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

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

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    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.

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    Katherine J. Wu

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  • Why We Just Can’t Quit the Handshake

    Why We Just Can’t Quit the Handshake

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    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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  • Consider Armadillo COVID

    Consider Armadillo COVID

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    This past spring, Amanda Goldberg crouched in the leafy undergrowth of a southwestern Virginia forest and attempted to swab a mouse for COVID. No luck; its nose was too tiny for her tools. “You never think about nostrils until you start having to swab an animal,” Goldberg, a conservation biologist at Virginia Tech University, told me. Larger-nosed creatures that she and her team had trapped, such as raccoons and foxes, had no issue with nose swabs—but for mice, throat samples had to do. The swabs fit reasonably well into their mouths, she said, though they endured a fair bit of munching.

    Goldberg’s throat-swabbing endeavors were part of a study she and her colleagues devised to answer an unexplored question: How common is COVID in wildlife? Of the 333 forest animals her team swabbed around Blacksburg, Virginia, spanning 18 species, one—an opossum—tested positive. This was to be expected, Goldberg said; catching a wild animal that happened to have an active infection right when it was swabbed was like finding Waldo. But the researchers also collected blood samples, and those were more telling about whether the animals had experienced previous bouts with COVID. Analysis by the Molecular Diagnostics Lab and the Fralin Biomedical Research Institute at Virginia Tech revealed antibodies across 24 animals spanning six species, including the opossum, the Eastern gray squirrel, and two types of mice. “Our minds were blown,” Goldberg said. “It was basically every species we sent” to the lab.

    That animals can get COVID is one of the earliest things we learned about the virus. Despite the endless debate over its origins, SARS-CoV-2 most likely jumped from an animal through an intermediate host to humans in Wuhan. Since then, it has since spread back to a range of animals. People have passed it to household pets, such as dogs and cats, and to a Disney movie’s worth of beasts, including lions, hippos, hyenas, tigers, mink, and hamsters. Three years into the pandemic, animals are still falling sick with COVID, just as we are. COVID is likely circulating more widely in animals than we are aware of, Edward Holmes, a biologist at the University of Sydney, told me. “In all my 30-plus years of doing work on this subject, I have never seen a virus that can infect so many animal species,” he said. More than 500 other mammal species are predicted to be highly susceptible to infection.

    Given that most people nowadays aren’t fretting too much about human-to-human spread, it makes sense that animal-to-human spread has largely been forgotten. But even when there are so many other pandemic concerns, animal COVID can’t be ignored. The consequences of sustained animal transmission are exactly the same as they are in people: The more COVID spreads, the more opportunities the virus has to evolve into new variants. What’s most alarming is the chance that one of those variants could spill back into humans. As we’ve known since the pandemic started, SARS-CoV-2 is not a human virus, but one that can infect multiple animals, including humans. As long as animals are still getting COVID, we’re not out of the doghouse either.

    Perhaps part of the reason COVID in animals has been overlooked—apart from the fact that they’re not people—is that most species don’t seem to get very sick. Animals that have gotten infected generally exhibit mild symptoms—typically some coughing and sluggishness, as in pumas and lions. But our research has gone only fur-deep. “We certainly can’t ask them, ‘Are you feeling headaches, or sluggish?’” said Goldberg, who worries about long-term or invisible symptoms going undiagnosed in species. And so animal COVID has lingered unchecked, increasing the chances that it could mean something bad for us.

    The good news is that the overall risk of getting COVID from animals is considered low, according to the CDC. This is partly explained by evolutionary theory, which predicts that most variants that emerge in an animal population will have adapted to become better at infecting the host animal—not us. But some of them, strictly by chance, “could be highly transmissible or virulent in humans,” Holmes said. “It’s an unpredictable process.” His concern is not that animals will start infecting people en masse—your neighbors are far likelier to do that than raccoons—but that in animals, SARS-CoV-2 could form new variants that can spill over into people. Some scientists believe that Omicron emerged this way in mice, though evidence remains scant.

