vox--2020-08-19--Coronavirus is in the air. Here’s how to get it out.

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Here ’ s how to get it out .
SARS-CoV-2 , the virus that causes Covid-19 , can float in the air .
In particular , it can linger in poorly ventilated indoor spaces , spreading farther than 6 feet from its source .
These indoor public spaces are high risk and should be avoided while the virus is still spreading .
But , increasingly , people are returning to those spaces : Some schools and universities are opening up , restaurants are operating in limited capacity , @ @ @ @ @ @ @ ) polls will open for people to vote in the presidential election .
Right now , in August , it ’ s possible to enjoy many activities outside , where the risk of Covid-19 transmission is lower .
But cold weather will push many of these activities back indoors .
To make indoor communal spaces safer , experts keep stressing , they need to be “ well-ventilated.
” But what does that mean ?
In conversations with several air quality experts and engineers , I found ventilation to be simple in concept and @ @ @ @ @ @ @ ’ s a huge engineering problem , ” Shelly Miller , an environmental engineer at the University of Colorado Boulder , says .
“ We don ’ t have the systems in place for many buildings to be operated appropriately during a pandemic.
” As Derek Thompson observes in the Atlantic , a lot of places have put on a big show about cleaning surfaces — what he calls “ hygiene theater ” — though surface contamination is not thought to be a large source of Covid-19 transmission .
Making places safer , @ @ @ @ @ @ @ .
But “ have you ever heard a restaurant reopening announce they ’ ve improved ventilation or increased ventilation ?
” Lidia Morawska , an engineer and the director of the International Laboratory for Air Quality and Health at Queensland University of Technology , recently told me .
“ No.
” Ventilation concerns are not limited to restaurants and schools .
Recently , a report from the University of California San Francisco noted “ exceedingly poor ventilation ” at the San Quentin State Prison , which saw a huge outbreak of more than @ @ @ @ @ @ @ fall into the “ hygiene theater ” trap if not done well .
So here ’ s a guide for how to think about safer — but not necessarily “ safe ” — indoor air , and all the hurdles that may get in the way .
We need to think about controlling the source of the virus indoors , about mixing more outdoor air with indoor air , and about air filtration and cleaning devices .
The experts I spoke with agreed : We can ’ t ventilate and air purify our @ @ @ @ @ @ @ masks , reduce occupancy in indoor spaces ( or just avoid many of them all together ) , and physically distance .
The indoor space that can ’ t enforce these measures , or allow activities that involve mask removal — like bars and restaurants — probably shouldn ’ t be open .
And , still , the most important way to make indoor spaces safer is to decrease community Covid-19 spread as much as possible .
It may not be easy for all spaces to achieve ideal ventilation .
There are no @ @ @ @ @ @ @ , but there are clear goals to have in mind when trying to make them safer with ventilation .
Here ’ s where to start .
First : Limit the amount of virus in the air in the first place Intuitively , I think we all know how to think about cleaning surfaces : Wipe them down with a disinfectant , or scrub with good old soap and water .
Cleaning the air is an entirely different challenge .
You can ’ t just spray it with chemicals and call it a day @ @ @ @ @ @ @ least as important as cleaning surfaces , but you do it very differently , ” says Linsey Marr , a Virginia Tech engineer who studies the airborne spread of viruses .
“ We end up having to breathe whatever it is we spray .
And if it ’ s harmful to the virus , it ’ s likely it ’ s also harmful to us .
So we need to take a totally different approach.
” There are other challenges to cleaning the air , too .
One big one : Floating particles @ @ @ @ @ @ @ section of air in a space , new dirty air can move in and replace it .
Also , air cleaning needs to be continuous in the spaces we inhabit .
As long as there are living , breathing people in a space , we ’ re potentially contaminating it with virus .
The first thing to do in thinking about cleaning the air , says Jeffrey Siegel , an air filtration expert at the University of Toronto , is to think about limiting the source of the contagion in the first place @ @ @ @ @ @ @ ) .
There ’ s an old saying in his line of work : “ If you ’ ve got the odor of manure , don ’ t try and ventilate to get rid of it , get rid of the manure , ” he says .
“ That ’ s the exact idea , right ?
Get rid of the source or manage that source.
” SARS-CoV-2 gets into the air via human breath .
So we should start by reducing the number of humans in a space , masking those who @ @ @ @ @ @ @ like singing or shouting that can propel even more virus-laden particles into the air .
From contact tracing studies , we know the virus spreads most readily through close contact , with the risks increasing with the amount of time spent in close proximity .
However , there are some situations in poorly ventilated indoor spaces where the virus may be able to float in the air for an extended period ( tens of minutes or more ) , or spread in a gaseous cloud over an area larger than 6 feet ( @ @ @ @ @ @ @ still be able to infect people , some of it may not ) .
Ventilation may help decrease the chances of transmission in these indoor environments .
“ Ventilation may be able to help reduce indoors transmission , but it ’ s never going to be as effective as simply not having lots of people in a single indoor space , ” Boston University epidemiologist Eleanor Murray says in an email .
“ If a workplace can function with employees working remotely , then it will be safer for them to do so @ @ @ @ @ @ @ to work even with better ventilation .
But there may be a few employees who would be better served by being at the office , and for those , improving ventilation will help make the office as safe as possible.
” Outside of source control , there are three basic ways to clean the air and reduce the concentration of airborne virus .
The first is to simply ventilate , or increase the amount of outdoor air in indoor spaces , and to make sure the inside air is replaced by outside air @ @ @ @ @ @ @ the air in your home probably changes over once every hour or two hours , ” Marr says .
“ We ’ re aiming for an air exchange rate of , like , six per hour.
” That recommendation , she says , comes from studies of tuberculosis transmission .
( Tuberculosis is not SARS-CoV-2 .
TB is much more contagious and is thought to be able to spread farther and stay longer in the air . )
It ’ s important to remember , too , that scientists still don ’ t @ @ @ @ @ @ @ amounts to a dangerous , infectious concentration of virus in the air .
“ There ’ s no perfectly ‘ safe ’ level of ventilation because we don ’ t actually know what ‘ safe ’ is , since we don ’ t know how much exposure leads to transmission , ” Angela Rasmussen , a Columbia University virologist , says in an email .
Six air changes an hour is a baseline .
“ If you want the risk down to zero , you ’ ve got to get to an infinite @ @ @ @ @ @ @ ” Marr adds .
Which is impossible .
Again , more ventilation may be “ safer , ” but it ’ s not “ safe.
” The easiest way to increase ventilation : open windows .
This will increase the amount of outside air ( which does not have virus in it ) coming in to dilute indoor air ( which may have virus in it ) .
The less concentrated the virus is in the air , the less likely it is to infect people .
It seems simple , but it @ @ @ @ @ @ @ some specific scenarios where opening windows can be counterproductive and yield unpredictable effects , as Siegel explains .
Let ’ s say you have a bathroom .
It would be a good idea to keep the bathroom air in the bathroom .
After all , many types of viruses can spread in bathrooms , and in the case of Covid-19 , it ’ s possible for the virus to be sent into the air via toilet flushes ( though it ’ s less clear if someone can be infected this way ) .
@ @ @ @ @ @ @ not let that bathroom air get out into other spaces .
To keep the air in the bathroom in the bathroom , it needs what engineers call “ negative pressure , ” meaning that air can flow into the bathroom but not out .
“ And then you open a window in the room beside the bathroom , ” Siegel says .
“ And once you open windows , you give up on any idea of controlling pressurization or depressurization.
” When this happens , the potentially contaminated air in the bathroom will @ @ @ @ @ @ @ this example isn ’ t to make people scared of opening windows .
It ’ s just that indoor spaces are complicated , and airflow can be hard to predict .
“ No one I know — even some of the best building modelers in the world — can accurately model a building with open windows , ” he says .
“ It ’ s just way too dynamic of a system .
We know that , in general , ventilation rate increases .
And I ’ m not going to tell anyone @ @ @ @ @ @ @ really we can ’ t tell you what it ’ s doing to airflow in the space.
” This is one of the potential pitfalls with ventilation : “ Ventilation pathway matters too , ” Siegel explained on Twitter .
If a fan meant to increase ventilation ends up blowing virus across people ’ s faces , it ’ s self-defeating .
This is what ’ s believed to have happened in a restaurant in China , where people sitting in the path of an air conditioning fan got sick .
Later , @ @ @ @ @ @ @ system pulled in no outdoor air , and the air in the restaurant wasn ’ t replaced even once in an hour , let alone six times , which likely contributed to the outbreak there .
So how do you know if you ’ re doing ventilation right ?
Is there any way to monitor your airflow and know the air exchange rate ?
Here , things get tricky .
One indirect way to do this is to purchase a carbon dioxide detector ( which are around $ 100 online ) to give @ @ @ @ @ @ @ .
When we exhale , we exhale CO2 .
“ How much CO2 is in an indoor space is basically a metric of how much air other people have expelled in that space , ” Jose-Luis Jimenez , a chemistry professor at the University of Colorado Boulder , says .
So high and rising CO2 levels in a space can be a sign it ’ s not properly ventilated .
“ The relationship between CO2 and outside air ventilation is really complicated and not something I ’ m advocating the public try to @ @ @ @ @ @ @ But , as a general benchmark , the average C02 concentration of outdoor air is around 400 ppm ( parts per million ) .
So indoor spaces should ideally have a CO2 concentration of under 500 or 600 ppm in a room where people are breathing .
That will tell , roughly , whether outdoor air is being mixed with indoor air at a reasonable level .
Building managers , though , shouldn ’ t depend entirely on a CO2 monitor .
Again , it ’ s an indirect measure .
If there @ @ @ @ @ @ @ space , they may not generate enough CO2 to make the sensor rise that much even in a stagnant environment .
