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‘Odds are, people are going to get sick this year,’”

In typical years, flu hospitalizes an estimated 140,000 to 710,000 people in the United States alone; some years, RSV can add on some 200,000 more. “Our baseline has never been great,” Yvonne Maldonado, a pediatrician at Stanford, told me. “Tens of thousands of people die every year.”

this time of year, on top of RSV, flu, and COVID, we also have to contend with a maelstrom of other airway viruses—among them, rhinoviruses, parainfluenza viruses, human metapneumovirus, and common-cold coronaviruses.

Illnesses not severe enough to land someone in the hospital could still leave them stuck at home for days or weeks on end, recovering or caring for sick kids—or shuffling back to work

“This is a more serious pathogen that is also more infectious,” Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me. In the past year, COVID-19 has killed some 80,000 Americans—a lighter toll than in the three years prior, but one that still dwarfs that of the worst flu seasons in the past decade.

Globally, the only infectious killer that rivals it in annual-death count is tuberculosis

Rivers also pointed to CDC data that track trends in deaths caused by pneumonia, flu, and COVID-19. Even when SARS-CoV-2 has been at its most muted, Rivers said, more people have been dying—especially during the cooler months—than they were at the pre-pandemic baseline.

This year, for the first time, millions of Americans have access to three lifesaving respiratory-virus vaccines, against flu, COVID, and RSV. Uptake for all three remains sleepy and halting; even the flu shot, the most established, is not performing above its pre-pandemic baseline.

COVID could now surge in the summer, shading into RSV’s autumn rise, before adding to flu’s winter burden, potentially dragging the misery out into spring. “Based on what I know right now, I am considering the season to be longer,” Rivers said.

barring further gargantuan leaps in viral evolution, the disease will continue to slowly mellow out in severity as our collective defenses build; the virus may also pose less of a transmission risk as the period during which people are infectious contracts

even if the dangers of COVID-19 are lilting toward an asymptote, experts still can’t say for sure where that asymptote might be relative to other diseases such as the flu—or how long it might take for the population to get there.

it seems extraordinarily unlikely to ever disappear. For the foreseeable future, “pretty much all years going forward are going to be worse than what we’ve been used to before,”

although a core contingent of Americans might still be more cautious than they were before the pandemic’s start—masking in public, testing before gathering, minding indoor air quality, avoiding others whenever they’re feeling sick—much of the country has readily returned to the pre-COVID mindset.

When I asked Hanage what precautions worthy of a respiratory disease with a death count roughly twice that of flu’s would look like, he rattled off a familiar list: better access to and uptake of vaccines and antivirals, with the vulnerable prioritized; improved surveillance systems to offer  people at high risk a better sense of local-transmission trends; improved access to tests and paid sick leave

Without those changes, excess disease and death will continue, and “we’re saying we’re going to absorb that into our daily lives,” he said.

And that is what is happening.

last year, a CDC survey found that more than 3 percent of American adults were suffering from long COVID—millions of people in the United States alone.

“We get used to things we could probably fix.” The years since COVID arrived set a horrific precedent of death and disease; after that, this season of n+1 sickness might feel like a reprieve. But compare it with a pre-COVID world, and it looks objectively worse. We’re heading toward a new baseline, but it will still have quite a bit in common with the old one: We’re likely to accept it, and all of its horrors, as a matter of course.

Covid deaths, though always concentrated in older people, have in 2022 skewed toward older people more than they did at any point since vaccines became widely available.

That swing in the pandemic has intensified pressure on the Biden administration to protect older Americans, with health officials in recent weeks encouraging everyone 50 and older to get a second booster and introducing new models of distributing antiviral pills.

But the mortality gap between older and younger people has grown: Middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are now benefiting from new stores of immune protection in the population as Covid deaths once again cluster around older people.

among people 65 and older, 13 percent are unvaccinated, 3 percent have a single Moderna or Pfizer shot and another 14 percent are vaccinated but not boosted.

“The government wasn’t sure about the booster shot,” he said. “If they weren’t sure about it, and they’re the ones who put it out, why would I take it?” Mr. Thomas said Covid recently killed a former boss of his and hospitalized an older family friend.

But scientists warned that many older Americans remained susceptible. To protect them, geriatricians called on nursing homes to organize in-home vaccinations or mandate additional shots.

That changed last summer and fall, during the Delta surge. Older people were getting vaccinated more quickly than other groups: By November, the vaccination rate in Americans 65 and older was roughly 20 percentage points higher than that of those in their 40s. And critically, those older Americans had received vaccines relatively recently, leaving them with strong levels of residual protection.

As a result, older people suffered from Covid at lower rates than they had been before vaccines became available. Among people 85 and older, the death rate last fall was roughly 75 percent lower than it had been in the winter of 2020, Dr. Stokes’s recent study found.

The rebalancing of Covid deaths was so pronounced that, among Americans 80 and older, overall deaths returned to prepandemic levels in 2021, according to a study posted online in February.

“In 2021, you see the mortality impact of the pandemic shift younger,” said Ridhi Kashyap, a lead author of that study and a demographer at the University of Oxford.

For some people, even three vaccine doses appear to become less protective over time against Omicron-related hospital admissions.

During the Omicron wave, Covid death rates were once again dramatically higher for older Americans than younger ones, Dr. Stokes said. Older people also made up an overwhelming share of the excess deaths — the difference between the number of people who actually died and the number who would have been expected to die if the pandemic had never happened.

Long-ago Covid cases do not prevent future infections, but reinfected people are less likely to become seriously ill.

Eventually, her family had to arrange a trip to a pharmacy on their own for a second booster.“It just seems that now the onus is put completely on the individual,” she said. “It’s not like it’s made easy for you.”

State media suggest that the opening ceremony is unlikely to be such a full-throated celebration of China’s greatness as was seen at the launch of the games in 2008, when thousands of costumed troops took part in grandiose performances.

