Daily Archives: February 26, 2022

Each week, we answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line "Weekly Coronavirus Questions." See an archive of our FAQs here.

Lots of people are giving up masks in public places maybe they think the pandemic is over, maybe they're putting their faith in vaccines, maybe they're just tired of masking. But I still want to mask up when I'm around others omicron is out there, infections can happen if you're vaccinated. Is one-way masking wearing a mask helpful in any way?

It can be lonely out there as the solo masker in a sea of exposed chins and noses.

And there's no getting around the fact that having everyone wear a mask cuts down the risk of spreading the coronavirus in a public space much more effectively than a scattershot approach.

"One-way masking isn't doing that," says Kristen Coleman, an assistant research professor at the University of Maryland School of Public Health. "We're not maximizing the benefits of masks [if] only a proportion of the population" wears them.

But it looks as if an end to mask mandates will increasingly be the reality, given the Centers for Disease Control and Prevention's new guidance that much of the public can forgo masks if local hospitals are not dealing with a high level of disease.

But if you plan to continue wearing a mask, you can still get substantial protection as the sole mask-wearer what's being called "one-way masking" if you do it right.

If it's pouring outside, would you throw on a cotton hoodie and expect to stay dry?

The same principle applies to masks and pathogens.

Unlike a cloth or surgical mask, an N95 respirator (as well as similar products, like a KN95 or KF94) is specifically designed to filter out the tiny viral particles that stay suspended in the air when exhaled by someone who's infected and not just the larger respiratory droplets that spray out like cannonballs and fall to the ground at close range.

(These models are often referred to as masks but are technically known as respirators.)

"The only thing I recommend is something like an N95 respirator," says Lisa Brosseau, a bioaerosol scientist and industrial hygienist who's a consultant for the University of Minnesota's Center for Infectious Disease Research and Policy.

Lots of studies dating well before the coronavirus pandemic, in the laboratory and in workplaces, demonstrate that fit-tested respirators protect the wearer from hazardous airborne contaminants, she says.

"From Day 1, we have collectively done a poor job at communicating the strong efficacy of N95 respirators," adds Coleman.

Of course, any kind of protection is better than nothing at all. If you have no other options, surgical masks are better than cloth masks because the material has electrostatic charge to trap incoming particles, says Abraar Karan, an infectious disease physician at Stanford University but if you're serious, don't count on them to keep you safe when most people nearby are unmasked.

Karan has taken care of hundreds of COVID-19 patients over the past two years and knows how well N95s work, even if you're face-to-face with a contagious unmasked person.

"I've been very close to them while they were coughing and weren't able to wear masks and never got COVID from a patient," he says.

The only real downside of wearing an N95 is that some models can compress your face, pinch your nose and make it hard to breathe. The key is to find one that you can tolerate wearing, while making sure there aren't big gaps around your nose or chin (if your nostrils are showing, forget about it!).

"They all feel slightly differently," says Karan, who personally prefers a model made by 3M called the VFlex.

But keep in mind that an N95 on its own isn't foolproof.

Health care workers go through fit tests to ensure the ones they're wearing are sealed properly. Even so, Brosseau says research shows that about 10% of particles will leak through during the normal wear and tear of the day.

Of course, most of the N95-wearing public will not undergo a rigorous fit test. Brosseau had studied this scenario people who had no prior experience or assistance putting on a respirator. She found that the majority of them could get a fit that would result in about 20% leakage.

This drop in effectiveness should not deter you, she stresses.

"It just means that it doesn't offer that 95% protection that's been advertised, but it's still going to be providing more protection than a surgical mask or a cloth mask," says Coleman.

Even with a solid choice like an N95, you need to calculate the risks you'll face as a one-way masker.

"Just wearing a mask it helps, but it is not going to turn being indoors into something that has no risk," says Jose-Luis Jimenez, a professor at the University of Colorado Boulder and an aerosols scientist.

Many of the considerations should feel familiar at this point, if not hard-wired into our pandemic-weary brains.

Poorly ventilated indoor spaces, especially where people are talking loudly, singing or exercising, carry the highest risk. If you do go inside, the safest situation is an uncrowded venue. And the longer you spend indoors, the more you open yourself up to infection.

The final big risk consideration comes down to how many people are contagious in your community. Dr. Lisa Maragakis says you can look at the number of new cases per capita in your community over the past week.

"That number needs to be in the single digits somewhere between one to five cases per 100,000 before we've reached that low level where the probability is such that you're less likely to encounter someone with the virus," says Maragakis, who's senior director of infection prevention at the Johns Hopkins Health System.

And remember: There are no hard-and-fast rules.

