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  • Austin Pets Alive! | Austin Animal Welfare Policy in 2023

    Austin Pets Alive! | Austin Animal Welfare Policy in 2023

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    Nov 04, 2022

    When I moved to Austin in the 90s, the city looked much different than it does today. The population stood under 600,000, what would become a booming tech culture was in its infancy, traffic was manageable, and the city’s weirdly famous motto wasn’t even a thing. Austin was also more than a decade away from being heralded as a leading No Kill city in the United States.

    I can still feel the revulsion that jolted through me when I learned that 85% of pets—more than 25,000—were killed in the city shelter each year. Wriggly, energetic puppies and kittens. Healthy cats. Sweet dogs who were licking people’s faces as they were being injected with lethal doses of pentobarbital. The state of animal welfare in late 1990s Austin sat in stark contrast to the city’s identity as a burgeoning epicenter of innovation.

    Austinites knew their city could do better, and the community fought and won a battle to become one of the nation’s leading No Kill cities. We went from 85% of pets being killed to more than 95% of pets leaving the shelter alive. Austin’s No Kill status—11 years running—is one of the gems that makes Austin, Austin. And it’s at risk.

    Now the 11th largest city in the nation, Austin is at a pivotal moment in history. With rapid growth has come pain points such as affordability, housing limitations, and unintentional neglect of the things that make Austin stand out. The effects of these pain points extend to animal welfare.

    From the bats under Congress Avenue bridge that have been dying off year after year, to Austin’s renowned status as the largest No Kill city in the U.S. being under fire, we know that now is the time to protect what so many people in Austin care deeply about.

    With a new council coming in, there is tremendous potential for progress to be made or progress to be lost.

    To keep Austin No Kill we must develop a comprehensive, citywide approach to animal welfare. There is no other city that has done this, and Austin can and should be the first.

    If we lean into progress, it can mean an even larger economic impact than No Kill alone has realized, and it can be a crown jewel of Austin that ties many of the city’s major initiatives together.

    On the surface, this challenge appears daunting. But if we look deeper we can see that animal welfare leaders do not have to work alone. Seven out of 10 Austin households have pets and almost all view their pets as family members. This is one of the largest and most passionate groups of people in Austin.

    As a city, we need to do more to engage with pet owners and utilize animal welfare issues to secure support for Austin overall. If we band together as a community to implement community-wide solutions, we can ensure that all pets are given the chance to live.

    The following steps will bring us closer to creating that approach and making No Kill permanent in Austin:

    Conduct a comprehensive study of Austin pet owners.

    To better support people with pets, there should be an Austin-wide study to really understand how major systemic societal problems affect pet owners and their companion animals.

    We know that pet ownership transcends all demographics. We also know that many pet owners are struggling under the weight of significant financial burdens that have increased because of Austin’s dramatic and rapid growth. Now we need to know more about the specific struggles so we can support residents in ways that keep them with their pets.

    When we help pets in crisis we are also helping humans in crisis. For example, over 70% of women in domestic violence shelters report that their abuser threatened, injured, or killed a pet as a means of control. Nearly half of domestic abuse survivors delayed leaving their abuser because they could not take their pets with them. People’s worries about pet care can lead them to put off medical treatment, or to leave the hospital early.

    There are many more examples, involving people experiencing housing insecurity, at-risk older residents and youth, and groups facing numerous other challenges that demonstrate the interconnectedness between people’s and pets’ well-being. These clearly make the case for helping pets, while helping the people who love them.

    Once we understand more, we can dive deep into solutions to support pet owners with the top problems that humans and pets face together.

    Weave pet ownership through a wide range of city communications.

    Pet ownership in Austin translates into lower crime rates, and greater mental and physical health of community members, leading to decreased healthcare costs, and a lot more money entering the local economy. Let’s look at the key drivers and obstacles for pet owners, and work on talking to and about them in many more of our citywide communications. More pet owners means a healthier city overall.

    Form an economic development task force to make Austin the epicenter of the booming corporate pet industry.

    The pet industry is poised to almost double to $240B by 2030. But no city is yet capitalizing on this enormous opportunity.

    Austin is a natural fit to become the corporate headquarters for so many pet-related companies as progress is made in this relatively new industry. The city could provide incentives for green programming in areas such as pet food, which is a top contributor to greenhouse gas emissions, and for for-profit companies to form partnerships with sheltering nonprofits to modernize the archaic dog pound industry to save more lives. Austin-based companies could be incentivized to develop fireworks that don’t kill native wildlife and create pet products that are earth-friendly and recyclable.

    Making Austin the epicenter of the booming pet industry would put Austin on the map in yet another distinct way and contribute to the local economy through conferences, even more pet-friendly businesses, and local spending.

    Create an innovation task force to make Austin the home of the first wraparound human + animal welfare system in the world.

    Austin has been the largest No Kill city in the U.S. for 11 years. It is time for Austin to lead in a much more comprehensive and effective way. This city should be the home of the next social innovation in animal welfare, where the community, animal services, and human services operate as one.

    Right now, animal services tend to be reacting to what has been historically viewed as an “irresponsible public.” When someone is struggling to care for their pets, due to job loss, housing insecurity, or for another reason, they may not know about or have access to options beyond giving up their pet to an overcrowded shelter.

    With a comprehensive makeover focused on dignity and preservation of the human-animal bond, the city shelter could instead be the go-to place for support—including crisis boarding for owned pets whose owners are hospitalized or otherwise temporarily can’t care for them; support for fighting housing restrictions; pet sitting for people experiencing homelessness who need a safe place for their dog to stay while they attend a job interview or court date; full spectrum veterinary care for low-income pet owners; at-risk youth programs to introduce careers in animal welfare; other workforce development opportunities; and much more.

    The city could also be the best in the world when it comes to how our hospitals, our police, our builders, and our fire/EMS services operate, by including pet specifics in training, metrics, and vision.

    Tackling comprehensive citywide problems through the lens of pet ownership offers a manageable vein of solutions and can serve as an example for the next lens of comprehensive problem solving.

    Bring civic engagement departments and organizations together to find common ground with pet owners.

    Pet owners are passionate about their pets. Pets are linked to higher self confidence and increased civic engagement. Pet owners report stronger neighborhood social connections than non-pet owners, with greater degrees of trust between neighbors.

    The trust inherent in these connections can be used to create mutual aid channels for pet owners in crisis and to increase civic engagement in areas that are tangentially related to animals, such as increasing participation and recruitment in Austin’s 100 boards and commissions. Every single one touches animals in some way and building excitement about topics that don’t generally drive the most participation leads to a stronger community led by community members.

    Task the Austin Animal Advisory Commission with developing a plan for Austin Animal Center to sustainably operate as a No Kill facility, and also to lead, support, and mentor other jurisdictions on No Kill.

    In 2010, the City Council approved a No Kill plan that they had tasked the Austin Animal Advisory Commission to create, using cities with an over 90% live release rate as their only resource. That single resolution has now resulted, conservatively, in over $200M in economic impact for the city of Austin and hundreds of thousands of lives saved.This figure is based on a 2017 report measuring the economic impact of the No Kill resolution from 2010 until 2016. At that time, the figure was over $157,000,000. In the six years since, it is fair to estimate that number has at least doubled.

    Now the city council can have the same groundbreaking No Kill success by tasking the commission with a similar request—this time two-fold:

    1. Create a plan to develop the most important standard operating procedures for saving the myriad lives that enter the Animal Center doors, using only cities/programs that have the same or higher live release rates as models for each type of at-risk animal population or program.

    2. Create a plan to teach these standard operating procedures to shelters all over the country. This not only solves the chronic problems that are inevitably associated with saving lives instead of killing them by offering quality assurance and oversight internally, but also positions Austin as the city to watch as No Kill becomes stronger and even more successful.

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  • The College-Admissions Merit Myth

    The College-Admissions Merit Myth

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    Tomorrow, the Supreme Court will hear oral arguments in two cases that could end America’s experiment with affirmative action in higher education. The challenges to the admissions programs at Harvard and at the University of North Carolina at Chapel Hill—both brought by Students for Fair Admissions, a coalition of unnamed students assembled by the conservative legal strategist Edward Blum—argue that the institutions discriminate against Asian American students, and that eliminating the use of race in admissions would fix the problem.

    Lower courts have rejected SFFA’s arguments, leaning on more than 40 years of precedent that says the use of race in admissions is permissible in narrow circumstances. “Harvard has demonstrated that no workable and available race-neutral alternatives would allow it to achieve a diverse student body while still maintaining its standards for academic excellence,” Judge Allison Burroughs wrote in her 2019 opinion. But SFFA pressed on, and now the case sits before a conservative Supreme Court that has shown a willingness to overturn well-established precedents.

    In her new book, Is Affirmative Action Fair? The Myth of Equity in College Admissions, Natasha Warikoo, a sociologist at Tufts University who has spent years examining race-conscious admissions, assesses the positions of those for and against affirmative action, and argues that we’re asking the wrong questions about how students get into college. By exalting merit, Warikoo warns, Americans have developed a skewed perception of the process—a perception that leads to challenges such as the one before the Court.

    I spoke with Warikoo about her book, the Supreme Court hearing, and how we can better understand admissions.

    This conversation has been edited for length and clarity.


    Adam Harris: You write, “When we recognize the diverse goals that universities attempt to address through college admissions, it becomes clear that admission is not a certification of individual merit, or deservingness, nor was it ever meant to be.” Can you expand on that idea? Where do we have flaws in our understanding of college admissions?

    Natasha Warikoo: In the past, it was like “We want to have a bar.” You had to have some demonstration that you could handle the work that we’re going to give you. And some of that was exclusionary. It was like “Can you pass the Latin test?” Well, most schools didn’t teach kids Latin, so it’s not that that was fair—it was “You’re going to be doing Latin; do you know Latin?”

    But now, when we’re talking about super-selective places—there are more than 200 of them, so not just the Ivies, but also not most colleges—they have so many different interests that are playing into who they’re admitting. You’ve got the sports coaches who are trying to get their recruits; you’ve got the development office that gives a list and says, “These people have done a lot for this university—make sure you take a close look at that”; there’s the humanities departments who want to make sure there are people interested in the humanities, not just in STEM; the orchestra’s bassoon player may have graduated, and now the orchestra needs a bassoon player. So, there are all these different things that are going on, and the admissions office is trying to fulfill all these different interests and needs.

    But ordinary people treat admissions as, you know, they’re lining people up from best to worst and taking the top ones, and if one of these says they’re not coming, then they take the next person. Well, that’s not how it works. They’re fulfilling organizational needs and desires. But somehow, we treat it as a prize—and whoever is most deserving gets in.

    Harris: That plays into the broader idea in America around merit, and the way that we’ve oriented our society around merit. How do merit and the idea of fairness work together to give us the wrong idea about admission systems?

    Warikoo: In all of these international surveys, when you look at respondents’ belief about whether people should be rewarded for merit over other things, Americans are much more likely to say yes than people in most other countries. A lot of modern societies believe in these ideas of meritocracy, but the United States is especially attached to the idea. We have this belief that some people are deserving—and the unspoken idea that some are undeserving. And there’s a sense of entitlement, like I did all of these things; I deserve a spot at these places.

    But we should stop treating college admissions as if everybody is on an equal playing field and that the person who is the smartest, the most hardworking, the one with the most grit, is the one getting in. Instead of arguing about how affirmative action goes against our ideas of meritocracy, we should look at what colleges are actually trying to do.

    Harris: Well, let’s talk about affirmative action. How has it been viewed since Justice Lewis Powell accepted the diversity rationale in the Regents of the University of California v. Bakke case in 1978?

    Warikoo: There’s a whole industry of research that develops after that decision to really try to dig into the impact of a diverse learning environment: What is the impact of having a roommate of a different race, going to a college that is diverse, being in a class with students who are a different race? And this research shows all these benefits: Groups make better decisions; students have more intellectual engagement; they improve their racial attitudes. There are even some findings that show a positive impact on civic engagement down the line. A student may not even have a diverse set of friends, but if they’re on a diverse campus, there seems to be some kind of impact.

    So, all of this research shows these positive effects, and those data have been used in subsequent court cases defending affirmative action. But in the public conversation, many people recognize that it’s also an equity issue.

    Harris: In 2003, Justice Sandra Day O’Connor said the Court expects that 25 years from now, the use of racial preferences will no longer be necessary. And that’s what a lot of opponents of affirmative action say now: It may have been justified in the past, but it’s no longer necessary—and if we need something, we might be able to find a proxy. Are there proxies for race in admissions?

    Warikoo: The legal requirement is that when you’re using these suspect categories such as race in a policy, you have to show that there’s no other way that you could do things instead. And it’s pretty clear that there’s no good stand-in for race. We can use class, and class is important. But I don’t see these as either-or. The Georgetown law professor Sheryll Cashin has looked at zip code as a stand-in, and it’s pretty clear that such an approach is not going to have an impact on the numbers of underrepresented minority students on campus. Because, you know, the overwhelming majority of people in the United States today are white. The majority of people who are poor in this country are white. So you’re not really going to racially diversify by looking at class.

    Colleges have tried different things, such as the Texas “10 percent plan.” The research suggests that these other ideas are somewhat helpful, but the problem has been that graduation rates can go down when you’re just using a percent plan. And it’s not a stand-in for race-based affirmative action.

    We can look at the data from the states that have banned affirmative action to understand that they have not figured out a stand-in. We see declines in every state, year on year, of the number of underrepresented minorities when affirmative action gets banned.

    Harris: One of the through lines in the book is the purpose of higher education. What can colleges do better to be more honest about their goals?

    Warikoo: One is being careful about how they talk about admissions. And when you dig into their language, many schools say that they’re looking to build a class, and that everyone makes a unique contribution. But they’re still publishing acceptance rates. There are so many ways in which the language they use buys into this idea that they are a place of excellence. This is the best class ever, you’re told when you’re a freshman.

    When you have these elite colleges in which the student body comes from more resourced families than the average across 18 year-olds, it’s not just the best of the best. Your family’s resources play a role—whether you have parents who went to college, whether you grew up in certain neighborhoods or went to certain schools. Two-thirds of American adults don’t have a bachelor’s degree.

    But I keep coming back to the question of What are we trying to do here? Our spending in the U.S. on higher education is regressive. The most elite colleges accept students who are the highest achieving and most resourced. But who needs the most support? When you look at what community colleges are doing in terms of social mobility, they blow places like Harvard and Tufts out of the water. Colleges should think much more about the role they want to play in our society, and how they should align admissions to those goals.

    Harris: As I got toward the end of the book, where you talk about solutions, a couple of things really stuck out: the sort of anti-inclusive instinct that a lot of institutions have in terms of increasing their enrollment, where they don’t want to increase enrollment because that may upset alumni who attach value to the selectiveness of their institution. Or, if there were an admission lottery, families of high achievers may be frustrated. And my takeaway was: There’s really nothing the institutions may be able to do that is going to make everyone happy, so maybe they should just do what’s just.

    Warikoo: Yes. There are so many more amazing 18-year-olds in our country—deserving, hardworking, ambitious, smart, whatever superlative you want to use—than there is space for them at Harvard, at UNC, at any given school.

    But we have to stop acting like you deserve it and you don’t deserve it. It’s not about who deserves it. And that’s why I talk about a lottery system, because it implies you don’t deserve this more than anyone else—you got lucky. It already is luck: that your parents could afford to buy a house near a school that had a college counselor, or you had a tutor who could help you with your essay, or you went to a school with a crew team and you got recruited for crew—all kinds of things. It is luck. Why not call it what it is?

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    Adam Harris

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  • America’s COVID Booster Rates Are a Bad Sign for Winter

    America’s COVID Booster Rates Are a Bad Sign for Winter

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    And just like that, with the passing of Labor Day, fall was upon us. Seemingly overnight, six-packs of pumpkin beer materialized on grocery shelves, hordes of city dwellers descended upon apple orchards—and America rolled out new COVID boosters. The timing wasn’t a coincidence. Since the beginning of the pandemic, cases in North America and Europe have risen during the fall and winter, and there was no reason to expect anything different this year. Spreading during colder weather is simply what respiratory diseases like COVID do. The hope for the fall booster rollout was that Americans would take it as an opportunity to supercharge their immunological defenses against the coronavirus in advance of a winter wave that we know is going to come.

    So far, reality isn’t living up to that hope. Since the new booster became available in early September, fewer than 20 million Americans have gotten the shot, according to the CDC—just 8.5 percent of those who are eligible. The White House COVID-19 response coordinator, Ashish Jha, said at a press conference earlier this month that he expects booster uptake to increase in October as the temperatures drop and people start taking winter diseases more seriously. That doesn’t seem to be happening yet. America’s booster campaign is going so badly that by late September, only half of Americans had heard even “some” information about the bivalent boosters, according to a recent survey. The low numbers are especially unfortunate because the remaining 91.5 percent of booster-eligible people have already shown that they’re open to vaccines by getting at least their first two shots—if not already at least one booster.

    Now the bungled booster rollout could soon run headfirst into the winter wave. The virus is not yet surging in the United States—at least as far as we can tell—but as the weather cools down, cases have been on the rise in Western Europe, which has previously foreshadowed what happens in the U.S. At the same time, new Omicron offshoots such as BQ.1 and BQ.1.1 are gaining traction in the U.S., and others, including XBB, are creating problems in Singapore. Boosters are our best chance at protecting ourselves from getting swept up in whatever this virus throws at us next, but too few of us are getting them. What will happen if that doesn’t change?

    The whole reason for new shots is that though the protection conferred by the original vaccines is tremendous, it has waned over time and with new variants. The latest booster, which is called “bivalent” because it targets both the original SARS-CoV-2 virus and BA.5, is meant to kick-start the production of more neutralizing antibodies, which in turn should prevent new infection in the short term, Katelyn Jetelina, a public-health expert who writes the newsletter Your Local Epidemiologist, told me. The other two goals for the vaccine are still being studied: The hope is that it will also broaden protection by teaching the immune system to recognize other aspects of the virus, and that it will make protection longer-lasting.

