scientificamerican--2020-09-05--Schools Have No Good Options for Reopening during COVID-19

Editor ’ s Note ( 9/4/20 ) : This story is being republished as school districts grapple with the challenges of reopening .
New York City , the only large district attempting to do so , recently delayed the start of in-person classes until September 21 .
Even as schools have already begun reopening across the U.S. , debate is still intensifying over whether students should be physically present in classrooms .
Children are widely thought to be at relatively low risk of developing severe COVID-19 , but a new report from the American Academy of Pediatrics ( AAP ) @ @ @ @ @ @ @ the past month : between July 9 and August 13 , the number increased from about 200,000 to more than 406,000 .
Physically reopening schools might accelerate the increase—potentially raising the number of children with severe symptoms and spurring spread among the community at large .
Whether children attend classrooms or learn remotely at home , each option carries a risk of harm to students , their families and the adults who work with them .
The novel coronavirus that causes COVID-19 can spread through the enclosed halls and classrooms of a school @ @ @ @ @ @ @ learning alone may disrupt a child ’ s educational and social development and can have serious longer-term economic repercussions .
In an attempt to minimize damage , individual schools are implementing a variety of different plans and are prepared to change course if local conditions shift .
Existing evidence suggests that children—though definitely not immune to COVID-19—are in some ways less vulnerable than adults .
A June study in Nature Medicine found that people younger than 20 are half as likely as older adults to contract the disease .
The AAP report that @ @ @ @ @ @ @ this population represents just 9.1 percent of all U.S. COVID-19 cases—and that severe cases of coronavirus are rare among children , resulting in fewer hospitalizations and deaths .
“ Fortunately , COVID in children , in the vast majority of cases , is a very mild , self-limited illness .
Many children are often even asymptomatic , ” says Danielle Dooley , a pediatrician and spokesperson for the AAP .
Although the risk is lower , it is not nonexistent .
The AAP report , which includes data from 44 states , notes @ @ @ @ @ @ @ group—between 0.2 and 8.8 percent of child COVID-19 cases—did require hospitalization .
The same report indicates that 19 of the states reported no deaths among children , and the highest rate of pediatric deaths was 0.6 percent of cases .
But if the total number of infections in this age group rises , the number of those that develop a severe case would likely increase as well .
Children also might pass the coronavirus to adults , who tend to have much more severe symptoms .
Teachers , janitors , bus drivers and @ @ @ @ @ @ @ time with students in enclosed spaces , where they are at a relatively high risk of contracting COVID-19 from children ( as well as one another ) .
Before students even entered public school buildings in Gwinnett County in Georgia , 260 employees who attended planning meetings either tested positive for COVID-19 or had had contact with someone else who had .
In Santa Clara , Calif. , 40 school officials took part in an indoor meeting .
Days later , one of the officials received a positive COVID-19 test—and as a result @ @ @ @ @ @ @ the other attendees had to go into quarantine .
Many school employees fear that returning to the classroom will put their life , and the lives of their loved ones , at very real risk .
“ The issue we need to worry about is whether or not [ children are ] vectors , ” says Helen Jenkins , an infectious disease epidemiologist at Boston University School of Public Health .
The science on how much children transmit the coronavirus is not settled .
Some data suggest , Jenkins says , that “ @ @ @ @ @ @ @ adults to transmit to others.
” Dooley notes that “ we also are seeing increasing data that [ children ] don ’ t tend to be spreaders , so they ’ re not necessarily passing it to other children or other adults in their household or their community—from the data that we have so far.
” But other data indicate children older than 10 can act as vectors .
A study in Emerging Infectious Diseases , published online in July , analyzed contact-tracing reports for nearly 6,000 coronavirus patients in South Korea and @ @ @ @ @ @ @ the virus as much as adults did .
[ More information on the ongoing question of how children spread the coronavirus . ]
Even if transmission rates and serious cases are very low , students physically attending school could carry at least some infections home to family members—who could face far worse health threats and spread the virus more effectively among the general population .
This problem may have contributed to a second wave of coronavirus cases in Israel .
In May the country ’ s numbers were encouragingly low , so schools @ @ @ @ @ @ @ the number of infections in children quickly spiked , followed by those among older Israelis .
In other countries , schools safely reopened by being more cautious and implementing a variety of restrictions—mandating masks , limiting student interaction , or slowly ramping up their plans to begin reopening with only younger children present or for only one day a week .
There are enormous advantages to having kids in classrooms .
“ Schools play a really central role in children ’ s lives , and it ’ s just not possible to deliver @ @ @ @ @ @ @ schools when you are in a remote learning situation , ” Dooley says .
She explains that schools often provide food—more than 30 million children rely on them for nutritious meals—as well as recreation and physical and mental health care .
Beyond this , “ being around your peers , being around a community of supportive adults—that ’ s really critical for a child 's development , ” she points out .
“ They need that contact with their peers in order to grow.
” Of course , all that is on top @ @ @ @ @ @ @ : education .
“ Education is a really important determinant of health and lifelong health outcomes , ” Dooley says .
Students who try to take classes virtually require the equipment and Internet connections to do so .
Special education students need extra attention that they can not always receive via videoconference .
Younger children require adult engagement , often from a stay-at-home parent or a hired tutor , in order to complete their work .
Many students , particularly those from lower-income households , lack these options and are falling behind in @ @ @ @ @ @ @ families can buy supplies , provide high-speed Internet and hire private tutors , allowing their children to avoid such setbacks .
Also , the wealth gap between white and minority families means this imbalance in school outcomes may increase the achievement gap between white and minority students , according to reports from the research institute Center for American Progress and the consulting firm McKinsey & Company .
Many parents and communities also have to rely on school systems for basic childcare during working hours .
And because online learning itself often requires at @ @ @ @ @ @ @ who are able to work from home can find themselves in the extremely stressful position of having what amounts to two full-time jobs : paid work and unpaid childcare and teaching .
The situation is often described in terms such as “ crushing.
” It can cause economic problems , as well as mental health ones .
If schools do not reopen , some parents ( many of them mothers ) may be forced to leave the workforce—and then be unable to return .
On an individual level , families will lose income @ @ @ @ @ @ @ economy could be severely damaged .
To avoid this problem , institutions such as the AAP , the U.S. Centers for Disease Control and Prevention , educators ’ organizations and the National Academies of Sciences , Engineering , and Medicine have advocated for in-person schooling—if it can be done safely .
This requirement means establishing effective and rigorously enforced rules and protocols that will allow students to physically attend school while minimizing risks to their health and that of their communities .
There can be no universal , one-size-fits-all rules for reopening physical @ @ @ @ @ @ @ greatly from region to region and month to month .
Different districts face widely disparate financial realities .
Even within the same school system , younger and older students differ in their ability to learn virtually—and in their likelihood of spreading the novel coronavirus .
“ We have to be prepared and flexible for an ever changing school year , ” Dooley says .
“ Protocols and procedures put in place at the beginning of the school year may need to change as the level of disease may increase in a community.
” @ @ @ @ @ @ @ attendees safe are the same as the ones meant to help protect the general population : covering faces , regularly washing or sanitizing hands throughout the day , limiting students to small social “ bubbles ” ( also called “ pods ” or “ cohorts ” ) , improving ventilation in classrooms and even teaching outdoors when possible .
Keeping children and adults at a distance from one another would also help , but this can be difficult because it requires space that is often simply unavailable .
Some contend this problem can @ @ @ @ @ @ @ student attends classes in person fewer days a week ( studying online from home the rest of the time ) , thus reducing the number of people in a building at a given time .
“ Another thing we can do is regular testing , ” Jenkins says .
“ Children are more likely to be asymptomatic , ” so rapid testing would allow schools to identify and isolate people with COVID-19 to protect other students and teachers .
Several of these measures—improving ventilation , having some children attend classes virtually , and @ @ @ @ @ @ @ and require additional funding , potentially from the federal government .
Perhaps because of this difficulty ( as well as political pressure from some who insist that enforcing pandemic precautions is unnecessary or overly intrusive ) , many schools have pushed to physically reopen without the requisite precautions .
Last month Florida and Iowa announced that schools must provide in-person instruction , despite the fact that COVID-19 cases were rising in both states .
