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Tag: long time

  • Darth Vader balloon faces uncertain future as fans rally for its revival

    BEING NEW BALLOONS TO ONE OF THE POPULAR SHAPES EVERY YEAR IS THAT DARTH VADER BALLOON. BUT THE FUTURE IS ACTUALLY UNCERTAIN, AS THAT BALLOON IS AT THE END OF ITS LIFESPAN. SO NOW THERE’S AN EFFORT TO KEEP THE TRADITION ALIVE. PEYTON SPELLACY JOINS US LIVE FROM THE PARK WITH MORE ON THIS STORY. HEY, PEYTON. HEY, GOOD MORNING TODD, I WANT TO SHOW YOU YODA IS BEING SET UP RIGHT NOW. NOW, HIS COUNTERPART, DARTH VADER, IS NOT SO LUCKY. LIKE YOU SAID, HIS FLYING DAYS ARE NUMBERED. BUT FOR NEARLY TWO DECADES, HE’S BEEN LOOMING LARGE OVER BALLOON FIESTA PARK. HE’S A FAN FAVORITE FROM THE GALAXY FAR, FAR AWAY. BUT THIS CREW SAYS HIS FLYING DAYS AREN’T OVER WITHOUT A FIGHT. THE BALLOON IS 19 YEARS OLD. IT’S REALLY A LONG TIME FOR A SHAPE, AND SO WE WE REALLY EXPECT WE CAN CONTINUE THE STORY. BENOIT LAMBERT HAS BEEN FLYING THE STAR WARS SPECIAL SHAPE SINCE 2007, AND SAYS FROM THE MOMENT HE SAW THEM, HE KNEW THE FORCE WAS STRONG WITH HIM. BUT TIME, EVEN FOR THE DARK SIDE, HAS TAKEN ITS TOLL. YOU CAN SEE IT START TO BE HARD BECAUSE THE FABRIC STARTS TO BE DEFLATED ON THE NECK, BUT IT’S PART OF THE PROCESS. DARTH VADER MAY BE GROUNDED, BUT HIS CREW ISN’T THROWING IN THE LIGHTSABER YET. THEY’RE FUNDRAISING TO REBUILD IT BECAUSE IT’S MORE THAN JUST A BALLOON. IT’S THE SHOW EVERYONE’S LOOKING FOR. WE HAVE 100 TROOPERS AROUND MY BALLOONS. DARK SIDE. IT’S THE KIDS THAT’S SEEING THE KIDS SEE ACTUAL CHARACTERS IN REAL LIFE. BUT IT’S NOT JUST FOR KIDS. FANS OF ALL AGES ARE DRAWN IN. COME ON, EVEN THE BIG KIDS COULD GET SOME BIG KIDS. I SAW THE STORMTROOPERS WITH THEIR LIGHTSABERS AND THEIR GUIDES AND I WAS LIKE, WE NEED TO FOLLOW THEM. KATRINA’S A FIRST TIMER AT FIESTA, BUT THE FORCE IS STRONG WITH HER. I EVEN HAVE A TATTOO RIGHT HERE WITH THE DEATH STAR IN THE MIDDLE OF MY SUNFLOWER. AS SOON AS I GET SOME TIME, I’M GOING TO GET ONLINE AND I’M GOING TO DONATE TO YOU GUYS BECAUSE I THINK THIS IS SOMETHING MAGICAL THAT WE NEED TO SEE EVERY YEAR. THAT PASSION, GIVING THE CREW HOPE THAT ONE DAY SOON THE SITH LORD WILL RISE AGAIN. DO YOU THINK HE’LL MAKE A RETURN? I HOPE SO, YES. THAT’S MY PLAN. YES. IF YOU WANT TO SEE THESE CHARACTERS ALONGSIDE DARTH VADER, YOU CAN DONATE ONLINE. WE HAVE THAT LINK ON OUR WEBSITE, BUT FOR NOW, LOOKS LIKE DARTH VADER AND YODA WILL BE FLYING. MAYBE STATIC, MAYBE YODA WILL BE FLYING OVER HERE AT OUR ONE MARKER REPORTING LIVE

    Darth Vader balloon faces uncertain future as fans rally for its revival

    Updated: 1:17 AM EDT Oct 10, 2025

    Editorial Standards

    The Darth Vader balloon, a fan favorite at the Balloon Fiesta in Albuquerque, New Mexico, for nearly two decades, faces an uncertain future as its fabric deteriorates, prompting efforts to keep the tradition alive.Beniot Lambert, who has been flying the “Star Wars” special shapes since 2007, said, “So the balloon is 19 years old. The fabric starts to behold. So we are planning a way to continue the story.”Lambert noted the toll time has taken on the balloon, saying, “You can see it start to behold because the fabric starts to be deflated on the neck. But it’s part of the process.”Despite the challenges, the crew is determined to rebuild the balloon, recognizing its significance beyond just being a balloon.Video below: ‘Star Wars’ opens in theaters”We have 100 troopers around my balloons,” Lambert said.The balloon’s appeal extends beyond children, drawing fans of all ages. One first-time attendee, Katrina Bustillos, shared her excitement, saying, “I saw the stormtroopers with their lightsabers and their guides, and I was like, we need to follow them.”Bustillos, who has a tattoo of the Death Star, expressed her commitment to the cause, saying, “As soon as I get some time, I’m going to get online and I’m going to donate to you guys, because I think this is something magical that we need to see every year.”The crew remains hopeful that the Sith Lord will rise again, with Lambert expressing his optimism, “Do you think he’ll make a return? I hope so. Yes, that’s my plan.”

    The Darth Vader balloon, a fan favorite at the Balloon Fiesta in Albuquerque, New Mexico, for nearly two decades, faces an uncertain future as its fabric deteriorates, prompting efforts to keep the tradition alive.

    Beniot Lambert, who has been flying the “Star Wars” special shapes since 2007, said, “So the balloon is 19 years old. The fabric starts to behold. So we are planning a way to continue the story.”

    Lambert noted the toll time has taken on the balloon, saying, “You can see it start to behold because the fabric starts to be deflated on the neck. But it’s part of the process.”

    Despite the challenges, the crew is determined to rebuild the balloon, recognizing its significance beyond just being a balloon.

    Video below: ‘Star Wars’ opens in theaters

    “We have 100 troopers around my balloons,” Lambert said.

    The balloon’s appeal extends beyond children, drawing fans of all ages. One first-time attendee, Katrina Bustillos, shared her excitement, saying, “I saw the stormtroopers with their lightsabers and their guides, and I was like, we need to follow them.”

    Bustillos, who has a tattoo of the Death Star, expressed her commitment to the cause, saying, “As soon as I get some time, I’m going to get online and I’m going to donate to you guys, because I think this is something magical that we need to see every year.”

    The crew remains hopeful that the Sith Lord will rise again, with Lambert expressing his optimism, “Do you think he’ll make a return? I hope so. Yes, that’s my plan.”

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  • Mexico hands over fugitive wanted in 2008 killing of L.A. County sheriff’s deputy

    A man wanted in connection with the 2008 killing of a Los Angeles County sheriff’s deputy in Cypress Park has been returned to the U.S. from Mexico to face charges.

    Roberto Salazar, 38, was arrested in March by Mexican authorities and transferred Tuesday into U.S. custody.

    “Justice has been a long time coming, but today we are one step closer,” Sheriff Robert Luna said during a news conference at the Hall of Justice on Wednesday afternoon.

    The L.A. County district attorney’s office will charge Salazar with first-degree murder with special circumstances and conspiracy to commit murder. He faces a life sentence without the possibility of parole.

    Salazar’s arraignment Thursday morning was postponed until Sept. 22 because he did not yet have a defense attorney. Appearing before Judge Theresa McGonigle, Salazar stood slightly stooped over in a glass-enclosed holding area with his hair buzzed and wearing an orange jail shirt.

    Two female relatives of Salazar who attended the hearing declined to comment, as did Deputy Dist. Atty. Eric Siddall, who appeared for the prosecution.

    Salazar was handed over along with 25 other prisoners described by U.S. and Mexican authorities as high-ranking drug cartel members. Mexico long ago abolished capital punishment and reportedly agreed to the mass prisoner transfer on the condition that none face the death penalty.

    Salazar’s case dates back to Aug. 2, 2008, when Juan Abel Escalante was shot in the back of the head as he was reaching to adjust a child’s seat inside his car outside his parents’ house as he readied to leave for his job at Men’s Central Jail.

    By December 2012, four of the six alleged members of the notorious Avenues gang that authorities accused of having been involved in the killing had been arrested and charged. That list included Carlos Velasquez, who was arrested in December 2008 and ultimately pleaded guilty to murder and possession of a firearm by a convicted felon. Authorities said Velasquez shot Escalante multiple times after mistaking him for a rival gang member.

    U.S. Atty. Gen. Pamela Bondi described the return of the 26 men as “the latest example of the Trump administration’s historic efforts to dismantle cartels and foreign terrorist organizations” in a statement Tuesday.

    Celeste Escalante, the widow of Juan Abel Escalante, and their daughter watch as pallbearers carry the deputy’s casket during funeral services on Aug. 8, 2008.

    (Al Seib / Los Angeles Times)

    Escalante and his family were living at his parents’ home in Cypress Park at the time of his slaying. He had served in the Army Reserve and had been working for the Sheriff’s Department for 2½ years.

    “My words go out to the Escalante family,” Dist. Atty. Nathan Hochman said Wednesday. “That relentess pursuit of justice is not over, but we are almost there.”

    Connor Sheets, Sandra McDonald

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  • The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

    The Pandemic’s ‘Ghost Architecture’ Is Still Haunting Us

    Last Friday, in a bathroom at the Newark airport, I encountered a phrase I hadn’t seen in a long time: Stop the spread. It accompanied an automatic hand-sanitizing station, which groaned weakly when I passed my hand beneath it, dispensing nothing. Presumably set up in the early pandemic, the sign and dispenser had long ago become relics. Basically everyone seemed to ignore them. Elsewhere in the terminal, I spotted prompts to maintain a safe distance and reduce overcrowding, while maskless passengers sat elbow-to-elbow in waiting areas and mobbed the gates.

    Beginning in 2020, COVID signage and equipment were everywhere. Stickers indicated how to stand six feet apart. Arrows on the grocery-store floor directed shopping-cart traffic. Plastic barriers enforced distancing. Masks required signs dotted store windows, before they were eventually replaced by softer pronouncements such as masks recommended and masks welcome. Such messages—some more helpful than others—became an unavoidable part of navigating pandemic life.

    Four years later, the coronavirus has not disappeared—but the health measures are gone, and so is most daily concern about the pandemic. Yet much of this COVID signage remains, impossible to miss even if the messages are ignored or outdated. In New York, where I live, notices linger in the doorways of apartment buildings and stores. A colleague in Woburn, Massachusetts, sent me a photo of a sign reminding park-goers to gather in groups of 10 or less; another, in Washington, D.C., showed me stickers on the floors of a bookstore and pier bearing faded reminders to stay six feet apart. “These are artifacts from another moment that none of us want to return to,” Eric Klinenberg, a sociologist at NYU and the author of 2020: One City, Seven People, and the Year Everything Changed, told me. All these fliers, signs, and stickers make up the “ghost architecture” of the pandemic, and they are still haunting America today.

    That some COVID signage persists makes sense, considering how much of it once existed. According to the COVID-19 Signage Archive, one store in Key West had a reminder to mask up during the initial Omicron wave: Do not wear it above chin or below nose. In the summer of 2021, a placard at a Houston grocery store indicated that the shopping carts had been “sanitizd.” And in November 2020, you could have stepped on a customized welcome mat in Washington, D.C., that read Thank you for practicing 6 ft social distancing. Eli Fessler, a software engineer who launched the crowdsourced archive in December 2020, wanted “to preserve some aspect of [COVID signage] because it felt so ephemeral,” he told me. The gallery now comprises nearly 4,000 photos of signs around the world, including submissions he received as recently as this past October: a keep safe distance sign in Incheon, South Korea.

    No doubt certain instances of ghost architecture can be attributed to forgetfulness, laziness, or apathy. Remnants of social-distancing stickers on some New York City sidewalks appear too tattered to bother scraping away; outdoor-dining sheds, elaborately constructed but now barely used, are a hassle to dismantle. A faded decal posted at a restaurant near my home in Manhattan depicts social-distancing guidelines for ordering takeout alcohol that haven’t been relevant since 2020. “There’s a very human side to this,” Fessler said. “We forget to take things down. We forget to update signs.”

    But not all of it can be chalked up to negligence. Signs taped to a door can be removed as easily as they are posted; plastic barriers can be taken down. Apart from the ease, ghost architecture should have disappeared by now because spotting it is never pleasant. Even in passing, the signs can awaken uncomfortable memories of the early pandemic. The country’s overarching response to the pandemic is what Klinenberg calls the “will not to know”—a conscious denial that COVID changed life in any meaningful way. Surely, then, some examples are left there on purpose, even if they evoke bad memories.

    When I recently encountered the masks required sign that’s still in the doorway of my local pizza shop, my mind flashed back to more distressing times: Remember when that was a thing? The sign awakened a nagging voice in my brain reminding me that I used to mask up and encourage others to do the same, filling me with guilt that I no longer do so. Perhaps the shop owner has felt something similar. Though uncomfortable, the signs may persist because taking them down requires engaging with their messages head-on, prompting a round of fraught self-examination: Do I no longer believe in masking? Why not? “We have to consciously and purposely say we no longer need this,” Klinenberg told me.

    Outdated signs are likely more prevalent in places that embraced public-health measures to begin with, namely bluer areas. “I would be surprised to see the same level of ghost architecture in Florida, Texas, or Alabama,” Klinenberg said. But ghost architecture seems to persist everywhere. A colleague sent a photo of a floor sticker in a Boise, Idaho, restaurant that continues to thank diners for practicing social distancing. These COVID callbacks are sometimes even virtual: An outdated website for a Miami Beach spa still encourages guests to physically distance and to “swipe your own credit card.”

    Most of all, the persistence of ghost architecture directly reflects the failure of public-health messaging to clearly state what measures were needed, and when. Much of the signage grew out of garbled communication in the first place: “Six feet” directives, for example, far outlasted the point when public-health experts knew it was a faulty benchmark for stopping transmission.

    The rollback of public-health precautions has been just as chaotic. Masking policy has vacillated wildly since the arrival of vaccines; although the federal COVID emergency declaration officially ended last May, there was no corresponding call to end public-health measures across the country. Instead, individual policies lapsed at different times in different states, and in some cases were setting-specific: California didn’t end its mask requirement for high-risk environments such as nursing homes until last April. Most people still don’t know how to think about COVID, Klinenberg said, and it’s easier to just leave things as they are.

    If these signs are the result of confusing COVID messaging, they are also adding to the problem. Prompts to wash or sanitize your hands are generally harmless. In other situations, however, ghost architecture can perpetuate misguided beliefs, such as thinking that keeping six feet apart is protective in a room full of unmasked people, or that masks alone are foolproof against COVID. To people who must still take precautions for health reasons, the fact that signs are still up, only to be ignored, can feel like a slap in the face. The downside to letting ghost architecture persist is that it sustains uncertainty about how to behave, during a pandemic or otherwise.

    The contradiction inherent in ghost architecture is that it both calls to mind the pandemic and reflects a widespread indifference to it. Maybe people don’t bother to take the signs down because they assume that nobody will follow them anyway, Fessler said. Avoidance and apathy are keeping them in place, and there’s not much reason to think that will change. At this rate, COVID’s ghost signage may follow the same trajectory as the defunct Cold War–era nuclear-fallout-shelter signs that lingered on New York City buildings for more than half a century, at once misleading observers and reminding them that the nuclear threat, though diminished, is still present.

    The signs I saw at the Newark airport seemed to me hopelessly obsolete, yet they still stoked unease about how little I think about COVID now, even though the virus is still far deadlier than the flu and other common respiratory illnesses. Passing another stop the spread hand-sanitizing station, I put my palm under the dispenser, expecting nothing. But this time, a dollop of gel squirted into my hand.

    Yasmin Tayag

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  • Plenty of People Could Quit Therapy Right Now

    Plenty of People Could Quit Therapy Right Now


    About four years ago, a new patient came to see me for a psychiatric consultation because he felt stuck. He’d been in therapy for 15 years, despite the fact that the depression and anxiety that first drove him to seek help had long ago faded. Instead of working on problems related to his symptoms, he and his therapist chatted about his vacations, house renovations, and office gripes. His therapist had become, in effect, an expensive and especially supportive friend. And yet, when I asked if he was considering quitting treatment, he grew hesitant, even anxious. “It’s just baked into my life,” he told me.