    In theory, this souped-up booster would make a big difference heading into another wave. In September, a forecast presented by the Advisory Committee on Immunization Practices (ACIP), which advises the CDC, showed that if people get the bivalent booster at the same rate as they do the flu vaccine—optimistic, given that about 50 percent of people have gotten the flu vaccine in recent years—roughly 25 million infections, 1 million hospitalizations, and 100,000 deaths could be averted by the end of March 2023.

    But these numbers shouldn’t be taken as gospel, because protection across the population varies widely and modeling can’t account for all of the nuance that happens in real life. Gaming out exactly what our dreadful booster rates mean going forward is not a simple endeavor “given that the immune landscape is becoming more and more complex,” Jetelina told me. People received their first shots and boosters at different times, if they got them at all. And the same is true of infections over the past year, with the added wrinkle that those who fell sick all didn’t get the same type of Omicron. All of these factors play a role in how much America’s immunological guardrails will hold up in the coming months. “But it’s very clear that a high booster rate would certainly help this winter,” Jetelina said.

    At this point in the pandemic, getting COVID is far less daunting for healthy people than it was a year or two ago (although the prospect of developing long COVID still looms). The biggest concerns are hospitalizations and deaths, which make low booster uptake among vulnerable groups such as the elderly and immunocompromised especially worrying. That said, everyone aged 5 and up who has received their primary vaccine is encouraged to get the new boosters. It bears repeating that vaccination not only protects against severe illness and death but has the secondary effect of preventing transmission, thereby reducing the chances of infecting the vulnerable.

    What will happen next is hard to predict, Michael Osterholm, an epidemiologist at the University of Minnesota, told me, but now is a bad time for booster rates to be this low. Conditions are ripe for COVID’s spread. Protection is waning among the unboosted, immunity-dodging variants are emerging, and Americans just don’t seem to care about COVID anymore, Osterholm explained. The combination of these factors, he said, is “not a pretty picture.” By skipping boosters, people are missing out on the chance to offset these risks, though non-vaccine interventions such as masking and ventilation improvements can help, too.

    That’s not to say that the immunity conferred by the vaccination and the initial boosters is moot. Earlier doses still offer “pretty substantial protection,” Saad Omer, a Yale epidemiologist, told me. Not only are eligible Americans slacking on booster uptake, but lately vaccine uptake among the unvaccinated hasn’t risen much either. Before the new bivalent shots came around, less than half of eligible Americans had gotten a booster. “That means we are, as a population, much more vulnerable going into this fall,” James Lawler, an infectious-diseases expert at the University of Nebraska Medical Center, told me.

    If booster uptake—and vaccine uptake overall—remains low, expecting more illness, particularly among the vulnerable, would be reasonable, William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, told me. Hospitalizations will rise more than they would otherwise, and with them the stress on the health-care system, which will also be grappling with the hundreds of thousands of people likely to be hospitalized for flu. While Omicron causes relatively minor symptoms, “it’s quite capable of producing severe disease,” Schaffner said. Since August, it has killed an average of 300 to 400 people each day.

    All of this assumes that we won’t get a completely new variant, of course. So far, the BA.5 subvariant targeted by the bivalent booster is still dominating cases around the world. Newer ones, such as XBB, BQ.1.1, and BQ.1, are steadily gaining traction, but they’re still offshoots of Omicron. “We’re still very hopeful that the booster will be effective,” Jetelina said. But the odds of what she called an “Omicron-like event,” in which a completely new SARS-CoV-2 lineage—one that warrants a new Greek letter—emerges out of left field, are about 20 to 30 percent, she estimated. Even in this case, the bivalent nature of the booster would come in handy, helping protect against a wider crop of potential variants. The effectiveness of our shots against a brand-new variant depends on its mutations, and how much they overlap with those we’ve already seen, so “we’ll see,” Omer said.

    Just as it isn’t too late to get boosted, there’s still time to improve uptake in advance of a wave. If you’re three to six months out from an infection or your last shot, the best thing you can do for your immune system right now is to get another dose, and do it soon. Though there’s no perfect and easy solution that can overcome widespread vaccine fatigue, that doesn’t mean trying isn’t worthwhile. “Right now, we don’t have a lot of people that feel the pandemic is that big of a problem,” and people are more likely to get vaccinated if they feel their health is challenged, Osterholm said.

    There’s also plenty of room to crank the volume on the messaging in general: Not long ago, the initial vaccine campaign involved blasting social media with celebrity endorsers such as Dolly Parton and Olivia Rodrigo. Where is that now? Lots of pharmacies are swimming in vaccines, but making getting boosted even easier and more convenient can go a long way too. “We need to catch them where they come,” said Omer, who thinks boosters should be offered at workplaces, in churches and community centers, and at specialty clinics such as dialysis centers where patients are vulnerable by default.

    After more than two years of covering and living through the pandemic, believe me: I get that people are over it. It’s easy not to care when the risks of COVID seem to be negligible. But while shedding masks is one thing, taking a blasé attitude toward boosters is another. Shots alone can’t solve all of our pandemic problems, but their unrivaled protective effects are fading. Without a re-up, when the winter wave reaches U.S. shores and more people start getting sick, the risks may no longer be so easy to ignore.

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    Yasmin Tayag

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  • Will the Bivalent Booster Cause Worse Side Effects?

    Will the Bivalent Booster Cause Worse Side Effects?

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    For as long as my marriage lasts, my household will be divided by reactions to vaccines.

    I am, fortunately, speaking of physical reactions rather than ideological ones; my partner and I are both shot enthusiasts, a fact we verified on our first date. But if my immune system is a bashful wallflower, rarely triggering more than a sore arm in the hours after I get a vaccine, then my spouse’s is a party animal. Every immunization I’ve watched him receive—among them, four doses of Moderna’s COVID-19 vaccine—has absolutely clobbered him with fevers, chills, fatigue, and headaches for about a full day. When he got the flu shot and the bivalent COVID jab together a few weeks ago, he ended up taking his first day off work in more than a decade. As usual, the same injections caused me so few symptoms that I wondered if I was truly dead inside.

    “Why don’t you feel anything?” my spouse howled at me from the bedroom, where his sweat was soaking through the sheets. “Sorry,” I yelled back from the kitchen, where I was prepping four days’ worth of meals between work calls after returning from an eight-mile run.

    If this is how every autumn will go from now on, so be it: A few hours of discomfort is still worth the rev-up in defenses that vaccines offer against serious disease and death. But it’s not hard to see that gnarly side effects will only add to the many other factors that work against COVID-vaccine uptake, including lack of awareness, sloppy messaging, dwindling access, and spotty community outreach. Back in the spring, when I spoke with several people who hadn’t gotten boosters despite being eligible for many, many months, several of them cited the post-shot discomfort as a reason. Now I’m getting texts and calls from family members and friends—all up to date on their previous COVID vaccines—admitting they’ve been dillydallying on the bivalent to avoid those symptoms too. “I don’t know if we’re going to continue to get strong buy-in from the public if they have this sort of reaction every year,” says Cindy Leifer, an immunologist at Cornell University.

    The good news, at least, is that experts told me they don’t expect this bivalent recipe—or future autumn COVID shots, for that matter—to be worse, side-effect-wise, than the ones we’ve received before. It’ll take a while for data to confirm that, especially considering that more than a month into this fall’s rollout, fewer than 15 million Americans have received the updated shot. But Kathleen Neuzil, a vaccinologist at the University of Maryland School of Medicine who has studied the performance of COVID vaccines in clinical trials, pointed out to me that the mRNA shots’ ingredients have been swapped out before without altering the rate of side effects. As the alphabet soup of variants began to sweep the world in early 2021, she told me, vaccine makers started to tinker with alternate formulations, sometimes combining multiple versions of the spike protein into a single shot—“and they’re all comparable.” (If anything, early data suggest that bivalent shots containing an Omicron variant spike may be easier to take.) The same goes for flu vaccines, which are also retooled each year: When measured across the population, the frequency and intensity of side effects remain more or less the same.

    On average, then, mRNA-vaxxed people can probably expect to have an annual experience that’s pretty similar to the one they had with their first COVID booster. As studies have shown, that one was actually better for most people than dose No. 2, the most unpleasant of the injections so far. (The math, of course, becomes tougher for people getting another vaccine, such as the flu shot, at the same time.) There are probably two main reasons why side effects have lessened overall, experts told me. First, the spacing: Most people received the second dose in their Pfizer or Moderna primary series just three or four weeks after the first. That’s an efficient way to get a lot of people “fully vaccinated” in a short period of time, but it means that many of the immune system’s defensive cells and molecules will still be on high alert. The second shot could end up fanning a blaze of inflammation that was never quite put out. In line with that, researchers have found that spacing out the primary-series doses to eight weeks, 12 weeks, or even longer can prune some side effects.

    Dose matters a lot too: Vaccines are, in a way, stimulants meant to goad the immune system into reacting; bigger servings should induce bigger jolts. When vaccine makers were tinkering with their recipes in early trials, higher doses—including ones that were deemed too large for further testing—produced more side effects. Each injection in Moderna’s primary series contains more than three times the mRNA packaged into Pfizer’s, and Moderna has, on average, caused more intense side effects. But Moderna’s booster and bivalent doses contain a smaller scoop of the stimulating material: People 12 and older, for instance, get 50 micrograms instead of the 100 micrograms in each primary dose; kids 6 to 11 years old get 25 micrograms instead of 50. (All of Pfizer’s doses stay the same size across primaries and boosters, as long as people stay in the same age group.) People who switch between brands, then, may also notice a difference in symptoms.

    It’s a tricky balance, though. Sometimes, the immune system adjusts the magnitude of its protection to match the danger posed by a pathogen (or shot), a bit like titrating a crisis response to the severity of a threat—so it’s important that vaccine makers don’t undershoot. For better or worse, the mRNA-based COVID vaccines do seem to cause a rougher response than most other vaccines, including annual flu shots. One of the offending ingredients might be the mRNA itself, which codes for SARS-CoV-2’s spike protein. But Michela Locci, an immunologist at the University of Pennsylvania, told me that the mRNA’s packaging—a greasy fat bubble called a lipid nanoparticle—may be the more likely culprit. For some people, in any case, the side effects of COVID shots might be on par with those of the two-dose Shingrix vaccine, one of the most infamously reactogenic immunizations in our roster. Leifer, who has received both, told me the second dose of each “floored” her to about the same extent.

    The fact that I get fewer side effects than my spouse does not imply that I’m any less protected. A ton of factors—genetics, hormone levels, age, diet, sleep, stress, pain tolerance, and more—could potentially influence how someone experiences a shot. Women tend to have more reactive bodies, as do younger people. But there are exceptions to those trends: I’m one of them. The whole topic is understudied, Locci told me. Her own recent experience with the bivalent threw her for a loop. After her first, second, and third dose of Moderna each ratcheted up in side-effect severity, she cleared her calendar for the couple of days following her bivalent, “afraid I was going to be in bed with a fever again,” she said: “But it was a light headache for a morning, and then it was over.” She has no idea what next year will bring.

    Either way, side effects such as fevers and chills tend to be short-lived. “Very few side effects are severe,” Neuzil told me, “and COVID continues to be a severe disease.” Still, Grace Lee, a pediatrician at Stanford and the chair of the CDC’s Advisory Committee on Immunization Practices, hopes that scientists will keep developing new COVID vaccines that might come with fewer post-shot issues—including the very rare ones, such as myocarditis—without sacrificing immune protection. Lee doesn’t tend to react much to vaccines, but her daughter “always misses school the next day,” she told me. “I plan her shots for a Friday afternoon so she can lay out all Saturday.” Early on, when hardly anyone had immunity to the virus, signing everyone up for somewhat reactogenic shots was a no-brainer—especially given the hope that two doses would yield many, many years of protection. Now that we know it’s a repeated need, Neuzil said, “the equation changes a bit.”

    People aren’t totally helpless against side effects. Deepta Bhattacharya, an immunologist at the University of Arizona, had an “awful, terrible” experience with his second and third doses, which slammed him with 102- and 103-degree fevers, respectively. He weathered the side effects without intervention, worried that a painkiller would curb not just the agony, but also his protective immune response. This time, though, armed with new knowledge from his own lab that anti-inflammatory and pain-relieving drugs don’t blunt antibody levels, “the first sign I feel even the slightest bit shitty,” he told me, “I’m dosing up.”

    I’ll probably do the same for my spouse the next time he’s due for a vaccine of any kind … likely while I chill on the sidelines. Bhattacharya’s spouse, too, is kind of an immune introvert, a fact that he bemoans. “Her only side effect was she felt thirsty,” he said. “It’s just not fair.”

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    Katherine J. Wu

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  • America’s Teeth Grinders Are Turning to Botox

    America’s Teeth Grinders Are Turning to Botox

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    With the pinch of a needle, cosmetic dermatologists such as Michele Green can make forehead wrinkles disappear and deep-furrowed crow’s-feet puff back out like yeasted dough. Botox is totally magic, a little unsettling, and very in demand: Green’s New York City practice has been swamped as Americans seek to give themselves a “post-pandemic” glow-up. But these days, many of her patients aren’t after eternal youth and sex appeal. When Green reviews her schedule for the week each Monday morning, she told me, “I’m just like, Oh my god.” At least a quarter of her Botox appointments are for people with a different motive entirely: They can’t stop clenching their jaw and grinding their teeth.

    Across the country, patients dealing with the meddlesome condition are now turning to Botox—yes, Botox.  “It’s a very popular treatment” for people who grind and clench their teeth, Lauren Goodman, a L.A.-based cosmetic nurse, told me. Bruxism, the official term encompassing both behaviors, is an involuntary action that tends to happen when people are sleeping at night, for reasons including alcohol and tobacco use, sleep apnea, and stress—perhaps why the condition has soared in the United States during the pandemic. The condition is a tolerable nuisance for many people, but the symptoms can get very real: With bruxism on the rise, dentists are reporting more chipped and cracked teeth in patients, along with jaw pain and facial soreness. In the most severe cases, patients can suffer debilitating headaches and jaw dislocation. The most common treatments, such as mouth guards and lifestyle changes, only sometimes help get rid of symptoms.

    That’s what makes Botox so appealing for the recent flood of teeth grinders. Jaw injections relax the chewing muscles that clench and grind with up to 250 pounds of force—potentially relieving pain and preventing dental issues in the process. It’s not as though every teeth grinder in America is hotfooting it to their nearest Botox clinic, but the procedure seems to have blown up since the start of the pandemic. Five dentists and cosmetic experts told me they’d noticed an increase in teeth grinders and clenchers getting Botox. People who have exhausted more traditional routes are “really just committed to alleviating their pain,” said Samantha Rawdin, a prosthodontist in New York City. “If that means getting a needle to the face, so be it.”

    But even if Botox has some upsides, it’s hardly the permanent, sure-thing solution that dentists and patients have long searched for. That’s been the narrative all along with bruxism: Because there are so many possible causes, treatments are an educated dice roll—and none of them is universally effective. “I don’t tell my patients I can treat them,” Gilles Lavigne, a dentistry professor at the University of Montreal, told me. “I tell them I can help them manage their condition.” So, how do we still not always know how to handle this incredibly common ailment?


    Botox has been creeping onto the teeth-grinding stage since long before the pandemic. Although it has gained noticeable traction over the past few years, research on the efficacy of Botox stretches back to the late 1990s. In the years since, researchers have also discovered that the injections, which temporarily paralyze the masseter muscles responsible for grinding and clenching, can reduce the frequency and intensity of bruxism. It’s one of a slew of non-cosmetic Botox uses that have been identified since the drug hit the market in 1989: Injections also treat issues such as excessive underarm sweating, acne, and migraines.

    Botox for bruxism hasn’t been FDA approved, so it’s still considered off-label—but anyone with a Botox license can legally inject a willing teeth grinder. And at least in theory, Botox has some advantages over other bruxism treatments. Night guards might prevent you from gnashing your teeth into smithereens while you sleep, but they can be ineffective at stopping the behavior and can even make it worse—especially if you have sleep apnea, Jamison Spencer, a dentist and sleep-apnea expert based in Boise, Idaho, told me. Minimally invasive regimes such as yoga, meditation, cognitive behavioral therapy, and physical therapy are hit or miss. Muscle relaxers can be helpful for some patients, but those aren’t universally popular among the dentists I spoke with, some of whom cited America’s opioid crisis as a concern.

    When less invasive treatments don’t work, Botox might be “the next frontier,” Leena Palomo, a professor at New York University’s College of Dentistry, told me. Grinders and clenchers seem to be learning about the injections from a variety of sources. Rita Mizrahi, an oral surgeon in New York who offers Botox for bruxism, told me that her patients are typically referred by their regular dentists. Others discover jaw Botox in online forums such as Reddit and the beauty network RealSelf, where often anonymous discussions of the procedure abound. And some are reading mainstream-media testimonials or hearing about it from friends or family—particularly as more and more Americans embrace Botox for cosmetic purposes.

    At its best, the procedure can really help certain teeth grinders: Studies have indicated that Botox can decrease pain levels. One RealSelf reviewer described trying night guards, stress relief, and cutting out caffeine before getting jaw injections. “Thank goodness for something like Botox to come along in this day and age,” they wrote four months after getting the procedure. The procedure comes with some cosmetic changes too: Grinding and clenching all night can be a workout, which might lead to enlarged chewing muscles and a square, boxy face. The injections slim the jawline for many patients, giving it “more of a V-shape,” Green said.

    But Botox has some real downsides—and plenty of dentists are still hesitant to recommend it. For starters, it’s expensive and impermanent. The procedure typically costs at least $1,000; is not covered by medical or dental insurance; and usually won’t last for more than four months. “This isn’t a onetime thing and you’re good,” Mizrahi said. And like most of the other treatments available, jaw Botox attacks teeth-grinding and clenching symptoms, but not the cause. Because people still need to chew, the masseter muscle isn’t totally immobilized—meaning that patients “will just grind with less power,” Lavigne said.