In Georgia , photographs of mostly maskless high school students crowding a hallway spread on social media .
After @ @ @ @ @ @ @ the school had to institute online-only learning while the building was closed for cleaning .
Without safety measures—or with sudden spikes in community spread—other schools may reopen only to quickly close campuses as well .
“ One of the best things we can do to keep [ schools ] safe is to keep local community transmission low , ” Jenkins says .
To do so , she recommends that authorities take strong action to control the virus—even when that means closing businesses such as gyms and bars .
“ It ’ s very @ @ @ @ @ @ @ industries making money as possible , because there ’ s big pressure to get the economy going , ” she says .
“ But it ’ s unlikely we can have everything .
I hope [ governors are ] thinking of priorities , and I ’ d hope schools would come near the top of that.
” Read more about the coronavirus outbreak from Scientific American here .
And read coverage from our international network of magazines here .

Editor’s Note (9/4/20): This story is being republished as school districts grapple with the challenges of reopening. New York City, the only large district attempting to do so, recently delayed the start of in-person classes until September 21.
Even as schools have already begun reopening across the U.S., debate is still intensifying over whether students should be physically present in classrooms. Children are widely thought to be at relatively low risk of developing severe COVID-19, but a new report from the American Academy of Pediatrics (AAP) indicates that cumulative cases doubled in roughly the past month: between July 9 and August 13, the number increased from about 200,000 to more than 406,000. Physically reopening schools might accelerate the increase—potentially raising the number of children with severe symptoms and spurring spread among the community at large.
Whether children attend classrooms or learn remotely at home, each option carries a risk of harm to students, their families and the adults who work with them. The novel coronavirus that causes COVID-19 can spread through the enclosed halls and classrooms of a school building. But prolonged reliance on virtual learning alone may disrupt a child’s educational and social development and can have serious longer-term economic repercussions. In an attempt to minimize damage, individual schools are implementing a variety of different plans and are prepared to change course if local conditions shift.
The Public Health Risk
Existing evidence suggests that children—though definitely not immune to COVID-19—are in some ways less vulnerable than adults. A June study in Nature Medicine found that people younger than 20 are half as likely as older adults to contract the disease. The AAP report that indicated increasing cases among children also found this population represents just 9.1 percent of all U.S. COVID-19 cases—and that severe cases of coronavirus are rare among children, resulting in fewer hospitalizations and deaths. “Fortunately, COVID in children, in the vast majority of cases, is a very mild, self-limited illness. Many children are often even asymptomatic,” says Danielle Dooley, a pediatrician and spokesperson for the AAP.
Although the risk is lower, it is not nonexistent. The AAP report, which includes data from 44 states, notes that a small percentage of this age group—between 0.2 and 8.8 percent of child COVID-19 cases—did require hospitalization. The same report indicates that 19 of the states reported no deaths among children, and the highest rate of pediatric deaths was 0.6 percent of cases. But if the total number of infections in this age group rises, the number of those that develop a severe case would likely increase as well.
Children also might pass the coronavirus to adults, who tend to have much more severe symptoms. Teachers, janitors, bus drivers and others must all spend significant amounts of time with students in enclosed spaces, where they are at a relatively high risk of contracting COVID-19 from children (as well as one another). Before students even entered public school buildings in Gwinnett County in Georgia, 260 employees who attended planning meetings either tested positive for COVID-19 or had had contact with someone else who had. In Santa Clara, Calif., 40 school officials took part in an indoor meeting. Days later, one of the officials received a positive COVID-19 test—and as a result of that person’s exposure, the other attendees had to go into quarantine. Many school employees fear that returning to the classroom will put their life, and the lives of their loved ones, at very real risk.
“The issue we need to worry about is whether or not [children are] vectors,” says Helen Jenkins, an infectious disease epidemiologist at Boston University School of Public Health. The science on how much children transmit the coronavirus is not settled. Some data suggest, Jenkins says, that “those infected are half as likely as adults to transmit to others.” Dooley notes that “we also are seeing increasing data that [children] don’t tend to be spreaders, so they’re not necessarily passing it to other children or other adults in their household or their community—from the data that we have so far.” But other data indicate children older than 10 can act as vectors. A study in Emerging Infectious Diseases, published online in July, analyzed contact-tracing reports for nearly 6,000 coronavirus patients in South Korea and found those aged 10 to 19 spread the virus as much as adults did.
[More information on the ongoing question of how children spread the coronavirus.]
Even if transmission rates and serious cases are very low, students physically attending school could carry at least some infections home to family members—who could face far worse health threats and spread the virus more effectively among the general population. This problem may have contributed to a second wave of coronavirus cases in Israel. In May the country’s numbers were encouragingly low, so schools reopened with few restrictions. But then the number of infections in children quickly spiked, followed by those among older Israelis. In other countries, schools safely reopened by being more cautious and implementing a variety of restrictions—mandating masks, limiting student interaction, or slowly ramping up their plans to begin reopening with only younger children present or for only one day a week.
The Developmental Risk
There are enormous advantages to having kids in classrooms. “Schools play a really central role in children’s lives, and it’s just not possible to deliver all of the services and benefits of schools when you are in a remote learning situation,” Dooley says. She explains that schools often provide food—more than 30 million children rely on them for nutritious meals—as well as recreation and physical and mental health care. Beyond this, “being around your peers, being around a community of supportive adults—that’s really critical for a child's development,” she points out. “They need that contact with their peers in order to grow.”
Of course, all that is on top of the most important service schools provide: education. “Education is a really important determinant of health and lifelong health outcomes,” Dooley says. Students who try to take classes virtually require the equipment and Internet connections to do so. Special education students need extra attention that they cannot always receive via videoconference. Younger children require adult engagement, often from a stay-at-home parent or a hired tutor, in order to complete their work. Many students, particularly those from lower-income households, lack these options and are falling behind in their studies as a result. Wealthy families can buy supplies, provide high-speed Internet and hire private tutors, allowing their children to avoid such setbacks. Also, the wealth gap between white and minority families means this imbalance in school outcomes may increase the achievement gap between white and minority students, according to reports from the research institute Center for American Progress and the consulting firm McKinsey & Company.
Many parents and communities also have to rely on school systems for basic childcare during working hours. And because online learning itself often requires at least some adult help, even parents who are able to work from home can find themselves in the extremely stressful position of having what amounts to two full-time jobs: paid work and unpaid childcare and teaching. The situation is often described in terms such as “crushing.” It can cause economic problems, as well as mental health ones. If schools do not reopen, some parents (many of them mothers) may be forced to leave the workforce—and then be unable to return. On an individual level, families will lose income; on a society-wide level, the economy could be severely damaged.
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To avoid this problem, institutions such as the AAP, the U.S. Centers for Disease Control and Prevention, educators’ organizations and the National Academies of Sciences, Engineering, and Medicine have advocated for in-person schooling—if it can be done safely. This requirement means establishing effective and rigorously enforced rules and protocols that will allow students to physically attend school while minimizing risks to their health and that of their communities.
How to Reopen Schools
There can be no universal, one-size-fits-all rules for reopening physical campuses safely. Community transmission rates vary greatly from region to region and month to month. Different districts face widely disparate financial realities. Even within the same school system, younger and older students differ in their ability to learn virtually—and in their likelihood of spreading the novel coronavirus. “We have to be prepared and flexible for an ever changing school year,” Dooley says. “Protocols and procedures put in place at the beginning of the school year may need to change as the level of disease may increase in a community.”
Many of the measures for keeping school attendees safe are the same as the ones meant to help protect the general population: covering faces, regularly washing or sanitizing hands throughout the day, limiting students to small social “bubbles” (also called “pods” or “cohorts”), improving ventilation in classrooms and even teaching outdoors when possible. Keeping children and adults at a distance from one another would also help, but this can be difficult because it requires space that is often simply unavailable. Some contend this problem can be addressed by staggering schedules so each student attends classes in person fewer days a week (studying online from home the rest of the time), thus reducing the number of people in a building at a given time. “Another thing we can do is regular testing,” Jenkins says. “Children are more likely to be asymptomatic,” so rapid testing would allow schools to identify and isolate people with COVID-19 to protect other students and teachers.
