ReportWire

Tag: older people

  • After making a big arrest, here’s what Prince George’s Co. police are saying about scams targeting elderly people – WTOP News

    After making a big arrest, here’s what Prince George’s Co. police are saying about scams targeting elderly people – WTOP News

    [ad_1]

    Four people were arrested last week in Prince George’s County, Maryland, after scamming a woman out of more than $30,000. Police said people should be vigilant.

    An old scam has come back to Prince George’s County parking lots recently, with the recent arrest of four people that police said scammed a woman out of well over $30,000 in cash last week.

    It’s called a “pigeon drop scam” but it’s not clear why the victim is called a pigeon. But the victims approached in public are usually older, and police are hoping children will have tough conversations with their parents before they lead to even tougher conversations.

    “This is a conversation we should all be having with our parents or our grandparents,” said Lt. Robert Weaver, who leads the financial crimes section within the Prince George’s County Police Department. “There are multitudes of scams that all prey on the elderly community, and this is just one of those.”

    In the most recently publicized case, the victim was approached in a parking lot in District Heights and asked about a big bag of money the suspects — who have addresses listed in Alabama and Tennessee — allegedly found.

    “The ploy was that they didn’t want the money (or) the serial numbers to be traced. ‘So I can’t just give you this money right now, it could be traced and you could get in trouble,’” said Weaver. “‘So we’re going to deposit this money into an account so that we can then withdraw it and get different serial numbers, so that this money, when we finally give it to you, that it can’t be traced.’”

    The four suspects were arrested on Oct. 25 in Clinton, Maryland, as they were approaching another older person in a different parking lot.

    “The only common denominator in all of these scams (is) that they’re targeting our elderly community and they are using some type of immediate threat or immediate gain,” said Weaver.

    And there’s always urgency involved, whether someone has to act fast to make money, or do something quick to avoid getting in trouble.

    “Our average age of the victims have been targeting these scams is 74, which is significantly higher than the average age of the victims in most of our financial frauds and crimes,” said Weaver. “But they’ll target an elderly citizen, usually by themselves in a parking lot, most likely a shopping center.”

    He said the suspects arrested — James Davis, 77, of Birmingham, Alabama, Connie Williams, 64, of Birmingham, Alabama, Mary Daniel, 59, of Antioch, Tennessee, and Kenneth Gooden, 36, of Birmingham, Alabama — could be connected to similar crimes all across the country, including in California and Illinois.

    Police are still looking into whether other cases on their radar are connected to them. Since the arrests were announced, detectives have heard from several other people around the area who came in contact with the suspects, though none of them fell for the scam.

    “We’re all going to encounter people that we don’t know in our day-to-day interactions,” said Weaver. “But when those interactions introduce something of monetary gain, or those interactions turn to talk of a transfer of money or account information, those should be huge red flags that everyone’s aware of.”

    Get breaking news and daily headlines delivered to your email inbox by signing up here.

    © 2024 WTOP. All Rights Reserved. This website is not intended for users located within the European Economic Area.

    [ad_2]

    John Domen

    Source link

  • Older Americans Are About to Lose a Lot of Weight

    Older Americans Are About to Lose a Lot of Weight

    [ad_1]

    Imagine an older man goes in to see his doctor. He’s 72 years old and moderately overweight: 5-foot-10, 190 pounds. His blood tests show high levels of triglycerides. Given his BMI—27.3—the man qualifies for taking semaglutide or tirzepatide, two of the wildly popular injectable drugs for diabetes and obesity that have produced dramatic weight loss in clinical trials. So he asks for a prescription, because his 50th college reunion is approaching and he’d like to get back to his freshman-year weight.

    He certainly could use these drugs to lose weight, says Thomas Wadden, a clinical psychologist and obesity researcher at the University of Pennsylvania, who recently laid out this hypothetical in an academic paper. But should he? And what about the tens of millions of Americans 65 and older who aren’t simply trying to slim down for a cocktail party, but live with diagnosable obesity? Should they be on Wegovy or Zepbound?

    Already, seniors make up 26.6 percent of the people who have been prescribed these and other GLP-1 agonists, including Ozempic, since 2018, according to a report from Truveta, which draws data from a large network of health-care systems. In the coming years, that proportion could rise even higher: The bipartisan Treat and Reduce Obesity Act, introduced in Congress last July, would allow Medicare to cover drug treatments for obesity among its roughly 50 million Part D enrollees above the age of 65; in principle, about two-fifths of that number would qualify as patients. Even if this law doesn’t pass (and it’s been introduced half a dozen times since 2012), America’s retirees will continue to be prescribed these drugs for diabetes in enormous numbers, and they’ll be losing weight on them as well. One way or another, the Boomers will be giving shape to our Ozempic Age.

    Economists say the cost to Medicare of giving new drugs for obesity to just a fraction of this aging generation would be staggering—$13.6 billion a year, according to an estimate published in The New England Journal of Medicine last March. But the health effects of such a program might also be unsettling. Until recently, the very notion of prescribing any form of weight loss whatsoever to an elderly patient—i.e., someone 65 or older—was considered suspect, even dangerous. “Advising weight loss in obese older adults is still shunned in the medical community,” the geriatric endocrinologist Dennis Villareal and his co-authors wrote in a 2013 “review of the controversy” for a medical journal. More than a decade later, clinicians are still struggling to reach consensus on safety, Villareal told me.

    Ample research shows that interventions for seniors with obesity can resolve associated complications. Wadden helped run a years-long, randomized trial of dramatic calorie reduction—using liquid meal replacements, in part—and stringent exercise advice for thousands of overweight adults with type 2 diabetes. “Clearly the people who were older did have benefits in terms of improved glycemic control and blood-pressure control,” he told me. Other, smaller studies led by Villareal find that older people who succeed at losing weight through diet and exercise end up feeling more robust.

    Such outcomes are significant on their own terms, says John Batsis, who treats and studies geriatric obesity at the UNC School of Medicine. “When we talk about older adults, we really need to be thinking about what’s important to older adults,” he told me. “It’s for them to be able to get on the floor and play with their grandchildren, or to be able to walk down the hallway without being completely exhausted.” But weight loss can also have adverse effects. When a person addresses their obesity through dieting alone, as much as 25 percent of the weight they lose derives from loss of muscle, bone, and other fat-free tissue. For seniors who, through natural aging, are already near the threshold of developing a functional impairment, a sudden drop like this could be enfeebling. Wadden’s trial found that, among the people who were on the weight-loss program for more than a decade, their risk of fracture to the hip, shoulder, upper arm, or pelvis increased by 39 percent. An analogous increase has turned up in studies of patients who undergo bariatric surgery, Batsis told me.

    Read: Ozempic makes you lose more than fat

    The effect of dieting on muscle and bone can be attenuated, but not prevented, through resistance training. And obesity itself—which is associated with higher bone density, but perhaps also reduced bone quality—may pose its own fracture risks, Batsis said. But even when a weight-loss treatment benefits an older patient, what happens when it ends? People tend to regain fat, but they don’t recover bone and muscle, Debra Waters, the director of gerontology research at the University of Otago, in New Zealand, told me. That makes the long-term effects of these interventions for older adults very murky. “What happens when they’re 80? Are they going to have really poor bone quality, and be at higher risk of fracture? We don’t know,” Waters said. “It’s a pretty big gamble to take, in my opinion.”

    Villareal told me that doctors should apply “the general principle of starting slow and going slow” when their older patients are trying to lose weight. But that approach doesn’t necessarily square with the rapid and remarkable weight loss seen in patients who are taking semaglutide or tirzepatide, which may produce a greater proportional loss of muscle and bone. (For semaglutide, it appears to be about 40 percent.)

    Then again, when given to laboratory animals, GLP-1 drugs seem to tamp down inflammation in the brain; and they’re now in clinical trials to see whether they might slow the progression of Alzheimer’s disease and dementia. Their multiple established benefits could also help seniors address several chronic problems—diabetes, obesity, fatty liver disease, and kidney disease, for instance—all at once. “Such a ‘one-stop shop’ approach can lead to reduction of medication burden, adverse drug events, hypoglycemic episodes, medication costs, and treatment nonadherence,” one team of geriatricians proposed in 2019.

    Overall, Batsis remains optimistic. “As a clinician, I’m very excited about these medications,” he told me. As a scientist, though, he’s inclined to wait and see. It’s surely true that some degree of weight loss is a great idea for some older patients. “But the million-dollar question is: What’s the sweet spot? How much weight is really enough? Is it 5 to 10 percent? Or is it 25 percent? We don’t know.” Waters said that if Medicare is going to pay for people’s Wegovy, then it should also cover scans of their body composition, to help predict how weight loss might affect their muscles and bones. Wadden said he thinks that treatments should be limited to people who have specific, weight-related complications. For everyone else—as for the hypothetical 72-year-old man who is prepping for his college reunion—he counsels prudence.