    A troubling sign is that there’s already some evidence that COVID has made its way from humans to animals, where it mutated, and then made its way back into humans. Take white-tailed deer, by now a well-known COVID host. Every fall, hunters take to the golden meadows and reddening forests of southwestern Ontario to shoot the deer, giving researchers an opportunity to test some of the hunted animals for COVID. The species has been infected with the same variants circulating widely in humans—a handful of Staten Island deer caught Omicron last winter, for example—which suggests that people are infecting them. How the deer get infected still isn’t clear: Extended face time with humans, nosing around in trash, or slurping up our wastewater are all possibilities.

    The researchers in Canada found not only that some of the animals tested positive, but also that the variant they carried had never before been seen in humans, indicating that the virus had been spreading and mutating within the population for a long time, Brad Pickering, a research scientist for the Canadian government who studied the deer, told me. In fact, the new variant is among the most evolutionarily divergent ones identified so far. But despite its differences, it appeared to have infected at least one person who had interacted with deer the week before falling ill. “We can’t make a direct link between them,” Pickering said, but the fact that such a highly diverged deer variant was detected in a human is very suggestive of how that person got sick.

    This research adds to the small but growing body of evidence that the COVID we spread to animals could come back to bite us. Fortunately, this particular spillback does not appear to have had serious consequences for humans; rogue deer variants don’t seem to be circulating in southern Canada. But this is not the sole documented instance of animal-to-human spread: People have been infected by mink in the Netherlands, hamsters in Hong Kong, and a cat in Thailand. Other spillbacks have probably occurred and gone unnoticed. So far, no data show that the animal variants that have spread to humans are more dangerous for us. Even if a potential animal variant isn’t the next Omicron, it could still be better at dodging our existing treatments and vaccines, Pickering said.

    But there is also, frankly, a lack of data. Local wildlife-surveillance efforts led by researchers like Goldberg and Pickering are ongoing, but they do not exist in most countries, Holmes said. An international database of known animal infections, maintained by Complexity Science Hub Vienna, is a promising start. An interactive map shows the locations of previously infected animals, including large hairy armadillos (Argentina), manatees (Brazil), and cats (everywhere). At the very least, with animal COVID, “we need to know what species it’s in, in what abundance, and genetically, what those variants look like,” Holmes said. “It’s absolutely critical to know where [the virus] is going.” Without this, there is no way of knowing how often spillback occurs and whether it puts humans at risk. And we can’t tell whether new COVID variants are also putting animals in danger, Goldberg said; a devastating Omicron-like variant could emerge in their populations too.

    The steps we need to take to mitigate the animal-COVID problem—and prevent other zoonotic diseases from jumping into humans—are clear, even if they don’t seem to be happening. Eliminating wet markets where wild animals are sold is an obvious preventive measure, but it has been difficult to implement because the livelihoods and diets of many people, especially in the global South, depend on them. As climate change and land development decimate even more habitats, wildlife will be forced into ever-closer quarters with us, fostering an even more efficient exchange of viruses between species. Unlike mask wearing and other straightforward options for curbing the human spread of COVID, preventing its transmission to, from, and among animals will require major upheavals to the way our societies run, likely far greater than we are willing to commit to.

    Humans tend to act like COVID ends up afflicting us after traveling through a long chain of species. But to think so is like living in the Middle Ages, Holmes said, when the Earth was considered the center of the universe. As we learned then, we are not that important: Humans are but a node in an immense network of species that viruses move through in many directions. Just as animal viruses infect us, human viruses can spread to animals (measles, for example, kills a variety of great apes). There are definitely bigger problems than animal COVID—no one needs to hunker down for fear of sneezing deer—but as long as animals keep getting infected, we can’t overlook what that means for us. Paying attention to animal COVID often starts with a single swab—and a snout to stick it in.

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    Yasmin Tayag

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  • The Fatal Error of an Ancient, HIV-Like Virus

    The Fatal Error of an Ancient, HIV-Like Virus

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    Many, many millions of years ago, an HIV-like virus wriggled its way into the genome of a floofy, bulgy-eyed lemur, and got permanently stuck.

    Trapped in a cage of primate DNA, the virus could no longer properly copy itself or cause life-threatening disease. It became a tame captive, passed down by the lemur to its offspring, and by them down to theirs. Today, the benign remains of that microbe are still wedged among a fleet of lemur genes—all that is left of a virus that may have once been as deadly as HIV is today.