Several of these measures—improving ventilation, having some children attend classes virtually, and providing fast and regular tests—will be inconvenient and require additional funding, potentially from the federal government. Perhaps because of this difficulty (as well as political pressure from some who insist that enforcing pandemic precautions is unnecessary or overly intrusive), many schools have pushed to physically reopen without the requisite precautions. Last month Florida and Iowa announced that schools must provide in-person instruction, despite the fact that COVID-19 cases were rising in both states. In Georgia, photographs of mostly maskless high school students crowding a hallway spread on social media. After nine people tested positive for COVID-19, the school had to institute online-only learning while the building was closed for cleaning. Without safety measures—or with sudden spikes in community spread—other schools may reopen only to quickly close campuses as well.
“One of the best things we can do to keep [schools] safe is to keep local community transmission low,” Jenkins says. To do so, she recommends that authorities take strong action to control the virus—even when that means closing businesses such as gyms and bars. “It’s very tempting to want to reopen as many industries making money as possible, because there’s big pressure to get the economy going,” she says. “But it’s unlikely we can have everything. I hope [governors are] thinking of priorities, and I’d hope schools would come near the top of that.”
Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.


scientificamerican--2020-09-05--Nine Important Things We've Learned about the Coronavirus Pandemic So Far

Editor ’ s Note ( 9/4/20 ) : Six months after COVID-19 was declared a pandemic , this story is being republished as a reminder of the many things scientists have learned about the disease and how it spreads .
We ’ re in a terrifying and confusing pandemic , with new and sometimes conflicting information about COVID-19 emerging all the time .
In the early days , a lot of public health advice was based on what we knew about previous disease outbreaks .
But this new coronavirus behaves in unexpected ways , and it ’ s hard to @ @ @ @ @ @ @ , people tend to remember the first things they learn about a new subject , a phenomenon called `` anchoring bias , '' and it ’ s psychologically challenging to replace old information with new knowledge .
Here are nine of the most important things we ’ ve learned about SARS-CoV-2 in the past seven months and why we didn ’ t fully understand or appreciate them at first .
Outbreaks of COVID-19 can happen anywhere .
There was a lot of wishful thinking and othering ( as in : it ’ s @ @ @ @ @ @ @ in the first months of the pandemic : Chinese people got it because of where they buy their groceries .
Italian people got it because they greet each other with kisses on the cheeks .
People on cruise ships got it because of the buffets .
People in nursing homes got it because they are frail .
People in New York got it because the city is crowded .
Now we know that outbreaks can happen in urban areas , rural areas , suburbs and any culture around the world .
COVID-19 can @ @ @ @ @ @ @ victims of the pandemic were disproportionately older or had existing health conditions .
Age and frailty are still risk factors for serious disease and death , but we now know the disease can kill young and healthy people .
It can kill young adults .
It can kill teenagers .
It can kill children .
Contaminated surfaces are not the main danger .
Early on , public health experts advised people to wash their hands frequently ( while singing “ Happy Birthday ” twice ) , disinfect surfaces and avoid touching their face @ @ @ @ @ @ @ how other diseases spread , such as norovirus and viruses that cause the common cold .
It ’ s still a good idea to wash your hands regularly ( and avoid handshakes ) , but now we know that surfaces aren ’ t the main vector for SARS-CoV-2 .
It is in the air .
At first , experts thought the virus was spread primarily through globs of mucus and saliva expelled when people cough or sneeze .
They thought these droplets were heavy enough to drop out of the air fairly quickly @ @ @ @ @ @ @ spread , the virus seemed to be aerosolized—that is , lofted into the air in particles small enough to float—only by certain medical procedures such as placing someone on a ventilator .
But we now know that the virus is expelled in a range of droplet sizes , with some particles small enough to persist in the air , especially in indoor , poorly ventilated spaces .
Many people are infectious without being sick .
Other respiratory diseases make people cough and sneeze .
The original SARS outbreak made people so sick , @ @ @ @ @ @ @ went to the hospital .
Temperature checks and telling sick people to stay home can stop symptomatic diseases from spreading , and in the first months of the pandemic , many countries started screening people at their borders to detect these cases .
But the biggest challenge for stopping SARS-CoV-2 is that many apparently healthy people spread the disease without symptoms or before symptoms start , simply through talking and breathing .
Warm summer weather will not stop the virus .
Influenza is a seasonal respiratory disease that peaks in the winter , @ @ @ @ @ @ @ COVID-19 would show a similar pattern and slow in the Northern Hemisphere during the spring and summer .
Now we know that people ’ s behavior , regardless of season , is the strongest predictor of whether the disease will spread .
Masks work .
When the pandemic began , experts worried that mass mask-buying could exacerbate shortages of personal protective equipment for health care workers and others who needed them .
They also warned that masks might make people complacent about social distancing and that cloth or paper masks ( unlike N95 @ @ @ @ @ @ @ the smallest aerosolized viral particles .
Now we know that masks can greatly reduce the amount of virus that people expel into the air while speaking , and that masks protect people who are wearing them—not perfectly , but enough to reduce transmission of the disease .
Racism , not race , is a risk factor .
The pandemic should put an end to the common misconception that race , a social construct , is a biological explanation for health disparities .
COVID-19 has disproportionately killed people of color in the United States @ @ @ @ @ @ @ differences but because of systemic racism that has isolated and impoverished many Native American people and made Black and Latinx people more likely to have “ essential ” jobs that expose them to infection , a greater burden of stress and less access to high-quality health care .
Misinformation kills .
The president of the United States , other politicians , anti-vaccine activists , and members of the right-wing media , to their everlasting shame , have used the pandemic to stoke racism , spread misinformation and amplify conspiracy theories .
Their followers @ @ @ @ @ @ @ Fauci and his family ; refused to wear masks ; refused to cooperate with contact tracers ; and rejected proven basic public health advice about social distancing .
Representative Louie Gohmert , who refused to wear a mask in the Capitol and reportedly discouraged his staff and interns from wearing masks , tested positive for SARS-CoV-2 and is being treated with hydroxychloroquine , a drug that Trump has endorsed but that has failed in clinical trials .
Trump supporter Herman Cain died of COVID-19 on July 30 , weeks after attending a rally @ @ @ @ @ @ @ to poison-control centers spiked after Trump speculated that injecting or ingesting disinfectants could protect against the coronavirus .
Early evidence suggests people who watched Fox News were more likely to downplay the pandemic , worsening the spread .
The most important public health measure during a pandemic of a disease with no cure or vaccine—as many countries around the world that have controlled the virus have shown—is to help experts share clear , trustworthy , accurate , actionable information based on the best evidence .
Spreading lies has spread this disease .
Read @ @ @ @ @ @ @ American here .
And read coverage from our international network of magazines here .

Editor’s Note (9/4/20): Six months after COVID-19 was declared a pandemic, this story is being republished as a reminder of the many things scientists have learned about the disease and how it spreads.
We’re in a terrifying and confusing pandemic, with new and sometimes conflicting information about COVID-19 emerging all the time. In the early days, a lot of public health advice was based on what we knew about previous disease outbreaks. But this new coronavirus behaves in unexpected ways, and it’s hard to keep up. What’s more, people tend to remember the first things they learn about a new subject, a phenomenon called "anchoring bias," and it’s psychologically challenging to replace old information with new knowledge. Here are nine of the most important things we’ve learned about SARS-CoV-2 in the past seven months and why we didn’t fully understand or appreciate them at first.
Outbreaks of COVID-19 can happen anywhere. There was a lot of wishful thinking and othering (as in: it’s those other people’s problem) in the first months of the pandemic: Chinese people got it because of where they buy their groceries. Italian people got it because they greet each other with kisses on the cheeks. People on cruise ships got it because of the buffets. People in nursing homes got it because they are frail. People in New York got it because the city is crowded. Now we know that outbreaks can happen in urban areas, rural areas, suburbs and any culture around the world.
COVID-19 can sicken and kill anyone. The first victims of the pandemic were disproportionately older or had existing health conditions. Age and frailty are still risk factors for serious disease and death, but we now know the disease can kill young and healthy people. It can kill young adults. It can kill teenagers. It can kill children.
