It’s been nearly a year since Julie Horowitz-Jackson’s mother, Arlene, died of Covid-19 in a nursing facility in Philadelphia. “What hit me recently is that the world is opening back up, and my mom’s still dead,” Horowitz-Jackson says.
At this point in the Covid-19 pandemic, as vaccines get rolled out in the United States and around the globe, there is a glimmer of hope that life will safely start shifting back to “normal” in the coming months. But so many people, like Horowitz-Jackson, are still working through their grief, and it won’t just disappear when the virus does. Horowitz-Jackson, 51, says she was coping well with the loss of her mom until recently, when, in Chicago, where she lives, she saw many people out and about, celebrating St. Patrick’s Day in large crowds. “I get angry,” she says. “I get angry that people aren’t taking it seriously.”
With over 550,000 reported Covid-19 deaths in the US and 2.8 million worldwide, a massive grief crisis is upon us — with large, unaddressed mental health and economic implications.
“For a large share of people, these [losses] lead to bouts of prolonged grief disorder and depression,” says Ashton Verdery, a Penn State sociologist who studies the societal costs of bereavement. “But also they have huge impacts on their finances, on their employment, on their relationships, and on all kinds of aspects of thriving in the world.”
And new research here provides a broad window onto the lasting scope of our national tragedy.
“These losses that are felt now will be felt for some time to come — even individuals who aren’t born yet will potentially be missing these relatives who might have been alive during their formative years,” says Mallika Snyder, a graduate researcher at UC Berkeley who is also working on estimates with colleagues of the “excess bereavement” felt in the United States and other countries this year.
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There’s no exact figure on the amount of “excess bereavement,” but it’s likely very large, and very devastating.
So many more people are grieving this year than normal
Lately, I’ve been trying to understand the long-term consequences of the Covid-related death — the blank spaces and shadows it leaves behind. Death is not a one-dimensional statistic. It ripples across time, leaving holes in people’s present and future where their loved ones would have been. So, so many people are sensing these holes in their lives right now.
Recently, Verdery and colleagues estimated that, roughly, every person who dies from Covid-19 in the United States leaves nine grieving people behind. Since more than 550,000 people have died of Covid-19 here, then there are nearly 5 million people who’ve suffered the loss of someone close to them.
Verdery’s work is based on a statistical model of the personal connections people typically have. The Centers for Disease Control and Prevention collects data on who is dying of Covid-19, but not the survivors they leave behind.
That said, Verdery says his team’s work suggests a huge swath of people are dealing with loss. “Each death [regardless of their age at death] is going to leave a 4-year-old, a 50-year-old, a 60-year-old, a 10-year-old bereaved, on average,” he says.
And researchers know from past disasters that those losses can leave a lasting mark.
Meghan Zacher, a sociology researcher at Brown, has recently re-analyzed some mental health and wellness data collected from survivors of Hurricane Katrina, in an attempt to predict some of the long-term consequences of the pandemic. “Katrina and Covid are different in really important ways,” she stresses. “This isn’t an apples-to-apples comparison. But there really isn’t an apples-to-apples comparison to the pandemic, at least in modern history.”
She and her co-authors found that the experience of losing a relative or a friend during the storm and its aftermath had the “largest effects on mental and physical health, one year after the storm,” she says. “Also things like fearing for your loved ones’ safety had sizable impacts, as did unmet medical needs. And those are all things that people have experienced during the pandemic.”
Many people experiencing loss from death could benefit from counseling. Covid-19 swells their numbers.
The loss of a loved one is really hard, and not everyone copes in the same way. But there’s some research into the broad buckets of need grieving people fall into. And that helps us understand the immediate impact this bereavement crisis is having in the country — and around the world.
Survey research suggests that, at least in Western contexts, around 60 percent of people dealing with a loss cope by relying on friends and family to support them. “They handle it in their own way,” says Catriona Mayland, a physician and researcher at the University of Sheffield who studies end-of-life issues. It’s not necessarily easy for this group to deal with loss. But they manage.
A further 30 percent might need some more structured help. “So that might be group bereavement support from a faith-based or community-based group,” Mayland says.
And then around 10 percent of those who lose someone close to them experience symptoms qualifying them for a prolonged grief disorder, a diagnosis that soon will be included in the DSM (the psychology/psychiatry official diagnostic manual).
The diagnosis recognizes that sometimes grief rises to the level of severely interfering with the normal function of life, and that people experiencing prolonged grief could benefit from mental health care.
That 10 percent figure is both small and large. It means that, yes, most people cope with loss in their own time. But it’s also not uncommon for someone to need extra help.
And then consider the Covid-19 pandemic. Again, there could be 5 million people grieving losses due to the pandemic. If 10 percent of those people qualify for this diagnosis, that’s half a million people.
There’s even some limited research from the Netherlands suggesting losses due to Covid-19 are harder to take, resulting in more grief, compared to deaths from more typical natural causes.
Talking with people who have experienced loss, it’s easy to see why. Horowitz-Jackson’s family is Jewish, and it’s custom for the family and surrounding community of the deceased to hold a week-long open house “shiva” period, where there’s near-constant company in the home.
“Shiva Zoom was about the worst thing I’ve ever experienced,” she says. Particularly, she remembers how her father, hard of hearing, struggled with the technology. “The ritual of seeing each other and leaning on one another,” she says, just couldn’t be facilitated as well over the internet.
Mayland worries, too, that “there actually could be an upward shift” in the number of people needing more than informal support after a loss, since due to the social distancing restrictions of the pandemic, “normal support” from family and friends may be limited.
Which is all to say: More people than usual may need support to deal with their loss.
Bereavement can impact health and well-being differently at different ages
A person older than 65 who loses a spouse has a “shockingly elevated” increased risk of dying over the next year, Verdery says — estimates range from 15 to 30 percent higher risk of dying. There are many reasons: Our loved ones take care of us when we’re sick, they prod us to get checked out by a doctor, they provide emotional and sometimes financial support. When a loved one gets taken out of the picture, so many cracks can form in the foundations of our lives.
There is, quite literally, a condition called “broken heart syndrome,” or takotsubo cardiomyopathy. It’s when, in reaction to a sudden surge in stress, the heart’s left ventricle weakens.
The experience of loss can be particularly impactful on the trajectory of a life when it comes to young people: When a person under the age of 18 loses a parent, they become less likely to finish high school or college. “Because we know that education is so strongly linked to all manner of life course outcomes — like involvement in the prison system, socioeconomic status in adulthood, unemployment spells, early pregnancy, all sorts of stuff — this does suggest that some of these bereavement events might be really derailing,” Verdery says.
The impact of these deaths is so powerful that bereavement is thought to be a source of racial disparities in health and education in America. By age 20, a Black child is twice as likely to experience the death of a mother and 50 percent more likely to experience the death of a father. The pandemic is likely to make this trend worse — as we know Covid-19 has been taking minorities at younger ages than white people dying from it.
And American society doesn’t do well to protect these grieving kids. It’s estimated that less than 50 percent of children who experience the loss of a parent receive Social Security survivors benefits (which they may be entitled to). “This is one of the most staggering statistics that I found,” Verdery says. “The kids are already dealing with so much. And we’re not even getting them in touch with the benefits they’re entitled to.”
What should we do about this?
After experiencing the loss of her child, Joyal Mulheron, a former adviser to Michelle Obama’s “Let’s Move” campaign, felt the extreme, life-altering pain bereavement can bring. “I basically drove to work every day for 18 months and cried to and from work,” she says. And it wasn’t just her personal pain that was horrible — she also realized that society often overlooks bereavement issues.
Now Mulheron runs Evermore, a bereavement-focused nonprofit, and hopes the pandemic will be a wake-up call for the country to start paying closer attention to the societal strain bereavement puts on the country. “The challenge is no one is thinking about it as an event that can change the course of an individual’s life,” she says.
For instance, she points out that “bereavement is not part of the FMLA” — the Family and Medical Leave Act, which provides time off for those caring for sick family members, but not to cope with their loss. She calls for better housing protections for those who lose financial support after losing a loved one, more transparent funeral pricing, and better Social Security assistance for kids who lose parents.
She also simply would like to see this issue be studied more thoroughly. “We’ve not had the data to really contextualize this,” Mulheron says. “We’ve really thought of a death event as a personal tragedy, rather than a family or a community experience.” At the very least, Mulheron would like to see the White House establish an Office of Bereavement Care, to set a national agenda on this issue.
On a smaller scale, Mayland, the physician who studies end-of-life issues, says it can be helpful just to find spaces to talk about grief, and more helpful still if friends and family reach out with an ear to listen. “Sometimes it’s therapeutic to be able to tell a story,” she says.