    Among those who can afford it, regular psychotherapy is often viewed as a lifelong project, like working out or going to the dentist. Studies suggest that most therapy clients can measure their treatments in months instead of years, but a solid chunk of current and former patients expect therapy to last indefinitely. Therapists and clients alike, along with celebrities and media outlets, have endorsed the idea of going to therapy for extended stretches, or when you’re feeling fine. I’ve seen this myself with friends who are basically healthy and think of having a therapist as somewhat like having a physical trainer. The problem is, some of the most commonly sought versions of psychotherapy are simply not designed for long-term use.

    Therapy comes in many varieties, but they all share a common goal: to eventually end treatment because you feel and function well enough to thrive on your own. Stopping doesn’t even need to be permanent. If you’ve been going to therapy for a long time, and you’re no longer in acute distress, and you have few symptoms that bother you, consider taking a break. You might be pleasantly surprised by how much you learn about yourself.

    Therapy, in both the short and long term, can be life-altering. Short-term therapy tends to be focused on a particular problem, such as a depressed mood or social anxiety. In cognitive behavioral therapy, usually used for depressive and anxiety disorders, a clinician helps a client relieve negative feelings by correcting the distorted beliefs that he has about himself. In dialectical behavior therapy, commonly used to treat borderline personality disorder, patients learn skills to manage powerful emotions, which helps improve their mood and relationships. Both treatments typically last less than a year. If you start to get rusty or feel especially challenged by life events that come your way, you simply return for another brief stint. Termination is expected and normal.

    Some types of therapy, such as psychodynamic therapy and psychoanalysis, are designed to last for several years—but not forever. The main goal of these therapies is much more ambitious than symptom relief; they aim to uncover the unconscious causes of suffering and to change a client’s fundamental character. At least one well-regarded study found that long-term therapy is both highly effective and superior to briefer treatment for people diagnosed with a clinically significant psychiatric illness; other papers have shown less conclusive evidence for long-term therapy. And few studies compare short and extended treatment for clients with milder symptoms.

    In fact, there’s reason to believe that talk therapy in the absence of acute symptoms may sometimes cause harm. Excessive self-focus—easily facilitated in a setting in which you’re literally paying to talk about your feelings—can increase your anxiety, especially when it substitutes for tangible actions. If your neurotic or depressive symptoms are relatively mild (meaning they don’t really interfere with your daily functioning), you might be better served by spending less time in a therapist’s office and more time connecting with friends, pursuing a hobby, or volunteering. Therapists are trained to use the tools they’ve learned for certain types of problems, and many of the stress-inducing minutiae of daily life are not among them. For example, if you mention to your therapist that you’re having trouble being efficient at work, he might decide to teach you a stress-reduction technique, but your colleagues or boss might provide more specific strategies for improving your performance.

    One of my childhood friends, whose parents were both psychoanalysts, went to weekly therapy appointments while we were growing up. He was a happy, energetic kid, but his parents wanted him and his sister to be better acquainted with their inner lives, to help them deal with whatever adversity came their way. My friend and his sister both grew up to be successful adults, but also highly anxious and neurotic ones. I imagine their parents would say the kids would have been worse without the therapy—after all, mental illness ran in their family. But I can find no substantial clinical evidence supporting this kind of “preventive” psychotherapy.

    Beginning therapy in the first place is, to be clear, a privilege. Therapy is not covered by many insurance plans, and a very large number of people who could benefit from it can’t afford it for any duration. Only 47 percent of Americans with a psychiatric illness received any form of treatment in 2021; in fact, federal estimates suggest that the United States is several thousand mental-health professionals short, a gap that is likely to grow in the coming years. Stopping therapy when you’re ready opens up space for others who might need this scarce service more than you do.

    I do not mean to suggest that a therapy vacation should be considered lightly, or that it’s for everyone. If you have a serious mental-health disorder, such as major depression or bipolar disorder, you should discuss with your mental-health provider whether ending therapy is appropriate for your individual situation. (Keep in mind that your therapist might not be ready to quit when you are. Aside from a financial incentive to continue treatment, parting with a charming, low-maintenance patient is not so easy.) My rule of thumb is that you should have minimal to no symptoms of your illness for six months or so before even considering a pause. Should you and your therapist agree that stopping is reasonable, a temporary break with a clear expiration date is ideal. At any time, if you’re feeling worse, you can always go back.

    Psychiatrists do something similar with psychiatric meds: For example, when I prescribe a depressed patient an antidepressant, and then they remain stable and free of symptoms for several years, I usually consider tapering the medication to determine whether it’s still necessary for the patient’s well-being. I would do this only for patients who are at a low risk of relapse—for example, people who’ve had just one or two episodes, rather than many over a lifetime. Pausing therapy should be even less risky: The beautiful thing about therapy is that, unlike a drug, it equips you with new knowledge and skills, which you carry with you when you leave.

    About a year after my patient and I first talked about ending therapy, I ran into him in a café. He told me that stopping had taken him six months, but now he was thriving. Maybe you, like my patient, are daunted by the idea of quitting cold turkey. If so, consider taking a vacation from treatment instead. It might be the perfect way to see how far you’ve really come.



    Richard A. Friedman

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  • One of Tuberculosis’s Biggest, Scariest Numbers Is Probably Wrong

    One of Tuberculosis’s Biggest, Scariest Numbers Is Probably Wrong

    Growing up in India, which for decades has clocked millions of tuberculosis cases each year, Lalita Ramakrishnan was intimately familiar with how devastating the disease can be. The world’s greatest infectious killer, rivaled only by SARS-CoV-2, Mycobacterium tuberculosis spreads through the air and infiltrates the airways, in many cases destroying the lungs. It can trigger inflammation in other tissues too, wearing away bones and joints; Ramakrishnan watched her own mother’s body erode in this way. The sole available vaccine was lackluster; the microbe had rapidly evolved resistance to the drugs used to fight it. And the disease had a particularly insidious trait: After entering the body, the bacterium could stow away for years or decades, before erupting without warning into full-blown disease.

    This state, referred to as latency, supposedly afflicted roughly 2 billion people—a quarter of the world’s population. Ramakrishnan, now a TB researcher at the University of Cambridge, heard that fact over and over, and passed it down to her own students; it was what every expert did with the dogma at the time. That pool of 2 billion people was understood to account for a large majority of infections worldwide, and it represented one of the most intimidating obstacles to eradicating the disease. To end TB for good, the thinking went, the world would need to catch and cure every latent case.

    In the years since, Ramakrishnan’s stance on latent TB has shifted quite a bit. Its extent, she argues, has been exaggerated for a good three decades, by at least an order of magnitude—to the point where it has scrambled priorities, led scientists on wild-goose chases, and unnecessarily saddled people with months of burdensome treatment. In her view, the term latency is so useless, so riddled with misinformation, that it should disappear. “I taught that nonsense forever,” she told me; now she’s spreading the word that TB’s largest, flashiest number may instead be its greatest, most persistent myth.

    Ramakrishnan isn’t the only one who thinks so. Together with her colleagues Marcel Behr, of Quebec’s McGill University, and Paul Edelstein, of the University of Pennsylvania (“we call ourselves the three BERs,” Ramakrishnan told me), she’s been on a years-long crusade to set the record straight. Their push has attracted its fair share of followers—and objectors. “I don’t think they’re wrong,” Carl Nathan, a TB researcher at Cornell, told me. “But I’m not confident they’re right.”

    Several researchers told me they’re largely fine with the basic premise of the BERs’ argument: Fewer than 2 billion isn’t that hard to get behind. But how many fewer matters. If current latency estimates overshoot by just a smidge, maybe no practical changes are necessary. The greater the overestimate, though, the more treatment recommendations might need to change; the more research and funding priorities might need to shift; the more plans to control, eliminate, and eventually eradicate disease might need to be wholly and permanently rethought.

    The muddled numbers on latency seem to be based largely on flawed assumptions about certain TB tests. One of the primary ways to screen people for the disease involves pricking harmless derivatives of the bacterium into skin, then waiting for an inflamed lump to appear—a sign that the immune system is familiar with the microbe (or a TB vaccine), but not direct proof that the bacterium itself is present. That means that positive results can guarantee only that the immune system encountered something resembling MTB at some point—perhaps even in the distant past, Rein Houben, an epidemiologist at the London School of Hygiene & Tropical Medicine, told me.

    But for a long time, a prevailing assumption among researchers was that all TB infections had the potential to be lifelong, Behr told me. The thought wasn’t entirely far-fetched: Other microbial infections can last a lifetime, and there are historical accounts of lasting MTB infections, including a case in which a man developed tuberculosis more than 30 years after his father passed the bacterium to him. Following that logic—that anyone once infected had a good enough chance of being infected now—researchers added everyone still reacting to the bug to the pool of people actively battling it. By the end of the 1990s, Behr and Houben told me, prominent epidemiologists had used this premise to produce the big 2 billion number, estimating that roughly a third of the population had MTB lurking within.

    That eye-catching figure, once rooted, rapidly spread. It was repeated in textbooks, academic papers and lectures, news articles, press releases, government websites, even official treatment guidelines. The World Health Organization parroted it too, repeatedly calling for research into vaccines and treatments that could shrink the world’s massive latent-TB cohort. “We were all taught this dogma when we were young researchers,” Soumya Swaminathan, the WHO’s former chief scientist, told me. “Each generation passed it on to the next.”

    But, as the BERs argue, for TB to be a lifelong sentence makes very little sense. Decades of epidemiological data show that the overwhelming majority of disease arises within the first two years after infection, most commonly within months. Beyond that, progression to symptomatic, contagious illness becomes vanishingly rare.

    The trio is convinced that a huge majority of people are clearing the bug from their body rather than letting it lie indefinitely in wait—a notion that recent modeling studies support. If the bacteria were lingering, researchers would expect to see a big spike in disease late in life among people with positive skin tests, as their immune system naturally weakens. They would also expect to see a high rate of progression to full-blown TB among people who start taking immunosuppressive drugs or catch HIV. And yet, neither of those trends pans out: At most, some 5 to 10 percent of people who have tested positive by skin test and later sustain a blow to their immune system develop TB disease within about three to five years—a hint that, for almost everyone else, there may not be any MTB left. “If there were a slam-dunk experiment, that’s it,” William Bishai, a TB researcher at Johns Hopkins, told me.

    Nathan, of Cornell, was less sold. Immunosuppressive drugs and HIV flip very specific switches in the immune system; if MTB is being held in check by multiple branches, losing some immune defenses may not be enough to set the bacteria loose. But most of the experts I spoke with are convinced that lasting cases are quite uncommon. “Some people will get into trouble in old age,” Bouke de Jong, a TB researcher at the Institute of Tropical Medicine, in Antwerp, told me. “But is that how MTB hangs out in everybody? I don’t think so.”

    If anything, people with positive skin tests might be less likely to eventually develop disease, Ramakrishnan told me, whether because they harbor defenses against MTB or because they are genetically predisposed to clear the microbe from their airway. In either case, that could radically change the upshot of a positive test, especially in countries such as the U.S. and Canada, where MTB transmission rarely occurs and most TB cases can be traced from abroad. Traditionally, people in these places with positive skin tests and no overt symptoms have been told, “‘This means you’ve got sleeping bacteria in you,’” Behr said. “‘Any day now, it may pop out and cause harm.’” Instead, he told me, health-care workers should be communicating widely that there could be up to a 95 percent chance that these patients have already cleared the infection, especially if they’re far out from their last exposure and might not need a drug regimen. TB drugs, although safe, are not completely benign: Standard regimens last for months, interact with other meds, and can have serious side effects.

    At the same time, researchers disagree on just how much risk remains once people are a couple of years past an MTB exposure. “We’ve known for decades that we are overtreating people,” says Madhu Pai, a TB researcher at McGill who works with Behr but was not directly involved in his research. But treating a lot of people with positive skin tests has been the only way to ensure that the people who are carrying viable bacteria get the drugs they need, Robert Horsburgh, an epidemiologist at Boston University, told me. That strategy squares, too, with the goal of elimination in places where spread is rare. To purge as much of the bug as possible, “clinicians will err on the side of caution,” says JoAnne Flynn, a TB researcher at the University of Pittsburgh.

    Elsewhere in the world, where MTB transmission is rampant and repeat infections are common, “to be honest, nobody cares if there’s latent TB,” Flynn told me. Many people with very symptomatic, very contagious cases still aren’t getting diagnosed or treated; in too many places, the availability of drugs and vaccines is spotty at best. Elimination remains a long-term goal, but active outbreaks demand attention first. Arguably, quibbling about latency now is like trying to snuff stray sparks next to an untended conflagration.

    One of the BERs’ main goals could help address TB’s larger issues. Despite decades of research, the best detection tools for the disease remain “fundamentally flawed,” says Keertan Dheda, a TB researcher at the London School of Hygiene & Tropical Medicine and the University of Cape Town. A test that could directly detect viable microbes in tissues, rather than an immune proxy, could definitively diagnose ongoing infections and prioritize people across the disease spectrum for treatment. Such a diagnostic would also be the only way to finally end the fuss over latent TB’s prevalence. Without it, researchers are still sifting through only indirect evidence to get at the global TB burden—which is probably still “in the hundreds of millions” of cases, Houben told me, though the numbers will remain squishy until the data improve.

    That 2 billion number is still around—though not everywhere, thanks in part to the BERs’ efforts. The WHO’s most recent annual TB reports now note that a quarter of the world’s population has been infected with MTB, rather than is infected with MTB; the organization has also officially discarded the term latent from its guidance on the disease, Dennis Falzon, of the WHO Global TB Programme, told me in an email. However subtle, these shifts signal that even the world’s biggest authorities on TB are dispensing with what was once conventional wisdom.

    Losing that big number does technically shrink TB’s reach—which might seem to minimize the disease’s impact. Behr argues the opposite. With a huge denominator, TB’s mortality rate ends up minuscule—suggesting that most infections are benign. Deflating the 2 billion statistic, then, reinforces that “this is one of the world’s nastiest pathogens, not some symbiont that we live with in peace,” Behr told me. Fewer people may be at risk than was once thought. But for those who are harboring the microbe, the dangers are that much more real.

    Katherine J. Wu

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  • It’s scary season for kids’ teeth. Help keep them cavity-free with these tips

    It’s scary season for kids’ teeth. Help keep them cavity-free with these tips

    As Halloween nears, you might be strategizing how to deal with your child’s annual sack of Halloween candy after a big night of trick-or-treating.

    It’s no secret that sugar is bad for teeth. But the effects of poor dental health extend far beyond a treat-heavy holiday.

    Dental issues are a leading cause of absence from school, and California ranks right near the bottom among states when it comes to kids’ oral health. However, parents can fend off sugar’s role in dental decay and infections, Venice Family Clinic dental director Dr. Jaspreet Kaur said.

    “Halloween is a reminder and a learning opportunity to set boundaries,” she said. “Teach your kids that they can enjoy the treats, but in balance.”

    Here are some tips from dentists for keeping your child’s mouth healthy at Halloween and beyond:

    Avoid chewy, sticky, hard and sour treats

    Candies that are chewy or sticky tend to stay in a child’s mouth longer than others. Soft, taffy-like candy, caramel and gummies get caught between teeth or in their grooves. Hard candies, like lollipops that children suck on, linger longer in the mouth.

    When the candy isn’t washed or brushed away quickly it produces acid, which can break down the enamel that protects teeth and causes cavities, according to Dr. Santos Cortez, a pediatric dentist in Long Beach. Sour candies are extra damaging because they not only introduce sugar to the mouth, but also acids when first eaten.

    The texture issues don’t just apply to candy either. That packet of raisins in your child’s trick-or-treat bag isn’t necessarily a better option. The sticky texture of the raisins causes the sugar to stick to the teeth in the same way as candy, making the mouth more susceptible to cavities, Cortez said.

    Juice and soda are also a problem. Like with hard candies, the sugar may stay on your child’s teeth for a while, especially if they take a long time to drink it, which means the teeth are exposed longer.

    Opt instead for sweets like chocolate — dark chocolate if you can. Chocolate, as long as it isn’t mixed with something like caramel, tends to melt in the mouth faster and is easier to brush off.

    Bring a water bottle with you on your Halloween route.

    Have your child drink water after eating candy. The water can help wash away some of the residue left behind by the sweet treat, according to Cortez. Keep a bottle handy as you trick-or-treat to have your child sip and wash off some of the stickiness as they enjoy the night. That will help reduce sugars until they are able to brush their teeth.

    Make a habit of having them drink water any time they consume sugar and can’t brush right away. Instead of bottled water, give them tap water, which should contain fluoride to help stave off dental decay.

    Of course, brush their teeth

    Make sure your child brushes their teeth as soon as possible after eating candy or anything sweet. If your child is determined to brush on their own, let them, but make sure to get in there afterward to remove plaque. Continue to brush your child’s teeth for them until they are 8 years old, using a pea-sized amount of fluoride toothpaste. Using a fluoride toothpaste helps combats the effects of sugar.

    In baby teeth, cavities tend to develop between teeth, so be sure to help you child floss once they’re ready.