    Lentiviruses, the viral group that includes HIV, are an undeniable scourge. The viruses set up chronic, slow-brewing infections in mammals, typically crippling a subset of immune cells essential to keeping dangerous pathogens at bay. And as far as scientists know, these viruses are pretty uniformly devastating to their hosts—or at least, that’s true of “all the lentiviruses that we know of,” says Aris Katzourakis, an evolutionary virologist at the University of Oxford. Which means, a long time ago, that lemur lentivirus was likely devastating too. But somewhere along the way, the strife between lemur and lentivirus dissipated enough that their genomes were able to mix. It’s proof, says Andrea Kirmaier, an evolutionary virologist at Boston College, that lentivirus and host “can coexist, that peace can be made.”

    Détentes such as these have been a fixture of mammals’ genomic history for countless millennia. Scientists have stumbled across lentiviruses embedded in the DNA of not just lemurs, but rabbits, ferrets, gliding mammals called colugos, and most recently, rodents—all of them ancient, all of them quiescent, all of them seemingly stripped of their most onerous traits. The infectious versions of those viruses are now extinct. But the fact that they posed an infectious threat in the past can inform the strategies we take against wild lentiviruses now. Finding these defunct lentiviruses tells us which animals once harbored, or might still harbor, active ones and could potentially pass them to us. Their existence also suggests that, in the tussle between lentivirus and host, the mammal can gain the upper hand. Lemurs, rabbits, ferrets, colugos, and rodents, after all, are still here; the ancient lentiviruses are not. Perhaps humans could leverage these strange genetic alliances to negotiate similar terms with HIV—or even extinguish the modern virus for good.


    When viruses assimilate themselves into animal genomes in a heritable way, a process called endogenization, scientists generally see it as “kind of a mistake,” says Daniel Blanco-Melo, a virologist at the Fred Hutchinson Cancer Center. Once cemented into one host, the virus can no longer infect others; much of its genome may even end up degrading over time, which is “certainly not what it evolved to do.” The blunders usually happen with retroviruses, which have RNA-based genomes that they convert into DNA once they enter cells. The flip allows the viruses to plug their genetic material into that of their host, which is then forced to manufacture its pathogen’s proteins alongside its own. Sometimes, a retrovirus will inadvertently stitch itself into the genome of a sperm or an egg, and its blueprints end up passed to its host’s progeny. If the melding doesn’t kill the animal, the once-pathogen can become a permanent fixture of the creature’s DNA.

    Over time, the human genome has amassed a horde of these viral hitchhikers. Our DNA is so riddled with endogenous retroviruses, ERVs for short, that they technically occupy more space in our genomes than bona fide, protein-manufacturing genes do. But on the long list of ERVs that have breached our borders, lentiviruses are conspicuously absent, in both our genomes and those of other animals; up until the mid-aughts, some scientists thought lentiviruses might not endogenize at all. It wasn’t a totally wonky idea: Lentiviruses have complex genomes, and are extremely picky about the tissues they invade; they’re also quite dangerous, not exactly the kind of tenant that most creatures want occupying their cellular real estate. Or perhaps, some researchers posited, lentiviruses were endogi-capable, but simply too young. If they had only begun infecting mammals within the past few hundreds of thousands of years, there might not have been time for such accidents to occur.

    Then, some 15 years ago, a team led by Katzourakis and Rob Gifford, an evolutionary virologist at the University of Glasgow, discovered an endogenous lentivirus called RELIK in the genomes of rabbits and then in hares, a hint that it had lodged itself in the animals’ mutual ancestor at least 12 million years before. In an instant, the lentivirus timeline stretched, and in the years since has kept growing. Scientists have now identified endogenous lentiviruses in a wide enough array of mammals, Gifford told me, to suspect that lentiviruses may have been a part of our history for at least 100 million years—entering our very distant ancestors’ genomes before the demise of the dinosaurs, before the rise of primates, before the land masses of North and South America kissed. “That tells us just how long virus and host have been connected,” Katzourakis told me. Through those eons, lentiviruses and the mammals they afflict have been evolving in concert—the pathogen always trying to infect better, the animal always trying to more efficiently head its enemy off.

