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  • America Is Having a Senior Moment on Vaccines

    America Is Having a Senior Moment on Vaccines

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    For years now, health experts have been warning that COVID-era politics and the spread of anti-vaxxer lies have brought us to the brink of public-health catastrophe—that a Great Collapse of Vaccination Rates is nigh. This hasn’t come to pass. In spite of deep concerns about a generation of young parents who might soon give up on immunizations altogether—not simply for COVID, but perhaps for all disease—many of the stats we have are looking good. Standard vaccination coverage among babies and toddlers, including the pandemic babies born in 2020, is “high and stable,” the CDC reports. And kindergarteners’ immunization rates, which dipped after the pandemic started, are no longer losing ground.

    Whatever gaps in early childhood vaccination were brought on by the chaos of early 2020 have since been reversed, Alison Buttenheim, a professor of nursing and health policy at the University of Pennsylvania, told me: “We’ve substantially caught up, which is incredible. It’s actually an amazing feat.”

    Read: The good news about vaccine hesitancy

    But even in the shadow of this triumph, a more specific crisis in vaccine acceptance has emerged. Americans aren’t now suspicious of inoculations on the whole—the nation isn’t anti-vax—but we have lost faith in yearly COVID shots. Barely any children have been getting them. Among adults, the drop in uptake has been rapid and relentless: By the spring of 2022, 56 percent of all adults had received their initial booster shot; a year later, just 28 percent were up to date; so far this COVID season, just 19 percent can say the same.

    Of course, the dangers from infection have been dropping too. Almost all of us have been exposed to COVID at this point, either through prior immunization, natural infection, or—most likely—both. That makes the disease much less deadly than it’s ever been before. (Among kids, the CDC now attributes “0.00%” of weekly deaths to COVID.) But for one age group in particular—people over 65—the crashing vaccination rates should inspire dread. More than 1,500 deaths each week are still associated with COVID, and almost all of them are senior citizens; current data hint that COVID has been killing seniors at seven times the rate of flu. Across the nation’s nursing homes and retirement communities, the Great Collapse is real.

    Like younger American adults, seniors haven’t been avoiding all recommended immunizations, just the ones for COVID. Their flu-shot rates have gone down a little in the past few years, but only by a handful of percentage points from a pandemic-driven, all-time high of 75 percent. This season, about 70 percent of people over 65 have received their flu vaccine, in line with average rates that haven’t changed that much for decades. In the meantime, seniors’ uptake of the latest COVID shots has fallen off by more than half since 2022, to just 38 percent. These diverging rates—steady for the flu, plummeting for COVID—are notably at odds with the attendant risks. Seniors seem to understand the value of inoculating themselves against the flu. So why do they forgo the same precaution against something so much worse?

    Read: The COVID strategy America hasn’t really tried

    One might blame the toxic political battles around vaccines, and rampant misinformation about their ill effects. “Something terrible has happened to broaden and intensify public rejection of vaccines and other biomedical innovations in the United States,” the vaccine expert Peter Hotez wrote in his recent book The Deadly Rise of Anti-science. Certainly, toxic politics and rampant misinformation exist, but the turn against the experts that Hotez and others have decried doesn’t really fit the emergency described above. Taken as a whole, the population of Americans over 65 is hardly soured on vaccines. Nor are they afraid of COVID vaccination in particular: Though political divides persist, more than 95 percent of seniors received their initial round of shots. More than 95 percent!

    Echoing Hotez in an opinion piece for JAMA that came out last week, the FDA commissioner, Robert Califf, and a senior FDA official named Peter Marks cited the abysmal uptake of COVID shots by senior citizens as one of several signs that the country is nearing “a dangerous tipping point” on vaccination, driven by an oceanic online tide of vaccine misinformation. (Health-care providers should try to stem that tide, they wrote, with “large amounts of truthful, accessible scientific evidence.”) But the volume and intensity of anti-vaccine rhetoric seems to have diminished somewhat since 2022, Buttenheim told me: “You’d have to come up with some reason why it’s having more of an effect now than it did over the past couple of years.”

