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Tag: worst-case scenario

  • 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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  • The Masks We’ll Wear in the Next Pandemic

    The Masks We’ll Wear in the Next Pandemic

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    On one level, the world’s response to the coronavirus pandemic over the past two and half years was a major triumph for modern medicine. We developed COVID vaccines faster than we’d developed any vaccine in history, and began administering them just a year after the virus first infected humans. The vaccines turned out to work better than top public-health officials had dared hope. In tandem with antiviral treatments, they’ve drastically reduced the virus’s toll of severe illness and death, and helped hundreds of millions of Americans resume something approximating pre-pandemic life.

    And yet on another level, the pandemic has demonstrated the inadequacy of such pharmaceutical interventions. In the time it took vaccines to arrive, more than 300,000 people died of COVID-19 in America alone. Even since, waning immunity and the semi-regular emergence of new variants have made for an uneasy détente. Another 700,000 Americans have died over that period, vaccines and antivirals notwithstanding.

    For some pandemic-prevention experts, the takeaway here is that pharmaceutical interventions alone simply won’t cut it. Though shots and drugs may be essential to softening a virus’s blow once it arrives, they are by nature reactive rather than preventive. To guard against future pandemics, what we should focus on, some experts say, is attacking viruses where they’re most vulnerable, before pharmaceutical interventions are even necessary. Specifically, they argue, we should be focusing on the air we breathe. “We’ve dealt with a lot of variants, we’ve dealt with a lot of strains, we’ve dealt with other respiratory pathogens in the past,” Abraar Karan, an infectious-disease physician and global-health expert at Stanford, told me. “The one thing that’s stayed consistent is the route of transmission.” The most fearsome pandemics are airborne.

    Read: The plan to stop every respiratory virus at once

    Numerous overlapping efforts are under way to stave off future outbreaks by improving air quality. Many scientists have long advocated for overhauling the way we ventilate indoor spaces, which has the potential to transform our air in much the same way that the advent of sewer systems transformed our water. Some researchers are similarly enthusiastic about the promise of germicidal lighting. Retrofitting a nation’s worth of buildings with superior ventilation systems or germicidal lighting is likely a long-term mission, though, requiring large-scale institutional buy-in and probably a considerable amount of government funding. Meanwhile, a more niche subgroup has zeroed in on what is, at least in theory, a somewhat simpler undertaking: designing the perfect mask.

    Two and a half years into this pandemic, it’s hard to believe that the masks widely available to us today are pretty much the same masks that were available to us in January 2020. N95s, the gold standard as far as the average person is concerned, are quite good: They filter out at least 95 percent of .3-micron particles—hence N95—and are generally the masks of preference in hospitals. And yet, anyone who has worn one over the past two and a half years will know that, lucky as we are to have them, they are not the most comfortable. At a certain point, they start to hurt your ears or your nose or your whole face. When you finally unmask after a lengthy flight, you’re liable to look like a raccoon. Most existing N95s are not reusable, and although each individual mask is pretty cheap, the costs can add up over time. They impede communication, preventing people from seeing the wearer’s facial expressions or reading their lips. And because they require fit-testing, the efficacy for the average wearer probably falls well short of the advertised 95 percent. In 2009, the federal government published a report with 28 recommendations to improve masks for health-care workers. Few seem to have been taken.

    These shortcomings are part of what has made efforts to get people to wear masks an uphill battle. What’s more,Over the course of the pandemic, several new companies have submitted new mask designs to NIOSH, the federal agency tasked with certifying and regulating masks,. Few, if any, have so far been certified. The agency appears to be overworked and underfunded. In addition, Joe and Kim Rosenberg, who in the early stages of the pandemic launched a mask company that applied unsuccessfully for NIOSH approval, told me the certification process is somewhat circular: A successful application requires huge amounts of capital, which in turn require huge amounts of investment, but investors generally like to see data showing that the masks work as advertised in, say, a hospital, and masks cannot be tested in a hospital without prior NIOSH approval. (NIOSH did not respond to a request for comment.)

    New products aside, there do already exist masks that outperform standard N95s in one way or another. Elastomeric respirators are reusable masks that you outfit with replaceable filters. Depending on the filter you use, the mask can be as effective as an N95 or even more so. When equipped with HEPA-quality filters, elastomerics filter out 99.97 percent of particles. And they come in both half-facepiece versions (which cover the nose and mouth) and full-facepiece versions (which also cover the eyes). Another option are PAPRs, or powered air-purifying respirators—hooded, battery-powered masks that cover the wearer’s entire head and constantly blow HEPA-filtered air for the wearer to breathe.