    To some extent, such advice is beside the point. Older people are already on Ozempic, and they’re already on Trulicity, and some of them are already taking GLP-1 drugs as a treatment for obesity. Truveta reported that the patients in its member health-care systems who are over 65 have received 281,000 prescriptions for GLP-1 drugs across the past five years. Given the network’s size, one can assume that at least 1 million seniors, overall, have already tried these medications. Millions more will try them in the years to come. If we still have questions about their use, mass experience will start providing answers.

    [ad_2]

    Daniel Engber

    Source link

  • Why These Progressives Stopped Helping Biden

    Why These Progressives Stopped Helping Biden

    [ad_1]

    Updated at 10:54 a.m. ET on December 6, 2023

    Throughout the summer, the Progressive Change Institute, a prominent grassroots organization aligned with Democrats, teamed up with the White House to promote President Joe Biden’s domestic agenda. The group helped organize events across the country, including in battleground states such as Pennsylvania and Michigan, to publicize one of the president’s most popular proposals: a crackdown on unnecessary or hidden consumer charges popularly known as “junk fees.”

    The institute was encouraged by how much positive local-media coverage the events generated, taking it as a sign that a concerted campaign could lift the president’s lackluster approval ratings ahead of his reelection bid. Its leaders were eying a second round of activity this fall to amplify Biden’s record on lowering prescription-drug and child-care costs.

    Since October 7, however, those plans are on hold. Many progressives are protesting the administration’s support for Israel’s military offensive in Gaza, which began after Hamas’s massacre of more than 1,200 Israelis and has left more than 16,000 dead, according to Gaza’s Hamas-controlled health ministry. On perhaps no other issue is the gap between Democratic leaders and young progressives wider than on the Israel-Palestine conflict. “It’s just a reality that the Middle East crisis is a superseding priority for many activists and takes oxygen out of the room on other issues the White House needs to break through on,” Adam Green, a co-founder of the Progressive Change Institute, told me. “We’ve let that be known.”

    Biden had hoped to extend a fragile week-long truce that the United States helped broker between Israel and Hamas, during which Hamas returned dozens of hostages it had captured on October 7 in exchange for the release of three times as many Palestinians imprisoned by Israel. But now that cease-fire has ended. And the president’s advocating unconditional aid to Israel and his embrace of Prime Minister Benjamin Netanyahu’s war aims have fractured the Democratic coalition that Biden will need to reassemble in order to beat Donald Trump, the current Republican front-runner for 2024.

    Franklin Foer: Inside Biden’s ‘hug Bibi’ strategy

    The president had won over many of his critics on the left—the institute’s campaign arm, for example, had backed one of his more progressive rivals, Senator Elizabeth Warren, in the 2020 Democratic primary before supporting Biden—with his run of domestic legislative victories during his first two years in office, including a major climate bill last year. Now left-wing groups that worked to persuade and turn out key constituencies in 2020, especially young and nonwhite voters, are participating in demonstrations against the president’s Middle East policy rather than selling his economic message.

    “Our public communications have been transformed by this moment,” says Maurice Mitchell, the national director of the Working Families Party, which initially endorsed Warren and then Bernie Sanders in 2020 but spent the general-election campaign mobilizing progressive voters for Biden in swing-state cities such as Phoenix, Philadelphia, Milwaukee, and Atlanta.

    The Sunrise Movement, a climate advocacy group associated with the Green New Deal, has never been a big fan of Biden. But its leaders worked with the White House over the summer as the administration developed the American Climate Corps, an initiative to train 20,000 young people for jobs in the clean-energy industry. When Biden announced the program in September, the Sunrise Movement hailed it as “a visionary new policy.” Two months later, the group joined activists holding a hunger strike outside the White House in protest of Biden’s support for Israel’s offensive. Given the president’s stance, “we cannot explain his policy to our generation, and that makes it very difficult for any of his administration’s good deeds to resonate,” Michele Weindling, the Sunrise Movement’s political director, told me.

    Young people in particular have soured on the president, a big factor in poll results showing Biden trailing Trump in a potential 2024 general election. Voters under the age of 30 backed Biden by 24 points in 2020, according to exit polls; some surveys over the past few weeks show Biden and Trump nearly tied among the same cohort.

    “Man, it is jaded right now among this generation,” Elise Joshi, the 21-year-old executive director of Gen-Z for Change, a group of social-media activists that organized under the banner of “TikTok for Biden” during the 2020 campaign, told me. Young voters’ disenchantment with the president predates October 7; they have long been more likely than older people to rate the economy poorly, and the Biden administration’s approval earlier this year of oil and natural-gas projects in Alaska and West Virginia frustrated younger climate activists. But anger toward the president erupted once Israel began shelling Gaza. “There’s been a surge since October 7,” Joshi said. “When it comes to Gaza, there’s little optimism that there’s much of a difference between the Democratic and the Republican Party.”

    Read: Is Biden toast?

    Biden, along with his party’s most powerful members of Congress, have broadly supported Israel’s war against Hamas despite their discomfort with Netanyahu’s conservative government. That stance is in accord with polls of the general public, but not with the views of more liberal voters. In protests on college campuses and elsewhere, left-wing demonstrators have denounced Israel as an apartheid state waging a campaign of ethnic cleansing—or worse—against the Palestinians. “Instead of using the immense power he has as president to save lives, he’s currently fueling a genocide,” Weindling said of Biden.

    When the Progressive Change Campaign Committee (PCCC)—the political affiliate of the Progressive Change Institute—surveyed more than 4,000 of its members in early November, just 8 percent said they supported the actions of the Netanyahu government, and more than two-thirds wanted Biden to do more “to stop the killing of civilians.” In Biden’s support for Israel, many young progressives see a Democratic president giving cover to a far-right leader whose bid to weaken Israel’s judiciary sparked enormous protests only a few months ago. “There is a serious disconnect between arguing that you are a bulwark against authoritarianism at home and then aligning with authoritarians abroad,” Mitchell told me.

    When asked for comment, the Biden campaign touted the continuing support of a wide array of “groups and allies from across our 2020 coalition” that it considers essential to reelecting the president next year and have not been reluctant to help the campaign over the past two months. In addition to the immigrant-advocacy group America’s Voice and the abortion-rights PAC Emily’s List, those groups include youth-led organizations who say that, as the election nears, opposition to Trump among Gen Z will easily outweigh concerns about Biden’s support for Israel’s invasion of Gaza. “Joe Biden and Donald Trump are like night and day for young people,” Santiago Mayer, the 21-year-old founder of the Gen Z group Voters of Tomorrow, told me. “I can’t really be convinced that both of these candidates have an equal chance of winning over young people.”

    In a national Harvard University poll of 18-to-29-year-olds released yesterday, just 35 percent of respondents said they approved of Biden’s performance overall. And only 25 percent said they trusted Biden to handle the Israel-Hamas war, less than the 29 percent who said they trusted Trump on the issue. But this survey had better news for the president than other recent polls: In a hypothetical head-to-head 2024 matchup, Biden led Trump by 11 points, and that advantage grew to 24 points among those who said they will definitely vote next year.

    NextGen America, a young voter group founded by the billionaire Tom Steyer, endorsed Biden’s reelection over the summer. Its president, Cristina Tzintzún Ramirez, pointed out that polls show that young voters prioritize inflation, climate change, and the prevalence of gun violence over foreign policy. But she told me that the level of opposition to Biden’s handling of the Israel-Hamas war was significant. “We encourage the administration to listen to the concerns that young people have on this issue,” Ramirez said.

    Ronald Brownstein: Is Gen Z coming for the GOP?

    Biden has shifted his rhetoric in the past couple of weeks, acknowledging the high civilian death toll in Gaza and intensifying pressure on Israel to allow the delivery of humanitarian aid and agree to a pause in the fighting. Last Tuesday, he angered pro-Israel hawks with a post on X (formerly Twitter) quoting a passage from a speech he had recently delivered. In context, it was a push for a two-state solution, but devoid of that context, many read it as a push for an extension of the cease-fire in which he appeared to equate Israel’s military offensive with a campaign of terror. “To continue down the path of terror, violence, killing, and war is to give Hamas what they seek,” the president wrote. “We can’t do that.”

    Pro-Palestinian progressives told me they view the change in language, as well as Biden’s involvement in brokering the short-lived truce, as evidence that their activism is working. But their goal is a permanent cease-fire that will allow Palestinians to return to—and in many cases, rebuild—their homes in Gaza and resume their push for statehood.

    None of the activists I interviewed was certain about how lasting the political damage Biden has suffered among progressives will be. Elise Joshi said she had seen a rise in young people vowing on TikTok not to vote for Biden. “We’re almost certain that we’re going to have the same 2020 choices,” she said. “But whether we’re excited to vote or have people who don’t feel comfortable showing up or feeling too jaded to show up to vote is dependent on this administration.”