No foreign visitors, other than invited guests, have been let into China to watch the games. Tickets are not being sold to people in the country. Fearful of recent outbreaks of covid-19, the government says it will “organise” people to attend.

They may clap, but not shout. The athletes, their support staff and journalists are being kept in a “closed loop”, isolated from the local community. Dozens of them are testing positive.

Protections make sense when admitting 30,000 foreigners into a country that lacks a highly effective vaccine (because it has not approved foreign jabs), and whose population has acquired no immunity from infections.

it is palpable: what happens in the UK and Europe doesn’t stay in the UK and Europe.

In the past couple of weeks, the UK and several countries in Europe, including Germany, France and Switzerland, are experiencing a new wave.

This is the sixth warning from the UK and Europe to the United States.

Wastewater surveillance is relatively sparse in the United States, but 15% of the 410 sites where it was conducted between 24 February to 10 March 2022 showed a greater than 1000% increase compared with the prior 15-day period

the BA.2 variant is gaining steam in the United States and is now accounting for more than 30% of new cases.

Rather than focusing on what precisely is driving the new wave, the imperative is to drive some preventive action.

As with the first five warnings from the UK and Europe, the United States did not take heed. Instead of proactively gearing up with non-pharmaceutical interventions (masks, quality of masks, distancing, air filtration, ventilation, aggressive testing, etc.), it just reacted to the surges when they were manifest.

Now we are at a point with very low vaccination and booster rates, only 64% of the populations has had two shots, and 29% three shots. That puts the United States at 65th and 70th in the world ranking of countries, respectively.

Not only is there a gaping hole in our immunity wall, but the $58bn budget of the American Pandemic Prepared Plan (AP3) advanced by the White House to comprehensively address the deficiencies was gutted by the Senate, reduced to $2bn, now threatening to cancel the order of more than 9.2m Paxlovid pills, the Test-to Treat program announced at the State of the Union address, along with better data, wastewater surveillance, efforts to develop a pan-coronavirus vaccine, research on long Covid, and many other critical public health measures.

We haven’t even seen a new, major variant yet, but there are too many reasons to believe that is likely in the months ahead, owing to extensive animal reservoirs and documented cases of spillover to humans, a large number of immunocompromised people in whom the virus can undergo accelerated evolution, rare but increasingly seen co-infections, and lack of containment of the virus globally.

Unfortunately, we have a mindset that the pandemic is over, which couldn’t be further than the truth

dd to all this is what is happening in China, which has fully relied on a zero-Covid policy, resulting in very little natural immunity, and vaccines that have weak efficacy against Omicron

One of the first questions experts asked me was whether my family was vaccinated. Yes, I said: My husband and I are vaccinated and boosted, and our kids are vaccinated but not yet boosted. This is a relevant question because, if you’re exposed to the virus that causes Covid-19, “your immune system kicks into action a lot faster if you’re vaccinated versus not vaccinated,”

First, the swift immune reaction slows the rate of viral reproduction and spread. “This is what the vaccines are there for — to educate your immune system so that it gets a jump on the invaders before they are able to replicate out of control,”

Because the virus doesn’t replicate as quickly in vaccinated people, they may be less likely to test positive for Covid-19 after coronavirus exposure, because their immune system “keeps the viral load below the level of detection,”

It’s possible, then, that my husband and son did catch Covid-19, but their vaccinated immune systems fended off the infection so well that they never had enough viral proteins in their nose or throat to test positive. And their continual negative tests probably meant that they were never that contagious

If my husband and son never tested positive, why did they feel sick? Even if a vaccinated person doesn’t have much virus in their body, they can still have powerful Covid symptoms

That’s because many illness symptoms — fever, malaise, runny nose, fatigue — are actually caused by the immune system’s response to the virus, rather than the virus itself

And as for why I felt fine, Dr. Morrison said that perhaps my immune system fought off the incoming virus so quickly that I didn’t even have a chance to feel sick. “It sounds to me like you were definitely exposed,”

maybe I had high levels of vaccine antibodies or immune cells called T cells that were able to kill the invading virus before it had a chance to alert the parts of my immune system that would incite symptoms.

All this said, nobody really knows what happened to me, my son or my husband. When it comes to understanding how Covid-19 affects the body, “there are so many open questions,”

people can have different experiences for many different reasons. For instance, Dr. Andino said, it’s possible that the virus was replicating in parts of my husband’s or my son’s body that the tests didn’t reach

Research suggests that the coronavirus can replicate in the pancreas, heart, brain, kidneys and other organs, although vaccination may reduce the chance that the virus spreads outside the respiratory system.

Dr. Andino said that he and his colleagues have been conducting studies in which they follow and repeatedly test entire households after one person in the home tests positive for Covid-19. “What we see is exactly what you described — that some people in the household don’t test positive,”

The COVID vaccines are, without exaggeration, among the safest and most effective therapies in all of modern medicine. An unvaccinated adult is an astonishing 68 times more likely to die from COVID than a boosted one

Yet widespread vaccine hesitancy in the United States has caused more than 163,000 preventable deaths and counting

Even in absolute numbers, America’s unvaccinated and current-smoker populations seem to match up rather well: Right now, the CDC pegs them at 13 percent and 14 percent of all U.S. adults, respectively, and both groups are likely to be poorer and less educated.

Countries such as Denmark and Sweden have already declared themselves broken up with COVID. They are confidently doing so not because the virus is no longer circulating or because they’ve achieved mythical herd immunity from natural infection; they’ve simply inoculated enough people.

data suggest that most of the unvaccinated hold that status voluntarily at this point

The same arguments apply to tobacco: Smokers are 15 to 30 times more likely to develop lung cancer. Quitting the habit is akin to receiving a staggeringly powerful medicine, one that wipes out most of this excess risk.

If everyone who is eligible were triply vaccinated, our health-care system would be functioning normally again.