And it only takes one person to start an outbreak .
In commercial settings , some building operators might be able to adjust the amount of fresh air pumped into a building ’ s ventilation system .
During the pandemic , they should do this .
But , as Miller explains , “ many [ commercial HVAC ] systems don ’ t run on 100 percent outside air.
” It ’ s @ @ @ @ @ @ @ t provide air conditioning and heat with 100 percent outside air , ” she says .
So , in some cases , there is a limit to how much outside air an HVAC system can mix into a building .
Other systems might be in disrepair and unable to ideally ventilate buildings , even if their systems are cranked up .
Particularly in schools , ventilation systems can be old and in disrepair .
In June , the Government Accountability Office published a survey of 65 school districts that receive aid from the @ @ @ @ @ @ @ of the districts needed to update HVAC equipment in half of their schools .
Separately , in New York City , a Daily News investigation found that “ roughly 650 of the 1,500 buildings surveyed in 2019 by city inspectors had at least one deficiency in their exhaust fans.
” A huge part of the challenge of increasing ventilation is that different buildings , built in different eras for different purposes , will need potentially different solutions .
Older buildings might not have any central HVAC systems at all .
And some with @ @ @ @ @ @ @ rooms but less well in others .
“ When I think about my daughter ’ s school , ” Siegel says , “ I don ’ t worry about the school as a whole as much as I worry about that classroom where they can ’ t open the windows because there ’ s a construction site right nearby.
” It ’ s important to know here that ventilating schools has benefits that are broader than its pandemic applications .
Kids need to breathe healthy air ( the dangers of air quality for @ @ @ @ @ @ @ well-being are as clear and critical as ever ) .
And allowing them to do so will require huge investments .
“ We can ’ t even get the Congress to allocate , you know , $ 600 a week in unemployment , let alone a billion dollars to schools to upgrade their HVAC , ” Miller says .
“ We have systematically neglected our HVAC systems for a very , very long time , ” Siegel says .
“ Schools are one classic example of that .
But also every building .
@ @ @ @ @ @ @ , we ’ ve got a pandemic , and we say , well , we want to increase ventilation ... you don ’ t get there without some amount of investment.
” Air filters can work too — if used properly The goal in ventilation is to replace potentially virus-laden air indoors with virus-free air .
One way to do this is to bring more outdoor air inside .
The other way is to filter the indoor air itself .
This also is simple in theory , but the implementation can be tricky @ @ @ @ @ @ @ air filter .
For this , the American Society of Heating , Refrigerating , and Air-Conditioning Engineers suggests using filters with a MERV-13 designation or higher .
Or use a portable HEPA filter ( there are some DIY versions you can try on the cheap ) .
MERVs are based on a filter ’ s performance in filtering out particles between 0.3 and 10 microns .
SARS-CoV-2 could very well be found in respiratory droplets in this size range ; the higher the MERV number , the higher the probability that the filter @ @ @ @ @ @ @ , more common in portable air filters , are slightly different .
The “ HEPA ” designation means they filter out at least 99.97 percent of particles that are 0.3 microns .
Which is to say , they filter out practically everything .
( A quirk of the physics of filtration is the very smallest particles are actually easier to filter out than the 0.3 micron ones .
The smallest particles get pushed toward filter fibers because of their collisions with gas molecules in the air , Siegel explains . )
“ I @ @ @ @ @ @ @ good conscience , ‘ This is the filter you should use to protect against Covid-19 transmission , ’ because it really depends how you use that filter , ” Siegel says .
“ We much more often have an implementation problem than a lack of technology problem.
” Often , he says , in buildings , a filter will be improperly sealed so that some unfiltered air sneaks past it and recirculates in the building ; this downgrades its filtering ability .
Also , not all systems can run these higher-efficiency filters , @ @ @ @ @ @ @ often require more powerful fans to push air through .
For instance , Siegel says that , typically , home window AC units don ’ t operate with very powerful fans .
So if you put a good filter in the unit , “ you would not move any air , your air conditioner would cease to perform as an air conditioner , the coil would ice up very rapidly , and you ’ d have a nice block of ice with no air blowing across it.
” The other consideration : These @ @ @ @ @ @ @ frequently as they “ fill up ” with more stuff more quickly and it becomes harder to push air through the filter .
Also ( this list of caveats and considerations is getting long , right ? )
you need to buy a unit that ’ s sized correctly for the space you are in .
The filtering unit should ideally , along with ventilation , lead to six or more air exchanges per hour .
“ You want something that ’ s good for the size of your room or bigger ; @ @ @ @ @ @ @ , ” Marr says .
“ But , you know , even if you get something that ’ s smaller , it ’ s not going to harm you.
” She adds that you also need to be careful when changing the filters because they could be contaminated with virus .
And finally : Air filters have to be constantly running to work .
“ Forced air systems [ like centralized heating and cooling ] in most residential contexts and in some commercial context only come on when there ’ s a need @ @ @ @ @ @ @ That is , they only turn on when it gets too cold or too hot .
For a filter to work at its best , air needs to be constantly running through it .
Some systems may need to be tinkered with to get this to happen .
Again , it ’ s hard to know , exactly , what impact air purifiers will have on transmission .
“ My main concern with these ventilation systems is that we do not know really whether they will decrease transmission risk substantially , ” Muge @ @ @ @ @ @ @ at the University of St. Andrews , says in an email .
After all , there aren ’ t randomized controlled studies of using air cleaners during this pandemic to decrease transmission .
In theory , air purifiers should help .
“ It ’ s not rocket science , ” Jimenez , who strongly advocates for their use , says .
“ If you pass air through the filter , it will catch the particles.
” There ’ s yet another option for removing virus from the air : killing it with ultraviolet @ @ @ @ @ @ @ who specializes in studying devices that do this sort of thing — doesn ’ t recommend these for the average consumer .
“ While they can be effective , there is not enough testing/certification for these devices , ” she says .
“ These are pretty complex , and there are a lot of great applications and some really good companies that can help with design and install.
” But , she says “ there are also a lot of bad lamp manufacturers and people selling devices that don ’ t work .
@ @ @ @ @ @ @ to support these installations.
” If you look at air cleaning products , you ’ ll find a lot of gimmicks : ionizers , plasma generators that claim to amp up the power of filters .
“ There ’ s very little science behind them , ” Siegel says .
“ It ’ s not only that the devices are ineffective and maybe lull people into a false sense of security , but in some cases they ’ re actually harmful.
” Watch out , in particular , for machines that can generate @ @ @ @ @ @ @ can interact with a lot of different products in your home and create harmful chemicals to breathe in .
“ It reacts with carpets and skin oil and all kinds of things inside of buildings , ” Siegel says , “ forming all kinds of harmful byproducts , ultra-fine particles , formaldehyde , all kinds of other things that we would worry about indoors.
” So stick with HEPA or MERV-13+ rated filters .
Or just open windows .
Remember : Hygiene theater is possible when it comes to air quality as well @ @ @ @ @ @ @ space says it has improved ventilation , ask how .
Marr suggests asking building operators what the air exchange rate is ( if they don ’ t know it , maybe be wary about the space ) .
Ask about what filters have been put in place .
Ask if their HVAC systems have been routinely maintained .
“ Even if you can ’ t reach the target — six air changes per hour — if you can improve , that will still be helpful , ” Marr says .
“ Do what @ @ @ @ @ @ @ the risk of transmission .
Don ’ t give up.
” We need to invest in cleaner air , period .
Pandemic or not .
There are no risk-free situations in a pandemic .
Again , good ventilation is meant to supplement the other precautions we have in place .
The hope is “ if we can take this whole suite of stopgap measures from the ventilation standpoint and add it to masks , social distancing , reduced occupancy , limited time indoors , the whole package could reduce our risk substantially to @ @ @ @ @ @ @ ” Miller says .
This is particularly important heading into the fall and winter seasons , when more people will be spending more time indoors in potentially risky environments .
Experts also worry that the US Centers for Disease Control and Prevention is not being helpful enough in its air quality recommendations .
For instance , the CDC recommends that schools “ ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible , for example by opening windows and doors.
” But they don ’ t even weigh @ @ @ @ @ @ @ HEPA air purifier in each classroom .
“ It would carry more credibility , ” Jimenez says , if the CDC would discuss their use rather than leave the conversation in the hands of independent scientists speaking for themselves .
“ When I was talking to a school district , they were all saying , ‘ Well , the CDC doesn ’ t recommend air cleaners.
’ ” In Jimenez ’ s mind , air cleaners are essential .
But it ’ s hard to get the message across without a huge institution @ @ @ @ @ @ @ much of the pain of the pandemic builds on preexisting problems .
Too many schools and other buildings have overlooked their ventilation and indoor air quality to begin with .
Addressing ventilation can ’ t just be a one-time Band-Aid during the pandemic .
It ’ s an investment .
And not just for future pandemics but for our overall health .
“ The best possible case is that you reduce risk of Covid-19 and you make your indoor air quality better , ” Siegel says .
“ The worst possible case is @ @ @ @ @ @ @ but don ’ t appreciably change Covid-19 risk.
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Share All sharing options for: Coronavirus is in the air. Here’s how to get it out.
SARS-CoV-2, the virus that causes Covid-19, can float in the air. In particular, it can linger in poorly ventilated indoor spaces, spreading farther than 6 feet from its source. These indoor public spaces are high risk and should be avoided while the virus is still spreading.
But, increasingly, people are returning to those spaces: Bars and restaurants are operating in limited capacity in some places, and are fully reopened in others. Some schools and universities have resumed in-person classes, and mayors are allowing some live entertainment venues to host events.
With the weather growing colder, experts fear indoor gatherings in these and private spaces could spark new outbreaks. Already, cases are increasing nationwide, and experts are growing more concerned about a potential fall-winter Covid-19 surge.