“Each time I talk about it, I feel like I’m honoring her memory,” Horowitz-Jackson, the Chicago woman who lost her mother, says.
And don’t forget, Mayland stresses, “Individual kindness can have an impact. It often is the small things that actually can make a difference.”
If you’re reading this, having lost someone to Covid-19, know that you are not alone. So many people are experiencing loss in the country right now, and the pain might not go away when life appears to return to normal.
For some additional resources on bereavement, check out Refuge in Grief, a website and online community with worksheets and courses for processing grief. And you can read more about therapies designed to help people with complicated grief here.
Over the past few days, Covid-19 cases have taken an upward turn — a trend that led Centers for Disease Control and Prevention Director Rochelle Walensky to say she has a sense of “impending doom.”
The increase might seem small; the US is still better off than it was in January. And news about America’s Covid-19 vaccine rollout keeps getting better and better. But there’s a reason Walensky and other public health officials and experts are still so worried about the uptick in cases: exponential spread.
With Covid-19, as well as other infectious pathogens, the start of new waves of disease comes slowly. But as more people get infected with the virus, the surge starts to pick up. Pretty soon, daily new cases can start doubling in a matter of days or weeks — and by then, any reaction from the public or policymakers is doomed to be too little, too late. It’s made even worse by the possibility of coronavirus variants: As the virus spreads and replicates exponentially, it gets more chances to mutate, potentially leading to another new, possibly more infectious variant.
So now is the time to redouble efforts against the coronavirus — before things get out of control. That means continuing the basic precautions that have long worked against Covid-19: social distancing, masking, and testing and tracing. It also means speeding up America’s vaccine rollout.
The good news: This could be the last threat of a Covid-19 surge that the US has to deal with, at least in the near future. With the vaccine rollout picking up nationally, America is now on track to vaccinate every adult by July 4. Once that happens, the threat of the coronavirus could very well be behind us — barring any new variants or needed refreshers in immunity if the vaccines’ effects prove to be temporary.
But with the end so close, experts say now is not the time to ease up. Every single infection, hospitalization, and death that’s avoided now is an infection, hospitalization, and death that truly might never happen. The finish line is near, and the goal should be ensuring more people make it across.
“Summer will be great,” Brown University School of Public Health dean Ashish Jha wrote. “How many get infected now, sick or die next month is up to us.”
Covid-19 cases have picked up across the US
According to the CDC’s tracker, Covid-19 cases have ticked up a bit over the past couple of weeks. On March 14, the country reported a recent low below 53,000 cases a day, on a weekly average. Most recently, as of March 29, the country neared 62,000 cases a day.
That has not yet translated to a significant increase in hospitalizations or deaths nationally. But hospitalizations and deaths tend to be a lagging indicator — people can take days or even weeks to land in the hospital once they’re infected, and then deaths can occur a few weeks after that.
The increase seems to be driven by surges in a few states, including Michigan, New York, New Jersey, and Connecticut. Notably, Covid-19 hospitalizations and deaths in Michigan — which has seen one of the worst recent surges — have already trended up.
The national increase in cases is likely tied to a variety of factors: the public easing up on precautions, policymakers relaxing restrictions, and more infectious coronavirus variants reaching the US.
Now that increase is causing concern among health officials that America could be seeing the sparks of a fourth surge. Covid-19, like other epidemics, tends to start slowly, with the spread of the virus rapidly picking up as more people get infected.
For example: During the US’s third surge, in the fall, the country took about one month to double from around 40,000 to 80,000 cases. But then it took only around two weeks for cases to double once again, from 80,000 to 160,000 cases. That’s exponential spread.
The goal of public health is to avoid letting the situation get this bad to begin with. In fact, with Covid-19 cases still so high — the US’s recent plateau of around 50,000 cases is still higher than its plateau before the fall surge — the preference would be to bring cases lower, as close to zero as possible. That’s why Walensky is sounding the alarm now.
Instead, states are moving in the opposite direction. Over the past few weeks, state leaders have eased their Covid-19 restrictions — with some, like Texas, ending their mask mandates entirely. There’s good evidence that the restrictions, including mask mandates, work, so the states’ moves could help cause the fourth surge the CDC’s director is now worried about.
It’s particularly alarming, though, because these states may only have to hold out a little while longer to avoid any more surges.
The end of the pandemic is near. Let’s make sure more people make it.
America’s Covid-19 vaccine campaign is truly getting better. The country has gone from administering fewer than 1 million shots a day before President Joe Biden’s inauguration to nearly 2.8 million a day as of March 30. At the current rates, every adult in the US could be fully vaccinated by July 4 — a new kind of Independence Day.
We’re probably already feeling some of the effects of these vaccine efforts. According to the CDC, about 73 percent of adults 65 and older, the group that represents roughly 80 percent of Covid-19 deaths, have gotten at least one shot, and nearly 50 percent are fully vaccinated. It’s likely that the high vaccination rate for older Americans is already saving a lot of lives — and may prevent a potential fourth surge from being as deadly as past waves.
But that’s not to say the end is here; it’s merely near. More than half of the very vulnerable 65-plus population still isn’t fully vaccinated, and around 80 percent of the rest of the adult population still isn’t fully vaccinated. There are also big racial disparities, with white people more likely to have received their vaccine so far than their Black or Hispanic peers, even as Covid-19 has hit Black and Hispanic communities harder. That leaves hundreds of millions of people in vulnerable populations still susceptible to the virus.
The known coronavirus variants, and the possibility that more might emerge, are also a reason for concern. Some known variants are more infectious and can partly overcome immunity — not enough to nullify vaccine-induced immunity, based on the evidence so far, but still a concerning sign. There’s a lot of anxiety within public health circles that the coronavirus could find the right set of mutations to completely overcome the current vaccines, putting us all back to square one in fighting the pandemic.
The one way to prevent the development of new variants is by slowing the spread of the coronavirus. Every time the coronavirus infects another host, it quickly replicates so it can continue spreading. With each of these replications, there’s a chance that the virus will mutate. If that mutation proves beneficial to the virus and catches on more broadly, that could develop into yet another variant of concern. The best way to prevent all of this is by ensuring the coronavirus doesn’t find new hosts to replicate in and spread through to begin with.
This has to be done globally — a variant that shows up in another country could easily end up in the US, as we’ve seen with the variants first found in the UK, South Africa, and Brazil already. But Americans can begin this work at home.
For the public, stopping a fourth wave and discouraging the growth of new variants means taking the usual precautions against the virus, like social distancing and masking, and getting a vaccine when it’s available. For lawmakers and the health care system, it means holding steady on restrictions for now and speeding up the vaccination campaign.
The US can finally see the end of the pandemic. But between now and then, possibly tens or hundreds of thousands of people could die to Covid-19, depending on how bad we let things get. Making sure a fourth surge never comes is the one way we can guarantee that more of our family, friends, and neighbors make it to that finish line. The history of Covid-19 shows that to really do that, though, the country will have to take action sooner rather than later.
About 2 percent of new cars on US roads right now run on electricity. The auto industry expects that by 2030, half of new car sales will be electric. And President Joe Biden is stepping on the gas pedal to make that happen.
Among the many provisions of the White House’s $2 trillion infrastructure and jobs plan released last week is $174 billion to support electric vehicles, the single largest item in the proposal’s transportation section.
That money will help pay for 500,000 electric vehicle chargers over the next decade, an idea from Senate Majority Leader Chuck Schumer. It also covers modifying factories to build electric vehicles (EVs), grants and tax incentives to encourage buyers, and shoring up a domestic supply chain to make electric cars and trucks.
Electrifying transportation is a major component of how the Biden administration plans to tackle climate change. The transportation sector is the largest source of greenhouse gases in the US. Cars and light trucks account for 60 percent of these emissions. So EVs would be a huge step toward meeting Biden’s goal of decarbonizing the US economy by 2050, alongside a decarbonization of the power sector.
These ideas are an abrupt turn from Biden’s predecessor. The Trump administration moved to weaken federal fuel economy rules for cars and light trucks, going as far as to sue the state of California for reaching a voluntary agreement with several automakers to impose its own stricter standards.
Getting a significant share of the US’s 270 million vehicles electrified by 2030 would be a massive leap. And US automakers, despite their insistence on an electric future, have so far been lackadaisical in their electric offerings, while continuing to crank out fuel-thirsty SUVs, crossovers, and even larger pickup trucks.
The effort to switch to EVs is a microcosm of the broader effort to fight climate change — any shift to a carbon-neutral economy requires everyone to act, but the federal government only has so many levers. Short of direct mandates, the government will need to use a system of nudges and prods to get everyone from companies to car buyers to homeowners to make the requisite investments in clean energy.