With a vaccination timeline that stretches over years, our patience for restrictions, especially on the already vaccinated, will be very limited. But there is middle ground. We haven’t banned tobacco outright—in fact, most states protect smokers from job discrimination—but we have embarked on a permanent, society-wide campaign of disincentivizing its use.

We should neither expect that every stubbornly unvaccinated person will get jabbed before next winter nor despair that none of them will ever change their mind. Let’s accept instead that we may make headway slowly, and with considerable effort

Long-term actions for COVID might include charging the unvaccinated a premium on their health insurance, just as we do for smokers, or distributing frightening health warnings about the perils of remaining uninoculated

And once the political furor dies down, COVID shots will probably be added to the lists of required vaccinations for many more schools and workplaces.

nother aspect of where we’re headed with COVID. Tobacco is lethal enough that we are willing to restrict smokers’ personal freedoms—but only to a degree. As deadly as COVID is, some people won’t get vaccinated, no matter what, and both the vaccinated and unvaccinated will spread disease to others.

anti-COVID actions, much like anti-smoking policies, will be limited not by their effectiveness but by the degree to which they are politically palatable.

Without greater vaccination, living with COVID could mean enduring a yearly death toll that is an order of magnitude higher than the one from flu.

this, too, might come to feel like its own sort of ending. Endemic tobacco use causes hundreds of thousands of casualties, year after year after year, while fierce public-health efforts to reduce its toll continue in the background. Yet tobacco doesn’t really feel like a catastrophe for the average person.

Losing a year or two from average life expectancy only bumps us back to where we were in … 2000.

We still care for smokers when they get sick, of course, and we reduce harm whenever possible. The health-care system makes $225 billion every year for doing so—paid out of all of our tax dollars and insurance premiums

Hospitals have a well-honed talent for transforming any terrible situation into a marketable “center of excellence.”

But we shouldn’t forget the most important reason that the coronavirus isn’t like the flu: We’ve never had vaccines this effective in the midst of prior influenza outbreaks, which means we didn’t have a simple, clear approach to saving quite so many lives. Compassionate conversations, community outreach, insurance surcharges, even mandates—I’ll take them all. Now is not the time to quit.

Leaders in the deeply conservative Utah say they need the law to protect women's sports. As cultural shifts raise LGBTQ visibility, the lawmakers argue that, without their intervention, more transgender athletes with apparent physical advantages could eventually dominate the field and change the nature of women's sports.

he team is also partially owned by NBA all-star Dwyane Wade, who has a transgender daughter.

The looming threat of a lawsuit worries school districts and the Utah High School Athletic Association, which has said it lacks the funds to defend the policy in court. Later Friday, lawmakers are expected to change the bill so state money would cover legal fees.

The group Visit Salt Lake, which hosts conferences, shows and events, said the override could cost the state $50 million in lost revenue. The Utah-based DNA-testing genealogy giant Ancestry.com also urged the Legislature to find another way. The American Principles Project is confident that states with bans won't face boycotts like North Carolina did after limiting public restrooms transgender people could use. It focused on legislation in populous, economic juggernaut states like Texas and Florida that would be harder to boycott, Schilling said.

Friday's deliberations came after more than a year of debate and negotiation between social conservatives and LGBTQ advocates. Republican sponsor Rep. Kera Birkeland worked with Cox and civil rights activists at Equality Utah before introducing legislation that would require transgender student-athletes to go before a government-appointed commission.

The proposal, although framed as a compromise, failed to gain traction on either side. LGBTQ advocates took issue with Republican politicians appointing commission members and evaluation criteria that included body measurements such as hip-to-knee ratio.

But the ban won support from a vocal conservative base that has particular sway in Utah's state primary season. Even with primaries looming, however, some Republicans stood with Cox to reject the ban.

Ready for more bad infectious diseases news? There's an outbreak of bird flu making its way into U.S. poultry flocks. If the virus continues to spread, it could affect poultry prices — already higher amid widespread inflation. The price of chicken breasts this week averaged $3.63 per pound at U.S. supermarkets — up from $3.01 a week earlier and $2.42 at this time last year, the Agriculture Department says.

The latest data from the USDA show 59 confirmed sites of avian flu across commercial and backyard flocks in 17 states since the start of the year. That figure includes chickens, turkey and other poultry. The USDA identified a case of avian flu in a wild bird in mid-January, the first detection of the virus in wild birds in the U.S. since 2016. Wild birds can spread the virus to commercial and backyard flocks. By Feb. 9, the virus had been identified in a commercial flock in Indiana.

The last major avian flu outbreak in the U.S. was from December 2014 to June 2015, when more than 50 million chickens and turkeys either died from highly pathogenic avian influenza (HPAI) or were destroyed to stop its spread.

Whether the 2022 avian flu will affect the price of eggs and poultry depends on how widespread it becomes, says Ron Kean, a poultry science expert at the University of Wisconsin-Madison Department of Animal and Dairy Sciences. "In 2015, we did see quite an increase in egg prices," Kean told Wisconsin Public Radio. "The chicken meat wasn't severely affected at that time. We did see quite a loss in turkeys, so turkey prices went up. So, we'll see. If a lot of farms contract this, then we could see some real increases in price."

For producers who suspect their flock may be affected by avian flu, the USDA has a guide to the warning signs, including a sudden increase in bird deaths, lack of energy and appetite, and a decrease in egg production. If a flock is found to be infected by bird flu, the USDA moves quickly — within 24 hours — to assist producers to destroy the flock and prevent the virus from spreading.

A new Virginia state law prohibiting mask mandates in public schools does not apply to 12 students with disabilities whose parents challenged the law, a federal judge has ruled. Last month, the parents of 12 students across Virginia asked the court to halt enforcement of the law, saying it violated their rights under the federal American with Disabilities Act. The law, signed by newly elected Republican Gov. Glenn Youngkin, went into effect March 1; it gives parents a say over whether their children should wear masks in school.