    Knowing that lentiviruses are so deeply laced into our past can help us understand how other mammals are faring against the ones that are still around today. Two species of monkeys, sooty mangabeys and African green monkeys, have spent so much evolutionary time with a lentivirus called SIV—the simian version of HIV—that they’ve grown tolerant of it. Even when chock-full of virus, the monkeys don’t seem to suffer the severe, immunocompromising disease that the pathogen induces in other primates, says Nikki Klatt, a microbiologist and an immunologist at the University of Minnesota. The key seems to be in the monkeys’ ultra-resilient, fast-healing guts, as well as their immune systems, which launch more muted attacks on SIV, keeping the body from destroying itself as it fights. Such immunological shrugs could enable certain retroviruses to eventually endogenize, says Lucie Etienne, an evolutionary virologist at the International Center for Infectiology Research, in Lyon, France.

    Many mammals have also developed powerful tools to prevent lentiviruses from reproducing in their bodies in the first place—proteins that can, for instance, mess with viral entry or replication, or prevent new viral particles from busting out of already infected cells. Viruses, too, can mutate and evolve, far faster than animals can. That’s given the pathogens plenty of chances to counteract these defenses; HIV, for instance, has no trouble sidestepping or punching through many of the shields that human cells raise against it.

    But take the equivalent immune-defense protein from a monkey, and HIV “cannot degrade that,” says Michael Emerman, a virologist at the Fred Hutchinson Cancer Center. Other primates have had different infectious histories from ours, which have shaped their immune evolution in distinct ways. Studying those primates’ genomes—or maybe even the genomes of mammals that are carrying lentiviruses as neutered genetic cargo—might eventually inspire therapies that “augment our immunity,” Emerman told me. At the very least, such experiments could point scientists to lentiviruses’ common weak spots: the parts of the virus that ancient immune systems once targeted successfully enough that their hosts survived to tell the tale. “Evolution has already taught us the best places to target retroviruses,” says Maria Tokuyama, a virologist at the University of British Columbia. “Why not push for the types of interactions that we already know have worked?”

    Another, perhaps more radical idea might yet give way to an HIV cure: speeding the path toward endogenization—allowing lentiviruses to tangle themselves into our genomes, in the hopes that they’ll stay permanently, benignly put. “We could figure out a way to silence the virus, such that it’s there but we don’t care about it,” says Oliver Fregoso, a virologist at UCLA. One of the holy grails of HIV research has always been cooking up a vaccine that could prevent infection—an extraordinarily difficult thing to do. But if some sort of gentle armistice can be reached, Boston College’s Kirmaier told me, “maybe we don’t need to go that far.”

    Cedric Feschotte and Sabrina Leddy, virologists at Cornell, are among those pushing for such an intervention. They’re capitalizing on HIV’s tendency to go dormant inside cells, where it can hide from some of our most powerful antiretroviral drugs. The virus essentially “plays dead,” Leddy told me, then reawakens when the coast is clear. But if HIV could be silenced stably, its rampage would end when it jammed itself into the genome. “We’re hoping to emulate this natural path that ERVs have taken,” where they’re effectively locked in place, Leddy said. The imprisoned viruses could then be excised from cells with gene editing.

    The idea’s ambitious and still a way off from yielding usable treatments. But if it works, it could produce an additional perk. After setting up shop inside us, our viral tenants can start to offer their landlord benefits—such as fighting off their own active kin. In recent years, researchers have found that some animals, including cats, chickens, mice, primates, sheep, and even humans, have been able to co-opt proteins from certain endogenous retroviruses to create blockades against incoming viruses of similar ilk. Blanco-Melo and Gifford were part of a team that made one such discovery in 2017, describing an ERV that ancient monkeys and apes might have used to strip viral entryways off the surfaces of their cells. When encountering an ERV-ed-up host, the infectious, still-pathogenic version of that ERV would no longer have been able to get in.

    Eventually, the active retrovirus “just went extinct,” Blanco-Melo told me—an outcome that he thinks could be attributable to the antics of its endogenous counterpart. It’s a devious move, essentially a way to “turn the virus against itself,” Kirmaier said. This sort of friendly-fire tactic may already be at work among lentiviruses, duking it out inside and outside host genomes: Species with endogenous lentiviruses usually aren’t bedeviled by active lentiviruses, at least none that has been identified yet, Fregoso told me. With any luck, the same could someday be true for HIV, the virus little more than a memory—or an idle fragment in our cells.