Contaminated surfaces are not the main danger. Early on, public health experts advised people to wash their hands frequently (while singing “Happy Birthday” twice), disinfect surfaces and avoid touching their face. This was based on studies of how other diseases spread, such as norovirus and viruses that cause the common cold. It’s still a good idea to wash your hands regularly (and avoid handshakes), but now we know that surfaces aren’t the main vector for SARS-CoV-2.
It is in the air. At first, experts thought the virus was spread primarily through globs of mucus and saliva expelled when people cough or sneeze. They thought these droplets were heavy enough to drop out of the air fairly quickly. Based on early cases of hospital spread, the virus seemed to be aerosolized—that is, lofted into the air in particles small enough to float—only by certain medical procedures such as placing someone on a ventilator. But we now know that the virus is expelled in a range of droplet sizes, with some particles small enough to persist in the air, especially in indoor, poorly ventilated spaces.
Many people are infectious without being sick. Other respiratory diseases make people cough and sneeze. The original SARS outbreak made people so sick, so quickly, that most of them went to the hospital. Temperature checks and telling sick people to stay home can stop symptomatic diseases from spreading, and in the first months of the pandemic, many countries started screening people at their borders to detect these cases. But the biggest challenge for stopping SARS-CoV-2 is that many apparently healthy people spread the disease without symptoms or before symptoms start, simply through talking and breathing.
Warm summer weather will not stop the virus. Influenza is a seasonal respiratory disease that peaks in the winter, and some experts hoped the spread of COVID-19 would show a similar pattern and slow in the Northern Hemisphere during the spring and summer. Now we know that people’s behavior, regardless of season, is the strongest predictor of whether the disease will spread.
Masks work. When the pandemic began, experts worried that mass mask-buying could exacerbate shortages of personal protective equipment for health care workers and others who needed them. They also warned that masks might make people complacent about social distancing and that cloth or paper masks (unlike N95 surgical masks) can’t stop the smallest aerosolized viral particles. Now we know that masks can greatly reduce the amount of virus that people expel into the air while speaking, and that masks protect people who are wearing them—not perfectly, but enough to reduce transmission of the disease.
Racism, not race, is a risk factor. The pandemic should put an end to the common misconception that race, a social construct, is a biological explanation for health disparities. COVID-19 has disproportionately killed people of color in the United States. This is not because of genetic differences but because of systemic racism that has isolated and impoverished many Native American people and made Black and Latinx people more likely to have “essential” jobs that expose them to infection, a greater burden of stress and less access to high-quality health care.
Misinformation kills. The president of the United States, other politicians, anti-vaccine activists, and members of the right-wing media, to their everlasting shame, have used the pandemic to stoke racism, spread misinformation and amplify conspiracy theories. Their followers have threatened health officials, including Tony Fauci and his family; refused to wear masks; refused to cooperate with contact tracers; and rejected proven basic public health advice about social distancing. Representative Louie Gohmert, who refused to wear a mask in the Capitol and reportedly discouraged his staff and interns from wearing masks, tested positive for SARS-CoV-2 and is being treated with hydroxychloroquine, a drug that Trump has endorsed but that has failed in clinical trials. Trump supporter Herman Cain died of COVID-19 on July 30, weeks after attending a rally in Tulsa without a mask. Calls to poison-control centers spiked after Trump speculated that injecting or ingesting disinfectants could protect against the coronavirus. Early evidence suggests people who watched Fox News were more likely to downplay the pandemic, worsening the spread. The most important public health measure during a pandemic of a disease with no cure or vaccine—as many countries around the world that have controlled the virus have shown—is to help experts share clear, trustworthy, accurate, actionable information based on the best evidence. Spreading lies has spread this disease.
Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.


scientificamerican--2020-09-05--The Failure of Public Health Messaging about COVID-19

It seems that science has lost , and politics won , in the battle against COVID-19 here in the United States .
A recent Pew Research study reports that up to 25 percent of people surveyed see some truth to conspiracy theories saying that people deliberately planned the that has now led to the demise of over 170,000 Americans .
As a physician , I have been frustrated by the turn in which this pandemic has taken .
I have put on my PPE , feeling defeated by the revolt against masking and science .
My initial instincts have been @ @ @ @ @ @ @ apparent divisiveness has not been productive .
So , instead I have tried to take a step back and consider why this mistrust exists .
How has it that those that were once seen as the experts have now , to some , become pawns in a story about biological warfare ?
Or part of a ploy to shift economics ?
In some ways , I can see how a failure to communicate came to be .
Public communication was never a part of my curriculum in all my years of schooling .
@ @ @ @ @ @ @ advocacy of modern medicine and science as part of my daily work .
Instead I have gone along in my career naively assuming everyone sees science the way I do—as the closest thing to understanding how things work at any given point in time .
Perhaps we could have done better in the beginning by being overly transparent that research around this novel virus would take a significant amount of time , and additionally longer to validate findings .
We should have spent more time explaining that science is not so much a @ @ @ @ @ @ @ method of study ; that any hypothesis would need to be proven or disproven consistently , and that more evidence could lead to further evolutions in care .
A quote attributed to French scientist-philosopher Blaise Pascal says it best : “ There is no such thing as the truth , we can only deliver the best available evidence and calculate a probability.
” Today , new medications and vaccines endure trial after trial before we deem it safe to enter masses of human bodies .
But why wait when we are in such @ @ @ @ @ @ @ pandemic ?
Why can ’ t we use the vaccine Russia claims to have developed ?
What is the harm in trying “ harmless ” drugs to see if they work ?
We can use history to explain why .
For example , thalidomide was released in the 1950s , marketed as a “ miracle drug ” for morning sickness .
The medication ’ s impact on fetuses was never well investigated prior to widespread use , resulting in a devastating number of fetal deaths and physical anomalies that could have been avoided @ @ @ @ @ @ @ more stringent in our drug and vaccine approval processes .
AZT , the first antiviral drug to treat HIV/AIDS during the epidemic in the 1980s , was “ fast-tracked ” for FDA approval—which still took a record 20 months .
We have not even made it 12 months into the COVID-19 pandemic reaching American soil , so it is not unreasonable that a vaccine has not been approved .
If we are lucky enough to have a vaccine by early 2021 , we will be on a faster track than any other normal @ @ @ @ @ @ @ world is anxiously watching and waiting for answers .
So , communication on process and progress is key .
However , where social media should have been our friend in disseminating truth and communicating processes , it ’ s become clear that there are others who know how to use it better .
Now we are scrambling to figure out how to battle untruths being spread faster than we can keep up .
To be sure , there are many disease experts that are breaking into the “ influencer ” market , but @ @ @ @ @ @ @ health care workers and scientists now hustle to play both offense and defense , too distracted to play both roles well .
Failure in public education shouldn ’ t have ever been an option , because the outcome of this failure is tragedy .
Coronavirus deaths in the United States now account for over 20 percent of the total worldwide deaths recorded and health disparities have been further augmented by the pandemic , demonstrated by the disproportionate impact of COVID-19 on African American , Latinx and Native American communities .
I can only @ @ @ @ @ @ @ become the experts again , supported and given the platform they need to educate the American public .

It seems that science has lost, and politics won, in the battle against COVID-19 here in the United States. A recent Pew Research study reports that up to 25 percent of people surveyed see some truth to conspiracy theories saying that people deliberately planned the coronavirus outbreak that has now led to the demise of over 170,000 Americans.
As a physician, I have been frustrated by the turn in which this pandemic has taken. I have put on my PPE, feeling defeated by the revolt against masking and science. My initial instincts have been to be angry, but it is apparent divisiveness has not been productive. So, instead I have tried to take a step back and consider why this mistrust exists. How has it that those that were once seen as the experts have now, to some, become pawns in a story about biological warfare? Or part of a ploy to shift economics?
In some ways, I can see how a failure to communicate came to be. Public communication was never a part of my curriculum in all my years of schooling. For so long, I never considered advocacy of modern medicine and science as part of my daily work. Instead I have gone along in my career naively assuming everyone sees science the way I do—as the closest thing to understanding how things work at any given point in time.