    Given the challenges of persuading many Americans to wear even flimsy surgical masks during the past couple of years, though, the issues with these superior masks—the current models, at least—are probably disqualifying as far as widespread adoption would go in future outbreaks. Elastomerics generally are bulky, expensive, limit range of motion, obscure the mouth, and require fit testing to ensure efficacy. PAPRs have a transparent facepiece and in many cases don’t require fit testing, but they’re also bulky, currently cost more than $1,000 each, and, because they’re battery-powered, can be quite noisy. Neither, let me assure you, is the sort of thing you’d want to wear to the movie theater.

    Read: Is it time to start masking again?

    The people who seem most fixated on improving masks are a hodgepodge of biologists, biosecurity experts, and others whose chief concern is not another COVID-like pandemic but something even more terrifying: a deliberate act of bioterrorism. In the apocalyptic scenarios that most worry them—which, to be clear, are speculative—bioterrorists release at least one highly transmissible pathogen with a lethality in the range of, say, 40 to 70 percent. (COVID’s is about 1 percent.) Because this would be a novel virus, we wouldn’t yet have vaccines or antivirals. The only way to avoid complete societal collapse would be to supply essential workers with PPE that they can be confident will provide infallible protection against infection—so-called perfect PPE. In such a scenario, N95s would be insufficient, Kevin Esvelt, an evolutionary biologist at MIT, told me: “70-percent-lethality virus, 95 percent protection—wouldn’t exactly fill me with confidence.”

    Existing masks that use HEPA filters may well be sufficiently protective in this worst-case scenario, but not even that is a given, Esvelt told me. Vaishnav Sunil, who runs the PPE project at Esvelt’s lab, thinks that PAPRs show the most promise, because they do not require fit testing. At the moment, the MIT team is surveying existing products to determine how to proceed. Their goal, ultimately, is to ensure that the country can distribute completely protective masks to every essential worker, which is firstly a problem of design and secondly a problem of logistics. The mask Esvelt’s team is looking for might already be out there, just selling for too high a price, in which case they’ll concentrate on bringing that price down. Or they might need to design something from scratch, in which case, at least initially, their work will mainly consist of new research. More likely, Sunil told me, they’ll identify the best available product and make modest adjustments to improve comfort, breathability, useability, and efficacy.

    Esvelt’s team is far from the only group exploring masking’s future. Last year, the federal government began soliciting submissions for a mask-design competition intended to spur technological development. The results were nothing if not creative: Among the 10 winning prototypes selected in the competition’s first phase were a semi-transparent mask, an origami mask, and a mask for babies with a pacifier on the inside.

    In the end, the questions of how much we should invest in improving masks and how we should actually improve them boil down to a deeper question about which possible future pandemic concerns you most. If your answer is a bioengineered attack, then naturally you’ll commit significant resources to perfecting efficacy and improving masks more generally, given that, in such a pandemic, masks may well be the only thing that can save us. If your answer is SARS-CoV-3, then you might worry less about efficacy and spend proportionally more on vaccines and antivirals. This is not a cheery choice to make. But it is an important one as we inch our way out of our current pandemic and toward whatever waits for us down the road.

    Read: The pandemic’s legacy is already clear

    For the elderly and immunocompromised, super-effective masks could be useful even outside a worst-case scenario. But more traditional public-health experts, who don’t put as much stock in the possibility of a highly lethal, deliberate pandemic, are less concerned about perfecting efficacy for the general public. The greater gains, they say, will come not from marginally improving the efficacy of existing highly effective masks but from getting more people to wear highly effective masks in the first place. “It’s important to make masks easier for people to use, more comfortable and more effective,” Linsey Marr, an environmental engineer at Virginia Tech, told me. It wouldn’t hurt to make them a little more fashionable either, she said. Also important is reusability, Jassi Pannu, a fellow at the Johns Hopkins Center for Health Security, told me, because in a pandemic stockpiles of single-use products will almost always run out.

    Stanford’s Karan envisions a world in which everyone in the country has their own elastomeric respirator—not, in most cases, for everyday use, but available when necessary. Rather than constantly replenishing your stock of reusable masks, you would simply swap out the filters in your elastomeric (or perhaps it will be a PAPR) every so often. The mask would be transparent, so that a friend could see your smile, and relatively comfortable, so that you could wear it all day without it cutting into your nose or pulling on your ears. When you came home at night, you would spend a few minutes disinfecting it.