But if the US can pull off electrification of its greatest contributor to climate change, it bodes well for decarbonizing the rest of the economy.
Biden’s plan requires the government to lead by example — with big fleets of electric vehicles
One of the big challenges with switching over to EVs is that a lot of people have to choose to buy them. It’s tricky to convince finicky consumers to buy something without a mandate, but Biden does have the massive purchasing power of the government at his disposal.
He has already pledged to replace the federal government’s 650,000 vehicle motor pool with electrics. “The federal government also owns an enormous fleet of vehicles, which we’re going to replace with clean electric vehicles made right here in America made by American workers,” Biden said in a January press conference. Currently, the US government’s fleet has just over 3,000 electric vehicles.
The new infrastructure proposal also calls for electrifying 20 percent of the nearly 500,000 US school buses with a grant program administered through the Environmental Protection Agency.
Some Democratic lawmakers are also pushing to halt a $6 billion contract to build the next generation of US Postal Service delivery vehicles. The contract, awarded in February, calls for up to 165,000 vehicles from a mix of gasoline and electric variants. Democrats want those vehicles to be entirely electric.
Delivery vehicle fleets are a ripe target for electrification because purchasers like USPS can take advantage of bulk discounts. Mail trucks also return to a central location at the end of their rounds, meaning less charging infrastructure is needed.
“Squandering this once-in-a-generation opportunity by spending billions of dollars on vehicles that will be custom built for obsolescence — indeed, by the end of their operating lives they will be the last internal combustion fleet vehicles on the road — and defying President Biden’s Executive Order is utterly unacceptable,” 13 House Democrats wrote in a letter to the Postal Service’s Board of Governors last month.
Private delivery fleets are already investing in electric delivery, with FedEx vowing to run a 100 percent electric fleet by 2040.
While big purchases of delivery trucks and buses aren’t likely to sway car buyers, ordinary drivers considering EVs could still benefit from the supply chain boost for components like batteries and the buildup of charging infrastructure.
Another upside of electrifying trucks, buses, and delivery vehicles is the opportunity to get many of them off of diesel fuel. Diesel pollution accounts for 180,000 deaths around the world each year. So the transition to cleaner fleets doesn’t just have a benefit to the climate over the long term but yields an immediate health benefit.
The government and the auto industry still need to do more to meet their electric goals
Bulk purchases and a massive expansion of EV charging are important steps, but they aren’t enough on their own to convince wary car buyers to give up the rumble of a gasoline engine.
A YouGov poll from October 2020 found that half of Americans would support a mandate to end fossil fuel-powered vehicle sales, similar to California’s plan to limit auto sales to zero-emissions vehicles by 2035.
However, the main deterrent to buying EVs for most Americans isn’t the number of charging stations. According to the poll, the highest-ranking concern was charging time, followed by a higher upfront cost for EVs, the hassle of charging, and the cost of charging at home. Subsidies and tax credits can offset some of the cost concerns, but the other hurdles may require technological advances that aren’t here yet.
Carmakers, for their part, have put out plans for more electric vehicles over the coming decade. Volkswagen recently joked that it was changing its name to Voltswagen. Even Ford is working on an electric version of its F-150 pickup truck, one of the best-selling vehicles in the US.
But car companies will also have to put more marketing muscle behind their electric vehicles. Environmental groups have observed that automakers spend much less when advertising their cleaner vehicles than their larger, more expensive trucks and SUVs. These larger vehicles tend to have bigger profit margins than EVs.
Switching over to EVs would also require an incentive to take some of the oldest, dirtiest cars off the road at a faster rate, something that isn’t addressed in the current plan. During the Covid-19 pandemic, new car sales dropped, and used car sales shot up. Schumer has called for a “cash for clunkers” program, based on a similar idea from 2009, where people could trade in their gas guzzlers for discounts on EVs.
And while running an electric car is as clean as the electricity that charges it up, making EVs to begin with can have a higher carbon footprint, so better sourcing of critical components (like lithium for batteries) and more efficient manufacturing are also needed.
Automakers will need to prepare for even bigger changes on the horizon: How people drive today may not be how they drive tomorrow. With the advent of ride-hail apps, the push for greater urban density, more options for short trips like electric scooters, and the potential for autonomous vehicles, there is less need for everyone to have their own car. So while car companies may grumble about switching gears to cleaner cars, they still have to keep their eyes on the road ahead.
With the news Wednesday from Pfizer/BioNTech that preliminary data suggests their vaccine is effective and safe in youth ages 12 to 15, Covid-19 shots for those under 16 seem like they might finally be on the horizon. But the big question of whether most kids will be able to get vaccinated before they head back to school in the fall remains.
Children were left out of the earliest vaccine trials as pharmaceutical companies prioritized adults at higher risk of hospitalization and death. Which made sense: The disease has killed approximately 270 children in the US, compared with more than 424,000 people age 65 and older.
But many kids have caught the virus, with about 3.4 million pediatric Covid-19 cases reported as of March 25 — likely a substantial undercount because these cases are often mild or asymptomatic. There have also been more than 2,600 children in the US who have gotten a severe inflammatory syndrome following infection, and many reports of children with persistent, debilitating symptoms after even a mild Covid-19 illness.
Not to mention the broader impact of the pandemic on children’s lives, with less social contact with peers and extended family members, increased risk of abuse at home, and major disruptions to education that is widening the existing chasms of inequality.
Because of these hardships, the National Academy of Medicine, in its fall 2020 recommendations for vaccine allocation, said that children should be in phase 3 of recipients — which would fall before the general adult population and in the same group as many essential workers. But this clearly did not come to pass.
Importantly, we have yet to formally ensure the vaccines are effective and safe in children, whose immune systems can work slightly differently than adults’. (Pfizer/BioNTech’s new data is preliminary and has not yet been peer-reviewed.)
But vaccine companies are racing to gather more data, and the FDA has okayed Pfizer and Moderna to start new studies of their vaccines in kids 11 and younger. Moderna has a trial underway and expects initial results in the coming months. Johnson & Johnson is still in the planning phases.
Pfizer/BioNTech say they’ll submit their new findings on adolescents to the US Food and Drug Administration in the weeks ahead in hopes of having their vaccine authorized for ages 12 and up. (It is currently authorized for emergency use for those 16 and older; Moderna and Johnson & Johnson’s vaccine can be given to those 18 and up.)
Here’s where we are in learning about the Covid-19 vaccines in children and teens — and what parents, teachers, and family members should do to keep the virus in check before they are ready.
Why most kids can’t get vaccinated for Covid-19 yet
The prospects for kids getting vaccinated are looking good. In addition to the new early Pfizer information on kids 12 to 15, we also have that reassuring pile of data about the vaccines’ safety and efficacy in adults. Nevertheless, several factors make these vaccine trials in children slightly more challenging.
“Since the infection is a mild one in the majority of children, the bar for a Covid-19 vaccine to be safe in children is even higher,” Kristin Moffitt, a pediatric infectious disease specialist at Boston Children’s Hospital, wrote in an email to Vox. “This is different than an experimental medication designed to treat a terrible disease, where side effects might be tolerated. A vaccine designed to prevent infection must be safe.”
We also cannot assume the vaccines will behave in children exactly as they do in adults. And this is especially true of younger children, who haven’t yet been included in completed trials.
“Children’s immune systems sometimes act slightly differently than adults’ when they’re given the same vaccine,” says James Campbell, a pediatric infectious disease specialist at the University of Maryland School of Medicine who also runs clinical trials at the school’s Center for Vaccine Development and Global Health. This is because kids’ immune systems are busy maturing from before birth through mid-childhood.
And although most vaccines work equally well in adults and children, some, such as the pneumococcal vaccine, aren’t effective in children under age 2. (That vaccine, however, is of a different type than the ones authorized for Covid-19.) Others need to be given in different amounts or spaced differently when given to younger kids versus adults.
Most experts do expect younger children will respond well to Covid-19 vaccines. But even then, they’ll still want to find the optimal doses and dose spacing for these immunizations at each age group. This might be different for, say, a 6-month-old than for a 16-year-old.
How scientists are testing Covid-19 vaccines in children
To learn how vaccines work best in kids, scientists usually study them in different age groups. For Covid-19, researchers are working backward down the age ladder.
Starting trials in teenagers makes sense for a number of reasons. First, “adolescents are more likely to experience a similar safety profile and immune response as adults than very young children,” Moffitt explained.
Second, this age group is more likely than younger children (except for infants) to become severely ill and die of the disease.