    The election, however, is still nearly a year away. And interest groups often warn about their voters staying home partly as a way to pressure a presidential administration to change course. Should the war end in the coming weeks or months, the issue is likely to fade from the headlines by Election Day. Groups like the PCCC and the Working Families Party aren’t threatening to withhold support for the Democratic ticket when the alternative is Trump. In previous presidential races, early polls have shown tighter-than-expected margins for Democrats among young and nonwhite voters only for those groups to come back around as the election neared. “It’s not Will the coalition show up? It’s At what rate?” Mitchell told me. “Today,” he continued, “I’m looking at a fraying coalition that needs to come together.”

    This article originally stated that the Working Families Party initially endorsed Bernie Sanders in 2020. In fact, the party endorsed Elizabeth Warren before endorsing Sanders.

    [ad_2]

    Russell Berman

    Source link

  • How Bad Are America’s COVID-Vaccination Rates?

    How Bad Are America’s COVID-Vaccination Rates?

    [ad_1]

    Relatively speaking, 2023 has been the least dramatic year of COVID living to date. It kicked off with the mildest pandemic winter on record, followed by more than seven months of quietude. Before hospitalizations started to climb toward their September mini-spike, the country was in “the longest period we’ve had without a peak during the entire pandemic,” Shaun Truelove, an infectious-disease modeler at Johns Hopkins University, told me. So maybe it’s no surprise that, after a year of feeling normalish, most American adults simply aren’t that worried about getting seriously sick this coming winter.

    They also are not particularly eager to get this year’s COVID shot. According to a recent CDC survey, just 7 percent of adults and 2 percent of kids have received the fall’s updated shot, as of October 14; at least another 25 percent intends to nab a shot for themselves or their children but haven’t yet. And even those lackluster stats could be an overestimate, because they’re drawn from the National Immunization Surveys, which is done by phone and so reflects the answers of people willing to take federal surveyors’ calls. Separate data collected by the CDC, current as of October 24, suggest that only 12 million Americans—less than 4 percent of the population—have gotten the new vaccine, according to Dave Daigle, the associate director for communications at the CDC’s Center for Global Health.

    CDC Director Mandy Cohen still seems optimistic that the country will come close to the uptake rates of last autumn, when 17 percent of Americans received the updated bivalent vaccine. But for that to happen, Americans would have to maintain or exceed their current immunization clip—which Gregory Poland, a vaccine expert at Mayo Clinic, told me he isn’t betting on. (Already, he’s worried about the possible dampening effect of new data suggesting that getting flu and COVID shots simultaneously might slightly elevate the risk of stroke for older people.) As things stand, the United States could be heading into the winter with the fewest people recently vaccinated against COVID-19 since the end of 2020, when most people didn’t yet have the option to sign up at all.

    This winter is highly unlikely to reprise that first one, when most of the population had no immunity, tests and good antivirals were scarce, and hospitals were overrun. It’s more likely to be an encore of this most recent winter, with its relative calm. But that’s not necessarily a comfort. If that winter was a kind of uncontrolled experiment in the damage COVID could do when unchecked, this one could codify that experiment into a too-complacent routine that cements our tolerance for suffering—and leaves us vulnerable to more.

    To be fair, this year’s COVID vaccines have much been harder to get. With the end of the public-health emergency, the private sector is handling most distribution—a transition that’s made for a more uneven, chaotic rollout. In the weeks after the updated shot was cleared for use, many pharmacies were forced to cancel vaccination appointments or turn people away because of inadequate supply. At one point, Jacinda Abdul-Mutakabbir, an infectious-disease pharmacist at UC San Diego, who’s been running COVID and flu vaccination in her local community, was emailing her county’s office three times a week, trying to get vaccine vials. Even when vaccines have been available, many people have been dismayed to find they need to pay out of pocket for the cost. (Most people, regardless of insurance status, are supposed to be able to receive a free COVID-19 vaccine.)

    [Read: Fall’s vaccine routine didn’t have to be this hard]

    The vaccine is now easier to find, in many places; insurance companies, too, seem to be fixing the kinks in compensation. But Abdul-Mutakabbir told me she worries that many of the people who were initially turned away may simply never come back. “You lose that window of opportunity,” she told me. Even people who haven’t gotten their autumn shot may be hesitating to try if they expect access to be difficult, as the emergency physician Jeremy Faust points out in his Inside Medicine newsletter.

    Plus, because the rollout started later this year than in 2022, many people ended up infected before they could get vaccinated and may now be holding off on the shot—or skipping it entirely. And some Americans have simply decided against getting the shot. The CDC reported that 38 percent don’t plan to vaccinate themselves or their children; earlier this fall, more than half of respondents in a Kaiser Family Foundation poll said they probably or definitely wouldn’t be signing up themselves or their kids. More than 40 percent of those polled by KFF remain doubtful, too, that COVID shots are safe—dwarfing the numbers of people worried about flu shots, and even about RSV shots, which are newer than their COVID counterparts.

    The consequences of low COVID-vaccine uptake are hard to parse. This year, like last year, most Americans have been vaccinated, infected, or both, many of them quite recently. COVID’s average severity has, for many months, been at a relatively consistent low. The last catastrophic SARS-CoV-2 variant—one immune-evasive enough to spark a massive wave of sickness, death, and long COVID—arrived two years ago. Barring another feat of viral evolution, perhaps these dynamics have reached something like a stable state, Justin Lessler, an infectious-disease modeler at the University of North Carolina at Chapel Hill, told me. So maybe the most likely scenario is a close repeat of last winter: a rise in hospitalizations and deaths that’s ultimately far more muted than any earlier in the outbreak. And the COVID-19 Scenario Modeling Hub, which Lessler co-leads alongside Truelove and a large cohort of other researchers, projects that “next year will look a lot like this year, whatever this year ends up looking like,” Lessler said.

    But predictability is distinct from peace. COVID has still been producing roughly twice the annual mortality that flu does; roughly 17,000 people are being hospitalized for the disease each week. SARS-CoV-2 infections also still carry a risk, far higher than flu’s, of debilitating some people for years. “And I do think we’re going to experience a winter increase,” Truelove told me. Even if this year’s COVID-vaccine uptake were to climb above 30 percent, models suggest that January hospitalizations could rival numbers from early 2023. Go much lower than that, and several scenarios point to outcomes being worse.

    Based on the limited data available, at least one trend is mildly encouraging: Adults 75 and older, the age demographic most vulnerable to COVID and that stands to benefit most from annual shots, also have the highest vaccine uptake so far, at about 20 percent. At the same time, Katelyn Jetelina, the epidemiologist who writes the popular Your Local Epidemiologist newsletter, points out that CDC data suggest that only 8 percent of nursing-home residents are up to date on their COVID shots. “That is what keeps me up at night,” Jetelina told me. Early National Immunization Surveys data also suggest that uptake is lagging among other groups that might fare less well against COVID—among them, rural populations, Hispanic people, American Indians and Alaskan Natives, the uninsured, and people living below the poverty line.

    Last winter was widely considered to be a bullet dodged, and the reactions to the coming months may be similar: At least it’s no longer that bad. Since the winter of Omicron, the country has been living with lower vaccine uptake while experiencing lower COVID peaks. But those lower peaks shouldn’t undermine the importance of vaccines. Infection-induced immunity, past vaccinations, improvements in treatments, and other factors have combined to make COVID look like a gentler disease. Add more recent vaccination to that mix, and many of those gains would likely be enhanced, keeping immunity levels up without the risks of illness or passing the virus to someone else.

    [Read: The one thing everyone should know about fall COVID vaccines]

    As relatively “okay” as this past year-plus has been, it could have been better. Missed vaccinations still translate into more days spent suffering, more chronic illnesses, more total lives lost—an enormous burden to put on an already stressed health-care system, Jetelina told me. For the flu, more Americans act as if they understand this relationship: This year, as of November 1, nearly 25 percent of American adults, and more than 20 percent of American kids, have gotten their fall flu shot. Most of the experts I spoke with would be surprised to see such rates for COVID vaccines even at the end of this rollout.

    If last winter was a preview of future COVID winters, our behaviors, too, could predict the patterns we’ll follow going forward. We may not be slammed with the next terrible variant this year, or the next, or the next. When one does arrive, though, as chances are it will, the precedent we’re setting now may leave us particularly unprepared. At that point, people may be years out from their most recent COVID shot; whole swaths of babies and toddlers may have yet to receive their first dose. Some of us may still have some immunity from recent infections, sure—but it won’t be the same as dosing up right before respiratory-virus season with protection that’s both reliable and safe. Systems once poised to deliver COVID vaccines en masse may struggle to meet demand. Or maybe the public will be slow to react to the new emergency at all. Our choices now “will be self-reinforcing,” Poland told me. We still won’t be doomed to repeat our first full COVID winter. But we may get closer than anyone cares to endure.