The group of parents have children whose health conditions range from cystic fibrosis to asthma that put them at heightened risk for COVID-19.

The American Civil Liberties Union, which was one of several legal organizations that filed on behalf of the plaintiffs, said the injunction served as a "blueprint."

In a statement, Virginia Attorney General Jason Miyares said the ruling affirms that "parents have the right to make choices for their children."

When Judge Katanji Brown Jackson entered the Senate chamber this week to face questions on her readiness to join the Supreme Court, she did so as the first Black woman in the nation's history to be nominated to that position. For many Black law students and professionals, including a group of 150 who traveled from across the country to watch the historic hearing, Jackson's rise to likely associate justice gives a message of profound hope for what they too might one day be able to accomplish.

Dudley was one of 100 law students selected nationwide to attend a series of events and watch parties for Jackson's nomination, hosted by the progressive organization, Demand Justice. The group also included 50 public defenders — a nod to Jackson's own background in that field. "I see a lot of myself in her. I see a lot of my friends in her, and I wanted to be there to support," Dudley said, calling Jackson "overly qualified to sit on the Supreme Court."

The cohort of legal professionals cheered on Jackson as she faced questions from Republicans about her past cases, particularly those relating to child sex abuse, and on what school of thought she would bring to determining the constitutionality of high-profile cases. Republicans had vowed to oppose President Joe Biden's nominees to the court, and when news of Justice Stephen Breyer's imminent retirement broke, the GOP quickly mobilized to attack potential nominees who might replace the longtime liberal justice on the bench.

Particularly, some sentencing decisions in child pornography cases drew GOP fire. But Jackson's measured responses throughout the three days of questioning solidified the support of many onlookers, who reveled in what it would mean to have a Black woman sit on the bench for the first time in the court's 233-year history. "The fact of the matter is that I'm the father of three black girls, right? And to be able to tell them that finally, someone who is Black — female nonetheless — is finally on the precipice of a mountain that has never been climbed before by any other Black woman, is huge," said Edrius Stagg, a third-year law student at Southern University Law Center in Baton Rouge.

Sen. Joe Manchin of West Virginia — whose break from Democrats on a number of politically fraught votes had worried some as to whether he would support Biden's nominee — announced on Friday he would vote in favor of Jackson's confirmation, all but assuring her path to join the bench.

For some, the optics of seeing Jackson — a Black woman — defend her credentials to a group of largely white, predominantly male detractors, was a familiar scene. It has played out, students said, in workplaces the world over and across the socioeconomic spectrum.

Booker called the attacks on Jackson's record "dangerous" and "disingenuous," noting the complexities of cases that had been boiled down to their basest points in order to damage Jackson's image.

"I'm not gonna let my joy be stolen," he continued. "Because I know, you and I, we appreciate something that we get that a lot of my colleagues don't." And while Jackson's opponents peppered her with politically polarizing questions, her supporters grew even more convinced that Jackson was qualified for the job. "To see her hold her composure and just answer the questions just to the best of her capabilities was just really great to see," said Jasmine McMillion, a third-year law student at Florida Agricultural and Mechanical University College of Law.

Jansen's fascination with medicine began at a young age, thanks to her father's ability to cure her frequent throat infections and coughs. "You're a small person, and you have this violent cough, and you feel sick as a dog," she recalls. "And then you get this drug. And it makes you feel better."

A few years after earning her Ph.D. in 1984, Jansen accepted a job at Merck's vaccine division. Her first challenge was to create a vaccine for the human papillomavirus, which was believed to cause cervical cancer in the 1980s. Jansen faced significant opposition, both from researchers — who thought the vaccine would not work— and Merck's finance gurus — who believed it would not be profitable. But she persisted. The Gardasil vaccine, approved in 2006, now earns Merck billions of dollars annually.

“My first and biggest wish is that we had known early that Covid-19 was airborne,”

, “Once you’ve realized that, it informs an entirely different strategy for protection.” Masking, ventilation and air cleaning become key, as well as avoiding high-risk encounters with strangers, he says.

Instead of washing our produce and wearing hand-sewn cloth masks, we could have made sure to avoid superspreader events and worn more-effective N95 masks or their equivalent. “We could have made more of an effort to develop and distribute N95s to everyone,” says Dr. Volckens. “We could have had an Operation Warp Speed for masks.”

We didn’t realize how important clear, straight talk would be to maintaining public trust. If we had, we could have explained the biological nature of a virus and warned that Covid-19 would change in unpredictable ways.  

In the face of a pandemic, he says, the public needs an early basic and blunt lesson in virology

“The science is really important, but if you don’t get the trust and communication right, it can only take you so far,”

and mutates, and since we’ve never seen this particular virus before, we will need to take unprecedented actions and we will make mistakes, he says.

Since the public wasn’t prepared, “people weren’t able to pivot when the knowledge changed,”

By the time the vaccines became available, public trust had been eroded by myriad contradictory messages—about the usefulness of masks, the ways in which the virus could be spread, and whether the virus would have an end date.

, the absence of a single, trusted source of clear information meant that many people gave up on trying to stay current or dismissed the different points of advice as partisan and untrustworthy.

We didn’t know how difficult it would be to get the basic data needed to make good public-health and medical decisions. If we’d had the data, we could have more effectively allocated scarce resources

For much of the pandemic, doctors, epidemiologists, and state and local governments had no way to find out in real time how many people were contracting Covid-19, getting hospitalized and dying

Doctors didn’t know what medicines worked. Governors and mayors didn’t have the information they needed to know whether to require masks. School officials lacked the information needed to know whether it was safe to open schools.

people didn’t know whether it was OK to visit elderly relatives or go to a dinner party.

just months before the outbreak of the pandemic, the Council of State and Territorial Epidemiologists released a white paper detailing the urgent need to modernize the nation’s public-health system still reliant on manual data collection methods—paper records, phone calls, spreadsheets and faxes.