For example, you can spend the same amount of time in similar indoor spaces, but the chance of infection can go up enormously depending on what people are doing.

"We've seen tons of outbreaks in choirs, none in libraries and movie theaters that I know of," says Jimenez, who has developed a tool that estimates risk in different scenarios.

Some researchers have tried to specifically quantify the risk of being infected when one person is wearing a mask and the other isn't i.e., one-way masking. But many factors come into play.

One recent modeling study found a 90% risk of being infected after 30 minutes when a person wears a surgical mask and is about 5 feet away from an infected unmasked person. Switching to a respirator drops that risk to 20% over the course of an hour. And if both people are wearing a respirator, it's under 1% in an hour.

Brosseau has also analyzed this kind of scenario, although with a different approach that looks at how long it would take to get a big enough "dose" of the virus that you'd likely be infected. She found it would be about an hour and 15 minutes for someone wearing an N95 (not fit tested) to get infected when in close contact with a contagious person.

Of course, all these estimates are based on certain assumptions and can't be taken as a strict guide. Brosseau's relies on the idea that there's a high risk of infection for two unmasked people in close proximity for 15 minutes but that time span comes from contact-tracing guidance used by the Centers for Disease Control and Prevention, not data about the virus.

"These are not bright lines between safe and unsafe," she says.

Even among experts, there's considerable variation in how much they're going to rely on one-way masking when infection rates are high in their community.

Karan feels comfortable going into places that would be considered riskier if he's wearing the N95 he likes: "I use that to work out in the gym. I wear it everywhere. I wear it in the hospital or just out and about."

Others play it much safer. Jimenez says he isn't going back to the grocery store yet, even with a high-quality respirator.

Brosseau is back to shopping for groceries but avoids busy times and still rules out certain destinations. "I haven't gone back to church since the beginning of the pandemic," she says.

The decision to be a one-way masker can also add to your pandemic stress. It can be awkward to be the only person in a public place who's wearing one. And given the way that masks have been politicized, you may feel that your decision to be a one-way masker could be taken as a confrontational action.

As a one-way masker, epidemiology professor Charlotte Baker at Virginia Tech often finds herself one of the few people wearing a mask. And she recognizes that it can be a lonely road.

She suggests giving yourself a little pep talk to strengthen your resolve: "I'm doing this so I can see my parents," or "I'm doing this so I can keep my kids safe." In her case, she is immunocompromised and reminds herself, "I don't want to die" but notes "that might be a bit too on the nose for many people."

And don't obsess about the non-maskers around you, she says: "I suggest ignoring people, focusing on the task at hand and getting out of there."

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Will one-way masking protect you from COVID in public spaces? : Goats and Soda - NPR

England begins living with the virus

This week Prime Minister Boris Johnson announced that he was scrapping the remaining coronavirus restrictions in England, saying it was time to live with the virus.

While he did not declare the nations health crisis over, the move put his country ahead of most others in Europe regarding the speed with which it hopes to return to normal life.

For insight into the approach, I spoke with Claire Moses, a writer for The Morning in London.

What happened in this latest round of lifting restrictions?

Basically, everything has been lifted. A lot of things had been open already restaurants, pubs, movie theaters, you name it but now the final restrictions are also gone. That includes mask requirements, even on Londons public transportation, and legal isolation requirements, even if you have the virus.

We also have access to free rapid tests, which we get through the National Health Service, but those wont be free anymore after April 1. My guess is that will mean that people will stop testing, unless theyre very ill, because no one is going to say, Lets buy tests before we see each other. Its just not realistic.

What does lifting isolation requirements mean?

So if I test positive, I no longer have to isolate. Im still encouraged to stay home, but its no longer legally required. If you get Covid or a nasty flu, youre probably going to do the responsible thing and stay home anyway. But since you essentially no longer have to tell anyone if you test positive and after April, you may not even know if you are infected unless you pay for a test it may change the calculation for some people. Maybe you have a trip planned and youre not going to cancel it. Or maybe you have a party or a dinner you really want to go to, so you do. This makes everyones personal risk assessment very, very difficult.

Why is Boris Johnson doing this?

On the one hand, hes saying the virus is here to stay and we need to accept that and adopt it into our daily lives. But hes also in the middle of a major political scandal here. There is a police inquiry into whether he broke his own governments lockdown rules by attending multiple parties. So his critics are saying that lifting the remaining restrictions is a way to distract attention from that.

What are health experts saying?

Health officials are extremely wary, and N.H.S. leaders have also said theyre against the end of the free testing. Something else to keep in mind is that the lifting of all restrictions doesnt protect vulnerable people. They have warned that politicians shouldnt say the pandemic is over, because it isnt Covid is still among us, and while cases have been dropping dramatically, tens of thousands of people around the country still test positive every day.