    [ad_2]

    Katherine J. Wu

    Source link

  • Fall’s Vaccine Routine Didn’t Have to Be This Hard

    Fall’s Vaccine Routine Didn’t Have to Be This Hard

    [ad_1]

    In an ideal version of this coming winter, the United States would fully revamp its approach to respiratory disease. Pre-pandemic, fall was just a time for flu shots, if that. Now, hundreds of millions of Americans have at their fingertips vaccines that can combat three cold-weather threats at once: flu, COVID, and, for a subset of us, respiratory syncytial virus. If everyone signed up to get the shots they qualified for, “it would be huge,” says Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital. Hospital emergency rooms and intensive-care units wouldn’t fill; most cases of airway illness would truly, actually feel like “just” a common cold. “We would save tens of thousands of lives in the United States alone,” Levy told me.

    The logic of the plan is simple: Few public-health priorities are more pressing than getting three lifesaving vaccines to those who need them most, ahead of winter’s viral spikes. The logistics, however, are not as clear-cut. The best way to get vaccines into as many people as possible is to make getting shots “very, very easy,” says Chelsea Shover, an epidemiologist at UCLA. But that’s just not what we’ve set up this fall lineup of shots to do.

    Read: The flu-ification of COVID policy is almost complete

    Convenience isn’t the only issue keeping shots out of arms. But move past fear, distrust, or misinformation, solve for barriers such as insurance coverage, and getting a vaccine in the United States still means figuring out when shots are available and which you qualify for, finding and booking appointments, carving out the time to go. For adults, especially, who don’t routinely visit their doctor for wellness checkups, and whose workplaces don’t require vaccines to the extent that schools do, vaccination has become an onerous exercise in opt-ins.

    Bundling this year’s flu, COVID, and RSV vaccines into a single visit could, in theory, help ease the way to becoming a double or triple shotter. “Any time we can cut down on the number of visits for a patient to take care of them, we know that’s a big boost,” says Tochi Iroku-Malize, the president of the American Academy of Family Physicians. But the easiest iteration of that strategy, a three-in-one shot, similar to the MMR and DTaP vaccines of childhood, doesn’t yet exist (though some are in trials). Even the shorter-term solution—giving up to three injections at once—is hitting stumbling blocks. Pharmacies started receiving flu vaccines earlier this summer and are already giving them out to anyone over the age of six months. RSV vaccines, too, have hit shelves, and have been approved for people over the age of 60 and those 32 to 36 weeks pregnant; so far, however, they are being offered only to the first group. And although nearly all Americans are expected to be eligible for autumn’s updated COVID vaccines, those shots aren’t slated to make an appearance until mid-September or so, according to Kevin Griffis, a CDC spokesperson.

    Timing two or three shots together isn’t a perfect plan. Get them all too early, and some people’s protections against infection might fade before the season gets into full swing; get all of them too late, and a virus might beat the vaccine to the punch. Respiratory viruses don’t coordinate their seasons: Right now, for instance, COVID cases are on a sharp rise, but flu and RSV ones are not. Some data on the new RSV vaccines also suggests that co-administering them with other shots might trigger slightly worse side effects, or mildly curb the number of antibodies that the injections raise. Still, Levy argues that those theoretical downsides are outweighed by known benefits. “If someone is at clinic in the fall, they should get all the vaccines they’re eligible for,” he told me. Getting a slightly less effective, slightly more ornery shot a few months early is better than never getting a shot at all.

    All of that supposes that people understand that they are eligible for these shots. But already, family-medicine physicians such as Iroku-Malize, who practices in Long Island, have been fielding queries about the RSV vaccines from confused patients. Some new parents, for instance, have gotten the impression that the RSV vaccines are designed to be administered to infants, which isn’t quite right: Babies are the target of protection for the shots for pregnant people, but only because they temporarily inherit antibodies—not because they can get the injections themselves. Regulators also haven’t yet nailed down how often older adults might need the shot, though the current thinking is that the vaccine’s protection will last at least a couple of years. “It’s very hard to tell people, ‘I don’t know,’” says Jacinda Abdul-Mutakabbir, an infectious-disease pharmacist at UC San Diego.

    Other parts of the RSV-shot messaging are peppered with even more unknowns. The CDC has yet to release its final recommendation for pregnant people; for people over 60, the agency’s language has been “noncommittal,” says Rupali Limaye, a behavioral scientist at Johns Hopkins University. Unlike past guidelines that have straightforwardly recommended flu shots or most doses of the COVID-19 vaccine, RSV guidance says that eligible people may protect themselves against the virus—and are urged to first consult a health-care provider, which not all people have. The wishy-washiness is partly about safety: A few rare but serious medical events cropped up during the RSV vaccines’ clinical trials, including abnormal heartbeats and neurological complications. None of the experts I spoke with had qualms about recommending the shots anyway. Even so, some private health-insurance companies have seized on the CDC’s watered-down recommendation—and the fact that the agency hasn’t yet included RSV in its annual vaccine schedule for adults—as an excuse to not cover the shot, leaving some patients paying $300-plus out of pocket.

    For any of these shots, viral reputation matters too. Despite hospitalizing tens of thousands of Americans each year, especially at age extremes—numbers that, in some years, nearly rival those linked to flu—RSV is a lesser-known winter disease. People tend to take it less seriously, if it’s on their radar at all, Abdul-Mutakabbir told me. Which bodes poorly for future RSV-shot uptake. Annual flu shots have been recommended for 13 years for every American over the age of six months for 13 years. And still, just half the eligible population gets them in any given year. People tend to dismiss shots as subpar interventions against a disease that they don’t much fear, Limaye told me. With COVID, too, “people think it’s gotten mild,” she said. Only 28 percent of American adults are currently up to date on their COVID vaccine. And although older people have historically been more vigilant about nabbing shots, even vaccines against shingles—a notoriously painful disease—have reached just over a third of people who are 60-plus.

    Read: America’s flu-shot problem is also its COVID-shot problem

    To establish fall as an immunity-seeking season, shots would need to become an annual habit, ideally one easy to form. Mandates and financial incentives do prod people toward vaccines, but smaller nudges can persuade people to take initiative on their own. Some strategies may be as simple as semantic tweaks. Studies on HPV and flu vaccines suggest that telling patients they are “due” for a shot is better than offering it as an optional choice, says Gretchen Chapman, a behavioral scientist at Carnegie Mellon University. Other research suggests that carefully worded text-message reminders can evoke ownership—noting that a shot is “waiting for you,” or that the time has come to “claim your dose.” Noel Brewer, a behavioral scientist at the University of North Carolina at Chapel Hill, also thinks that vaccine deliverers could take inspiration from dentists who gently dog their patients with phone calls and postcards.

    Other interventions could be aimed at streamlining delivery. Government funding could make shots more available in rural regions, ensure access for those who lack insurance, and help local health departments offer shots in churches and hair salons, or even bring them door to door. More schools and workplaces, too, might try boosting uptake among students and employees. And although most shots are already given within the health-care system, there’s sludge to clear from that pipeline too. Better universal recordkeeping could help track people’s vaccination status through their lifetime. Kimberly Martin, a behavioral scientist at Yale, is researching ways to revamp medical training to help health-care providers earn their patients’ trust—especially among populations that remain marginalized by systemic racism. “The single biggest impact on vaccine uptake,” Brewer told me, “is a health-care provider recommendation.”

    An ideal vision of a fall in the future, then, would be turning vaccines into a default form of prevention—a more typical part of this country’s wellness workflow, says Saad Omer, the dean of the Peter O’Donnell Jr. School of Public Health, at UT Southwestern. After getting their vital signs checked, patients could have their vaccination status reviewed. “And then, if they’re eligible, you vaccinate them,” Omer told me. It’s a routine that pediatricians already have down pat. If adult health care follows suit, regular immunization is a habit we may never have to outgrow.

    [ad_2]

    Katherine J. Wu

    Source link

  • Quit Your Bucket List

    Quit Your Bucket List

    [ad_1]

    Years ago, just after I finished my psychiatry residency, a beloved supervisor called to say she had some bad news. At a routine checkup, she had glanced at her chest X-ray up on the viewing box while waiting for her doctor to come into the room. She was a trauma surgeon before becoming a psychiatrist and had spent years reading chest X-rays, so she knew that the coin-size lesion she saw in her lung was almost certainly cancer, given her long history of smoking.

    We had dinner soon after. She was still more than two years away from the end of her life and felt physically fine—vital, even. That’s why I was so surprised when she said she had no desire to spend whatever time she had left on exotic travel or other new adventures. She wanted her husband, her friends, her family, dinner parties, and the great outdoors. “Just more Long Island sunsets. I don’t need Bali,” she told me.