To make indoor communal spaces safer, experts keep stressing that they need to be “well-ventilated.” But what does that mean? In conversations with several air quality experts and engineers, I found ventilation to be simple in concept and potentially fraught in execution.
“It’s a huge engineering problem,” Shelly Miller, an environmental engineer at the University of Colorado Boulder, says. “We don’t have the systems in place for many buildings to be operated appropriately during a pandemic.”
As Derek Thompson observes in the Atlantic, a lot of places have put on a big show about cleaning surfaces — what he calls “hygiene theater” — though surface contamination is not thought to be a large source of Covid-19 transmission.
Making places safer, instead, should mean improving air quality. But “have you ever heard a restaurant reopening announce they’ve improved ventilation or increased ventilation?” Lidia Morawska, an engineer and the director of the International Laboratory for Air Quality and Health at Queensland University of Technology, recently told me. “No.”
Ventilation concerns are not limited to restaurants and schools. Recently, a report from the University of California San Francisco noted “exceedingly poor ventilation” at the San Quentin State Prison, which saw a huge outbreak of more than 2,200 cases.
Ventilation efforts could easily fall into the “hygiene theater” trap if not done well. So here’s a guide for how to think about safer — but not necessarily “safe” — indoor air, and all the hurdles that may get in the way. We need to think about controlling the source of the virus indoors, about mixing more outdoor air with indoor air, and about air filtration and cleaning devices.
The experts I spoke with agreed: We can’t ventilate and air purify our way out of the need to wear masks, reduce occupancy in indoor spaces (or just avoid many of them all together), and physically distance. The indoor space that can’t enforce these measures, or allow activities that involve mask removal — like bars and restaurants — probably shouldn’t be open. And, still, the most important way to make indoor spaces safer is to decrease community Covid-19 spread as much as possible. It may not be easy for all spaces to achieve ideal ventilation.
There are no perfectly safe indoor environments during the pandemic, but there are clear goals to have in mind when trying to make them safer with ventilation. Here’s where to start.
First: Limit the amount of virus in the air in the first place
Intuitively, I think we all know how to think about cleaning surfaces: Wipe them down with a disinfectant, or scrub with good old soap and water. Cleaning the air is an entirely different challenge. You can’t just spray it with chemicals and call it a day.
“Cleaning the air is at least as important as cleaning surfaces, but you do it very differently,” says Linsey Marr, a Virginia Tech engineer who studies the airborne spread of viruses. “We end up having to breathe whatever it is we spray. And if it’s harmful to the virus, it’s likely it’s also harmful to us. So we need to take a totally different approach.”
There are other challenges to cleaning the air, too. One big one: Floating particles can move. If you clean one section of air in a space, new dirty air can move in and replace it. Also, air cleaning needs to be continuous in the spaces we inhabit. As long as there are living, breathing people in a space, we’re potentially contaminating it with virus.
The first thing to do in thinking about cleaning the air, says Jeffrey Siegel, an air filtration expert at the University of Toronto, is to think about limiting the source of the contagion in the first place (i.e., living, breathing people). There’s an old saying in his line of work: “If you’ve got the odor of manure, don’t try and ventilate to get rid of it, get rid of the manure,” he says. “That’s the exact idea, right? Get rid of the source or manage that source.”
SARS-CoV-2 gets into the air via human breath. So we should start by reducing the number of humans in a space, masking those who have to enter, and limiting activities like singing or shouting that can propel even more virus-laden particles into the air.
From contact tracing studies, we know the virus spreads most readily through close contact, with the risks increasing with the amount of time spent in close proximity. However, there are some situations in poorly ventilated indoor spaces where the virus may be able to float in the air for an extended period (tens of minutes or more), or spread in a gaseous cloud over an area larger than 6 feet (some of that long-range floating virus may still be able to infect people, some of it may not). Ventilation may help decrease the chances of transmission in these indoor environments.
“Ventilation may be able to help reduce indoors transmission, but it’s never going to be as effective as simply not having lots of people in a single indoor space,” Boston University epidemiologist Eleanor Murray says in an email. “If a workplace can function with employees working remotely, then it will be safer for them to do so than to have all employees come back to work even with better ventilation. But there may be a few employees who would be better served by being at the office, and for those, improving ventilation will help make the office as safe as possible.”
Second: Ventilate
Outside of source control, there are three basic ways to clean the air and reduce the concentration of airborne virus. The first is to simply ventilate, or increase the amount of outdoor air in indoor spaces, and to make sure the inside air is replaced by outside air several times per hour.
“So the air in your home probably changes over once every hour or two hours,” Marr says. “We’re aiming for an air exchange rate of, like, six per hour.” That recommendation, she says, comes from studies of tuberculosis transmission. (Tuberculosis is not SARS-CoV-2. TB is much more contagious and is thought to be able to spread farther and stay longer in the air.)
It’s important to remember, too, that scientists still don’t really have a specific figure on what amounts to a dangerous, infectious concentration of virus in the air. “There’s no perfectly ‘safe’ level of ventilation because we don’t actually know what ‘safe’ is, since we don’t know how much exposure leads to transmission,” Angela Rasmussen, a Columbia University virologist, says in an email.
Six air changes an hour is a baseline. “If you want the risk down to zero, you’ve got to get to an infinite number of air changes per hour,” Marr adds. Which is impossible.
Again, more ventilation may be “safer,” but it’s not “safe.”
The easiest way to increase ventilation: open windows. This will increase the amount of outside air (which does not have virus in it) coming in to dilute indoor air (which may have virus in it). The less concentrated the virus is in the air, the less likely it is to infect people.
It seems simple, but it’s not foolproof. There are some specific scenarios where opening windows can be counterproductive and yield unpredictable effects, as Siegel explains.
Let’s say you have a bathroom. It would be a good idea to keep the bathroom air in the bathroom. After all, many types of viruses can spread in bathrooms, and in the case of Covid-19, it’s possible for the virus to be sent into the air via toilet flushes (though it’s less clear if someone can be infected this way). So it’s ideally best to not let that bathroom air get out into other spaces.
To keep the air in the bathroom in the bathroom, it needs what engineers call “negative pressure,” meaning that air can flow into the bathroom but not out.
“And then you open a window in the room beside the bathroom,” Siegel says. “And once you open windows, you give up on any idea of controlling pressurization or depressurization.” When this happens, the potentially contaminated air in the bathroom will start flowing out.
The point of this example isn’t to make people scared of opening windows. It’s just that indoor spaces are complicated, and airflow can be hard to predict.
“No one I know — even some of the best building modelers in the world — can accurately model a building with open windows,” he says. “It’s just way too dynamic of a system. We know that, in general, ventilation rate increases. And I’m not going to tell anyone not to open the windows. But really we can’t tell you what it’s doing to airflow in the space.”
This is one of the potential pitfalls with ventilation: “Ventilation pathway matters too,” Siegel explained on Twitter. If a fan meant to increase ventilation ends up blowing virus across people’s faces, it’s self-defeating. This is what’s believed to have happened in a restaurant in China, where people sitting in the path of an air conditioning fan got sick. Later, researchers also said that the restaurant A/C system pulled in no outdoor air, and the air in the restaurant wasn’t replaced even once in an hour, let alone six times, which likely contributed to the outbreak there.
How to monitor ventilation
So how do you know if you’re doing ventilation right? Is there any way to monitor your airflow and know the air exchange rate? Here, things get tricky. One indirect way to do this is to purchase a carbon dioxide detector (which are around $100 online) to give you a rough sense of air quality. When we exhale, we exhale CO2. “How much CO2 is in an indoor space is basically a metric of how much air other people have expelled in that space,” Jose-Luis Jimenez, a chemistry professor at the University of Colorado Boulder, says. So high and rising CO2 levels in a space can be a sign it’s not properly ventilated.
“The relationship between CO2 and outside air ventilation is really complicated and not something I’m advocating the public try to figure out,” Miller says. But, as a general benchmark, the average C02 concentration of outdoor air is around 400 ppm (parts per million). So indoor spaces should ideally have a CO2 concentration of under 500 or 600 ppm in a room where people are breathing. That will tell, roughly, whether outdoor air is being mixed with indoor air at a reasonable level.
Building managers, though, shouldn’t depend entirely on a CO2 monitor. Again, it’s an indirect measure. If there are only a few people in a space, they may not generate enough CO2 to make the sensor rise that much even in a stagnant environment. And it only takes one person to start an outbreak.
(There’s also some room for commonsense measurements, too: Use your nose. If you can smell odors wafting through a building coming from indoor sources, the space may not be adequately ventilated. “If you walk into a place and it feels stuffy and the windows aren’t open, then that’s an indicator that there’s not good ventilation there,” Marr says.)
In commercial settings, some building operators might be able to adjust the amount of fresh air pumped into a building’s ventilation system. During the pandemic, they should do this. But, as Miller explains, “many [commercial HVAC] systems don’t run on 100 percent outside air.” It’s too energy-intensive. “You can’t provide air conditioning and heat with 100 percent outside air,” she says. So, in some cases, there is a limit to how much outside air an HVAC system can mix into a building.
Other systems might be in disrepair and unable to ideally ventilate buildings, even if their systems are cranked up. Particularly in schools, ventilation systems can be old and in disrepair. In June, the Government Accountability Office published a survey of 65 school districts that receive aid from the federal government. It found 41 percent of the districts needed to update HVAC equipment in half of their schools. Separately, in New York City, a Daily News investigation found that “roughly 650 of the 1,500 buildings surveyed in 2019 by city inspectors had at least one deficiency in their exhaust fans.”
A huge part of the challenge of increasing ventilation is that different buildings, built in different eras for different purposes, will need potentially different solutions. Older buildings might not have any central HVAC systems at all. And some with HVAC systems may operate well for some rooms but less well in others.