    If you have a baby whose first tooth is just appearing, brush it with a small smear of fluoride toothpaste on a baby toothbrush twice a day — just enough to color the bristles. For infants without teeth, dentists recommend wiping their gums with a clean cloth after feedings.

    Remember, taking care of baby teeth is just as important as taking care of the permanent teeth. Problems that affect the baby teeth now can affect the permanent teeth later on if not addressed.

    Set rules on candy

    Set rules about how much candy your child can consume — a small amount daily. It’s better to let them eat a piece or two at once rather than allowing them to snack on sugary treats multiple times throughout the day, according to pediatric dentist Dr. Alexander Alcaraz, the program director of pediatric dentistry at USC Ostrow School of Dentistry. Constant and long exposures to sugar feed the bacteria that develop cavities. Saliva also needs time to neutralize the acids in the mouth that can break down the enamel.

    Kaur also recommends limiting the time a child sucks on hard candy such as a lollipop. Some kids will suck on candy for up to half an hour. Opt for 10 minutes, for example, she said.

    Have them eat candy with a meal

    Leave candy — or any sweets for that matter — for an after-meal snack. When kids eat, more saliva is produced, which can better wash away the goodies. It might make it easier to remember to have your kids brush their teeth soon afterward as well, since many parents have kids brush their teeth after a meal.

    Some foods also have self-cleaning qualities. Fruits and vegetables like apples, celery and carrot sticks rub into the enamel when you bite into them, removing plaque.

    Exchange the candy

    Limit how long the candy bag is available so your child does not get used to having it within reach. Remove some of the candy your child collected or trade it all for a toy or extra play time. Check if your dentist or another group is sponsoring a candy donation effort.

    You can also take part in a new tradition and invite the “Switch Witch” into your home. Have you child put aside some of their candy for the Switch Witch, who’ll visit overnight to pick up the candy and leave something fun in its place. You can leave a toy for them to find the next morning.

    “Cavities don’t happen overnight,” Alcaraz said. “It takes time. It’s not a one-day process.”

    Go to the dentist

    After the first baby tooth emerges or your child reaches age 1, it’s time to see the dentist, who can add a coat of fluoride varnish to strengthen tooth enamel. Their efforts can make the effect of sugar-filled holidays less stressful.

    A dentist will let you know early on, for example, to avoid putting an infant to bed with a bottle of milk or formula because the liquid can sit on their teeth, and the sugars cause cavities, sometimes even before the first tooth emerges.

    Developing a relationship with dentists with an appointment every six months will also help keep you better informed as they grow. For young kids, the goal is to set strategies for families to keep the teeth healthy and reduce risk of gum disease and dental decay, Cortez said.

    Ask the dentist to apply sealants to a child’s back molars around the age of 6, the Los Angeles County Department of Public Health recommends. The thin coating can protect the chewing surface of the teeth from developing cavities.

    “It’s the most common chronic disease in children, more common than asthma,” Cortez said about dental decay, which affects more than 60% of kids in California by third grade. “We need to pay more attention. And so for pediatric dentists anyway, and for all dentistry, I think that the key is to start early.”

    This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.

    Kate Sequeira

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  • How Do I Make Sense of My Mother’s Decision to Die?

    How Do I Make Sense of My Mother’s Decision to Die?

    My mom could always leap into the coldest water. Every summer when we visited my grandma in upstate New York, my mom dove straight into the freezing lake, even when the temperature outdoors hit the 50s. The dogs, who usually trailed her everywhere, would whine in protest before paddling after her, and the iciness left her breathless when she surfaced. “Just jump, Lil,” she’d yell to me, laughing, before swimming off to vanish into the distance.

    But I never could. I didn’t think much about that difference between us, until I flew north to be with her on the day she’d chosen to die.

    When my mom found out in May last year that she had pancreatic cancer, the surgeon and the oncologist explained to our family that cutting out her tumor might extend her prognosis by about a year; chemotherapy could tack on another six months. A few days later, my mom asked if we could spend time together in Seattle over the summer, if we could get lemonade at the coffee shop while I was there, if I wanted to play Scrabble before I left. “Yeah, of course,” I said. “But—” She interrupted me: “I’m not getting surgery.”

    After a decade of Parkinson’s disease, my mom already experienced frequent periods of uncontrolled writhing and many hours spent nearly paralyzed in bed. That illness wounded her the way losing vision might pain a photographer: Throughout her life, she had reveled in physicality, working as a park caretaker, ship builder, and costume designer. Now, plagued by a neurological disorder that would only worsen, she didn’t want to also endure postoperative wounds, vomiting from chemo, and the gloved hands of strangers hefting her onto a bedpan after surgery. Nor did she want to wait for the pain cancer could inflict. Instead, my mom said, she planned to request a prescription under Washington’s Death With Dignity Act, which allows doctors, physician assistants, and nurse practitioners to provide lethal drugs for self-administration to competent adult residents with six months or less to live.

    As a doctor myself, I’ve confronted plenty of death, yet I still found myself at a loss over how to react to my mom’s choice. I know that the American tropes of illness—“battling to the end,” “hoping for a miracle,” being “a fighter”—often do harm. In clinical training, none of us wanted to unleash the fury of modern medicine upon a 98-year-old with cancer who’d just lost his pulse, but we all inflicted some version of it: ramming his purpled breastbone against his stilled heart, sending electricity jagging through his chest, and breaching his throat, blood vessels, and penis with tubes, only to watch him die days later. I didn’t want that for my mom; I had no desire for her to cling futilely to life.

    And yet, even though it shamed me, I couldn’t deny feeling unnerved by my mom’s choice. I understood why she’d made it, but I still ruminated over alternate scenarios in which she gave chemo a shot or tried out home hospice. Though her certainty was comforting, I was also devastated about losing her, and uneasy about how soon after a new diagnosis she might die.

    My mom had made her end-of-life wishes known by the time I was in fifth grade. Our rental home still held the owners’ books, among them Final Exit, a 1991 guide for dying people to end their lives. The author dispensed step-by-step advice on how to carry out your own death, at a time when nothing like the Death With Dignity Act existed in any state. When I found the book, my mom snatched it away. But months later, after her best friend died of brain cancer, she asked if I remembered it.

    “If I ever get really sick, Lil,” she said, “I don’t plan to suffer for a long time just to die in the end anyhow. I would take my life before it gets to that point, like in that book. Just so you know.”

    After her Parkinson’s diagnosis, my mom moved across the country to Washington, mostly to be near my sister, but also because in 2008, it became only the second state to approve lethal prescriptions for the terminally ill. Since then, despite much contention, the District of Columbia and eight more states have followed—including California, where I live and practice medicine. No dying patient of mine had ever requested the drugs, so I didn’t think much about the laws. Then my mom got cancer, and suddenly, the controversies ceased to be abstract.

    Proponents of aid-in-dying laws tend to say that helping very sick patients die when they want to is compassionate and justified, because people of sound mind should be free to decide when their illnesses have become unbearable. Access to lethal medications (which many recipients never end up using) lets them concentrate on their remaining life. I sympathize: I’ve seen patients who, despite palliative care, suffered irremediable existential or physical pain that they could escape only with sedating doses of narcotics.

    But I grasped the other side of the argument as well: that self-determination has limits. Aid-in-dying opponents have said that doctors who hasten death violate the Hippocratic Oath. Although I disagree with these moral objections, I do share some of the antagonists’ policy concerns. Many worry that state laws will expand to encompass children and the mentally ill, as they do in countries such as Belgium and the Netherlands. They argue that a nation that still devalues disabled people needs to invest in care, rather than permit death and open up the risk of coercion. So far, Americans who have used these laws have been overwhelmingly white and college-educated. But I could imagine patients of mine requesting death for suffering that’s been amplified by their poverty or uninsurance.

    These policies are so polarizing that people can’t even agree on language. Detractors refer to “assisted suicide,” or even murder, while supporters prefer medical “aid-in-dying,” which I’ll use, because it’s less charged. But I don’t much like either term, and neither did my mom. She was already dying, so she didn’t think of her death as suicide. Nor would she accept a passive term such as aid-in-dying, when she was the one taking action. Lacking any suitable word, she settled on a phrase that felt stark but honest. “When I kill myself,” she’d say. When she killed herself, we should give her spice rack to a friend. When she killed herself, we shouldn’t hold a funeral, because that would be depressing. Her tone was always matter-of-fact. My stomach always somersaulted.

    That summer, I read constantly about aid-in-dying—accounts of its use in Switzerland, essays in American medical journals, articles written by people who’d lost a loved one that way. I was the exception in our family. My mom was concerned with bigger issues, like whether the ice-cream shop would restock the lemon flavor before she died. My sister thought I was overintellectualizing things—and she was right. Sometimes we do the only thing we know how to, to keep from falling apart.

    So I kept looking for the solace of stories that felt as complicated as my own thoughts. They were remarkably rare. To me, loving my mom meant acknowledging my own hesitation yet still respecting her measure of the unendurable. Juggling these emotions felt nuanced, but most of what I read didn’t. So many narratives cast aid-in-dying as either an abomination or the epitome of virtue, in which a dying person could be rewarded for courageous serenity with a perfect death.

    Another daughter whose mother pursued aid-in-dying spoke in a TED Talk of the “design challenge” to “rebrand” death as “honest, noble, and brave.” But however tantalizing the prospect, the promise that we can scrub death of ugliness felt dangerously dishonest. Death can be wrenching and awful no matter where and how it happens: on a ventilator in an intensive-care unit, on morphine in hospice, or with a lethal prescription at home, surrounded by family. Being able to control death doesn’t mean we can perfect it.

    The myth of the “good death”—graceful and unsullied, beatific even—has infiltrated the human subconscious since at least the 15th century, when the Ars Moriendi, Christian treatises on the art of dying, proliferated in Europe. A translation of one version counsels the sick on how to die “gladly.” The moral in these texts bludgeons you: How you die is a referendum on how you lived, with only a picturesque exit guaranteeing repose for the soul.

    The notion has seeped through generations. “I hope if I’m ever in that situation, I’d have the bravery to do that,” one friend said about my mom’s choice. “It’s good she’ll die with her dignity intact,” said another. My mom’s physicians, kind and smart people, seemed so eager to validate her decision that the aid-in-dying criteria distilled to a checklist rather than unfurling into conversation. Even the name of the law my mom intended to use, Death With Dignity, implies that planned death succeeds where other ways of dying don’t. More than half a millennium after the Ars Moriendi, we still seem to believe that you can fail at death itself.

    One doctor told us of a landscape architect who drank the fatal cocktail while exulting in her garden in full bloom. It sounded perfect—except that in all my years as a doctor, I’ve never seen a perfect death. Every time, there’s some flaw: physical discomfort, conversations left unfinished, terror, family conflict, a loved one who didn’t get there in time. Still, my sister and I tried to stage-manage a beautiful death. We booked a cabin in Olympic National Park for my mom’s exit. We would bake her famous olive bread and cook bouillabaisse. We’d wheel her to the beach, then to the towering cedar forest, then massage her feet with almond oil while we talked in front of a woodstove. The fireside conversation would be our parting exchange of gifts, full of meaning, remembrance, and closure.

    As our family waited for that day to come, we kept thinking we should be tearing through a bucket list. Instead, we did what we always had—cooked, played games, read. We just did it with an ever-present sense of countdown, in an apartment where nearly everything would outlive my mom: the succulent on the windowsill, the lasagna in the freezer she made us promise to eat when she was gone.

    My mom did have the lemon ice cream again, but our family never made it to the cabin in the forest. A month before the planned trip—10 weeks after my mom’s diagnosis—the pharmacy compounded the drugs: a mixture of morphine and three others. The bottle was amber, filled with dissolvable powder and labeled with the words No Refills. (“Now that would be a dark Saturday Night Live skit,” my mom told me.) The next morning, a Thursday, she called, dizzy and miserable. She wanted to die ahead of schedule, on Saturday. I got on a plane.

    My mom, my sister’s family, and I spent Friday grilling chicken and drinking good wine. After my older niece painted my mom’s nails lavender with polka dots, the kids and my brother-in-law said their goodbyes and left. The next morning, my sister and I laid out the backyard like a set: a couch swathed in blankets. Tables with plants and photos and huge candlesticks. A stereo to play the music of our childhood and her motherhood.

    But our revised choreography couldn’t erase how horrible my mom felt that morning, dispirited by her disease and deeply exhausted. We had to cajole her not to die in bed. Eventually, she came outside, where we drank peppermint tea and talked about nothing memorable. When the moment came to gulp the bottle’s contents, mixed into lemonade, she didn’t hesitate.

    “You would make the same choice if you were me, right?” she said, setting down the empty bottle. I knew she wasn’t second-guessing. She was ending her time as our mother not out of lack of devotion, but because all other options felt untenable, and she needed confirmation that we knew this.

    “Yes,” my sister said, “I would.”

    “Me too,” I said—but in truth, I didn’t know. Maybe I would have dwindled over months of chemo as I learned to reshape my life in the face of imminent death. Maybe I would have died in hospice, surrendering myself to the fog and mercy of morphine. Maybe I would have stowed the drugs in a cupboard, cradling them occasionally and then, unable to reconcile the simplicity and complexity of that ending, replacing them. Each of these paths would have demanded its own form of courage—just not my mom’s type.

    “I’ll just go to sleep now, right?” she asked.

    “Yeah, Mom, you’ll just go to sleep,” I said. “I love you.”

    My sister and I kissed her forehead, her cheeks, her collarbone. We avoided the poisonous sheen on her lips, where our tears had wet the residue of white powder.

    The aspens rustled, confetti of silver. My mom didn’t cry, and the slightest trace of a smile alighted on her face.

    “Bye,” she said. “You’ve been awesome.”

    And then she dove off the dock. Her lips blued, and when she tried to speak more, the words never surfaced.

    It took her five and a half hours to disappear completely, while my sister and I tamped down growing worries that the drugs hadn’t worked. My mom felt no pain—she couldn’t have, after all that morphine—but her passing wasn’t a fairy tale. Her suffering wasn’t embossed in meaning; she didn’t tile over her bitterness with saintly forbearance. My mom died on the day she was ready and by the means she chose. All of that matters, immensely so. She also died precipitously, far from the forest she’d dreamed of, while my sister and I were left with little closure and a prolonged, confusing death.

    Usually, I write when I’m most upset, but my mom’s death catapulted me into a frightening depth of wordlessness. Weeks passed before I realized that my problem was not that I couldn’t find words at all. It was that I couldn’t tell the tale I felt I was supposed to. In that myth, death has a metric of success, and that metric is beauty. The trouble is that you can’t grieve over a version of events that never happened. You can only grieve over the story you lived, with all of its ambiguities.

    My mom’s death was beautiful. It was also terrible, and fraught. That is to say, it was human.

    Lindsay Ryan

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  • Kevin McCarthy Finally Defies the Right

    Kevin McCarthy Finally Defies the Right

    The speaker made a last-minute reversal to avert a government shutdown. It could cost him his job.

    Anna Moneymaker / Getty

    Updated at 9:02 p.m. ET on September 30, 2023

    For weeks, Speaker Kevin McCarthy seemed to face an impossible choice as he haggled over spending bills with his party’s most hard-line members: He could keep the government open, or he could keep his job. At every turn, McCarthy’s behavior suggested that he favored the latter option. He continued accepting the demands of far-right Republicans to deepen spending cuts and dig in against the Democrats, making a shutdown at tonight’s midnight deadline all but a certainty.

    With just hours to go, however, the speaker abruptly changed course, defying his conservative tormentors and partnering with Democrats to avert a shutdown. The House this afternoon overwhelmingly approved a temporary extension of federal funding. The Senate passed the bill in the evening, putting off a shutdown for at least 45 days and buying both parties more time to negotiate spending for the next fiscal year.

    The question now is whether McCarthy’s pivot will end his nine-month tenure as speaker. By folding—for now—on the shutdown fight, he is effectively daring Representative Matt Gaetz of Florida and other hard-line Republicans to make good on their threats to depose him. “If somebody wants to remove [me] because I want to be the adult in the room, go ahead and try,” McCarthy told reporters before the vote. “But I think this country is too important.”

    The stopgap bill includes disaster-relief money sought by both parties, but McCarthy refused to add $6 billion in Ukraine aid that the Biden administration and a bipartisan majority of senators wanted. The Senate had been on the verge of passing its own extension that included the Ukraine money, but after the House vote it was expected to accept McCarthy’s proposal instead. Whether House Republicans agree to include Ukraine assistance in the next major spending bill is unclear, but Democrats and Senate Minority Leader Mitch McConnell are likely to make an aggressive push for it.