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    Katherine J. Wu

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  • Hundreds of Americans Will Die From COVID Today

    Hundreds of Americans Will Die From COVID Today

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    Over the past week, an average of 491 Americans have died of COVID each day, according to data compiled by The New York Times. The week before, the number was 382. The week before that, 494. And so on.

    For the past five months or so, the United States has trod along something of a COVID-death plateau. This is good in the sense that after two years of breakneck spikes and plummets, the past five months are the longest we’ve gone without a major surge in deaths since the pandemic’s beginning, and the current numbers are far below last winter’s Omicron highs. (Case counts and hospital admissions have continued to fluctuate but, thanks in large part to the protection against severe disease conferred by vaccines and antivirals, they have mostly decoupled from ICU admissions and deaths; the curve, at long last, is flat.) But though daily mortality numbers have stopped rising, they’ve also stopped falling. Nearly 3,000 people are still dying every week.

    We could remain on this plateau for some time yet. Lauren Ancel Meyers, the director of the University of Texas at Austin’s COVID-19 Modeling Consortium, told me that as long as a dangerous new variant doesn’t emerge (in which case these projections would go out the window), we could see only a slight bump in deaths this fall and winter, when cases are likely to surge, but probably—or at least hopefully—nothing too drastic. In all likelihood, though, deaths won’t dip much below their present levels until early 2023, with the remission of a winter surge and the additional immunity that surge should confer. In the most optimistic scenarios that Meyers has modeled, deaths could at that point get as low as half their current level. Perhaps a tad lower.

    By any measure, that is still a lot of people dying every day. No one can say with any certainty what 2023 might have in store, but as a reference point, 200 deaths daily would translate to 73,000 deaths over the year. COVID would remain a top-10 leading cause of death in America in this scenario, roughly twice as deadly as either the average flu season or a year’s worth of motor-vehicle crashes.

    COVID deaths persist in part because we let them. America has largely decided to be done with the pandemic, even though the pandemic stubbornly refuses to be done with America. The country has lifted nearly all of its pandemic restrictions, and emergency pandemic funding has been drying up. For the most part, people have settled into whatever level of caution or disregard suits them. A Pew Research survey from May found that COVID did not even crack Americans’ list of the top 10 issues facing the country. Only 19 percent said that they consider it a big problem, and it’s hard to imagine that number has gone anywhere but down in the months since. COVID deaths have shifted from an emergency to the accepted collateral damage of the American way of life. Background noise.

    On one level, this is appalling. To simply proclaim the pandemic over is to abandon the vulnerable communities and older people who, now more than ever, bear the brunt of its burden. Yet on an individual level, it’s hard to blame anyone for looking away, especially when, for most Americans, the risk of serious illness is lower now than it has been since early 2020. It’s hard not to look away when each day’s numbers are identically grim, when the devastation becomes metronomic. It’s hard to look each day at a number—491, 382, 494—and experience that number for what it is: the premature ending of so many individual human lives.

    People grow accustomed to these daily tragedies because to not would be too painful. “We are, in a way, victims of our own success,” Steven Taylor, a psychiatrist at the University of British Columbia who has written one book on the psychology of pandemics and is at work on another, told me. Our adaptability is what allowed us to weather the worst of the pandemic, and it is also what’s preventing us from fully escaping the pandemic. We can normalize anything, for better or for worse. “We’re so resilient at adapting to threats,” Taylor said, that we’ve “even habituated to this.”

    Where does that leave us? As the nation claws its way out of the pandemic—and reckons with all of its lasting damage—what do we do with the psychic burden of a death toll that might not decline substantially for a long time? Total inurement is not an option. Neither is maximal empathy, the feeling of each death reverberating through you at an emotional level. The challenge, it seems, is to carve out some sort of middle path. To care enough to motivate ourselves to make things better without caring so much that we end up paralyzed.

    Perhaps we will find this path. More likely, we will not. In earlier stages of the pandemic, Americans talked at length about a mythic “new normal.” We were eager to imagine how life might be different—better, even—after a tragedy that focused the world’s attention on disease prevention. Now we’re staring down what that new normal might actually look like. The new normal is accepting 400 COVID deaths a day as The Way Things Are. It’s resigning ourselves so completely to the burden that we forget that it’s a burden at all.

