted winter wave, and not just an intermittent rise in cases, depends on whom you ask. “I think it will continue,” Gregory Poland, a professor of medicine at the Mayo Clinic, told me. “We will pour more gas on the fire with Christmas travel.” Others hesitated to classify the uptick as such, because it has just begun. “It’s hard to know, but the case numbers are moving in the wrong direction,” Rimoin said. Case counts are unreliable as people have turned to at-home testing (or just not testing at all), though hospitalizations and wastewater readings remain reliable, albeit imperfect, metrics. “I’ve not seen a big enough change to call it a wave,” Susan Kline, an infectious-diseases expert at the University of Minnesota Medical School, told me.

    But what to call the ongoing trend matters less than the fact that it exists. For now, what happens next is anyone’s guess. The dominant variants—the Omicron offshoots BQ.1 and BQ.1.1—are worrying, but they don’t pose the same challenges as what hit us last winter. Omicron drove that wave, taking us and our immune systems by surprise. The emergence of a completely new variant is possible this year—and would change everything—but that is considered unlikely.

    The lack of data on people’s immune status makes it especially difficult to predict the outcome of the current rise. Widespread vaccination and infection mean we have a stronger wall of immunity now compared with the previous two winters, but that protection inevitably fades with time. The problem is, people fall sick asynchronously and get boosted on their own schedules, so the timing varies for everyone. “We don’t know anything about how long ago people were [vaccinated], and we don’t know anything about hybrid immunity, so it’s impossible to predict” just how bad things could get, Nash said.

    Still, a confluence of factors has created the ideal conditions for a sustained surge with serious consequences for those who get sick. Fading immunity, frustratingly low booster uptake, and the near-total abandonment of COVID precautions create ideal conditions for the virus to spread. Meanwhile, treatments for those who do get very sick are dwindling. None of the FDA-approved monoclonal antibodies, which are especially useful for the immunocompromised, works against BQ.1 and BQ.1.1., which make up about 68 percent of cases nationwide. Paxlovid is still effective, but it’s underprescribed by providers and, by one medical director’s estimate, refused by 20 to 30 percent of patients.

    The upside is that few people who get COVID now will get very sick—fewer than in previous winters. Even if cases continue to surge, most infections will not lead to severe illness because the bulk of the population has some level of immunity from vaccination, previous infection, or both. Still, long COVID can be “devastating,” Poland said, and it can develop after mild or even asymptomatic cases. But any sort of wave would in all likelihood lead to an uptick in deaths, too. So far, the death rate has remained stable, but 90 percent of people dying now are 65 and older, and only a third of them have the latest booster. Such low uptake “just drives home the fact that we have not really done a good job of targeting the right people around the country,” Nash said.

    Even if the winter COVID wave is not ultimately a big one, it will likely be bad news for hospitals, which are already filling up with adults with flu and children with respiratory syncytial virus, or RSV. Many health-care facilities are swamped; the situation will only worsen if there is a big wave. If you need help for severe COVID—or any kind of medical issue—more than likely, “you’re not going to get the same level of care that you would have without these surges,” Poland said. Critically ill kids are routinely turned away from overflowing emergency rooms, my colleague Katherine J. Wu recently reported.

    We can do little to predict how the ongoing surge might develop other than simply wait. Soon we should have a better sense of whether this is a blip in the pandemic or something more serious, and the trends of winters past can be helpful, Kline said. Last year, the Omicron-fueled surge did not begin in earnest until mid-December. “We haven’t even gotten to January yet, so I really think we’re not going to know [how bad this surge will be] for two months,” Kline said. Until then, “we just have to stay put and watch.”

    It is maddening that, this far into the pandemic, “stay put and watch” seems to be the only option when cases start to rise. It is not, of course: Plenty of tools—masking, testing, boosters—are within our power to deploy to great effect. They could flatten the wave, if enough people use them. “We have the tools,” said Nash, whose rapid test came out negative, “but the collective will is not really there to do anything about it.”

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    Yasmin Tayag

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  • Pandemic Babies’ Microbiomes Are Bound to Be Different

    Pandemic Babies’ Microbiomes Are Bound to Be Different

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    In the spring of 2021, Brett Finlay, a microbiologist at the University of British Columbia, offered the world a bold and worrying prediction. “My guess is that five years from now we are going to see a bolus of kids with asthma and obesity,” he told Wired. Those children, he said, would be “the COVID kids”: those born just before or during the height of the crisis, when the coronavirus was everywhere, and we cleaned everything because we didn’t want it to be.