“When I think about my daughter’s school,” Siegel says, “I don’t worry about the school as a whole as much as I worry about that classroom where they can’t open the windows because there’s a construction site right nearby.”
It’s important to know here that ventilating schools has benefits that are broader than its pandemic applications. Kids need to breathe healthy air (the dangers of air quality for children’s’ health and cognitive well-being are as clear and critical as ever). And allowing them to do so will require huge investments.
“We can’t even get the Congress to allocate, you know, $600 a week in unemployment, let alone a billion dollars to schools to upgrade their HVAC,” Miller says.
“We have systematically neglected our HVAC systems for a very, very long time,” Siegel says. “Schools are one classic example of that. But also every building. And so now all of a sudden, we’ve got a pandemic, and we say, well, we want to increase ventilation ... you don’t get there without some amount of investment.”
(Hospitals, you might be curious to know, already have extensive requirements in place for ventilation. So which comes at a great cost and takes lots of energy to use.)
Air filters can work too — if used properly
The goal in ventilation is to replace potentially virus-laden air indoors with virus-free air. One way to do this is to bring more outdoor air inside. But this isn’t always doable. You can’t easily open windows for ventilation when there’s a lot of hazardous pollution outside (like wildfire smoke). So, the other way is to filter the indoor air itself.
This also is simple in theory, but the implementation can be tricky.
It starts with getting a good air filter. For this, the American Society of Heating, Refrigerating, and Air-Conditioning Engineers suggests using filters with a MERV-13 designation or higher. Or use a portable HEPA filter (there are some DIY versions you can try on the cheap).
MERVs are based on a filter’s performance in filtering out particles between 0.3 and 10 microns. SARS-CoV-2 could very well be found in respiratory droplets in this size range; the higher the MERV number, the higher the probability that the filter will remove these droplets.
HEPA filters, more common in portable air filters, are slightly different. The “HEPA” designation means they filter out at least 99.97 percent of particles that are 0.3 microns. Which is to say, they filter out practically everything. (A quirk of the physics of filtration is the very smallest particles are actually easier to filter out than the 0.3 micron ones. The smallest particles get pushed toward filter fibers because of their collisions with gas molecules in the air, Siegel explains.)
But installing higher-quality filters isn’t enough.
“I can’t just tell you in good conscience, ‘This is the filter you should use to protect against Covid-19 transmission,’ because it really depends how you use that filter,” Siegel says. “We much more often have an implementation problem than a lack of technology problem.”
Often, he says, in buildings, a filter will be improperly sealed so that some unfiltered air sneaks past it and recirculates in the building; this downgrades its filtering ability. Also, not all systems can run these higher-efficiency filters, which can be quite dense. They often require more powerful fans to push air through.
For instance, Siegel says that, typically, home window AC units don’t operate with very powerful fans. So if you put a good filter in the unit, “you would not move any air, your air conditioner would cease to perform as an air conditioner, the coil would ice up very rapidly, and you’d have a nice block of ice with no air blowing across it.”
The other consideration: These higher-quality filters need to be replaced more frequently as they “fill up” with more stuff more quickly and it becomes harder to push air through the filter. Also (this list of caveats and considerations is getting long, right?) you need to buy a unit that’s sized correctly for the space you are in. The filtering unit should ideally, along with ventilation, lead to six or more air exchanges per hour.
“You want something that’s good for the size of your room or bigger; bigger will give you better cleaning power,” Marr says. “But, you know, even if you get something that’s smaller, it’s not going to harm you.” She adds that you also need to be careful when changing the filters because they could be contaminated with virus.
And finally: Air filters have to be constantly running to work.
“Forced air systems [like centralized heating and cooling] in most residential contexts and in some commercial context only come on when there’s a need for conditioning,” Siegel says. That is, they only turn on when it gets too cold or too hot. For a filter to work at its best, air needs to be constantly running through it. Some systems may need to be tinkered with to get this to happen.
Again, it’s hard to know, exactly, what impact air purifiers will have on transmission. “My main concern with these ventilation systems is that we do not know really whether they will decrease transmission risk substantially,” Muge Cevik, a physician and virology expert at the University of St. Andrews, says in an email. After all, there aren’t randomized controlled studies of using air cleaners during this pandemic to decrease transmission.
In theory, air purifiers should help. “It’s not rocket science,” Jimenez, who strongly advocates for their use, says. “If you pass air through the filter, it will catch the particles.”
Watch out for snake oil air-cleaning products
There’s yet another option for removing virus from the air: killing it with ultraviolet lamps. That said, Miller — who specializes in studying devices that do this sort of thing — doesn’t recommend these for the average consumer.
“While they can be effective, there is not enough testing/certification for these devices,” she says. “These are pretty complex, and there are a lot of great applications and some really good companies that can help with design and install.” But, she says “there are also a lot of bad lamp manufacturers and people selling devices that don’t work. Best left to engineers and reputable companies to support these installations.”
If you look at air cleaning products, you’ll find a lot of gimmicks: ionizers, plasma generators that claim to amp up the power of filters. “There’s very little science behind them,” Siegel says. “It’s not only that the devices are ineffective and maybe lull people into a false sense of security, but in some cases they’re actually harmful.”
Watch out, in particular, for machines that can generate ozone. Ozone is a pollutant that can interact with a lot of different products in your home and create harmful chemicals to breathe in. “It reacts with carpets and skin oil and all kinds of things inside of buildings,” Siegel says, “forming all kinds of harmful byproducts, ultra-fine particles, formaldehyde, all kinds of other things that we would worry about indoors.”
So stick with HEPA or MERV-13+ rated filters. Or just open windows.
Remember: Hygiene theater is possible when it comes to air quality as well. If a school or any indoor space says it has improved ventilation, ask how. Marr suggests asking building operators what the air exchange rate is (if they don’t know it, maybe be wary about the space). Ask about what filters have been put in place. Ask if their HVAC systems have been routinely maintained.
“Even if you can’t reach the target — six air changes per hour — if you can improve, that will still be helpful,” Marr says. “Do what you can, because that will reduce the risk of transmission. Don’t give up.”
We need to invest in cleaner air, period. Pandemic or not.
There are no risk-free situations in a pandemic. Again, good ventilation needs to take place alongside other precautions. The hope is “if we can take this whole suite of stopgap measures from the ventilation standpoint and add it to masks, social distancing, reduced occupancy, limited time indoors, the whole package could reduce our risk substantially to help get the case rates down,” Miller says.
This is particularly important heading into the fall and winter seasons, when more people will be spending more time indoors in potentially risky environments.
Experts also worry that the US Centers for Disease Control and Prevention is not being helpful enough in its air quality recommendations. For instance, the CDC recommends that schools “ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible, for example by opening windows and doors.” But they don’t even weigh in on the merits of putting a HEPA air purifier in each classroom.
“It would carry more credibility,” Jimenez says, if the CDC would discuss their use rather than leave the conversation in the hands of independent scientists speaking for themselves. “When I was talking to a school district, they were all saying, ‘Well, the CDC doesn’t recommend air cleaners.’” In Jimenez’s mind, air cleaners are essential. But it’s hard to get the message across without a huge institution like the CDC echoing it.
So much of the pain of the pandemic builds on preexisting problems. Too many schools and other buildings have overlooked their ventilation and indoor air quality to begin with. Addressing ventilation can’t just be a one-time Band-Aid during the pandemic. It’s an investment. And not just for future pandemics but for our overall health.
“The best possible case is that you reduce risk of Covid-19 and you make your indoor air quality better,” Siegel says. “The worst possible case is that you make indoor air quality better but don’t appreciably change Covid-19 risk.”
Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.


vox--2020-08-19--This might be your most important flu shot ever

This fall and winter , health experts expect two types of deadly viruses to be circulating widely in the US .
But they don ’ t yet know what the extent of the damage will be when the two collide .
In the absence of a coherent federal response , the novel coronavirus continues to spread across the country , with several states still battling active outbreaks .
Experts estimate it could continue to hospitalize thousands and kill hundreds of people a day into September — likely with more spikes in the coming months .
We ’ re also now @ @ @ @ @ @ @ which typically starts in October and burdens the health care system even in normal years .
The 2018–2019 flu season in the US , for example , resulted in about half a million hospitalizations and more than 34,000 deaths .
The previous season , deaths were double that .
And communities of color , which have already been disproportionately impacted by Covid-19 , historically have also been more likely to have chronic health conditions that put them at higher risk of influenza-related complications .
In the Southern Hemisphere this year , where the @ @ @ @ @ @ @ , there has been less fall and winter flu activity ( possibly due to effective Covid-19 measures , which can also limit the spread of other respiratory viruses ) .
But not all experts are counting on that same scenario in the US .
Which means the months ahead could be bleak .
“ Based on all the current trends in the US , and our inability to control Covid-19 spread , especially in some parts of the country , I think we are in for a rough fall and winter , ” @ @ @ @ @ @ @ University Medical Center and the Duke Human Vaccine Institute , told Vox in an email .
“ If we have Covid-19 on top of the usual seasonal rise in hospital admissions due to influenza and other illnesses , we could overwhelm the health care system.
” Stephen Morse , an epidemiologist at Columbia University Mailman School of Public Health , is also worried : “ Adding another half million [ flu ] patients needing hospitalization , some requiring ICU beds , is a recipe for disaster .
It could stretch our health care @ @ @ @ @ @ @ point.
” One problem is that because influenza and Covid-19 are both respiratory viruses , severe cases will be treated on much of the same limited medical equipment , like ventilators .
And because they can have overlapping symptoms , figuring out whether someone has the flu or Covid-19 — or neither — will be tricky but also important .