While the U.K. and Israel were collecting and disseminating Covid case data promptly, in the U.S. the CDC couldn’t. It didn’t have a centralized health-data collection system like those countries did, but rather relied on voluntary reporting by underfunded state and local public-health systems and hospitals.

doctors and scientists say they had to depend on information from Israel, the U.K. and South Africa to understand the nature of new variants and the effectiveness of treatments and vaccines. They relied heavily on private data collection efforts such as a dashboard at Johns Hopkins University’s Coronavirus Resource Center that tallied cases, deaths and vaccine rates globally.

With good data, Dr. Ranney says, she could have better managed staffing and taken steps to alleviate the strain on doctors and nurses by arranging child care for them.

To solve the data problem, Dr. Ranney says, we need to build a public-health system that can collect and disseminate data and acts like an electrical grid. The power company sees a storm coming and lines up repair crews.

If we’d known how damaging lockdowns would be to mental health, physical health and the economy, we could have taken a more strategic approach to closing businesses and keeping people at home.

t many doctors say they were crucial at the start of the pandemic to give doctors and hospitals a chance to figure out how to accommodate and treat the avalanche of very sick patients.

The measures reduced deaths, according to many studies—but at a steep cost.

The lockdowns didn’t have to be so harmful, some scientists say. They could have been more carefully tailored to protect the most vulnerable, such as those in nursing homes and retirement communities, and to minimize widespread disruption.

Lockdowns could, during Covid-19 surges, close places such as bars and restaurants where the virus is most likely to spread, while allowing other businesses to stay open with safety precautions like masking and ventilation in place.  

If England’s March 23, 2020, lockdown had begun one week earlier, the measure would have nearly halved the estimated 48,600 deaths in the first wave of England’s pandemic

If the lockdown had begun a week later, deaths in the same period would have more than doubled

The key isn’t to have the lockdowns last a long time, but that they are deployed earlier,

It is possible to avoid lockdowns altogether. Taiwan, South Korea and Hong Kong—all countries experienced at handling disease outbreaks such as SARS in 2003 and MERS—avoided lockdowns by widespread masking, tracking the spread of the virus through testing and contact tracing and quarantining infected individuals.

Had we known that even a mild case of Covid-19 could result in long Covid and other serious chronic health problems, we might have calculated our own personal risk differently and taken more care.

Early in the pandemic, public-health officials were clear: The people at increased risk for severe Covid-19 illness were older, immunocompromised, had chronic kidney disease, Type 2 diabetes or serious heart conditions

t had the unfortunate effect of giving a false sense of security to people who weren’t in those high-risk categories. Once case rates dropped, vaccines became available and fear of the virus wore off, many people let their guard down, ditching masks, spending time in crowded indoor places.

it has become clear that even people with mild cases of Covid-19 can develop long-term serious and debilitating diseases. Long Covid, whose symptoms include months of persistent fatigue, shortness of breath, muscle aches and brain fog, hasn’t been the virus’s only nasty surprise

In February 2022, a study found that, for at least a year, people who had Covid-19 had a substantially increased risk of heart disease—even people who were younger and had not been hospitalized

respiratory conditions.

Some scientists now suspect that Covid-19 might be capable of affecting nearly every organ system in the body. It may play a role in the activation of dormant viruses and latent autoimmune conditions people didn’t know they had

 A blood test, he says, would tell people if they are at higher risk of long Covid and whether they should have antivirals on hand to take right away should they contract Covid-19.

If the risks of long Covid had been known, would people have reacted differently, especially given the confusion over masks and lockdowns and variants? Perhaps. At the least, many people might not have assumed they were out of the woods just because they didn’t have any of the risk factors.

For every COVID death, many more older people develop serious illness. Risk increases with age, and people older than 70 “have a substantially higher rate of hospitalizations” than those ages 60 to 69,

Where America has landed is hardly a new way of life but rather one that is simply more onerous. “One way to think about it is that this is a new risk that’s out there” alongside other natural causes of death, such as diabetes and heart failure,

The antiviral Paxlovid was supposed to help blunt the wave of old people falling sick and ending up in the hospital—and it can reduce severe disease by 50 to 90 percent. But unfortunately, it is not widely used; as of July, just a third of Americans 80 or older took Paxlovid.

The reality is that as long as the virus continues to be prevalent, older Americans will face these potential outcomes every time they leave their home. That doesn’t mean they will barricade themselves indoors, or that they even should. Still, “every decision that we make now is weighing that balance between risk and socialization,”

Persistent coughs, aches, and joint pain can linger long after serious illness, together with indirect impacts such as loss of muscle strength and flexibility, which can affect older people’s ability to be independent, Rivers said. Older COVID survivors may also have a higher risk of cognitive decline. In some cases, these ailments could be part of long COVID, which may be more prevalent in older people.

Before the pandemic, the association between loneliness and higher mortality rates, increased cardiovascular risks, and dementia among older adults was already well established. Increased isolation during COVID amplified this association.

Even older adults who have weathered the direct and indirect effects of the pandemic still face other challenges that COVID has exacerbated. Many have long relied on personal caregivers or the staff at nursing facilities. These workers, already scarce before the pandemic, are even more so now because many quit or were affected by COVID themselves

“Long-term care has been in a crisis situation for a long time, but it’s even worse now,” Muramatsu said, noting that many home care workers are older adults themselves

Older people won’t have one single approach to contending with this sad reality. “Everybody is trying to figure out what is the best way to function, to try to have some level of everyday life and activity, but also keep your risk of getting sick as low as possible,”

Again, many of these people did not have it great before the pandemic, even if the rest of the country wasn’t paying attention. “We often don’t provide the basic social support that older people need,” Kenneth Covinsky, a clinician-researcher at the UCSF Division of Geriatrics, said. Rather, ageism, the willful ignorance or indifference to the needs of older people, is baked into American life.