    And all of the risks associated with the cosmetic use of Botox apply here too, such as bruising at the injection site, headaches, allergic reactions, and less desirable changes in facial expressions due to misplaced Botox. One RealSelf reviewer experienced no improvement in jaw pain but the unfortunate onset of a creepy grin that resembled a “chucky doll smile.” Another said that their headaches disappeared after the procedure, but so did their cheeks: “I couldn’t recognize myself in the mirror and looked like I had aged 10 years within a couple of months.”

    That grinders and clenchers are more frequently turning to Botox is hardly a pure success story. Early mentions of teeth gnashing exist in the Bible, yet we still don’t really understand how to make it stop. I know firsthand how frustrating that feels. In January, after trying (and failing) to open wide enough for a crispy chicken tender, I was finally motivated to see a dentist—who gave me a night guard so I’d quit slamming my teeth together. I meditate like it’s my job, I don’t have sleep apnea or take medications of any sort, and yet I still gnaw on that hunk of plastic like it’s gristle. My jaw doesn’t lock anymore but it’s still tense most mornings. I’m priced out of getting Botox—so, like many teeth grinders, I’m stuck in medical purgatory.

    Teeth grinding isn’t like a broken arm, where cause and effect are obvious and fixable. “Because the origin of [jaw] pain is not singular, you have to attack it from various modalities,” Mizrahi told me: “All the things that potentially contribute to the pain have to be addressed,” and that can involve fields far outside dentistry. Even dentists themselves aren’t always equipped with all the information: “We get virtually no bruxism education” in dental school, Spencer, the sleep-apnea researcher from Idaho, said.

    With all these roadblocks, many patients never find out why they’re clenching or grinding, says Alan Glaros, an emeritus professor of dentistry at the University of Missouri at Kansas City, who’s been researching the issue for more than 40 years. That’s partially because it’s a difficult problem to not only treat, but also study. Bruxism’s many causes intersect “a lot of disciplines,” such as dentistry, sleep health, and psychology, which muddies the research process. Each field is studying the behavior, but the results will only ever tell part of the story. “People act as if this is all solved, but it’s not,” Glaros told me.

    So for now, mouth guards, meditation, and Botox are what we have. The treatment, in all likelihood, isn’t going anywhere. “As people get to know others who have responded well, I predict that we’re going to see an uptick,” Palomo said. Grinders and clenchers will keep chomping on their plastic night guards or forking up thousands of dollars a year for temporary injections, all in a maybe-successful attempt to quell their pain. If only Botox could banish bruxism like it does stubborn wrinkles.

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    Ali Francis

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  • What Will Happen in Georgia?

    What Will Happen in Georgia?

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    ATLANTA—The three dozen young Black men and women who gathered in a church meeting room last Friday night were greeted with a rousing exhortation that had the added benefit of being true.

    In welcoming remarks, Bryce Berry, a senior at nearby Morehouse College and the president of the Young Democrats of Georgia club, told the group that none of the party’s national-policy accomplishments of the past two years would have been possible without people like them. “Without young Georgians, young Black Georgians,” Berry said for emphasis, “there would be no Associate Justice Ketanji Brown Jackson, no American Rescue Plan … no Inflation Reduction Act, no student-debt relief, and no gun-safety bill.”

    It was the sort of thing speakers always say to motivate a crowd at political rallies. But in this case it was historically accurate: Massive turnout and huge margins among young voters, especially young voters of color, were crucial to the twin runoff victories of Georgia Senators Jon Ossoff and Raphael Warnock in January 2021 that delivered Democrats their unexpected majority in the upper chamber.

    Young adults have become an essential electoral asset for Democrats—and loom as a potentially decisive factor in determining whether the party can avoid the worst outcomes up and down the ballot this November. In particular, young voters may decide whether Democrats can preserve the fragile hold on the Senate that Georgia provided to them.

    A sharp generation gap is among the most consistent findings in public polling across almost every competitive Senate race this year. Here in Georgia, for instance, an array of recent public polls (including surveys by Quinnipiac University, Marist College, Monmouth University, and the University of Georgia) have found Warnock leading the Republican Herschel Walker by as much as two to one among young adults from about 18 to 34 and consistently by a margin of about 10 percentage points among those in early middle age. Polls almost always show Walker at least slightly ahead among those in their later working years, and solidly leading among those 65 and older. (This week’s explosive allegations about Walker—the claim that he allegedly funded an abortion for a girlfriend and the subsequent accusations of domestic violence from his son—seem likely to weaken him, perhaps substantially, with every group, but are unlikely to erase these sharp generational differences.)

    These patterns are so common across the competitive states that it’s hard to imagine Democrats maintaining their Senate majority unless young voters like those who gathered at Atlanta’s Allen Temple AME Church turn out in substantial numbers.

    Compared with older generations, Millennials and members of Generation Z are more racially diverse, more likely to hold postsecondary degrees, and less likely to identify with any religious tradition. Both cohorts have leaned sharply Democratic since the first Millennials entered the electorate in large numbers in the 2004 election; the party has routinely carried about three-fifths of young adults in recent presidential contests. In 2018, Democrats hit a peak of support among young voters, winning two-thirds of those younger than 30 and three-fifths of those ages 30 to 44, according to estimates by Catalist, a Democratic targeting firm.

    Millennials and Gen Z are especially crucial to Democratic fortunes across Sun Belt states like Georgia and Arizona. In this region, younger generations are far more racially diverse than the mostly white, older voters who provide the backbone of GOP strength. In Arizona, for instance, Latino voters and other people of color compose almost three-fifths of the population under 30 but less than one-fifth of the population over 65, according to calculations from census data by William Frey, a demographer at Brookings Metro. In Georgia, Black voters and other people of color represent half of eligible voters under 45 but only three in 10 of those over 65. The gap between what I’ve called “the brown and the gray”—the diverse younger and the mostly white older generations—is comparably large in Texas and Nevada and nearly as big in North Carolina, Frey’s data show.

    For Democrats, this year’s nightmare scenario of losing both the House and Senate is a repeat of 2010 and 2014, when the GOP midterm sweeps were turbocharged by a catastrophic falloff in turnout among young people from the presidential race two years earlier.

    The anemic youth turnout in those off-year elections during Barack Obama’s presidency fueled a widespread perception that Democrats now faced a structural disadvantage in midterms because the electorate in those years was destined to be much older and whiter than in the presidential contest. But the 2018 results upended that assumption: Much more robust turnout among young adults helped power the Democratic gains that allowed them to recapture the House of Representatives. Compared with 2014, youth turnout increased in every state in 2018, more than doubling across the country overall, Circle, a think tank at Tufts University that studies young voters, has calculated. Some of the biggest increases occurred in Sun Belt states where the youth population is the most racially diverse, including Georgia, Arizona, and Nevada.

    The turnout surge continued into 2020, when exactly half of adults younger than 30 showed up to vote, a big increase from the 39 percent in 2016, Circle concluded. Georgia again ranked among the states with the biggest youth-turnout increase compared with 2016—a key factor in the Democrats’ razor-thin victories there in the presidential race and the two Senate runoffs.

    Democrats this year are highly unlikely to win as big a share of youth voters as they did during their 2018 sweep (they didn’t even equal it in 2020). But one of the pivotal questions remaining for the 2022 election is how close Democrats can come to matching the strength with young voters they displayed while Donald Trump was in the White House.

    Democrats face some serious headwinds. Never enthusiastic about President Joe Biden during the 2020 Democratic primaries, young people have given him lackluster approval ratings throughout his presidency. Generally operating with less of a financial cushion than older voters, young people have also been more affected by the highest inflation in four decades. “The cost of living is going up, but our salaries are not,” Alexia Brookins, a manager at a construction company, told me at the AME event sponsored by the group Millennials of Faith last weekend.

    In a mid-September NPR/PBS NewsHour/Marist poll, just 37 percent of Millennials and Gen Z said that Biden’s actions had strengthened the economy; 55 percent said that he had weakened it. In a late-September Yahoo News/YouGov survey, only about one-fifth of young adults ages 18 to 44 said life was better for people like them since Biden took office (the rest said it was unchanged or worse).

    Terrance Woodbury, a partner at HIT Strategies, a Democratic consulting firm that focuses on young voters of color, worries that these verdicts will make it difficult for Democrats to reach the turnout and margins they need among young voters. In polling that HIT recently conducted for the NAACP, he told me, three-fourths of Black adults younger than 50 said their lives had not improved since Biden took office.

    Woodbury told me that although the media seem fixated on whether potential Republican gains among men will widen the Black gender gap this year, he expects that the “generational gap” in the African American community will be much wider. “Younger voters are much more likely to say Democrats take Black voters for granted, much less likely to approve of the direction of the country, and much less likely to approve of the performance of Democrats in Congress and the White House,” he told me. “All of that is significantly higher by generation than by gender. I actually do think there is a real risk of Democrats underperforming with young voters, and specifically young voters of color.” Equis Research, a Democratic polling firm that specializes in Latino voters, raised similar warnings about young Hispanic voters in a late-September memo analyzing the upcoming election.

    But other factors may help Democrats approach, if not necessarily match, their recent advantages with young voters.

    More young adults may vote in 2022 simply because so many of them registered and voted in 2018 and 2020. One reason for that is structural: There are more young people on the voter rolls because of the [2018 and 2020] elections, which is a huge boost, because it means they are more likely to be contacted by parties and organizations,” and those contacts increase the likelihood of people voting, Abby Kiesa, Circle’s deputy director, told me.

    The other key reason is attitudinal: Higher youth turnout may mean that not only is voting becoming a habit for those who have already done it; it is also becoming more expected among the 18-year-olds who age into the electorate every two years (more than 8 million of them since 2020, Circle projects). At the AME event, for instance, Kendeius Mitchell, a disability-claims manager, told me that youth engagement in Georgia is feeding on itself. “Just having it around so much in the conversation now is making people take accountability,” he said.

    John Della Volpe, the director of polling at the Harvard Kennedy School Institute of Politics, sees the same trend in the institute’s national surveys. “Voting … could be becoming a part of this new generation and how they think,” he told me.

    Also lifting Democratic hopes is the party’s summer succession of policy advances on issues important to young people. Della Volpe said the “No. 1” criticism of Biden among young adults in the Harvard poll was “ineffectiveness.” But the passage of the Inflation Reduction Act, with its sweeping provisions to combat climate change, and the president’s decision to cancel up to $20,000 in student debt for millions of borrowers have provided Democratic organizers and ad makers something they lacked earlier this year: evidence to argue to young adults that their votes did produce change on things they care about. Biden gave organizers another talking point yesterday afternoon, when he announced a sweeping pardon of all people convicted of simple marijuana possession under federal law.

    On the ground in Georgia, Keron Blair, the chief organizing and field officer for the New Georgia Project, a grassroots political organization founded by the Democratic gubernatorial candidate Stacey Abrams, told me that with the Democrats’ recent successes, “it feels a little bit easier” than in the spring to make the case to young adults that their vote counts.

    Looking across the overall record of Democrats since they took power, “people aren’t like, ‘Oh my God, this is amazing,’” Blair told me. “But people are clear that some of the wins and the political and economic shifts that we are seeing [are] the result of the [voting] choices that people have made.”

    Also working for Democrats is the gulf in values between most young voters and the Trump-era Republican Party. Fully 70 percent of adults younger than 30, for instance, said in a Pew Research Center poll this summer that abortion should remain legal in all or most circumstances, by far the most of any age group. That places them in sharp opposition to a GOP that is intensifying talk of passing a national ban on abortion if it wins control of Congress. “If we maintain that [recent] surge among young voters and voters of color,” Woodbury said, “they are voting against the crazy on the other side.”

    Although different public surveys have sent different signals about youth engagement, the latest IOP youth survey, which is considered a benchmark in the field, found that as many young people said they “definitely” intend to vote this fall as did in 2018.

    That prospect points toward an incremental but inexorable power shift. In 2020, for the first time, Millennials and Gen Z roughly equaled Baby Boomers and their elders as a share of eligible voters. By 2024, the younger generations will establish a clear advantage. As their numbers grow, so does their capacity to influence the national direction. There’s no guarantee they will exercise that inherent power next month by turning out to vote in large numbers. But more young people appear to be recognizing how much their choices can matter. Berry, the young Georgia activist, told me that his message to his friends is centered on understanding the strength in numbers that they are accumulating: “I really impress on folks, ‘Look at what happened because of you. You understood the moment in 2020; now you have to understand the moment in 2022.’”

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    Ronald Brownstein

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  • I Was Allergic to Cats. Until Suddenly, I Wasn’t.

    I Was Allergic to Cats. Until Suddenly, I Wasn’t.

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    Of all the nicknames I have for my cat Calvin—Fluffernutter, Chonk-a-Donk, Fuzzy Lumpkin, Jerky McJerkface—Bumpus Maximus may be the most apt. Every night, when I crawl into bed, Calvin hops onto my pillow, purrs, and bonks his head affectionately against mine. It’s adorable, and a little bit gross. Tiny tufts of fur jet into my nose; flecks of spittle smear onto my cheeks.

    Just shy of a decade ago, cuddling a cat this aggressively would have left me in dire straits. From early childhood through my early 20s, I nursed a serious allergy that made it impossible for me to safely interact with most felines, much less adopt them. Just a few minutes of exposure was enough to make my eyes water and clog my nasal passages with snot. Within an hour, my throat would swell and my chest would erupt in crimson hives.

    Then, sometime in the early 2010s, my misery came to an abrupt and baffling end. With no apparent interventions, my cat allergy disappeared. Stray whiffs of dander, sufficient to send my body into conniptions mere months before, couldn’t even compel my nose to twitch. My body just up and decided that the former bane of its existence was suddenly totally chill.

    What I went through is, technically speaking, “completely weird,” says Kimberly Blumenthal, an allergist and immunologist at Massachusetts General Hospital. Some allergies do naturally fade with time, but short of allergy shots, which don’t always work, “we think of cat allergy as a permanent diagnosis,” Blumenthal told me. One solution that’s often proposed? “Get rid of your cat.”

    My case is an anomaly, but its oddness is not. Although experts have a broad sense of how allergies play out in the body, far less is known about what causes them to come and go—an enigma that’s becoming more worrying as rates of allergy continue to climb. Nailing down how, when, and why these chronic conditions vanish could help researchers engineer those circumstances more often for allergy sufferers—in ways that are actually under our control, and not just by chance.


    All allergies, at their core, are molecular screwups: an immune system mistakenly flagging a harmless substance as dangerous and attacking it. In the classic version, an allergen, be it a fleck of almond or grass or dog, evokes the ire of certain immune cells, prompting them to churn out an antibody called IgE. IgE drags the allergen like a hostage over to other defensive cells and molecules to rile them up too. A blaze of inflammation-promoting signals, including histamine, end up getting released, sparking bouts of itching, redness, and swelling. Blood vessels dilate; mucus floods out in gobs. At their most extreme, these reactions get so gnarly that they can kill.

    Just about every step of this chain reaction is essential to produce a bona fide allergy—which means that intervening at any of several points can shut the cascade down. People whose bodies make less IgE over time can become less sensitive to allergens. The same seems to be true for those who start producing more of another antibody, called IgG4, that can counteract IgE. Some people also dispatch a molecule known as IL-10 that can tell immune cells to cool their heels even in the midst of IgE’s perpetual scream.

    All this and more can eventually persuade a body to lose its phobia of an allergen, a phenomenon known as tolerance. But because there is not a single way in which allergy manifests, it stands to reason that there won’t be a single way in which it disappears. “We don’t fully understand how these things go away,” says Zachary Rubin, a pediatrician at Oak Brook Allergists, in Illinois.

    Tolerance does display a few trends. Sometimes, it unfurls naturally as people get older, especially as they approach their 60s (though allergies can appear in old age as well). Other diagnoses can go poof amid the changes that unfold as children zip through the physiological and hormonal changes brought on by toddlerhood, adolescence, and the teen years. As many as 60 to 80 percent of milk, wheat, and egg allergies can peace out by puberty—a pattern that might also be related to the instability of the allergens involved. Certain snippets of milk and egg proteins, for instance, can unravel in the presence of heat or stomach acid, making the molecules “less allergenic,” and giving the body ample opportunity to reappraise them as benign, says Anna Nowak-Węgrzyn, a pediatric allergist and immunologist at NYU Langone Health. About 80 to 90 percent of penicillin allergies, too, disappear within 10 years of when they’re first detected, more if you count the ones that are improperly diagnosed, as Blumenthal has found.

    Other allergies are more likely to be lifers without dedicated intervention—among them, issues with peanuts, tree nuts, shellfish, pollen, and pets. Part of the reason may be that some of these allergens are super tough to neutralize or purge. The main cat allergen, a protein called “Fel d 1” that’s found in feline saliva, urine, and gland secretions, can linger for six months after a cat vacates the premises. It can get airborne, and glom on to surfaces; it’s been found in schools and churches and buses and hospitals, “even in space,” Blumenthal told me.

    For hangers-on like these, allergists can try to nudge the body toward tolerance through shots or mouth drops that introduce bits of an allergen over months or years, basically the immunological version of exposure therapy. In some cases, it works: Dosing people with Fel d 1 can at least improve a cat allergy, but it’s hardly a sure hit. Researchers haven’t even fully sussed out how allergy shots induce tolerance—just that “they work well for a lot of patients,” Rubin told me. The world of allergy research as a whole is something of a Wild West: Some people are truly, genuinely, hypersensitive to water touching their skin; others have gotten allergies because of organ transplants, apparently inheriting their donor’s sensitivity as amped-up immune cells hitched a ride.

    Part of the trouble is that allergy can involve just about every nook and cranny of the immune system; to study its wax and wane, scientists have to repeatedly look at people’s blood, gut, or airway to figure out what sorts of cells and molecules are lurking about, all while tracking their symptoms and exposures, which doesn’t come easy or cheap. And fully disentangling the nuances of bygone allergies isn’t just about better understanding people who are the rule. It’s about delving into the exceptions to it too.