Fortunately , we already have a safe vaccine for the flu , and nearly 200 million doses are slated to be available in the coming months .
The Centers for Disease Control and @ @ @ @ @ @ @ 6 months and older ( with very rare exceptions , like a life-threatening egg allergy ) should get a flu shot .
And this year , it is more crucial than ever to get one , experts say , to reduce the spread of the virus and keep the health care system from being overtaxed with continued surges of Covid-19 .
Yet the barriers will also be higher than usual .
Many workplaces that typically offer flu shot clinics either aren ’ t open or are reducing their size .
Mass vaccination events @ @ @ @ @ @ @ centers , and religious institutions , have also been scaled back this fall due to physical distancing precautions .
Instead , many individuals will need to get their vaccine this year by visiting their doctor ’ s office or an urgent care clinic , pharmacy , or local health department .
It ’ s clear this year ’ s flu season in the midst of a pandemic promises to be especially fraught .
Let ’ s take a closer look at why that is — and why flu shots even under difficult circumstances @ @ @ @ @ @ @ this year ’ s flu season is extra unpredictable Uncertainty looms over flu season every year , but this time there are even more unknowns than usual — from precisely what strains will be circulating to how the virus will interact with Covid-19 to whether our new pandemic habits will impact its spread .
“ This year , in particular , we don ’ t know what to expect , ” says Stacey Schultz-Cherry , an influenza researcher at St. Jude ’ s Children ’ s Research Hospital .
The influenza virus is @ @ @ @ @ @ @ , and multiple strains circulate at any given time , some more harmful than others .
This is why each year ’ s flu shot hedges its bets by fending off a few different strains — and why you need to get a new flu shot every year .
This rapid evolution is also why it ’ s hard to develop a vaccine that is a precise match for the strains of flu that end up circulating .
Vaccines take months to manufacture in such large quantities , so the process of designing @ @ @ @ @ @ @ before flu season hits the US .
Early in the year , scientists start looking at what strains of influenza are circulating around the world , especially south of the equator , just before their full flu season starts .
But this year , we are largely missing this crucial piece to the puzzle because the Southern Hemisphere has seen very little flu .
The paucity of flu cases in the Southern Hemisphere this year also means that we haven ’ t been able to learn much about how Covid-19 interacts with influenza @ @ @ @ @ @ @ the pandemic , when the flu was still circulating in China over the winter , showed that some people did have simultaneous infections .
“ We really don ’ t know what a co-infection would look like , ” Schultz-Cherry says .
But , she says , “ I wouldn ’ t want to have the lungs that would find that out.
” She does hypothesize that it would be “ a more significant infection ” — especially in those at a higher risk for severe Covid-19 and for severe flu illness ( @ @ @ @ @ @ @ disease or cancer ) .
Other researchers have proposed a model by which familiar seasonal viruses , like the flu , might actually out-compete the novel coronavirus SARS-CoV-2 in the body ( due in part to its relatively slower replication rate ) , thus potentially making full-blown Covid-19 less likely .
And a preliminary report from China proposes limited clinical evidence for this idea .
Still other small reports have documented similar outcomes for patients with co-infections of the flu and Covid-19 as those who only had Covid-19 .
Moody notes that gathering @ @ @ @ @ @ @ to take time .
“ We expect that we will see co-infections once influenza season gets underway .
Unfortunately , we will probably be deep into influenza season before we can say if outcomes are worse if you have both , ” he says .
“ For this reason , we are encouraging people to get their influenza vaccine this season — to blunt this risk.
” We also don ’ t know how much our restrictions to reduce the spread of SARS-CoV-2 , such as mask-wearing and physical distancing , will impact @ @ @ @ @ @ @ Many experts attribute the decrease in flu cases in many Southern Hemisphere countries this year , including Chile , South Africa , and New Zealand , to these measures .
But it ’ s not clear whether the US , which has had patchwork restrictions on things like mask-wearing , will see the same trend .
“ I would be hesitant to compare ourselves to New Zealand , ” says Schultz-Cherry , where they have had virtually no flu this winter — but also went months without a single local transmission of Covid-19 @ @ @ @ @ @ @ of 95 new daily Covid-19 cases at the end of March and has recently had some new cases . )
James Quinn , an emergency medicine professor at the Stanford University Medical Center , says he is optimistic “ that our overall flu and common cold virus season will be much better this year , ” he wrote to Vox in an email .
“ I hope it will provide some relief to the surge in Covid-19 that we will undoubtedly see.
” No , the flu shot won ’ t give you @ @ @ @ @ @ @ a life Each year , only about half of people in the US get a flu shot .
One of the major blocks to higher uptake has been rampant misperceptions about it — and lack of understanding of how deadly the seasonal flu can be .
For example , contrary to popular belief , the flu shot can not actually give you the flu .
But it does have its share of shortcomings .
Researchers fully acknowledge that they can not always predict which strains they will need to fend off months ahead @ @ @ @ @ @ @ Schultz-Cherry , “ even if one of the components [ in the seasonal flu shot ] isn ’ t a good match , you ’ re still protected against the other circulating strains.
” The flu shot also doesn ’ t always keep people from getting the flu ( and of course doesn ’ t protect against other respiratory viruses ) .
But it does help keep their cases milder , including reducing the risk of getting admitted to the ICU .
Schultz-Cherry is constantly reminding people of this .
“ People come @ @ @ @ @ @ @ the time ” that they got a flu shot but still caught the flu that season .
Her response : “ Yeah , you got the flu .
But you didn ’ t die.
” This plays out on the population level , too .
For the 2018–2019 flu season , even with only about half of the US population getting a flu shot , it prevented about 4.4 million cases of the flu , 58,000 hospitalizations , and 3,500 deaths , according to a CDC analysis .
And this year , many @ @ @ @ @ @ @ be needed to treat Covid-19 patients .
“ We know flu vaccines aren ’ t perfect , but they do help , and can help blunt the onslaught , ” Morse says .
“ Anything that helps reduce disease is a terrific return on the investment.
” The power of the flu shot to prevent illness is so well-documented that many more workplaces and education systems are mandating it this year .
The entire University of California system , for example , announced that it is requiring all students and staff to get @ @ @ @ @ @ @ ( Universities often already require students to have certain vaccinations , such as the one for measles , mumps , and rubella . )
And some experts have argued that it is actually a smart business move to mandate flu vaccines for employees ; the CDC estimates that the US loses about 17 million workdays a year due to people getting sick with the flu .
And many health care systems already do this .
How overlapping Covid-19 and flu symptoms are going to make this season very confusing As US Surgeon General @ @ @ @ @ @ @ earlier this month , “ This is the most important flu season that we ’ ve faced , I ’ d say , in my lifetime.
” Beyond pushing hospitalization capacity , flu season also has the potential to overwhelm clinics and testing resources .
“ Both Covid-19 and the flu are contagious respiratory illnesses that present with similar symptoms , ” Libby Richards , who teaches nursing at Purdue University and studies individual health behavior , wrote to Vox in an email .
It is important to know whether someone has Covid-19 @ @ @ @ @ @ @ treatment can look very different , such as administering specific antiviral drugs for influenza .
And “ that puts even greater demand on our already-limited diagnostic testing capacity , ” Morse says .
“ Anything you can do to reduce the need for further testing is good .
The flu vaccine won ’ t prevent this , but hopefully it will reduce the problem by lowering flu incidence.
” A large part of the testing concern is that tests for influenza often rely on the same techniques and equipment as those we are @ @ @ @ @ @ @ of the lab tests for influenza use the same swabs and viral transport media that we use for SARS-CoV-2 testing , ” Melissa Stockwell , division chief of child and adolescent health at Columbia University who also studies population and family health , wrote to Vox in an email .
Major national testing companies are still figuring out how they will balance testing for Covid-19 and influenza at the same time .
“ Laboratories continue to navigate supply constraints , ” Julie Khani , president of the American Clinical Laboratory Association , whose @ @ @ @ @ @ @ other major testing companies , said in an email statement to Vox .
So “ boosting vaccination rates for the flu is just one way communities can do their part to minimize the burden on the health system and the labs performing critical Covid-19 testing.
” The very real potential for co-infection with the flu ( or a cold ) and Covid-19 also makes testing important and diagnosis tricky .
Things like a runny nose or sore throat aren ’ t all that common with Covid-19 , but as the authors of one @ @ @ @ @ @ @ doesn ’ t mean you definitely don ’ t also have the coronavirus .
They saw some patients with flu and Covid-19 , who “ may be a reminder to those who had [ those symptoms ] not to ignore the possibility of Covid-19 infection.
” And they caution health care providers not to overlook this possibility either , “ to make sure that we could provide the best and the most comprehensive treatment to the patients.
” In an effort to ease some of the testing burden ahead of flu season this @ @ @ @ @ @ @ Administration has approved a new PCR-based test that can look for Covid-19 and influenza in a single analysis .
This could not only save on testing resources but also give patients and health care professionals the best information for how to proceed .
So far , though , this test has only been made available to CDC-supported public health laboratories ( and not the many private laboratory companies , such as Quest or LabCorp , that are currently processing the bulk of the country ’ s Covid-19 tests ) .
But experts are @ @ @ @ @ @ @ or reduced spread due to physical distancing this year .
“ As Covid-19 sweeps through the country , local health care systems have been stretched to capacity in unimaginable ways .
It is hard to imagine how adding yearly influenza to that can be handled , ” Stockwell says .
“ It is something we are very worried about .
...
It is extremely important that people protect themselves in all ways that they can.
” Flu shots can only save lives if people can get them Although the pandemic has disrupted global @ @ @ @ @ @ @ we should have a steady supply of flu vaccines in September and October .