    McCarthy’s surprising about-face set off a wild few hours in the Capitol. Democrats were caught off guard and stalled for time to read the new bill, unsure if Republicans were trying to sneak conservative policy priorities into the legislation without anyone noticing. (In the end, only a single Democrat voted against it.) Representative Jamaal Bowman of New York, a second-term Democrat, caused the evacuation of an entire House office building when he pulled a fire alarm just before the vote, in what Republicans said was a deliberate—and possibly criminal—effort to delay the proceedings. (Bowman’s chief of staff said that the representative “did not realize he would trigger a building alarm as he was rushing to make an urgent vote. The Congressman regrets any confusion.”)

    On the right, the criticism of McCarthy was predictable and immediate. “Should he remain Speaker of the House?” one of his Republican opponents, Representative Andy Biggs of Arizona, tweeted after the vote, seemingly rhetorically. Yet to more moderate Republicans, the speaker’s decision was a long time coming. McCarthy’s months-long kowtowing to the right had frustrated more pragmatic and politically vulnerable House Republicans, a few of whom threatened to join Democratic efforts to avert, or end, a shutdown. But many Republicans are even more furious at Gaetz and his allies. “Why live in fear of these guys? If they want to have the fight, have the fight,” former Representative Charlie Dent of Pennsylvania, a moderate who served in the House with McCarthy for 12 years, told me. “I don’t understand why you would appease people who are doing nothing but trying to hurt and humiliate you.”

    This morning, the speaker finally came to the same conclusion. His move to relent on a shutdown only kicks the stalemate over federal spending to another day. Now it’s up to House Republicans to decide if McCarthy gets to stick around to resolve it.

    Russell Berman

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  • Humans Can No Longer Ignore the Threat of Fungi

    Humans Can No Longer Ignore the Threat of Fungi

    This article was originally published by Undark Magazine.

    Back at the turn of the 21st century, valley fever was an obscure fungal disease in the United States, with fewer than 3,000 reported cases a year, mostly in California and Arizona. Two decades later, cases of valley fever have exploded, increasing roughly sevenfold by 2019.

    And valley fever isn’t alone. Fungal diseases in general are appearing in places they have never been seen before, and previously harmless or mildly harmful fungi are becoming more dangerous for people. One likely reason for this worsening fungal situation, scientists say, is climate change. Shifts in temperature and rainfall patterns are expanding where disease-causing fungi occur; climate-triggered calamities can help fungi disperse and reach more people; and warmer temperatures create opportunities for fungi to evolve into more dangerous agents of disease.

    For a long time, fungi have been a neglected group of pathogens. By the late 1990s, researchers were already warning that climate change would make bacterial, viral, and parasite-caused infectious diseases such as cholera, dengue, and malaria more widespread. “But people were not focused at all on the fungi,” says Arturo Casadevall, a microbiologist and an immunologist at the Johns Hopkins Bloomberg School of Public Health. That’s because, until recently, fungi have caused humans relatively little trouble.

    Our high body temperature helps explain why. Many fungi grow best at about 12 to 30 degrees Celsius (roughly 54 to 86 degrees Fahrenheit). So though they find it easy to infect trees, crops, amphibians, fish, reptiles, and insects—organisms that do not maintain consistently high internal body temperatures—fungi usually don’t thrive inside the warm bodies of mammals, Casadevall wrote in an overview of immunity to invasive fungal diseases in the 2022 Annual Review of Immunology. Among the few fungi that do infect humans, some dangerous ones, such as species of Cryptococcus, Penicillium, and Aspergillus, have historically been reported more in tropical and subtropical regions than in cooler ones. This, too, suggests that climate may limit their reach.


    Today, however, the planet’s warming climate may be helping some fungal pathogens spread to new areas. Take valley fever, for instance. The disease can cause flu-like symptoms in people who breathe in the microscopic spores of the fungus Coccidioides. The climatic conditions favoring valley fever may occur in 217 counties of 12 U.S. states today, according to a 2019 study by Morgan Gorris, an Earth-system scientist at the Los Alamos National Laboratory, in New Mexico.

    But when Gorris modeled where the fungi could live in the future, the results were sobering. By 2100, in a scenario where greenhouse-gas emissions continue unabated, rising temperatures would allow Coccidioides to spread northward to 476 counties in 17 states. What was once thought to be a disease mostly restricted to the southwestern U.S. could expand as far as the U.S.-Canadian border in response to climate change, Gorris says. That was a real “wow moment,” she adds, because that would put millions more people at risk.

    Some other fungal diseases of humans are also on the move, such as histoplasmosis and blastomycosis. Both, like valley fever, are seen more and more outside what was thought to be their historical range.

    Such range extensions have also appeared in fungal pathogens of other species. The chytrid fungus that has contributed to declines in hundreds of amphibian species, for example, grows well at environmental temperatures from 17 to 25 degrees Celsius (63 to 77 degrees Fahrenheit). But the fungus is becoming an increasing problem at higher altitudes and latitudes, which likely is in part because rising temperatures are making previously cold regions more welcoming for the chytrid. Similarly, white-pine blister rust, a fungus that has devastated some species of white pines across Europe and North America, is expanding to higher elevations where conditions were previously unfavorable. This has put more pine forests at risk. Changing climatic conditions are also helping drive fungal pathogens of crops, like those infecting bananas and wheat, to new areas.

    A warming climate also changes cycles of droughts and intense rains, which can increase the risk of fungal diseases in humans. One study of more than 81,000 cases of valley fever in California from 2000 to 2020 found that infections tended to surge in the two years immediately following prolonged droughts. Scientists don’t yet fully understand why this happens. But one hypothesis suggests that Coccidioides survives better than its microbial competitors during long droughts, then grows quickly once rains return and releases spores into the air when the soil begins to dry again. “So climate is not only going to affect where it is, but how many cases we have from year to year,” says Gorris.

    By triggering more intense and frequent storms and fires, climate change can also help fungal spores spread over longer distances. Researchers have found a surge in valley-fever infections in California hospitals after large wildfires as far as 200 miles away. Scientists have seen this phenomenon in other species too: Dust storms originating in Africa may be implicated in helping move a coral-killing soil fungus to the Caribbean.

    Researchers are now sampling the air in dust storms and wildfires to see if these events can actually carry viable, disease-causing fungi for long distances and bring them to people, causing infections. Understanding such dispersal is key to figuring out how diseases spread, says Bala Chaudhary, a fungal ecologist at Dartmouth who co-authored an overview of fungal dispersal in the 2022 Annual Review of Ecology, Evolution, and Systematics. But there’s a long road ahead: Scientists still don’t have answers to several basic questions, such as where various pathogenic fungi live in the environment or the exact triggers that liberate fungal spores out of soil and transport them over long distances to become established in new places.


    Helping existing fungal diseases reach new places isn’t the only effect of climate change. Warming temperatures can also help previously innocuous fungi evolve tolerance for heat. Researchers have long known that fungi are capable of this. In 2009, for example, researchers showed that a fungus—in this case, a pathogen that infects insects—could evolve to grow at nearly 37 degrees Celsius, some five degrees higher than its previous upper thermal limit, after just four months. More recently, researchers grew a dangerous human pathogen, Cryptococcus deneoformans, at both 37 degrees Celsius (similar to human body temperature) and 30 degrees Celsius in the lab. The higher temperature triggered a fivefold rise in a certain type of mutation in the fungus’s DNA compared with the lower temperature. Rising global temperatures, the researchers speculate, could thus help some fungi rapidly adapt, increasing their ability to infect people.

    There are examples from the real world too. Before 2000, the stripe-rust fungus, which devastates wheat crops, preferred cool, wet parts of the world. But since 2000, some strains of the fungus have become better adapted to higher temperatures. These sturdier strains have been replacing the older strains and spreading to new regions.

    This is worrying, says Casadevall, especially with hotter days and heat waves becoming more frequent and intense. “Microbes really have two choices: adapt or die,” he says. “Most of them have some capacity to adapt.” As climate change increases the number of hot days, evolution will likely select more strongly for heat-resistant fungi.

    And as fungi in the environment adapt to tolerate heat, some might even become capable of breaching the human temperature barrier.

    This may have happened already. In 2009, doctors in Japan isolated an unknown fungus from the ear discharge of a 70-year-old woman. This new-to-medicine fungus, which was given the name Candida auris, soon spread to hospitals around the world, causing severe bloodstream infections in already sick patients. The World Health Organization now lists Candida auris in its most dangerous group of fungal pathogens, partly because the fungus is showing increasing resistance to common antifungal drugs.

    “In the case of India, it’s really a nightmare,” says Arunaloke Chakrabarti, a medical mycologist at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. When C. auris was first reported in India more than a decade ago, it was low on the list of Candida species threatening patients, Chakrabarti says, but now, it’s the leading cause of Candida infections. In the U.S., clinical cases rose sharply from 63 in the period from 2013 to 2016 to more than 2,300 in 2022.

    Where did C. auris come from so suddenly? The fungus appeared simultaneously across three different continents. Each continent’s version of the fungus was genetically distinct, suggesting that it emerged independently on each continent. “It’s not like somebody took a plane and carried them,” says Casadevall. “The isolates are not related.”

    Because all continents are exposed to the effects of climate change, Casadevall and his colleagues think that human-induced global warming may have played a role. C. auris may always have existed somewhere in the environment—potentially in wetlands, where researchers have recovered other pathogenic species of Candida. Climate change, they argued in 2019, may have exposed the fungus to hotter conditions over and over again, allowing some strains to become heat-tolerant enough to infect people—although the researchers cautioned that many other factors are also likely at play.

    Subsequently, scientists from India and Canada found C. auris in nature on the Andaman Islands in the Bay of Bengal. This “wild” version of C. auris grew much slower at human body temperature than did the hospital versions. “What that suggests to me is that this stuff is all over the environment and some of the isolates are adapting faster than others,” says Casadevall.

    Like other explanations for C. auris’s origin, Casadevall’s is only a hypothesis, says Chakrabarti, and still needs to be proved.

    One way to establish the climate-change link, Casadevall says, would be to review old soil samples and see whether they have C. auris in them. If the older versions of the fungus don’t grow well at higher temperatures, but over time they start to, that would be good evidence that they’re adapting to heat.

    In any case, the possibility of warmer temperatures bringing new fungal pathogens to humans needs to be taken seriously, says Casadevall—especially if drug-resistant fungi that currently infect species of insects and plants become capable of growing at human body temperature. “Then we find ourselves with organisms that we never knew before, like Candida auris.”

    Doctors are already encountering novel fungal infections in people, such as multiple new-to-medicine species of Emergomyces that have appeared mostly in HIV-infected patients across four continents, and the first record of Chondrostereum purpureum—a fungus that infects some plants of the rose family—infecting a plant mycologist in India. Even though these emerging diseases haven’t been directly linked to climate change, they highlight the threat that fungal diseases might pose. For Casadevall, the message is clear: It’s time to pay more attention.

    Shreya Dasgupta

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  • How Bad Could BA.2.86 Get?

    How Bad Could BA.2.86 Get?

    Since Omicron swept across the globe in 2021, the evolution of SARS-CoV-2 has moved at a slower and more predictable pace. New variants of interest have come and gone, but none have matched Omicron’s 30-odd mutations or its ferocious growth. Then, about two weeks ago, a variant descended from BA.2 popped up with 34 mutations in its spike protein—a leap in viral evolution that sure looked a lot like Omicron. The question became: Could it also spread as quickly and as widely as Omicron?

    This new variant, dubbed BA.2.86, has now been detected in at least 15 cases across six countries, including Israel, Denmark, South Africa, and the United States. This is a trickle of new cases, not a flood, which is somewhat reassuring. But with COVID surveillance no longer a priority, the world’s labs are also sequencing about 1 percent of what they were two years ago, says Thomas Peacock, a virologist at the Pirbright Institute. The less surveillance scientists are doing, the more places a variant could spread out of sight, and the longer it will take to understand BA.2.86’s potential.

    Peacock told me that he will be closely tracking the data from Denmark in the next week or two. The country still has relatively robust SARS-CoV-2 sequencing, and because it has already detected BA.2.86, we can now watch the numbers rise—or not—in real time. Until the future of BA.2.86 becomes clear, three scenarios are still possible.

    The worst but also least likely scenario is another Omicron-like surge around the world. BA.2.86 just doesn’t seem to be growing as explosively. “If it had been very fast, we probably would have known by now,” Peacock said, noting that, in contrast, Omicron’s rapid growth took just three or four days to become obvious.

    Scientists aren’t totally willing to go on record ruling out Omicron redux yet, if only because patchy viral surveillance means no one has a complete global picture. Back in 2021, South Africa noticed that Omicron was driving a big COVID wave, which allowed its scientists to warn the rest of the world. But if BA.2.86 is now causing a wave in a region that isn’t sequencing viruses or even testing very much, no one would know.

    Even in this scenario, though, our collective immunity will be a buffer against the virus. BA.2.86 looks on paper to have Omicron-like abilities to cause reinfection, according to a preliminary analysis of its mutations by Jesse Bloom, a virologist at the Fred Hutchinson Cancer Center, in Washington, but he adds that there’s a big difference between 2021 and now. “At the time of the Omicron wave, there were still a lot of people out there that had never been either vaccinated or infected with SARS-CoV-2, and those people were sort of especially easy targets,” he told me. “Now the vast, vast majority of people in the world have either been infected or vaccinated with SARS-CoV-2—or are often both infected and vaccinated multiple times. So that means I think any variant is going to have a very hard time spreading as well as Omicron.”

    A second and more likely possibility is that BA.2.86 ends up like the other post-Omicron variants: transmissible enough to edge out a previous variant, but not transmissible enough to cause a big new surge. Since the original Omicron variant, or BA.1, took over, the U.S. has successively cycled through BA.2, BA.2.12.1, BA.5, BQ.1, XBB.1.5—and if these jumbles of numbers and letters seem only faintly familiar, it’s because they never reached the same levels of notoriety as the original. Vaccine makers track them to keep COVID shots up to date, but the World Health Organization hasn’t deemed any worthy of a new Greek letter.

    If BA.2.86 continues to circulate, though, it could pick up mutations that give it new advantages. In fact, XBB.1.5, which rose to dominance earlier this year, leveled up this way. When XBB.1.5’s predecessor was first identified in Singapore, Peacock said, it wasn’t a very successful variant: Its spike protein bound weakly to receptors in human cells. Then it acquired an additional mutation in its spike protein that compensated for the loss of binding, and it turned into the later-dominant XBB.1.5. Descendents of BA.2.86 could eventually become more transmissible than the variant looks right now.

    A third scenario is that BA.2.86 just fizzles out and goes away. Scientists now believe that highly mutated variants such as BA.2.86 are probably products of chronic infections in immunocompromised patients. In these infections, the virus remains in the body for a long time, trying out new ways to evade the immune system. It might end up with mutations that make its spike protein less recognizable to antibodies, but those same mutations could also render the spike protein less functional and therefore the virus less good at transmitting from person to person.

    “Variants like that have been identified over the last few years,” Bloom said. “Often there’s one sample found, and that’s it. Or multiple samples all found in the same place.” BA.2.86 is transmissible enough to be found multiple times in multiple places, but whether it can overtake existing variants is unclear. To do so, BA.2.86 needs to escape antibodies while also preserving its inherent transmissibility. Otherwise, Bloom said, cases might crop up here and there, but the variant never really takes off. In other words, the BA.2.86 situation basically stays where it is right now.

    The next few weeks will reveal which of these futures we’re living in. If the number of BA.2.86 cases starts to go up, in a way that requires more attention, we’ll know soon. But each week that the variant’s spread does not jump dramatically, the less likely BA.2.86 is to end up a variant of actual concern.

    Sarah Zhang

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  • Americans Eat Obscene Amounts of Protein. Is It Enough?

    Americans Eat Obscene Amounts of Protein. Is It Enough?

    For years, the American approach to protein has been a never-ending quest for more. On average, each person in the United States puts away roughly 300 pounds of meat a year; we are responsible for more than a third of the multibillion-dollar protein-supplement market. Our recommended dietary allowance, or RDA, for protein is 0.8 grams per kilogram of body weight per day—a quota that a 160-pound person could meet with a couple of eggs in the morning and an eight-ounce steak at night. American adults consistently eat well above that amount, with men close to doubling it—and recent polls show that millions of us want to increase our intake.

    The American appetite for protein is, simply put, huge. And still, Jose Antonio thinks we’re getting nowhere near enough.

    The RDA of 0.8 grams per kilogram is “nothing, literally nothing,” Antonio, a health-and-human-performance researcher at Nova Southeastern University, in Florida, told me. “Most of my friends get that at breakfast.” In an ideal world, Antonio said, totally sedentary adults should consume at least twice that; people who seriously exercise should start with a minimum of 2.2 grams per kilogram, and ramp their levels up from there. (Antonio is also a co-founder of the International Society of Sports Nutrition, which has received sponsorships from companies that sell protein supplements.)

    In Antonio’s pro-protein world, people would be fitter, more energetic, and suffer less chronic disease; they’d build muscle more efficiently, and recover faster from workouts. There is no definitive cap, in his view, on how much protein people should strive for. The limit, he said, is “How much can a human consume in a single day?”