Perhaps we could have done better in the beginning by being overly transparent that research around this novel virus would take a significant amount of time, and additionally longer to validate findings. We should have spent more time explaining that science is not so much a collection of facts as it is a method of study; that any hypothesis would need to be proven or disproven consistently, and that more evidence could lead to further evolutions in care. A quote attributed to French scientist-philosopher Blaise Pascal says it best: “There is no such thing as the truth, we can only deliver the best available evidence and calculate a probability.”
Today, new medications and vaccines endure trial after trial before we deem it safe to enter masses of human bodies. But why wait when we are in such dire straits when it comes to this pandemic? Why can’t we use the vaccine Russia claims to have developed? What is the harm in trying “harmless” drugs to see if they work?
We can use history to explain why. For example, thalidomide was released in the 1950s, marketed as a “miracle drug” for morning sickness. The medication’s impact on fetuses was never well investigated prior to widespread use, resulting in a devastating number of fetal deaths and physical anomalies that could have been avoided.
Since then we have become progressively more stringent in our drug and vaccine approval processes. AZT, the first antiviral drug to treat HIV/AIDS during the epidemic in the 1980s, was “fast-tracked” for FDA approval—which still took a record 20 months. We have not even made it 12 months into the COVID-19 pandemic reaching American soil, so it is not unreasonable that a vaccine has not been approved. If we are lucky enough to have a vaccine by early 2021, we will be on a faster track than any other normal processes.
The issue is that the world is anxiously watching and waiting for answers. So, communication on process and progress is key. However, where social media should have been our friend in disseminating truth and communicating processes, it’s become clear that there are others who know how to use it better. Now we are scrambling to figure out how to battle untruths being spread faster than we can keep up. To be sure, there are many disease experts that are breaking into the “influencer” market, but there are not enough. So, health care workers and scientists now hustle to play both offense and defense, too distracted to play both roles well.
Failure in public education shouldn’t have ever been an option, because the outcome of this failure is tragedy. Coronavirus deaths in the United States now account for over 20 percent of the total worldwide deaths recorded and health disparities have been further augmented by the pandemic, demonstrated by the disproportionate impact of COVID-19 on African American, Latinx and Native American communities.
I can only hope that the experts can one day become the experts again, supported and given the platform they need to educate the American public.


scientificamerican--2020-09-06--'Warp Speed' COVID-19 Vaccine Efforts Aim for Diverse Volunteers and Long-Lasting Protection

Editor ’ s Note ( 9/4/20 ) : The U.S. Centers for Disease Control and Prevention just alerted states to prepare for a novel coronavirus vaccine as early as November .
In this story , Scientific American describes how the fast-track vaccine trials work and how they measure effectiveness and safety .
In late July , volunteers began receiving doses of a potential COVID-19 vaccine in the latest stage of a clinical trial at NYU Langone Health in New York City .
The more than 1,000 names on the waiting list suggest the local response to the trial “ has @ @ @ @ @ @ @ , an infectious disease specialist who directs NYU Langone ’ s Vaccine Center .
“ People are fed up with this disease and very motivated to help.
” The vaccine , which was co-developed by the pharmaceutical giant Pfizer and the German company BioNTech , is among front-runner efforts worldwide to develop immunizations for COVID-19 that are currently conducting or preparing to start phase III clinical trials—late-stage studies that test for efficacy and safety .
* Six of these efforts are backed by Operation Warp Speed , a Trump administration program with the @ @ @ @ @ @ @ the disease in the U.S. by January .
During the trials , enrolled subjects will get experimental shots or a placebo , and investigators will observe whether those who received the vaccine develop infections and illness at lower rates .
These assessments “ will ultimately support regulatory approval and recommendations for how vaccines can be used , ” says Penny Heaton , CEO of the Bill & Melinda Gates Medical Research Institute .
The institute is not directly involved in the efforts to develop a vaccine against COVID-19 , but it is working @ @ @ @ @ @ @ the world .
Phase III clinical trials often take years to reach their conclusion .
But vaccine developers now plan to test their candidates on rushed schedules that have sparked concerns over political meddling .
( The concerns are not without merit : on August 11 Russia announced it had approved a vaccine despite the fact that the drug has not been tested in large-scale trials . )
U.S. officials have insisted their own vaccines will be thoroughly vetted before approval .
Experts say such trials should also include adequate representation from vulnerable @ @ @ @ @ @ @ including the elderly , minority racial groups and individuals with underlying health problems .
Adding to the challenge , a growing number of people have shown skepticism toward an eventual vaccine .
And the trials have to answer key questions about how well human immune systems protect against SARS-CoV-2 , the novel coronavirus behind the disease .
Results from animal tests and early human safety studies look promising : vaccines generate encouraging immune responses , and the side effects they trigger—usually headache , arm pain , fatigue and fever—resolve quickly in most people @ @ @ @ @ @ @ can show which vaccines—if any—will actually provide protection .
The trick to delivering fast answers on vaccine safety and efficacy is to enroll large numbers of people , says Peter Gilbert , a biostatistician at the Fred Hutchinson Cancer Research Center .
Bigger study populations capture more incidences of viral exposure in a shorter amount of time than smaller ones , which are followed for longer periods .
Each of the phase III clinical trials in the U.S. aims to enroll 30,000 individuals .
This number is the lowest needed to rigorously show @ @ @ @ @ @ @ from getting COVID-19 over six months—the Food and Drug Administration ’ s minimum bar for approval .
Investigators will monitor the vaccinated and placebo , or control , groups until the number of symptomatic infections between them reaches 150 .
If the researchers can show , with 95 percent statistical confidence , that cases in the vaccinated group add up to half of those in the control group or fewer , the vaccine will have met its primary target .
“ Still , none of us will really be happy with 50 percent @ @ @ @ @ @ @ the statistical center for the federal government ’ s COVID-19 Prevention Trials Network , an organization that is trying to recruit volunteers for the phase III studies .
“ We all want 90 to 95 percent protection.
” Should a vaccine prove far more protective than the FDA ’ s minimum bar , he adds , there may be no need to wait for 150 cases .
“ We might look at 50 cases , and if the vaccine reduces disease rates by 80 percent , we might declare it successful and [ @ @ @ @ @ @ @ four months , ” Gilbert says .
Crucially , FDA guidelines for COVID-19 vaccine developers call for ideally monitoring participants over an additional one to two years after approval to assess how long protection lasts in the general population and whether vaccinated people who become infected develop worse symptoms .
The guidelines also encourage—but do not require—that vaccine developers enroll subpopulations most affected by COVID-19 , such as Black and Latino people , who are far more likely to become infected and die of the disease .
Doing so may not be easy @ @ @ @ @ @ @ have reason to be distrustful of clinical research , partly as a consequence of the Tuskegee study .
( That 40-year experiment was as an investigation of untreated syphilis .
When an effective penicillin treatment became available , the researchers unethically withheld it . )
To recruit more people of color , “ we have to engage them by reaching out to community-based organizations , such as churches , neighborhood groups , barbershops and stylists , and Black colleges , ” says Patricia Whitley-Williams , a pediatrician who specializes in infectious diseases at @ @ @ @ @ @ @ “ It ’ s essential that we tell our people of color that they ’ ve been sufficiently represented in the COVID-19 clinical trials.
” Kathrin Jansen , who leads vaccine research and development at Pfizer , agrees on the need to increase the representation of racial minorities in the company ’ s ongoing vaccine trial , which is enrolling people between the ages of 18 and 85 at sites across the U.S. , Europe and South America .
“ This is something we ’ re actively looking into , ” she says @ @ @ @ @ @ @ Pfizer and BioNTech ’ s earlier-phase trials were white , NYU Langone ’ s Mulligan says .
“ But we ’ re hoping to significantly change that for the phase III , ” Jansen says .
The study does not set quantitative targets for minority recruitment , “ but it will be monitored centrally , and feedback will be provided to each of the participating locations , '' Mulligan says .
“ We are committed to enrolling those most affected.
” Trial investigators will not only assess whether vaccines lower COVID-19 disease rates @ @ @ @ @ @ @ by probing the specific “ correlates of protection ” in blood samples that show if someone is , in fact , immune to the disease .
Preliminary research suggests that so-called neutralizing antibodies play outsize roles in protection .