The N.H.S. is also dealing with another crisis: The pandemic has worsened delays and backlogs. Millions of procedures have been delayed, including cancer screenings and essential care.

Whats the latest on Queen Elizabeth?

The queen, who is 95, seems to be having a mild case of Covid with coldlike symptoms. But she did cancel her virtual appearances. According to the media here, shes still performing some light duties. One of those duties, as the BBC reported, is reading state papers.

Whats life like in London these days?

Everything is open. More and more people are starting to return to the office. I was on the tube, what we call the subway here, during rush hour this week, and it was crowded. Even if it wasnt quite as crowded as two years ago. Nightlife is up and running. Theaters are full and the audiences seem extremely happy to be there. People are back in pubs. In many places in town, it looks like we are living with Covid.

How does that feel?

On the one hand it feels great, because who doesnt love normalcy? We love the theater. We love the pub. We love hugging each other. We love going to work sometimes. But on the other hand, this pandemic has been very scary for everyone in different ways, and especially so for people who are older or more vulnerable. So, going back to a world where it seemingly doesnt exist feels abrupt.

The World Health Organization announced plans to establish a training hub in South Korea to teach low- and middle-income countries to produce their own mRNA vaccines. The effort, which aims to train 370 people from around the world starting in July, would help to mitigate global vaccine inequality and the shortage of skilled workers in the vaccine manufacturing industry, the agency said.

The announcement followed the organizations ongoing effort in South Africa to reverse-engineer existing mRNA vaccines and share the technology with low-income countries, after attempts to cooperate with Pfizer and Moderna to share the technology had been unsuccessful.

The W.H.O. also said that African countries would be able to accelerate their vaccination programs because of a change in the system of vaccine distribution.

Whats at stake. The crisis has stoked speculations thatthe political future of Mr. Johnson might be at risk. Though few Conservatives in Parliament have publicly called on him to quit, if the investigation determines that he misled Parliament, it could cost him his job.

Previously, the agency would send vaccine doses to African countries as they became available. But since January, countries have been able to request the vaccines they need from the W.H.O. directly, specifying in what quantity and when. As a result, they have been able to significantly ramp up vaccination efforts.

The continent had been expected to reach the target of vaccinating 70 percent of the population by August 2024. But now, the W.H.O. said, it seemed like that target could be met by early 2023.

An average of about 90,000 Americans are being vaccinated per day, the lowest point since the early days of the campaign, The Associated Press reported.

Moderna said it expected to make at least $19 billion in Covid vaccine sales this year, CNBC reported.

The pandemic has increased reliance on pills for abortions in the U.S.

Is the BA.2 version of Omicron worse? Heres what you need to know.

A truck caravan, planned as an American version of the past months chaotic protest in Canada, left California for Washington, D.C.

Hopeful business executives are again planning for workers to return in person (fingers crossed).

A celebrated Broadway composer, who has suffered from long Covid for two years, is reclaiming his old life, breath by breath.

Well, we did EVERYTHING right. We wore masks, we ate all our meals with friends outdoors, we got vaccinated twice and then boosted. We made it just about two years without getting infected. We got the virus skiing in Park City in January 2022, where we again did everything outdoors and wore our masks indoors. It was a super frustrating experience to have played by the rules and still gotten sick. That experience definitely makes us feel more willing to live life a little bit more, because not doing so didnt really pay the expected dividends.

Ilene Winters, West Dover, Vt.

Let us know how youre dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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Email your thoughts to briefing@nytimes.com.

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Coronavirus Briefing: England is Living with the Virus - The New York Times

Take a deep breath, Parkites.

COVID-19 case numbers have plunged in recent weeks following the omicron-fueled surge that pushed coronavirus transmission to never-before-seen levels in Summit County and the rest of the state. For the first time since last summer, prior to the emergence of the delta and omicron variants, there is a sense of optimism that we may be nearing a point where the coronavirus recedes into the background of daily life.

State officials announced recently that they plan to close mass testing sites at the end of March and begin treating the coronavirus as endemic rather than as a pandemic. And the Summit County Health Department has indicated that it intends shortly to take a similar tack.

The current situation is particularly promising for people who are vaccinated or better yet, boosted. With case numbers similar to where they were in the early fall and hopefully continuing to decline, its reasonable for people whove been inoculated or have a measure of immunity through infection to let their guards down a bit as long as they abide by common-sense COVID guidelines.

The prospect of a time when we can learn to live with the virus like we do other diseases such as the flu is welcome as we near the two-year anniversary of the pandemic striking Summit County. It represents a kind of freedom that weve been largely living without since March 2020.