    Finlay’s forecast isn’t unfounded. As James Hamblin wrote in The Atlantic last year, our health relies on a constant discourse with trillions of microbes that live on or inside our bodies. The members of the so-called microbiome are crucial for digesting our food, training the immune system, even greasing the wheels of cognitive function; there does not seem to be a bodily system that these tiny tenants do not in some way affect. These microbe-human dialogues begin in infancy, and the first three or so years of life are absolutely pivotal: Bacteria must colonize babies, then the two parties need to get into physiological sync. Major disruptions during this time “can throw the system out of whack,” says Katherine Amato, a biological anthropologist at Northwestern University, and raise a kid’s risk of developing allergies, asthma, obesity, and other chronic conditions later in life.

    The earlier, more intense, and more prolonged the interruptions, the worse. Infants who receive heavy courses of antibiotics—which can nuke microbial diversity—are at greater risk of developing such problems; the same is roughly true for babies who are born by C-section, who formula feed, or who grow up in nature-poor environments. If pandemic-era mitigations re-create even an echo of those effects, that could spell trouble for a whole lot of little kids who may have lost out on beneficial microbes in the ongoing effort to keep nasty ones at bay.

    More than a year and a half after Finlay’s original prediction, children are back in day care and school. People no longer keep their distance or avoid big crowds. Even hygiene theater is (mostly) on the wane. And if the wave of respiratory viral illness now slamming much of the Northern Hemisphere is any indication, microbes are once again swirling between tiny hands and mouths. But for the circa-COVID kids, the specter of 2026 and Finlay’s anticipated chronic-illness “bump” still looms—and it’ll be a good while yet before researchers have clarity on just how much of a difference those months of relative microbial emptiness truly made.

    Read: A year without germs

    For now, “we are in the realm of speculation,” says Maria Gloria Dominguez Bello, a microbiologist at Rutgers. Scientists don’t understand how, or even which, behaviors may affect the composition of our inner flora throughout our life span. Chronic illnesses such as obesity and asthma also take time to manifest. There’s not yet evidence that they’re on the rise among children, and even if they were, researchers wouldn’t expect to see the signal for at least a couple of years, perhaps more.

    Finlay, for one, stands by his original prediction that the pandemic will bring a net microbiome negative. “We underwent a massive societal shift,” he told me. “I am sure we will see an effect.” And he is not the only one who thinks so. “I think it’s almost inevitable that there has been an impact,” says Graham Rook, a medical microbiologist at University College London. If the middle of this decade passes without incident, Rook told me, “I would be very surprised.” Other researchers, though, aren’t so sure. “I don’t think we have doomed a generation of kids,” says Melissa Manus, an anthropologist and microbiome researcher at the University of Manitoba. A few scientists are even pondering whether the pandemic’s ripple effects may have buoyed the microbiomes of the COVID kids. Martin Blaser, a microbiologist at Rutgers University, told me that, “with any luck,” rates of asthma and obesity might even dip in the next few years.

    When it comes to the pandemic’s potential fallout, researchers agree on just one thing: COVID babies undoubtedly had an unusual infancy; on average, their microbiomes are bound to look quite different. Different, though, isn’t necessarily bad. “It’s not like there is one golden microbiome,” says Efrem Lim, a microbiologist at Arizona State University. Take Liz Johnson’s sons, born in March 2018, August 2020, and March 2022. All three were born vaginally, in the same hospital, with the assistance of the same midwife; all of them then breastfed; and none of them has undergone an early, concerning antibiotic course. And still, “they all started off with different microbiomes,” she told me. (As a microbiome researcher at Cornell focused on infant nutrition, Johnson can check.)

    That’s probably totally fine. Across the human population, microbiomes are known to vary wildly: People can carry hundreds of bacterial species on and inside their bodies, with potentially zero overlap from one individual to the next. Bacterial communities aren’t unlike recipes—if you don’t have one ingredient on hand, another can usually take its place.

    Johnson’s middle son, Lucas, had a starkly different birth experience from that of his older brother—even, in many ways, from that of his younger brother. Lucas was born into a delivery room full of masked faces. In the days after his arrival, no family members came to visit him in the hospital. And although his brothers spent several of their early months jet-setting all around the world with their mother for work trips, Lucas stayed put. “Hardly anybody even knew he was born,” Johnson told me. But throughout his first two years, Lucas still breastfed and had plenty of contact with his family at home, as well as with other kids at day care; he romped in green spaces galore. Yet Johnson and others can’t say, precisely, whether all of that outweighs the sanitariness and the uncrowdedness of Lucas’s earliest days. There would have been a cost to both overcaution and under-caution, “so we just tried to balance everything,” Johnson said. When it comes down to it, scientists just don’t know how much microbial exposure constitutes enough.

    Read: Pregnant? Breastfeeding? The vaccine might protect you and your baby

    Among COVID babies, microbiome mileage will probably vary, depending on what decisions their parents made at the height of the pandemic—which itself hinges on the sorts of financial and social resources they had. Amato worries most about the families that may have packaged a bunch of sanitizing behaviors together with more established cullers of microbiome diversity: C-sections, formula-feeding, and antibiotic use. Meghan Azad, an infant-health researcher at the University of Manitoba, told me that some new parents might have found it far tougher to breastfeed during the pandemic’s worst—a time when in-person counseling resources were harder to access, and employment was in flux. Chronically poor diets and stress, which many people experienced these past few years, can also chip away at microbiome health.