    Karan’s vision might be a distant one. America’s tensions over masking throughout the pandemic give little reason to hope for any unified or universal uptake in future catastrophes. And even if that happened, everyone I spoke with agrees that masks alone are not a solution. They’re almost certainly the smallest part of the effort to ensure that the air we breathe is clean, to change the physical world to stop viral transmission before it happens. Even so, making and distributing millions of masks is almost certainly easier than installing superior ventilation systems or germicidal lighting in buildings across the country. Masks, if nothing else, are the low-hanging fruit. “We can deal with dirty water, and we can deal with cleaning surfaces,” Karan told me. “But when it comes to cleaning the air, we’re very, very far behind.”

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    Jacob Stern

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  • Liz Cheney Already Has a 2024 Strategy

    Liz Cheney Already Has a 2024 Strategy

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    The defiant speech from Representative Liz Cheney of Wyoming after her defeat in yesterday’s Republican primary could be reduced to a single message: This is round one.

    Cheney didn’t specify how, or where, she intends to continue her struggle against former President Donald Trump, after Harriet Hageman, the candidate Trump endorsed, routed her by more than two to one in the primary for Wyoming’s lone congressional seat.

    But Cheney dropped a big hint when she noted that the GOP’s Founding Father, Abraham Lincoln, lost elections for the House and Senate “before he won the most important election of all” by capturing the presidency. This morning, she went a step further, telling the Today show that she was “thinking about” joining the 2024 Republican presidential race.

    The magnitude of Cheney’s defeat yesterday underscores how strong Trump remains within the party, and how little chance a presidential candidacy based explicitly on repudiating him would have of capturing the nomination.

    Yet many of Trump’s remaining Republican critics believe that a Cheney candidacy in the 2024 GOP presidential primaries could help prevent him from capturing the next nomination—or stop him from winning the general election if he does. “Of course she doesn’t win,” Bill Kristol, the longtime strategist who has become one of Trump’s fiercest conservative critics, told me. But, he added, if Cheney “makes the point over and over again” that Trump represents a unique threat to American democracy and “forces the other candidates to come to grips” with that argument, she “could have a pretty significant effect” on Trump’s chances.

    In some ways, a Cheney 2024 presidential campaign would be unprecedented: There aren’t any clear examples of a candidate running a true kamikaze campaign.

    Cheney would have no trouble assembling the building blocks of a traditional presidential campaign. Her name identification is extremely high, for both her familial ties and her prominence as a Trump critic. Her potential fundraising base is strong: Through late July, she had already raised more than $15 million in her House race, and in a presidential run, she could tap into a huge pool of small-dollar donors (many of them Democrats) determined to block Trump. And with her unflinching attacks on the former president, she would be ensured bottomless media coverage.

    Cheney could face other logistical hurdles. She reduced her in-person campaign appearances in Wyoming because of security threats, and that problem would undoubtedly persist in any presidential campaign. Dave Kochel, a longtime Republican consultant with extensive experience in Iowa, told me that Cheney could likely find ways to deliver her message even amid such threats. “You would need a lot of security, no doubt about that,” he said. “But remember, these days you can do a lot of this stuff from the green room. You don’t have to be going to the diner or the Hy-Vee or the state fair. It’s essentially a media strategy.”

    More difficult to overcome would be obstacles erected by the national and state Republican parties. The laws governing which candidates can appear on a presidential primary ballot vary enormously across the states. For instance, in New Hampshire, anyone who meets the legal requirements for the presidency, fills out a one-page form, and pays $1,000 can appear on the venerable first-in-the-nation ballot. But in other states—including Iowa and South Carolina—the state party controls whose name can be included on the primary ballot. And in at least some of those places, either the state party or the Republican National Committee, which has subordinated itself to Trump under Chair Ronna McDaniel, would likely move to keep Cheney off the ballot as a means of protecting him.

    Debates could be another challenge for Cheney. The general feeling among Republicans I spoke with this week is that the RNC would go to almost absurd lengths to avoid allowing Cheney to appear on the same debate stage as Trump. Kristol predicted that the party might try to exclude her by requiring any candidate participating in a RNC-sanctioned debate to commit to supporting the party’s eventual nominee in the general election—something Cheney’s determination to stop Trump would not allow her to do. (In 2016, the RNC imposed such a loyalty oath primarily out of fear that Trump wouldn’t endorse the nominee if he lost. Trump signed it but characteristically renounced it in the race’s latter stage.)

    Read: The Mar-a-Lago ‘raid’ put Ron DeSantis in a box

    Even so, it would be difficult for any media organization that sponsors an RNC debate to agree to keep her off the stage. And if Cheney is registering reasonable support in the polls—say 5 percent or more—even state parties might think twice about barring her. “Every other candidate not named Trump is going to want Liz Cheney on the debate stage,” the GOP consultant Alex Conant, the communications director for Senator Marco Rubio’s 2016 presidential campaign, told me.