And, third, data so far suggests that this age group has been more responsible for spreading the virus than younger children, Moffitt explained.
So after studies have gathered enough data from adolescents, researchers can be more confident testing the vaccine in younger age groups. “A vaccine that was safe in 12-year-olds is more likely to be safe in 6- to 11-year-olds than one that has only been tested in adults,” Moffitt said. Likewise, “a vaccine that’s safe in school-aged children is more likely to be safe in toddlers.”
For the youngest children, figuring out not only the best dosing but also when to administer the test vaccines could be tricky.
“Infants and toddlers have a very busy vaccine schedule,” says Campbell, who also helped develop the National Institutes of Health’s pediatric vaccine trial protocols. So researchers need to figure out if they are going to lump the trial Covid-19 vaccine doses in with regular vaccine visits (which can generate their own passing side effects) or administer them between other vaccines (which sometimes fall just a month apart for newborns).
One bit of luck is that children’s vaccine trials can be much smaller than the adult trials. In addition to seeing who among participants naturally got sick with Covid-19, adult vaccine trials have been measuring immune response to the vaccines (by looking for antibodies in the blood).
This immune response data provides a reliable shortcut for trials in kids, showing researchers what a successful immune response to the vaccine looks like. So pediatric studies are looking for similar responses in children to assess whether it is effective in preventing Covid-19, rather than having to wait for dozens of them to come down with the disease.
So whereas each phase 3 adult trial had to enroll tens of thousands of people to find enough naturally occurring infections in a few short months, “as we are only measuring immune response in adolescents, we can get those answers with many less participants,” Robert Frenck, director of vaccine research at Cincinnati Children’s Hospital, wrote to Vox in an email. As such, the companies can do studies at less than a tenth of the scale.
The new Pfizer/BioNTech trial tested the vaccine against a placebo in 2,260 adolescents. In those who received the shot, the companies say a robust antibody response was seen, equating, they say, with 100 percent efficacy — an even better result than in those ages 16 to 25, the company reported in a press release. The company said no safety concerns emerged and side effects were similar to those seen in young adults.
In addition to apparently universal antibody coverage, the Pfizer vaccine’s efficacy also seemed to play out in the real world. Eighteen of the adolescents in the placebo group ended up getting Covid-19, but none in the vaccinated group.
And the FDA has cleared vaccine makers to rapidly expand testing in younger ages. Pfizer and Moderna both have early-stage studies underway in participants as young as 6 months. Pfizer is structuring research based on age group cohorts: 5 to 11 years, 2 to 5 years, and 6 months to 2 years, testing different doses in each.
The first experimental shots were given to kids in the 5- to 11-year-old age group last week, and they plan to give the first ones in the 2- to 5-year group next week, the company reported.
Moderna announced earlier this month that it has also started administering the vaccine to its pediatric trial participants younger than 12. Although early data is expected by this summer, it plans to also follow kids for a year after their shots to track longer-term efficacy and safety.
Will kids get the Covid-19 vaccine before the next school year?
Even if a Covid-19 vaccine hasn’t been authorized or distributed for most children by the end of the summer, it might still be possible to safely send students back to school. “If you are in a situation where you have drastically reduced mortality, you have covered the most vulnerable people, you have vaccinated the teachers, and have scaled up targeted testing for schoolchildren, you have a viable way of opening schools,” says Saad Omer, an infectious disease specialist at the Yale School of Medicine.
And getting kids safely back to in-person learning will be incredibly important to prevent further disparities from emerging and get education back on track. For younger children especially, they “have a shorter window for development, where if they miss it, there are long-term consequences,” says Omer, who was on the National Academy of Medicine committee that recommended children for phase 3 vaccine priority.
But the ultimate goal will be to have children vaccinated against the virus, and as soon as safely possible. So the leading vaccine companies are working hard to get the necessary approvals. Pfizer says it hopes it will be possible “to vaccinate this age group before the start of the next school year,” CEO Albert Bourla said in a press statement.
And the CDC is paying attention. Its Advisory Committee on Immunization Practices “is closely monitoring clinical trials in children and adolescents,” according to a December paper.
Many experts are optimistic that vaccines will be authorized for children as solid data comes in. “I think a good antibody response — with a good safety profile — in kids will be sufficient to have a vaccine candidate licensed,” said Frenck, who has worked on the Pfizer vaccine trials of 12- to 15-year-olds.
Omer agrees. “You don’t have to complete the trial. Even initial preliminary data may suffice.”
But it is still unclear if most children under the age of 16 will be able to be vaccinated before the start of the next school year. And the order in which children will be eligible for an approved vaccine will likely follow the sequence of trials, with adolescents coming first. “If we can at least get down to the older kids, it would be great,” Campbell says.
One big question still hangs in the balance about the utility of vaccinating all children, however. A lot of the impetus to vaccinate children has been not just to reduce incidence of the disease in that group but also to reduce kids’ role in spreading the disease. However, we still don’t have thorough information on how well the vaccines do this.
Early data suggests the vaccines might reduce the rate at which people carry the virus without getting sick. But we are still waiting for more details from the adult studies. “The most likely scenario is that you’re going to get the best protection against the most severe disease, 95 percent protection against all disease, and slightly lower protection against all infection,” Campbell says. (This thinking also helped inform the CDC’s March guidelines for fully vaccinated people.)
Even this level of protection, however, could go a long way in improving children’s lives — and those of their parents. It could allow them to much more safely play with friends and participate in more normal activities.
What should we do before a Covid-19 vaccine is available for kids?
Covid-19 continues to spread, with new worrying upticks in cases, hospitalizations, and deaths in several regions across the country. And kids remain vulnerable to getting the illness and to spreading it to others of any age.
So instead of having chickenpox-style Covid-19 exposure parties for kids, which can be dangerous, public health experts advocate continued vigilance against the virus. The CDC recommends children follow similar guidelines to unvaccinated adults. They should wash their hands frequently, avoid or limit contact with unvaccinated people outside their household, avoid those at high risk for the illness, wear a mask in public starting at age 2, have high-touch surfaces and toys disinfected frequently, and avoid unnecessary travel.
But with the early encouraging news from the first Covid-19 vaccine kids trial, we have more reason to expect shots for kids will be coming.
In the meantime, there’s no time to waste in helping prepare pediatricians and families for the vaccines’ arrival for kids, Campbell says. A January survey by the National Parents Union found that only about 35 percent of parents would immediately immunize their children against the disease, and almost a quarter would not get the shots for them at all. If a vast number of kids aren’t vaccinated, they could become a reservoir for the virus, spurring future outbreaks.
But Campbell is hopeful that time and experience will help resolve some of this reluctance. By the time these shots are available for kids, in addition to strong results from pediatric studies, he hopes many of the current questions and wariness around the new vaccines will also be soothed by the months of success in adults.
Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.
NINE GAA GAMES are live on TV this week as part of a hectic week of action.
Mayo and Tyrone face off next Saturday night.
Source: Laszlo Geczo/INPHO
On Saturday the inter-county action commences with the football league tie involving Tyrone against Mayo, a repeat of last year’s All-Ireland decider, and the hurling league clash of Down against Kerry.
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There’s also a ladies football league semi-final double-header with Dublin taking on Donegal and Meath facing Mayo.
Then Sunday’s league games involving Kilkenny against Waterford in hurling, while a pair of football games take place with Armagh playing Kerry and Dublin meeting Donegal.
Dublin meet Donegal on Saturday.
Source: John McVitty/INPHO
On Sunday, TG4 will trial a ‘picture in picture’ feature during their live coverage of Kilkenny v Waterford. These will show cutaways that feature the major moments from two key other Division 1 hurling matches, Limerick v Offaly and Laois v Dublin.
Before that Croke Park is the focus on Thursday for the All-Ireland senior colleges football and hurling finals, with the prestigious Hogan Cup and Croke Cup titles on offer. There are Kerry, Kildare, Limerick and Kilkenny sides all chasing glory in the deciders as St Brendan’s Killarney take on Naas CBS, before Ardscoil Rís play St Kieran’s Kilkenny.
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Here’s what’s in store:
Thursday
2pm: TG4 – St Brendan’s Killarney v Naas CBS – Hogan Cup final.
4pm: TG4 – St Kieran’s Kilkenny v Ardscoil Rís – Croke Cup final.
Saturday
1pm: TG4 – Dublin v Donegal – Division 1 ladies football league semi-final.
2pm: BBC Sport NI site – Down v Kerry – Division 2 hurling league.
3pm: TG4 – Meath v Mayo – Division 1 ladies football league semi-final.