These roving molecules deflect SARS-CoV-2 from attaching to its host cell receptor , preventing infection .
A July study reported that another Warp Speed vaccine contender , co-developed by Johnson & Johnson , elicited neutralizing antibodies that were detected at high levels in macaque monkeys .
When the researchers then exposed the animals to @ @ @ @ @ @ @ a single vaccine dose .
The company plans to launch its phase III clinical trial in September .
Among the other Operation Warp Speed companies , Moderna and the National Institute of Allergy and Infectious Diseases are already conducting a phase III trial of their vaccine , and Novavax is set to start one in the fall .
Legal agreements with each company stipulate how many millions of vaccine doses , at a minimum , the U.S. government will buy ( it aims to deliver 300 million by January ) .
The government @ @ @ @ @ @ @ additional doses , but it is not obligated to buy them if a vaccine is not approved .
Questions remain about the durability of the protection any vaccine will afford people , however .
Antibody levels can fall off soon after recovery , and that possibility has raised fears that COVID-19 immunity might wane quickly in those who have recovered from the illness or been vaccinated .
Yet Heaton strikes a more positive tone .
“ Ideally , you ’ ll get immunological memory , so that even if your antibodies wane , @ @ @ @ @ @ @ you ’ re reexposed to the virus , ” she says .
Phase III studies will monitor antibodies over time , Heaton adds , along with the actions of another key immune component , T cells , which might provide reinforcements .
Killer T cells , in particular , eliminate infected cells , destroying their viral invaders in the process .
But the response can cut two ways : these cells might also contribute to hyperactive immune reactions that are deadly for some patients .
“ We still need a much better understanding @ @ @ @ @ @ @ infection , ” says Avery August , an immunologist at Cornell University ’ s College of Veterinary Medicine , who studies T cell responses to COVID-19 infections .
“ But overall , I ’ m optimistic about the vaccine candidates going into phase III .
We have a lot more to learn , but the immune responses so far look promising.
” Read more about the coronavirus outbreak from Scientific American here .
And read coverage from our international network of magazines here .
*Editor ’ s Note ( 8/25/20 ) : This @ @ @ @ @ @ @ a reference to the number of front-runner efforts .

Editor’s Note (9/4/20): The U.S. Centers for Disease Control and Prevention just alerted states to prepare for a novel coronavirus vaccine as early as November. In this story, Scientific American describes how the fast-track vaccine trials work and how they measure effectiveness and safety.
In late July, volunteers began receiving doses of a potential COVID-19 vaccine in the latest stage of a clinical trial at NYU Langone Health in New York City. The more than 1,000 names on the waiting list suggest the local response to the trial “has been outstanding,” says Mark Mulligan, an infectious disease specialist who directs NYU Langone’s Vaccine Center. “People are fed up with this disease and very motivated to help.”
The vaccine, which was co-developed by the pharmaceutical giant Pfizer and the German company BioNTech, is among front-runner efforts worldwide to develop immunizations for COVID-19 that are currently conducting or preparing to start phase III clinical trials—late-stage studies that test for efficacy and safety.* Six of these efforts are backed by Operation Warp Speed, a Trump administration program with the optimistic goal of beginning mass inoculations against the disease in the U.S. by January. During the trials, enrolled subjects will get experimental shots or a placebo, and investigators will observe whether those who received the vaccine develop infections and illness at lower rates. These assessments “will ultimately support regulatory approval and recommendations for how vaccines can be used,” says Penny Heaton, CEO of the Bill & Melinda Gates Medical Research Institute. The institute is not directly involved in the efforts to develop a vaccine against COVID-19, but it is working on vaccines for other viral diseases around the world.
Phase III clinical trials often take years to reach their conclusion. But vaccine developers now plan to test their candidates on rushed schedules that have sparked concerns over political meddling. (The concerns are not without merit: on August 11 Russia announced it had approved a vaccine despite the fact that the drug has not been tested in large-scale trials.) U.S. officials have insisted their own vaccines will be thoroughly vetted before approval. Experts say such trials should also include adequate representation from vulnerable subgroups at high risk from COVID-19, including the elderly, minority racial groups and individuals with underlying health problems. Adding to the challenge, a growing number of people have shown skepticism toward an eventual vaccine. And the trials have to answer key questions about how well human immune systems protect against SARS-CoV-2, the novel coronavirus behind the disease. Results from animal tests and early human safety studies look promising: vaccines generate encouraging immune responses, and the side effects they trigger—usually headache, arm pain, fatigue and fever—resolve quickly in most people. Yet only phase III clinical trials can show which vaccines—if any—will actually provide protection.
Strategizing for Speed
The trick to delivering fast answers on vaccine safety and efficacy is to enroll large numbers of people, says Peter Gilbert, a biostatistician at the Fred Hutchinson Cancer Research Center. Bigger study populations capture more incidences of viral exposure in a shorter amount of time than smaller ones, which are followed for longer periods. Each of the phase III clinical trials in the U.S. aims to enroll 30,000 individuals. This number is the lowest needed to rigorously show that 50 percent of people are protected from getting COVID-19 over six months—the Food and Drug Administration’s minimum bar for approval.
Investigators will monitor the vaccinated and placebo, or control, groups until the number of symptomatic infections between them reaches 150. If the researchers can show, with 95 percent statistical confidence, that cases in the vaccinated group add up to half of those in the control group or fewer, the vaccine will have met its primary target. “Still, none of us will really be happy with 50 percent,” says Gilbert, who leads the statistical center for the federal government’s COVID-19 Prevention Trials Network, an organization that is trying to recruit volunteers for the phase III studies. “We all want 90 to 95 percent protection.” Should a vaccine prove far more protective than the FDA’s minimum bar, he adds, there may be no need to wait for 150 cases. “We might look at 50 cases, and if the vaccine reduces disease rates by 80 percent, we might declare it successful and [apply] for approval within three to four months,” Gilbert says.
Crucially, FDA guidelines for COVID-19 vaccine developers call for ideally monitoring participants over an additional one to two years after approval to assess how long protection lasts in the general population and whether vaccinated people who become infected develop worse symptoms.
Enrolling a Diverse Group
The guidelines also encourage—but do not require—that vaccine developers enroll subpopulations most affected by COVID-19, such as Black and Latino people, who are far more likely to become infected and die of the disease. Doing so may not be easy. Black Americans, in particular, have reason to be distrustful of clinical research, partly as a consequence of the Tuskegee study. (That 40-year experiment was as an investigation of untreated syphilis. When an effective penicillin treatment became available, the researchers unethically withheld it.) To recruit more people of color, “we have to engage them by reaching out to community-based organizations, such as churches, neighborhood groups, barbershops and stylists, and Black colleges,” says Patricia Whitley-Williams, a pediatrician who specializes in infectious diseases at Rutgers Robert Wood Johnson Medical School. “It’s essential that we tell our people of color that they’ve been sufficiently represented in the COVID-19 clinical trials.”
Kathrin Jansen, who leads vaccine research and development at Pfizer, agrees on the need to increase the representation of racial minorities in the company’s ongoing vaccine trial, which is enrolling people between the ages of 18 and 85 at sites across the U.S., Europe and South America. “This is something we’re actively looking into,” she says. Most of the people enrolled during Pfizer and BioNTech’s earlier-phase trials were white, NYU Langone’s Mulligan says. “But we’re hoping to significantly change that for the phase III,” Jansen says. The study does not set quantitative targets for minority recruitment, “but it will be monitored centrally, and feedback will be provided to each of the participating locations," Mulligan says. “We are committed to enrolling those most affected.”
Defining Markers of Protection
Trial investigators will not only assess whether vaccines lower COVID-19 disease rates; they will go a step further by probing the specific “correlates of protection” in blood samples that show if someone is, in fact, immune to the disease. Preliminary research suggests that so-called neutralizing antibodies play outsize roles in protection. These roving molecules deflect SARS-CoV-2 from attaching to its host cell receptor, preventing infection. A July study reported that another Warp Speed vaccine contender, co-developed by Johnson & Johnson, elicited neutralizing antibodies that were detected at high levels in macaque monkeys. When the researchers then exposed the animals to COVID-19, they were totally protected after a single vaccine dose. The company plans to launch its phase III clinical trial in September. Among the other Operation Warp Speed companies, Moderna and the National Institute of Allergy and Infectious Diseases are already conducting a phase III trial of their vaccine, and Novavax is set to start one in the fall. Legal agreements with each company stipulate how many millions of vaccine doses, at a minimum, the U.S. government will buy (it aims to deliver 300 million by January). The government has the option to purchase millions of additional doses, but it is not obligated to buy them if a vaccine is not approved.