    Part of the problem is that many of these risk factors, Rook told me, will disproportionately coalesce among people of lower socioeconomic status, who already tend to have less diverse microbiomes. “I worry this will further increase the health disparity between the rich and the poor,” he said. Even SARS-CoV-2 infections themselves, which have continued to concentrate among essential workers and in crowded living settings, appear to alter the microbiome—a shift that may be temporary in adults, but potentially less so in infants, whose microbiomes haven’t yet matured into a stable state.

    Many families exist in a gray zone. Maybe they bleached their households often, but found it easier to breastfeed and cook healthful meals while working from home. Maybe their kids weren’t mingling with tons of other toddlers at day care, but they spent much more time rolling around in the backyard, coated in their pandemic puppy’s drool. If all of those factors feed into an equation that sums up to healthy or not, scientists can’t yet do the math. They’re still figuring out how to appropriately weigh each component, and how to identify others they’ve missed.

    Even in the absence of extra outdoorsiness or dog slobber, Lim isn’t very concerned about the behavioral mitigations people picked up. We’re all “exposed to thousands of microbes all the time,” Lim, who has a 1-and-a-half-year-old daughter, told me. Some extra hand-washing, masking, and time at home is nothing compared with, say, an antibiotic blitzkrieg. Even kids who stayed pretty cloistered “were not living in a bubble.” Some of the social sacrifices kids made may even have strange silver linings. Children no longer attending day care or preschool might have skirted a whole slew of other viral infections that would otherwise have gotten them inappropriate and microbiome-damaging antibiotics prescriptions. Antibiotic use in outpatient settings dropped substantially in 2020, compared with the prior year. Stacked up against the relatively minor toll of pandemic mitigations, Blaser told me, the plus of avoiding antibiotics might just win out. When antibiotic use declines, for example, so do asthma rates.

    Finlay and others are still keeping an eye out for signals that might start to appear in the next few years. Perhaps most at risk are kids whose families went into “hyper-hygiene mode” in the first couple months of their life, when microbes are crucial for properly calibrating the immune system’s anti-pathogen alarms. Miss out on those opportunities, and our body’s defensive cells might end up mistaking enemies for allies, or vice versa, sparking particularly severe infections or autoimmune disease. Once wired into a developing child, Finlay said, such changes might be difficult to reverse, especially for the youngest of the COVID cohort. But other experts are hopeful that certain microbial losses can still be recouped through some combination of diet, outdoor play, and socialization (with people who aren’t sick)—restorative interventions that, ideally, happen as early as possible. “The sooner we fix it, the better,” Blaser said.

    Read: The pandemic broke the flu … again

    No one can choose precisely which microbes to be exposed to: Tactics that halt the transmission of known pathogens have a way of halting the transmission of benign bugs too. But context matters. It’s possible for microbe-inviting behaviors, such as outdoor play, to coexist alongside microbe-shunning tactics, such as ventilating indoor spaces when there’s a massive respiratory outbreak. The fact that we can influence microbial colonization at all is powerful. During the pandemic, mitigations that kept COVID at bay also cratered rates of flu and RSV. Now that those viruses are back, experts are pointing out that we already know how they can once again be stopped. And the choices that people made, and continue to make, to protect their families from pathogens shouldn’t be viewed as some harmful mistake, says Ariangela Kozik, a microbiologist at the University of Michigan.

    Pandemic kids can get on board with that concept too. Kozik’s now-7-year-old son was a toddler when the pandemic began; even amid society’s hygiene craze, he learned the joys of tumbling around in the dirt and playing with the family’s two dogs. “We talk about how not all germs are the same,” Kozik told me. Her son also picked up and maintained an infection-quashing habit that makes his mom proud: Every day, when he comes home from school, he makes a beeline for the sink to wash his hands. “It’s the first thing he does,” Kozik told me, “even without being asked.”

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    Katherine J. Wu

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  • The Pandemic’s Legacy Is Already Clear

    The Pandemic’s Legacy Is Already Clear

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    Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that “the pandemic is over.” Anthony Fauci described the controversy around the proclamation as a matter of “semantics,” but the facts we are living with can speak for themselves. COVID still kills roughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic “over” is like calling a fight “finished” because your opponent is punching you in the ribs instead of the face.