It is perhaps the main reason older adults were so badly affected by the pandemic in the first place, as illustrated by the delayed introduction of safety precautions in nursing homes and the blithe acceptance of COVID deaths among older adults. If Americans couldn’t bring themselves to care at any point over the past three years, will they ever?

titled “Tightness-Looseness Across the 50 United States,” the study calculated a catalog of measures for each state, including the incidence of natural disasters, disease prevalence, residents’ levels of openness and conscientiousness, drug and alcohol use, homelessness and incarceration rates.

Gelfand said:Some groups have much stronger norms than others; they’re tight. Others have much weaker norms; they’re loose. Of course, all cultures have areas in which they are tight and loose — but cultures vary in the degree to which they emphasize norms and compliance with them.

states in New England and on the West Coast were the loosest: California, Oregon, Washington, Maine, Massachusetts, Connecticut, New Hampshire and Vermont.

In both 2016 and 2020, Donald Trump carried all 10 of the top “tight” states; Hillary Clinton and Joe Biden carried all 10 of the top “loose” states.

“Rule Makers, Rule Breakers: How Tight and Loose Cultures Wire the World” in 2018, in which she described the results of a 2016 pre-election survey she and two colleagues had commissioned

The results were telling: People who felt the country was facing greater threats desired greater tightness. This desire, in turn, correctly predicted their support for Trump. In fact, desired tightness predicted support for Trump far better than other measures. For example, a desire for tightness predicted a vote for Trump with 44 times more accuracy than other popular measures of authoritarianism.

The 2016 election, Gelfand continued, “turned largely on primal cultural reflexes — ones that had been conditioned not only by cultural forces, but by a candidate who was able to exploit them.”

Along the same lines, if liberals and conservatives hold differing moral visions, not just about what makes a good government but about what makes a good life, what turned the relationship between left and right from competitive to mutually destructive?

Cultural differences, Gelfand continued, “have a certain logic — a rationale that makes good sense,” noting that “cultures that have threats need rules to coordinate to survive (think about how incredibly coordinated Japan is in response to natural disasters).

cultures that don’t have a lot of threat can afford to be more permissive and loose.”

The tight-loose concept, Gelfand argued,is an important framework to understand the rise of President Donald Trump and other leaders in Poland, Hungary, Italy, and France,

The gist is this: when people perceive threat — whether real or imagined, they want strong rules and autocratic leaders to help them survive

My research has found that within minutes of exposing study participants to false information about terrorist incidents, overpopulation, pathogen outbreaks and natural disasters, their minds tightened. They wanted stronger rules and punishments.

The South dominated the tight states: Mississippi, Alabama Arkansas, Oklahoma, Tennessee, Texas, Louisiana, Kentucky, South Carolina and North Carolina

Looseness, Gelfand posits, fosters tolerance, creativity and adaptability, along with such liabilities as social disorder, a lack of coordination and impulsive behavior.

If liberalism and conservatism have historically played a complementary role, each checking the other to constrain extremism, why are the left and right so destructively hostile to each other now, and why is the contemporary political system so polarized?

Gelfand writes that tightness encourages conscientiousness, social order and self-control on the plus side, along with close-mindedness, conventional thinking and cultural inertia on the minus side.

Niemi contended that sensitivity to various types of threat is a key factor in driving differences between the far left and far right.

She cited research thatfound 47 percent of the most extreme conservatives strongly endorsed the view that “The world is becoming a more and more dangerous place,” compared to 19 percent of the most extreme liberals

Conservatives and liberals, Niemi continued,see different things as threats — the nature of the threat and how it happens to stir one’s moral values (and their associated emotions) is a better clue to why liberals and conservatives react differently.

Unlike liberals, conservatives strongly endorse the binding moral values aimed at protecting groups and relationships. They judge transgressions involving personal and national betrayal, disobedience to authority, and disgusting or impure acts such as sexually or spiritually unchaste behavior as morally relevant and wrong.

Underlying these differences are competing sets of liberal and conservative moral priorities, with liberals placing more stress than conservatives on caring, kindness, fairness and rights — known among scholars as “individualizing values

conservatives focus more on loyalty, hierarchy, deference to authority, sanctity and a higher standard of disgust, known as “binding values.”

As a set, Niemi wrote, conservative binding values encompassthe values oriented around group preservation, are associated with judgments, decisions, and interpersonal orientations that sacrifice the welfare of individuals

Just as ecological factors differing from region to region over the globe produced different cultural values, ecological factors differed throughout the U.S. historically and today, producing our regional and state-level dimensions of culture and political patterns.

Niemi cited a paper she and Liane Young, a professor of psychology at Boston College, published in 2016, “When and Why We See Victims as Responsible: The Impact of Ideology on Attitudes Toward Victims,” which tested responses of men and women to descriptions of crimes including sexual assaults and robberies.

We measured moral values associated with unconditionally prohibiting harm (“individualizing values”) versus moral values associated with prohibiting behavior that destabilizes groups and relationships (“binding values”: loyalty, obedience to authority, and purity)

Increased endorsement of binding values predicted increased ratings of victims as contaminated, increased blame and responsibility attributed to victims, increased perceptions of victims’ (versus perpetrators’) behaviors as contributing to the outcome, and decreased focus on perpetrators.

For example, binding values are associated with Machiavellianism (e.g., status-seeking and lying, getting ahead by any means, 2013); victim derogation, blame, and beliefs that victims were causal contributors for a variety of harmful acts (2016, 2020); and a tendency to excuse transgressions of ingroup members with attributions to the situation rather than the person (2023).