As weve seen time and again, though, predicting the course of the pandemic is tricky. There are simply too many variables to say with certainty whether we are at a turning point. It felt like we were there in the late spring and summer last year, but then the variants plunged us back into crisis.

The optimism many people are feeling as spring approaches is justified. But another variant could arrive and wash it away.

Are we truly entering a new, less dangerous phase of the pandemic, or even the long-awaited transition to the coronavirus becoming endemic? Or is this merely another brief period of calm before the disease returns with a vengeance?

Its far too early to know. But for the first time in months, a return to normalcy appears close. Heres to hoping it actually arrives.

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Record editorial: A return to normalcy appears close. But the coronavirus has proven unpredictable. - The Park Record

Zia Hellman, a teacher, helps her student, Averie Colvin, 5, at Walter P. Carter Elementary/Middle School in Baltimore.Credit...Rosem Morton for The New York Times

A Maryland legislative committee on Friday approved the State Board of Educations decision to allow all 24 local school districts to decide whether to require face coverings in schools.

The decision, effective immediately, ends an emergency order mandating the masking in schools that had been in effect since the beginning of the school year. Both Gov. Larry Hogan, a Republican, and the state superintendent of schools, Mohammed Choudhury, had lobbied for the decision, which came on the same day that the Centers for Disease Control and Prevention issued new masking guidance that allows many more areas of the country to ease pandemic restrictions.

Other states also announced the easing of some restrictions on Friday, including California, Colorado and Illinois.

The Maryland State Education Association, the union that represents 76,000 teachers and other support staff, had urged caution, asking for the mask mandate to remain in place longer.

The mandate was updated in December to allow local school systems the option to end the mask requirement if the spread of the coronavirus remains moderate or low for two weeks, or if the vaccination rate is higher than 80 percent in the school or community. A few school districts have passed the threshold, and one, Anne Arundel County, met the standards and decided to make masks optional. Face coverings will remain required on school buses.

Cheryl Bost, a fourth- and fifth-grade teacher who serves as the unions president, said in an interview that the system was working well and that school districts were reaching safe levels. She had urged waiting a week or two before removing the state mask mandate.

You must allow districts and families transitional time to make decisions, she said. There are students and educators currently able to take part in in-person instruction because of the mask mandate.

Ms. Bost, who is immunocompromised, said the union wants students and families with higher levels of vulnerability to have increased remote-schooling options. Educators with special medical needs should also have paid sick leave or alternate job placements, she said, and districts should continue to provide masks, testing and contact tracing to keep community transmission rates low.

Fewer than 10 states still require masks in K-12 schools, though federal guidance recommends that people in places with outbreaks, and all students, teachers and school staff members, wear masks regardless of their vaccination status. Connecticut, Delaware, Massachusetts, New Jersey and Oregon, among other states, have announced plans to lift statewide mask requirements in schools, citing the easing of the Omicron surge.

The Centers for Disease Control and Prevention will release new guidelines on Friday for determining when and where people should wear masks, practice social distancing and avoid crowded indoor spaces. According to two federal officials with knowledge of the plans, the guidelines will direct counties to consider three measures to assess risk of the virus: new Covid-related hospital admissions over the previous week, the percentage of hospital beds occupied by Covid patients and new coronavirus cases per 100,000 people over the previous week.

Using the new framework, Maryland is in a great place, Mr. Choudhury, the school superintendent, said Friday afternoon. We cant mask our kids forever. This is a good time to do it.

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Covid-19, Mask Guidance, and Testing News: Live Updates - The New York Times

Family members at a mass crematorium ground in East Delhi, India, in April 2021.Credit...Atul Loke for The New York Times

A new study estimates that at least 5.2 million children around the world lost a parent or other caregiver to Covid-19 in the first 19 months of the pandemic.

Children are suffering immensely now and need our help, said Susan Hillis, a senior researcher at the University of Oxford and a lead author of the study, which was published in the medical journal The Lancet on Thursday.

The study was based on data from 20 countries, including India, the United States and Peru, and was completed by an international research team that included experts from the Centers for Disease Control and Prevention, the World Health Organization and several colleges and universities.

It warns that a child who loses a parent or a caregiver could suffer negative effects including an increased risk of poverty, sexual abuse, mental health challenges and severe stress.

An earlier study, focused on the first 13 months of the pandemic, arrived at an estimate of 1.5 million affected children. The new figure is much higher not just because it adds data for six more months, researchers say, but also because the first estimate was a significant undercount. Using updated figures on Covid-related deaths, the researchers now calculate that at least 2.7 million children lost a parent or caregiver during the first 13 months.