Because companies have to start making the vaccine so early , and because they have to do it every year , “ the supply chain for that process is secured well in advance ” of when they get distributed , explains Moody , who also is a principal investigator at the Duke Collaborative Influenza Vaccine Innovation Centers .
But even with ample supply , the barriers to getting a flu shot will be higher this year .
“ Unfortunately @ @ @ @ @ @ @ Covid-19 , such as stay-at-home orders , have led to a decreased use of preventive health care services , such as vaccines , ” Richards says .
And this sort of “ routine vaccination , including the flu shot , will prevent not only illness but also reduces unnecessary medical visits and hospitalizations.
” Uptake of the flu shot will also probably take an additional hit because many people are accustomed to getting it at their workplaces or other large flu shot events .
“ The mass flu shot clinics that people may @ @ @ @ @ @ @ or have decreased capacity due to the need for social distancing , ” Stockwell notes .
Instead , this year , more people will need to make a concerted effort to get their flu shot by , for example , making an appointment with a doctor , nurse , or local health department , or going to a pharmacy or urgent care clinic ( which , Richards says , are “ taking proper precautions to reduce the risk of disease transmission ” ) .
For those worried about visiting a doctor ’ s @ @ @ @ @ @ @ circulating , Richards says , “ I think it is a greater risk to not get a flu shot.
” And drive-through flu shot offerings could also be good options , especially for people looking to minimize their exposure , she notes .
Also , you might not want to get your seasonal flu shot just yet , according to experts at Harvard University .
Some studies have shown the vaccine ’ s efficacy can start to fade after four to six months .
And if peak flu season happens later in the @ @ @ @ @ @ @ power could already be waning by then .
They recommend early October as a good target , especially for older adults , whose immune systems tend to be weaker .
Even with the slightly higher barriers this year , Schultz-Cherry says , relatively speaking , “ this is a pretty easy thing .
It ’ s a vaccine-preventable disease .
Get a vaccine.
” The annual flu shot is also an equity and health care access issue .
Historically , many people of color have been less likely to have gotten a flu @ @ @ @ @ @ @ percent of white adults have typically gotten a flu shot ; that rate drops to about 39 percent for Black adults and 37 percent for Latinx adults .
Which packs an additional punch because people of color have also been more likely to have had reduced access to health care and preexisting conditions that put them at higher risk of complications from the flu .
And the pandemic might well drive these flu vaccination rates lower .
Richards notes that nonwhite individuals have been more likely to lose income and health insurance during @ @ @ @ @ @ @ impact vaccination rates , as those who are uninsured are less likely to receive a flu shot.
” ( She points out , though , that local health departments and community clinics offer low-cost or free flu vaccines for people without insurance . )
If this trend continues , it could add to the devastation many communities of color have experienced in vastly higher rates of hospitalization and death from Covid-19 .
“ Many people of color have lost faith in the health system , ” Lawrence Gostin , an expert on health @ @ @ @ @ @ @ co-author of a JAMA letter on the collision of Covid-19 and influenza , wrote to Vox in an email .
“ Covid-19 amplified distrust and highlighted unconscionable health inequalities .
It is likely to keep people away from vaccine clinics and doctors ’ offices .
This is a major health concern.
” The CDC has noted that it will be focusing more efforts to improve public health messaging around the flu shot this year , particularly in higher-risk and underserved groups .
Stockwell recommends that “ underscoring the importance of the flu vaccine @ @ @ @ @ @ @ flu — such as it ‘ just being a bad cold ’ — as well as the vaccine — such as that it ‘ causes the flu ’ — can be helpful.
” It might also help lay the groundwork for crucial vaccine use in the future .
Public health messaging about the flu shot could be stronger In recent years , the US has seen a downturn in people getting vaccines of all kinds .
We are even now teetering on the edge of losing our nation ’ s measles eradication status @ @ @ @ @ @ @ .
“ We need to socialize the idea of vaccinations , ” Adams said in his radio interview .
“ We ’ ve been backsliding in terms of vaccine confidence over the last several years.
” Many experts worry that these attitudes will carry over once a Covid-19 vaccine becomes available , leading to more unnecessary illness , disability , and death .
Not only that , but many questions remain about our country ’ s preparedness to widely deploy an effective Covid-19 vaccine once one becomes available .
Researchers estimate we will @ @ @ @ @ @ @ ( and possibly up to 82 percent ) to get the vaccine ( or be otherwise immune ) before we can keep the virus in check without major societal restrictions .
But reimagining flu vaccine distribution and communication this season could also help bolster uptake of the Covid-19 vaccine , Gostin and his co-author note in their JAMA letter .
For one , they advocate for improving health messaging around flu shots , “ focusing on public benefit and personal obligation , ” they write .
They also propose the federal government commit @ @ @ @ @ @ @ ( between 194 million and 198 million doses are expected to be available this flu season , based on estimates from private manufacturers ; although that is at least 7 million more than last year , it is not enough to vaccinate everyone who should get it ) .
This government commitment would help avoid shortages and allow more Americans to get a flu shot .
But it would also set a precedent for it placing orders for a future Covid-19 vaccine .
“ At the very least , ” they note , @ @ @ @ @ @ @ evidence-based immunization plans , appealing to individual ’ s ethical responsibilities to protect themselves , health care workers , family members , and vulnerable populations.
” By developing more effective and efficient ways of getting the flu vaccine to more people — and by honing public health communication around it — we could find ourselves better prepared not only for more protection this fall and winter , but also for a future in which we could get the Covid-19 vaccine to more people , faster .
In the meantime , Stockwell notes , @ @ @ @ @ @ @ SARS-CoV-2 vaccine , the influenza vaccine is something we have now that we know helps prevent influenza-related hospitalization and death.
” Will you become our 20,000th supporter ?
When the economy took a downturn in the spring and we started asking readers for financial contributions , we weren ’ t sure how it would go .
Today , we ’ re humbled to say that nearly 20,000 people have chipped in .
The reason is both lovely and surprising : Readers told us that they contribute both because they value explanation and because @ @ @ @ @ @ @ it , too .
We have always believed that explanatory journalism is vital for a functioning democracy .
That ’ s never been more important than today , during a public health crisis , racial justice protests , a recession , and a presidential election .
But our distinctive explanatory journalism is expensive , and advertising alone won ’ t let us keep creating it at the quality and volume this moment requires .
Your financial contribution will not constitute a donation , but it will help keep Vox free for all .
@ @ @ @ @ @ @ 3 .

This fall and winter, health experts expect two types of deadly viruses to be circulating widely in the US. But they don’t yet know what the extent of the damage will be when the two collide.
In the absence of a coherent federal response, the novel coronavirus continues to spread across the country, with two states still battling active outbreaks. Experts estimate it could continue to hospitalize thousands and kill hundreds of people a day into October, with more spikes in the coming months.
We’re also now staring down the annual flu season, which typically starts in October and burdens the health care system even in normal years. The 2018–2019 flu season in the US, for example, resulted in about half a million hospitalizations and more than 34,000 deaths. The previous season, deaths were double that. And communities of color, which have already been disproportionately impacted by Covid-19, historically have also been more likely to have chronic health conditions that put them at higher risk of influenza-related complications.
In the Southern Hemisphere this year, where the seasons are opposite those in the US, there has been substantially less fall and winter flu activity (possibly due to effective Covid-19 measures, which can also limit the spread of other respiratory viruses). But not all experts are counting on that same scenario in the US.
Yes, the preventative measures we’re taking for #COVID19 will have an impact on overall prevalence of influenza, but these preventative measures are not uniform across the US (eg <38 States have a mask mandate)
So...get your flu shot! — Dr. Syra Madad (@syramadad) September 17, 2020
Which means the months ahead could be bleak. “Based on all the current trends in the US, and our inability to control Covid-19 spread, especially in some parts of the country, I think we are in for a rough fall and winter,” Tony Moody, an immunologist at Duke University Medical Center and the Duke Human Vaccine Institute, told Vox in an email. “If we have Covid-19 on top of the usual seasonal rise in hospital admissions due to influenza and other illnesses, we could overwhelm the health care system.”
Stephen Morse, an epidemiologist at Columbia University Mailman School of Public Health, is also worried: “Adding another half million [flu] patients needing hospitalization, some requiring ICU beds, is a recipe for disaster. It could stretch our health care systems and personnel close to the breaking point.”
One problem is that because influenza and Covid-19 are both respiratory viruses, severe cases will be treated on much of the same limited medical equipment, like ventilators. And because they can have overlapping symptoms, figuring out whether someone has the flu or Covid-19 — or neither — will be tricky but also important.
Fortunately, we already have a safe vaccine for the flu, and nearly 200 million doses are slated to be available. Access and supply issues could arise in the pandemic, but in a more typical year, some research shows October may be the best time to get the flu vaccine.
The Centers for Disease Control and Prevention (CDC) says that everyone 6 months and older (with very rare exceptions) should get a flu shot. And this year, it is more crucial than ever to get one, experts say, to reduce the spread of that virus and keep the health care system from being overtaxed with continued surges of Covid-19.
Yet the barriers will also be higher than usual. Many workplaces that typically offer flu shot clinics either aren’t open or are reducing their size. Mass vaccination events, like those at schools, community centers, and religious institutions, have also been scaled back this fall due to physical distancing precautions. Instead, many individuals will need to get their vaccine this year by visiting their doctor’s office or an urgent care clinic, pharmacy, or local health department.
It’s clear this year’s flu season in the midst of a pandemic promises to be especially fraught. Let’s take a closer look at why that is — and why flu shots even under difficult circumstances should be worth the effort.
Why this year’s flu season is extra unpredictable
Uncertainty looms over flu season every year, but this time there are even more unknowns than usual — from precisely which strains will be circulating to how the virus will interact with Covid-19 to whether our new pandemic habits will impact its spread. “This year, in particular, we don’t know what to expect,” says Stacey Schultz-Cherry, an influenza researcher at St. Jude’s Children’s Research Hospital.