    American leaders and pundits have been trying to call an end to the pandemic since its beginning, only to be faced with new surges or variants. This mindset not only compromises the nation’s ability to manage COVID, but also leaves it vulnerable to other outbreaks. Future pandemics aren’t hypothetical; they’re inevitable and imminent. New infectious diseases have regularly emerged throughout recent decades, and climate change is quickening the pace of such events. As rising temperatures force animals to relocate, species that have never coexisted will meet, allowing the viruses within them to find new hosts—humans included. Dealing with all of this again is a matter of when, not if.

    In 2018, I wrote an article in The Atlantic warning that the U.S. was not prepared for a pandemic. That diagnosis remains unchanged; if anything, I was too optimistic. America was ranked as the world’s most prepared country in 2019—and, bafflingly, again in 2021—but accounts for 16 percent of global COVID deaths despite having just 4 percent of the global population. It spends more on medical care than any other wealthy country, but its hospitals were nonetheless overwhelmed. It helped create vaccines in record time, but is 67th in the world in full vaccinations. (This trend cannot solely be attributed to political division; even the most heavily vaccinated blue state—Rhode Island—still lags behind 21 nations.) America experienced the largest life-expectancy decline of any wealthy country in 2020 and, unlike its peers, continued declining in 2021. If it had fared as well as just the average peer nation, 1.1 million people who died last year—a third of all American deaths—would still be alive.

    America’s superlatively poor performance cannot solely be blamed on either the Trump or Biden administrations, although both have made egregious errors. Rather, the new coronavirus exploited the country’s many failing systems: its overstuffed prisons and understaffed nursing homes; its chronically underfunded public-health system; its reliance on convoluted supply chains and a just-in-time economy; its for-profit health-care system, whose workers were already burned out; its decades-long project of unweaving social safety nets; and its legacy of racism and segregation that had already left Black and Indigenous communities and other communities of color disproportionately burdened with health problems. Even in the pre-COVID years, the U.S. was still losing about 626,000 people more than expected for a nation of its size and resources. COVID simply toppled an edifice whose foundations were already rotten.

    In furiously racing to rebuild on this same foundation, America sets itself up to collapse once more. Experience is reputedly the best teacher, and yet the U.S. repeated mistakes from the early pandemic when faced with the Delta and Omicron variants. It got early global access to vaccines, and nonetheless lost almost half a million people after all adults became eligible for the shots. It has struggled to control monkeypox—a slower-spreading virus for which there is already a vaccine. Its right-wing legislators have passed laws and rulings that curtail the possibility of important public-health measures like quarantines and vaccine mandates. It has made none of the broad changes that would protect its population against future pathogens, such as better ventilation or universal paid sick leave. Its choices virtually guarantee that everything that’s happened in the past three years will happen again.

    The U.S. will continue to struggle against infectious diseases in part because some of its most deeply held values are antithetical to the task of besting a virus. Since its founding, the country has prized a strain of rugged individualism that prioritizes individual freedom and valorizes self-reliance. According to this ethos, people are responsible for their own well-being, physical and moral strength are equated, social vulnerability results from personal weakness rather than policy failure, and handouts or advice from the government are unwelcome. Such ideals are disastrous when handling a pandemic, for two major reasons.

    First, diseases spread. Each person’s choices inextricably affect their community, and the threat to the collective always exceeds that to the individual. The original Omicron variant, for example, posed slightly less risk to each infected person than the variants that preceded it, but spread so quickly that it inundated hospitals, greatly magnifying COVID’s societal costs. To handle such threats, collective action is necessary. Governments need policies, such as vaccine requirements or, yes, mask mandates, that protect the health of entire populations, while individuals have to consider their contribution to everyone else’s risk alongside their own personal stakes. And yet, since the spring of 2021, pundits have mocked people who continue to think this way for being irrational and overcautious, and government officials have consistently framed COVID as a matter of personal responsibility.

    Second, a person’s circumstances always constrain their choices. Low-income and minority groups find it harder to avoid infections or isolate when sick because they’re more likely to live in crowded homes and hold hourly-wage jobs without paid leave or the option to work remotely. Places such as prisons and nursing homes, whose residents have little autonomy, became hot spots for the worst outbreaks. Treating a pandemic as an individualist free-for-all ignores how difficult it is for many Americans to protect themselves. It also leaves people with vulnerabilities that last across successive pathogens: The groups that suffered most during the H1N1 influenza pandemic of 2009 were the same ones that took the brunt of COVID, a decade later.

    America’s individualist bent has also shaped its entire health-care system, which ties health to wealth and employment. That system is organized around treating sick people at great and wasteful expense, instead of preventing communities from falling sick in the first place. The latter is the remit of public health rather than medicine, and has long been underfunded and undervalued. Even the CDC—the nation’s top public-health agency—changed its guidelines in February to prioritize hospitalizations over cases, implicitly tolerating infections as long as hospitals are stable. But such a strategy practically ensures that emergency rooms will be overwhelmed by a fast-spreading virus; that, consequently, health-care workers will quit; and that waves of chronically ill long-haulers who are disabled by their infections will seek care and receive nothing. All of that has happened and will happen again. America’s pandemic individualism means that it’s your job to protect yourself from infection; if you get sick, your treatment may be unaffordable, and if you don’t get better, you will struggle to find help, or even anyone who believes you.