    Confusion and fatigue may well be bigger factors here than fear or false beliefs. Many Americans, young and old, have long since moved beyond the pandemic in their daily life, and may not want to think about the topic long enough to schedule another shot. The fact that people are fed up with COVID and all of the arguments it spawned is a “major drag on uptake of the vaccine,” Noel Brewer, a professor who studies health behavior at the University of North Carolina at Chapel Hill, told me. Along with many other adults, seniors have also been thrown off by changes in what the shot is called and when it’s recommended for which groups. Buttenheim doesn’t think that people are particularly afraid of this year’s dose. “This is not, like, Back off,” she said. “It’s like, Oh, there is one?”

    Read: America’s fall booster plan has a fatal paradox

    Another theory holds that the CDC is responsible for this indifference, by pushing yearly COVID shots on people of all ages, including those for whom the net benefits of further vaccination are hard to see. In the U.K., where a much narrower group of people is eligible for updated COVID shots, uptake among seniors has been almost double what it is in the U.S., at 70 percent. That’s not because the British health-care system is better organized than ours—or not only on account of that. Even in that context, British seniors only get their flu shots at a rate that’s slightly higher than American seniors do.

    The broader rollout could contribute to the problem, Rupali Limaye, an epidemiologist who studies health communication at Johns Hopkins University, told me: “When it’s a blanket recommendation, it does dilute the message.” The CDC’s messaging on COVID shots has the benefit of being simple, but at the cost of being less persuasive for the people who are at highest risk. Then again, all Americans above the age of six months are advised to get the flu shot, and more or less the same proportions do so every year. That’s a product of our training, Brewer told me: “The U.S. has invested for decades in developing the habit of getting an annual flu shot. Older adults know that this is the thing they need to do, and they are used to it.”

    Even more important than the habit of getting flu shots is the habit of supplying them. Local clinics, businesses, and retirement communities know how to give these vaccinations (and they understand how the costs will be covered); they’ve been doing this for years. Buttenheim told me that her university sets up a flu-shot clinic every fall, where she can usually get immunized in less than 90 seconds. But the equivalent for COVID shots is yet to become routine. Where the vaccines are available, appointments have been canceled over missing doses or mix-ups with insurance. Government efforts to improve access were delayed.

    With the end of the pandemic emergency, obtaining a COVID shot has simply gotten harder, no matter your intentions or beliefs. “The very well-structured and scaffolded process for getting those vaccines before has just evaporated,” Buttenheim said. For the uptake rates to turn around, a new, post-emergency system for delivery might have to be established, with less confusion over cost and coverage. Even that development alone would do a lot to end the geriatric vaccine crash. If COVID shots could be made as standardized and reflexive as the ones for flu, seasonal vaccination rates might start rising once again, at least until about two-thirds of people over 65 are getting shots. That’s the rate we see for flu shots, and probably an upper limit, Brewer said: “We won’t do better than that.”

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    Daniel Engber

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  • You Really Don’t Want to Be Thirsty in a Heat Wave

    You Really Don’t Want to Be Thirsty in a Heat Wave

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    The heat—miserable and oppressive—is not abating. Today, a third of Americans are under a heat alert as temperatures keep breaking records: Phoenix has hit 110 degrees Fahrenheit for two weeks straight, while this weekend Death Valley in California could surpass the all-time high of 130 degrees.

    Even less extreme heat than that can be dangerous. Recently, in Texas, Louisiana, part of Arizona, and Florida, there have been reports of deaths from heat, and many more hospitalizations. The toll of a heat wave is not always clear in the moment: A new report suggests that last summer’s historic heat wave in Europe killed more than 60,000 people.

    Ideally, you’d stay in the air-conditioned indoors as much as possible. That’s not an option for everyone. The other thing to do is stay hydrated. The importance of getting enough fluid is hard to overstate—and often underappreciated: Last month, the Texas state legislature banned local governments from mandating water breaks for construction workers. In the heat, hydration “impacts everything,” Stavros Kavouras, the director of the Hydration Science Lab at Arizona State University, in Phoenix, told me. And with temperatures continuing to rise, it’s essential to get it right.

    Serious dehydration is really, really bad for you. Your blood volume decreases, which makes your heart work less effectively. “Your ability to thermoregulate declines,” Kavouras told me, “so your body temperature is getting higher and higher.” You might feel weak or dizzy. Your heart rate rises; it gets harder to focus. The worst-case scenario is heatstroke, when your body stops being able to cool itself—a  potentially fatal medical emergency.