    Among nutritionists, Antonio’s viewpoint is pretty fringe. There is, other experts told me, such a thing as too much protein—or at least a point of rapidly diminishing returns. But researchers don’t agree on how much protein is necessary, or how much is excessive; they’ve reached no consensus on the extent of its benefits, or whether eating extra servings can send our health into decline. Which leaves Americans with no protein ceiling—and plenty of room for our protein hunger to grow, and grow, and grow.

    Not having enough protein is clearly very bad. Protein is essential to the architecture of our cells; we rely on it for immunity and hormone synthesis, and cobble it together to build muscles, skin, and bone. Among the three macronutrients—the other two being carbohydrates and fat—protein is the only one that “we need to get every day,” Joanne Slavin, a nutrition researcher at the University of Minnesota, told me. Nearly half of the 20 amino-acid building blocks that make up protein can’t be produced in-house. Go without them for too long, and the body will start to break its own tissues down to scavenge the molecules it needs.

    That state of deficiency is exactly what the protein RDA was designed to avoid. Researchers decided the threshold decades ago, based on their best estimations of the amount of protein people needed to balance out their loss of nitrogen—a substance that’s in amino acids but that the body can’t itself make. The average person in the study, they found, needed 0.66 grams of protein per kilogram of body weight to avoid going into the red. So they set the guidelines at 0.8, a level that would keep the overwhelming majority of the population out of the deficiency zone. That number has stuck in the many years since, and Slavin, who has sat on the Dietary Guidelines Advisory Committee, sees no reason for it to change. People who are expending extra energy on growth, or whose muscles are taxed by exercise or aging, might need more. But for the typical American adult, Slavin said, “I think 0.8 is the right number.”

    Others vehemently disagree. The current standard is “not enough to support everyday living,” Abbie Smith-Ryan, a sports-nutrition expert at the University of North Carolina at Chapel Hill, told me. Adults, she and others told me, should be getting more like 1.2 or 1.6 grams per kilogram at baseline. Their beef with the RDA is twofold. For one, the original nitrogen analyses oversimplified how the body metabolizes and retains protein, Stuart Phillips, a protein researcher at McMaster University, in Canada, told me. And second, even if the 0.8 number does meet our barest needs, “there’s a much more optimal amount we should be consuming” that would further improve our health, Katie Hirsch, an exercise physiologist at the University of South Carolina, told me. (I reached out to the USDA, which helps develop the U.S.’s official Dietary Guidelines, about whether the RDA needed to change; a spokesperson referred me to the National Academy of Sciences, which said that the RDA was last reviewed in 2002, and was expected to be reviewed again soon.)

    If Hirsch and others are right, even people who are slightly exceeding the government guideline might not be maximizing their resilience against infections, cardiovascular disease, metabolic issues, muscle loss, and more. People who are working out and still eating the measly 0.8 grams per kilogram per day, Antonio told me, are also starving themselves of the chance to build lean muscle—and of performance gains.

    But the “more” mentality has a limit. Experts just can’t agree on what it is. It does depend on who’s asking, and their goals. For most people, the benefits “diminish greatly” past 1.6 grams per kilogram, Phillips told me. Smith-Ryan said that levels around 2.2 were valid for athletes trying to lose weight. Antonio is more liberal still. Intakes of 3.3 or so are fair game for body builders or elite cyclists, he told me. In one of his studies, he had athletes pack in 4.4 grams of protein per kilogram of body weight for weeks—a daily diet that, for a 160-pound person, would require three-plus pounds of steak, 16 cups of tofu, or 89 egg whites.

    That is … a lot of protein. And most of the other experts I spoke with said that they didn’t see the point, especially for Americans, who already eat more protein than people in most other countries. “There’s very little evidence that more is better,” Marion Nestle, a nutrition researcher at New York University, told me.

    The worry isn’t necessarily that tons of protein would cause acute bodily harm, at least not to people who are otherwise in good health. Over the years, researchers have raised concerns that too much protein could damage the kidneys or liver, leach calcium from the bones, or even trigger cancer or early death—but the evidence on all fronts is, at best, mixed. In Antonio’s high-protein studies with athletes, he told me, their organs have remained in tip-top shape. The known drawbacks are more annoying than dangerous: High-protein diets can raise the risk of bloating, gas, and dehydration; burning through tons of protein can also make people feel very, very hot. Roughly a quarter of the participants in Antonio’s ultra-high-protein study dropped out: Many of them felt too full, he told me, and no longer enjoyed food. One volunteer was so plagued by night sweats by the close of the trial, he said, that she could no longer fall asleep.

    Whether many years of an ultrahigh-protein lifestyle could be harmful is less clear. Native communities in the Arctic have healthfully subsisted on such diets for generations, but they’ve had a long time to adapt; those in Western society might not fare the same.

    Over the years, it’s gotten easy to interpret protein’s apparent lack of immediate downsides as permission to reach for more. But for now, many experts would rather err on the side of moderation. “Would I feed that much to one of my relatives? I would not,” Susan Roberts, a nutrition researcher at Tufts University, told me. Even if protein itself turns out not to be hard on the body, the foods it comes in still might be, including processed meats or sugary “high-protein” powders, shakes, cookies, chips, and bars. People pounding protein also risk squeezing other nutrients out of their diet, Roberts told me—whole grains, nuts, fruits, and vegetables, all of them packed with fiber, a vital ingredient that nutritionists actually do agree we lack.

    Plus, Slavin argued, there’s a point at which excess protein becomes a straight-up waste. When people eat more than about 20 to 40 grams of protein in a single sitting, their protein-processing machinery can get overwhelmed; the body eliminates the nitrogen as waste, then treats the rest as it would a carbohydrate or fat. “You can get fat on proteins just like you can get fat on carbohydrates,” Slavin told me. Which makes overdoing protein, in her eyes, “expensive and stupid.”

    The excess can have consequences beyond what our own bodies endure. Meat production drives greenhouse-gas emissions and uses up massive tracts of land. And Maya Almaraz, a food-systems researcher at Princeton, has found that the majority of the nitrogen pollution in wastewater is a by-product of our diets. The more protein we eat, the more we might be feeding toxic algal blooms.

    There’s no denying that protein deficiency is a problem in many parts of the world, even within the United States. Protein sources are expensive, putting them out of reach of poor communities. Meanwhile, many of the people who worry most about getting enough of it—the wealthy, the ultra-athletic, the educated—are among those who need to supplement the least. Experts, for now, may not agree on how much protein is too much for individuals. But if appetite is all we have to curb our intake, going all in on protein might create problems bigger than anything we’ve had to stomach so far.

    Katherine J. Wu

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  • What ‘Fitboxing’ Is Missing

    What ‘Fitboxing’ Is Missing

    Outside the door, I heard a flurry of thudding that reverberated back through the floor. I looked at my friend, then stepped in behind her. The room was damp and stuffy, despite a fan droning loudly in the corner. Six people were dispersed across the floor, weaving to their own rhythms. I was 18 and hadn’t been to a gym more than twice in my life; this was my first boxing class.

    Though I was the least fit person in the room, the coach put me through all the drills: shadowboxing in front of the mirror (fine), punching a bag (cathartic), light sparring (rough). The coach struck my nose, my forehead, my jaw, my abdomen as he reminded me to keep my hands up and to keep moving. My legs were screaming; even a gentle tap on the nose stung. (It didn’t help that mine’s been broken since I was 7.) I realized that I liked martial arts anyway.

    I wasn’t trying to be an amateur fighter, but I wanted to keep getting stronger and quicker. In this boxing class held at my college gym, and at the gyms I found to train in over summers, sparring was a given. The whole point of training was to get better at landing punches (and eluding them) in the ring. I liked to feel myself improving concretely every time I stepped back in to face a real opponent. But after graduating, I discovered that the experience I’d had that first day, an immediate induction into boxing by light sparring, was almost impossible to find.

    Over the past several years, the popularity of “fitboxing” classes, which involve intense cardio, strength training, and ab workouts, has skyrocketed. These classes might look a lot like boxing, but they have a key difference: For the grand finale, you get to punch … a bag. Many of these gyms are entirely “noncontact,” and the few that do let you spar tend to charge extra for it. I asked Bryan Corrigan, my coach that first day, what he sees as the value of sparring—why had he started me on it the very first time I’d boxed? “It’s the whole mind game behind boxing and the science of it,” he told me. Yes, getting hit can be scary, but you learn to keep your calm and be strategic in the face of it. Without sparring, “that gets lost.”

    For a long time, boxing gyms were, by nature, fighting gyms: You couldn’t find one without a ring. “In the beginning, we only had professional players and amateur fighters,” Bruce Silverglade, the owner of Gleason’s Gym, in Brooklyn, New York, told me. Many gyms were in low-income areas, and many of the people who fought in them were new immigrants or members of minority groups. Some viewed the sport as “a positive alternative to the streets.”

    By the time “fitboxing” started to gain ground, that landscape had shifted. Many professional boxing matches had moved to pay-per-view TV, some fans had come to question the sport’s inherent brutality, and others were gravitating toward MMA fights. Professional fights were harder to find in New York and other storied boxing cities; those shows had moved largely to Las Vegas. Many free programs such as Cops and Kids, which made boxing accessible and provided a pathway for promising fighters from underserved neighborhoods, had also shrunk or shut down altogether. People inside and outside the sport were contending with boxing’s violence, and the brain damage that often resulted.

    Meanwhile, fitness classes everywhere were exploding: barre, hot yoga, spinning. Fitboxing soon joined the ranks, and enough white-collar professionals were interested to start a sea change: Michael Hughes, the head trainer at Church Street Boxing, in Manhattan, New York, dates this shift to about 2012. Boutique boxing gyms sprang up to cater to this new clientele; many old-school fighting gyms had to revamp their offerings too. “Today, probably 85 percent of my members are businessmen and women that are just here for conditioning workouts,” Silverglade said.

    And most of these newer boxers just weren’t interested in sparring, gym owners told me. As a result, now even many more traditional boxing gyms either don’t offer sparring or separate it out from their regular classes. Joey DeMalavez, the owner of Joltin’ Jabs, in Conshohocken, Pennsylvania, explained that sparring is simply not profitable, especially when gym owners have to contend with increasing rents and high insurance costs. “There’s just not enough people that want to get in there and do that,” DeMalavez told me. “To offer sparring into a regular boxing class will scare a lot more people than it’ll help.” What people really want is the experience of boxing without the possibility of getting hit.

    The fear concerning safety is real, and it makes sense. Katalin Rodriguez Ogren, the owner of Pow! Gym Chicago, acknowledges the tension. “An old-school boxing gym doesn’t necessarily mean it’s a safe training environment,” she told me in an email. While these gyms will give you what Rodriguez Ogren calls an “authentic” experience, many “don’t understand injury prevention, or have the education to provide safe training classes,” she said. That’s not to say gyms can’t be both safe and authentic to boxing. With sparring (as opposed to actual fighting), the point is not to hurt someone or knock anyone out; it’s to hone accuracy and reflex. You take knocks where your defense is weak, and there is always a risk of accidents, much as in any sport, but the shots are not full power. Being hit and being hurt are different.

    There’s nothing wrong with wanting a boxing-inspired workout—all of the boxing coaches I spoke with agreed. It has some very real fitness benefits: It’s good cardio and can build strength and coordination. But fitboxing is not growing in popularity alongside boxing; it’s overtaking boxing. The few authentic boxing gyms I was able to find in Manhattan and Brooklyn can cost more than $100 a month to join. And boxing without sparring is a fundamentally different activity. “I kind of look at it like, Zumba is super fun and I love Zumba, but I’m not going to go to a Zumba class if I actually want to learn how to salsa dance,” Rodriguez Ogren said.

    The risk of getting hit gives you direct, instant feedback about how much better you’re getting—and an extra boost of confidence and reward when you find that you are. “In order to keep you safe, you rely on your skill,” Peter Olusoga, a senior psychology lecturer at Sheffield Hallam University who has a background in sports and exercise psychology, told me. “The confidence boost that you get from seeing yourself improving and feeling more competent is really beneficial.” Although simply rehearsing boxing moves, as in fitboxing, can give you a taste, sparring enhances that feeling. Actually trying to hit another person, and keep yourself from being hit, represents a higher level of difficulty and intimacy with your sparring partners.

    When I asked people in the boxing world what they consider the inherent value of sparring, many spoke to the discipline gained, or the visceral lessons it offers in dealing with adversity. But for me, it’s even more basic. A boxing-inspired workout is a great way to get in shape; sparring is a mind game. No matter how much I do it, I’ll still get hit, but I can now hold my own in the ring (mostly). I may never want to fight, but sparring is more than a workout—it’s a form of problem-solving that’s equal parts mental and physical. If you’re interested in boxing, I suggest slipping into the ring and actually trying it out.

    Zoya Qureshi

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  • Why Biden Caved

    Why Biden Caved

    The White House and Congress have not made much progress in their talks to avert an unprecedented, and potentially calamitous, national default that could occur as soon as early June. But on the most fundamental point of dispute, President Joe Biden has already caved: He’s negotiating with Republicans over the debt ceiling.

    For months, the president’s ironclad position has been that the debt ceiling is not a bargaining chip. No longer would Democrats allow Republicans to hold hostage the nation’s creditworthiness and economic prestige. Paying the government’s bills by raising the U.S.’s statutory borrowing limit would be nonnegotiable. As recently as Friday, White House Press Secretary Karine Jean-Pierre declared without equivocation, “We are not going to negotiate over the debt limit.”

    But Biden himself has dropped the pretense that his weeks-long budget discussions with the GOP have not revolved around the debt ceiling. Asked specifically about the debt ceiling on Sunday—in anticipation of a second White House visit by congressional leaders, planned for today—Biden told reporters, “Well, I’ve learned a long time ago, and you know as well as I do: It never is good to characterize a negotiation in the middle of a negotiation.”

    So there you go: It’s a negotiation. Exactly what the two parties are discussing is only starting to become clear. According to various reports, a deal to avert default could include some changes to permitting rules that would speed up domestic-energy production; a revocation of unused COVID funds; additional work requirements for some federal programs (although the president has ruled out any modifications to Medicaid); and, most significant, a cap on overall federal spending.

    The Biden administration still claims to be haggling only over the budget, not the debt ceiling. “The president has been emphasizing for months that he’s eager to have budget negotiations,” a White House official, who requested anonymity to explain the administration’s somewhat tortured position, told me. “That’s of course different from avoiding default, which is nonnegotiable.”

    Biden’s no-negotiation stance was born of past experience, when in 2011 Republicans dragged out debt talks with the Obama administration to the brink of default, resulting in a downgrade of the U.S.’s credit rating. But Biden’s approach this time is proving to be neither realistic nor sustainable, especially after Speaker Kevin McCarthy defied expectations last month by getting a budget-slashing debt-ceiling bill through his narrow House majority.

    Crucially, Biden failed to win strong support for his strategy from House centrists. Democrats had been hoping to persuade Republicans representing swing districts to buck McCarthy and help pass a debt-ceiling increase. But those lawmakers have stuck by the speaker. Complaining about a lack of outreach from the White House, they instead criticized Biden over his refusal—until recently—to negotiate. With Republicans unwilling to budge, Democratic centrists began to lose patience with Biden’s approach and conducted their own bipartisan negotiations.

    “We believe it’s very important in general that both sides sit down and try to work this out,” Representative Josh Gottheimer of New Jersey, the Democratic co-chair of the bipartisan Problem Solvers Caucus, told me before Biden’s first meeting last week with McCarthy and other top congressional leaders. “This can’t become a part of a political back-and-forth as the country drives off the cliff.”

    Last month the Problem Solvers offered their own plan, which they presented as a fallback option that could win bipartisan support should Biden and McCarthy fail to strike a deal in time. The proposal would immediately suspend the borrowing limit through the end of the year to buy time for broader budget talks. If Congress agrees to unspecified budget limits and creates a fiscal commission to tackle the nation’s long-term deficits and debt, the plan stipulates that the debt ceiling would be increased through the 2024 elections.

    The compromise has yet to gain momentum, but its release seemed to undermine the Biden administration’s insistence that Democrats would not tie a debt-ceiling increase to spending reforms. “We didn’t try to fill in every blank, but we thought this was a really good framework to become the meat of the deal,” Representative Scott Peters of California, a Democrat who helped write the Problem Solvers plan, told me.

    It could still prove handy. Biden struck an optimistic note on Sunday, telling reporters, “I really think there’s a desire on [Republicans’] part, as well as ours, to reach an agreement, and I think we’ll be able to do it.” But McCarthy is sounding more dour. “I still think we’re far apart,” he told NBC News yesterday morning. The speaker said that Biden “hasn’t taken it serious” and warned that an agreement needed to happen by this weekend in order for the House and Senate to have time to debate and pass it by early June.