What happened to people ecologically affected social-political developments, including the content of the rules people made and how they enforced them

Numerous factors potentially influence the evolution of liberalism and conservatism and other social-cultural differences, including geography, topography, catastrophic events, and subsistence styles

Joshua Hartshorne, who is also a professor of psychology at Boston College, took issue with the binding versus individualizing values theory as an explanation for the tendency of conservatives to blame victims:

I would guess that the reason conservatives are more likely to blame the victim has less to do with binding values and more to do with the just-world bias (the belief that good things happen to good people and bad things happen to bad people, therefore if a bad thing happened to you, you must be a bad person).

Belief in a just world, Hartshorne argued, is crucial for those seeking to protect the status quo:It seems psychologically necessary for anyone who wants to advocate for keeping things the way they are that the haves should keep on having, and the have-nots have got as much as they deserve. I don’t see how you could advocate for such a position while simultaneously viewing yourself as moral (and almost everyone believes that they themselves are moral) without also believing in the just world

Conversely, if you generally believe the world is not just, and you view yourself as a moral person, then you are likely to feel like you have an obligation to change things.

I asked Lene Aaroe, a political scientist at Aarhus University in Denmark, why the contemporary American political system is as polarized as it is now, given that the liberal-conservative schism is longstanding. What has happened to produce such intense hostility between left and right?

There is variation across countries in hostility between left and right. The United States is a particularly polarized case which calls for a contextual explanatio

A central explanation typically offered for the current situation in American politics is that partisanship and political ideology have developed into strong social identities where the mass public is increasingly sorted — along social, partisan, and ideological lines.

I then asked Aaroe why surveys find that conservatives are happier than liberals. “Some research,” she replied, “suggests that experiences of inequality constitute a larger psychological burden to liberals because it is more difficult for liberals to rationalize inequality as a phenomenon with positive consequences.”

Steven Pinker, a professor of psychology at Harvard, elaborated in an email on the link between conservatism and happiness:

t’s a combination of factors. Conservatives are likelier to be married, patriotic, and religious, all of which make people happier

They may be less aggrieved by the status quo, whereas liberals take on society’s problems as part of their own personal burdens. Liberals also place politics closer to their identity and striving for meaning and purpose, which is a recipe for frustration.

Some features of the woke faction of liberalism may make people unhappier: as Jon Haidt and Greg Lukianoff have suggested, wokeism is Cognitive Behavioral Therapy in reverse, urging upon people maladaptive mental habits such as catastrophizing, feeling like a victim of forces beyond one’s control, prioritizing emotions of hurt and anger over rational analysis, and dividing the world into allies and villains.

Why, I asked Pinker, would liberals and conservatives react differently — often very differently — to messages that highlight threat?

It may be liberals (or at least the social-justice wing) who are more sensitive to threats, such as white supremacy, climate change, and patriarchy; who may be likelier to moralize, seeing racism and transphobia in messages that others perceive as neutral; and being likelier to surrender to emotions like “harm” and “hurt.”

The authors used neural imaging to follow changes in the dorsomedial prefrontal cortex (known as DMPFC) as conservatives and liberals watched videos presenting strong positions, left and right, on immigration.

there are ways to persuade conservatives to support liberal initiatives and to persuade liberals to back conservative proposals:

While liberals tend to be more concerned with protecting vulnerable groups from harm and more concerned with equality and social justice than conservatives, conservatives tend to be more concerned with moral issues like group loyalty, respect for authority, purity and religious sanctity than liberals are. Because of these different moral commitments, we find that liberals and conservatives can be persuaded by quite different moral arguments

For example, we find that conservatives are more persuaded by a same-sex marriage appeal articulated in terms of group loyalty and patriotism, rather than equality and social justice.

“political arguments reframed to appeal to the moral values of those holding the opposing political position are typically more effective

We find support for these claims across six studies involving diverse political issues, including same-sex marriage, universal health care, military spending, and adopting English as the nation’s official language.”

In one test of persuadability on the right, Feinberg and Willer assigned some conservatives to read an editorial supporting universal health care as a matter of “fairness (health coverage is a basic human right)” or to read an editorial supporting health care as a matter of “purity (uninsured people means more unclean, infected, and diseased Americans).”

Conservatives who read the purity argument were much more supportive of health care than those who read the fairness case.

Liberals who read the fairness argument were substantially more supportive of military spending than those who read the loyalty and authority argument.

In “Conservative and Liberal Attitudes Drive Polarized Neural Responses to Political Content,” Willer, Yuan Chang Leong of the University of Chicago, Janice Chen of Johns Hopkins and Jamil Zaki of Stanford address the question of how partisan biases are encoded in the brain:

society. How do such biases arise in the brain? We measured the neural activity of participants watching videos related to immigration policy. Despite watching the same videos, conservative and liberal participants exhibited divergent neural responses. This “neural polarization” between groups occurred in a brain area associated with the interpretation of narrative content and intensified in response to language associated with risk, emotion, and morality. Furthermore, polarized neural responses predicted attitude change in response to the videos.

The four authors argue that their “findings suggest that biased processing in the brain drives divergent interpretations of political information and subsequent attitude polarization.” These results, they continue, “shed light on the psychological and neural underpinnings of how identical information is interpreted differently by conservatives and liberals.”

While liberals and conservatives, guided by different sets of moral values, may make agreement on specific policies difficult, that does not necessarily preclude consensus.

or each video,” they write,participants with DMPFC activity time courses more similar to that of conservative-leaning participants became more likely to support the conservative positio

Conversely, those with DMPFC activity time courses more similar to that of liberal-leaning participants became more likely to support the liberal position. These results suggest that divergent interpretations of the same information are associated with increased attitude polarizatio

Together, our findings describe a neural basis for partisan biases in processing political information and their effects on attitude change.

Describing their neuroimaging method, the authors point out that theysearched for evidence of “neural polarization” activity in the brain that diverges between people who hold liberal versus conservative political attitudes. Neural polarization was observed in the dorsomedial prefrontal cortex (DMPFC), a brain region associated with the interpretation of narrative content.