The new study covers data through October 2021, and does not include the latest surge in cases from the Omicron variant, which have undoubtedly added to the toll.

It took 10 years for five million children to be orphaned by H.I.V./AIDS, whereas the same number of children have been orphaned by Covid-19 in just two years, Lorraine Sherr, a professor of psychology at University College London and an author of the study, said in a statement.

Davyon Johnson, 11, from Muskogee, Okla., is one of the millions of children to have lost a parent in his case, his father, Willie James Logan, who died two days after being hospitalized with Covid in August 2021.

Its been a rocky road, Ill say it like that, Davyons mother, LaToya Johnson, said in an interview.

Davyon has dealt with the grief as best as he can, she said. His grades are still strong. Hes still eager to see friends. Still, there are days when they are both exhausted.

Up and down up and down, Ms. Johnson said of their emotions. Its him wanting to call his daddy and not being able to.

Darcey Merritt, a professor of child welfare at New York University who was not involved in the study, said the deaths of parents and caregivers would have a long, far-reaching impact on children, especially those in lower-income households.

Children of color in the United States, she added, are particularly at risk of negative consequences.

A study in the journal Pediatrics last year found that in the United States, one in every 168 American Indian or Alaska Native children, one in every 310 Black children, one in every 412 Hispanic children, and one in every 612 Asian children had lost a caregiver, compared with one in 753 white children.

The study in The Lancet found that two out of three children orphaned are between 10 and 17, and a majority of the children who lost a parent lost their father.

Juliette Unwin, a lead author of the study from Imperial College London, said in a statement that as the researchers receive more data, they expected the figures to grow 10 times higher than what is currently being reported.

The pandemic is still raging worldwide, Dr. Unwin said, which means Covid-19-related orphanhood will also continue to surge.

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Covid News: Several Parts of U.S. Ease Mask Rules - The New York Times

Sir Patrick Vallance, the governments chief scientific adviser, and Sir Chris Whitty, Englands chief medical officer, became household names after they were propelled into the spotlight by the Covid pandemic. For the past two years, they have flanked Boris Johnson at Downing Street briefings armed with PowerPoint slides and exponential curves. But with the announcement this week of Englands plan for living with Covid the advisers are expected to take a step back. Here are some of their most memorable moments.

Early in the coronavirus pandemic, Sir Patrick Vallance suggested that building herd immunity in the UK through widespread transmission could be the UKs strategy for handling the pandemic.

On 13 March 2020, Sir Patrick Vallance, speaking to the BBCs Today show, said the key things the UK needed to do was to fight the pandemic was to build up some degree of herd immunity, saying that because the vast majority of people with coronavirus get a mild illness, herd immunity would mean that more people are immune to the virus and transmission would be reduced.

The concept of building herd immunity through exposure prompted backlash and was criticised by figures such as former health secretary Jeremy Hunt.

Speaking to the health select committee on the 17 March 2020, Sir Patrick Vallance stated that if the number of coronavirus deaths reached 20,000 or below, that would be a good outcome, although it would still be horrible and an enormous number of deaths.

Of course, the UKs total coronavirus death toll greatly surpassed this prediction. As of 25 February 2022, there were a total of 161,104 deaths recorded within 28 days of a positive test.

Amid the controversy over Dominic Cummingss journey to Durham during lockdown, Whitty and Vallance were asked whether they were entirely comfortable with the prime minister telling you you cant answer questions about Dominic Cummings.

In response, Chris Whitty said: I can assure you, the desire not to get pulled into politics is far stronger on the part of Sir Patrick [Vallance] and me than it is on the prime minister.

Vallance added: Im a civil servant, Im politically neutral and I dont want to get involved in politics at all.

On 10 June 2020, When looking at specific ways the UK could have improved their response to the coronavirus pandemic when it first emerged, Whitty said that if he had to choose one issue, it would be looking at how we could speed up testing early on in the epidemic.

There are many good reasons why it was tricky, but if I was to play things again, and this is largely based on what some other countries were able to do, in particular Germany, I think thats the one thing we would have put more emphasis on at an earlier stage.

In April 2020, the UKs daily coronavirus testing rate had only just passed 10,000.

In June 2021, a video was widely shared on social media of a man putting Whitty in a headlock when he declined to be in a photograph with him.

Whitty later said that he did not think anything of it and was surprised that the media picked up on it.

Im sure he will become a model citizen in due course, he added.

Both Lewis Hughes and Jonathan Chew, who were both involved in the incident and appeared in the video, were prosecuted.

Jonathan Chew was sentenced to eight weeks in prison in January after admitting harassment of Whitty on 29 June 2021.