    How frustratingly little we know about allergies is compounded by the fact that the world is becoming a more allergic place. A lot of the why remains murky, but researchers think that part of the problem can be traced to the perils of modern living: the wider use of antibiotics; the shifts in eating patterns; the squeaky-cleanness of so many contemporary childhoods, focused heavily on time indoors. About 50 million people in the U.S. alone experience allergies each year—some of them little more than a nuisance, others potentially deadly when triggered without immediate treatment. Allergies can diminish quality of life. They can limit the areas where people can safely rent an apartment, or the places where they can safely dine. They can hamper access to lifesaving treatments, leaving doctors scrambling to find alternative therapies that don’t harm more than they help.

    But if allergies can rise this steeply with the times, maybe they can resolve rapidly too. New antibody-based treatments could help silence the body’s alarm sensors and quell IgE’s rampage. Some researchers are even looking into how fecal transplants that port the gut microbiome of tolerant people into allergy sufferers might help certain food sensitivities subside. Anne Liu, an allergist and immunologist at Stanford, is also hopeful that “the incidence of new food allergies will decline over the next 10 years,” as more advances come through. After years of advising parents against introducing their kids to sometimes-allergenic substances such as milk and peanuts too young, experts are now encouraging early exposures, in the hopes of teaching tolerance. And the more researchers learn about how allergies naturally abate, the better they might be able to safely replicate fade-outs.

    One instructive example could come from cases quite opposite to mine: longtime pet owners who develop allergies to their animals after spending some time away from them. That’s what happened to Stefanie Mezigian, of Michigan. After spending her entire childhood with her cat, Thumper, Mezigian was dismayed to find herself sneezing and sniffling when she visited home the summer after her freshman year of college. Years later, Mezigian seems to have built a partial tolerance up again; she now has another cat, Jack, and plans to keep felines in her life for good—both for companionship and to wrangle her immune system’s woes. “If I go without cats, that seems to be when I develop problems,” she told me.

    It’s a reasonable thought to have, Liu told me. People in Mezigian’s situation probably have the reactive IgE bopping around their body their entire life. But maybe during a fur-free stretch, the immune system, trying to be “parsimonious,” stops making molecules that rein in the allergy, she said. The immune system is nothing if not malleable, and a bit diva-esque: Set one thing off kilter, and an entire network of molecules and cells can revamp its approach to the world.

    I may never know why my cat allergy ghosted me. Maybe I got infected by a virus that gently rewired my immune system; maybe my hormone levels went into flux. Maybe it was the stress, or joy, of graduating college and starting grad school; maybe my diet or microbiome changed in just the right way, at just the right time. Perhaps it’s pointless to guess. Allergy, like the rest of the immune system, is a hot, complicated mess—a common fixture of modern living that many of us take for granted, but that remains, in so many cases, a mystery. All I can do is hope my cat allergy stays gone, though there’s no telling if it will. “I have no idea,” Nowak-Węgrzyn told me. “I’m just happy for you. Go enjoy your cats.”

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    Katherine J. Wu

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  • The Pandemic’s Legacy Is Already Clear

    The Pandemic’s Legacy Is Already Clear

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

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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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    Ed Yong

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  • Effective Altruism’s Philosopher King Just Wants to Be Practical

    Effective Altruism’s Philosopher King Just Wants to Be Practical

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    Academic philosophers these days do not tend to be the subjects of overwhelming attention in the national media. The Oxford professor William MacAskill is a notable exception. In the month and a half since the publication of his provocative new book, What We Owe the Future, he has been profiled or excerpted or reviewed or interviewed in just about every major American publication.

    MacAskill is a leader of the effective-altruism, or EA, movement, whose adherents use evidence and reason to figure out how to do as much good in the world as possible. His book takes that fairly intuitive-sounding project in a somewhat less intuitive direction, arguing for an idea called “longtermism,” the view that members of future generations—we’re talking unimaginably distant descendants, not just your grandchildren or great-grandchildren—deserve the same moral consideration as people living in the present. The idea is predicated on brute arithmetic: Assuming humanity does not drive itself to premature extinction, future people will vastly outnumber present people, and so, the thinking goes, we ought to be spending a lot more time and energy looking out for their interests than we currently do. In practice, longtermists argue, this means prioritizing a set of existential threats that the average person doesn’t spend all that much time fretting about. At the top of the list: runaway artificial intelligence, bioengineered pandemics, nuclear holocaust.

    Whatever you think of longtermism or EA, they are fast gaining currency—both literally and figuratively. A movement once confined to university-seminar tables and niche online forums now has tens of billions of dollars behind it. This year, it fielded its first major political candidate in the U.S. Earlier this month, I spoke with MacAskill about the logic of longtermism and EA, and the future of the movement more broadly.

    Our conversation has been edited for length and clarity.


    Jacob Stern: Effective altruists have been focused on pandemics since long before COVID. Are there ways that EA efforts helped with the COVID pandemic? If not, why not?

    William MacAskill: EAs, like many people in public health, were particularly early in terms of warning about the pandemic. There were some things that were helpful early, even if they didn’t change the outcome completely. 1Day Sooner is an EA-funded organization that got set up to advocate for human-challenge trials. And if governments had been more flexible and responsive, that could have led to vaccines being rolled out months earlier, I think. It would have meant you could get evidence of efficacy and safety much faster.

    There is an organization called microCOVID that quantifies what your risk is of getting COVID from various sorts of activities you might do. You hang out with someone at a bar: What’s your chance of getting COVID? It would actually provide estimates of that, which was great and I think widely used. Our World in Data—which is kind of EA-adjacent—provided a leading source of data over the course of the pandemic. One thing I think I should say, though, is it makes me wish that we’d done way more on pandemics earlier. You know, these are all pretty minor in the grand scheme of things. I think EA did very well at identifying this as a threat, as a major issue we should care about, but I don’t think I can necessarily point to enormous advances.

    Stern: What are the lessons EA has taken from the pandemic?

    MacAskill: One lesson is that even extremely ambitious public-health plans won’t necessarily suffice, at least for future pandemics, especially if one was a deliberate pandemic, from an engineered virus. Omicron infected roughly a quarter of Americans within 100 days. And there’s just not really a feasible path whereby you design, develop, and produce a vaccine and vaccinate everybody within 100 days. So what should we do for future pandemics?

    Early detection becomes absolutely crucial. What you can do is monitor wastewater at many, many sites around the world, and you screen the wastewater for all potential pathogens. We’re particularly worried about engineered pathogens: If we get a COVID-19-scale pandemic once every hundred years or so from natural origins, that chance increases dramatically given advances in bioengineering. You can take viruses and upgrade them in terms of their destructive properties so they can become more infectious or more lethal. It’s known as gain-of-function research. If this is happening all around the world, then you just should expect lab leaks quite regularly. There’s also the even more worrying phenomenon of bioweapons. It’s really a scary thing.

    In terms of labs, possibly we want to slow down or not even allow certain sorts of gain-of-function research. Minimally, what we could do is ask labs to have regulations such that there’s third-party liability insurance. So if I buy a car, I have to buy such insurance. If I hit someone, that means I’m insured for their health, because that’s an externality of driving a car. In labs, if you leak, you should have to pay for the costs. There’s no way you actually can insure against billions dead, but you could have some very high cap at least, and it would disincentivize unnecessary and dangerous research, while not disincentivizing necessary research, because then if it’s so important, you should be willing to pay the cost.

    Another thing I’m excited about is low-wavelength UV lighting. It’s a form of lighting that basically can sterilize a room safe for humans. It needs more research to confirm safety and efficacy and certainly to get the cost down; we want it at like a dollar a bulb. So then you could install it as part of building codes. Potentially no one ever gets a cold again. You eradicate most respiratory infections as well as the next pandemic.

    Stern: Shifting out of pandemic gear, I was wondering whether there are major lobbying efforts under way to persuade billionaires to convert to EA, given that the potential payoff of persuading someone like Jeff Bezos to donate some significant part of his fortune is just massive.

    MacAskill: I do a bunch of this. I’ve spoken at the Giving Pledge annual retreat, and I do a bunch of other speaking. It’s been pretty successful overall, insofar as there are other people kind of coming in—not on the size of Sam Bankman-Fried or Dustin Moskovitz and Cari Tuna, but there’s definitely further interest, and it is something I’ll kind of keep trying to do. Another organization is Longview Philanthropy, which has done a lot of advising for new philanthropists to get them more involved and interested in EA ideas.

    I have not ever successfully spoken with Jeff Bezos, but I would certainly take the opportunity. It has seemed to me like his giving so far is relatively small scale. It’s not clear to me how EA-motivated it is. But it would certainly be worth having a conversation with him.

    Stern: Another thing I was wondering about is the issue of abortion. On the surface at least, longtermism seems like it would commit you to—or at least point you in the direction of—an anti-abortion stance. But I know that you don’t see things that way. So I would love to hear how you think through that.

    MacAskill: Yes, I’m pro-choice. I don’t think government should interfere in women’s reproductive rights. The key distinction is when pro-life advocates say they are concerned about the unborn, they are saying that, at conception or shortly afterwards, the fetus becomes a person. And so what you’re doing when you have an abortion is morally equivalent or very similar to killing a newborn infant. From my perspective, what you’re doing when having an early-term abortion is much closer to choosing not to conceive. And I certainly don’t think that the government should be going around forcing people to conceive, and then certainly they shouldn’t be forcing people to not have an abortion. There is a second thought of Well, don’t you say it’s good to have more people, at least if they have sufficiently good lives? And there I say yes, but the right way of achieving morally valuable goals is not, again, by restricting people’s rights.

    Stern: I think there are at least three separate questions here. The first being this one that you just addressed: Is it right for a government to restrict abortion? The second being, on an individual level, if you’re a person thinking of having an abortion, is that choice ethical? And the third being, are you operating from the premise that unborn fetuses are a constituency in the same way that future people are a constituency?

    MacAskill: Yes and no on the last thing. In What We Owe the Future, I do argue for this view that I still find kind of intuitive: It can be good to have a new person in existence if their life is sufficiently good. Instrumentally, I think it’s important for the world to not have this dip in population that standard projections suggest. But then there’s nothing special about the unborn fetus.

    On the individual level, having kids and bringing them up well can be a good way to live, a good way of making the world better. I think there are many ways of making the world better. You can also donate. You can also change your career. Obviously, I don’t want to belittle having an abortion, because it’s often a heart-wrenching decision, but from a moral perspective I think it’s much closer to failing to conceive that month, rather than the pro-life view, which is it’s more like killing a child that’s born.

    Stern: What you’re saying on some level makes total sense but is also something that I think your average pro-choice American would totally reject.

    MacAskill: It’s tough, because I think it’s mainly a matter of rhetoric and association. Because the average pro-choice American is also probably concerned about climate change. That involves concern for how our actions will impact generations of as-yet-unborn people. And so the key difference is the pro-life person wants to extend the franchise just a little bit to the 10 million unborn fetuses that are around at the moment. I want to extend the franchise to all future people! It’s a very different move.

    Stern: How do you think about trying to balance the moral rigor or correctness of your philosophy with the goal of actually getting the most people to subscribe and produce the most good in the world? Once you start down the logical path of effective altruism, it’s hard to figure out where to stop, how to justify not going full Peter Singer and giving almost all your money away. So how do you get people to a place where they feel comfortable going halfway or a quarter of the way?

    MacAskill: I think it’s tough because I don’t think there’s a privileged stopping point, philosophically. At least not until you’re at the point where you’re really doing almost everything you can. So with Giving What We Can, for example, we chose 10 percent as a target for what portion of people’s income they could give away. In a sense it’s a totally arbitrary number. Why not 9 percent or 11 percent? It does have the benefit of 10 percent being a round number. And it also is the right level, I think, where if you get people to give 1 percent, they’re probably giving that amount anyway. Whereas 10 percent, I think, is achievable yet at the same time really is a difference compared to what they otherwise would have been doing.

    That, I think, is just going to be true more generally. We try to have a culture that is accepting and supportive of these kinds of intermediate levels of sacrifice or commitment. It is something that people within EA struggle with, including myself. It’s kind of funny: People will often beat themselves up for not doing enough good, even though other people never beat other people up for not doing enough good. EA is really accepting that this stuff is hard, and we’re all human and we’re not superhuman moral saints.

    Stern: Which I guess is what worries or scares people about it. The idea that once I start thinking this way, how do I not end up beating myself up for not doing more? So I think where a lot of people end up, in light of that, is deciding that what’s easiest is just not thinking about any of it so they don’t feel bad.

    MacAskill: Yeah. And that’s a real shame. I don’t know. It bugs me a bit. It’s just a general issue of people when confronted with a moral idea. It’s like, Hey, you should become vegetarian. People are like, Oh, I should care about animals? What about if you had to kill an animal in order to live? Would you do that? What about eating sugar that is bleached with bone? You’re a hypocrite! Somehow people feel like unless you’re doing the most extreme version of your views, then it’s not justified. Look, it’s better to be a vegetarian than to not be a vegetarian. Let’s accept that things are on a spectrum.

    On the podcast I was just on, I was just like, ‘Look, these are all philosophical issues. This is irrelevant to the practical questions.’ It’s funny that I am finding myself saying that more and more.

    Stern: On what grounds, EA-wise, did you justify spending an hour on the phone with me?

    MacAskill: I think the media is important! Getting the ideas out there is important. If more people hear about the ideas, some people are inspired, and they get off their seat and start doing stuff, that’s a huge impact. If I spend one hour talking to you, you write an article, and that leads to one person switching their career, well, that’s one hour turned into 80,000 hours—seems like a pretty good trade.

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    Jacob Stern

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

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

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    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.

    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.

    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? Organtransplant 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.

    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.

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    Katherine J. Wu

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  • The Glory of Feeling Fine

    The Glory of Feeling Fine

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    A few months ago, I got food poisoning. The sequence of events that led to my downfall began with a carton of discounted grocery-store sushi purchased and consumed on a Thursday, which led to me waking up a little queasy on a Friday, which devolved into a 12-hour stretch of me vomiting and holding myself in a fetal position, until my legs ached from dehydration. On Saturday the smell of my partner cooking breakfast still made me gag; I sipped water, napped fitfully, and nibbled little golf balls of white rice.

    But Sunday, glorious Sunday, I awoke to a marvelous lack of pain and fatigue. The brain fog was gone. My skin felt plump with fluids. Enthralled by recovery, I found myself behaving with uncharacteristic serenity. When I dropped and broke a ceramic bowl while unloading the dishwasher, I didn’t curse and freak out. Instead, I swept up the shards with cheer. I wouldn’t sweat the small stuff. I was my normal self again, and it felt sublime.

    Yet as I relished in my newfound bliss, a foreboding thought gnawed at me: I knew that as the hours passed and the specter of illness retreated, my fresh perspective, too, would fade. So much of my exuberance was defined by absence, the lifting of the burden of aches and puking. It would only be a matter of time until normal felt normal again, and I’d be back to worrying about all the petty minutiae I always worry about.

    People have different baselines of health, and some might be more or less appreciative of whatever condition they’re in. Even so, humans have long lamented the ephemeral joy of relief. The feeling manifests in all kinds of circumstances: meeting a deadline, passing a test, finishing a marathon. And it can be especially acute in matters of wellness. “Health is not valued, till sickness comes,” wrote the 17th-century British scholar Thomas Fuller. Or as the 19th-century German philosopher Arthur Schopenhauer bemoaned: “Just as we do not feel the health of our entire body but only the small place where the shoe pinches, so too we do not think of the totality of our well-functioning affairs, but of some insignificant trifle that annoys us.”

    So many of us, in other words, are very bad at appreciating good health when we’re fortunate enough to have it. And anyone experiencing this transcendent gratitude is unlikely to hold on to it for long. Indeed, by Monday morning, the afterglow of recovery had worn off; I was engrossed in emails and work again, unaware that just 60 hours prior I could barely sit upright in bed, let alone at my desk. This troubled me. Am I cursed to be like this forever? Or is there anything I can do to change?

    To some extent, I’m sad to report, the answer might well be no. While certainly some people can have experiences of major illness or injury that change their entire outlook on life, the tendency to revert to forgetfulness seems to run pretty deep in the human psyche. We have limited attentional resources, the UC Davis psychology professor Robert Emmons told me, so in the interest of survival, our brain tends not to waste them focusing on systems that are working well. Instead, our mind evolved to identify threats and problems. Psychologists call this negativity bias: We direct our attention more to what’s wrong than what’s right. If your body’s in check, your brain seems to reason, better to stress about the project that’s overdue or the conflict with your friend than sit around feeling like everything’s fine.

    A second psychological phenomenon that might work against any enduring joy in recovery from illness is hedonic adaptation, the notion that after positive or negative life events we, basically, get used to our new circumstances and return to a baseline level of subjective well-being. Hedonic adaptation has been used to explain why, in the long term, people who won the lottery were no happier than those who didn’t; and why romantic partners lose passion, excitement, and appreciation for each other over time.

    Arguably, adaptation need not be seen as any great tragedy. For health, in particular, there’s an element of practicality in the human capacity to exist without fussy attentiveness. This is how we’re supposed to operate. “If our body isn’t causing us problems, it doesn’t actually pay to walk around being grateful all the time. You should be using your mental energy on other things,” Amie Gordon, an assistant professor of psychology at the University of Michigan, told me. If we had to sense our clothes on our bodies all day, for example, we’d constantly be distracted, she said. (This is actually a symptom of certain chronic disorders, like fibromyalgia—Lauren Zalewski, a writer who was diagnosed with both fibromyalgia and lupus 22 years ago, told me that it makes her skin sensitive to the touch, as if she constantly has the flu.)

    All that said, there are real costs to taking health for granted. For one, it can make you less healthy, if as a result you don’t take care of yourself. For another, maintaining some level of appreciation is a good way to avoid becoming an entitled jerk. Throughout the pandemic, for instance, there has been “this language around how the ‘only’ people dying are ‘old people’ or people with pre-existing conditions,” as if these deaths were more acceptable, Emily Taylor, a vice president for the Long-COVID Alliance, a group that advocates for research into post-viral illnesses, told me. Acknowledging that our own health is tenuous—and that certainly, many of us are going to get old—could counter this kind of callousness and encourage people to treat the elderly and those with chronic conditions or disabilities with more respect and kindness, Taylor argued.

