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Study: You Should Take Blood Pressure in Both Arms

Laura Williamson wrote . . . . . . . . .

Taking blood pressure readings from both arms and using the higher reading would more accurately capture who has high blood pressure – and is at increased risk for cardiovascular disease and death – than relying on readings from a single arm, new research suggests.

While current recommendations call for using the higher arm reading, there was previously no evidence in the scientific literature to support the practice, which isn’t routinely followed, according to the study. The findings appeared this week in the American Heart Association journal Hypertension.

“If you are only doing one arm, you can’t know which is the higher-reading arm,” said lead study author Christopher Clark, a clinical senior lecturer in primary care at the University of Exeter Medical School in Devon, England. “And if you don’t catch high blood pressure, you can’t treat it. We can now support the adoption of using the higher reading from both arms.”

Nearly half of U.S. adults have high blood pressure, also known as hypertension. Blood pressure is considered high if the systolic reading – the top number – is 130 mmHg or more, or the diastolic reading – the bottom number – is 80 mmHg or more. High blood pressure is a risk factor for heart disease, heart attacks and strokes.

In a 2019 scientific statement detailing proper blood pressure measurement, the AHA recommended taking readings from both arms during an initial patient visit and using the arm with the higher reading for measurements at subsequent visits. The statement also called for making sure to use the proper cuff size based on the patient’s arm circumference, among other guidance.

In the new study, researchers analyzed medical data for 53,172 adults from 23 studies in countries around the world. Participants were an average of 60 years old.

They found using the lower arm’s reading, compared with the reading from the higher arm, resulted in 12% of people who had hypertension falling below thresholds for diagnosis or treatment of the condition.

Because hypertension also is used to help calculate a person’s risk for cardiovascular disease, missing a diagnosis of high blood pressure can have serious consequences, the authors noted.

Using the higher arm reading, compared with the lower one, researchers reclassified 3.5% of participants – or 645 more people – as at-risk for cardiovascular disease using the risk score developed by the AHA and American College of Cardiology. The researchers reclassified 4.6% of participants – or more than 1,000 extra people – as at-risk for coronary heart disease based on another model, the Framingham risk score, which is used to predict the risk of developing heart disease in people with no symptoms.

For both risk scores, using the higher arm readings better predicted cardiovascular illness.

According to the Centers for Disease Control and Prevention, high blood pressure was the primary or contributing cause of more than 670,000 deaths in the U.S. in 2020.

High or poorly controlled blood pressure is a major cause of premature death and cardiovascular events globally, “so we’re dealing with something that’s really very common here,” Clark said.

For people whose blood pressure is being monitored at home with an ambulatory device, the monitor should be attached to the arm with the highest reading, he said. And those who self-monitor should check both arms to see which arm is consistently higher and use that arm for routine measurements.

Taking blood pressure in both arms will take health care professionals more time, but it should be done to provide more accurate readings, said Dr. Shawna Nesbitt, a professor of internal medicine at UT Southwestern Medical Center in Dallas.

“And you should really measure more than once to get the most accurate reading,” said Nesbitt, who specializes in blood pressure disorders. Not doing so could mean measurements aren’t consistently accurate. “We may be allowing people to walk around with higher pressures than they should.”

The longer a person experiences uncontrolled high blood pressure, the higher their risk for heart attacks or strokes, Nesbitt said.

“This study is clinically relevant to what we do every single day,” she said. “Every hospital or clinic visit we have – even going to the dentist – somebody is measuring your blood pressure.”

Source: American Heart Association

‘Living with COVID’: Where the Pandemic Could Go Next

Jennifer Rigby and Julie Steenhuysen wrote . . . . . . . . .

As the third winter of the coronavirus pandemic looms in the northern hemisphere, scientists are warning weary governments and populations alike to brace for more waves of COVID-19.

In the United States alone, there could be up to a million infections a day this winter, Chris Murray, head of the Institute of Health Metrics and Evaluation (IHME), an independent modeling group at the University of Washington that has been tracking the pandemic, told Reuters. That would be around double the current daily tally.

Across the United Kingdom and Europe, scientists predict a series of COVID waves, as people spend more time indoors during the colder months, this time with nearly no masking or social distancing restrictions in place.

However, while cases may surge again in the coming months, deaths and hospitalizations are unlikely to rise with the same intensity, the experts said, helped by vaccination and booster drives, previous infection, milder variants and the availability of highly effective COVID treatments.

“The people who are at greatest risk are those who have never seen the virus, and there’s almost nobody left,” said Murray.