    In the time since you started reading this story, someone in the United States has died of COVID. I could tell you a story about this person. I could tell you that he was a retired elementary-school teacher. That he was planning a trip with his wife to San Diego, because he’d never seen the Pacific Ocean. That he was a long-suffering Knicks fan and baked a hell of a peach cobbler, and when his grandchildren visited, he’d get down on his arthritic knees, and they’d play Connect Four, and he’d always let them win. These details, though hypothetical, might sadden you—or sadden you more, at least, than when I told you simply that since you started this story, one person had died of COVID. But I can’t tell you that story 491 times in one day. And even if I could, could you bear to listen?

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    Jacob Stern

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  • You’ve Probably Seen Yourself in Your Memories

    You’ve Probably Seen Yourself in Your Memories

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    Pick a memory. It could be as recent as breakfast or as distant as your first day of kindergarten. What matters is that you can really visualize it. Hold the image in your mind.

    Now consider: Do you see the scene through your own eyes, as you did at the time? Or do you see yourself in it, as if you’re watching a character in a movie? Do you see it, in other words, from a first-person or a third-person perspective? Usually, we associate this kind of distinction with storytelling and fiction-writing. But like a story, every visual memory has its own implicit vantage point. All seeing is seeing from somewhere. And sometimes, in memories, that somewhere is not where you actually were at the time.

    This fact is strange, even unsettling. It cuts against our most basic understanding of memory as a simple record of experience. For a long time, psychologists and neuroscientists did not pay this fact much attention. That has changed in recent years, and as the amount of research on the role of perspective has multiplied, so too have its potential implications. Memory perspective, it turns out, is tied up in criminal justice, implicit bias, and post-traumatic stress disorder. At the deepest level, it helps us make sense of who we are.

    The distinction between first- and third-person memories dates back at least as far as Sigmund Freud, who first commented on it near the end of the 19th century. Not for another 80 years, though, did the first empirical studies begin fleshing out the specifics of memory perspective. And it was only in the 2000s that the field really started picking up steam. What those early studies found was that third-person memories were far less unusual than once thought. The phenomenon is associated with a number of mental disorders, such as depression, anxiety, and schizophrenia, but it is not merely a symptom of pathology; even among healthy people, it is quite common.

    Just how common is tricky to quantify. Peggy St. Jacques, a psychology professor at the University of Alberta who studies perspective in memory, told me that roughly 90 percent of people report having at least one third-person memory. For the average person, St. Jacques estimates, on the basis of her research, that about a quarter of memories from the past five years are third-person. (At least a couple of papers have found that women tend to have more third-person memories than men do, but a third study turned up no statistically significant difference; on the whole, research on possible demographic disparities is scant.) In certain rare cases, people may have only third-person memories. As you try to recall your own, be warned that things can get confusing fast. Perhaps you can call to mind early-childhood scenes that you picture from a third-person perspective. But it’s hard to know whether these are genuine memories translated from the first person to the third person, or third-person scenes constructed from stories or photographs. To some people, third-person memories are second nature; to others, they sound like science fiction.

    Why any given memory gets recalled from one perspective rather than the other is the result of a whole bunch of intersecting factors. People are more likely to remember experiences in which they felt anxious or self-conscious—say, when they gave a presentation in front of a crowd—in the third person, St. Jacques told me. This makes sense: When you’re imagining how you look through an audience’s eyes in the moment, you’re more likely to see yourself through their eyes at the time of recall. Researchers have also repeatedly found that the older a memory is, the more likely you are to recall it from the third person. This, too, is fairly intuitive: If first-person recollection is the ability to adopt the position—and inhabit the experience—of your former self, then naturally you’ll have more trouble seeing the world the way you did as a 6 year old than the way you did last week. The tendency for older memories to be translated into the third person may also have to do with the fact that the more distant the memory is, the less detail you’ll likely have, and the less detail you have, the less likely you are to be able to reassume the vantage point from which you originally witnessed the scene, David Rubin, a Duke University psychology professor who has published dozens of papers on autobiographical memory, told me.