    In extreme temperatures, heat injuries can happen quicker than you might think. Given that the human body is mostly water, you might assume that there is some to spare, but inconveniently, this is not the case. “If you lose even 10 percent of [the water] your body has, you are entering the zone of serious clinical dehydration,” Kavouras said. “And if you look at optimal health, even losing just 1 percent of your body weight impacts your ability to function.” There are two basic ways your body cools itself when it gets hot. One is to send more blood to the skin, which releases heat from the core of your body, and is the reason you turn red when you’re overheated. The other is to sweat. It evaporates off your body, and in the process, your body loses excess heat. You can’t cool yourself as effectively if you’re not properly hydrated. At the same time, one of your main cooling mechanisms is actively dehydrating, which means the goal is not just to be hydrated, but to stay that way.

    What that takes depends on many factors rather than a single universal rule, but in general, the danger zone is “high humidity with anything above 90 degrees,” Kavouras said, at which point, “it’s actually dangerous” just to be outside. The more active you are in the heat, and the hotter and more humid it is, the greater the risk—and the more important proper hydration becomes. The standard water target in the U.S. during non-heat-wave times is 3.7 liters a day for men and 2.7 liters for women. When it’s very, very hot out, you need more. Even if you spend most of the day in the bliss of AC, you are almost certainly leaving the house at some point.

    Instead of trying to figure out what that precise amount should be, Kavouras recommends you focus on two things instead. “No. 1, keep water close to you. If you have water close to you, or whatever healthy beverage, you’ll end up drinking more, just because it’s closer,” he said. And second: Keep an eye on how often you pee—pale urine, six to seven times a day, or every two to three hours, is good. You want it to be “basically like a Chablis, a Riesling, Pinot Grigio, or champagne-colored,” John Higgins, a sports cardiologist at McGovern Medical School at UTHealth, in Houston, told me. “If you notice the urine is getting darker, like a Chardonnay- or Sauvignon Blanc–type of thing, that generally means you are dehydrated.”

    Certain groups are especially at risk. Older adults are more prone to dehydration, as are young children, people who are pregnant, and people taking certain medications—blood-pressure medications, for example. None of this requires you to take in extra fluids per se, just that you need to be even more careful that you’re getting enough.

    As for what to drink, as a go-to beverage, straight water is hard to beat. Water with fruit slices floating in it has the benefit of feeling like something from a luxury hotel. Carbonated water is also good—you might not be able to drink quite as much of it, which is a potential drawback, but “there is no mechanism in your GI system that will make sparkling water less effective at hydrating you,” Kavouras said. You probably want to avoid downing giant buckets of coffee—caffeine is a diuretic in large quantities and Higgins warns against sugary drinks for the same reason. (A daily iced coffee is fine.) If you’re doing hours of heavy sweating, then you might work in some (less sugary) sports drinks. But for the majority of people, water remains the ideal. Food can also be a fluid source: “Make sure you’re eating a diet that’s rich in vegetables and fruits that have water content,” William Adams, the director of the University of North Carolina at Greensboro’s Hydration, Environment and Thermal (H.E.A.T) Stress Lab, advised. Alcohol, which causes you to lose fluid, is definitively unhelpful.

    There are lots of water myths out there. Can you go too hard? Technically, it’s possible to over-hydrate, causing an electrolyte imbalance, but all three experts agreed that for most people, this isn’t really a concern. You can find arguments for drinking hot drinks in the summer—the idea being that they increase the amount you sweat, thereby promoting cooling. But Kavouras is emphatic that you’re better off with cold drinks, which cool your body, he said. In the moments before a race, marathon runners will sometimes take it one step further, slurping ice slurries to lower their body temperature. For good old-fashioned drinking water, about 50 degrees Fahrenheit is best—roughly the temperature of cool water from the tap.