These forecasts raise new questions about when countries will move out of the COVID emergency phase and into a state of endemic disease, where communities with high vaccination rates see smaller outbreaks, possibly on a seasonal basis.

Many experts had predicted that transition would begin in early 2022, but the arrival of the highly mutated Omicron variant of coronavirus disrupted those expectations.

“We need to set aside the idea of ‘is the pandemic over?'” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. He and others see COVID morphing into an endemic threat that still causes a high burden of disease.

“Someone once told me the definition of endemicity is that life just gets a bit worse,” he added.

The potential wild card remains whether a new variant will emerge that out-competes currently dominant Omicron subvariants.

If that variant also causes more severe disease and is better able to evade prior immunity, that would be the “worst-case scenario,” according to a recent World Health Organization (WHO) Europe report.

“All scenarios (with new variants) indicate the potential for a large future wave at a level that is as bad or worse than the 2020/2021 epidemic waves,” said the report, based on a model from Imperial College of London.


Many of the disease experts interviewed by Reuters said that making forecasts for COVID has become much harder, as many people rely on rapid at-home tests that are not reported to government health officials, obscuring infection rates.

BA.5, the Omicron subvariant that is currently causing infections to peak in many regions, is extremely transmissible, meaning that many patients hospitalized for other illnesses may test positive for it and be counted among severe cases, even if COVID-19 is not the source of their distress.

Scientists said other unknowns complicating their forecasts include whether a combination of vaccination and COVID infection – so-called hybrid immunity – is providing greater protection for people, as well as how effective booster campaigns may be.

“Anyone who says they can predict the future of this pandemic is either overconfident or lying,” said David Dowdy, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health.

Experts also are closely watching developments in Australia, where a resurgent flu season combined with COVID is overwhelming hospitals. They say it is possible that Western nations could see a similar pattern after several quiet flu seasons.

“If it happens there, it can happen here. Let’s prepare for a proper flu season,” said John McCauley, director of the Worldwide Influenza Centre at the Francis Crick Institute in London.

The WHO has said each country still needs to approach new waves with all the tools in the pandemic armory – from vaccinations to interventions, such as testing and social distancing or masking.

Israel’s government recently halted routine COVID testing of travelers at its international airport, but is ready to resume the practice “within days” if faced with a major surge, said Sharon Alroy-Preis, head of the country’s public health service.

“When there is a wave of infections, we need to put masks on, we need to test ourselves,” she said. “That’s living with COVID.”

Source : Reuters

Chemicals Produced in the Gut after Eating Red Meat May Contribute to Heart Disease Risk

Chemicals produced by microbes in the digestive tract may be partly responsible for the increased heart disease risk associated with higher consumption of red meats such as beef and pork, a new study suggests.

Cardiovascular disease – which includes heart attacks and strokes – is the leading cause of death in the U.S. and around the world. As people age, their cardiovascular disease risk increases.

But risks can be lowered by eating a diet emphasizing fruits and vegetables, legumes, nuts, whole grains, lean protein and fish, staying physically active, getting enough sleep, maintaining a healthy body weight, not smoking and properly managing blood pressure, cholesterol and blood sugar levels.

“Most of the focus on red meat intake and health has been around dietary saturated fat and blood cholesterol levels,” study co-author Meng Wang said in a news release. Wang is a postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

“Based on our findings, novel interventions may be helpful to target the interactions between red meat and the gut microbiome to help us find ways to reduce cardiovascular risk,” she said.

The study was published Monday in the American Heart Association journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Prior research has shown some chemical byproducts of food digestion, called metabolites, are associated with a higher cardiovascular disease risk. Trimethylamine N-oxide, or TMAO, is a metabolite produced by gut bacteria to help digest red meat. High blood levels of TMAO may be associated with higher risk for cardiovascular disease, chronic kidney disease and Type 2 diabetes.

In the new study, researchers measured metabolites in the blood samples of nearly 4,000 people in the Cardiovascular Health Study, which investigated risk factors for cardiovascular disease in adults age 65 and older.

Study participants, who were an average 73 years old at the study’s onset, were recruited from Sacramento, California; Hagerstown, Maryland; Winston-Salem, North Carolina; and Pittsburgh. They were followed for an average of 12.5 years and in some cases up to 26 years.

Participants answered questionnaires about their dietary habits, including how often they ate foods such as red meat, processed meat, fish, poultry and eggs.

Eating more meat – especially red meat and processed meat – was associated with a higher risk for atherosclerotic cardiovascular disease. The risk was 22% higher for about every daily serving.