    At the end of life, you might expect people to feel regret for all the things they wanted to do and never made time for. But I have yet to know a patient or friend who, facing the blunt fact of their own mortality, had anything close to a bucket list. This squares with some recent research that shows that people tend to prefer familiar experiences more when they are reminded that their days are limited. The people I know even regretted the novelty they’d chased along the way, whether it was recreational-drug use or dating exciting people who they knew weren’t relationship material.

    Deathbed pronouncements can have limited applications for the rest of life, but this pattern suggests that novelty is perhaps overrated. Chasing the high of new sensations simply isn’t appealing for many people, and can sometimes even be bad for our health. I suspect that’s because, too often, the pursuit of novelty requires sacrificing the things we already know we love.

    It’s a common misconception that people who don’t have a taste for the newest, sexiest experience are dull, incurious, and unimaginative. A 2002 study found that people will switch away from their favorite, habitual choices when they know others are watching in order to avoid being judged as narrow-minded. And yet, Warren Buffett notoriously eats breakfast at the same fast-food restaurant every day and sticks to a strict work schedule. Taylor Swift’s music can be redundant and predictable. Barack Obama is famous for his strict morning exercise regime and daily reading time.

    Even when they’re not facing death, many people just don’t seem to like novelty that much. In 2017, a poll by a British soup company found that 77 percent of U.K. workers had consumed the exact same lunch every day for nine months and that one in six people had done so for at least two years. You might think it’s just a matter of convenience or economic exigency (the study didn’t say), but I’m not so sure; wealthy people I know partake in similar behavior, even if they do it at a fancy restaurant. Consider, too, that when people lose a pet, many run out and get a replacement of the same breed with a similar temperament. They repeatedly date people with the same quirks and problems. They return to a favorite vacation spot. They listen to the same musical artists and styles time and again.

    Read: The people who eat the same meal every day

    Research shows that humans have an intrinsic preference for things and people they are familiar with, something called the mere exposure effect. Several studies have shown that people who listen to unfamiliar songs repeatedly grow fonder of the songs they hear most  by the end of the experiment, even if they did not initially like them very much. You don’t even have to be aware that you’re growing used to something for the effect to work.

    This tendency toward repetition may seem natural, even lazy, but it runs counter to much of our history. We, along with other animals, evolved to be exquisitely sensitive to novel experiences. Way back in the Paleolithic era, there was a clear survival advantage to being attuned to new situations, which could lead someone to a potential mate or a piece of mastodon, or reveal a deadly threat. Nowadays, though, with every conceivable reward—food, sex, drugs, emotional validation, you name it—either a click, tap, or ChatGPT query away, conventional novelty-seeking has lost much of its adaptive advantage.

    As Arthur Brooks has written in The Atlantic, novelty can be fun and exciting. New and unexpected experiences activate the brain’s reward pathway more powerfully than familiar ones, leading to greater dopamine release and a more intense sense of pleasure. But on its own, excitement won’t bring about enduring happiness. Human beings habituate rapidly to what is new. To achieve a lifetime of stimulation, you would have to embark on an endless search for the unfamiliar, which would inevitably lead to disappointment. Worse, the unfettered pursuit of novelty can lead to harm through excessive thrill-seeking—including antisocial behavior such as reckless driving—particularly when the novelty seeker has poor impulse control and a disregard for others.

    Read: Don’t approach life like a picky eater

    There’s a better way. Research shows that when novelty-seeking is paired with persistence, people are far more likely to be happy, probably because they are able to achieve something meaningful. You might, for example, take a variety of courses in college or try different summer internships if you’re not yet sure what interests you. When one really clicks, you should explore it in depth; it might even become a lifelong passion. This principle relates to less consequential pleasures, too: If you’re checking out a new neighborhood joint, consider ordering different things during your first few visits, then picking your favorite and sticking with it.

    Novelty-seeking is most valuable when you use it as a tool to discover the things and people you love—and once you find them, go deep and long with those experiences and relationships. The siren call that tells you there might be a new and better version of what you already have is likely an illusion, driven by your brain’s relentless reward pathway. When in doubt, pick a beloved activity over an unfamiliar one.

    This golden rule of novelty may help explain why some people at the end of their life regret having spent so much time exploring new things, even if they once brought fleeting pleasure. Age, too, might partly explain this feeling, because older people tend to be less open to new experiences. But that’s probably not the whole story. My colleagues who treat children and adolescents have mentioned that, in the face of life-threatening diagnoses, even young people prefer the familiar. They do so not only because the familiar is known and safe, but because it is more meaningful to them. After all, things become familiar to us because we choose them repeatedly—and we do that because they are deeply rewarding.

    Read: Make a to-don’t list

    Imagine, just for a moment, that your death is near. What might you miss out on if you put your bucket list on hold? Sure, you won’t make it to Bali or Antarctica. But maybe instead you could fit in one last baseball game with your kids, one last swim in the ocean, one last movie with your beloved, one last Long Island sunset. If you prioritize the activities and people you already love, you won’t reach the end of your life wishing you’d made more time for them.

    [ad_2]

    Richard A. Friedman

    Source link

  • Life Is Worse for Older People Now

    Life Is Worse for Older People Now

    [ad_1]

    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?

    [ad_2]

    Yasmin Tayag

    Source link

  • Psychedelics Open Your Brain. You Might Not Like What Falls In.

    Psychedelics Open Your Brain. You Might Not Like What Falls In.

    [ad_1]

    If you’ve ever been to London, you know that navigating its wobbly grid, riddled with curves and dead-end streets, requires impressive spatial memory. Driving around London is so demanding, in fact, that in 2006 researchers found that it was linked with changes in the brains of the city’s cab drivers: Compared with Londoners who drove fixed routes, cabbies had a larger volume of gray matter in the hippocampus, a brain region crucial to forming spatial memory. The longer the cab driver’s tenure, the greater the effect.

    The study is a particularly evocative demonstration of neuroplasticity: the human brain’s innate ability to change in response to environmental input (in this case, the spatially demanding task of driving a cab all over London). That hard-won neuroplasticity required years of mental and physical practice. Wouldn’t it be nice to get the same effects without so much work?

    To hear some people tell it, you can: Psychedelic drugs such as psilocybin, LSD, ayahuasca, and Ecstasy, along with anesthetics such as ketamine, can enhance a user’s neuroplasticity within hours of administration. In fact, some users take psychedelics for the express purpose of making their brain a little more malleable. Just drop some acid, the thinking goes, and your brain will rewire itself—you’ll be smarter, fitter, more creative, and self-aware. You might even get a transcendent experience. Popular media abound with anecdotes suggesting that microdosing LSD or psilocybin can expand divergent thinking, a more free and associative type of thinking that some psychologists link with creativity.

    Read: Here’s what happens when a few dozen people take small doses of psychedelics

    Research suggests that psychedelic-induced neuroplasticity can indeed enhance specific types of learning, particularly in terms of overcoming fear and anxiety associated with past trauma. But claims about the transformative, brain-enhancing effects of psychedelics are, for the most part, overstated. We don’t really know yet how much microdosing, or a full-blown trip, will change the average person’s mental circuitry. And there’s reason to suspect that, for some people, such changes may be actively harmful.

    There is nothing new about the notion that the human and animal brain are pliant in response to everyday experience and injury. The philosopher and psychologist William James is said to have first used the term plasticity back in 1890 to describe changes in neural pathways that are linked to the formation of habits. Now we understand that these changes take place not only between neurons but also within them: Individual cells are capable of sprouting new connections and reorganizing in response to all kinds of experiences. Essentially, this is a neural response to learning, which psychedelics can rev up.

    We also understand how potent psychedelic drugs can be in inducing changes to the brain. Injecting psilocybin into a mouse can stimulate neurons in the frontal cortex to grow by about 10 percent and sprout new spines, projections that foster connections to other neurons. It also alleviated their stress-related behaviors—effects that persisted for more than a month, indicating enduring structural change linked with learning. Presumably, a similar effect takes place in humans. (Comparable studies on humans would be impossible to conduct, because investigating changes in a single neuron would require, well, sacrificing the subject.)

    The thing is, all those changes aren’t necessarily all good. Neuroplasticity just means that your brain—and your mind—is put into a state where it is more easily influenced. The effect is a bit like putting a glass vase back into the kiln, which makes it pliable and easy to reshape. Of course you can make the vase more functional and beautiful, but you might also turn it into a mess. Above all else, psychedelics make us exquisitely impressionable, thanks to their speed of action and magnitude of effect, though their ultimate effect is still heavily dependent on context and influence.