    In the late 19th century, many scholars realized that epidemics were social problems, whose spread and toll are influenced by poverty, inequality, overcrowding, hazardous working conditions, poor sanitation, and political negligence. But after the advent of germ theory, this social model was displaced by a biomedical and militaristic one, in which diseases were simple battles between hosts and pathogens, playing out within individual bodies. This paradigm conveniently allowed people to ignore the social context of disease. Instead of tackling intractable social problems, scientists focused on fighting microscopic enemies with drugs, vaccines, and other products of scientific research—an approach that sat easily with America’s abiding fixation on technology as a panacea.

    The allure of biomedical panaceas is still strong. For more than a year, the Biden administration and its advisers have reassured Americans that, with vaccines and antivirals, “we have the tools” to control the pandemic. These tools are indeed effective, but their efficacy is limited if people can’t access them or don’t want to, and if the government doesn’t create policies that shift that dynamic. A profoundly unequal society was always going to struggle with access: People with low incomes, food insecurity, eviction risk, and no health insurance struggled to make or attend vaccine appointments, even after shots were widely available. A profoundly mistrustful society was always going to struggle with hesitancy, made worse by political polarization and rampantly spreading misinformation. The result is that just 72 percent of Americans have completed their initial course of shots and just half have gotten the first of the boosters necessary to protect against current variants. At the same time, almost all other protections have been stripped away, and COVID funding is evaporating. And yet the White House’s recent pandemic-preparedness strategy still focuses heavily on biomedical magic bullets, paying scant attention to the social conditions that could turn those bullets into duds.

    Technological solutions also tend to rise into society’s penthouses, while epidemics seep into its cracks. Cures, vaccines, and diagnostics first go to people with power, wealth, and education, who then move on, leaving the communities most affected by diseases to continue shouldering their burden. This dynamic explains why the same health inequities linger across the decades even as pathogens come and go, and why the U.S. has now normalized an appalling level of COVID death and disability. Such suffering is concentrated among elderly, immunocompromised, working-class, and minority communities—groups that are underrepresented among political decision makers and the media, who get to declare the pandemic over. Even when inequities are highlighted, knowledge seems to suppress action: In one study, white Americans felt less empathy for vulnerable communities and were less supportive of safety precautions after learning about COVID’s racial disparities. This attitude is self-destructive and limits the advantage that even the most privileged Americans enjoy. Measures that would flatten social inequities, such as universal health care and better ventilation, would benefit everyone—and their absence harms everyone, too. In 2021, young white Americans died at lower rates than Black and Indigenous Americans, but still at three times the rate of their counterparts in other wealthy countries.

    By failing to address its social weaknesses, the U.S. accumulates more of them. An estimated 9 million Americans have lost close loved ones to COVID; about 10 percent will likely experience prolonged grief, which the country’s meager mental-health services will struggle to address. Because of brain fog, fatigue, and other debilitating symptoms, long COVID is keeping the equivalent of 2 million to 4 million Americans out of work; between lost earnings and increased medical costs, it could cost the economy $2.6 trillion a year. The exodus of health-care workers, especially experienced veterans, has left hospitals with a shortfall of staff and know-how. Levels of trust—one of the most important predictors of a country’s success at controlling COVID—have fallen, making pandemic interventions harder to deploy, while creating fertile ground in which misinformation can germinate. This is the cost of accepting the unacceptable: an even weaker foundation that the next disease will assail.

    In the spring of 2020, I wrote that the pandemic would last for years, and that the U.S. would need long-term strategies to control it. But America’s leaders consistently acted as if they were fighting a skirmish rather than a siege, lifting protective measures too early, and then reenacting them too slowly. They have skirted the responsibility of articulating what it would actually look like for the pandemic to be over, which has meant that whenever citizens managed to flatten the curve, the time they bought was wasted. Endemicity was equated with inaction rather than active management. This attitude removed any incentive or will to make the sort of long-term changes that would curtail the current disaster and prevent future ones. And so America has little chance of effectively countering the inevitable pandemics of the future; it cannot even focus on the one that’s ongoing.

    If change happens, it will likely occur slowly and from the ground up. In the vein of ACT UP—the extraordinarily successful activist group that changed the world’s approach to AIDS—grassroots organizations of long–haulers, grievers, immunocompromised people, and others disproportionately harmed by the pandemic have formed, creating the kind of vocal constituency that public health has long lacked.