The increase in TMAO and related metabolites associated with eating red meat was responsible for one-tenth of the higher cardiovascular risk, according to the study.

Researchers also found evidence that blood sugar levels and inflammation may play a more important role in linking red meat consumption to cardiovascular risk than blood cholesterol or blood pressure.

The findings suggest a need for more research into the different chemicals that may play a role in red meat consumption, the authors said.

“Research efforts are needed to better understand the potential health effects,” Wang said.

Source: American Heart Association

Scientists Design Skin Patch That Takes Ultrasound Images

The future of ultrasound imaging could be a sticker affixed to the skin that can transmit images continuously for 48 hours.

Researchers at Massachusetts Institute of Technology (MIT) have created a postage stamp-sized device that creates live, high-resolution images. They reported on their progress this week.

“We believe we’ve opened a new era of wearable imaging: With a few patches on your body, you could see your internal organs,” said co-senior study author Xuanhe Zhao, a professor of mechanical engineering and civil and environmental engineering at MIT.

The sticker — about 3/4-inch across and about 1/10-inch thick — could be a substitute for bulky, specialized ultrasound equipment available only in hospitals and doctor’s office, where technicians apply a gel to the skin and then use a wand or probe to direct sound waves into the body.

The waves reflect back high-resolution images of a major blood vessels and deeper organs such as the heart, lungs and stomach. While some hospitals already have probes affixed to robotic arms that can provide imaging for extended periods, the ultrasound gel dries over time.

For now, the stickers would still have to be connected to instruments, but Zhao and other researchers are working on a way to operate them wirelessly.

That opens up the possibility of patients wearing them at home or buying them at a drug store. Even in their current design, they could eliminate the need for a technician to hold a probe in place for a long time.

In the study, the patches adhered well to the skin, enabling researchers to capture images even if volunteers moved from sitting to standing, jogging and biking.

“We envision a few patches adhered to different locations on the body, and the patches would communicate with your cellphone, where AI algorithms would analyze the images on demand,” Zhao explained in an MIT news release.

A different approach tested — stretchable ultrasound probes — yielded images with poor resolution.

“[A] Wearable ultrasound imaging tool would have huge potential in the future of clinical diagnosis. However, the resolution and imaging duration of existing ultrasound patches is relatively low, and they cannot image deep organs,” said co-lead author Chonghe Wang, a graduate student who works in Zhao’s Lab.

The MIT team’s new ultrasound sticker produces higher resolution images by pairing a stretchy adhesive layer with a rigid array of transducers (they convert energy from one form to another). In the middle is a solid hydrogel that transmits sound waves. The adhesive layer is made from two thin layers of elastomer.

“The elastomer prevents dehydration of hydrogel,” co-lead author Xiaoyu Chen explained. “Only when hydrogel is highly hydrated can acoustic waves penetrate effectively and give high-resolution imaging of internal organs.”

Healthy volunteers wore the stickers on various areas, including the neck, chest, abdomen and arms. The stickers produced clear images of underlying structures, including the changing diameter of major blood vessels, for up to 48 hours. They stayed attached while volunteers sat, stood, jogged, biked and lifted weights.

They showed how the heart changes shape as it exerts during exercise and how the stomach swells, then shrinks, as volunteers drank and then eliminated juice. Researchers also could detect signs of temporary micro-damage in muscles as volunteers lifted weights.

“With imaging, we might be able to capture the moment in a workout before overuse, and stop before muscles become sore,” Chen said. “We do not know when that moment might be yet, but now we can provide imaging data that experts can interpret.”

In addition to working on wireless technology for the stickers, the team is developing software algorithms based on artificial intelligence that can better interpret the ultrasound images.

Zhao thinks patients may one day be able to buy stickers that could be used to monitor internal organs, the progression of tumors and development of fetuses in the womb.

“We imagine we could have a box of stickers, each designed to image a different location of the body,” Zhao said. “We believe this represents a breakthrough in wearable devices and medical imaging.”

The findings were published in Science.

Source: HealthDay

Getting More Exercise than Guidelines Suggest May Further Lower Death Risk

Doubling to quadrupling the minimum amount of weekly physical activity recommended for U.S. adults may substantially lower the risk of dying from cardiovascular disease and other causes, new research finds.

The study, published in the American Heart Association journal Circulation, found people who followed the minimum guidelines for moderate or vigorous long-term, leisure physical activity lowered their risk of dying from any cause by as much as 21%. But adults who exercised two to four times the minimum might lower their mortality risk by as much as 31%.

“Our study provides evidence to guide individuals to choose the right amount and intensity of physical activity over their lifetime to maintain their overall health,” study author Dong Hoon Lee said in a news release. Lee is a research associate in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.