The influenza virus is a mercurial one. It mutates quickly, and multiple strains circulate at any given time, some more harmful than others. This is why each year’s flu shot hedges its bets by fending off a few different strains — and why you need to get a new flu shot every year.
This rapid evolution is also why it’s hard to develop a vaccine that is a precise match for the strains of flu that end up circulating. Vaccines take months to manufacture in such large quantities, so the process of designing the year’s vaccine begins way before flu season hits the US.
Early in the year, scientists start looking at what strains of influenza are circulating around the world, especially south of the equator, just before their full flu season starts. But this year, we are largely missing this crucial piece to the puzzle because the Southern Hemisphere has seen very little flu. According to a September CDC report, rates of positive influenza test results in South Africa, Chile, and Australia overall have been just a fraction of what they usually are (0.06 percent this year, compared with 13.7 percent for 2017-2019).
The paucity of flu cases in the Southern Hemisphere this year also means we haven’t been able to learn much about how Covid-19 interacts with influenza.
Some case reports from early in the pandemic, when the flu was still circulating in China over the winter, showed that some people did have simultaneous infections.
“We really don’t know what a co-infection would look like,” Schultz-Cherry says. But, she says, “I wouldn’t want to have the lungs that would find that out.” She does hypothesize that it would be “a more significant infection” — especially in those at a higher risk for severe Covid-19 and for severe flu illness (including older adults and people with heart disease or cancer).
Other researchers have proposed a model by which familiar seasonal viruses, like the flu, might actually out-compete the novel coronavirus SARS-CoV-2 in the body (due in part to its relatively slower replication rate), thus potentially making full-blown Covid-19 less likely. And a preliminary report from China proposes limited clinical evidence for this idea.
Still other small reports have documented similar outcomes for patients with co-infections of the flu and Covid-19 as those who only had Covid-19.
Moody notes that gathering more of this important data is going to take time. “We expect that we will see co-infections once influenza season gets underway. Unfortunately, we will probably be deep into influenza season before we can say if outcomes are worse if you have both,” he says. “For this reason, we are encouraging people to get their influenza vaccine this season — to blunt this risk.”
We also don’t know how much our restrictions to reduce the spread of SARS-CoV-2, such as mask-wearing and physical distancing, will impact the spread of influenza this year. Many experts attribute the decrease in flu cases in many Southern Hemisphere countries this year, including Chile, South Africa, and New Zealand, to these measures. But it’s not clear whether the US, which has had patchwork restrictions on things like mask-wearing, will see the same trend.
“I would be hesitant to compare ourselves to New Zealand,” says Schultz-Cherry, where there has been virtually no flu this winter — but also went months without a single local transmission of Covid-19. (The country spiked a high of 95 new daily Covid-19 cases at the end of March.)
James Quinn, an emergency medicine professor at the Stanford University Medical Center, says he is optimistic “that our overall flu and common cold virus season will be much better this year,” he wrote to Vox in an email. “I hope it will provide some relief to the surge in Covid-19 that we will undoubtedly see.”
No, the flu shot won’t give you the flu — and it could save a life
Each year, only about half of people in the US get a flu shot. One of the major blocks to higher uptake has been rampant misperceptions about it — and lack of understanding of how deadly the seasonal flu can be.
For example, contrary to popular belief, the flu shot cannot actually give you the flu.
But it does have its share of shortcomings. Researchers fully acknowledge that they cannot always predict which strains they will need to fend off months ahead of time. But, says, Schultz-Cherry, “even if one of the components [in the seasonal flu shot] isn’t a good match, you’re still protected against the other circulating strains.”
The flu shot also doesn’t always keep people from getting the flu (and of course doesn’t protect against other respiratory viruses). But it does help keep their cases milder, including reducing the risk of getting admitted to the ICU.
Schultz-Cherry is constantly reminding people of this. “People come up to me and argue all of the time” that they got a flu shot but still caught the flu that season. Her response: “Yeah, you got the flu. But you didn’t die.”
This plays out on the population level, too. For the 2018–2019 flu season, even with only about half of the US population getting a flu shot, it prevented about 4.4 million cases of the flu, 58,000 hospitalizations, and 3,500 deaths, according to a CDC analysis. And this year, many of those additional hospital beds will likely be needed to treat Covid-19 patients.
“We know flu vaccines aren’t perfect, but they do help, and can help blunt the onslaught,” Morse says. “Anything that helps reduce disease is a terrific return on the investment.”
The power of the flu shot to prevent illness is so well-documented that many more workplaces and education systems are mandating it this year. The entire University of California system, for example, announced that it is requiring all students and staff to get a flu shot by November 1. (Universities often already require students to have certain vaccinations, such as the one for measles, mumps, and rubella.) And some experts have argued that it is actually a smart business move to mandate flu vaccines for employees; the CDC estimates that the US loses about 17 million workdays a year due to people getting sick with the flu. And many health care systems already do this.
How overlapping Covid-19 and flu symptoms are going to make this season very confusing
As US Surgeon General Jerome Adams noted in a radio interview in August, “This is the most important flu season that we’ve faced, I’d say, in my lifetime.”
Beyond pushing hospitalization capacity, flu season also has the potential to overwhelm clinics and testing resources. “Both Covid-19 and the flu are contagious respiratory illnesses that present with similar symptoms,” Libby Richards, who teaches nursing at Purdue University and studies individual health behavior, wrote to Vox in an email.
It is important to know whether someone has Covid-19, influenza, or neither, because treatment can look very different, such as administering specific antiviral drugs for influenza. And “that puts even greater demand on our already-limited diagnostic testing capacity,” Morse says. “Anything you can do to reduce the need for further testing is good. The flu vaccine won’t prevent this, but hopefully it will reduce the problem by lowering flu incidence.”
A large part of the testing concern is that tests for influenza often rely on the same techniques and equipment as those we are now using for Covid-19. “Many of the lab tests for influenza use the same swabs and viral transport media that we use for SARS-CoV-2 testing,” Melissa Stockwell, division chief of child and adolescent health at Columbia University who also studies population and family health, wrote to Vox in an email.
Major national testing companies are still figuring out how they will balance testing for Covid-19 and influenza at the same time. “Laboratories continue to navigate supply constraints,” Julie Khani, president of the American Clinical Laboratory Association, whose members include Quest, LabCorp, and other major testing companies, said in an email statement to Vox. So “boosting vaccination rates for the flu is just one way communities can do their part to minimize the burden on the health system and the labs performing critical Covid-19 testing.”
The very real potential for co-infection with the flu (or a cold) and Covid-19 also makes testing important and diagnosis tricky. Things like a runny nose or sore throat aren’t all that common with Covid-19, but as the authors of one paper on the topic noted, that doesn’t mean you definitely don’t also have the coronavirus. They saw some patients with flu and Covid-19, who “may be a reminder to those who had [those symptoms] not to ignore the possibility of Covid-19 infection.” And they caution health care providers not to overlook this possibility either, “to make sure that we could provide the best and the most comprehensive treatment to the patients.”
In an effort to ease some of the testing burden ahead of flu season this year, the US Food and Drug Administration has approved a new PCR-based test that can look for Covid-19 and influenza in a single analysis. This could not only save on testing resources but also give patients and health care professionals the best information for how to proceed. So far, though, this test has only been made available to CDC-supported public health laboratories (and not the many private laboratory companies, such as Quest or LabCorp, that are currently processing the bulk of the country’s Covid-19 tests).
But experts are not hanging their hats on dual testing or reduced spread due to physical distancing this year. “As Covid-19 sweeps through the country, local health care systems have been stretched to capacity in unimaginable ways. It is hard to imagine how adding yearly influenza to that can be handled,” Stockwell says. “It is something we are very worried about. ... It is extremely important that people protect themselves in all ways that they can.”
Flu shots can only save lives if people can get them
Although the pandemic has disrupted global medical supply chains, experts say that we should have a steady supply of flu vaccines. Because companies have to start making the vaccine so early, and because they have to do it every year, “the supply chain for that process is secured well in advance” of when they get distributed, explains Moody, who also is a principal investigator at the Duke Collaborative Influenza Vaccine Innovation Centers.
But even with ample supply, the barriers to getting a flu shot will be higher this year. “Unfortunately, efforts to reduce the spread of Covid-19, such as stay-at-home orders, have led to a decreased use of preventive health care services, such as vaccines,” Richards says. And this sort of “routine vaccination, including the flu shot, will prevent not only illness but also reduces unnecessary medical visits and hospitalizations.”
Updated recommendations from the CDC for this year’s flu season, for example, remind clinicians to offer the flu shot during most visits with patients. Even if the person has already had one bout of the flu that season, the other strains in the vaccine could still help protect them against future infections.
Uptake of the flu shot will also probably take an additional hit because many people are accustomed to getting it at their workplaces or other large flu shot events. “The mass flu shot clinics that people may usually depend on may not be available or have decreased capacity due to the need for social distancing,” Stockwell notes.
Instead, this year, more people will need to make a concerted effort to get their flu shot by, for example, making an appointment with a doctor, nurse, or local health department, or going to a pharmacy or urgent care clinic (which, Richards says, are “taking proper precautions to reduce the risk of disease transmission”). For those worried about visiting a doctor’s office or pharmacy while the coronavirus is circulating, Richards says, “I think it is a greater risk to not get a flu shot.” Drive-through flu shot offerings could also be good options, especially for people looking to minimize their exposure, she notes.