    Read: A new chapter in the science of psychedelic microdosing

    We have all experienced heightened neuroplasticity during the so-called sensitive periods of brain development, which typically unfold between the ages of 1 and 4 when the brain is uniquely responsive to environmental input. This helps explain why kids effortlessly learn all kinds of things, like how to ski or speak a new language. But even in childhood, you don’t acquire your knowledge and skills by magic; you have to do something in a stimulating enough environment to leverage this neuroplastic state. If you have the misfortune of being neglected or abused during your brain’s sensitive periods, the effects are likely to be adverse and enduring—probably more so than if the same events happened later in life.

    Being in a neuroplastic state enhances our ability to learn, but it might also burn in negative or traumatic experiences—or memories—if you happen to have them while taking a psychedelic. Last year, a patient of mine, a woman in her early 50s, decided to try psilocybin with a friend. The experience was quite pleasurable until she started to recall memories of her emotionally abusive father, who had an alcohol addiction. In the weeks following her psilocybin exposure, she had vivid and painful recollections of her childhood, which precipitated an acute depression.

    Her experience might have been very different—perhaps even positive—if she’d had a guide or therapist with her while she was tripping to help her reappraise these memories and make them less toxic. But without a mediating positive influence, she was left to the mercy of her imagination. This must have been just the sort of situation legislators in Oregon had in mind last month when they legalized recreational psilocybin use, but only in conjunction with a licensed guide. It’s the right idea.

    Read: What it’s like to trip on the most potent magic mushroom

    In truth, researchers and clinicians haven’t a clue whether people who microdose frequently with psychedelics—and are thus walking around in a state of enhanced neuroplasticity—are more vulnerable to the encoding of traumatic events. In order to find out, you would have to compare a group of people who microdose against a group of people who don’t over a period of time and see, for example, if they differ in rates of PTSD. Crucially, you’d have to randomly assign people to either microdose or abstain—not simply let them pick whether they want to try tripping. In the absence of such a study, we are all currently involved in a large, uncontrolled social experiment. The results will inevitably be messy and inconclusive.

    Even if opening your brain to change were all to the good, the promise of neuroplasticity without limit—that you can rejuvenate and remodel the brain at any age—far exceeds scientific evidence. Despite claims to the contrary, each of us has an upper limit to how malleable we can make our brain. The sensitive periods, when we hit our maximum plasticity, is a finite window of opportunity that slams shut as the brain matures. We progressively lose neuroplasticity as we age. Of course we can continue to learn—it just takes more effort than when we were young. Part of this change is structural: At 75, your hippocampus contains neurons that are a lot less connected to one another than they were at 25. That’s one of the major reasons older people find that their memory is not as sharp as it used to be. You may enhance those connections slightly with a dose of psilocybin, but you simply can’t make your brain behave as if it’s five decades younger.

    Read: What it’s like to get worse at something

    This reality has never stopped a highly profitable industry from catering to people’s anxieties and hopes—especially seniors’. You don’t have to search long online before you find all kinds of supplements claiming to keep your brain young and sharp. Brain-training programs go even further, purporting to rewire your brain and boost your cognition (sound familiar?), when in reality the benefits are very modest, and limited to whatever cognitive task you’ve practiced. Memorizing a string of numbers will make you better at memorizing numbers; it won’t transfer to another skill and make you better at, say, chess.

    We lose neuroplasticity as we age for good reason. To retain our experience, we don’t want our brain to rewire itself too much. Yes, we lose cognitive fluidity along the way, but we gain knowledge too. That’s not a bad trade-off. After all, it’s probably more valuable to an adult to be able to use all of their accumulated knowledge than to be able to solve a novel mathematical problem or learn a new skill. More important, our very identity is encoded in our neural architecture—something we wouldn’t want to tinker with lightly.

    At their best, psychedelics and other neuroplasticity-enhancing drugs can do some wonderful things, such as speed up the treatment of depression, quell anxiety in terminally ill patients, and alleviate the worst symptoms of PTSD. That’s enough reason to research their uses and let patients know psychedelics are an option for psychiatric treatment when the evidence supports it. But limitless drug-induced self-enhancement is simply an illusion.

    [ad_2]

    Richard A. Friedman

    Source link

  • What Does It Mean to Care About COVID Anymore?

    What Does It Mean to Care About COVID Anymore?

    [ad_1]

    After nearly three years of constantly thinking about COVID, it’s alarming how easily I can stop. The truth is, as a healthy, vaxxed-to-the-brim young person who has already had COVID, the pandemic now often feels more like an abstraction than a crisis. My perception of personal risk has dropped in recent months, as has my stamina for precautions. I still care about COVID, but I also eat in crowded cafés and go mask-free at parties.

    Heading into the third pandemic winter, things have changed. Most Americans seem to have tuned out COVID. Precautions have virtually disappeared; except for in the deepest-blue cities, wearing a mask is, well, weird. Reported cases are way down since the spring and summer, but perhaps the biggest reason for America’s behavioral let-up is that much of the country sees COVID as a minor nuisance, no more bothersome than a cold or the flu.

    And to a certain degree, they’re right: Most healthy, working-age adults who are up-to-date on their vaccinations won’t get severely ill—especially now that antivirals such as Paxlovid are available. Other treatments can help if a patient does get very sick. “People who are vaccinated and relatively healthy who are getting COVID are not getting that sick,” Lisa Lee, an epidemiologist at Virginia Tech, told me. “And so people are thinking, Wow, I’ve had COVID. It wasn’t that bad. I don’t really care anymore.”

    Still, there are many reasons to continue caring about COVID. About 300 people are still dying every day; COVID is on track to be the third-leading cause of death in the U.S. for the third year running. The prospect of developing long COVID is real and terrifying, as are mounting concerns about reinfections. But admittedly, these sometimes manifest in my mind as a dull, omnipresent horror, not an urgent affront. Continuing to care about COVID while also loosening up behaviors is an uncomfortable position to be in. Most of the time, I just try to ignore the guilt gnawing at my brain. At this point, when so few people feel that the potential benefit of dodging an infection is worth the inconvenience of precautions, what does it even mean to care about COVID?

    Read: Hundreds of Americans will die from COVID today

    In an ideal epidemiological scenario, everyone would willingly deploy the full arsenal of COVID precautions, such as masking and forgoing crowded indoor activities, especially during waves. But that kind of all-out response no longer makes sense. “It’s probably not realistic to expect people to take precautions every time, perpetually, or even every winter or fall, unless there is a particularly concerning reason to do that,” Jennifer Nuzzo, an epidemiologist at Brown University, told me.

    But, now more than ever, we must remember that COVID is not just a personal threat but a community one. For older and immunocompromised people, the risks are still significant. For example, people over 50 account for 93 percent of COVID-related deaths in the U.S., even though they represent just 35.7 percent of the population. As long as the death rate remains as high as it is, caring about COVID should mean orienting precautions to protect them. This idea has been around since the pandemic began, but its prominence faded as Americans put their personal health first. “If you’re otherwise healthy, it’s so easy just to think about yourself,” Lee said. “We have to think very carefully about that other part of infectious disease, which is the part where we can potentially hurt other people.”

    Orienting behavior in this way gives low-risk people a way to care about COVID that doesn’t entail constant masking or skipping all indoor activities: They can relax when they know they aren’t going to encounter vulnerable people. Like the productivity adage “work smarter, not harder,” this perspective allows people to take precautions strategically, not always. In practice, all it takes is some foresight. If you don’t live with vulnerable people, make it second nature to ask: Will I be seeing vulnerable people anytime soon? If the answer is no, do whatever you’re comfortable with given your own risk. If you are a healthy 30-something who lives alone, going to a Friendsgiving with other people your age is different from spending Thanksgiving dinner with parents and grandparents.

    If you will be seeing someone vulnerable, the most straightforward way to avoid giving them COVID is to avoid getting infected yourself, which means wearing a good mask in public settings and minimizing your interactions with others the week before, in what some experts have called a “mini-quarantine.” Not everyone has that luxury: Parents, for example, have to send their kids to school.

    Spontaneous interactions with vulnerable people are trickier to plan for, but they follow the same principle. On a crowded bus, for example, “there’s no question that if you’re close enough to someone who could be hurt by getting COVID and you could have it, then, yeah, a mask is the way to go,” Lee said. Of course, it isn’t always possible to know when someone is high-risk; young people, too, can be medically vulnerable. There’s no clear guidance for those situations, but remaining cautious doesn’t require much effort. “Carry a mask with you,” Lee said. “It’s not a big lift.”

    Get boosted—if not for yourself, then for them. Just 11.3 percent of eligible Americans have gotten the latest, bivalent shot, which potentially reduces your chances of getting COVID and passing it along. It also means getting tested, so you know when you’re infectious, and being aware of respiratory symptoms—of any kind. Alongside COVID, the flu and RSV are putting many people in the hospital, especially the very young and the very old. No matter how low your personal risk, if you have symptoms, avoiding transmission is crucial. “A reasonable thing to prioritize is: If you have symptoms, take care to prevent it from spreading,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, told me.