    In my view, there’s something to be gained on an individual level, too. In recent years I’ve seen friends and loved ones deal with life-altering injuries and diagnoses. I know that one’s circumstances can turn on a phone call or a moment of inattention. To be healthy, to have basic needs met—to have life be so “normal” that it’s even a little boring—is a luxury. While I am living in those blessedly unremarkable times, I don’t want my fortune to escape my notice. When things are good, I want to know how good I’ve got it.

    What I want, really, is to hold on to a sense of gratitude. In the field of psychology, gratitude can be something of a loaded term. Over the past decade or so, articles, podcast episodes, self-help books, research papers, celebrities, and wellness influencers alike have all extolled the benefits of being thankful. (Oprah famously kept a gratitude journal for more than a decade.) At times, gratitude’s popularity has been to its own detriment: The modern-day gratitude movement has been criticized for overstating its potential benefits and pushing a Western, wealthy, and privileged perspective that can seem to ignore the realities of extreme suffering or systemic injustices. It’s also annoying to constantly be told that you should really be more thankful for stuff.

    But part of the reason gratitude has become such a popular concept is due to bountiful research that does point to genuine emotional upsides. Feeling grateful has been associated with better life satisfaction, an increased sense of well-being, and a greater ability to form and maintain relationships, among other benefits. (The research on gratitude’s effects on physical health is inconclusive.) For me, though, the pull is less scientific and more commonsense anyway: Learning to genuinely appreciate day-to-day boons like having good health, or food in the fridge, seems like being able to tap into a renewable source of contentment. It’s always so easy to find stress in life. Let me remember the things to smile about, too.

    One way to make the most of gratitude may be to reframe how people tend to think of it. A popular misconception, Emmons told me over email, is that gratitude is a positive emotion that results from something good happening to us. (This might also be part of the reason it can be hard to appreciate conditions like health that for many people remain stable day after day.) Gratitude is an emotion, but it can also be a disposition, something researchers call “trait gratitude.” Some people are more predisposed to feeling thankful than others, by virtue of factors like genetics and personality. But Emmons says this kind of “undentable thankfulness” can also be learned, by developing habits that contribute to more of a persistent, ambient awareness, rather than a conditional reaction to ever-changing circumstances.

    What does this look like, practically speaking? “I don’t know that we can, with every breath we have every moment, feel grateful that we’re breathing. That’s a pretty tall order,” says Gordon. “But that’s not to say that you don’t build in a moment for it at some point in your day.” If you’re recovering from a cold, for example, you can practice pausing whenever you’re walking out the door to appreciate that your nose isn’t stuffy before just barreling on with life. Another tactic, from Emmons, is to reflect upon your worst moments, such as times you’ve been ill. “Our minds think in terms of counterfactuals,” he said, which are comparisons between the way things are and how they might have been. “When we remember how difficult life used to be and how far we have come, we set up an explicit contrast in our mind, and this contrast is fertile ground for gratefulness.”

    You can also think of gratitude as an action, Emmons has written. This hews closer to the historical notion of gratitude, which as far back as the Roman days was associated with ideas like duty and reciprocity—when someone does something kind for us, we’re expected to return the favor, whether that’s thanking them, paying them back, or paying it forward. In that sense, being grateful for your body probably means doing your best to care for it (and, probably, refraining from risky behaviors like rolling the dice on discounted grocery-store sushi).

    In 2015, Lauren Zalewski, the writer with fibromyalgia, founded an online community that supports people living with chronic pain by helping them to cultivate a grateful mindset. She tells me that before her diagnosis, she took her health for granted and “beat her body up.” Now, she eats vegan, takes supplements, does yoga, stretches, sleeps more, and gets sun regularly—these are the small things she has personally found helpful for managing her constant pain. “So while I am a chronically ill person,” she muses, “I consider myself pretty healthy.”

    Looking back on my food-poisoning incident, I think I was primed to ruminate more deeply than usual on the topics of sickness and health. In the past two and a half years, I’ve watched COVID-19 show that anyone can get ill, perhaps seriously so. Now, as the head of the World Health Organization tells us that “the end is in sight” for the pandemic  (and President Joe Biden controversially declares the pandemic over), it’s tempting to imagine that humanity is on the brink of waking up the morning after a hellish sickness.

    It’s probably delusional to hope that even a global pandemic could prompt some kind of long-term collective mental shift about the impermanence of health, and of life. I didn’t become a radically different person after recovering from puking my guts out a few months ago either. But maybe the simple act of remembering the health we still have in the pandemic’s wake can make a small difference in how we go forward—if not as a society, then at least as individuals. I’m sure I’ll never fully override my tendency to take my body for granted until it’s too late. But for now, each day, I still get the golden opportunity to try. And I’d like to take it.

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    Gloria Liu

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  • What They Aren’t Telling You About Hypoallergenic Dogs

    What They Aren’t Telling You About Hypoallergenic Dogs

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    As someone with dog allergies who nevertheless has been around many dogs as a trainer, a fosterer, and an owner, Candice has learned not to trust the promise of a “hypoallergenic” dog. She’s met low-shedding, hypoallergenic poodles and Portuguese water dogs that supposedly shouldn’t trigger her allergies yet very much did. But she has also met fluffy, longhaired breeds such as huskies and spitzes that set off nary a sneeze. “I’ve had more misery with short-haired dogs,” she told me. That includes her own Belgian Malinois, Fiore, with whom her symptoms got so bad that she started allergy shots. Fiore’s equally furry full sister Fernando, though? Totally fine. No reaction!

    Candice—whose last name I’m not using for medical-privacy reasons—is not alone in discerning no rhyme or reason to which dogs she’s allergic to. In studies, scientists have found no difference in how much of the dog allergen Can f 1 is present in homes with hypoallergenic versus non-hypoallergenic breeds. One study found no difference in the amount of allergen on the fur of different dogs either. Another actually found more allergen on the fur of hypoallergenic breeds. Hypoallergenic doesn’t seem to mean much at all.

    “There’s really, truly no completely, 100 percent hypoallergenic dog. Even hairless dogs can make the allergen,” says John James, a spokesperson for the Asthma and Allergy Foundation of America. “It’s really a marketing term,” says David Stukus, an allergist at Nationwide Children’s Hospital and a member of AAFA’s Medical Scientific Council. When I asked several allergists around the country if perplexed owners ever come in allergic to their expensive, supposedly hypoallergenic dog, their answers were unequivocal: “All the time.” One of the biggest sources of misinformation on this topic is, in fact, a former U.S. president. “When President Obama was in office, they allegedly had a hypoallergenic dog because their daughter had allergies, and that didn’t help matters,” Stukus told me, referring to the Obamas’ first Portuguese water dog, Bo. “Everybody got Portuguese water dogs.”  And—surprise—they can still cause allergies.

    Technically, hypoallergenic means that a dog is less likely to cause allergies, not that it never causes allergies, though this distinction is often lost in colloquial use. But even then, there is no such thing as a consistently hypoallergenic breed. That’s because, although breeds that shed less fur or hair are commonly considered hypoallergenic, the fur or hair itself is not what causes allergies. Rather, it is proteins present in the dander, or small flakes of skin, or saliva. All dogs make these proteins, and all dogs have skin and saliva.

    It is true, though, that a person might find one dog less allergenic than another. The studies that couldn’t find a clear pattern of lower allergens in hypoallergenic breeds did find differences among individual dogs of the same breed. And a smaller dog is generally going to shed less dander than a big one. On size alone, “it does make sense that a chihuahua is less problematic than a Great Dane,” says Richard Lockey, an allergist at the University of South Florida. Dogs also make a whole suite of proteins that can cause allergies. The best known is Can f 1, although there are seven others. Some people might be more allergic to one of these proteins than another; some dogs might make more of one of these proteins than another. Whether a particular human actually ends up allergic to a particular dog depends on these details—and can’t be predicted from the breed alone. For this reason, doctors recommend that anyone with allergies spend time with a specific dog before taking it home. “I literally say, ‘Have your child hug them, rub their face on them.’ If nothing happens, that’s a good sign,” Stukus said.

    People who are allergic can also develop tolerance to a specific dog over time. Candice, for example, eventually developed a tolerance to her German-shepherd mix, Tesla, despite getting all watery-eyed and sneezy at first. In addition, allergy shots, also called immunotherapy, can help people build up tolerance by gradually increasing exposure to an allergen; Candice eventually resorted to them with Fiore. The inverse of this principle explains the Thanksgiving effect, where people who leave for college come home suddenly allergic to their childhood pet after not being exposed for a long time.

    Nasal steroid sprays and antihistamines such as Claritin and Allegra, which are available over the counter, can also be used to manage allergies these days. That wasn’t always the case, recalls Lockey, who began practicing medicine in the 1960s. Back then, there weren’t good medications for controlling allergies, and he would just tell patients to keep their pets outdoors. “That just doesn’t go anymore,” he told me. Now few dogs are kept exclusively outdoors, especially in cities. They sleep in our homes and even our beds. As dogs have become physically enmeshed in our lives, dog allergies can no longer be as easily ignored as when the animals lived outside.

    The myth of an allergy-free dog persists, though, and Stukus often sees this frustration play out in families with allergic kids. “This is the point that I hear all the time from families: It’s the grandparents,” he told me. Parents might quickly discover that their kids are allergic to “hypoallergenic” dogs. But grandparents, eager for their grandkids to visit, push back because their expensive pet is supposed to be hypoallergenic—“The Obamas had the same dog. It’s fine!”—only for the kids to end up coughing and miserable. He keeps hearing the same lament. “They just don’t understand,” the parents tell him, “that there’s no such thing as a hypoallergenic dog.”

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    Sarah Zhang

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  • One of Long COVID’s Worst Symptoms Is Also Its Most Misunderstood

    One of Long COVID’s Worst Symptoms Is Also Its Most Misunderstood

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    On March 25, 2020, Hannah Davis was texting with two friends when she realized that she couldn’t understand one of their messages. In hindsight, that was the first sign that she had COVID-19. It was also her first experience with the phenomenon known as “brain fog,” and the moment when her old life contracted into her current one. She once worked in artificial intelligence and analyzed complex systems without hesitation, but now “runs into a mental wall” when faced with tasks as simple as filling out forms. Her memory, once vivid, feels frayed and fleeting. Former mundanities—buying food, making meals, cleaning up—can be agonizingly difficult. Her inner world—what she calls “the extras of thinking, like daydreaming, making plans, imagining”—is gone. The fog “is so encompassing,” she told me, “it affects every area of my life.” For more than 900 days, while other long-COVID symptoms have waxed and waned, her brain fog has never really lifted.

    Of long COVID’s many possible symptoms, brain fog “is by far one of the most disabling and destructive,” Emma Ladds, a primary-care specialist from the University of Oxford, told me. It’s also among the most misunderstood. It wasn’t even included in the list of possible COVID symptoms when the coronavirus pandemic first began. But 20 to 30 percent of patients report brain fog three months after their initial infection, as do 65 to 85 percent of the long-haulers who stay sick for much longer. It can afflict people who were never ill enough to need a ventilator—or any hospital care. And it can affect young people in the prime of their mental lives.

    Long-haulers with brain fog say that it’s like none of the things that people—including many medical professionals—jeeringly compare it to. It is more profound than the clouded thinking that accompanies hangovers, stress, or fatigue. For Davis, it has been distinct from and worse than her experience with ADHD. It is not psychosomatic, and involves real changes to the structure and chemistry of the brain. It is not a mood disorder: “If anyone is saying that this is due to depression and anxiety, they have no basis for that, and data suggest it might be the other direction,” Joanna Hellmuth, a neurologist at UC San Francisco, told me.

    And despite its nebulous name, brain fog is not an umbrella term for every possible mental problem. At its core, Hellmuth said, it is almost always a disorder of “executive function”—the set of mental abilities that includes focusing attention, holding information in mind, and blocking out distractions. These skills are so foundational that when they crumble, much of a person’s cognitive edifice collapses. Anything involving concentration, multitasking, and planning—that is, almost everything important—becomes absurdly arduous. “It raises what are unconscious processes for healthy people to the level of conscious decision making,” Fiona Robertson, a writer based in Aberdeen, Scotland, told me.

    For example, Robertson’s brain often loses focus mid-sentence, leading to what she jokingly calls “so-yeah syndrome”: “I forget what I’m saying, tail off, and go, ‘So, yeah …’” she said. Brain fog stopped Kristen Tjaden from driving, because she’d forget her destination en route. For more than a year, she couldn’t read, either, because making sense of a series of words had become too difficult. Angela Meriquez Vázquez told me it once took her two hours to schedule a meeting over email: She’d check her calendar, but the information would slip in the second it took to bring up her inbox. At her worst, she couldn’t unload a dishwasher, because identifying an object, remembering where it should go, and putting it there was too complicated.

    Memory suffers, too, but in a different way from degenerative conditions like Alzheimer’s. The memories are there, but with executive function malfunctioning, the brain neither chooses the important things to store nor retrieves that information efficiently. Davis, who is part of the Patient-Led Research Collaborative, can remember facts from scientific papers, but not events. When she thinks of her loved ones, or her old life, they feel distant. “Moments that affected me don’t feel like they’re part of me anymore,” she said. “It feels like I am a void and I’m living in a void.”

    Most people with brain fog are not so severely affected, and gradually improve with time. But even when people recover enough to work, they can struggle with minds that are less nimble than before. “We’re used to driving a sports car, and now we are left with a jalopy,” Vázquez said. In some professions, a jalopy won’t cut it. “I’ve had surgeons who can’t go back to surgery, because they need their executive function,” Monica Verduzco-Gutierrez, a rehabilitation specialist at UT Health San Antonio, told me.

    Robertson, meanwhile, was studying theoretical physics in college when she first got sick, and her fog occluded a career path that was once brightly lit. “I used to sparkle, like I could pull these things together and start to see how the universe works,” she told me. “I’ve never been able to access that sensation again, and I miss it, every day, like an ache.” That loss of identity was as disruptive as the physical aspects of the disease, which “I always thought I could deal with … if I could just think properly,” Robertson said. “This is the thing that’s destabilized me most.”


    Robertson predicted that the pandemic would trigger a wave of cognitive impairment in March 2020. Her brain fog began two decades earlier, likely with a different viral illness, but she developed the same executive-function impairments that long-haulers experience, which then worsened when she got COVID last year. That specific constellation of problems also befalls many people living with HIV, epileptics after seizures, cancer patients experiencing so-called chemo brain, and people with several complex chronic illnesses such as fibromyalgia. It’s part of the diagnostic criteria for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS—a condition that Davis and many other long-haulers now have. Brain fog existed well before COVID, affecting many people whose conditions were stigmatized, dismissed, or neglected. “For all of those years, people just treated it like it’s not worth researching,” Robertson told me. “So many of us were told, Oh, it’s just a bit of a depression.

    Several clinicians I spoke with argued that the term brain fog makes the condition sound like a temporary inconvenience and deprives patients of the legitimacy that more medicalized language like cognitive impairment would bestow. But Aparna Nair, a historian of disability at the University of Oklahoma, noted that disability communities have used the term for decades, and there are many other reasons behind brain fog’s dismissal beyond terminology. (A surfeit of syllables didn’t stop fibromyalgia and myalgic encephalomyelitis from being trivialized.)

    For example, Hellmuth noted that in her field of cognitive neurology, “virtually all the infrastructure and teaching” centers on degenerative diseases like Alzheimer’s, in which rogue proteins afflict elderly brains. Few researchers know that viruses can cause cognitive disorders in younger people, so few study their effects. “As a result, no one learns about it in medical school,” Hellmuth said. And because “there’s not a lot of humility in medicine, people end up blaming patients instead of looking for answers,” she said.

    People with brain fog also excel at hiding it: None of the long-haulers I’ve interviewed sounded cognitively impaired. But at times when her speech is obviously sluggish, “nobody except my husband and mother see me,” Robertson said. The stigma that long-haulers experience also motivates them to present as normal in social situations or doctor appointments, which compounds the mistaken sense that they’re less impaired than they claim—and can be debilitatingly draining. “They’ll do what is asked of them when you’re testing them, and your results will say they were normal,” David Putrino, who leads a long-COVID rehabilitation clinic at Mount Sinai, told me. “It’s only if you check in on them two days later that you’ll see you’ve wrecked them for a week.”

    “We also don’t have the right tools for measuring brain fog,” Putrino said. Doctors often use the Montreal Cognitive Assessment, which was designed to uncover extreme mental problems in elderly people with dementia, and “isn’t validated for anyone under age 55,” Hellmuth told me. Even a person with severe brain fog can ace it. More sophisticated tests exist, but they still compare people with the population average rather than their previous baseline. “A high-functioning person with a decline in their abilities who falls within the normal range is told they don’t have a problem,” Hellmuth said.

    This pattern exists for many long-COVID symptoms: Doctors order inappropriate or overly simplistic tests, whose negative results are used to discredit patients’ genuine symptoms. It doesn’t help that brain fog (and long COVID more generally) disproportionately affects women, who have a long history of being labeled as emotional or hysterical by the medical establishment. But every patient with brain fog “tells me the exact same story of executive-function symptoms,” Hellmuth said. “If people were making this up, the clinical narrative wouldn’t be the same.”


    Earlier this year, a team of British researchers rendered the invisible nature of brain fog in the stark black-and-white imagery of MRI scans. Gwenaëlle Douaud at the University of Oxford and her colleagues analyzed data from the UK Biobank study, which had regularly scanned the brains of hundreds of volunteers for years prior to the pandemic. When some of those volunteers caught COVID, the team could compare their after scans to the before ones. They found that even mild infections can slightly shrink the brain and reduce the thickness of its neuron-rich gray matter. At their worst, these changes were comparable to a decade of aging. They were especially pronounced in areas such as the parahippocampal gyrus, which is important for encoding and retrieving memories, and the orbitofrontal cortex, which is important for executive function. They were still apparent in people who hadn’t been hospitalized. And they were accompanied by cognitive problems.