5.45pm: RTÉ 2 – Tyrone v Mayo – Division 1 football league.
Sunday
1.45pm: TG4 – Kilkenny v Waterford – Division 1 hurling league.
2pm: TG4 app – Armagh v Kerry – Division 1 football league…(Deferred coverage on TG4 at 5.35pm)
3.45pm: TG4 – Dublin v Donegal – Division 1 football league.
– Originally published at 12:37
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Last year, as then-President Donald Trump railed against Covid-19 lockdowns and called on states to reopen their economies, he claimed the shutdowns would lead to a spike in suicides: “You’re going to lose more people by putting a country into a massive recession or depression. You’re going to lose people. You’re going to have suicides by the thousands.”
But new data suggests that the number of suicides actually decreased in the US last year. According to the National Center for Health Statistics, suicides totaled fewer than 45,000 in 2020, down from about 47,500 in 2019 and more than 48,000 in 2018.
So far, this seems to be true globally. England saw no increase in suicides in the aftermath of lockdowns, Louis Appleby, a researcher on suicide and self-harm at the University of Manchester, wrote for the medical journal BMJ. The same seems to be true in other nations, including Australia, Canada, New Zealand, Norway, Peru, and Sweden, based on data for the first few months of lockdowns around the globe.
“Our conclusions at this stage, however, should be cautious. These are early findings and may change,” Appleby wrote in BMJ. “Beneath the overall numbers there may be variations between demographic groups or geographical areas. After all, the impact of covid-19 itself has not been uniform across communities.”
Still, the news overall seems good.
Trump wasn’t alone in his concerns. For much of 2020, this was a popular argument among opponents of lockdowns — that the measures would lead to an increase in suicides. Various news articles have echoed the claim in some form, exemplified by the recent New York Times headline, “Suicide and Self-Harm: Bereaved Families Count the Costs of Lockdowns.”
It’s all wrapped up in an argument that lockdowns weren’t worth the costs. As Trump put it, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”
The reality is lockdowns worked to contain the spread of Covid-19, based on studies from Health Affairs, The Lancet, the Centers for Disease Control and Prevention, and others. And experts now widely agree that it was the US’s move to reopen too quickly, fueled in part by Trump’s claims, that made the country one of the worst in the world for Covid-19 deaths.
That’s not to say the lockdowns were costless. The emotional anguish brought by isolation and lack of social contact, as well as the economic calamity of the last year, are both clear examples of the downsides to lockdowns — even if the measures were ultimately worth it in the face of a deadly pandemic.
According to one CDC study, self-reported mental distress increased in the early months of the pandemic (though it’s not clear if lockdowns were the cause).
Another category of “deaths of despair” — drug overdoses — also appeared to increase dramatically last year: The latest data shows there were more than 88,000 overdose deaths in the year through August 2020, up from nearly 70,000 in the same time period of 2019. It’s plausible that lockdowns fueled overdoses as people turned to drugs during isolation or as addiction treatment and harm reduction services closed down, though it’s also possible that the increase was driven by something else, like the continued spread of the dangerous synthetic opioid fentanyl in illicit drug markets.
There’s also genuine debate about how the lockdowns worked. Based on the more recent evidence, it seems like mass closings of schools were ultimately misguided — as children and schools ended up not being major vectors of the coronavirus’s spread. Meanwhile, the risky indoor spaces many states pushed to reopen quickly, like bars and restaurants, have proven to be significant sources of outbreaks. All of that suggests the US may have closed down the wrong places, while reopening the wrong places too.
At the very least, though, it seems lockdowns didn’t produce one of the bad effects people initially feared.
If you or anyone you know in the US is considering suicide or self-harm, or is anxious, depressed, upset, or needs to talk, you can call the National Suicide Prevention Hotline at 1-800-273-8255, or text CRISIS to 741741 for free, confidential crisis counseling. Outside the US, the International Association for Suicide Prevention maintains a list of crisis hotlines and their respective phone numbers around the world.
It’s an exciting time in particle physics. The results of a new experiment out of Fermilab in Illinois — involving a subatomic particle wobbling weirdly — could lead to new ways of understanding our universe.
To understand why physicists are so excited, consider the ambitious task they’ve set for themselves: decoding the fundamental building blocks of everything in the universe. For decades, they’ve been trying to do that by building a big, overarching theory known as the standard model.
The standard model is like a glossary, describing all the building blocks of the universe that we’ve found so far: subatomic particles like electrons, neutrinos, and quarks that make up everything around us, and three of the four fundamental forces (electromagnetic, weak, and strong) that hold things together.
But, as Jessica Esquivel, a particle physicist at Fermilab, tells Vox, scientists suspect this model is incomplete.
“One of the big reasons why we know it’s incomplete is because of gravity. We know it exists because apples fall from trees and I’m not floating off my seat,” Esquivel says. But they haven’t yet found a fundamental particle that conveys gravity’s force, so it’s not in the standard model.
Esquivel says the model also doesn’t explain two of the biggest mysteries in the universe: dark matter, an elusive substance that holds galaxies together, and dark energy, an even more poorly understood force that is accelerating the universe’s expansion. And since the overwhelming majority of the universe might be made up of dark matter and dark energy, that’s a pretty big oversight.
The problem is, the standard model works really well on its own. It describes the matter and energy we’re most familiar with, and how it all works together, superbly. Yet, as physicists have tried to expand the model to account for gravity, dark matter, and dark energy, they’ve always come up short.
That’s why Esquivel and the many other particle physicists we’ve spoken to are so excited about the results of a new experiment at Fermilab. It involves muons — subatomic particles that are like electrons’ heavier, less stable cousins. This experiment might, finally, have confirmed a crack in the standard model for particle physicists to explore. It’s possible that crack could lead them to find new, fundamental building blocks of nature.
Esquivel worked on the experiment, so we asked her to walk us through it for the Unexplainable podcast. What follows is a transcript of that conversation, edited for clarity and length.
Noam Hassenfeld
What was this muon experiment?
Jessica Esquivel
So at Fermilab, we can create particle beams of muons — a very, very intense beam. You can imagine it like a laser beam of particles. And we shoot them into detectors. And then by taking a super, super close measurement of those muons, we can use that as kind of a probe into physics beyond our standard model.
Noam Hassenfeld
So how, exactly, does this muon experiment point to a hole in the model, or to a new particle to fill that gap?
Jessica Esquivel
So the muon g-2 experiment is actually taking a very precise measurement of this thing that we call the precession frequency. And what that means is that we shoot a whole bunch of muons into a very, very precise magnetic field and we watch them dance.
Noam Hassenfeld
They dance?
Jessica Esquivel
Yeah! When muons go into a magnetic field, they precess, or they spin like a spinning top.
One of the really weird quantum-y, sci-fi things that happens is that when you are in a vacuum or an empty space, it actually isn’t empty. It’s filled with this roiling, bubbling sea of virtual particles that just pop in and out of existence whenever they want, spontaneously. So when we shoot muons into this vacuum, there are not just muons going around our magnet. These virtual particles are popping in and out and changing how the muon wobbles.
Noam Hassenfeld
Wait, sorry … what exactly are these virtual particles popping in and out?
Jessica Esquivel
So, virtual particles, I … see them as like ghosts of actual particles. We have photons that kind of pop in and out and they’re just kind of like there, but not really there. I think a really good depiction of this, the weirdness of quantum mechanics, is Ant-Man. There’s this scene where he shrinks down to the quantum realm, and he gets stuck and everything is kind of like wibbly-wobbling and something’s there, but it’s really not there.
That’s kind of like what virtual particles are. It’s just hints of particles that we’re used to seeing. But they’re not actually there. They just pop in and out and mess with things.
Noam Hassenfeld
So quantum mechanics says that there are virtual particles, sort of like ghosts of particles we already know about in our standard model, popping in and out of existence. And they’re bumping into muons and making them wobble?
Jessica Esquivel
Yes. But again, theoretical physicists know this, and they’ve come up with a really good theory of how the muon will change with regards to which particles are popping in and out.So we know specifically how every single one of these particles interacts with each other and within the magnetic field, and they build their theories based on what we already know — what is in the standard model.
Noam Hassenfeld
Got it. So even though there are these virtual ghost particles popping in and out, as long as they’re versions of particles we know, then physicists can predict exactly how the muons are going to wobble. So were the predictions off?
Jessica Esquivel
So what we just unveiled is that precise measurement doesn’t align with the theoretical predictions of how the muons are supposed to wobblein a magnetic field. It wobbled differently.
Noam Hassenfeld
And the idea is that you have no idea what’s making it do that extra wobble, so it might be something that hasn’t been discovered yet? Something outside the standard model?