Questions remain about the durability of the protection any vaccine will afford people, however. Antibody levels can fall off soon after recovery, and that possibility has raised fears that COVID-19 immunity might wane quickly in those who have recovered from the illness or been vaccinated. Yet Heaton strikes a more positive tone. “Ideally, you’ll get immunological memory, so that even if your antibodies wane, they’ll shoot back up when you’re reexposed to the virus,” she says. Phase III studies will monitor antibodies over time, Heaton adds, along with the actions of another key immune component, T cells, which might provide reinforcements. Killer T cells, in particular, eliminate infected cells, destroying their viral invaders in the process. But the response can cut two ways: these cells might also contribute to hyperactive immune reactions that are deadly for some patients. “We still need a much better understanding of how T cells respond to SARS-CoV-2 infection,” says Avery August, an immunologist at Cornell University’s College of Veterinary Medicine, who studies T cell responses to COVID-19 infections. “But overall, I’m optimistic about the vaccine candidates going into phase III. We have a lot more to learn, but the immune responses so far look promising.”
Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.
*Editor’s Note (8/25/20): This sentence was edited after posting to correct a reference to the number of front-runner efforts.


scientificamerican--2020-09-06--Coronavirus and the Flu: A Looming Double Threat

Editor ’ s Note ( 9/4/20 ) : As flu season begins , many people now worry about the double whammy of influenza and COVID-19 .
Scientific American sketched out what could happen with these two diseases earlier this year .
Uncertainty about the future seems to be the one sure thing in the coronavirus pandemic .
No one knows if COVID-19 will persist at its current pace or if recent increased interactions among people will spawn an onslaught of smaller outbreaks or a larger second wave .
But a few things are clear : The virus that causes the @ @ @ @ @ @ @ the population until there is a vaccine .
And flu season is only a few months away .
The overlap of COVID-19 and influenza has epidemiologists and some policy makers concerned .
The U.S. may soon face two epidemics at the same time , they worry , and this combination could precipitate a crisis unlike any other .
“ The worst-case scenario is both [ the coronavirus and the flu ] are spreading fast and causing severe disease , complicating diagnoses and presenting a double burden on the health care system , ” @ @ @ @ @ @ @ Harvard University .
A few states are planning for extra capacity in hospitals to deal with both illnesses .
Yet another , more favorable future also might be possible as these viruses cross paths , Lipsitch and other infectious disease forecasters say .
The behavioral changes people have already adopted to flatten the curve of COVID-19—such as social distancing , hand washing , and mask wearing—could lessen the impact of the flu .
“ It is hard to predict , ” says Sarah Cobey , an epidemiologist at the University of Chicago .
@ @ @ @ @ @ @ coronavirus will ebb and flow as seasons change , but “ what 's really hard is that I don ’ t have a good forecast for human behavior and policy decisions that are going to be made over the next couple of months , ” she says .
Jeffrey Shaman , an epidemiologist at Columbia University , says if SARS-CoV-2 follows seasonal patterns like some other coronaviruses and influenza viruses do , it could subside in the summer .
“ But that could come back to haunt us , ” he adds .
@ @ @ @ @ @ @ might not be prepared.
” Four flu virus pandemics over the past 100 years—H1N1 in 1918 , H2N2 in 1957 , H3N2 in 1968 and H1N1 in 2009—had a deadly second wave around the fall and early winter .
COVID-19 could do the same .
“ The concern that we might have a double whammy of flu and coronavirus is legitimate , ” Shaman says .
[ Both indoor and outdoor factors influence how viruses wax and wane with the seasons . ]
Every year , influenza sickens millions of people in the @ @ @ @ @ @ @ flu surges overwhelm hospitals and health care systems .
During the 2017–2018 flu season , local news outlets reported that hospitals across the country flew in nurses from other states , erected tents in parking lots and sent incoming ambulances to other facilities because of the overload of patients .
The U.S. Centers for Disease Control and Prevention estimates that between 46,000 and 95,000 Americans died from the illness that season .
Though the new coronavirus and influenza viruses can cause some of the same symptoms—such as fever , cough and fatigue—these similarities @ @ @ @ @ @ @ different receptors on cells to gain access to our bodies .
As a result , SARS-CoV-2 could enter one way , while a flu virus slips in another .
A study of about 1,200 patients , conducted in northern California and published in JAMA in April , found that one in five people who were diagnosed with COVID-19 were coinfected with another respiratory virus .
The risk of such coinfections is typically low , says Ben Cowling , an epidemiologist at the University of Hong Kong , but it gets higher when two @ @ @ @ @ @ @ region .
“ It ’ s possible you could get infected with both at the exact same time—if you 're having a really bad day , ” he says .
Cowling and some other epidemiologists think the way viruses interact and interfere with each other could reduce the impact of any coronavirus-influenza collision , however .
They have tracked epidemics for decades and have found that outbreaks of respiratory viruses usually do not reach their peaks during the same time period .
Though no one knows exactly why , a study published last @ @ @ @ @ @ @ Academy of Sciences USA hypothesized that temporary bursts of immunity to different viruses on the cellular level could shift the course of future epidemics .
For example , an outbreak of a rhinovirus—which causes a common cold—appears to have delayed the arrival of the 2009 influenza pandemic in Europe .
And that effect , in turn , likely postponed epidemics of another disease : respiratory syncytial virus .
“ Right now COVID-19 has a huge fraction of the population susceptible to it , ” Cobey says .
“ Assuming that we ’ re @ @ @ @ @ @ @ it ’ s going to continue burning through populations , leaving this wake of immunity that might be slightly effective against other viruses.
” She admits this idea sits on the “ speculative side of hypotheses.
” And the theoretical immunity would not be strong enough for , say , someone who has recovered from a coronavirus to shrug off the flu , or vice versa .
But on a population level , it could mean that other viruses might not spread as quickly as normal , so their epidemic peaks could be @ @ @ @ @ @ @ might not be dramatic has less to do with virology and more to do with human behavior : both COVID-19 and the flu are transmitted , for the most part , by respiratory droplets , so the same prevention strategies used to reduce the spread of the former will also work for the latter .
[ How does the coronavirus spread through the air ?
Scientists explain what they know about transmission . ]
In a study in the Lancetin April , Cowling showed that the public health measures introduced in Hong Kong @ @ @ @ @ @ @ , quarantine and isolation , social distancing , mask wearing and hand washing—led to a rapid decline in flu activity .
In the U.S. , new flu cases plummeted a few weeks after COVID-19 was declared a global pandemic .
The 2019–2020 flu season , once headed to be among the worst in decades , ended six weeks early .
But as states in the U.S. ease restrictions on activity and travel , people ’ s behaviors could change in ways that ease virus transmission , so a double threat is still possible @ @ @ @ @ @ @ , if any , federal response is being mounted to prepare for it .
In April Robert Redfield , director of the CDC , told the Washington Post that “ we ’ re going to have the flu epidemic and the coronavirus epidemic at the same time.
” After President Donald Trump claimed that Redfield was misquoted , the director walked his statement back , saying he did not mean the current crisis would be worse , just “ more difficult and potentially complicated.
” ( The CDC did not respond to Scientific @ @ @ @ @ @ @ . )
In late May a group of Democratic senators sent a letter to the White House asking it to prepare for the worst overlap scenario .
“ We urge you to begin planning for and activating the resources of the federal government now , ” they wrote , “ to increase capacity , supplies , and vaccinations to prevent public health and medical systems from being overwhelmed by simultaneous peaks of both of these deadly infectious diseases in the fall.
” On the state level , some are updating hospital surge plans @ @ @ @ @ @ @ include both the flu and COVID-19 .