    More pandemics will happen, and the U.S. has spectacularly failed to contain the current one. But it cannot afford the luxury of nihilism. It still has time to address its bedrocks of individualism and inequality, to create a health system that effectively prevents sickness instead of merely struggling to treat it, and to enact policies that rightfully prioritize the needs of disabled and vulnerable communities. Such changes seem unrealistic given the relentless disappointments of the past three years, but substantial social progress always seems unfeasible until it is actually achieved. Normal led to this. It is not too late to fashion a better normal.

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    Ed Yong

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  • The Strongest Signal That Americans Should Worry About Flu This Winter

    The Strongest Signal That Americans Should Worry About Flu This Winter

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    Sometime in the spring of 2020, after centuries, perhaps millennia, of tumultuous coexistence with humans, influenza abruptly went dark. Around the globe, documented cases of the viral infection completely cratered as the world tried to counteract SARS-CoV-2. This time last year, American experts began to fret that the flu’s unprecedented sabbatical was too bizarre to last: Perhaps the group of viruses that cause the disease would be poised for an epic comeback, slamming us with “a little more punch” than usual, Richard Webby, an influenza expert at St. Jude Children’s Research Hospital, in Tennessee, told me at the time.

    But those fears did not not come to pass. Flu’s winter 2021 season in the Southern Hemisphere was once again eerily silent; in the north, cases sneaked up in December—only to peter out before a lackluster reprise in the spring.

    Now, as the weather once again chills in this hemisphere and the winter holidays loom, experts are nervously looking ahead. After skipping two seasons in the Southern Hemisphere, flu spent 2022 hopping across the planet’s lower half with more fervor than it’s had since the COVID crisis began. And of the three years of the pandemic that have played out so far, this one is previewing the strongest signs yet of a rough flu season ahead.

    It’s still very possible that the flu will fizzle into mildness for the third year in a row, making experts’ gloomier suspicions welcomingly wrong. Then again, this year is, virologically, nothing like the last. Australia recently wrapped an unusually early and “very significant” season with flu viruses, says Kanta Subbarao, the director of the WHO Collaborating Centre for Reference and Research on Influenza at the Doherty Institute. By sheer confirmed case counts, this season was one of the country’s worst in several years. In South Africa, “it’s been a very typical flu season” by pre-pandemic standards, which is still enough to be of note, according to Cheryl Cohen, a co-head of the country’s Centre for Respiratory Disease and Meningitis at the National Institute for Communicable Diseases. After a long, long hiatus, Subbarao told me, flu in the Southern Hemisphere “is certainly back.”

    Read: The pandemic broke the flu

    That does not bode terribly well for those of us up north. The same viruses that seed outbreaks in the south tend to be the ones that sprout epidemics here as the seasons do their annual flip. “I take the south as an indicator,” says Seema Lakdawala, a flu-transmission expert at Emory University. And should flu return here, too, with a vengeance, it will collide with a population that hasn’t seen its likes in years, and is already trying to marshal responses to several dangerous pathogens at once.

    The worst-case scenario won’t necessarily pan out. What goes on below the equator is never a perfect predictor for what will occur above it: Even during peacetime, “we’re pretty bad in terms of predicting what a flu season is going to look like,” Webby, of St. Jude, told me. COVID, and the world’s responses to it, have put experts’ few forecasting tools further on the fritz. But the south’s experiences can still be telling. In South Africa and Australia, for instance, many COVID-mitigation measures, such as universal masking recommendations and post-travel quarantines, lifted as winter arrived, allowing a glut of respiratory viruses to percolate through the population. The flu flood also began after two essentially flu-less years—which is a good thing at face value, but also represents many months of missed opportunities to refresh people’s anti-flu defenses, leaving them more vulnerable at the season’s start.

    Some of the same factors are working against those of us north of the equator, perhaps to an even greater degree. Here, too, the population is starting at a lower defensive baseline against flu—especially young children, many of whom have never tussled with the viruses. It’s “very, very likely” that kids may end up disproportionately hit, Webby said, as they appear to have been in Australia—though Subbarao notes that this trend may have been driven by more cautious behaviors among older populations, skewing illness younger.

    Interest in inoculations has also dropped during the pandemic: After more than a year of calls for booster after booster, “people have a lot of fatigue,” says Helen Chu, a physician and flu expert at the University of Washington, and that exhaustion may be driving already low interest in flu shots even further down. (During good years, flu-shot uptake in the U.S. peaks around 50 percent.) And the few protections against viruses that were still in place last winter have now almost entirely vanished. In particular, schools—a fixture of flu transmission—have loosened up enormously since last year. There’s also just “much more flu around,” all over the global map, Webby said. With international travel back in full swing, the viruses will get that many more chances to hopscotch across borders and ignite an outbreak. And should such an epidemic emerge, with its health infrastructure already under strain from simultaneous outbreaks of COVID, monkeypox, and polio, America may not handle another addition well. “Overall,” Chu told me, “we are not well prepared.”