    Although SARS-CoV-2, the coronavirus that causes COVID, can enter and infect the central nervous system, it doesn’t do so efficiently, persistently, or frequently, Michelle Monje, a neuro-oncologist at Stanford, told me. Instead, she thinks that in most cases the virus harms the brain without directly infecting it. She and her colleagues recently showed that when mice experience mild bouts of COVID, inflammatory chemicals can travel from the lungs to the brain, where they disrupt cells called microglia. Normally, microglia act as groundskeepers, supporting neurons by pruning unnecessary connections and cleaning unwanted debris. When inflamed, their efforts become overenthusiastic and destructive. In their presence, the hippocampus—a region crucial for memory—produces fewer fresh neurons, while many existing neurons lose their insulating coats, so electric signals now course along these cells more slowly. These are the same changes that Monje sees in cancer patients with “chemo fog.” And although she and her team did their COVID experiments in mice, they found high levels of the same inflammatory chemicals in long-haulers with brain fog.

    Monje suspects that neuro-inflammation is “probably the most common way” that COVID results in brain fog, but that there are likely many such routes. COVID could possibly trigger autoimmune problems in which the immune system mistakenly attacks the nervous system, or reactivate dormant viruses such as Epstein-Barr virus, which has been linked to conditions including ME/CFS and multiple sclerosis. By damaging blood vessels and filling them with small clots, COVID also throttles the brain’s blood supply, depriving this most energetically demanding of organs of oxygen and fuel. This oxygen shortfall isn’t stark enough to kill neurons or send people to an ICU, but “the brain isn’t getting what it needs to fire on all cylinders,” Putrino told me. (The severe oxygen deprivation that forces some people with COVID into critical care causes different cognitive problems than what most long-haulers experience.)

    None of these explanations is set in stone, but they can collectively make sense of brain fog’s features. A lack of oxygen would affect sophisticated and energy-dependent cognitive tasks first, which explains why executive function and language “are the first ones to go,” Putrino said. Without insulating coats, neurons work more slowly, which explains why many long-haulers feel that their processing speed is shot: “You’re losing the thing that facilitates fast neural connection between brain regions,” Monje said. These problems can be exacerbated or mitigated by factors such as sleep and rest, which explains why many people with brain fog have good days and bad days. And although other respiratory viruses can wreak inflammatory havoc on the brain, SARS-CoV-2 does so more potently than, say, influenza, which explains both why people such as Robertson developed brain fog long before the current pandemic and why the symptom is especially prominent among COVID long-haulers.

    Perhaps the most important implication of this emerging science is that brain fog is “potentially reversible,” Monje said. If the symptom was the work of a persistent brain infection, or the mass death of neurons following severe oxygen starvation, it would be hard to undo. But neuroinflammation isn’t destiny. Cancer researchers, for example, have developed drugs that can calm berserk microglia in mice and restore their cognitive abilities; some are being tested in early clinical trials. “I’m hopeful that we’ll find the same to be true in COVID,” she said.


    Biomedical advances might take years to arrive, but long-haulers need help with brain fog now. Absent cures, most approaches to treatment are about helping people manage their symptoms. Sounder sleep, healthy eating, and other generic lifestyle changes can make the condition more tolerable. Breathing and relaxation techniques can help people through bad flare-ups; speech therapy can help those with problems finding words. Some over-the-counter medications such as antihistamines can ease inflammatory symptoms, while stimulants can boost lagging concentration.

    “Some people spontaneously recover back to baseline,” Hellmuth told me, “but two and a half years on, a lot of patients I see are no better.” And between these extremes lies perhaps the largest group of long-haulers—those whose brain fog has improved but not vanished, and who can “maintain a relatively normal life, but only after making serious accommodations,” Putrino said. Long recovery periods and a slew of lifehacks make regular living possible, but more slowly and at higher cost.

    Kristen Tjaden can read again, albeit for short bursts followed by long rests, but hasn’t returned to work. Angela Meriquez Vázquez can work but can’t multitask or process meetings in real time. Julia Moore Vogel, who helps lead a large biomedical research program, can muster enough executive function for her job, but “almost everything else in my life I’ve cut out to make room for that,” she told me. “I only leave the house or socialize once a week.” And she rarely talks about these problems openly because “in my field, your brain is your currency,” she said. “I know my value in many people’s eyes will be diminished by knowing that I have these cognitive challenges.”

    Patients struggle to make peace with how much they’ve changed and the stigma associated with it, regardless of where they end up. Their desperation to return to normal can be dangerous, especially when combined with cultural norms around pressing on through challenges and post-exertional malaise—severe crashes in which all symptoms worsen after even minor physical or mental exertion. Many long-haulers try to push themselves back to work and instead “push themselves into a crash,” Robertson told me. When she tried to force her way to normalcy, she became mostly housebound for a year, needing full-time care. Even now, if she tries to concentrate in the middle of a bad day, “I end up with a physical reaction of exhaustion and pain, like I’ve run a marathon,” she said.

    Post-exertional malaise is so common among long-haulers that “exercise as a treatment is inappropriate for people with long COVID,” Putrino said. Even brain-training games—which have questionable value but are often mentioned as potential treatments for brain fog—must be very carefully rationed because mental exertion is physical exertion. People with ME/CFS learned this lesson the hard way, and fought hard to get exercise therapy, once commonly prescribed for the condition, to be removed from official guidance in the U.S. and U.K. They’ve also learned the value of pacing—carefully sensing and managing their energy levels to avoid crashes.

    Vogel does this with a wearable that tracks her heart rate, sleep, activity, and stress as a proxy for her energy levels; if they feel low, she forces herself to rest—cognitively as well as physically. Checking social media or responding to emails do not count. In those moments, “you have to accept that you have this medical crisis and the best thing you can do is literally nothing,” she said. When stuck in a fog, sometimes the only option is to stand still.

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    Ed Yong

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  • ‘It Just Seems Like My Patients Are Sicker’

    ‘It Just Seems Like My Patients Are Sicker’

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    The most haunting memory of the pandemic for Laura, a doctor who practices internal medicine in New York, is a patient who never got COVID at all. A middle-aged man diagnosed with Stage 3 colon cancer in 2019, he underwent surgery and a round of successful chemotherapy and was due for regular checkups to make sure the tumor wasn’t growing. Then the pandemic hit, and he decided that going to the hospital wasn’t worth the risk of getting COVID. So he put it off … and put it off. “The next time I saw him, in early 2022, he required hospice care,” Laura told me. He died shortly after. With proper care, Laura said, “he could have stayed alive indefinitely.” (The Atlantic agreed to withhold Laura’s last name, because she isn’t authorized to speak publicly about her patients.)

    Early in the pandemic, when much of the country was in lockdown, forgoing nonemergency health care as Laura’s patient did seemed like the right thing to do. But the health-care delays didn’t just end when America began to reopen in the summer of 2020. Patients were putting off health care through the end of the first pandemic year, when vaccines weren’t yet widely available. And they were still doing so well into 2021, at which point much of the country seemed to be moving on from COVID.

    By this point, the coronavirus has killed more than 1 million Americans and debilitated many more. One estimate shows that life expectancy in the U.S. fell 2.41 years from 2019 to 2021. But the delays in health care over the past two and a half years have allowed ailments to unduly worsen, wearing down people with non-COVID medical problems too. “It just seems like my patients are sicker,” Laura said. Compared with before the pandemic, she is seeing more people further along with AIDS, more people with irreversible heart failure, and more people with end-stage kidney failure. Mental-health issues are more severe, and her patients struggling with addiction have been more likely to relapse.

    Even as Americans are treating the pandemic like an afterthought, a disturbing possibility remains: COVID aside, is the country simply going to be in worse health than before the pandemic? According to health-care workers, administrations, and researchers I talked with from across the country, patients are still dealing with a suite of problems from delaying care during the pandemic, problems that in some cases they will be facing for the rest of their lives. The scope of this damage isn’t yet clear—and likely won’t come into focus for several years—but there are troubling signs of a looming chronic health crisis the country has yet to reckon with. At some point, the emergency phase of COVID will end, but the physical toll of the pandemic may linger in the bodies of Americans for decades to come.


    During those bleak pre-vaccine dark ages, going to the doctor could feel like a disaster in waiting. Many of the country’s hospitals were overwhelmed with COVID patients, and outpatient clinics had closed. As a result, in every week through July 2020, roughly 45 percent of American adults said that over the preceding month, they either put off medical care or didn’t get it at all because of the pandemic. Once they did come in, they were sicker—a trend observed for all sorts of ailments, including childhood diabetes, appendicitis, and cancer. A recent study analyzed the 8.4 million non-COVID Medicare hospitalizations from April 2020 to September 2021 and found not only that hospital admissions plummeted, but also that those admitted to hospitals were up to 20 percent more likely to die—an astonishing effect that lasted through the length of the study.

    Partly, that result came about because only those who were sicker made it to the hospital, James Goodwin, one of the study’s authors and a professor at the University of Texas Medical Branch, in Galveston, told me. It was also partly because overwhelmed hospitals were giving worse care. But Goodwin estimates that “more than half the cause was people delaying medical care early in their illness and therefore being more likely to die. Instead of coming in with a urinary tract infection, they’re already getting septic. I mean, people were having heart attacks and not showing up at the hospital.”

    For some conditions, skipping a checkup or two may not matter all that much in the long run. But for other conditions, every doctor’s visit can count. Take the tens of millions of Americans with vascular issues in their feet and legs due to diabetes or peripheral artery disease. Their problems might lead to, say, ulcers on the foot that can be treated with regular medical care, but delays of even a few months can increase the risk of amputation. When patients came in later in 2020, it was sometimes too late to save the limb. An Ohio trauma center found that the odds of undergoing a diabetes-related amputation in 2020 were almost 11 times higher once the pandemic hit versus earlier in the year.

    Although only a small percentage of Americans lost a limb, the lack of care early in the pandemic helped fuel a dangerous spike in substance-abuse disorders. In a matter of weeks or months, people’s support systems collapsed, and for some, years of work overcoming an addiction unraveled. “My patients took a huge step back, probably more than many of us realize,” Aarti Patel, a physician assistant at a Lower Manhattan community hospital, told me. One of her patients, a man in his late 50s who was five years sober, started drinking again during the pandemic and eventually landed in the hospital for withdrawal. Patients like this man, she said, “would have really difficult, long hospital stays, because they were at really high risk of DTs, alcohol seizures. Some of them even had to go to the ICU because [the withdrawal] was so severe.”

    Later in the year, when doctors’ offices were up and running, “a lot of patients expressed that they didn’t want to go back for care right away,” says Kim Muellers, a graduate student at Pace University who is studying the effects of COVID on medical care in New York City, North Carolina, and Florida. Indeed, through the spring of 2021, the top reason Medicare recipients failed to seek care was they didn’t want to be at a medical facility. Other people were avoiding the doctor because they’d lost their job and health insurance and couldn’t afford the bills.

    The problem, doctors told me, is that all of those missed appointments start to add up. Patients with high blood pressure or blood sugar, for example, may now be less likely to have their conditions under control—which after enough time can lead to all sorts of other ailments. Losing a limb can pose challenges for patients that will last for the rest of their lives. Relapses can put people at a higher risk for lifelong medical complications. Cancer screenings plummeted, and even a few weeks without treatment can increase the chance of dying from the disease. In other words, even short-term delays can cause long-term havoc.

    To make matters worse, the health-care delays fueling a sicker America may not be totally over yet, either. After so many backups, some health-care systems, hobbled by workforce shortages, are scrambling to address the pent-up demand for care that patients can simply no longer put off, according to administrators and doctors from several major health systems, including Cleveland Clinic, the Veterans Health Administration, and Mayo Clinic. Disruptions in the global supply chain are forcing doctors to ration basic supplies, adding to backlogs. Amy Oxentenko, a gastroenterologist at Mayo Clinic in Arizona who helps oversee clinical practice across the entire Mayo system, says that “all of these things are just adding up to a continued delay, and I think we’ll see impacts for years to come.”


    It’s still early, and not everything that providers told me is necessarily showing up in the data. Oddly enough, the CDC’s National Health Interview Survey found that most Americans were able to see a doctor at least once during the first year of the pandemic. And the same survey has not revealed any uptick in most health conditions, including asthma episodes, high blood pressure, and chronic pain—which might be expected if America were getting sicker.

    It’s even conceivable that the disturbing observations of clinicians are a statistical illusion. If for whatever reason only sicker people are now being seen by—or able to access—a doctor, then it can be true both that providers are seeing more seriously ill patients in medical facilities and that the total number of seriously ill people in the community is staying the same. The scope of the damage just isn’t yet clear: Maybe a smaller number of people will be worse off because of delayed cancer care or substance-abuse relapses, or maybe far more people—more than tens of million of Americans—will be dealing with exacerbated issues for the rest of their lives.

    None of this accounts for what COVID itself is doing to Americans, of course. The health-care system is only beginning to grapple with the ways in which a past bout with COVID is a long-term risk for overall health, or the extent to which long COVID can complicate other conditions. The pandemic may feel “over” for lots of Americans, but many who made it through the gantlet of the past two-plus years may end up living sicker, and dying sooner.

    This disturbing prospect is not only poised to further devastate communities; it’s also bad news for health-care workers already exhausted by COVID. Laura, the Manhattan internist who treated the colon-cancer patient, told me it’s disheartening to see so many people showing up at irreversible points in their disease. “As doctors,” she said, “our overall batting average is going down.” Aarti Patel, the physician assistant, put it in blunter terms: “Burnout is probably too simple a term. We’re in severe moral distress.”

    Nothing about this grim fate was inevitable. Laura told me that “going to the doctor mid-pandemic may have posed a small risk in terms of COVID, but not going was risky in terms of letting disease go unchecked. And in retrospect it seems that many people didn’t quite get that.” But there didn’t have to be such a stark trade-off between fighting a pandemic and maintaining health care for other medical conditions.

    Some hospitals—at least the better-resourced ones—figured out how to avoid the worst kind of delays. Mayo Clinic, for example, is one of a number of systems with a sophisticated triage algorithm that prioritizes patients needing acute care. In the spring of 2021, Cleveland Clinic launched a massive outreach blitz to schedule some 86,000 appointments, according to Lisa Yerian, the chief improvement officer. And the Veterans Health Administration provided iPads to thousands of veterans who lacked other means of accessing the internet in the spring of 2020, ensuring a more seamless transition to virtual care, Joe Francis, who directs health-care analytics, told me. Thanks in part to these efforts, Francis said, high-risk patients at the VHA were being seen at pre-pandemic levels a mere six months into the pandemic.

    These health-care systems also suggest a path forward. America may still be able to stave off the worst of the collateral damage by reaching the patients who have fallen through the cracks—and already the data suggest that these patients tend to be disproportionately Black, Hispanic, and low-income. Tragically, it’s too late for some Americans: People who died of cancer can’t come back to life; amputated limbs can’t regrow. Others still have plenty of time. Hypertension that’s currently uncontrolled can be tamped down before causing an early heart attack; drinking that’s gotten out of hand can be corralled before it leads to liver failure in a decade; undetected tumors can be spotted in time for treatment. An uptick in premature death and disability, summed over millions of Americans, could strain the health-care system for years. But it’s still possible to prevent an acute public-health crisis from seeding an even bigger chronic one.

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    Tim Requarth

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  • A Simple Rule for Planning Your Fall Booster Shot

    A Simple Rule for Planning Your Fall Booster Shot

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    In less than two weeks, you could walk out of a pharmacy with a next-generation COVID booster in your arm. Just a few days ago, the Biden administration indicated that the first updated COVID-19 vaccines would be available shortly after Labor Day to Americans 12 and older who have already had their primary series. Unlike the shots the U.S. has now, the new doses from Pfizer and Moderna will be bivalent, which means they’ll contain genetic material based both on the ancestral strain of the coronavirus and on two newer Omicron subvariants that are circulating in the U.S.

    These shots’ new formulation promises some level of protection that simply hasn’t been possible with the original vaccines. “A bivalent vaccine will have some benefit for almost everybody who gets it,” Rishi Goel, an immunologist at the University of Pennsylvania, told me. “How much benefit that is, we’re still not exactly sure.” People who aren’t at high risk could end up only marginally more protected against severe outcomes, and no one thinks the shots will banish COVID infections for good. There is, however, a simple rule of thumb that nearly everyone can follow to maximize the uncertain gains from a shot: Wait three to six months from your last COVID infection or vaccination.

    Put that rule into action, and it plays out a little differently, depending on your circumstances.

    If you haven’t had an Omicron infection:

    If you haven’t had COVID since about November 2021, the advantage of a bivalent booster over the original formula is obvious, and as long as you haven’t gotten boosted recently, there’s every reason to get the new one right away. (If you have been boosted in the past few months, your antibody levels are probably still too high for a new shot to do much for you.) Marion Pepper, an immunologist at the University of Washington, told me that Americans who have already gotten three or more doses “have probably maxed out the protective capacity” of the original shots. By contrast, the bivalent vaccines offer something new to those who have so far escaped Omicron: a lesson on the spike proteins of the BA.4 and BA.5 subvariants, which will help the immune system fight the real thing should it get into your body. “I’m just super excited to get the bivalent vaccine,” says Jenna Guthmiller, an immunologist at the University of Colorado who has not yet had COVID. “I think it’ll be really nice and ease my mind a little bit.”

    If you have had an Omicron infection:

    Veterans of Omicron infections might still have something to gain from seeing the BA.4 and BA.5 spike proteins—especially if your goal is to avoid getting sick with COVID at all. Past a certain number of shots, boosters’ impact on your long-term protection against severe disease is unclear, Goel told me. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told me he doesn’t plan on getting a booster at all this fall because, after three vaccine doses and an infection, “I think I’m protected against serious illness.” But if you want to stave off infection, Goel said, “the bivalent vaccines, or really any variant-containing vaccines, have real value.” That’s because formulas based on a given variant have been shown to temporarily increase your stock of antibodies that target that variant.