North Carolina ’ s state health director Elizabeth Tilson , who co-chairs the state ’ s coronavirus task force , has been working with health systems to develop plans for increasing their surge capacity by converting unused facilities , procuring extra beds or hiring extra staff .
“ Thankfully , we haven ’ t had to pull the trigger on any of our emergency med surge plans .
But we have all those plans in place , whether it be COVID-19 or COVID-19 and flu , @ @ @ @ @ @ @ trying to convince the government of her home state of Illinois to set up a sentinel surveillance plan that could alert officials to coming surges of COVID-19 and flu cases .
But she says her suggestions have received little traction .
Such surveillance systems already exist in other states , including North Carolina and Michigan .
The CDC also tracks both illnesses on the national level and releases a weekly surveillance report on the viruses that cause them .
Tilson points out that whatever happens , there is one basic step people can @ @ @ @ @ @ @ either epidemic .
“ Look , we don ’ t have a vaccine for COVID-19 , ” she says .
“ We do have a vaccine for flu .
Get the vaccine.
” Read more about the coronavirus outbreak from Scientific American here .
And read coverage from our international network of magazines here .

Editor’s Note (9/4/20): As flu season begins, many people now worry about the double whammy of influenza and COVID-19. Scientific American sketched out what could happen with these two diseases earlier this year.
Uncertainty about the future seems to be the one sure thing in the coronavirus pandemic. No one knows if COVID-19 will persist at its current pace or if recent increased interactions among people will spawn an onslaught of smaller outbreaks or a larger second wave. But a few things are clear: The virus that causes the disease is likely to continue circulating through the population until there is a vaccine. And flu season is only a few months away.
The overlap of COVID-19 and influenza has epidemiologists and some policy makers concerned. The U.S. may soon face two epidemics at the same time, they worry, and this combination could precipitate a crisis unlike any other. “The worst-case scenario is both [the coronavirus and the flu] are spreading fast and causing severe disease, complicating diagnoses and presenting a double burden on the health care system,” says Marc Lipsitch, an epidemiologist at Harvard University. A few states are planning for extra capacity in hospitals to deal with both illnesses.
Yet another, more favorable future also might be possible as these viruses cross paths, Lipsitch and other infectious disease forecasters say. The behavioral changes people have already adopted to flatten the curve of COVID-19—such as social distancing, hand washing, and mask wearing—could lessen the impact of the flu.
“It is hard to predict,” says Sarah Cobey, an epidemiologist at the University of Chicago. Not only is it unknown whether the coronavirus will ebb and flow as seasons change, but “what's really hard is that I don’t have a good forecast for human behavior and policy decisions that are going to be made over the next couple of months,” she says.
Jeffrey Shaman, an epidemiologist at Columbia University, says if SARS-CoV-2 follows seasonal patterns like some other coronaviruses and influenza viruses do, it could subside in the summer. “But that could come back to haunt us,” he adds. “We might get complacent; we might not be prepared.” Four flu virus pandemics over the past 100 years—H1N1 in 1918, H2N2 in 1957, H3N2 in 1968 and H1N1 in 2009—had a deadly second wave around the fall and early winter. COVID-19 could do the same. “The concern that we might have a double whammy of flu and coronavirus is legitimate,” Shaman says.
[Both indoor and outdoor factors influence how viruses wax and wane with the seasons.]
Every year, influenza sickens millions of people in the U.S. In particularly bad years, flu surges overwhelm hospitals and health care systems. During the 2017–2018 flu season, local news outlets reported that hospitals across the country flew in nurses from other states, erected tents in parking lots and sent incoming ambulances to other facilities because of the overload of patients. The U.S. Centers for Disease Control and Prevention estimates that between 46,000 and 95,000 Americans died from the illness that season.
Though the new coronavirus and influenza viruses can cause some of the same symptoms—such as fever, cough and fatigue—these similarities are mostly superficial. The pathogens use different receptors on cells to gain access to our bodies. As a result, SARS-CoV-2 could enter one way, while a flu virus slips in another. A study of about 1,200 patients, conducted in northern California and published in JAMA in April, found that one in five people who were diagnosed with COVID-19 were coinfected with another respiratory virus. The risk of such coinfections is typically low, says Ben Cowling, an epidemiologist at the University of Hong Kong, but it gets higher when two viruses are circulating heavily in the same region. “It’s possible you could get infected with both at the exact same time—if you're having a really bad day,” he says.
Cowling and some other epidemiologists think the way viruses interact and interfere with each other could reduce the impact of any coronavirus-influenza collision, however. They have tracked epidemics for decades and have found that outbreaks of respiratory viruses usually do not reach their peaks during the same time period. Though no one knows exactly why, a study published last year in the Proceedings of the National Academy of Sciences USA hypothesized that temporary bursts of immunity to different viruses on the cellular level could shift the course of future epidemics. For example, an outbreak of a rhinovirus—which causes a common cold—appears to have delayed the arrival of the 2009 influenza pandemic in Europe. And that effect, in turn, likely postponed epidemics of another disease: respiratory syncytial virus.
“Right now COVID-19 has a huge fraction of the population susceptible to it,” Cobey says. “Assuming that we’re not incredibly diligent about stopping transmission, it’s going to continue burning through populations, leaving this wake of immunity that might be slightly effective against other viruses.” She admits this idea sits on the “speculative side of hypotheses.” And the theoretical immunity would not be strong enough for, say, someone who has recovered from a coronavirus to shrug off the flu, or vice versa. But on a population level, it could mean that other viruses might not spread as quickly as normal, so their epidemic peaks could be delayed.
Another reason why the collision might not be dramatic has less to do with virology and more to do with human behavior: both COVID-19 and the flu are transmitted, for the most part, by respiratory droplets, so the same prevention strategies used to reduce the spread of the former will also work for the latter.
[How does the coronavirus spread through the air? Scientists explain what they know about transmission.]
In a study in the Lancetin April,Cowling showed that the public health measures introduced in Hong Kong to contain the coronavirus—such as border restrictions, quarantine and isolation, social distancing, mask wearing and hand washing—led to a rapid decline in flu activity. In the U.S., new flu cases plummeted a few weeks after COVID-19 was declared a global pandemic. The 2019–2020 flu season, once headed to be among the worst in decades, ended six weeks early.
But as states in the U.S. ease restrictions on activity and travel, people’s behaviors could change in ways that ease virus transmission, so a double threat is still possible. And it is not clear what, if any, federal response is being mounted to prepare for it. In April Robert Redfield, director of the CDC, told the Washington Post that “we’re going to have the flu epidemic and the coronavirus epidemic at the same time.” After President Donald Trump claimed that Redfield was misquoted, the director walked his statement back, saying he did not mean the current crisis would be worse, just “more difficult and potentially complicated.” (The CDC did not respond to Scientific American’s requests for further comment.)
In late May a group of Democratic senators sent a letter to the White House asking it to prepare for the worst overlap scenario. “We urge you to begin planning for and activating the resources of the federal government now,” they wrote, “to increase capacity, supplies, and vaccinations to prevent public health and medical systems from being overwhelmed by simultaneous peaks of both of these deadly infectious diseases in the fall.”
On the state level, some are updating hospital surge plans and expanding infectious disease surveillance programs to include both the flu and COVID-19. North Carolina’s state health director Elizabeth Tilson, who co-chairs the state’s coronavirus task force, has been working with health systems to develop plans for increasing their surge capacity by converting unused facilities, procuring extra beds or hiring extra staff. “Thankfully, we haven’t had to pull the trigger on any of our emergency med surge plans. But we have all those plans in place, whether it be COVID-19 or COVID-19 and flu,” she says.
Cobey has been trying to convince the government of her home state of Illinois to set up a sentinel surveillance plan that could alert officials to coming surges of COVID-19 and flu cases. But she says her suggestions have received little traction. Such surveillance systems already exist in other states, including North Carolina and Michigan. The CDC also tracks both illnesses on the national level and releases a weekly surveillance report on the viruses that cause them.
Tilson points out that whatever happens, there is one basic step people can take that may alter the trajectory of either epidemic. “Look, we don’t have a vaccine for COVID-19,” she says. “We do have a vaccine for flu. Get the vaccine.”
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