    Read: The most important vaccine I’ll get this fall

    At the same time, though, countries around the world have taken such different approaches to COVID mitigation that the pandemic may have further uncoupled their flu-season fate. Australia’s experience with the flu, for instance, started, peaked, and ended early this year; the new arrival of more relaxed travel policies likely played a role in the outbreak’s beginning, before a mid-year BA.5 surge potentially hastened the sudden drop. It’s also very unclear whether the U.S. may be better or worse off because its last flu season was wimpy, weirdly shaped, and unusually late. South Africa saw an atypical summer bump in flu activity as well; those infections may have left behind a fresh dusting of immunity and blunted the severity of the following season, Cohen told me. But it’s always hard to tell. “I was quite strong in saying that I really believed that South Africa was going to have a severe season,” she said. “And it seems that I was wrong.” The long summer tail of the Northern Hemisphere’s most recent flu season could also exacerbate the intensity of the coming winter season, says John McCauley, the director of the Worldwide Influenza Centre at the Francis Crick Institute, in London. Kept going in their off-season, the viruses may have an easier vantage point from which to reemerge this winter.

    COVID’s crush has shifted flu dynamics on the whole as well. The pandemic “squeezed out” a lot of diversity from the influenza-virus population, Webby told me; some lineages may have even entirely blipped out. But others could also still be stewing and mutating, potentially in animals or unmonitored pockets of the world. That these strains—which harbor especially large pandemic potential—could emerge into the general population is “my bigger concern,” Lakdawala, of Emory, told me. And although the particular strains of flu that are circulating most avidly seem reasonably well matched to this year’s vaccines, the dominant strains that attack the north could yet shift, says Florian Krammer, a flu virologist at Mount Sinai’s Icahn School of Medicine. Viruses also tend to wobble and hop when they return from long vacations; it may take a season or two before the flu finds its usual rhythm.

    Another epic SARS-CoV-2 variant could also quash a would-be influenza peak. Flu cases rose at the end of 2021, and the dreaded “twindemic” loomed. But then, Omicron hit—and flu “basically disappeared for one and a half months,” Krammer told me, only tiptoeing back onto the scene after COVID cases dropped. Some experts suspect that the immune system may have played a role in this tag-team act: Although co-infections or sequential infections of SARS-CoV-2 and flu viruses are possible, the aggressive spread of a new coronavirus variant may have set people’s defenses on high alert, making it that much harder for another pathogen to gain a foothold.

    Read: Don’t worry, it’s not the flu

    No matter the odds we enter flu season with, human behavior can still alter winter’s course. One of the main reasons that flu viruses have been so absent the past few years is because mitigation measures have kept them at bay. “People understand transmission more than they ever did before,” Lakdawala told me. Subbarao thinks COVID wisdom is what helped keep Australian flu deaths down, despite the gargantuan swell in cases: Older people took note of the actions that thwarted the coronavirus and applied those same lessons to flu. Perhaps populations across the Northern Hemisphere will act in similar ways. “I would hope that we’ve actually learned how to deal with infectious disease more seriously,” McCauley told me.

    But Webby isn’t sure that he’s optimistic. “People have had enough hearing about viruses in general,” he told me. Flu, unfortunately, does not feel similarly about us.

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    Katherine J. Wu

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  • How the Democrats Rallied

    How the Democrats Rallied

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    By now you’ve surely heard: Reports of the Democrats’ inevitable defeat this November (might) have been exaggerated. The party infamous for its disarray is suddenly passing legislation left and right (well, center), making a mockery of its effete opposition, and scoring huge abortion-rights victories in Republican strongholds. Inflation may have peaked, and President Joe Biden slayed a terrorist (while sick with COVID). On Capitol Hill, Democrats finally mounted an effective case against former President Donald Trump, who, by the way, had his mansion searched by the FBI for the possible pilfering of nuclear and other highly sensitive secrets.

    The Democrats’ recent hot streak has political prognosticators reassessing the party’s once-brutal outlook for this fall’s midterm elections. Its chances of retaining control of the Senate and swing-state governorships are rising, and although Democrats remain an underdog in the battle for the House, a GOP majority isn’t the sure thing it once was. Republicans have nominated highly flawed candidates in key Senate races (most notably Dr. Mehmet Oz in Pennsylvania and Herschel Walker in Georgia), and Democrats have gained ground in the closely watched generic-ballot polling measure.

    Democrats have plenty of reason for caution. Polls are notoriously unreliable in August, and recent elections have shown that political fortunes can change fast. Biden’s lackluster approval ratings remain a clear drag for the party, and even a slowdown in inflation means prices will remain high for a while. The president’s party historically loses seats in a midterm election even when voters are happy about the economy; the Democrats’ majorities in Congress are tiny to begin with. Yet the party’s prospects are clearly better now than they were back in the spring, thanks in large measure to three main developments.