Jessica Esquivel
Yeah, exactly. It’s not considered new physics yet because we as physicists give ourselves a very high bar to reach before we say something is potentially new physics. And that’s 5 sigma [a measure of the probability that this finding wasn’t a statistical error or a random accident.] And right now, we’re at 4.2 sigma. But it’s pretty exciting.
Noam Hassenfeld
So if it clears that bar, would this break the standard model? Because I’ve seen that framing in a bunch of headlines.
Jessica Esquivel
No, I don’t think I would say the standard model is broken. I mean, we’ve known for a long time that it’s missing stuff. So it’s not that what’s there doesn’t work as it’s supposed to work.
It’s just that we’re adding more stuff to the standard model, potentially. Just like back in the day when scientists were adding more elements to the periodic table … even back then, they had spots where they knew an element should go, but they hadn’t been able to see it yet. That’s essentially where we’re at now. We know we have the standard model, but we’re missing things. So we have holes that we’re trying to fill.
Noam Hassenfeld
How exciting does all of this feel?
Jessica Esquivel
I think it’s like a career-defining moment. It’s a once-in-a-lifetime. We’re chasing new physics and we’re so close, we can taste it.
What I’m studying isn’t in any textbook that I’ve read or peeked through before, and the fact that the work that I’m doing could potentially be in textbooks in the future … that people can be learning about the dark matter particle that g-2 had a role in finding … it gives me chills just thinking about it!
Over the past few months, the Centers for Disease Control and Prevention (CDC) was criticized for playing it too cautiously with its Covid-19 guidance. The agency had recommended people wear masks outdoors, even kids in the outdoor heat of summer camp. It has overestimated the risk of outdoor spread and surface transmission. It was too slow to tell the fully vaccinated that they can go about their lives, living closer to normal.
So experts argued that the CDC was failing to seize on a moment of victory: Vaccines are triumphing over the virus. The US needs more people to get the shots — and needs to encourage them to do so with the promise of a light at the end of the tunnel.
But on Thursday, the CDC leaped ahead of the criticisms — announcing that it no longer recommends the vaccinated mask up, even in most indoor settings. The agency named a few specific exceptions for health care settings, public transportation, prisons, jails, and homeless shelters. And people should continue to follow local and state laws. But the overall message was unambiguous: Vaccinated Americans can start getting back to normal.
“The science is clear: If you are fully vaccinated, you are protected, and you can start doing the things that you stopped doing because of the pandemic,” the CDC said in a statement.
With the news, the CDC snapped out of its cautious ways, moving faster than widely expected, given that the majority of Americans still aren’t fully vaccinated. And it finally embraced the power of the Covid-19 vaccines.
For months, some experts have lamented that the vaccines were being undersold. Clinical trials and real-world evidence have found the shots are very effective, nearly eliminating the risk of severe disease, hospitalization, and death. Recent research, including from the CDC, also found that the shots seem to stop the vaccinated from transmitting the virus to others. And data from Israel, as well as early signs in the US, suggests that mass vaccination truly causes Covid-19 cases and deaths to plummet.
As vaccination rates in America began to plateau then fall, it seemed more urgent for the agency to signal that vaccines will let people return to normal by dangling a huge incentive — a normal post-pandemic life — in front of unvaccinated people. It’s that pressure, along with the mounting evidence of vaccines’ effectiveness, that seems to have led the CDC to change course.
A big question with the CDC’s new guidance is how it will be carried out in the real world. In public settings, are people simply supposed to trust that the maskless are vaccinated? Will businesses start asking for proof of vaccination before someone can shed the mask? Will there be any enforcement at all, or will the assumption be that the unvaccinated are left to fend for themselves? All of that remains to be seen.
Still, this is a big step for America toward a post-pandemic normal. As CDC director Rochelle Walensky told reporters on Thursday, “We have all longed for this moment — when we can get back to some sense of normalcy. Based on the continuing downward trajectory of cases, the scientific data on the performance of our vaccines, and our understanding of how the virus spreads, that moment has come for those who are fully vaccinated.”
Yes, the Covid-19 vaccines are that amazing
The CDC is acting on mounting evidence that the vaccines are truly effective, including against variants.
The initial clinical trials put the efficacy of the two-shot Moderna and Pfizer/BioNTech vaccines at 95-plus percent and the one-shot Johnson & Johnson vaccine at more than 70 percent. All three vaccines also drove the risk of hospitalization and death to nearly zero.
The real-world evidence backed this up, too. Data from Israel, which has the most advanced vaccination campaign in the world, found that the Pfizer/BioNTech vaccine was 90 percent effective at preventing Covid-19, with better rates for symptomatic disease, hospitalization, and death. Israel has seen this effectiveness firsthand: Since reopening in March, after most people in the country got at least one dose, daily new Covid-19 cases have fallen by more than 95 percent and daily deaths now number in the single digits or zero.
A hint of these results is visible in the US figures, too. As the country has vaccinated more people, daily new Covid-19 cases in America have dropped by nearly 50 percent since mid-April, with hospitalizations and deaths trending down as well. The remaining serious cases are also all among the unvaccinated, with the Cleveland Clinic estimating 99.75 percent of its Covid-19 patients between January and mid-April weren’t vaccinated.
One lingering concern is that the vaccines might be less effective against the coronavirus variants that have popped up across the world, some of which seem to be better at evading existing immunity. But the research has shown that the vaccines approved in the US are really effective against the variants, too, preventing the risk of serious illness and death.
There have been some breakthrough cases of Covid-19 among the vaccinated. But these tend to be milder infections, less likely to transmit, and far from common. “This is less than 0.01 percent of the vaccinated,” Akiko Iwasaki, an immunologist at Yale, previously told me, citing CDC data. “So extremely rare!”
There were also some concerns that a vaccinated person could spread the virus. But over the past few weeks, some studies have indicated that the vaccines also stop vaccinated people from spreading the virus. The CDC summarized one such real-world study for the Pfizer/BioNTech and Moderna vaccines, showing the vaccines stop not just symptoms but overall infections and, therefore, transmission:
Results showed that following the second dose of vaccine (the recommended number of doses), risk of infection was reduced by 90 percent two or more weeks after vaccination. Following a single dose of either vaccine, the participants’ risk of infection with SARS-CoV-2 was reduced by 80 percent two or more weeks after vaccination.
Some experts have recently cited this growing evidence to embrace old freedoms after getting vaccinated.
“I am fully vaccinated and have resumed normal activities,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, previously told me. “I have gone indoor dining, went to my first movie theater, and would go to a bar if there was an opportunity!”
The CDC is now adopting this attitude. On top of its change to its mask guidance, the agency said it will review its other recommendations to make sure they line up with the current understanding of the evidence. Overall, it’s signaling the vaccinated should be confident they are safe.
“The science demonstrates that if you are fully vaccinated, you are protected,” Walensky said. “It is the people who are not fully vaccinated in those settings who are not protected.”
US policy now focuses on getting more people vaccinated
With the news, America has entered a new phase in its Covid-19 response, in which it’s all-in on the vaccines.
It’s a reflection of the current reality: Now that the vaccines are widely available and more than half of US adults have gotten at least one dose, it’s less tenable to continue asking the vaccinated to make huge sacrifices. At the same time, the unvaccinated remain at risk of a deadly virus, and policymakers should do everything they can to make sure as many people as possible get the shot.
Much of the country had already moved to reopen, with 14 states already doing away with mask mandates entirely. The CDC’s guidance will likely nudge states further, perhaps causing them to, at the very least, find ways to let the vaccinated evade mask mandates.
Meanwhile, President Biden’s administration has emphasized that it’s now focused on vaccinating as many people as possible, adopting strategies to boost access, encourage the skeptical to get the shot, and reward those who do get inoculated. The administration has set a goal of vaccinating 70 percent of adults by July 4 — with the promise that at that point, much of the country can truly return to normal.
Ohio is a recent example of this kind of shift. This week, Gov. Mike DeWine (R) announced the state will rescind Covid-related health orders, including its mask mandate, in June. At the same time, he unveiled a lottery in which five vaccinated people will have a chance to win $1 million each.
The CDC’s announcement offers yet another incentive, with the promise that if you are vaccinated, in most cases you no longer have to worry about the risk to your health and can shed the mask.
This is what a return to normal looks like. By embracing the vaccines, America is now able to slowly but surely put Covid-19 — and all the changes it forced on our lives — behind us.
The future of America’s Covid-19 epidemic can now be distilled into this: long-term confidence and hope, but short-term uncertainty and, perhaps, even despair.
Vaccines are rolling out quickly, setting up the country to crush the outbreaks that have warped our lives for the past year.