Lewis Hughes, who was sacked from his job as an estate agent after the incident, received a suspended sentence last July for his involvement.

Asked about claims by the rapper Nicki Minaj that the coronavirus vaccine could make you impotent, Whitty said that people who know they are peddling untruths should be ashamed.

He said: There are a group of people who have strange beliefs, and thats fine but there are also people who go round trying to discourage other people from taking a vaccine which could be life saving.

And many of those people, I regret to say, know that they are peddling untruths, and still do it. And in my view, they should be ashamed.

In December last year, as the Omicron wave started taking off, Whitty said that people should prioritise what matters, and that by definition means de-prioritising other things.

I think I would recommend that, and most people would recommend that, and you dont need a medical degree to realise that is a sensible thing to do with an incredibly infectious virus.

At the time of Whittys comments, Independent Sage published a statement calling for an emergency circuit break lockdown given the rise of the Omicron variant, with numbers of infections doubling in England every two days.

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PowerPoint slides and exponential curves: Vallance and Whittys best bits - The Guardian

(THE CONVERSATION) Thankfully, most people who get COVID19 dont become seriously ill especially those who are vaccinated. But a small fraction do get hospitalized, and a smaller fraction do die. If you are vaccinated and catch the coronavirus, what are your chances of getting hospitalized or dying?

Asan epidemiologist, I have been asked to respond to this question in one form or another throughout the pandemic. This is a very reasonable question to ask, but a challenging one to answer.

To calculate the risk of hospitalization or death after getting infected with SARS-CoV-2 you need to know the total number of infections. The problem is that nobody knows exactly how many people have been infected by the coronavirus. So while it is very hard to estimate the true risk of dying if you are vaccinated and come down with COVID-19, there are some ways to better understand the risks.

Counting infections

The first thing to consider when thinking about risk is that the data has to be fresh. Each new variant has its own characteristics that change the risk it poses to those it infects. Omicron came on quickly and seems to be leaving quickly, so there has been little time for researchers or health officials to collect and publish data that can be used to estimate the risk of hospitalization or death.

If you have enough good data, it would be possible to calculate the risk of hospitalization or death. You would need to count the number of people who were hospitalized or died and divide that number by the total number of infections. Its also important to take into account time delays between infection, hospitalization and death. Doing this calculation would give you the true infection hospitalization or fatality rate. The trouble is health officialsdont know with certainty how many people have been infected.

The omicron variant is incredibly infectious, but therisk of it causing significant illness is much lowercompared to previous strains. Its great that omicron is less severe, but that may lead to fewer people seeking tests if they are infected.

Further complicating things is the widespread availability of at-home test kits. Recentdata from New York Citysuggests that 55% of the population had ordered these and that about a quarter of individuals who tested positive during the omicron surge used a home test. Many people who use home tests report their results,but many do not.

Finally, some people who do get symptoms simply may not get tested because they cant readily access testing resources, or they dont see a benefit in doing so.

When you combine all these factors, the result is that the official, reported count of coronavirus cases in the U.S. isfar lower than the actual number.

Estimating cases

Since the beginning of the pandemic, epidemiologists have been working on ways to estimate the true number of infections. There are a few ways to do this.

Researchers have previously usedantibody tests resultsfrom large populations to estimate the prevalence of the virus. This type of testing takes time to organize, and as of late February 2022, it doesnt appear that anyone has done this for omicron.

Another way to estimate cases is to rely onmathematical models. Researchers have used these models to make estimates oftotal case numbersand also forinfection fatality rates. But the models dont distinguish between estimated infections of vaccinated and unvaccinated individuals.

Research has shown time and again that vaccinationgreatly reduces ones risk of serious illness or death. This means that calculating the risk of death is only really useful if you can distinguish by vaccination status, and existing models dont enable this.

Whats known and what to do?

Without a good estimate of total cases by vaccination status, the best data available is known cases, hospitalizations and deaths. While this limited information doesnt allow researchers to calculate the absolute risk an individual faces, it is possible to compare the risk between vaccinated and unvaccinated people.

The mostrecent data from the Centers for Disease Control and Preventionshows that hospitalization rates are 16 times higher in unvaccinated adults compared to fully vaccinated ones, andrates of death are 14 times higher.

What is there to take away from all this? Most importantly,vaccination greatly reduces the riskof hospitalization and death by many times.

But perhaps a second lesson is that the risks of hospitalization or death are much more complicated to understand and study than you might have thought and the same goes for deciding how to react to those risks.

I look at the numbers and feel confident in the ability of my COVID-19 vaccination and booster to protect me from severe disease. I also choose to wear a high-quality mask when Im indoors with lots of people to lessen my own risk even further and to protect those who may be unable to get vaccinated.