    Less intuitive, perhaps, is the reverse: People are able to recall a scene in greater detail when they’re asked to take a first-person perspective than when they’re asked to take a third-person perspective. “Sometimes in a courtroom, an eyewitness to a holdup might be asked to recall what happened from the perspective of the clerk,” St. Jacques told me. But if her research is any indication, such tactics may blur rather than sharpen the witness’s memory. “Our research suggests that might actually be more likely to make the memory less vivid, make the eyewitness less likely to remember the specifics.”

    Even without an examiner’s instructions, such an eyewitness might be predisposed to recall the robbery in the third person: Researchers have found that people often translate traumatic or emotionally charged memories out of the first person. This may be because first-person memories tend to elicit stronger emotional reactions at the time of recall, and by taking a third-person perspective, we can distance ourselves from the painful experience, Angelina Sutin, a psychologist at Florida State University, told me. It may also be a function of the information at our disposal. In charged situations, Rubin said, people tend to zero in on the object of their anger or fear. Take the bank-robbery scenario: The police “want the teller to describe the person who’s robbing them, and instead he describes in great detail the barrel of the gun pointed at his head.” He can’t remember much beyond that. And so, lacking the information necessary to situate himself in his original perspective, he floats.

    This distancing effect has some fairly mind-bending potential applications, none more so, perhaps, than to the problem of near-death experiences. For many years, philosophers and psychologists have documented instances of people reporting that, in moments of trauma, they felt as though they were floating outside—usually above—their body. Rubin points out, however, that such reports are not in-the-moment descriptions but after-the-fact accounts. So he has a controversial idea: What in retrospect seems like an out-of-body experience may in fact be only the trauma-induced translation of a first-person memory into a third-person memory, one so compelling that it deceives you into thinking the experience itself occurred in the third person. The recaller, in this theory, is like a person peering through a convex window, mistaking a distortion of the glass for a distortion of the world.

    Traumatic dissociations are dramatic but by no means isolated cases of what Rubin calls the “constructive nature of the world.” In a 2019 review article on memory perspective, St. Jacques noted that shifting your vantage and fabricating an entirely new scene rely on the same mental processes occurring in the same regions of the brain. So similar are recollecting the past and projecting into the future that some psychologists lump them into a single category: “mental time travel.” Both are acts of construction. The distinction between memory and imagination blurs.

    At some level, people generally understand this, but rarely do we get so incontrovertible an example as with third-person memories. If you and a friend try to recall the decor at the restaurant where you got dinner last month, you might find that you disagree on certain points. You think the wallpaper was green, your friend thinks blue, one of you is wrong, and you’re both sure you’re right. With third-person memories, though, you know the memory is distorted, because you could not possibly have been looking at yourself at the time. If, without even realizing it, you can change something so central as the perspective from which you view a memory, how confident can you really be in any of the memory’s details?

    In this way, third-person memories are sort of terrifying. But shifts in perspective are more than mere deficiencies of memory. In her lab at Ohio State University, the psychologist Lisa Libby is investigating the relationship between memory perspective and identity—that is, the way shifts in our memory play a role in how we make sense of who we are. In one experiment, Libby asked a group of female undergraduates whether they were interested in STEM. The students then participated in a science activity, some in a version designed to be engaging, others in a version designed to be boring. Afterward, when she surveyed the undergrads about how they’d found the exercise, she instructed some to recall it from a first-person perspective and others from a third-person perspective. The first-person group’s answers corresponded to how interesting the task really was; the third-person group’s corresponded to whether they’d said they liked STEM in the initial survey.

    Libby’s takeaway: Each type of memory seems to have its own function. “One way to think about the two perspectives is that they help you represent … two different components of who you are as a person,” Libby told me. Remembering an event from a first-person perspective puts you in an experiential frame of mind. It helps you recall how you felt in the moment. Remembering an event from a third-person perspective puts you in a more narrative frame of mind. It helps you contextualize your experience by bringing it in line with your prior beliefs and fitting it into a coherent story. Memory is the—or at least a—raw material of identity; perspective is a tool we use to mold it.

    Maybe the most interesting thing about all of this is what it suggests about the human proclivity for narrative. When we shift our memories from one perspective to another, we are, often without even realizing it, shaping and reshaping our experience into a story, rendering chaos into coherence. The narrative impulse, it seems, runs even deeper than we generally acknowledge. It is not merely a quirk of culture or a chance outgrowth of modern life. It’s a fact of psychology, hardwired into the human mind.

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    Jacob Stern

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