    Whether a Biden-McCarthy deal could even get through the House is also in question. Democrats have largely stayed quiet on Biden’s evident capitulation to Republicans, and the talks initially did not stir a backlash. But that may be changing as the president openly considers concessions that would be anathema to progressives, such as the possibility of adding work requirements to social safety-net programs. Still, the lack of a credible primary challenge to Biden’s reelection has helped give him room to negotiate, as Democrats fret about the effect that a default could have on the president’s already tenuous public standing.

    “As long as he continues to try to avoid default, and avoid the middle class having to pay the cost for it, then he’s in the position that the majority of the electorate wants him to be,” Jesse Ferguson, a longtime Democratic strategist, told me.

    McCarthy has much more to worry about. He traded away his own job security to win the speakership in January, agreeing to rule changes that would make it easier for hard-right conservatives to depose him. A debt-ceiling deal that fails to secure deep enough spending cuts or policy concessions from Democrats could threaten his position. “Default can be avoided. The question is whether Kevin McCarthy could withstand putting that bill on the floor,” Ferguson said.

    The speaker has secured no substantive commitments from Biden, nothing specific that he can sell to his party. But McCarthy has elicited one major concession from the president, which serves as a prerequisite for any others to come. Biden has come to the table with default in the balance, and he’s negotiating on the GOP’s terms.

    Russell Berman

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  • Will COVID’s Spring Lull Last?

    Will COVID’s Spring Lull Last?

    By all official counts—at least, the ones still being tallied—the global situation on COVID appears to have essentially flatlined. More than a year has passed since the world last saw daily confirmed deaths tick above 10,000; nearly a year and a half has elapsed since the population was pummeled by a new Greek-lettered variant of concern. The globe’s most recent winters have been the pandemic’s least lethal to date—and the World Health Organization is mulling lifting its COVID emergency declaration sometime later this year, as the final pandemic protections in the United States prepare to disappear. On the heels of the least-terrible winter since the pandemic’s onset, this spring in the U.S. is also going … kind of all right. “I am feeling less worried than I have been in a while,” Shweta Bansal, an infectious-disease modeler at Georgetown University, told me.

    That sense of phew, though, Bansal said, feels tenuous. The coronavirus’s evolution is not yet predictable; its effects are nowhere near benign. This might be the longest stretch of quasi-normalcy that humanity has had since 2020’s start, but experts can’t yet tell whether we’re at the beginning of post-pandemic stability or in the middle of a temporary reprieve. For now, we’re in a holding pattern, a sort of extended coda or denouement. Which means that our lived experience and scientific reality might not match up for a good while yet.

    There is, to be fair, reason to suspect that some current trends will stick. The gargantuan waves of seasons past were the rough product of three factors: low population immunity, genetic changes that allowed SARS-CoV-2 to skirt what immunity did exist, and upswings in behaviors that brought people and the virus into frequent contact. Now, though, just about everyone has had some exposure to SARS-CoV-2’s spike protein, whether by infection or injection. And most Americans have long since dispensed with masking and distancing, maintaining their exposure at a consistently high plateau. That leaves the virus’s shape-shifting as the only major wild card, says Emily Martin, an infectious-disease epidemiologist at the University of Michigan. SARS-CoV-2 could, for instance, make another evolutionary leap large enough to re-create the Omicron wave of early 2022—but a long time has passed since the virus managed such a feat. Tentatively, carefully, experts are hopeful that we’re at last in a “period that could be kind of indicative of what the new normal really is,” says Virginia Pitzer, an infectious-disease epidemiologist at Yale.

    Top American officials are already gambling on that guess. At a conference convened in late March by the Massachusetts Medical Society, Ashish Jha, the outgoing coordinator of the White House COVID-19 Response Team, noted that the relative tameness of this past winter was a major deciding factor in the Biden administration’s decision to let the U.S. public-health emergency lapse. The crisis-caliber measures that were essential at the height of the pandemic, Jha said, were no longer “critical at this moment” to keep the nation’s health-care system afloat. Americans could rely instead primarily on shots and antivirals to keep themselves healthy—“If you are up to date on your vaccines and you get treated with Paxlovid, if you get an infection, you just don’t die of this virus,” he said. (That math, of course, doesn’t hold up as well for certain vulnerable groups, including the elderly and the immunocompromised.) The pharmaceuticals-only strategy asks much less of people: Going forward, most Americans will need to dose up on their COVID vaccines only once a year in the fall, a la seasonal flu shots.

    Making sweeping assessments at this particular juncture, though, is tough. Experts expect SARS-CoV-2 cases to take a downturn as winter transitions into spring—as many other respiratory viruses do. And a half-ish year of relative quietude is, well, just a half-ish year of relative quietude—too little data for scientists to definitively declare the virus seasonal, or even necessarily stable in its annual patterns. One of the most telling intervals is yet to come: the Northern Hemisphere’s summer, says Alyssa Bilinski, a health-policy researcher at Brown University. In previous years, waves of cases have erupted pretty consistently during the warmer months, especially in the American South, as people flock indoors to beat the heat.

    SARS-CoV-2 might not end up being recognizably seasonal at all. So far, the virus has circulated more or less year-round, with erratic bumps in the winter and, to a lesser extent, the summer. “There is a consistency there that is very enticing,” Bansal told me. But many of the worst surges we’ve weathered were driven by a lack of immunity, which is less of an issue now. “So I like to be extremely careful about the seasonality argument,” she said. In future years, the virus may break from its summer-winter shuffle. How SARS-CoV-2 will continue to interact with other respiratory viruses, such as RSV and flu, also remains to be seen. After an extended hiatus, driven largely by pandemic mitigations, those pathogens came roaring back this past autumn—making it more difficult, perhaps, for the coronavirus to find unoccupied hosts. Experts can’t yet tell whether future winters will favor the coronavirus or its competitors. Either way, scientists won’t know until they’ve collected several more years of evidence—“I would want at least a handful, like four or five,” Bansal said.

    Amassing those numbers is only getting tougher, though, as data streams dry up, Martin told me. Virus-surveillance systems are being dismantled; soon, hospitals and laboratories will no longer be required to share their COVID data with federal officials. Even independent trackers have sunsetted their regular updates. Especially abysmal are estimates of total infections, now that so many people are using only at-home tests, if they’re testing at all—and metrics such as hospitalization and death don’t fully reflect where and when the virus is moving, and which new variants may be on the rise.

    Shifts in long-term approaches to virus control could also upend this period of calm. As tests, treatments, and vaccines become privatized, as people lose Medicaid coverage, as community-outreach programs fight to stay afloat, the virus will find the country’s vulnerable pockets again. Those issues aren’t just about the coming months: COVID-vaccination rates among children remain worryingly low—a trend that could affect the virus’s transmission patterns for decades. And should the uptake of annual COVID shots continue on its current trajectory—worse, even, than America’s less-than-optimal flu vaccination rates—or dip even further down, rates of severe disease may begin another upward climb. Experts also remain concerned about the ambiguities around long COVID, whose risks remain ill-defined.

    We could get lucky. Maybe 2023 is the start of a bona fide post-pandemic era; maybe the past few months are genuinely offering a teaser trailer of decades to come. But even if that’s the case, it’s not a full comfort. COVID remains a leading cause of death in the United States, where the virus continues to kill about 200 to 250 people each day, many of them among the population’s most vulnerable and disenfranchised. It’s true that things are better than they were a couple of years ago. But in some ways, that’s a deeply unfair comparison to make. Deaths would have been higher when immunity was low; vaccines, tests, and treatments were scarce; and the virus was far less understood. “I would hope our standard for saying that we’ve succeeded and that we don’t need to do more is not Are we doing better than some of the highest-mortality years in history?” Bilinski told me. Perhaps the better question is why we’re settling for the status quo—a period of possible stability that may be less a relief and more a burden we’ve permanently stuck ourselves with.

    Katherine J. Wu

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  • Seltzer Is Torture

    Seltzer Is Torture

    I do not like carbonated beverages, plain and simple. I won’t drink soda, and you’ll never catch me with a beer. Gin and tonics are a no. Sparkling water? A beast in disguise. Oh, the cocktail is not that fizzy, you say? I’ve heard that one before. And get your slushie out of my face. As I said, I do not like carbonated beverages. I do not like them at all.

    I don’t just mean that they taste bad to me, the way soap or penicillin does. I mean that they hurt me. They inflict actual, physical pain on my mouth. The sensation is prickly, like having my tongue poked with hundreds of needles. On the handful of foolhardy occasions when I’ve dared take a sip of Coke, it’s felt like what I imagine sipping static electricity would feel like, at least until the pain subsides and I’m left with nothing but the hyper-saturated sweetness of a melted freezer pop. Even after I swallow, my mouth feels raw.

    When I try to explain this aversion, people sometimes struggle to wrap their mind around it. “Even sparkling cider?” they ask incredulously. “Even cream soda?” Yes, even sparkling cider. Yes, even cream soda. Occasionally, people try to relate: “Oh, I hate carbonation tooexcept in champagne.” Whatever these people mean by “hate” is clearly not the same thing I mean. The specifics of the drink make no difference to me. The carbonation itself is the problem.

    Part of me wonders whether this all traces back to an incident from my childhood. When I was 6 or 7 years old, I accidentally ate a piece of sushi covered in more wasabi than I’d bargained for and, in a panic, took a big gulp of water—except the water wasn’t water; it was seltzer, and I spit it all over the table. A couple of years later, I tried root beer at day camp and spat that out too. By that point, I’d pretty much learned my lesson.

    So why am I like this? It’s not as though my mouth is hypersensitive to all tastes and sensations. I pop Sour Skittles at the movies and have a pretty high spice tolerance. My issue is more specific and, given that Americans consume more than 40 gallons of soda a person each year, very rare. But apparently I’m not the only one: On Reddit’s r/unpopularopinion forum and others like it, never-fizzers find common cause. Drinking carbonated beverages is “kinda masochist.” It’s “pure agony.” It’s like “swallowing battery acid.” “I feel like I’m drinking flesh eating bacteria,” one Redditor writes. “I swear I thought I was the only one who thinks they hurt,” another replies.

    You can find dozens of posts like these online—so many, in fact, that you may begin to wonder: How many times can an unpopular opinion be posted before it ceases to qualify as an unpopular opinion? Scientists, for their part, have documented at least one instance of an anaphylactic reaction to sparkling water. That reaction was not caused by the bubbles themselves, but neither is carbonation’s distinctive mouthfeel. For a long time, people assumed that the fizzy sensation was just the tactile experience of having bubbles pop inside your mouth. Early suspicions to the contrary came from mountaineers, who reported that when they raised a toast at the summit, their bubbly champagne tasted flat. In 2013, researchers confirmed that the “bite” of carbonation is not dependent on bubbles: Even after drinking sparkling water in a pressure chamber, where bubbles cannot form, test subjects still reported feeling the slight “sting, burn, or pungency” associated with fizzy drinks, both on the tip of their tongue and at the back of their throat.

    The source of that bite, scientists determined, is the carbonic acid formed when enzymes in the mouth break down carbon dioxide. (That process happens to be inhibited by a medication commonly taken by mountaineers to stave off altitude sickness.) The acid activates pain receptors, Earl Carstens, a neurobiologist at UC Davis, told me, so the experience of drinking a carbonated beverage should be sharp and irritating for everyone. In that sense, the weird thing is not that some people hate carbonation; it’s that anyone likes it at all. Social conditioning may play a role: We accept the pain of drinking soda because we’re taught that it’s okay. Or perhaps the mild pain is associated with a pleasurable release of endorphins, as can occur when people eat a spicy food. Both of those factors are likely in play, Carstens said.

    But as my experience shows, not everyone experiences carbonic-acid pain the same way. Some people feel a refreshing tickle, others a chemical assault. No one knows why. Scientists have traced other aversions—to cilantro, for example, or tannic wines—to natural variations in human taste and smell receptors. “We are not at the same place in our knowledge of carbonation,” Emily Liman, a neurobiologist at the University of Southern California, told me. The problem faced by sodaphobes may yet turn out to have a genetic explanation, but for the moment, scientists don’t even understand exactly which cells are involved in the sensation. Pain receptors (such as the ones that detect spiciness) and taste cells (such as the ones that detect sourness) seem to play a part in feeling carbonation, Liman said, but it’s unclear exactly which cells contribute.

    In short, there’s no way to know whether I’m the victim of busted mouth biology, or of some long-repressed experience that bubbles up as oral pain, or of something else entirely. In any case, hating carbonation only means that I have to do a lot of polite declining. It’s not a huge deal, yet I sometimes find myself perturbed to to be cut off from a whole sector of human experience, to dislike something that almost everyone else seems to like, and to dislike it not because of some contrarian impulse or principled objection but because of my physiology or my psychology. Best not to indulge such musings, though—they can easily give way to temptation. Last summer, after years of strict avoidance, I ordered a cider at a bar, thinking that maybe, after all these years, something had changed. Nope!

    Jacob Stern

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  • Life Is Worse for Older People Now

    Life Is Worse for Older People Now

    Last December, during a Christmas Eve celebration with my in-laws in California, I observed what I now realize was the future of COVID for older people. As everyone crowded around the bagna cauda, a hot dipping sauce shared like fondue, it was clear that we, as a family, had implicitly agreed that the pandemic was over. Our nonagenarian relatives were not taking any precautions, nor was anyone else taking precautions to protect them. Endive spear in hand, I squeezed myself in between my 94-year-old grandfather-in-law and his spry 99-year-old sister and dug into the dip.

    We all knew that older people bore the brunt of COVID, but the concerns seemed like a relic from earlier in the pandemic. The brutal biology of this disease meant that they disproportionately have fallen sick, been hospitalized, and died. Americans over 65 make up 17 percent of the U.S. population, but they have accounted for three-quarters of all COVID deaths. As the death count among older people began to rise in 2020, “a lot of my patients were really concerned that they were being exposed without anyone really caring about them,” Sharon Brangman, a geriatrician at SUNY Upstate University Hospital, told me.

    But even now, three years into the pandemic, older people are still in a precarious position. While many Americans can tune out COVID and easily fend off an infection when it strikes, older adults continue to face real threats from the illness in the minutiae of their daily life: grocery trips, family gatherings, birthday parties, coffee dates. That is true even with the protective power of several shots and the broader retreat of the virus. “There is substantial risk, even if you’ve gotten all the vaccines,” Bernard Black, a law professor at Northwestern University who studies health policy, told me. More than 300 people still die from COVID each day, and the overwhelming majority of them are older. People ages 65 and up are currently hospitalized at nearly 11 times the rate of adults under 50.

    Compounding this sickness are all the ways that, COVID aside, this pandemic has changed life for older adults. Enduring severe isolation and ongoing caregiver shortages, they have been disproportionately harmed by the past few years. Not all of them have experienced the pandemic in the same way. Americans of retirement age, 65 and older, are a huge population encompassing a range of incomes, health statuses, living situations, and racial backgrounds. Nevertheless, by virtue of their age alone, they live with a new reality: one in which life has become more dangerous—and in many ways worse—than it was before COVID.


    The pandemic was destined to come after older Americans. Their immune systems tend to be weaker, making it harder for them to fight off an infection, and they are more likely to have comorbidities, which further increases their risk of severe illness. The precarity that many of them already faced going into 2020—poverty, social isolation and loneliness, inadequate personal care—left them poorly equipped for the arrival of the novel coronavirus. More than 1 million people lived in nursing homes, many of which were densely packed and short on staff when COVID tore through them.

    A major reason older people are still at risk is that vaccines can’t entirely compensate for their immune systems. A study recently published in the journal Vaccines showed that for vaccinated adults ages 60 and over, the risk of dying from COVID versus other natural causes jumped from 11 percent to 34 percent within a year of completing their primary shot series. A booster dose brings the risk back down, but other research shows that it wears off too. A booster is a basic precaution, but “not one that everyone is taking,” Black, a co-author of the study, told me. Booster uptake among older Americans for the reengineered “bivalent” shots is the highest of all age groups, but still, nearly 60 percent have not gotten one.

    For every COVID death, many more older people develop serious illness. Risk increases with age, and people older than 70 “have a substantially higher rate of hospitalizations” than those ages 60 to 69, Caitlin Rivers, an epidemiologist at Johns Hopkins University, told me. Unlike younger people, most of whom fully recover from a bout with COVID, a return to baseline health is less guaranteed for older adults. In one study, 32 percent of adults over 65 were diagnosed with symptoms that lasted well beyond their COVID infection. Persistent coughs, aches, and joint pain can linger long after serious illness, together with indirect impacts such as loss of muscle strength and flexibility, which can affect older people’s ability to be independent, Rivers said. Older COVID survivors may also have a higher risk of cognitive decline. In some cases, these ailments could be part of long COVID, which may be more prevalent in older people.