There have been many lessons learned from this pandemic, and there are many things researchers and the public still need to do better. It turns out that studying and talking about risk is one of them.

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If I am vaccinated and get COVID-19, what are my chances of dying? The answer is surprisingly hard to find - KRQE News 13

Last June, as the Delta variant sat poised to take the globe by storm, Pfizers CEO, Albert Bourla, promised the world speed. Should an ultra-mutated version of SARS-CoV-2 sprout, he said, his company could have a variant-specific shot ready for rollout in about 100 daysa pledge he echoed in November when Omicron reared its head.

Now, with the 100-day finish line fast approaching and no clinical-trial data in sight, the company seems unlikely to meet its mark. (I asked Pfizer about this super-speedster timeline; when we have the data analyzed, we will share an update, the company responded.) Moderna, which started brewing up an Omicron vaccine around the same time, is eyeing late summer for its own debut.

Not that an Omicron vaccine would necessarily make a huge difference, even if Pfizer had made good. In many parts of the world, the variants record-breaking wave is receding. Having a bespoke vaccine in 100 days would have been an unprecedented accomplishment, but Omicron was simply too fast for a cooked-to-order shot to beat it, says Soumya Swaminathan, the chief scientist at the World Health Organization. This time, all things considered, we got lucky: Our original-recipe vaccines still work quite well against the variant, especially when theyre delivered as a trio of jabsenough that some researchers have wondered whether well ever need the elusive Omivax.

But Omicron wont be the last antibody-dodging variant that splinters off of the SARS-CoV-2 treewhich means the vaccines, too, will need to keep coming. Tough decisions are ahead about what triggers might prompt a whole new variant-specific vaccine campaign, and how well manage the shift in time. That said, we dont have to resign ourselves to a bleak future of infinite catch-up, with shots always lagging strains. Vaccine updates might not be that necessary that often, and when they are, we can poise ourselves to rapidly react. Rather than scrambling to sprint after SARS-CoV-2 every time it surprises us, we could watch the virus more closely, and use the intel we gather to act more deliberately.

To vaccinate properly against a variant, we must first detect it. That means keeping tabs on the coronavirus and rooting out the places where it likes to hide and transform.

Flu presents an excellent template for this sort of viral voyeurism. The viruses that cause that disease also shape-shift frequently enough to elude the immune systems grasp. For decades, scientists have been maintaining a massive, global surveillance network, now made of some 150 laboratories, that each year amasses millions of samples from sick people and susses out the genetic sequences of the viruses that linger within. That information then goes to the WHO, which convenes two meetings each yearone per hemisphereto decide which strains should be included in next winters vaccine.

A watchdog system for SARS-CoV-2 could piggyback off of flus. The symptoms of the two diseases overlap; hospitals are already collecting those samples, says Richard Webby, the director of the WHO Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds. Youd just test them for two agents now. Scientists could scour coronavirus genomes for little red flagsbig-deal changes in the spike protein, say, that might befuddle antibodiesthen shuttle the most worrisome morphs to a high-security lab, where they could be pitted directly against immune molecules and cells. Based on flus model, ideal candidates for a vaccine revision might meet three criteria: Theyre riddled with unusual mutations; theyre recognized poorly by antibodies; and theyre spreading at least somewhat rapidly from one person to the next. A variant so heavily modified that it overcomes our immunity enough to make even healthy, vaccinated people quite sick would make the clearest-cut case for editing a shots recipe, Swaminathan told me.

Read: The coronavirus will surprise us again

In September, the WHO formed a new technical advisory group thats been tasked with recommending ingredient adjustments to COVID vaccines as needed; Swaminathan envisions the committee operating parallel to one that calls the shots for flu. But over time, the conditions that demand we take quick action for COVID vaccines might not arise all that often. At least some coronaviruses are thought to metamorphose more slowly and less dramatically than flu viruses, once they settle into a population, which could mean a less frantic variant pummel than what weve experienced so far. Some experts also hope that as the world continues to rack up infections and vaccinations, our immunity against this new coronavirus will hold better. Our defenses against flu have always been a bit brittlevaccine effectiveness for these shots doesnt start terribly high, then drops rather rapidly. If our shields against SARS-CoV-2 are more stalwart, and the virus genetically quiets, perhaps we will need to rejigger COVID vaccines less often than we do for flu.