But in the short term, perhaps the next month, the US faces a few potential paths. The worst scenario: A fourth surge of the coronavirus outpaces vaccinations and kills thousands more people even as the country nears the finish line with Covid-19. The best possibility: The accelerating vaccine rollout and continued vigilance keep the virus at its current level or, hopefully, results in fewer infections — letting the US cross the finish line safely and with more lives saved. Then there’s a middle path: Cases rise, but vaccines shield the country from more hospitalizations and deaths.
The path the US takes, though, will be decided by one of the most unpredictable things of all: human behavior.
The public could loosen up on Covid-19 precautions too quickly, discarding masks and failing to social distance before enough people are vaccinated. As has already been done in some areas, policymakers could push the country in this direction by ending restrictions before the vaccine rollout is truly at critical mass. Either of those things, or a combination of both, could lead to a fourth surge.
But if Americans hold out just a bit longer, and vaccination rates continue to pick up, the US could reach the end of the current large outbreaks — as cases dwindle down close to zero — before that happens.
The good news is, an end seems to be in sight. At current vaccination rates, the country could inoculate its entire adult population by July, leaving us ample time over the summer to start getting our lives back to normal and, hopefully, celebrate with others. One country that has vaccinated the bulk of its population, Israel, has shown this is possible, reopening its economy and crushing the Covid-19 curve at the same time.
“Yes, there are some near-term concerns,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “But so far we’re — cautiously — on the other side of it. … If we push ahead and really accelerate vaccination, by the summer we’ll be in a much, much better place.”
The question now is what lies between here and there.
The worst short-term scenario: Cases, hospitalizations, and deaths rise in a fourth surge
This is the worst-case scenario — the one that CDC Director Rochelle Walensky said fills her with a feeling of “impending doom.”
Here’s how it could play out: In the next few weeks, states continue to loosen the restrictions they put in place to combat Covid-19, opening up businesses (particularly indoor locations) and revoking their mask mandates. The public follows suit, embracing the near-end of Covid-19 by going out and engaging in close-contact activities with family, friends, and strangers, even if they’re not yet fully vaccinated. The vaccine campaign can’t keep up with all of this new social activity, and more people catch the virus than are inoculated.
So the coronavirus spreads, jumping between all these vulnerable people mingling together again, while more-infectious coronavirus variants spread rapidly at the same time, pushing the wave even higher. (B.1.1.7, the variant that appears to have originated in the UK, is now the dominant cause of new infections in the US, Walensky said Wednesday.)
That said, it doesn’t seem like the US overall is heading toward the worst-case scenario, at least not yet. A recent uptick in Covid-19 cases might have hit a plateau. The US still has a lot of daily new Covid-19 cases — nearly 500 times that of Australia after controlling for population — but it may not be getting worse.
The concern is that could all change — and quickly — due to exponential spread, which causes infections to pick up at an accelerating pace. During the US’s third surge in the fall, it took roughly a month for daily new cases to double from about 40,000 to 80,000. But it took only around two weeks for daily new cases to double once again, from 80,000 to 160,000.
This might already be happening in Michigan, which has been hit hard by Covid-19 in the past few weeks. The state’s current surge isn’t quite as bad yet as its previous one, but it’s still leading to more hospitalizations and deaths. If it’s already happening there, it could happen elsewhere.
The middle short-term path: Covid-19 cases rise, but not hospitalizations and deaths
Throughout the pandemic, Covid-19 deniers have claimed rises in cases were only a “casedemic,” meaning that cases rose but hospitalizations and deaths didn’t, and therefore there was nothing to worry about.
That was nonsense for much of the past year, fueled by a crucial misunderstanding: Increases in hospitalizations and deaths tend to lag behind increases in cases because it takes time for people to get sick, land at the hospital, and die after getting infected.
But something like this could happen now, thanks to the vaccines. So far, the populations more vulnerable to Covid-19, based on age, have gotten more of the vaccine. The result is that more than 76 percent of adults 65 and older have gotten at least one dose, and more than 57 percent have been fully vaccinated (either by the one-shot Johnson & Johnson vaccine or a two-shot vaccine from Moderna or Pfizer). Over the past year, this age group represented around 80 percent of all Covid-19 deaths in the US.
With much of the vulnerable vaccinated, a rise in Covid-19 cases may not translate to a significant rise in hospitalizations and deaths. Younger people may contract the virus, but they won’t show up at the hospital or die at the same rates as older individuals. The virus would lose the race to the vaccines.
So the US may still see a fourth surge in cases. But, as Amesh Adalja at the Johns Hopkins Center for Health Security told me, “It’s going to be of a different flavor than prior waves” because the vaccines “have defanged the virus,” including the variants that have been discovered so far.
This is still speculative.
“I think it’s a bit too early to tell,” George Mason University epidemiologist Saskia Popescu said about that scenario. Reducing a fourth surge to a “casedemic” still requires action — ensuring vaccines continue to go out quickly, especially to vulnerable populations.
The best short-term scenario: No fourth surge at all
This scenario — where cases, hospitalizations, and deaths all hold steady or continue to fall — is contingent on policymakers not reopening their states too quickly, the American people continuing to follow public health guidelines such as social distancing and masking, and the vaccine rollout improving, or at the very least, maintaining its current pace.
It could also be helped along by warmer weather in most of the country in the coming weeks, pushing Americans to do more in outdoor spaces where the virus doesn’t spread as easily.
History might not give much reason for optimism. America has generally done a bad job with its policy approach and public adherence throughout the pandemic (hence America’s high death toll relative to many of its developed peers). As Popescu put it, “The US has really struggled when it comes to maintaining vigilance when the finish line is in sight.”
But the country could do it. If Americans hold out a little while longer — possibly just several weeks — we could suddenly find ourselves in a world where most US adults have gotten at least one shot of the vaccine. If we get there and avoid the first scenario on this list, it could translate to tens of thousands more of us being around to celebrate.
The longer-term scenario is more certain — and hopeful
For all the uncertainty surrounding the short term, there’s a longer-term scenario that seems very likely: Thanks to the vaccines, the US will reach the end of the large outbreaks, and the summer will be the beginning of our return to normal.
There’s a real-world example that should fill Americans with hope: Israel. Thanks to good planning and flexibility, Israel has fully vaccinated more than 56 percent of its population, including the vast majority of older demographics. That’s allowed it to almost fully open its economy again as Covid-19 cases plummet to levels not seen since summer 2020.
This is incredibly encouraging. It shows that the vaccines work and are truly a way out of the pandemic. “It’s there,” Adalja said. “The real-world data shows what future we’ll eventually achieve if everything stays on track and we continue to vaccinate.”
The US is well on its way to that point. Already, more than 19 percent of the US population is fully vaccinated. With more than 3 million doses being administered a day, the country will be able to fully inoculate the majority of its population in a little more than a month — and all adults within three months. If that trend continues, the US could reproduce Israel’s crushed curve in just months or even weeks.
Then it will finally happen. We’ll find ourselves back at parties with family, at dinners with friends, and in movie theaters with strangers. What was considered too risky just months ago will be the normal we’ve desired for a year.
“I reckon that point will become apparent in retrospect,” Bill Hanage, an epidemiologist at Harvard, previously told me. “We will suddenly realize that we are laughing, indoors, with people we don’t know and whose vaccine status is unknown, and we will think, ‘Wow, this would have been unimaginable back when …’”
There are still major challenges ahead. Avoiding the deadliest of the short-term scenarios could save tens of thousands of lives. Ensuring enough people get vaccinated — by both improving access and addressing vaccine hesitancy — will be crucial. And it’s a race against time: The possibility that worse variants will emerge increases as the virus continues to spread and mutate.
It’s important to help the rest of the world in its efforts too — not simply for humanitarian reasons, but because the coronavirus and its variants could creep back into the US from other countries.
Still, the happier future now looks like a matter of when, not if. After a year of our futures constantly seeming so uncertain, we now have this respite to look forward to — and it’s likely just a matter of time.
In the coming months, America could reach a point when it has more Covid-19 vaccines than people want.
Between efforts from the federal government and drug companies to step up manufacturing and distribution, the US’s vaccine supply is truly increasing: At least 150 million doses are expected through March — a rate of more than 3 million shots a day, the kind of speed the country needs to reach herd immunity, when enough people are protected against the virus to stop its spread, this summer.
But public health experts are increasingly warning of what may come as America inches closer to the finish line in its vaccine campaign: After the majority of people who want a vaccine get one, there’s a large minority of people who have voiced skepticism in public surveys. And if these people don’t change their minds in the coming months, they could doom any chance the US has of reaching herd immunity.