Also, you might not want to get your seasonal flu shot just yet, according to experts at Harvard University. Some studies have shown the vaccine’s efficacy can start to fade after four to six months. It can be a tricky balancing act, as the CDC recommends getting a flu shot before the flu begins circulating in your community, which tends to happen as early as October. But if peak flu happens later in the winter, in January or February — or even March — an August shot’s power could already be waning by then. So it recommends October as a good target, especially for older adults, whose immune systems tend to be weaker. But if the question is between getting a flu shot in September or not getting one at all, the CDC advocates getting the shot early.
Even with the slightly higher barriers this year, Schultz-Cherry says, relatively speaking, “this is a pretty easy thing. It’s a vaccine-preventable disease. Get a vaccine.”
The annual flu shot is also an equity and health care access issue. Historically, many people of color have been less likely to have gotten a flu vaccine. Richards notes that about 48 percent of white adults have typically gotten a flu shot; that rate drops to about 39 percent for Black adults and 37 percent for Latinx adults. Which packs an additional punch because people of color have also been more likely to have had reduced access to health care and preexisting conditions that put them at higher risk of complications from the flu.
And the pandemic might well drive these flu vaccination rates lower. Richards notes that nonwhite individuals have been more likely to lose income and health insurance during the pandemic. “This will likely impact vaccination rates, as those who are uninsured are less likely to receive a flu shot.” (She points out, though, that local health departments and community clinics offer low-cost or free flu vaccines for people without insurance.)
If this trend continues, it could add to the devastation many communities of color have experienced in vastly higher rates of hospitalization and death from Covid-19.
“Many people of color have lost faith in the health system,” Lawrence Gostin, an expert on health law and policy at Georgetown Law and co-author of a JAMA letter on the collision of Covid-19 and influenza, wrote to Vox in an email. “Covid-19 amplified distrust and highlighted unconscionable health inequalities. It is likely to keep people away from vaccine clinics and doctors’ offices. This is a major health concern.”
The CDC has noted that it will focus more efforts to improve public health messaging around the flu shot this year, particularly in higher-risk and underserved groups. Stockwell recommends that “underscoring the importance of the flu vaccine as well as countering misperceptions about the flu — such as it ‘just being a bad cold’ — as well as the vaccine — such as that it ‘causes the flu’ — can be helpful.” It might also help lay the groundwork for crucial vaccine use in the future.
Public health messaging about the flu shot could be stronger
In recent years, the US has seen a downturn in people getting vaccines of all kinds. The country is even now teetering on the edge of losing its measles eradication status because of people not vaccinating their children. “We need to socialize the idea of vaccinations,” Adams said in his radio interview. “We’ve been backsliding in terms of vaccine confidence over the last several years.”
Many experts worry that these attitudes will carry over once a Covid-19 vaccine becomes available, leading to more unnecessary illness, disability, and death. Not only that, but many questions remain about our country’s preparedness to widely deploy an effective Covid-19 vaccine once one becomes available. Researchers estimate we will need at least 55 percent of people (and possibly up to 82 percent) to get the vaccine (or be otherwise immune) before we can keep the virus in check without major societal restrictions.
But reimagining flu vaccine distribution and communication this season could also help bolster uptake of the Covid-19 vaccine, Gostin and his co-author note in their JAMA letter. For one, they advocate for improving health messaging around flu shots, “focusing on public benefit and personal obligation,” they write.
They also propose the federal government commit to purchasing additional flu vaccine this year (between 194 million and 198 million doses are expected to be available this flu season, based on estimates from private manufacturers; although that is at least 7 million more than last year, it is not enough to vaccinate everyone who should get it).
This government commitment would help avoid shortages and allow more Americans to get a flu shot. But it would also set a precedent for it placing orders for a future Covid-19 vaccine. “At the very least,” they note, “all levels of government should develop evidence-based immunization plans, appealing to individual’s ethical responsibilities to protect themselves, health care workers, family members, and vulnerable populations.”
By developing more effective and efficient ways of getting the flu vaccine to more people — and by honing public health communication around it — we could find ourselves better prepared not only for more protection this fall and winter, but also for a future in which we could get the Covid-19 vaccine to more people, faster.
In the meantime, Stockwell notes, “as we are all awaiting a SARS-CoV-2 vaccine, the influenza vaccine is something we have now that we know helps prevent influenza-related hospitalization and death.”
Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.


vox--2020-08-19--Welcome to the Escape Issue of The Highlight

August typically is the month of hurricanes and a treacherous stock market .
It ’ s when coworkers jet off to the Cape Cod homes you didn ’ t know they could afford , and when the mosquitoes win .
It was always the airless , miserable nadir of the summer , even before Covid-19 and the looming fears of an ugly , lawless election .
Now , we must contend with those , too .
So , maybe , you find yourself up at 2 am , casually cruising for Airbnbs in Maine .
Or you ’ ve looked @ @ @ @ @ @ @ , or bought your first car solely for road trips .
This month ’ s issue of The Highlight is an acknowledgment of this primal instinct to escape , on full display some five months into a pandemic with no foreseeable end .
Filled with stories meant to take you far from the current moment , the Escape Issue is as much about the reverie of a good story as it is about literally leaving a way of life behind .
Maggie Parker was looking for just that — refuge from a troubled @ @ @ @ @ @ @ hurdles that seemed to hamper women in sport — when she left her Michigan home as a teenager to ride bulls .
A curiosity because of her beauty , an outcast because of her gender , Parker would find trouble wasn ’ t limited to the 2,000-pound bulls waiting for her in the chutes across the rodeo circuit .
Our cover story isn ’ t just one of escape ; it is escape , as Steven Leckart takes us into the rough-and-tumble world of rodeos , where winning means conquering a beast before @ @ @ @ @ @ @ for more .
After Phil Nichols ’ s father abandoned his family , he sent his son a letter ; inside was a lone penny , and nothing else .
The family never heard from Robert Ivan Nichols again .
Or rather , not for decades , until a deceased 76-year-old named Joseph Newton Chandler III was found to be someone other than who he claimed , writes Katya Cengel .
Groundbreaking DNA testing and genealogical research was called in to help solve the mystery , but the case of Robert Nichols would @ @ @ @ @ @ @ is about secrets , and the right to move on from them .
Can anyone escape their DNA ?
Also in this issue : Workers reflect on how receiving unemployment allowed some to find relief from the grind ; nightclubs were fantastical places , until the coronavirus revealed that their strength — the kinetic energy of bodies , lots of them — was also their vulnerability .
And finally , a dreamy comic explores the ways the pandemic prompts a renewal of the senses as we search for meaning in small things , @ @ @ @ @ @ @ the night sky .
She wanted to ride with men in one of the world ’ s most dangerous sports .
She had a lot more than her competition to be worried about .
The man without a name Robert Ivan Nichols simply disappeared from his average , 1960s Midwestern life — until , using DNA , sleuths uncovered the truth .
But were they digging where they shouldn ’ t have been ?
“ For the first time in my life , I had money in my savings ” : Workers on @ @ @ @ @ @ @ Is this the end of clubs ?
Farewell ( for now ) to dark rooms , flashing lights , sweaty bodies , and escapism .
The unexpected joy of the worst summer of our lives Covid-19 made my world small and bleak .
But I still found solace in the quietest places .

August typically is the month of hurricanes and a treacherous stock market. It’s when coworkers jet off to the Cape Cod homes you didn’t know they could afford, and when the mosquitoes win. It was always the airless, miserable nadir of the summer, even before Covid-19 and the looming fears of an ugly, lawless election. Now, we must contend with those, too.
So, maybe, you find yourself up at 2 am, casually cruising for Airbnbs in Maine. Or you’ve looked up the weather in Tulum, Mexico, or bought your first car solely for road trips. This month’s issue of The Highlight is an acknowledgment of this primal instinct to escape, on full display some five months into a pandemic with no foreseeable end. Filled with stories meant to take you far from the current moment, the Escape Issue is as much about the reverie of a good story as it is about literally leaving a way of life behind.
Maggie Parker was looking for just that — refuge from a troubled family life, a way over the hurdles that seemed to hamper women in sport — when she left her Michigan home as a teenager to ride bulls. A curiosity because of her beauty, an outcast because of her gender, Parker would find trouble wasn’t limited to the 2,000-pound bulls waiting for her in the chutes across the rodeo circuit. Our cover story isn’t just one of escape; it is escape, as Steven Leckart takes us into the rough-and-tumble world of rodeos, where winning means conquering a beast before it kills you, and crowds clamor for more.
After Phil Nichols’s father abandoned his family, he sent his son a letter; inside was a lone penny, and nothing else. The family never heard from Robert Ivan Nichols again. Or rather, not for decades, until a deceased 76-year-old named Joseph Newton Chandler III was found to be someone other than who he claimed, writes Katya Cengel. Groundbreaking DNA testing and genealogical research was called in to help solve the mystery, but the case of Robert Nichols would offer no pat answers. The story is about secrets, and the right to move on from them. Can anyone escape their DNA?
Also in this issue: Workers reflect on how receiving unemployment allowed some to find relief from the grind; nightclubs were fantastical places, until the coronavirus revealed that their strength — the kinetic energy of bodies, lots of them — was also their vulnerability. And finally, a dreamy comic explores the ways the pandemic prompts a renewal of the senses as we search for meaning in small things, from scenic beauty to video games to the night sky.
She wanted to ride with men in one of the world’s most dangerous sports. She had a lot more than her competition to be worried about.
by Steven Leckart
Robert Ivan Nichols simply disappeared from his average, 1960s Midwestern life — until, using DNA, sleuths uncovered the truth. But were they digging where they shouldn’t have been?
by Katya Cengel
How Covid-19 unemployment benefits changed these workers’ lives.
by Michael Waters
Farewell (for now) to dark rooms, flashing lights, sweaty bodies, and escapism.
by Lavanya Ramanathan
Covid-19 made my world small and bleak. But I still found solace in the quietest places.
by Christine Mi