    Certainly, some older adults are able to make a full recovery. Brangman said she has “old and frail” geriatric patients who bounced back after flu-like symptoms, and younger ones who still experience weakness and fatigue. Still, these are not promising odds. The antiviral Paxlovid was supposed to help blunt the wave of old people falling sick and ending up in the hospital—and it can reduce severe disease by 50 to 90 percent. But unfortunately, it is not widely used; as of July, just a third of Americans 80 or older took Paxlovid.

    The reality is that as long as the virus continues to be prevalent, older Americans will face these potential outcomes every time they leave their home. That doesn’t mean they will barricade themselves indoors, or that they even should. Still, “every decision that we make now is weighing that balance between risk and socialization,” Brangman said.


    Long before the pandemic, the threat of illness was already very real for older people.  Where America has landed is hardly a new way of life but rather one that is simply more onerous. “One way to think about it is that this is a new risk that’s out there” alongside other natural causes of death, such as diabetes and heart failure, Black said. But it’s a risk older Americans can’t ignore, especially as the country has dropped all COVID precautions. Since Christmas Eve, I have felt uneasy about how readily I normalized putting so little effort into protecting my nonagenarian loved ones, despite knowing what might happen if they got sick. For older people, who must contend with the peril of attending similar gatherings, “there’s sort of no good choice,” Black said. “The world has changed.”

    But this new post-pandemic reality also includes insidious effects on older people that aren’t directly related to COVID itself. Those who put off nonemergency visits to the doctor earlier in the pandemic, for example, risked worsening their existing health conditions. The first year of the pandemic plunged nearly everyone into isolation, but being alone created problems for older adults that still persist. Before the pandemic, the association between loneliness and higher mortality rates, increased cardiovascular risks, and dementia among older adults was already well established. Increased isolation during COVID amplified this association.

    The consequences of isolation were especially profound for older adults with physical limitations, Naoko Muramatsu, a community-health professor at the University of Illinois at Chicago, told me. When caregivers or family members were unable to visit, people who required assistance for even the smallest tasks, such as fetching the mail and getting dressed, had no options. “If you don’t walk around and if you don’t do anything, we can expect that cognitive function will decline,” Muramatsu said; she has observed this firsthand in her research. One Chinese American woman, interviewed in a survey of older adults living alone with cognitive impairment during the pandemic, described the debilitating effect of sitting at home all day.“I am so useless now,” she told the interviewer. “I am confused so often. I forget things.”

    Even older adults who have weathered the direct and indirect effects of the pandemic still face other challenges that COVID has exacerbated. Many have long relied on personal caregivers or the staff at nursing facilities. These workers, already scarce before the pandemic, are even more so now because many quit or were affected by COVID themselves. “Long-term care has been in a crisis situation for a long time, but it’s even worse now,” Muramatsu said, noting that many home care workers are older adults themselves. Nursing homes nationwide now have nearly 200,000 fewer employees compared with March 2020, which is especially concerning as the proportion of Americans over age 65 explodes.

    Older people won’t have one single approach to contending with this sad reality. “Everybody is trying to figure out what is the best way to function, to try to have some level of everyday life and activity, but also keep your risk of getting sick as low as possible,” Brangman said. Some of her patients are still opting to be cautious, while others consider this moment their “only chance to see grandchildren or concerts or go to family gatherings.” Either way, older Americans will have to wrestle with these decisions without so many of their peers who have died from COVID.

    Again, many of these people did not have it great before the pandemic, even if the rest of the country wasn’t paying attention. “We often don’t provide the basic social support that older people need,” Kenneth Covinsky, a clinician-researcher at the UCSF Division of Geriatrics, said. Rather, ageism, the willful ignorance or indifference to the needs of older people, is baked into American life. It is perhaps the main reason older adults were so badly affected by the pandemic in the first place, as illustrated by the delayed introduction of safety precautions in nursing homes and the blithe acceptance of COVID deaths among older adults. If Americans couldn’t bring themselves to care at any point over the past three years, will they ever?

    Yasmin Tayag

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  • Radio Atlantic: This Is Not Your Parents’ Cold War

    Radio Atlantic: This Is Not Your Parents’ Cold War

    During the Cold War, NATO had nightmares of hundreds of thousands of Moscow’s troops pouring across international borders and igniting a major ground war with a democracy in Europe. Western governments feared that such a move by the Kremlin would lead to escalation—first to a world war and perhaps even to a nuclear conflict.

    That was then; this is now.

    Russia’s invasion of Ukraine is nearly a year old, and the Ukrainians are holding on. The Russians, so far, not only have been pushed back, but are taking immense casualties and material losses. For many Americans, the war is now just another conflict in the news. Do we need to worry about the nuclear threat of Putin’s war in Europe the way we worried about such things three decades ago?

    Our staff writer Tom Nichols, an expert on nuclear weapons and the Cold War, counsels Americans not to be obsessed with nuclear escalation, but to be aware of the possibilities for accidents and miscalculations. You can hear his thoughts here:

    The following is a transcript of the episode:

    Tom Nichols: It’s been a year since the Russians invaded Ukraine and launched the biggest conventional war in Europe since the Nazis. One of the things that I think we’ve all worried about in that time is the underlying problem of nuclear weapons.

    This is a nuclear-armed power at war with hundreds of thousands of people in the middle of Europe. This is the nightmare that American foreign policy has dreaded since the beginning of the nuclear age.

    And I think people have kind of put it out of their mind, how potentially dangerous this conflict is, which is understandable, but also, I think, takes us away from thinking about something that is really the most important foreign problem in the world today.

    During the Cold War, we would’ve thought about that every day, but these days, people just don’t think about it, and I think they should.

    My name is Tom Nichols. I’m a staff writer at The Atlantic. And I’ve spent a lot of years thinking about nuclear weapons and nuclear war. For 25 years, I was a professor of national-security affairs at Naval War College.

    For this episode of Radio Atlantic, I want to talk about nuclear weapons and what I think we should have learned from the history of the Cold War about how to think about this conflict today.

    I was aware of nuclear weapons at a pretty young age because my hometown, Chicopee, Massachusetts, was home to a giant nuclear-bomber base, Strategic Air Command’s East Coast headquarters, which had the big B-52s that would fly missions with nuclear weapons directly to the Soviet Union.

    I had a classic childhood of air-raid sirens, and hiding in the basement, and going under the desks, and doing all of that stuff. My high-school biology teacher had a grim sense of humor and told us, you know, because of the Air Force base, we were slated for instant destruction. He said, Yeah, if anything ever happens, we’re gone. We’re gone in seven or eight minutes. So I guess the idea of nuclear war and nuclear weapons was a little more present in my life at an earlier age than for a lot of other kids.

    It’s been a long time since anyone’s really had to worry about global nuclear war. It’s been over 30 years since the fall of the Berlin Wall. I think people who lived through the Cold War were more than happy to forget about it. I know I am glad to have it far in the past. And I think younger people who didn’t experience it have a hard time understanding what it was all aboutand what that fear was about—because it’s part of ancient history now.

    But I think people really need to understand that Cold War history to understand what’s going on today, and how decision makers in Washington and in Europe, and even in Moscow, are playing out this war—because many of these weapons are still right where we left them.

    We have fewer of them, but we still have thousands of these weapons, many of them on a very short trigger. We could go from the beginning of this podcast to the end of the world, that short of [a] time. And it’s easy to forget that. During the Cold War, we were constantly aware of it, because it was the central influence on our foreign policy. But it’s important for us to look back at the history of the Cold War because we survived a long and very tense struggle with a nuclear-armed opponent. Now, some of that was through good and sensible policy. And some of it was just through dumb luck.

    Of course, the first big crisis that Americans really faced where they had to think about the existential threat of nuclear weapons was the Cuban missile crisis, in October of 1962.

    I was barely 2 years old. But living next to this big, plump nuclear target in Massachusetts, we actually knew people in my hometown who built fallout shelters. But we got through the Cuban missile crisis, in part because President Kennedy and Soviet Premier Nikita Khrushchev realized what was at stake.

    The gamble to put missiles in Cuba had failed, and that we had to—as Khruschev put it in one of his messages—we had to stop pulling on the ends of the rope and tightening the knot of war. But we also got incredibly lucky.

    There was a moment aboard a Soviet submarine where the sub commander thought they were under attack. And he wanted to use nuclear-tipped torpedoes to take out the American fleet, which would’ve triggered a holocaust.

    I mean, it would’ve been an incredible amount of devastation on the world. Tens, hundreds of millions of people dead. And, um, fortunately a senior commander who had to consent to the captain’s idea vetoed the whole thing. He said, I don’t think that’s what’s happening. I don’t think they’re trying to sink us, and I do not consent. And so by this one lucky break with this one Soviet officer, we averted the end of the world. I mean, we averted utter catastrophe.

    After the Cuban missile crisis, people are now even more aware of this existential threat of nuclear weapons and it starts cropping up everywhere, especially in our pop culture. I mean, they were always there in the ’50s; there were movies about the communist threat and attacks on America. But after the Cuban missile crisis, that’s when you start getting movies like Dr. Strangelove and Fail Safe.

    Both were about an accidental nuclear war, which becomes a theme for most of the Cold War. In Dr. Strangelove, an American general goes nuts and orders an attack on Russia. And in Fail Safe, a piece of machinery goes bad and the same thing happens. And I think this reflected this fear that we now had to live with, this constant threat of something that we and the Soviets didn’t even want to do, but could happen anyway.

    Even the James Bond movies, which were supposed to be kind of campy and fun, nuclear weapons were really often the source of danger in them. You know, bad guys were stealing them; people were trying to track our nuclear submarines. Throughout the ’60s, the ’70s, the ’80s nuclear weapons really become just kind of soaked into our popular culture.

    We all know the Cuban missile crisis because it’s just part of our common knowledge about the world, even for people that didn’t live through it. I think we don’t realize how dangerous other times were. I always think of 1983 as the year we almost didn’t make it.

    1983 was an incredibly tense year. President Ronald Reagan began the year calling the Soviet Union an “evil empire.” And announced that the United States would start pouring billions of dollars into an effort to defend against Soviet missiles, including space-based defenses, which the Soviets found incredibly threatening.

    The relationship between the United States and the Soviet Union had just completely broken down. Really, by the fall of 1983, it felt like war was inevitable. It certainly felt like to me war was inevitable. There was kind of that smell of gunpowder in the air. We were all pretty scared. I was pretty scared. I was a graduate student at that point. I was 23 years old, and I was certain that this war, this cataclysmic war, was going to happen not only in my lifetime, but probably before I was 30 years old.

    And then a lot of things happened in 1983 that elevated the level of tension between the United States and the Soviet Union to extraordinary levels. I would say really dangerous levels. The Soviets did their best to prove they were an evil empire by shooting down a fully loaded civilian airliner, killing 269 people. Just weeks after the shoot-down of the Korean airliner, Soviet Air Defenses got an erroneous report of an American missile launch against them. And this is another one of those cases where we were just lucky. We were just fortunate.

    And in this case, it was a Soviet Air Defense officer, a lieutenant colonel, who saw this warning that the Americans had launched five missiles. And he said, You know, nobody starts World War III with five missiles. That seems wrong.

    And he said, I just, I think the system—which still had some bugs—I just don’t think the system’s right. We’re gonna wait that out. We’re gonna ignore that. He was actually later reprimanded.

    It was almost like he was reprimanded and congratulated at the same time, because if he had called Moscow and said, Look, I’m doing my duty. I’m reporting Soviet Air Defenses have seen American birds are in the air. They’re coming at us and over to you, Kremlin. And from there, a lot of bad decisions could have cascaded into World War III, especially after a year where we had been in such amazingly high conflict with each other.

    Once again, just as after the Cuban missile crisis, the increase in tension in the 1980s really comes through in the popular culture. Music, movies, TV puts this sense of threat into the minds of ordinary Americans in a way that we just don’t have now. So people are going to the movies and they’re seeing movies like WarGames, once again about an accidental nuclear war. They’re seeing movies like Red Dawn, about a very intentional war by the Soviet Union against the United States.

    The Soviets thought that Red Dawn was actually part of Reagan’s attempt to use Hollywood to prepare Americans for World War III. In music, Ronald Reagan as a character made appearances in videos by Genesis or by Men at Work. That November, the biggest television event in history was The Day After, which was a cinematic representation of World War III.

    I mean, it was everywhere. By 1983, ’84, we were soaked in this fear of World War III. Nuclear war and Armageddon, no matter where you looked. I remember in the fall of 1983 going to see the new James Bond movie, one of the last Roger Moore movies, called Octopussy. And the whole plot amazed me because, of course, I was studying this stuff at the time, I was studying NATO and nuclear weapons.

    And here’s this opening scene where a mad Soviet general says, If only we can convince the West to give up its nuclear weapons, we can finally invade and take over the world.

    I saw all of these films as either a college student or a young graduate student, and again, it was just kind of woven into my life. Well, of course, this movie is about nuclear war. Of course, this movie is about a Soviet invasion. Of course, this movie is about, you know, the end of the world, because it was always there. It was always in the background. But after the end of the Cold War, that remarkable amount of pop-culture knowledge and just general cultural awareness sort of fades away.

    I think one reason that people today don’t look back at the Cold War with the same sense of threat is that it all ended so quickly. We went from [these] terrifying year[s] of 1983, 1984. And then suddenly Gorbachev comes in; Reagan reaches out to him; Gorbachev reaches back. They jointly agree in 1985—they issue a statement that to this day, is still considered official policy by the Russian Federation and by the United States of America. They jointly declare a nuclear war can never be won and must never be fought.

    And all of a sudden, by the summer of 1985, 1986, it’s just over, and, like, 40 years of tension just came to an end in the space of 20, 24 months. Something I just didn’t think I would see in my lifetime. And I think that’s really created a false sense of security in later generations.

    After the Cold War, in the ’90s we have a Russia that’s basically friendly to the United States but nuclear weapons are still a danger. For example, in 1995, Norway launched a scientific satellite on top of a missile—I think they were gonna study the northern lights—and the scientists gave everybody notice, you know, We’re gonna be launching this satellite. You’re gonna see a missile launch from Norway.

    Somebody in Russia just didn’t get the message, and the Russian defense people came to President Boris Yeltsin and they said, This might be a NATO attack. And they gave him the option to activate and launch Russian nuclear weapons. Yeltsin conferred with his people, and fortunately—because our relations were good, and because Boris Yeltsin and Bill Clinton had a good relationship, and because tensions were low in the world—Yeltsin says, Yeah, okay. I don’t buy that. I’m sure it’s nothing.

    But imagine again, if that had been somebody else.

    And that brings us to today. The first thing to understand is: We are in a better place than we were during the Cold War in many ways. During the Cold War, we had tens of thousands of weapons pointed at each other. Now by treaty, the United States and the Russian Federation each have about 1,500 nuclear weapons deployed and ready to go. Now, that’s a lot of nuclear weapons, but 1,500 is a lot better than 30,000 or 40,000.

    Nonetheless, we are dealing with a much more dangerous Russian regime with this mafia state led by Vladimir Putin.

    Putin is a mafia boss. There is no one to stop him from doing whatever he wants. And he has really convinced himself that he is some kind of great world historical figure who is going to reestablish this Christian Slavic empire throughout the former Soviet Union and remnants of the old Russian empire. And that makes him uniquely dangerous.

    People might wonder why Putin is even bothering with nuclear threats, because we’ve always thought of Russia as this giant conventional power because that’s the legacy of the Cold War. We were outnumbered. NATO at the time was only 16 countries. We were totally outnumbered by the Soviets and the Warsaw Pact in everything—men, tanks, artillery—and of course, the only way we could have repulsed an attack by the Soviet Union into Europe would’ve been to use nuclear weapons.

    I know earlier I mentioned the movie Octopussy. We’ve come a long way from the days when that mad Russian general could say, If only we got rid of nuclear weapons and NATO’s nuclear weapons, we could roll our tanks from Czechoslovakia to Poland through Germany and on into France.

    What people need to understand is that Russia is now the weaker conventional power. The Russians are now the ones saying, Listen, if things go really badly for us and we’re losing, we reserve the right to use nuclear weapons. The difference between Russia now and NATO then is: NATO was threatening these nuclear weapons if they were invaded and they were being just rolled over by Soviet tanks on their way to the English channel. The Russians today are saying, We started this war, and if it goes badly for us, we reserve the right to use nuclear weapons to get ourselves out of a jam.

    This conventional weakness is actually what makes them more dangerous, because they’re now continually being humiliated in the field. And a country that had gotten by by convincing people that they were a great conventional power, that they had a lot of conventional capability, they’re being revealed now as a hollow power. They can’t even defeat a country a third of their own size.

    And so when they’re running out of options, you can understand at that point where Putin says, Well, the only way to scramble the deck and to get a do-over here is to use some small nuclear weapon in that area to kind of sober everybody up and shock them into coming to the table or giving me what I want.