    How long that extra-protective state lasts, or whether it’s sufficient to prevent any infection whatsoever, is still a scientific puzzle. The original boosters were shown to increase antibody levels to a peak about two weeks after the shot, then decay steadily over the following three months. We don’t know yet whether a bivalent formula will change that timeline, Goel said.

    But you can still use it to estimate approximately when your protection will be at its highest. You might, for example, choose to err on the early side of that three-to-six-month timeline if you have a particularly high-risk event coming up in the next few weeks. “If all we had was the original booster and I was going to an indoor wedding or something, I think it would be reasonable to get that booster,” Pepper said.

    If you had an Omicron infection this summer:

    “You’re still riding the wave of antibodies that you generated as a result of that infection,” Guthmiller told me, so a shot won’t do much for you yet. That’s true regardless of which Omicron subvariant you might have been infected with, she said, because BA.2 infections have been shown to protect fairly well against today’s dominant strains, BA.4 and BA.5. (BA.2 became dominant in the United States back in March.) The severity of your illness doesn’t really matter either, Goel said. A higher fever and more intense cough might indicate that your immune system got extra revved up, he said, but they could just as easily mean that your body needs more help responding to the coronavirus. In either case, once a little more time has passed, getting the bivalent vaccine could help extend your body’s memory of its last COVID encounter, and keep infection at bay.

    If you’re at high risk:

    Certain groups of people should get any booster as soon as it’s available to them, the experts I spoke with emphasized to me: immunocompromised people, people over the age of 50 or so, and people with medical conditions that put them at high risk of severe disease. If you fall in one of these categories and haven’t received all the boosters you’re eligible for, “I wouldn’t wait for the bivalent,” Offit said. For people in these high-risk categories who have already gotten the recommended number of boosters, you should get the new one as soon as it’s available to you. (The FDA and CDC have not yet indicated whether they will recommend a waiting period between your most recent shot and the bivalent booster.) Goel recommended waiting at least a month after your most recent infection or shot, but if you’re very worried about your risk, you don’t need to stretch the delay to three months. Your body might still have extra antibodies floating around, but with no practical way to check at scale, “I’m honestly in favor of recommending boosting as a way to maximize individual benefit,” he said.

    If you want to wait and see:

    Waiting is always an option if you want to know more about how the bivalent vaccines perform. The FDA and CDC are set to green-light the shots based on human data from the existing boosters and other experimental bivalent boosters that didn’t make it to market in the U.S.—plus trials on the new formula in mice. Pfizer and Moderna simply haven’t progressed very far in their human trials. While there’s no reason to suspect that the new shots won’t be safe, Offit recommended opting for the original boosters until more safety and efficacy data are available, which could be as soon as a couple of months after the rollout—as long as the vaccine makers or the government collects that information and makes it public. But Guthmiller and Goel said they weren’t concerned about the lack of human data, and the bivalent shot is almost certainly the better bet.

    There is one significant reason to avoid waiting too long for the bivalent shot: It offers the greatest protection against infection from the subvariants it’s actually designed around. BA.4 and BA.5 might be with us through the fall and winter—or they might give way to a different branch of Omicron, or even a variant that’s entirely unlike Omicron. You’d certainly be better off against this new variant with a bivalent booster than no booster at all. But if you want to maximize your anti-infection shield while you have it, consider putting it up against the enemy you know.

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    Rachel Gutman-Wei

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  • Caitlin Dickerson on the Moral Catastrophe of Family Separations

    Caitlin Dickerson on the Moral Catastrophe of Family Separations

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    Jeffrey Goldberg, The Atlantic’s editor in chief, joined staff writer Caitlin Dickerson to discuss her cover story, a years-long investigation into the secret history of the Trump administration’s family-separation policy. Dickerson’s story argues that separating children was not an unintended side effect, as previously claimed, but its core intent. How did officials work to keep families apart longer? Did they obscure the truth to both Congress and the public? What will happen if the Trump administration is restored to power in the 2024 election? This dialogue is an edited and condensed version of a conversation Dickerson and Goldberg had on Friday for The Atlantic’s “Big Story” broadcast.

    Leer este artículo en español.


    Jeffrey Goldberg: When did you realize that the Trump administration was doing something new?

    Caitlin Dickerson: There were two things here that really stood out from the norm in my experience as a reporter. The first, with family separations, is just the mere fact that they took place in relative secrecy. In 2017, hundreds of separations took place starting out in El Paso, Texas, in a program that later expanded. But when reporters would ask about it, the administration would tell us, “No, this isn’t happening. You know, we’re not separating families.” There’s some complicated reasons for that which we can get into, but that’s really not normal. As a reporter, you’re used to hearing “no comment” in response to a story that the government doesn’t want you to report. Or you’re used to hearing a public-affairs officer offer some context that at least helps to soften the blow of a story that they know the public is not going to react kindly to. But in this case, we actually got denials.

    And then, of course, having looked back at immigration policy all the way back to the 19th century in the United States, separating children from their parents as an immigration policy hasn’t happened before. It was the harshest application any of us have seen of this basic concept of prevention by deterrence, which is how we approach immigration enforcement generally. And it was so harsh and painful for parents and for children, and continues to be, that I had to stick with it.

    Goldberg: So to be clear, no presidential administration going back all the way had ever done anything this dramatic?

    Dickerson: No. As you know, there are examples of kids being taken from their parents in American history, though not in a border context. We’ve had some pretty cruel and pretty harsh border-enforcement policies. But the forcible separation of children from their parents is just not something that the Border Patrol has ever engaged in in American history.

    Goldberg: One of the great achievements of your story is that you take us all the way into the bureaucratic decision making that allowed this to happen. But somebody had to think of this first. The assumption, on the part of people who think about this, is that it must have been Stephen Miller, Donald Trump’s very hard-line adviser. He worked for Jeff Sessions and brought a lot of his ideas to Donald Trump. But it’s more complicated than that.

    Dickerson: It took a lot more than Stephen Miller, Donald Trump, and Jeff Sessions to forcefully separate thousands of kids from their parents. The idea actually came from within the border-enforcement apparatus: a man named Tom Homan, who started out as a Border Patrol agent in his early 20s, spent a career in enforcement, and ultimately became the head of ICE under President Trump.

    He first came up with the idea to separate families as an escalation of the concept of prevention by deterrence: this idea of introducing consequences to discourage illegal border crossing, even when it’s for the purposes of seeking asylum. He first proposes separating children from their parents in 2014, during the Obama administration, which is when we saw the first major surge of children and families crossing the border. Border Patrol was totally overwhelmed at the time. Congress didn’t intervene. And so you have, essentially, a police force that’s left to figure this out—this policy, which is really humanitarian policy; it’s economic policy. When you leave this to the Border Patrol, the solution that they come up with time and again is punishment. So Homan proposes it, and Jeh Johnson, who was Homeland Security secretary at the time, rejects the idea. Then the idea resurfaces very soon after Donald Trump takes office.

    Goldberg: So there was a bureaucratic impetus from below. Take us through that—Donald Trump wins in 2016, comes into office, and this dormant idea is brought to whom?

    Dickerson: Trump comes into office and is visiting Border Patrol headquarters and Customs and Border Protection headquarters and saying, “Hey, we’ve got to shut this border down, and, really, we’ll stop at nothing to do it. Bring me your best ideas.” Tom Homan, who was the head of ICE, and a man named Kevin McAleenan, who was the head of Customs and Border Protection, very quickly reraise this concept that they had already talked about and already favored. They tell Miller about it, who gets really excited and kind of obsessed with it. And Miller continues to push for the next year and a half until it’s officially implemented. Donald Trump also begins to favor it.

    I was surprised about this, ultimately, but the story ends up being kind of a case for the bureaucracy. I learned, in reporting this, the way the policies are made. Typically, you have principals, who are the heads of agencies and have great decision-making power but have huge portfolios. Policy ideas should only ever reach the desk of someone like Kirstjen Nielsen—who was the Homeland Security secretary, who ultimately signs off on family separation—if they’ve been thoroughly vetted. Subject-matter experts have determined these policies are logistically feasible, they’re legal, they’re ethical. They make sense politically for the administration in office. All these layers exist to prevent bad policies from ever even reaching somebody who has the authority to sign. And these systems were really either sidelined, disempowered, or just completely cut out of the conversation. Everybody who was raising red flags was really cut out.

    Goldberg: I want you to talk about child separation in its details. The idea is preventative. Which is to say, if word gets out into Guatemala, Honduras, wherever, that if you try to cross the border with your kid, the U.S. government will take your kid from you—actually kidnap your child in some kind of bureaucratically legal way—then all the people who are trying to come to America, asylum seekers, workers, etc., will not come. Is that the theory of the case?

    Dickerson: That is the theory of the case. And there’s a lot of reason to believe it’s not a good theory.

    Goldberg: Why is it not a good theory? It sounds pretty scary if you’re sitting in Guatemala and somebody says you might lose your kid.

    Dickerson: It does. That’s what’s difficult about it: that it is somewhat intuitive, this idea of prevention by deterrence. Academics have been studying it for a long time and know what ways it works, and what ways it doesn’t work. In the early 2000s, we started prosecuting individual adults who crossed the border illegally.

    To begin with, there’s this program called Operation Streamline. It completely floods courts along the border, and immediately, prosecutors—assistant U.S. attorneys—are unhappy with it because they’re saying it’s taking away resources from these more important cases that we need to deal with. And not only that, but it doesn’t seem to be influencing long-term trends.

    If you look at shifts in migration that have taken place over the last 20 years, those can be explained entirely by looking at economic shifts and demographic shifts in the United States and the countries where people are coming from. All of those changes are attributable to the availability of resources here and the availability of jobs here, and then the inverse: what opportunities people have available to them in their home countries, as well as whether people actually feel safe.

    Even though prevention by deterrence, first in the form of Streamline, wasn’t making a dent in border crossings in any significant way, this idea becomes more and more popular until ultimately we get to the point of separating children from their parents. Anecdotally, Lee Gelernt—the ACLU lawyer who’s heading up the federal case against family separations, the main case that prompted family reunification—talks about asking every parent that he interviewed for that case, “If you had known about family separation, would you have left your country to begin with? Would you have decided to stay home?” And they’d just kind of shrug their shoulders and say, “Well, what was I going to do? You know, we left because our lives were in danger. I couldn’t stay.” That is something that people like Tom Homan, who came up with the idea to separate families, didn’t really take into account.

    Goldberg: The level of desperation at home is the key determinant of whether somebody is going to start the trek.

    Dickerson: It’s a very, very high bar to surpass when you’re talking to a parent who not only can’t feed themselves or their child, but on a day-to-day basis fears that their child may be killed.

    Goldberg: Stay on that for one second so people understand this population. You’re talking about people who are living in very dangerous Central American countries, mainly.

    Dickerson: You’re talking about a lot of times a combination of deep poverty, daily fear of death, and daily encounters with violence. I can tell you about my experiences reporting in parts of Mexico, where people come to the United States from, and in Central America. When The New York Times sent me to Guatemala to write about a family that was trying to get into the United States, I had security with me the entire time. Many people, just within this family, had been murdered. It’s a domino effect where a gang identifies one person in a family and wants that person to join the gang. If that first individual doesn’t do right by the gang, relatives continue to be murdered.

    When I would go house to house to visit with people associated with this family, we were hiding. They couldn’t let anybody know where they lived. They couldn’t let anybody know that I was there, because it would have put them in greater danger. The poverty, too, is really something that I don’t know a lot of Americans have really sat down and thought about. Houses that have no roofs, no floors. Families of four that are splitting a tortilla among them. Access to school is almost nonexistent. Kids don’t have shoes. It’s stuff that I think most Americans have a hard time envisioning. Think about how scared you would have to be to decide to go to the United States, knowing that you’re going to have to travel through a hot and dangerous desert and encounter murderous gangs. Nobody signs up to do that unless they feel like they have absolutely no choice.

    Goldberg: Let’s come back to the narrative of the adoption of this policy. One of the reasons, when we were talking about doing this story over the past year and a half, was to try to understand the mentality of government officials and bureaucrats. Somehow the idea of taking children from their parents becomes socialized within these government structures. Talk about that. Did anybody along the way say, “Hey, I’m all for deterrence. I have these views on immigration. I’m a hard-liner. But this does not seem to comport with my notions”—and I’m using this term advisedly—“my notions of family values”?

    Dickerson: A lot of people said that. And ultimately, by the time the decision to pursue separating families is made, they had been left out of the room. When family separations are first proposed, they’re described in pretty blatant terms. I interviewed Jeh Johnson—again, who was the Homeland Security secretary under President Obama, and did believe in deterrence—but he said, “That’s too far for me. I’m not comfortable with it.” John Kelly, who was President Trump’s first Homeland Security secretary and considered the idea after it was proposed by Tom Homan, Kevin McAleenan, and others, said the same thing. He wasn’t really a big believer in deterrence, but he’d taken the job for the Trump administration. But this felt too far for him.

    Goldberg: John Kelly then goes to the White House as chief of staff and is there when all of this is still going on. What role did he play there?

    Dickerson: Kelly told me that his approach to opposing family separations was to focus purely on the logistics. When the idea is formally proposed to him, he requests a briefing to find out whether it’s possible. And he learns, rightly, that the federal government did not have the resources to impose such a program without total chaos, which we ultimately saw—without losing track of parents and kids, without really inhumane situations where kids are being physically taken out of their parents’ arms. You need training, theoretically, to do this in a way that isn’t chaotic if you’re going to do it at all.

    He told me that he knew that appealing to the president and to Stephen Miller on some sort of moral basis wasn’t going to be effective. They weren’t going to listen. Instead, he said, you focus purely on the logistics. “It’s not possible. We just can’t do it.” He would say, “Mr. President, if you want to pursue this, you need to go ask Congress for the money,” knowing that Donald Trump wouldn’t be willing to do that. The problem is that when you ask these more hawkish members of the administration what their understanding of John Kelly’s view is, they would say to me, “Well, I didn’t know he had any issue with it. All he said was that we needed more money; we needed more training.” You can see that there’s logic behind Kelly’s approach, but there’s also, as a result of it, repeated meetings where this idea is being discussed. He could have jumped up and down and screamed and said, “I oppose this; I don’t want to do it.” But he didn’t. He just said, “Sir, we don’t have the money.”

    Goldberg: I mean, to be fair to Kelly, he did have a reasonable understanding that Trump would never respond to the humanitarian argument.

    Dickerson: There are so many different approaches that people say they took to try to prevent this, and it ultimately didn’t work. The higher the numbers rose, the more obsessed Donald Trump became with finding some way to minimize them.

    Goldberg: I do want to ask about two people whose names are very intimately associated with this. Kirstjen Nielsen, who was the DHS secretary and signed off on this, and Stephen Miller. I want you to talk about her role, which is more complicated, morally, than we initially thought. And Miller, who obviously is still the ideological driver of a whole set of policies.

    Dickerson: Kirstjen Nielsen came into the Trump administration a moderate. She was a cybersecurity expert who helped to establish DHS the first time under George W. Bush. No experience in immigration, and no real strong feelings about immigration. She’s one of a lot of people whom I interviewed who joined DHS under Trump and just said, “I didn’t know all that much about immigration. It wasn’t that important to me.” From the very beginning, they seemed a bit misguided in terms of what their expectations for their job might look like, given how much this White House really cared about the issue.

    Family separations are proposed to her right after she’s confirmed, in December of 2017, and she says, “Absolutely not. John Kelly has said no to this. I’m not doing it. I oppose it. I don’t believe in it.” Over time, this alternative version of achieving the same end is proposed to her via prosecution, and conveyed to her in these terms that are quite bland. You know, “We’re going to pursue a prosecution initiative. There are people who have been committing misdemeanor crimes; we’ve been letting them go simply because they’re parents.” There was a lot of fearmongering around this idea that a lot of the parents might have been smugglers, that families may not have actually been related at all, that these children might all have been victims of trafficking. There’s no evidence to support that a significant number of those false families existed. She’s also told, “It’s been done before,” and that systems and processes exist to prevent chaos from ensuing. And so, based on that information, she ends up approving the policy.

    Another really important thing to know about her is she came into her role at a disadvantage because she was viewed as a moderate. She was one of a lot of people who were viewed very skeptically in the White House.

    Goldberg: Are these people who are trying to prove they’re tough so that Donald Trump likes them?

    Dickerson: Or keeps them in their job.I heard in my reporting that, in fact, “You’re not tough enough” is a quote that Trump repeated to Nielsen all the time. At one point an adviser suggested, “Maybe you should write a memoir and call it Tough Enough because he’s always telling you you’re not tough enough.” Nielsen was always trying to kind of meet these expectations and show that she wasn’t a closeted liberal. She eventually signs off on this policy that she intellectually, at least prior, seemed to totally oppose, but had convinced herself of a lot of illogical realities and decided, Okay, I agree to zero tolerance. She’s a really smart person, but she worked so hard to please her bosses.

    The other person you were asking about was Stephen Miller. What I understand from people close to him and familiar with his thinking is that he continues to believe that President Trump’s harshest immigration policies were Trump’s most popular and successful accomplishments. I think he still believes in separating families and doing anything to seal the border, stopping at nothing. He’s even made clear to close confidants that the groundwork has been laid so that a future Trump administration, or a future Republican administration that looks like Trump’s, can pursue these policies even more quickly and even more dramatically.

    He exerted pressure really kind of shamelessly. He would call not only Kirstjen Nielsen, who was Homeland Security secretary, but all of her advisers and even lower people in DHS: people who had no authority to sign off on anything. He was calling people incessantly to press for his policies, trying to get buy-in. I heard about something he would do on a conference call where he would introduce an idea and say, “Hey, I believe X, Y, and Z needs to happen. And this head of this division of DHS agrees with me.” Then that head of the division might say, “Oh, well, I have some questions about that. You know, I’m not exactly sure.” And Stephen would say, “Well, are you saying that this isn’t a priority?” And they would say, “Oh, no, I do agree with you that it’s a priority.” And Stephen would say, “Great; I have your support.” And then he would go into White House meetings and then repeat it and say that he had buy-in from DHS. He was bullying people into accidentally or tacitly or passively agreeing with his ideas. He was not embarrassed to keep people on the phone after midnight, ranting, not even letting the other person speak. It was a singular focus for him.