    One final key to staying hydrated: Start early. A lot of people, Higgins said, are lightly dehydrated all the time, heat wave or not. “So particularly when you first wake up in the morning, typically you are in a dehydrated state.” Accordingly, he recommends that people drink about a standard water bottle’s worth—roughly 17 ounces—as soon as they wake up. The other thing people forget about, he said, is what happens when they come back inside after enduring the outdoors. “You keep sweating,” he pointed out. In other words: hydrate, and then keep hydrating.

    As crucial as hydration is, it is not a miracle. “It doesn’t mean that you can say, ‘I hydrate well, so I’ll go out for a run in the 120-degree weather, and I’ll be fine because I’m drinking a lot,’” Kavouras said. “It doesn’t work this way.” Still, it is a simple but effective tool. As heat waves like this one become even more frequent, many more people will need to learn how to become attuned to their hydration. And perhaps adequate water can be a perverse sort of comfort: You can’t control the unrelenting heat, but you likely can control your water intake. In a heat wave, it helps to have a glass-half-full attitude—and an emptied glass of water.

    This story is part of the Atlantic Planet series supported by HHMI’s Science and Educational Media Group.

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    Rachel Sugar

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  • Get Used to Expensive Eggs

    Get Used to Expensive Eggs

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    Over the past week, my breakfast routine has been scrambled. I have had overnight oats, beans on sourdough, corned-beef hash and fried rice, and, on a particularly weird morning, leftover cream-of-broccoli soup. Under normal circumstances, I would be eating eggs. But right now, I’m in hoarding mode, jealously guarding the four that remain from a carton purchased indignantly for six dollars. For that price—50 damn cents each!—my daily sunny-side-up eggs will have to wait. The perfect moment beckons: Maybe a toasted slab of brioche will call for a luxurious soft scramble, or maybe I will cave to a powerful craving for an egg-salad sandwich.

    Eggs, that quintessential cheap food, have gotten very, very expensive in the United States. In December, the average price for a dozen eggs in U.S. cities hit an all-time high of $4.25, up from $1.78 a year earlier. Though the worst now seems to be behind us, there’s still a way to go before consumer prices hit reasonable levels, and now Americans are starting to crack. Online, the shortage has recently hatched endless memes: In some posts, people pretend to portion out eggs in plastic baggies, like drug dealers (Pablo Eggscobar, anyone?); another recurring bit suggests painting potatoes to hunt at Easter. The high prices have even led to egg smuggling, and raised the profile of “rent-a-chicken” services where customers can borrow hens, chicken feed, and a coop for a couple hundred bucks.

    Surging egg prices are partly a familiar story of pandemic-era inflation. Producing eggs costs more because fuel, transportation, feed, and packaging are more expensive now, Jada Thompson, an agricultural economist at the University of Arkansas, told me. And it doesn’t help that there are no great substitutes for eggs. But a big reason that prices are so high right now is because of the avian flu—a virus that infects many types of birds and is deadly for some. Right now, we’re facing the worst-ever wave in the U.S., which has decimated chicken flocks and dented America’s egg inventory. Just over the past year, more than 57 million birds have died from the flu. Some much-needed relief from sky-high egg prices is likely coming, but don’t break out the soufflé pans yet. All signs suggest that avian flu is here to stay. If such rampant spread of the virus continues, “these costs are not going to come down to pre-2022 levels,” Thompson told me. Cheap eggs may soon become a thing of the past.

    This isn’t the first time American egg producers have encountered the avian flu, but dealing with it is still a challenge. For one thing, the virus keeps changing. It has long infected but not killed waterfowl and shorebirds, such as ducks and geese, but by 1996, it had mutated into the “highly pathogenic” H5N1, a poultry-killing strain that is named for the nasty versions of its “H” and “N” proteins. (They form spikes on the virus’s surface—sound familiar?) In 2014 and 2015, H5N1 ignited a terrible outbreak of avian flu, which gave U.S. poultry farmers their first taste of just how bad egg shortages could get.

    But this outbreak is like nothing we’ve seen before. The strain of avian flu that’s behind this wave is indeed new, and in the U.S. the virus has been circulating for a full year now—far longer than during the last big outbreak. The virus has become “host-adapted,” meaning that it can infect its natural hosts without killing them, so wild waterfowl are ruthlessly efficient at spreading the virus to chickens, Richard Webby, the director of the World Health Organization Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds, told me.