The question is whether the political polarization that we are witnessing now proves to be a core, encoded aspect of the human mind, difficult to overcome — as Leong, Chen, Zaki and Willer sugges

— or whether, with our increased knowledge of the neural basis of partisan and other biases, we will find more effective ways to manage these most dangerous of human predispositions.

On the left, what gets termed “wokeness” is indissociable from self-help. How should we understand superficial, performative expressions of “anti-racism” or preening social-media politics if not as a way for self-described good-hearted liberals to make grand public displays of pruning their moral shrubbery?

We might call this turbocharged version of authenticity culture “therapeutic libertarianism”: the belief that self-improvement is the ultimate goal of life, and that no formal or informal constraints—whether imposed by states, faith systems, or other people—should impede each of us from achieving personal growth

This attitude is therapeutic because it is invariably couched in self-help babble. And it is libertarian not only because it makes a cult out of personal freedom, but because it applies market logic to human beings. We are all our own start-ups. We must all adopt a pro-growth mindset for our personhood and deregulate our desires.

We must all assess and reassess our own “fulfillment,” a kind of psychological Gross Domestic Product, on a near-constant basis. And like the GDP, our fulfillment must always increase.

Among the right, a new kind of reactionary self-help is ascendant. Its mainstream version is legible in the manosphere misogyny of Jordan Peterson, Joe Rogan, and Andrew Tate, while more eldritch currents lurk just beneath the surface. The Nietzscheanism of internet personalities like Bronze Age Pervert—who combines ethnonationalist chauvinism in politics and personal life with a Greco-Roman obsession with physical fitness—is only one of many examples of the trend the social critic Maya Vinokour has called “lifestyle fascism.”

Stewart’s response to the UTIs is not concern for his wife but irritation: “This guy is breaking all my toys,” he grumbles. When she gets upset that her husband keeps calling her a “cunt” and a “whore” during sex—something he professes not being able to help—Stewart does not change this habit. Instead they strike a preposterous bargain: “He will try his best not to scream cunt during sex, and I will do my best to ignore him if he does.”

What the author is trying to find in her open relationship is not sex, but self-understanding—what it means, how we get it, whether sex can provide it. And although the answers Molly arrives at are not cheaply won, they are cheap all the same.

his concept doesn’t quite capture the extent to which this relentless quest for self-optimizing authenticity has infused our social and even political sensibilities.

though Molly may tell herself and her readers that she is on a journey of learning and growth, the ugly truth is that More feels like a 290-page cry for help. Molly does not come off as a woman boldly finding herself, but rather as someone who is vulnerable to psychological manipulation and does not enjoy her open marriage.

if it seems like Molly Roden Winter does not want to be in an open marriage, it is because she often lets us know that she doesn’t want to be in an open marriage.

When a couples therapist asks the pair why they’re in counseling halfway through the book—prompted by a breakdown Molly experiences that stems from their marital arrangement—she explains: “We’re here because I don’t want to be in an open marriage anymore, but Stewart does.”

There are precious few sex scenes where Molly seems to be enjoying herself. When Molly is in the middle of a squirmy threesome she’s been dreading, she literally dissociates from her body, pretending that she is a director staging a scene in which her physical person is merely an actor. Molly describes how she performs her role with “a clinician’s detachment” and leaves the apartment rapidly so as not “to be pulled back into this scene.” After one of her dates repeatedly removes his condom without her consent—an act known as “stealthing,” which is considered a sex crime in a number of countries and the state of California—she contracts a series of urinary tract infections

Near the end of the memoir, the author’s mother provides the empty epiphany toward which the text careens. “Everything that happens in life,” her mom offers, “is an opportunity to learn about yourself. Marriage. Motherhood. Relationships. Even anger and illness. Nothing that happens is good or bad in and of itself. It’s all just an opportunity to learn and grow.” With this maternal revelation, Molly’s “skin starts to tingle.” She relates that the advice “feels almost holy.”

Winter is trapped in her therapeutic worldview, one imposed on her by an American culture that has made narcissism into not simply a virtue, but a quasi-religion that turns external obstacles into opportunities for internal self-improvement.

These obstacles include, in her case, profound gender inequality relating to Molly’s life as a parent to two sons, and a troubling family history. Molly’s mother joined a cult—and indoctrinated the author into it as a child—at the urging of a male partner in her own open marriage. The book makes tacit comparisons between Molly’s mother’s initiation into a cult at the behest of an extramarital partner, and Molly’s own initiation into an open marriage at the behest of her husband.

throughout More, the dominant emotion Molly reports is not lust but rage—primarily at the deeply unequal child-care burdens that are placed upon her. “I think about all the years I’ve spent my night alone with the kids—the dinners, the bedtimes, the dishes, the loneliness of doing it all by myself—because Stew had to work,” she laments at one point. That Stewart is now spending late nights not working (if he ever was) but rather schtupping his endless reserve of mistresses pushes Molly further to the brink: “I feel my jealousy mingle with the resentment I’ve kept at bay for years,”

Molly doubles down on her quest for self-actualization through the relentless pursuit of bitter novelty: new sexual experiences that she rarely seems to enjoy, new partners who rarely treat her kindly.

The only solution Molly can imagine is to persist in an open marriage, rather than push for an equal one. Inward sexual revolution plainly feels more possible than a revolution in who does the dishes.

The big question, then, is how do you bring about widespread, deep-seated cultural change within the organs of government and institutions connected to it?

Can you legislate to change a culture?

Sir Brian Langstaff, the report author, thinks you might be able to – or at least make a start.

He suggests there should be a so-called duty of candour demanded in law for civil servants and others.It would then become a legal obligation to speak up, rather than a cultural expectation to shut up.Whistleblowing would be mandatory.But will it happen, and will it make any difference?