    Now, I think that would be incredibly stupid. And I think a lot of people around the world, including China and other countries, have told Putin that would be a really bad idea. But I think one thing we’ve learned from this war is that Putin is a really lousy strategist who takes dumb chances because he’s just not very competent.

    And that comes back to the Cold War lesson—that you don’t worry about someone starting World War III as much as you worry about bumbling into World War III because of a bunch of really dumb decisions by people who thought they were doing something smart and didn’t understand that they were actually doing something really dangerous.

    So where does this leave us? This major war is raging through the middle of Europe, the scenario that we always dreaded during the Cold War; thousands and thousands of Moscow’s troops flooding across borders. What’s the right way to think about this? Perhaps the most important thing to understand is that this really is a war to defend democracy against an aggressive, authoritarian imperial state.

    The front line of the fight for civilization, really, is in Ukraine now. If Ukraine loses this war, the world will be a very different place. That’s what makes it imperative that Americans think about this problem. I think it’s imperative to support Ukraine in this fight, but we should do that with a prudent understanding of real risks that haven’t gone away.

    And so I think the Cold War provides some really good guidance here, which is to be engaged, to be aware, but not to be panicked. Not to become consumed by this fear every day, because that becomes paralyzing, that becomes debilitating. It’s bad for you as a person. And it’s bad for democracies’ ability to make decisions—because then you simply don’t make any decisions at all, out of fear.

    I think it’s important not to fall victim to Cold War amnesia and forget everything we learned. But I also don’t think we should become consumed by a new Cold War paranoia where we live every day thinking that we’re on the edge of Armageddon.

    Tom Nichols

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  • The COVID Emergency Is Ending. Is Vaccine Outreach Over Too?

    The COVID Emergency Is Ending. Is Vaccine Outreach Over Too?

    Stephen B. Thomas, the director of the Center for Health Equity at the University of Maryland, considers himself an eternal optimist. When he reflects on the devastating pandemic that has been raging for the past three years, he chooses to focus less on what the world has lost and more on what it has gained: potent antiviral drugs, powerful vaccines, and, most important, unprecedented collaborations among clinicians, academics, and community leaders that helped get those lifesaving resources to many of the people who needed them most. But when Thomas, whose efforts during the pandemic helped transform more than 1,000 Black barbershops and salons into COVID-vaccine clinics, looks ahead to the next few months, he worries that momentum will start to fizzle out—or, even worse, that it will go into reverse.

    This week, the Biden administration announced that it would allow the public-health-emergency declaration over COVID-19 to expire in May—a transition that’s expected to put shots, treatments, tests, and other types of care more out of reach of millions of Americans, especially those who are uninsured. The move has been a long time coming, but for community leaders such as Thomas, whose vaccine-outreach project, Shots at the Shop, has depended on emergency funds and White House support, the transition could mean the imperilment of a local infrastructure that he and his colleagues have been building for years. It shouldn’t have been inevitable, he told me, that community vaccination efforts would end up on the chopping block. “A silver lining of the pandemic was the realization that hyperlocal strategies work,” he said. “Now we’re seeing the erosion of that.”

    I called Thomas this week to discuss how the emergency declaration allowed his team to mobilize resources for outreach efforts—and what may happen in the coming months as the nation attempts to pivot back to normalcy.

    Our conversation has been edited for clarity and length.

    Katherine J. Wu: Tell me about the genesis of Shots at the Shop.

    Stephen B. Thomas: We started our work with barbershops and beauty salons in 2014. It’s called HAIR: Health Advocates In-Reach and Research. Our focus was on colorectal-cancer screening. We brought medical professionals—gastroenterologists and others—into the shop, recognizing that Black people in particular were dying from colon cancer at rates that were just unacceptable but were potentially preventable with early diagnosis and appropriate screening.

    Now, if I can talk to you about colonoscopy, I could probably talk to you about anything. In 2019, we held a national health conference for barbers and stylists. They all came from around the country to talk about different areas of health and chronic disease: prostate cancer, breast cancer, others. We brought them all together to talk about how we can address health disparities and get more agency and visibility to this new frontline workforce.

    When the pandemic hit, all the plans that came out of the national conference were on hold. But we continued our efforts in the barbershops. We started a Zoom town hall. And we started seeing misinformation and disinformation about the pandemic being disseminated in our shops, and there were no countermeasures.

    We got picked up on the national media, and then we got the endorsement of the White House. And that’s when we launched Shots at the Shop. We had 1,000 shops signed up in I’d say less than 90 days.

    Wu: Why do you think Shots at the Shop was so successful? What was the network doing differently from other vaccine-outreach efforts that spoke directly to Black and brown communities?

    Thomas: If you came to any of our clinics, it didn’t feel like you were coming into a clinic or a hospital. It felt like you were coming to a family reunion. We had a DJ spinning music. We had catered food. We had a festive environment. Some people showed up hesitant, and some of them left hesitant but fascinated. We didn’t have to change their worldview. But we treated them with dignity and respect. We weren’t telling them they’re stupid and don’t understand science.

    And the model worked. It worked so well that even the health professionals were extremely pleased, because now all they had to do was show up with the vaccine, and the arms were ready for needles.

    The barbers and stylists saw themselves as doing health-related things anyway. They had always seen themselves as doing more than just cutting hair. No self-respecting Black barber is going to say, “We’ll get you in and out in 10 minutes.” It doesn’t matter how much hair you have: You’re gonna be in there for half a day.

    Wu: How big of a difference do you think your network’s outreach efforts made in narrowing the racial gaps in COVID vaccination?

    Thomas: Attribution is always difficult, and success has many mothers. So I will say this to you: I have no doubt that we made a huge difference. With a disease like COVID, you can’t afford to have any pocket unprotected, and we were vaccinating people who would otherwise have never been vaccinated. We were dealing with people at the “hell no” wall.

    We were also vaccinating people who were homeless. They were treated with dignity and respect. At some of our shops, we did a coat drive and a shoe drive. And we had dentists providing us with oral-health supplies: toothbrush, floss, paste, and other things. It made a huge difference. When you meet people where they are, you’ve got to meet all their needs.

    Wu: How big of a difference did the emergency declaration, and the freeing-up of resources, tools, and funds, make for your team’s outreach efforts?

    Thomas: Even with all the work I’ve been doing in the barber shop since 2014, the pandemic got us our first grant from the state. Money flowed. We had resources to go beyond the typical mechanisms. I was able to secure thousands of KN95 masks and distribute them to shops. Same thing with rapid tests. We even sent them Corsi-Rosenthal boxes, a DIY filtration system to clean up indoor air.

    Without the emergency declaration, we would still be in the desert screaming for help. The emergency declaration made it possible to get resources through nontraditional channels, and we were doing things that the other systems—the hospital system, the local health department—couldn’t do. We extended their reach to populations that have historically been underserved and distrustful.

    Wu: The public-health-emergency declaration hasn’t yet expired. What signs of trouble are you seeing right now?

    Thomas: The bridge between the barbershops and the clinical side has been shut down in almost all places, including here in Maryland. I go to the shop and they say to me, “Dr. T, when are we going to have the boosters here?” Then I call my clinical partners, who deliver the shots. Some won’t even answer my phone calls. And when they do, they say, “Oh, we don’t do pop-ups anymore. We don’t do community-outreach clinics anymore, because the grant money’s gone. The staff we hired during the pandemic, they use the pandemic funding—they’re gone.” But people are here; they want the booster. And my clinical partners say, “Send them down to a pharmacy.” Nobody wants to go to a pharmacy.

    You can’t see me, so you can’t see the smoke still coming out of my ears. But it hurts. We got them to trust. If you abandon the community now, it will simply reinforce the idea that they don’t matter.

    Wu: What is the response to this from the communities you’re talking to?

    Thomas: It’s “I told you so, they didn’t care about us. I told you, they would leave us with all these other underlying conditions.” You know, it shouldn’t take a pandemic to build trust. But if we lose it now, it will be very, very difficult to build back.

    We built a bridge. It worked. Why would you dismantle it? Because that’s exactly what’s happening right now. The very infrastructure we created to close the racial gaps in vaccine acceptance is being dismantled. It’s totally unacceptable.

    Wu: The emergency declaration was always going to end at some point. Did it have to play out like this?

    Thomas: I don’t think so. If you talk to the hospital administrators, they’ll tell you the emergency declaration and the money allowed them to add outreach. And when the money went away, they went back to business as usual. Even though the outreach proved you could actually do a better job. And the misinformation and the disinformation campaign hasn’t stopped. Why would you go back to what doesn’t work?

    Wu: What is your team planning for the short and long term, with limited resources?

    Thomas: As long as Shots at the Shop can connect clinical partners to access vaccines, we will definitely keep that going.

    Nobody wants to go back to normal. So many of our barbers and stylists feel like they’re on their own. I’m doing my best to supply them with KN95 masks and rapid tests. We have kept the conversation going on our every-other-week Zoom town hall. We just launched a podcast. We put out some of our stories in the form of a graphic novel, The Barbershop Storybook. And we’re trying to launch a national association for barbers and stylists, called Barbers and Stylists United for Health.

    The pandemic resulted in a mobilization of innovation, a recognition of the intelligence at the community level, the recognition that you need to culturally tailor your strategy. We need to keep those relationships intact. Because this is not the last time we’re going to see a pandemic even in our lifetime. I’m doing my best to knock on doors to continue to put our proposals out there. Hopefully, people will realize that reaching Black and Hispanic communities is worth sustaining.

    Katherine J. Wu

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  • Why We Just Can’t Quit the Handshake

    Why We Just Can’t Quit the Handshake

    Mark Sklansky, a pediatric cardiologist at UCLA, has not shaken a hand in several years. The last time he did so, it was only “because I knew I was going to go to the bathroom right afterwards,” he told me. “I think it’s a really bad practice.” From where he’s standing, probably a safe distance away, our palms and fingers are just not sanitary. “They’re wet; they’re warm; they’re what we use to touch everything we touch,” he said. “It’s not rocket science: The hand is a very good medium to transmit disease.”

    It’s a message that Sklansky has been proselytizing for the better part of a decade—via word of mouth among his patients, impassioned calls to action in medical journals, even DIY music videos that warn against puttin’ ’er there. But for a long time, his calls to action were met with scoffs and skepticism.

    So when the coronavirus started its sweep across the United States three years ago, Sklansky couldn’t help but feel a smidgen of hope. He watched as corporate America pocketed its dealmaking palms, as sports teams traded end-of-game grasps for air-fives, and as The New Yorker eulogized the gesture’s untimely end. My colleague Megan Garber celebrated the handshake’s demise, as did Anthony Fauci. The coronavirus was a horror, but perhaps it could also be a wake-up call. Maybe, just maybe, the handshake was at last dead. “I was optimistic that it was going to be it,” Sklansky told me.

    But the death knell rang too soon. “Handshakes are back,” says Diane Gottsman, an etiquette expert and the founder of the Protocol School of Texas. The gesture is too ingrained, too beloved, too irreplaceable for even a global crisis to send it to an early grave. “The handshake is the vampire that didn’t die,” says Ken Carter, a psychologist at Emory University. “I can tell you that it lives: I shook a stranger’s hand yesterday.”

    The base science of the matter hasn’t changed. Hands are humans’ primary tools of touch, and people (especially men) don’t devote much time to washing them. “If you actually sample hands, the grossness is something quite exceptional,” says Ella Al-Shamahi, an anthropologist and the author of the book The Handshake: A Gripping History. And shakes, with their characteristic palm-to-palm squeezes, are a whole lot more prone to spread microbes than alternatives such as fist bumps.

    Not all of that is necessarily bad: Many of the microscopic passengers on our skin are harmless, or even beneficial. “The vast majority of handshakes are completely safe,” says David Whitworth, a microbiologist at Aberystwyth University, in Wales, who’s studied the griminess of human hands. But not all manual microbes are benign. Norovirus, a nasty diarrheal disease infamous for sparking outbreaks on cruise ships, can spread easily via skin; so can certain respiratory viruses such as RSV.

    The irony of the recent handshake hiatus is that SARS-CoV-2, the microbe that inspired it, isn’t much of a touchable danger. “The risk is just not very high,” says Jessica Malaty Rivera, an infectious-disease epidemiologist at the Johns Hopkins Center for Health Security. Despite early pandemic worries, this particular coronavirus is more likely to use breath as a conduit than contaminated surfaces. That’s not to say that the virus couldn’t hop from hand to hand after, say, an ill-timed sneeze or cough right before a shake. But Emily Landon, an infectious-disease physician and hand-hygiene expert at the University of Chicago, thinks it would take a hefty dose of snot or phlegm, followed by some unwashed snacking or nose-picking by the recipient, to really pose a threat. So maybe it’s no shock that as 2020’s frantic sanitizing ebbed, handshakes started creeping back.

    Frankly, that doesn’t have to be the end of the world. Even when considering more shake-spreadable pathogens, it’s a lot easier to break hand-based chains of transmission than airborne ones. “As long as you have good hygiene habits and you keep your hands away from your face,” Landon told me, “it doesn’t really matter if you shake other people’s hands.” (Similar rules apply to doorknobs, light switches, subway handrails, phones, and other germy perils.) Then again, that requires actually cleaning your hands, which, as Sklansky will glady point out, most people—even health-care workers—are still pretty terrible about.

    For now, shakes don’t seem to be back to 2019 levels—at least, not the last time researchers checked, in the summer of 2022. But Gottsman thinks their full resurgence may be only a matter of time. Among her clients in the corporate world, where grips and grasps are currency, handshakes once again abound. No other gesture, she told me, hits the same tactile sweet spot: just enough touch to feel personal connection, but sans the extra intimacy of a kiss or hug. Fist bumps, waves, and elbow touches just don’t measure up. At the pandemic’s worst, when no one was willing to go palm-to-palm, “it felt like something was missing,” Carter told me. The lack of handshakes wasn’t merely a reminder that COVID was here; it signaled that the comforts of routine interaction were not.

    If handshakes survive the COVID era—as they seem almost certain to do—this won’t be the only disease outbreak they outlive, Al-Shamahi told me. When yellow fever pummeled Philadelphia in the late 18th century, locals began to shrink “back with affright at even the offer of a hand,” as the economist Matthew Carey wrote at the time. Fears of cholera in the 1890s prompted a small cadre of Russians to establish an anti-handshake society, whose members were fined three rubles for every verboten grasp. During the flu pandemic that began in 1918, the town of Prescott, Arizona, went so far as to ban the practice. Each time, the handshake bounced back. Al-Shamahi remembers rolling her eyes a bit in 2020, when she saw outlets forecasting the handshake’s untimely end. “I was like, ‘I can’t believe you guys are writing the obituary,’” she told me. “That is clearly not what is happening here.”

    Handshakes do seem to have a knack for enduring through the ages. A commonly cited origin story for the handshake points to the ancient Greeks, who may have deployed the behavior as a way to prove that they weren’t concealing a weapon. But Al-Shamahi thinks the roots of handshaking go way further back. Chimpanzees—from whom humans split some 7 million years ago—appear to engage in a similar behavior in the aftermath of fights. Across species, handshakes probably exchange all sorts of sensory information, Al-Shamahi said. They may even leave chemical residues on our palm that we can later subconsciously smell.

    Handshakes aren’t a matter of survival: Plenty of communities around the world get by just fine without them, opting instead for, say, the namaste or a hand over the heart. But palm pumping seems to have stuck around in several societies for good reason, outlasting other customs such as curtsies and bows. Handshakes are mutual, usually consensual; they’re imbued with an egalitarian feel. “I don’t think it’s a coincidence that you see the rise of the handshake amongst all the greetings at a time when democracy was on the rise,” Al-Shamahi told me. The handshake is even, to some extent, built into the foundation of the United States: Thomas Jefferson persuaded many of his contemporaries to adopt the practice, which he felt was more befitting of democracy than the snobbish flourishes of British court.

    American attitudes toward handshakes still might have undergone lasting, COVID-inspired change. Gottsman is optimistic that people will continue to be more considerate of those who are less eager to shake hands. There are plenty of good reasons for abstaining, she points out: having a vulnerable family member at home, or simply wanting to avoid any extra risk of getting sick. And these days, it doesn’t feel so strange to skip the shake. “I think it’s less a part of our cultural vernacular now,” Landon told me.

    Sklansky, once again in the minority, is disappointed by the recent turn of events. “I used to say, ‘Wow, it took a pandemic to end the handshake,’” he told me. “Now I realize, even a pandemic has failed to rid us of the handshake.” But he’s not ready to give up. In 2015, he and a team of his colleagues cordoned off part of his hospital as a “handshake-free zone”—an initiative that, he told me, was largely a success among health-care workers and patients alike. The designation faded after a year or two, but Sklansky hopes that something similar could soon return. In the meantime, he’ll settle for declining every proffered palm that comes his way—although, if you go for something else, he’d rather you not choose the fist bump: “Sometimes,” he told me, “they just go too hard.”

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    Katherine J. Wu

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