    Read: Democrats might avoid a midterm wipeout

    The Overturning of Roe

    If Democrats somehow maintain control of the House, or even lose their majority by less than expected, history will look at June 23—the date that the Supreme Court overturned Roe v. Wade. The 5–4 decision authored by Justice Samuel Alito was not a surprise to political junkies, but surveys suggest that it stunned rank-and-file voters who consistently told pollsters that they did not believe the end of Roe was coming. “It’s always been theoretical. People thought, Oh, they won’t go that far. And now it’s here,” Kelly Dietrich, a longtime Democratic operative who founded the National Democratic Training Committee, told me.

    The clearest signal of an electoral backlash came just six weeks later in Kansas, when voters in the solidly Republican state overwhelmingly defeated an amendment that would have allowed the legislature to ban abortion. Democrats, however, have seen indications of higher engagement in several elections in which abortion was not directly on the ballot. In special elections in Nebraska and Minnesota, Democrats lost both House races but kept the gap several points below Trump’s 2020 margin of victory in each district. They performed better in Washington State’s nonpartisan primaries than they did in comparable contests in 2010 and 2014, both GOP “red wave” years. And in Alaska, the party exceeded expectations in a special House election, positioning Democrats to possibly capture a seat that the party has not held in more than 50 years.

    Read: The Kansas abortion shocker

    Polls show Democratic enthusiasm for voting in the midterms—a data point in which they had severely lagged behind Republicans—spiking after the decision in Dobbs v. Jackson Women’s Health Organization. Dietrich told me that registrations for candidate trainings have also surged in the past two months, and new Democratic voter registrations have significantly outpaced Republican ones in states where abortion rights are at risk, such as Wisconsin and Michigan, according to data compiled by TargetSmart, a Democratic firm.

    Joe Manchin Gets to Yes

    After more than a year of on-and-off-again negotiations, the Senate’s Hamlet on the Potomac finally agreed to a deal with Senate Majority Leader Chuck Schumer to back legislation lowering prescription-drug prices and making the nation’s largest-ever investment in the fight against climate change. The oddly named Inflation Reduction Act, which doesn’t do much to tame inflation but will reduce the deficit, hands an enormous and long-sought victory to Biden and the Democrats just in time for the fall campaign.

    The law contains only a fraction of Biden’s original transformative vision, but because most Democrats had given up on Manchin entirely, they were ecstatic at his surprise, eleventh-hour decision to support a robust climate, health, and tax package. The elements of the law poll exceedingly well with key constituencies, making it an easy—and timely—issue for Democratic candidates to campaign on this fall.

    Whether the Inflation Reduction Act by itself will boost the party in the polls is hard to say. But its enactment is the latest in a string of legislative achievements for Biden, including the passage of a modest gun-reform bill, the CHIPS Act to support high-tech manufacturing, and the PACT Act to help veterans exposed to toxic burn pits. Along with last year’s $1.9 trillion American Rescue Plan and the $1 trillion infrastructure law, the recent run should erase the image of a do-nothing Congress and a Democratic Party that was seen as squandering its two years in power. “It’s an opportunity—almost a mandate—for Democrats to get out there and brag,” Dietrich said. “Democrats can’t be humble anymore.”

    The January 6 Hearings: This Summer’s Surprising Smash TV Hit

    Many cynics in media had low expectations for the hearings that the House Select Committee on January 6 would hold. But Democrats running the panel hired a former ABC News executive to help produce the events, and the result was a series of newsy and often riveting hearings that drew strong TV ratings and built a compelling case against Trump. The starring role of Vice Chair Liz Cheney of Wyoming lent the hearings a bipartisan sheen and helped obscure the lack of involvement from most other Republicans, and the committee made a smart decision to almost exclusively feature testimony from current and former Trump confidants rather than famous critics of the former president.

    Did the hearings change public opinion? For Democrats, the early evidence is mixed at best, and it’s possible that this month’s FBI search of Trump’s Florida home helped him consolidate support among Republicans all over again. Yet the hearings succeeded in reminding voters of the horror of the attack on the Capitol and what many of them disliked most about Trump. To that end, Democrats believed the hearings helped energize their base about the urgency of the fall elections, potentially protecting against a drop in turnout that would seal their defeat.

    The biggest question about the Democrats’ newfound momentum is how long it will last. Did the Supreme Court’s abortion ruling and the party’s flurry of legislative success in Congress represent a decisive turning point, or merely a brief calm before the crashing of a red wave? Republicans have history and, they believe, political gravity on their side. Biden’s approval ratings have ticked up a few points to an average of 40 percent, but that dismal standing would still ordinarily point to a rout for a president’s party in November. Democrats are left to hope that this is no ordinary year, and if they do come out ahead in the fall, this summer’s comeback will likely prove to be the reason.

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    Russell Berman

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