    Read: It’s a bad time to be a booster slacker

    As we move away from a personal approach to COVID, we have an opportunity to expand the idea of what caring looks like. Low-risk people can, and should, take an active role in bolstering the protection of vulnerable people they know. In practical terms, this means ensuring that people in your life who are over 50—especially those over 65—are boosted and have a plan to get Paxlovid if they fall sick, Nuzzo said. “I think our biggest problem right now is that not everybody has enough access to the tools, and that’s a place where people can help.” She noted that she is particularly concerned about older people who struggle to book vaccine appointments online. Caring “doesn’t mean abstaining, per se. It means facilitating. It means enabling and helping people in your community.” This holiday season, caring could mean sitting down at a computer to make Grandma’s booster appointment, or driving her to the drugstore to get it.

    If you have lost your motivation to care about COVID, you might find it in the people you love. I didn’t feel a personal need to wear a mask at the concert I attended yesterday, but I did it because I don’t want to accidentally infect my partner’s 94-year-old grandfather when I see him next week. To have this experience of the pandemic is a privilege. Many don’t have the option to stop caring, even for a moment.

    Barring another Omicron-esque event, we thankfully won’t ever return to a moment where Americans obsess over COVID en masse. But this virus isn’t going away, so we can’t escape having a population that is split between the high-risk minority and the low-risk majority. Rethinking what it means to care allows for a more nuanced and liveable idea of what responsible behavior looks like. Right now, Nuzzo told me, the language we use to describe one’s position on COVID is “black-and-white, absolutist—you either care or you don’t.” There is space between those extremes. At least for now, it’s the only way to compromise between the world we have and the world we want.

    [ad_2]

    Yasmin Tayag

    Source link

  • Annual COVID Shots Mean We Can Stop Counting

    Annual COVID Shots Mean We Can Stop Counting

    [ad_1]

    A couple of weeks ago, a friend asked me how many COVID shots I’d gotten so far. And for a brief, wonderful moment, I forgot.

    “Three,” I told them, before shaking my head. “No, actually, four.” I had no trouble recalling when I’d received my most recent shot (September). But it took me a moment to tabulate all the doses that had preceded it.

    By this point in the pandemic, a lot of people must be losing track. “I actually think this is a good thing,” says Grace Lee, a pediatrician at Stanford, and the chair of the CDC’s Advisory Committee on Immunization Practices. Now that so many Americans have racked up several shots or infections, she told me, the question is no longer “‘How many doses have you gotten cumulatively?’ It’s ‘Are you up to date for the season?’”

    The flip is subtle, but it marks a rethink of the COVID-vaccination paradigm. We’re at a define-the-relationship moment with these shots, when people are trying to commit—to normalize them as a routine part of our lives. At a September ACIP meeting, CDC officials noted that “we are changing the way we are thinking about these vaccines,” and trying to “get on a more regular schedule.” If COVID shots are here for good, then at least we can be rid of the bother of counting them.

    Read: It’s a bad time to be a booster slacker

    Counting doses was more apt early in the vaccine rollout, when it seemed that two jabs (or even one) would be enough to get Americans “fully vaccinated” and out of the danger zone. When more shots followed, they were often advertised with confusing finality: What some initially described as the booster was later retconned as the first booster after a second one was recommended for certain groups. But with immunity against infection more fragile than some hoped, and a virus that quickly shapeshifts out of antibodies’ grasp, those ordinal adjectives have stopped making sense. Until our vaccine tech becomes much more durable or variant-proof, repeat doses will be, for most of us, a fixture of the future—and it won’t do anyone much good to say, “‘I’m on shot 15’ or ‘I’m on shot 16,’” Angela Shen, a vaccine expert at Children’s Hospital of Philadelphia, told me.

    The numbers certainly matter when they’re small: It will continue to be important for people to count off their first few shots, for instance, especially those without a history of infections. But after that initial set of viral-spike-protein exposures, the total count is moot. In most cases, about three vaccinations or infections—preferably vaccinations, which are both safer and easier to accurately track—should be “enough to fully charge up the immune system’s battery” for the first time, says Rishi Goel, an immunologist at the University of Pennsylvania. Further COVID shots will help only insofar as they can recharge the battery toward max capacity when it starts to lose its juice. Scheduling a vaccine, then, becomes a matter of “how long it’s been since your last immunity-conferring event,” regardless of how many exposures a body has racked up, says Avnika Amin, a vaccine epidemiologist at Emory University.

    People who are immunocompromised may need four or more shots to establish that initial immunity charge, and their own (maybe smaller) peak capacity. But ultimately, the threshold effect they experience—a point of “diminishing returns”—is similar, says Marion Pepper, an immunologist at the University of Washington. Given how many vaccinations and infections the U.S. has now logged, the majority of Americans “can be done with counting,” she told me.

    If we’re going to shift our focus to timing shots, instead of counting them, we’ll have to schedule our shots smartly. Several prominent figures have already come out and said that yearly doses are a top choice. Albert Bourla, Pfizer’s CEO, has been pushing that idea since early 2021; Peter Marks, who heads the FDA’s Center for Biologics Evaluation and Research, has been delivering a similar line for several months. Even President Joe Biden has endorsed the annual approach, noting in a September statement that the debut of the bivalent shot heralded a new phase in COVID vaccination, in which Americans would receive a dose “once a year, each fall.”

    That plan is not unreasonable. Shots will have to come with at least some regularity, as variants keep rolling in and immunity against infection ebbs. But re-dose prematurely with a shot with similar ingredients, and the body—still hopped up from the previous dose—may destroy the vaccine before it has much effect, making it about as useful as charging a battery that’s already at 95 percent. SARS-CoV-2 antibody levels drop off steeply in the first six months following a vaccine dose, and then, the rate of drain slows down. It’s as if the immune system goes into “power-saver mode,” Goel told me, which means there might not be a huge difference between revaccinating twice a year or only once. Plus, living out much of the year with lower antibody levels is not as worrisome as it might sound. Although antibodies can be a rather useful proxy for our level of protection, especially against infection, they don’t paint the whole defensive picture: T cells and other fighters tend to stick around for far longer, maintaining safeguards against severe disease. (The immunocompromised and older people may still need more frequent COVID-immunity top-offs.)

    Read: Are we really getting COVID boosters every year forever?

    The optimal pace for COVID vaccination will also depend on the speed at which the virus spews out variants. A yearly schedule works for influenza, Shen told me, but “we know flu’s cadence.” SARS-CoV-2 hasn’t yet settled down into a predictable, seasonal pattern; its waves aren’t relegated to the chilliest months. The degree to which we, as the coronavirus’s hosts, tamp down transmission also matters quite a bit. Having more virus around puts more pressure on vaccines to perform, especially when there aren’t many other mitigation measures in place. If all this talk of “once a year, each fall” turns out to be another red-herring recommendation, Amin told me, it could undermine any messaging that follows.

    All of that said, the autumn regimen may yet stick around because it’s the easiest approach. Flu-shot uptake is far from perfect, but the messaging around it is “simple and clean,” says Rupali Limaye, a behavioral scientist and vaccine-attitudes researcher at Johns Hopkins. After dosing up twice in four weeks as infants, people are asked to get a yearly shot, and that’s it. Compare that with the most convoluted days of COVID vaccination, when people couldn’t dose up without accounting for their age, health status, number of previous doses, vaccine brand, time since last dose, and more. “That’s absolute overload,” Limaye told me. Complicated schedules burn people out—or dissuade them from showing up at all. This fall, when the bivalent shot debuted, a troubling proportion of Americans didn’t even know they were eligible.

    Encouraging COVID vaccines at the same, straightforward pace as flu shots would make it easy for people to sign up for both at once, and maybe, eventually, to get them in the same syringe. Vaccines tend to ride one another’s coattails, Shen told me. “In the fall, there’s a bump in other routine vaccines,” she said, because people “are already there for their flu shot.” It would also make a big difference if the COVID-vaccine recipes changed for everyone at the same time, as they do for flu.

    Read: When’s the perfect time to get a flu shot?

    If we’re going to pivot from numbering doses to timing them, we might as well take the opportunity to discard the term booster as well. Some people don’t understand what it means, Limaye told me, or they default to a logical question—How many more boosters will I need? Plus, booster may no longer fit the science. “When we start updating formulas, it’s not really a booster anymore,” Amin told me. That’s not how we generally talk about flu shots: I certainly couldn’t tell you how many “boosters” of that vaccine I’ve had. (I don’t know, maybe 14? 15?) Pivoting to a terminology of “seasonal shots” could make COVID vaccination that much more routine.

    So, fine, if anyone should ask: I’ve had (count ’em: one, two, three) four doses of the vaccine so far. But more important, I’ve gotten the shot most recently available to me.