    Many of these wild birds are migratory, and during their long journeys between Canada and South America, they descend on waterways and poop virus from the sky over poultry farms. Chickens stand no chance: The fleshy flaps on their heads may turn blue, their eyes and neck may swell, and, in rare instances, paralysis occurs. An entire poultry flock can be wiped out in 48 hours. Death is swift and vicious.

    Everything about this current wave has aligned to put a serious dent in our egg supply. Most eggs in the United States are hatched in jam-packed industrial egg farms, where transmission is next to impossible to stop, so the go-to move when the flu is detected is to “depopulate,” the preferred industry term for killing all of the birds. Without such a brutal tactic, Bryan Richards, the emerging-disease coordinator at the U.S. Geological Survey, told me, the current wave would be much worse.

    But this strategy also means fewer eggs, at least until new chicks grow into hens. That takes about six months, so there just haven’t been enough hens lately—especially for all the holiday baking people wanted to do, Thompson said. By the end of 2022, U.S. egg inventory was 29 percent lower than it had been at the beginning of the year. The chicken supply, in contrast, is robust because avian flu tends to affect older birds, like egg layers, Thompson said; at six to eight weeks old, the birds we eat, known as broilers, are not as susceptible. Also, she added, wild-bird migration pathways are not as concentrated in the Southeast, where most broiler production happens.

    Egg eaters should be able to return to their normal breakfast routines soon enough. New hens are now replenishing the U.S. egg supply—while waterfowl are wintering in the warmer climes of South America rather than lingering in the U.S. Since the holidays, “the price paid to the farmers for eggs has been decreasing rapidly, and usually, in time, the consumer price follows,” Maro Ibarburu, a business analyst at Iowa State University’s Egg Industry Center, told me.

    Still, going forward, it may be worth rethinking our relationship with eggs. There’s no guarantee that eggs will go back to being one the cheapest and most nutritious foods. When the weather warms, the birds will return, and “it’s highly likely that upon spring migration, we could see yet another wave,” said Richards. Europe, which experienced the H5N1 wave about six months before the Americas did, offers a glimpse of the future. “They went from being in a situation where the virus would come and go to a position where essentially it came and stayed,” Webby told me. If we’re lucky, though, birds will develop natural immunity to the virus, making it harder to spread, or the U.S. could start vaccinating poultry against the flu, which the country has so far been reluctant to do.

    Omelets aside, curbing the spread of avian flu is in our best interest, not just to help prevent $6 egg cartons, but also to avoid a much scarier possibility—the virus spilling over and infecting people. All viruses from the influenza-A family have an avian origin, noted Webby; a chilling example is the H1N1 strain behind the 1918 flu pandemic. Fortunately, though some people have been infected with H5N1, very few cases of human-to-human spread have been documented. But continued transmission, over a long enough period, could change that. The fact that the virus has recently jumped from birds into mammals, such as seals and bears, and has spread among mink, is troubling because that means that it is evolving to infect species that are more closely related to us. “The risk of this particular virus [spreading among humans] as it is now is low, but the consequences are potentially high,” said Webby. “If there is a flu virus that I don’t want to catch, this one would be it.”

    More than anything, the egg shortage is a reminder that the availability of food is not something we can take for granted going forward. Shortages of staple goods seem to be striking with more regularity, not only due to pandemic-related broken supply chains and inflation but also to animal and plant disease. In 2019, swine fever decimated China’s pork supply; the ongoing lettuce shortage, which rapper Cardi B bemoaned earlier this month, is due to both a plant virus and a soil disease. Last September, California citrus growers detected a virus known to reduce crop yields. By creating cozier conditions for some diseases, climate change is expected to raise risk of infection for both animals and plants. And as COVID has illustrated, any situation in which different species are forced into abnormally close quarters with one another is likely to encourage the spread of disease.

    Getting used to intermittent shortages of staple foods such as eggs and lettuce will in all likelihood become a normal part of meal planning, barring some sort of huge shift away from industrial farming and its propensity for fostering disease. These farms are a major reason that these foods are so inexpensive and widely available in the first place; if cheap eggs seemed too good to be true, it’s because they were. Besides, there are always alternatives: May I suggest cream-of-broccoli soup?

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    Yasmin Tayag

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