Even against Omicron, the most heavily altered variant of concern identified to date, vaccine protection against severe disease seems extraordinarily sturdy. I dont think the entire population is going to need annual vaccines, Swaminathan told me. (The important exceptions, she noted, might be vulnerable populations, among them immunocompromised people and older individuals.) And when we do need vaccine revamps, the blistering speed at which mRNA shots can be switched up will be an advantage. Because most flu vaccines need about six months to slog through the production pipeline, vaccine strains are selected at the end of winter and injected into arms the next fall. That leaves a gap for the viruses to morph even more. mRNA shots like Pfizers and Modernas, meanwhile, couldOmicron saga notwithstandingzing from conception to distribution in about half the time, and eliminate a good chunk of the guesswork.

Some parts of this relatively rosy future may not come to passor at least, they could be a long way off. We just dont understand SARS-CoV-2 as well as we do flu viruses. In most of the world, flu viruses tend to wax in the winter, then wane in the warmer months, giving us a sense of the optimal time to roll out vaccines. And flu evolution occurs in a linear, ladderlike fashion; last years major strains tend to beget this years major strains. That makes it reasonably straightforward to predict the direction that flu viruses are going in and design our vaccines accordingly, says Emma Hodcroft, a molecular epidemiologist at the University of Bern.

The evolution of SARS-CoV-2, meanwhile, so far looks more radial, Webby told me, with new variants erupting out of old lineages rather than reliably riffing on dominant ones. Omicron, for instance, wasnt an offshoot of Delta. If we saw ladderlike evolution, we would know we need an Omicron vaccine now, Florian Krammer, a flu-virus expert at the Icahn School of Medicine at Mount Sinai, told me. Thats not what we have seen. The coronavirus has also so far been serving up new variants at an absolutely staggering clipfar faster than virologists expected it to at the pandemics startand scientists are unsure whether that churn will stop.

The coronavirus may eventually settle into more flu-like patternstrending its evolution to be more stepwise than starburst, or sticking to winter wavesas population immunity grows and it learns to better coexist with us. Host defenses, when theyre strong and abundant enough, have a way of constraining which paths a virus can take; perhaps they will slow the speed at which new variants arise and take over. The hope is that we head toward seasonality and stability, Helen Chu, a flu-vaccine researcher at the University of Washington, told me.

But theres no telling how long that transition will take, or how bumpy it will be, or if it will occur at all. Chu also worries that we dont yet have the proper infrastructure to pinpoint variants that gain steam in places where they can mutate unusually quickly: people with weakened immune systems, perhaps, or animals that can contract the pathogen and boomerang it back. (Similar events for flu, wherein other species pass a foreign version of the virus to us, can cause pandemics.) SARS-CoV-2 is unlikely to prefer exactly the same real estate that flu viruses do, and so our surveillance strategies will need to look different too. Even flu monitoring has notable holes: It still lags, for instance, in low-resourced parts of the globe. We need eyes and ears everywhere, Swaminathan told me.

For at least the short term, our COVID-vaccine-update process is likely to remain a bit plodding; variants will crop up, and our shots will pursue them. Even late-arriving shot rewrites arent necessarily useless, Hodcroft pointed out. Say our next variant is an Omicron descendant; dosing people up with Omivax could still prep the body for whats up ahead, even if the shot arrives too late to prevent past surges. That said, well also have to be careful about going all in on Omicron; several experts recently warned me that its probably premature to totally trash our original-recipe shots. If we went straight for an Omicron vaccine and stopped the others, that could potentially open up an immunity gap for the ancestral strains to mutate, and their descendants to roar back, says Cheryl Cohen, a member of the WHOs technical advisory group on COVID-19 vaccines and an epidemiologist at the National Institute for Communicable Diseases, in South Africa.

Read: Should we go all in on Omicron vaccines?

The pitfalls of pivoting from one spike version to the next are part of why this whack-a-mole approach of chasing single variants must end, says Raina MacIntyre, a member of the WHOs technical advisory group on COVID-19 vaccines and a biosecurity expert at the University of New South Wales, in Australia. Ideally, future vaccines should protect, with a single injection, against multiple variants at once. An easy first step would be to combine multiple spikes into one shotan Omicron-original combo, say, or an Omicron-Delta-original triple threat. Eventually, we might hit upon a universal formula that guards against all variants, including ones we dont know about yet, Hodcroft said. If the flus any indication, that could be an enormous challenge: Even after many years of study, weve struggled to find a catch-all shot for that disease. With SARS-CoV-2, we dont yet have a strong enough sense of all the evolutionary paths the virus could take; we may not be able to execute a wider-range shot until we understand our enemy better. Still, with so many efforts in the vaccine pipeline, Swaminathan is optimistic. I am fairly confident it is scientifically feasible, she said. It is no longer, Can we do it? It is, We can.

Link:

How Often Will We Need to Update COVID Vaccines? - The Atlantic