“There’s going to be a point … where there’s going to be vaccine available, and getting people to take it will be the primary issue,” Emily Brunson, a medical anthropologist at Texas State University, told me.
To reach herd immunity, experts generally estimate that we’ll need to vaccinate at least 70 to 80 percent of the population — though it could be more or less, because we don’t really know for sure with a new virus. Yet according to a recent AP-NORC survey, 32 percent of Americans say they definitely or probably won’t get a Covid-19 vaccine. If that holds and the herd immunity estimates are correct, it would make herd immunity impossible.
Public health experts say there are ways to make people more willing to get vaccinated, but such efforts have to be flexible to match the different concerns about a vaccine different communities and individuals may hold. What might sway skeptical white Republicans who don’t see Covid-19 as a threat won’t necessarily work for Black communities that are distrustful of a medical establishment that has long neglected and even abused them.
Whatever anti-hesitancy campaigns take shape, though, must happen quickly. With every day the coronavirus continues to spread across America, the country sets itself up for hundreds if not thousands more deaths a day — not to mention the constant need for social distancing, a weakened economy, and potentially harsher restrictions on daily life. Each day of uncontrolled spread also brings the risk of new, more dangerous coronavirus variants, as each replication of the virus carries the risk of a mutation that catches on more widely.
Now, the days when hesitancy becomes the top vaccine problem may still be up to months away. But if the pandemic should have taught us anything, it’s that it’s better to be proactive than reactive. It’s not too late to get ahead of this problem before it becomes the next major bottleneck in America’s efforts to end its outbreak.
The US’s vaccine supply problem is getting better
The past few weeks have brought a lot of genuinely good news on the vaccine front.
The number of shots delivered has increased dramatically, from less than 1 million a day in mid-January to around 1.7 million in mid-February. (Though recent snowstorms likely slowed that down.) As bad as America’s initial rollout was, the US is still ahead of all countries except Israel, Seychelles, the United Arab Emirates, and the United Kingdom in vaccination rates — and it’s improving quickly enough, so far, to sustain that lead.
There have also recently been fewer mishaps at the state level. There were some alarming reports during the first few weeks of the rollout — machines breaking down, staffing issues, doses going unused. These problems still pop up (the US is big, and someone is always causing trouble here), but they seem to be happening less frequently as states and localities get the hang of the process. To this end, states are using much more of their vaccines: While it was rare for a state to report administering more than 60 percent of vaccine doses in January, it’s now pretty common for them to report using more than 80 or 90 percent.
Meanwhile, President Joe Biden’s administration has made some strides to improve both the supply of vaccines sent to states and communication with states on what supplies they can expect. The latter is particularly important because it lets states plan for the doses they’re getting — something they weren’t often able to do in the early stages of the vaccine rollout, as they would find out how many vaccines they were getting as late as the day they got the doses. That might help explain why states have been doing better.
There are still plenty of problems. The current rate of 1.7 million shots a day is still too slow; experts would like the country to get to 2 million or 3 million to get through the bulk of vaccine efforts this summer. While the country seems to be on track to get enough doses to do that next month, the question then becomes whether it has the distribution capacity to actually turn those doses into shots in arms — and the logistical challenges there will be immense.
Still, a world where there are enough vaccines to go around is rapidly approaching. Biden said vaccines will be available to all Americans by the end of July, while Anthony Fauci, the top federal infectious disease expert, took a slightly more optimistic outlook in saying it would be “open season” in late May or early June.
At that point, vaccine hesitancy may make supply less of a problem than demand.
America has a hesitancy problem
The views of one-third of Americans may not always amount to a national crisis, but those views matter a lot when the country needs to do something that requires nearly everybody on board. That’s the case with the Covid-19 vaccination campaign, where 70 or 80 percent — or more — of the country will need to get vaccinated to reach herd immunity. So surveys that show as many as one-third of Americans are skeptical amount to a real public health crisis.
Compounding that is the reality that a Covid-19 vaccine still hasn’t been approved for children — and that might not happen until later this summer or even 2022. Given that kids make up 22 percent of the population, herd immunity probably can’t happen without them. But even if herd immunity only requires the lower estimate of 70 percent of Americans, that still will be impossible if more than 30 percent of adults refuse a vaccine.
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Based on public surveys, particularly in-depth ones from the Kaiser Family Foundation, the skeptical report a variety of concerns regarding the Covid-19 vaccine.
A major one is concerns about side effects, particularly long-term health consequences. The Covid-19 vaccines do have side effects, but they’re almost entirely minor — temporary aches, fever, and cold-like symptoms — aside from rare allergic reactions, which require monitoring but are treatable. Still, people worry about the risks.
Some of the skeptics worry that the vaccine approval process, given its record speed, was rushed. But the Covid-19 vaccines still went through the three-phase clinical trial process required by the Food and Drug Administration, testing for safety and efficacy. The vaccines have also been out in the real world for months now, with still no reports of previously unknown and serious effects.
Some people of color also distrust the health care system, based on their experiences with a system that’s often discriminatory and a history of experimentation on Black bodies, such as the Tuskegee study. Surveys show that Latinos and Black people, in particular, are less likely to trust doctors and hospitals in general. That’s likely fed into distrust toward the vaccine, too.
A segment of the population, particularly on the right of the political spectrum, is also skeptical they even need a Covid-19 vaccine. Encouraged by people like former President Donald Trump, they tend to believe the threat of the coronavirus has long been overplayed in the media. Given other potential concerns, for instance about side effects and a rushed process, they question whether they should get a vaccine, believing that Covid-19 isn’t really a threat to them. The reality is it’s a threat to everyone — killing more people under 55 alone than all murders in a typical year — but the perception remains.
Then there are the concerns that fall more in the conspiracy theory camp, whether about certain wealthy people’s involvement in the vaccine process or more traditional (and debunked) anti-vaxxer concerns. But those tend to make up a very small minority of the US public and even Covid-19 vaccine skeptics.
There’s no one-size-fits-all solution
As the list above demonstrates, concerns about vaccines tend to vary and can differ significantly from community to community. Some concerns may not even show up in national surveys at all — they might be too localized to ever appear. This is a critical fact of public health, but it especially applies here: Local problems require local solutions, meaning messaging to combat vaccine hesitancy will have to be tailored differently from community to community.
“There will be similarities, and I think there will be some overlapping issues,” Brunson said. “But there will be local iterations of this that can vary quite widely.”
That doesn’t mean states or federal governments have no role to play. To the contrary, a big federal campaign about the basic facts, particularly the benefits, of the vaccines could be really helpful — and, in fact, experts have repeatedly told me such a campaign should have started months ago. Federal and state governments can also provide support, with money, personnel, guidance, and expertise, that local governments will need to execute on their plans.
The underlying theme of these campaigns, experts say, should be to meet people where they are. That begins with really hearing the community’s concerns, then transparently and honestly walking through why the vaccines’ benefits still dramatically outweigh any downsides. Doing that could require, at some points, acknowledging that people have a point — for example, the US health care system really does have a history of racism — but making the case that the evidence for vaccines is still strong and they’re still worth taking.
The messaging will have to be tested, and what works best will, again, likely differ from place to place and person to person. But experts pointed to several ideas: Campaigns can point to the evidence that the vaccines are very effective, particularly that they, based on the clinical trials, drive Covid-19 deaths down to zero and hospitalizations to almost zero. They can highlight the importance of everyone getting vaccinated to reach herd immunity and, subsequently, protect not just yourself but your friends, family, and community. They can tap into trusted or beloved sources, including doctors but also potentially celebrities.
A more controversial idea is to tell people about the personal benefits of the vaccines. Some of the public health messaging in the US has actually obscured this — telling people that even if they get a vaccine, they won’t be able to go back to their normal, pre-coronavirus lives right away.
Still, some experts argue that the restrained messaging can drive people to ask, “Why bother?” Masking and social distancing should be encouraged until America reaches herd immunity or close to it because we don’t yet know how effective vaccines are in driving down transmission. But people should be trusted with factual information about how vaccines will make certain activities less risky for them and others who get inoculated — and maybe they could safely enjoy some of those activities with their vaccinated friends and family once again.
“People undersell the vaccine,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “They don’t understand that if you tell people nothing changes when they get a vaccine — which I don’t think is true — then they’re not going to have an incentive to get the vaccine.”
Whatever form a pro-vaccine effort takes, experts are in agreement — and they have been for a long time — that some kind of big anti-hesitancy campaign needs to get going soon. Really, it should have started yesterday or last year. But there’s still time to act before the country gets to the point where supply is outstripping demand.
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