    Goldberg: John Kelly would give him the cold shoulder. But not everybody had John Kelly’s power, right?

    Dickerson: Exactly. And John Kelly is a career military official and general. He believed really strongly in the chain of command. He couldn’t believe that Miller would call people below Kelly and make demands and try to pressure Kelly into making decisions. And so Kelly would call the White House and actually try to get Miller in trouble. He’s one of the few people to do it. But other people much higher in the official chain of command, such as cabinet secretaries, really let themselves be bullied by Miller. When I would ask why, they basically just said Miller had this mystique. He was so close to the president and was protected because of this narrative that immigration is the reason why Donald Trump was elected president and was the key to him being able to hold on to power. Because of that, Miller was insulated from any kind of accountability, even as he defied the chain of command over and over again.

    Goldberg: Do you think that these same people, if they came back to government, would do it better? Do you think that they have learned lessons about how to try to pull this off in a more efficient, effective way that wouldn’t draw so much attention?

    Dickerson: I do think that a lot of them still believe in this idea, and they’ve taken lessons away from the experience in order to be able to “do it better.” They didn’t have a system for keeping track of parents and kids, so children were sent over to the Department of Health and Human Services, which houses any kid who’s in federal custody on their own. That agency doesn’t have computer systems that talk to DHS. Something like that could be updated. I do think that these officials would go into such a policy in the future a little bit more eyes open about what would actually happen once the separation occurs. But they still believe in this idea. And a lot of them, Tom Homan and many others, would sort of whisper out of the side of their mouth to me in interviews like, “Nobody really likes to say this, but it really worked. And zero tolerance was effective.” Again, the data that they’re citing is inaccurate. There isn’t evidence that family separations were effective. In fact, after zero tolerance ended was the year when a million people crossed the border under President Trump. It was a record-breaking year for border crossings.

    Goldberg: Are there any heroes in the story, from your perspective?

    Dickerson: There are a lot of people within the federal bureaucracy who tried to prevent family separations from taking place. Within the Health and Human Services agency, which cares for children, there was a man named Jonathan White who oversaw, at the beginning of the Trump administration, the program that houses kids in federal custody. He found out about family separation in an early and rare meeting where you actually had HHS invited to meet with the law-enforcement side. Normally those two agencies—which have to work together on immigration—really don’t play well together, because HHS is made up of a lot of people like White, who are social workers and have backgrounds in child welfare, and then are sitting in the room with cops. It’s a fraught relationship that is detrimental for all sides.

    White finds out in an early meeting about this proposal to separate families. And he starts writing up reports mentioning that the agency did not have enough space to house children who are separated, who tend to be younger than those who crossed the border on their own. They didn’t have the resources to deal with the emotional fallout that was easily anticipated by any expert familiar with child welfare and the state a child is going to be in when they’ve just been separated from their parent. He also pointed out that children who cross the border with their parents don’t necessarily have anywhere to go. A child who chooses to cross the border on their own is typically coming here because they have an aunt or a relative, somebody who can take them in in the United States. A child who comes to the United States with their parent is expecting to remain with their parent. Whether they get asylum status or are ultimately deported, the expectation is that they’re going to stay together. And so White started to point out, along with several of his colleagues, that not only did they believe this was a bad idea, the resources just didn’t exist.

    You have versions of that same fight, that same argument, being made within DHS, the DOJ, and the U.S. Marshal system. I found examples in all of these places of people within the federal bureaucracy who tried to raise concerns with the White House, with people in their agency leadership, about why this was such a bad idea. There are a lot of people who fought back, and ultimately they didn’t win the argument.

    Goldberg: What’s your assessment of the success of President Biden’s executive order setting up the task force for family reunification? How many children do we still think are out there floating in the bureaucratic abyss who haven’t been unified with their parents?

    Dickerson: Almost all of the children who were separated have been released from federal custody. If they haven’t been reunified with their parents, they’re in the care of a sponsor: an extended relative or a family friend who went through an application process and was approved to take that child in. That’s very different from reuniting them with the parent with whom they crossed the border, with whom they were living and planning to continue living more than four years ago. That number is between 700 and 1,000—those who have not been officially reunited with their parents, according to government records. Some of them may have, and are thought to have found, their parents on their own and just not reported it to the U.S. government, kind of understandably—not wanting to deal with the U.S. government anymore and fearing future consequences.

    The Biden administration had a really tall order in front of it when this task force to reunify separated families was established. So much time had passed, and record keeping was so poor that they had very little to work with. Thus far they’ve been able to track down more than 400 families that have been reunified, and there are several hundred more who are in the process of applying. What I hear from the ACLU and advocacy groups is that the Biden administration is working really hard and doing its best to reunify these families, and they’ve had a significant amount of success in the face of this challenge.

    But now they’re dealing with really complicated cases. I’ve heard about parents, for example, who were deported without their kids. That happened in over 1,000 cases. They’ve been back at home since then, and they’ve had to perhaps take custody of an extended relative’s child. I heard about one parent whose sister had been killed. And so the sister’s children were now being taken care of by the separated parent. So then the separated parent is applying to come back and rejoin their own child. And are those other children eligible to come to the United States? It’s not totally clear. I mean, this is what happens. It’s very messy logistically when you separate a family for four years and then try to bring them back together. And so the numbers are shrinking, but the challenge is kind of growing in terms of getting these final families reunified.

    Goldberg: Something that, in the colloquial sense, is completely unbelievable to me is that when family separation actually started, no one—for weeks—thought to even write down, keep a log, an Excel spreadsheet, of where the children were going, who their parents were. You could define that as negligence, but negligence bleeds over into immorality very quickly. That, to me, of all the incredible reporting that you did, struck me as almost too much. What for you is the aspect of this entire multiyear saga that you still can’t get your mind around? What’s the thing that still stays in your mind as, “I can’t believe that actually happened?”

    Dickerson: The one that I still can’t really believe is the number of people I interviewed who held very significant roles in DHS or in the White House overseeing this issue, to whom I had to explain basic tenets of the immigration-enforcement system. They would say to me, “We never expected to lose track of parents and children. Couldn’t have imagined things would go as poorly as they did.” That just doesn’t make any sense. You can call up any prosecutor in the country and ask them, “Hey, tomorrow I want to start prosecuting hundreds of parents at a time who are traveling with young children who are outside of their communities, with nobody nearby to take those children in. And by the way, they don’t speak the language that most government officials talking to them are going to be using. Is that going to work?” They would tell you it obviously won’t. I was shocked that, to this day, many people involved in this decision making still don’t understand how immigration enforcement works.

    Watch: Atlantic editor in chief Jeffrey Goldberg in conversation with staff writer Caitlin Dickerson

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  • Austin Pets Alive! | Letter from Dr. Jefferson: Tornado Help

    Austin Pets Alive! | Letter from Dr. Jefferson: Tornado Help

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    Mar 22, 2022

    I hope this finds you and yours safe after last night’s scary weather event.

    With multiple tornado touchdowns in Central Texas and morning reports today of damage, we wanted to reach out to let you know how we fared and what we’re doing to support response efforts.

    Firstly, our animals and facilities were unharmed. Our Town Lake Animal Center (TLAC) shelter, which as you probably know faces challenges, weathered the storm well! With our recent equipment upgrades and overnight staff additions, the teams were able to prepare the animals and facility ahead of the weather, as well as quickly mitigate any pooling water as storms hit our area. Thank you to our amazing staff and volunteers on the ground last night.

    Secondly, Austin Pets Alive! is offering assistance to local, county, and state government emergency operations teams as they assist with recovery efforts following yesterday’s tornadoes. We are concerned that many pet owners could be facing difficulties and pets could be struggling, displaced, and at risk. Through our Positive Alternatives to Shelter Surrender (P.A.S.S.) program, we will assist with finding temporary homes, food, and other pet need for people with pets affected by the tornadoes.

    Need help?

    Need help or know someone who needs help with pets affected by last night’s tornadoes? Email us at [email protected] or call us at 512-961-6519.

    Want to help?

    Join P.A.S.S.

    Our P.A.S.S. program, which we coordinate our community crisis response through, depends on peer-to-peer support so we are always looking for those willing to help other Austinites to join our Facebook group. Join us today to support our post-tornadoes response efforts for Austin-area people and pets.

    Donate

    You can also support all of our in-house programs, services, and support for people and pets in need by making a donation here.

    Thank you for all you do to support people and pets!

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  • Austin Pets Alive! | This Is a Call for Innovators and Entrepreneurs…

    Austin Pets Alive! | This Is a Call for Innovators and Entrepreneurs…

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    Mar 11, 2022

    An estimated one million pets will be dying in shelters this year because they haven’t been adopted—or weren’t kept out of the shelter with safety net programs to support people and pets.

    Meanwhile, in some parts of the country, there are not enough cats and dogs for the people who want to adopt them. See the issue?

    There is a veterinarian shortage, exacerbated by more people bringing pets into their homes during the pandemic. Vet prices are going up to meet the increased demand. This is leaving more and more people and pets behind.

    Underfunded government shelters can’t compete at all. Most are funded at just .2% of city and county budgets. That period is in the right place: .2%. It’s far from enough, given the literal life and death stakes. In this time that veterinary costs are rising, it means—among other things—that pets in shelters are not receiving enough medical care, and sometimes no care at all, which leads to more unnecessary death.

    We’ve got a quarter of pet owners saying they’ve had to move because of their pet, and 14% of renters have had to give up their pet because they could not find pet-inclusive housing, that they could afford. We could save millions of pets, with more rentals that are affordable and welcome pets.

    These are among the problems that pets, and people, need the brightest minds to solve.

    Dr. Jefferson recently spoke with Triple Pundit about how companies and individuals can help end pet homelessness. Read the interview here!

    We need tech innovators, entrepreneurs, and pet lovers looking to make a huge impact.

    These are not quick or easy projects. These are real global issues that, if solved, will mean a completely new world for pets and the people who love them.

    Here are some of the areas where we need your energy and expertise:

    • Tech to connect more people to pets in shelters, especially to help people adopt from shelters in another city or state. This is harder than it sounds—but we know with the right minds at work, excellent products and apps can do this critical job.

    • Tech for shelter resident flow tracking, like the systems used to track hospital patient flow. That will allow shelters to better manage their populations, and develop and meet goals for animals’ survival.

    • An app that will let people use their cell phones to scan pets for microchips, instead of needing to use a specialized device often found only in vets’ offices, police stations, and animal shelters. This app would make it significantly easier to get lost pets back home.

    • Other tech solutions for reuniting lost pets with their families, that anyone of any income can use—such as a free crowdsourcing app that pinpoints a pet’s location.

    • Tech and law to solve for too many vet patients and not enough veterinarians.

    • Business analysts to predict foster and adoptive capacity in any community—then build software to better facilitate pets going into foster and adoptive homes. Especially in communities with more capacity than their local shelters need, this is another instance where tech can save lives by connecting people to pets outside of their local community.

    • Tech support to build industry report cards that help any community see how they are doing in terms of pet ownership and pet equity.

    • Legislative support to overturn laws that allow for adoptable and treatable pets to be euthanized in shelters.

    • Legislative support to overturn laws that stand in the way of lifesaving cat programs like Trap Neuter Return, and to overturn breed-specific legislation—harmful laws that regulate or even prohibit dogs by breed, type, or appearance, and that lead to dogs being unable to find homes, which in turn leads to these dogs’ unnecessary death.

    • Funding for research into treatment for common diseases like distemper that affect hundreds of thousands of pets every year, but are largely overlooked by drug manufacturers.

    • Developing affordable pet products to keep pets occupied while a foster or owner is at work.

    • Affordable, healthy vegan pet food. The pet food industry is a major contributor to greenhouse gas emissions, responsible for the rough equivalent of driving 13.6 million cars per year. Yet there is still not a good, cheap, healthy vegan pet food alternative.

    • Entrepreneurs to greatly expand the pool of affordable, pet-inclusive housing, and tech to connect people with rentals where they and their pets can live.

    The majority of Americans own at least one pet. And if there is one thing we know, it’s that people LOVE their pets. In a recent national study, 98% of pet owners described their pets as family members who are as important as their human family members.

    The pet industry has been growing exponentially to meet those families’ wants and needs. For the past two years, Americans have spent more than $100 billion annually on their pets.

    But this boom leaves out a lot of families. Sixty-four percent of Americans are living paycheck to paycheck. Almost 1/3 of pet owners can’t afford an unexpected vet bill. Many even struggle to buy food or supplies for their pets.

    The government-funded animal shelters there to support pets and people, and to take in pets whose owners can no longer keep them, are drastically underfunded for the role they are there to serve.

    In a world where pets are often the most important connection we have in the world, this system is needlessly cruel and inhumane to people and the pets they call family.

    So how do we bring the awesomeness of the pet boom to all pets, since we have a shared belief that pets are family? That is where you come in. We know the problems. We need your help developing the tech, entrepreneurial, and legislative solutions that will keep people and pets together, and save pets’ lives.

    Link to form/registration

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  • Austin Pets Alive! | Austin Pets Are in Crisis. Supporting Families…

    Austin Pets Alive! | Austin Pets Are in Crisis. Supporting Families…

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    Oct 01, 2021

    Austin Pets Are in Crisis. Supporting Families Through Partnership Is the Answer.
    We must work together to keep pets with people and out of the shelter.

    Here in Austin, 38,000 pets could be displaced by evictions in the coming months. Nationally, that number could be as high as eight million.

    After speaking with American Pets Alive! and Human Animal Support Services project director Kristen Hassen, NBC shared this story about how the looming eviction crisis could impact overcrowded shelters by displacing the pets of families who lose their homes.

    Austin Pets Alive!, the parent organization to AmPA! and AmPA!’s HASS project, is already seeing the effects of the financial strain so many families have faced during the pandemic. Our APA! Positive Alternatives to Shelter Surrender Facebook page is currently receiving around 1,000 requests for help each month, with countless owners faced with the possibility of having to give up their pets.

    We help as many of these families as we can. But the situation for our community’s pet owners is growing increasingly dire. It will get much worse as more families are evicted.

    APA! is currently working with the City of Austin to renegotiate our partnership agreement so we can focus even more of our efforts on innovation and progress to support families and shelters in crisis. We want to ensure Austin Pets Alive! and Austin Animal Center can, with our complementary roles, develop our partnership to protect our city’s animals and families.

    We come to this partnership with deep experience. AmPA!’s Human Animal Support Services program leads nationwide efforts to develop and implement community-centered animal services programs to keep pets with people, and out of shelters.

    What we have learned while bringing this model to hundreds of communities across the country, is this is never a solo effort. Success requires government shelters to partner with other organizations.

    That means we and Austin Animal Center must work together, and be based together here in Austin, to ensure that the eviction crisis does not overwhelm AAC and lead to pets needlessly losing their homes, and even their lives.

    For a decade now, Austin has been looked to as a model for how to save animals. We are the country’s largest no kill city, and this is largely thanks to the longstanding partnership between Austin Animal Center and Austin Pets Alive!

    Other communities look to us for guidance, and inspiration. This is, as it should be, a source of pride for our residents.

    Now we need that partnership to sustain and evolve, to meet the tremendous challenges we face together, today, as animal welfare organizations and as a city.

    Thirty-eight thousand Austin pets are in danger of losing their homes to eviction, in the coming months. Working together, in our shared city, we can face this.

    We are proud to be the leader in animal welfare innovation and now we need a true partnership with our city, so together we can keep Austin pets with their families.

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  • Austin Pets Alive! | APA! IS ASKING COUNCIL FOR A FAIR AGREEMENT

    Austin Pets Alive! | APA! IS ASKING COUNCIL FOR A FAIR AGREEMENT

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    Oct 01, 2021

    There are only seven days until the final October City Council meeting agenda must be posted.

    That means we have seven days to make it clear to the city council members that No Kill in Austin is important and deserves their urgent attention.

    There are many layers to this problem, but right now one of the most important things that you, as a supporter of the animals who need us to save their lives, can know is that we simply need a relationship with the city that makes sense.

    APA! has kept Austin No Kill by taking animals off the city’s kill list every single day for 10 years now. We will continue to do that. We will not agree to continue serving as Austin Animal Center’s overflow partner. It doesn’t make sense to our mission as a nonprofit organization or the pets that never get a chance to leave a shelter alive.

    It is no longer fair to serve as an overflow partner for Austin Animal Center anymore for two main reasons:

    First, the rebuildable land leased to APA! by the City of Austin has been dramatically reduced to just one fourth of what we were promised in the Lamar Beach Master Plan. This is not reflected anywhere in the negotiations with city staff or in our actual license agreement. It is as if it doesn’t matter. But it does matter to us because, once we sign an agreement, we cannot use the property in the future the way we have been for the last 10 years. This means we can not build anything new on this property that will even come close to matching our current capacity. It is unreasonable to expect APA! to provide the same level of services to the City when the property we have been given in exchange for those services has been so significantly reduced.

    Second, the City of Austin Animal Center has received over $10,000,000 more dollars per year than they had when Austin first became a No Kill city. Our mission is to eliminate the killing of pets in shelters and as long as an animal is at risk in Austin, we will save it. It is not reasonable to ALSO ask APA! to provide free services to Austin Animal Center that they’ve been funded to provide to Austin people and animals.

    We believe that APA’s support of the City of Austin, in keeping Austin No Kill and driving the city to be progressive and sustainable, is worth the land we are being given. City Council will have to decide if they agree. Please contact your council member’s office today with an email and follow-up call if you agree. It is so important that the council offices hear your voice before they make the final determination.

    Thank you,

    Ellen

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