    [ad_2]

    Katherine J. Wu

    Source link

  • When’s the Perfect Time to Get a Flu Shot?

    When’s the Perfect Time to Get a Flu Shot?

    [ad_1]

    For about 60 years, health authorities in the United States have been championing a routine for at least some sector of the public: a yearly flu shot. That recommendation now applies to every American over the age of six months, and for many of us, flu vaccines have become a fixture of fall.

    The logic of that timeline seems solid enough. A shot in the autumn preps the body for each winter’s circulating viral strains. But years into researching flu immunity, experts have yet to reach a consensus on the optimal time to receive the vaccine—or even the number of injections that should be doled out.

    Each year, a new flu shot recipe debuts in the U.S. sometime around July or August, and according to the CDC the best time for most people to show up for an injection is about now: preferably no sooner than September, ideally no later than the end of October. Many health-care systems require their employees to get the shot in this time frame as well. But those who opt to follow the CDC current guidelines, as I recently did, then mention that fact in a forum frequented by a bunch of experts, as I also recently did, might rapidly hear that they’ve made a terrible, terrible choice.

    “There’s no way I would do what you did,” one virologist texted me. “It’s poor advice to get the flu vaccine now.” Florian Krammer, a virologist at Mount Sinai’s Icahn School of Medicine, echoed that sentiment in a tweet: “I think it is too early to get a flu shot.” When I prodded other experts to share their scheduling preferences, I found that some are September shooters, but others won’t juice up till December or later. One vaccinologist I spoke with goes totally avant-garde, and nabs multiple doses a year.

    Read: Should your flu and COVID shots go in different arms?

    There is definitely such a thing as getting a flu shot too early, as Helen Branswell has reported for Stat. After people get their vaccine, levels of antibodies rocket up, buoying protection against both infection and disease. But after only weeks, the number of those molecules begins to steadily tick downward, raising people’s risk of developing a symptomatic case of flu by about 6 to 18 percent, various studies have found. On average, people can expect that a good portion of their anti-flu antibodies “are meaningfully gone by about three or so months” after a shot, says Lauren Rodda, an immunologist at the University of Washington.

    That decline is why some researchers, Krammer among them, think that September and even October shots could be premature, especially if flu activity peaks well after winter begins. In about three-quarters of the flu seasons from 1982 to 2020, the virus didn’t hit its apex until January or later. Krammer, for one, told me that he usually waits until at least late November to dose up. Stanley Plotkin, a 90-year-old vaccinologist and vaccine consultant, has a different solution. People in his age group—over 65—don’t respond as well to vaccines in general, and seem to lose protection more rapidly. So for the past several years, Plotkin has doubled up on flu shots, getting one sometime before Halloween and another in January, to ensure he’s chock-full of antibodies throughout the entire risky, wintry stretch. “The higher the titers,” or antibody levels, Plotkin told me, “the better the efficacy, so I’m trying to take advantage of that.” (He made clear to me that he wasn’t “making recommendations for the rest of the world”—just “playing the odds” given his age.)

    Data on doubling up is quite sparse. But Ben Cowling, an epidemiologist and flu researcher at Hong Kong University, has been running a years-long study to figure out whether offering two vaccines a year, separated by roughly six months, could keep vulnerable people safe for longer. His target population is Hong Kongers, who often experience multiple annual flu peaks, one seeded by the Northern Hemisphere’s winter wave and another by the Southern Hemisphere’s. So far, “getting that second dose seems to give you additional protection,” Cowling told me, “and it seems like there’s no harm of getting vaccinated twice a year,” apart from the financial and logistical cost of a double rollout.

    Read: The strongest sign that Americans should worry about flu this winter

    In the U.S., though, flu season is usually synonymous with winter. And the closer together two shots are given, the more blunted the effects of the second injection might be: People who are already bustling with antibodies may obliterate a second shot’s contents before the vaccine has a chance to teach immune cells anything new. That might be why several studies that have looked at double-dosing flu shots within weeks of each other “showed no benefit” in older people and certain immunocompromised groups, Poland told me. (One exception? Organ–transplant recipients. Kids getting their very first flu shot are also supposed to get two of them, four weeks apart.)

    Even at the three-ish-month mark past vaccination, the body’s anti-flu defenses don’t reset to zero, Rodda told me. Shots shore up B cells and T cells, which can survive for many months or years in various anatomical nooks and crannies. Those arsenals are especially hefty in people who have banked a lifetime of exposures to flu viruses and vaccines, and they can guard people against severe disease, hospitalization, and death, even after an antibody surge has faded. A recent study found that vaccine protection against flu hospitalizations ebbed by less than 10 percent a month after people got their shot, though the rates among adults older than 65 were a smidge higher. Still other numbers barely noted any changes in post-vaccine safeguards against symptomatic flu cases of a range of severities, at least within the first few months. “I do think the best protection is within three months of vaccination,” Cowling told me. “But there’s still a good amount by six.”

    For some young, healthy adults, a decent number of flu antibodies may actually stick around for more than a year. “You can test my blood right now,” Rodda told me. “I haven’t gotten vaccinated just yet this year, and I have detectable titers.” Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he has found that some people who have regularly received flu vaccines have almost no antibody bump when they get a fresh shot: Their blood is already hopping with the molecules. Preexisting immunity also seems to be a big reason that nasal-spray-based flu vaccines don’t work terribly well in adults, whose airways have hosted far more flu viruses than children’s.

    Getting a second flu shot in a single season is pretty unlikely to hurt. But Ellebedy compares it to taking out a second insurance policy on a car that’s rarely driven: likely of quite marginal benefit for most people. Plus, because it’s not a sanctioned flu-vaccine regimen, pharmacists might be reluctant to acquiesce, Poland pointed out. Double-dosing probably wouldn’t stand much of a chance as an official CDC recommendation, either. “We do a bad enough job,” Poland said, getting Americans to take even one dose a year.

    Read: America’s flu-shot problem is also its next COVID-shot problem

    That’s why the push to vaccinate in late summer and early fall is so essential for the single shot we currently have, says Huong McLean, a vaccine researcher at the Marshfield Clinic Research Institute in Wisconsin. “People get busy, and health systems are making sure that most people can get protected before the season starts,” she told me. Ellebedy, who’s usually a September vaccinator, told me he “doesn’t see the point of delaying vaccination for fear of having a lower antibody level in February.” Flu seasons are unpredictable, with some starting as early as October, and the viruses aren’t usually keen on giving their hosts a heads-up. That makes dillydallying a risk: Put the shot off till November or December, and “you might get infected in between,” Ellebedy said—or simply forget to make an appointment at all, especially as the holidays draw near.

    In the future, improvements to flu-shot tech could help cleave off some of the ambiguity. Higher doses of vaccine, which are given to older people, could rile up the immune system to a greater degree; the same could be true for more provocative vaccines, made with ingredients called adjuvants that trip more of the body’s defensive sensors. Injections such as those seem to “maintain higher antibody titers year-round,” says Sophie Valkenburg, an immunologist at Hong Kong University and the University of Melbourne—a trend that Ellebedy attributes to the body investing more resources in training its fighters against what it perceives to be a larger threat. Such a switch would likely come with a cost, though, McLean said: Higher doses and adjuvants “also mean more adverse events, more reactions to the vaccine.”

    For now, the only obvious choice, Rodda told me, is to “definitely get vaccinated this year.” After the past two flu seasons, one essentially absent and one super light, and with flu-vaccination rates still lackluster, Americans are more likely than not in immunity deficit. Flu-vaccination rates have also ticked downward since the coronavirus pandemic began, which means there may be an argument for erring on the early side this season, if only to ensure that people reinforce their defenses against severe disease, Rodda said. Plus, Australia’s recent flu season, often a bellwether for ours, arrived ahead of schedule.

    Even so, people who vaccinate too early could end up sicker in late winter—in the same way that people who vaccinate too late could end up sicker now. Plotkin told me that staying apprised of the epidemiology helps: “If I heard influenza outbreaks were starting to occur now, I would go and get my first dose.” But timing remains a gamble, subject to the virus’s whims. Flu is ornery and unpredictable, and often unwilling to be forecasted at all.

    [ad_2]

    Katherine J. Wu

    Source link

  • Hundreds of Americans Will Die From COVID Today

    Hundreds of Americans Will Die From COVID Today

    [ad_1]

    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.

    Read: How did this many deaths become normal?

    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.”

    Read: America was in an early-death crisis long before COVID

    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?

    [ad_2]

    Jacob Stern

    Source link

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

    The Strongest Signal That Americans Should Worry About Flu This Winter

    [ad_1]

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

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

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

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

    Read: The pandemic broke the flu

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

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

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

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

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

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

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

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

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

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

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

    [ad_2]

    Katherine J. Wu

    Source link