    No one I talked with thinks Cheney could come anywhere close to winning the GOP nomination behind an anti-Trump message. The widespread success of Trump-endorsed candidates, almost all of whom overtly echo his lies about the 2020 election, in this year’s GOP primaries has made clear that the former president remains the party’s dominant figure (despite occasional losses for his picks). With Cheney’s defeat yesterday, four of the 10 House Republicans who voted to impeach Trump after the January 6 attack on the Capitol have now been ousted in primaries, and four others have retired; only two have survived to face voters in November. “Trump continues to own a majority share of the Republican Party and the GOP has remade itself in his image,” Sarah Longwell, founder of the Republican Accountability Project, a group critical of Trump, told me in an email.

    But many Republicans resistant to Trump believe that Cheney could rally the minority of party voters who continue to express reservations about the former president. In public polls, as many as one-fourth of Republicans and GOP-leaning independents reject Trump’s claim that the 2020 election was stolen, or criticize his efforts to overturn the result and his role in the January 6 insurrection. The share of Trump critics is usually slightly higher among Republicans holding at least a four-year college degree—a group that was notably cooler toward him during his first run to the nomination in 2016 and that sharply moved away from the GOP in the 2018 and 2020 elections. Some of those voters have since soured on President Joe Biden and the Democrats, but Cheney could spend months reminding them why they rejected Trump in the first place. “Especially among college-educated and donor-class Republicans, I think she continues to just chip away at Trump,” Kristol said.

    Whit Ayres, a longtime GOP pollster, believes that the core of Republican-leaning voters hostile to Trump is smaller—only about one in 10, rather than the roughly one in five suggested by some poll questions. But he believes a Cheney candidacy could reach beyond that circle to raise doubts among a much bigger group: Republicans who are neither hard-core Trump supporters or opponents, but are focused mostly on winning in 2024. Although Cheney might appeal solely to the thin sliver of die-hard Trump opponents “with a prophetic-moral case … about the importance of devotion to our democratic institutions and the U.S. Constitution,” Ayres said, that larger group might respond to “a very practical utilitarian case” that Trump has too much baggage to win a general election.

    The best-case scenario for the Trump critics if Cheney runs is that her battering-ram attacks weaken him to the point that someone else can capture the nomination. As Longwell told me, even if “Liz likely cannot win a Republican primary (though anything can happen!) … she can play a significant role in helping someone else beat Trump in a Republican primary.”

    The worst-case scenario raised by some Trump critics is that a sustained attack on him will encourage GOP voters, and even other candidates, to rally to his defense more than they would otherwise.

    But even those sympathetic to Cheney recognize that the 2024 primaries may offer only so much opportunity to change the party’s direction. Many of them view Trump’s strongest competitor in early polls, Governor Ron DeSantis of Florida, as little improvement over Trump in his commitment to a pluralistic democracy; Cheney recently told The New York Times that DeSantis has aligned himself so closely with Trump that she would find it “very difficult” to support him in 2024 either.

    These dynamics explain why many Cheney supporters believe that the real leverage for her—and other Trump critics—would come from working to defeat the former president, or a like-minded alternative, in the 2024 general election. The only plausible way to break Trump’s hold on the GOP, these critics believe, is to show that Trump, or Trumpism, cannot win national elections. Even if Cheney cannot deny Trump the nomination, she could still ultimately loosen his hold on the party, this thinking goes, if she persuades enough centrist and white-collar voters to reject him and ensure his defeat in a general election. To save the party, in other words, Cheney might first have to be willing to destroy it.

    Read: Liz Cheney, the Republican  from the state of reality

    Cheney signaled her willingness to accept such a mission yesterday, when her remarks condemned not only Trump but Republicans who have enabled him, especially those echoing his noxious discredited claims of fraud in 2020. But how she may pursue her goals remains unclear. Though most Republicans sympathetic to Cheney think she should run in the 2024 GOP primaries, others believe she might have more influence leading an outside movement against Trump. Cheney’s GOP supporters are even more divided over a possible general-election strategy; some sympathizers believe she would hurt Trump most by running as an independent third-party presidential candidate in the general election, and others worry that such a bid would help Trump by splitting voters resistant to him.

    Cheney has many months to resolve those choices. What she indicated yesterday is that when she talks about a long battle, she is looking not only past the Wyoming House GOP primary but even past the struggle for the next GOP presidential nomination. The real prize she’s keeping her eyes on is preventing Trump from ever occupying the White House again, whatever that takes.

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    Ronald Brownstein

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