“Our findings support the current national physical activity guidelines and further suggest that the maximum benefits may be achieved by performing medium to high levels of either moderate or vigorous activity or a combination.”

The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic exercise, 75 minutes per week of vigorous aerobic exercise, or a combination of both. That advice is based on federal guidelines for physical activity.

For the new research, a team analyzed 30 years of medical records and mortality data for over 100,000 adults enrolled in two large studies: the all-female Nurses’ Health Study and all-male Health Professionals Follow-Up Study. The data included self-reported measures of leisure time physical activity intensity and duration. Participants were an average 66 years old.

In the study, moderate physical activity was defined as walking, lower-intensity exercise, weightlifting and calisthenics. Vigorous activity included jogging, running, swimming, bicycling and other aerobic exercises.

Going above and beyond the recommended minimums reaped greater longevity rewards, especially for moderate physical activity. Extra moderate-intensity exercise – 300 to 600 minutes per week – was associated with a 26%-31% lower risk of death from any cause compared with almost no long-term moderate-intensity exercise. By comparison, people who hit just the minimum goals for moderate physical activity had a lower risk of 20%-21%.

For vigorous physical activity, getting 150 to 300 minutes a week was linked to a 21%-23% lower risk of death from any cause compared to getting none. That compared to a 19% lower risk for people who just met the minimum exercise target.

People who reported meeting the recommendation for moderate physical activity had a 22%-25% lower risk of dying from cardiovascular disease, while those who exercised two to four times the recommendation had a 28%-38% lower risk, the analysis found. Those reporting the recommended amount of vigorous physical activity were 31% less likely to die from cardiovascular disease, while those who doubled to quadrupled the recommended target had a 27%-33% lower risk.

Engaging in more than 300 weekly minutes of vigorous or 600 weekly minutes of moderate physical activity did not provide any further reduction in death risk, the study found. But it also did not harm cardiovascular health. Prior research has suggested long-term, high-intensity endurance activities – such as marathons, triathlons and long-distance bicycle races – may increase the risk for cardiovascular problems, including sudden cardiac death.

“This finding may reduce the concerns around the potential harmful effect of engaging in high levels of physical activity observed in several previous studies,” Lee said.

Donna K. Arnett, incoming executive vice president for academic affairs and provost at the University of South Carolina, said in the release that the findings fit with what is already known about the heart health benefits of regular physical activity.

“We have known for a long time that moderate and intense levels of physical exercise can reduce a person’s risk of both atherosclerotic cardiovascular disease and mortality,” said Arnett, who helped write guidelines for cardiovascular disease prevention from the AHA and American College of Cardiology. She was not involved in the new research.

“We have also seen that getting more than 300 minutes of moderate-intensity aerobic physical activity or more than 150 minutes of vigorous-intensity aerobic physical exercise each week may reduce a person’s risk of atherosclerotic cardiovascular disease even further, so it makes sense that getting those extra minutes of exercise may also decrease mortality,” she said.

Source: American Heart Association

New SARS-CoV-2 Variant BA.2.75 Evades All Approved Monoclonal Antibody Therapies

William A. Haseltine wrote . . . . . . . . .

Viral variation has proved to be a critical weak point in our approach to medical solutions for controlling Covid-19. Over the last two and a half years, we’ve seen successive waves of reinfection by new variants of those who’ve been previously infected, those who have been vaccinated and boosted, and those who have been infected, vaccinated, and boosted as well. Behind this unfortunate dynamic is the dramatic variation in the structure of the virus exterior, specifically the Spike protein, which plays a critical role early in infection by binding to the cell surface and forcing entry.

Antibodies that recognize this structure can block infection. However, changes in the exterior structure negate antibody collections in convalescent sera and monoclonal antibodies from binding and neutralizing the virus. A recent study by Yamasoba et al. summarizes the effectiveness of existing monoclonal antibodies against a successive set of virus variants, namely the BA.2 variant, which first emerged in late 2021 and quickly spread around the world, driving the most infectious wave of the virus to date, BA 4/5, which are the predominant strains circulating at the time of writing, and BA.2.75, a new sublineage of BA.2 which is likely more infectious and immune evasive than its predecessors, suggesting it may be the predominant variant in the coming weeks and months.

FIGURE 1: Neutralization assay was performed using pseudoviruses harboring the SARS-CoV-2 Spike … [+] YAMASOBA ET AL.

The ability of the virus to evade natural immunity from the previously infected and vaccinated is also reflected in its ability to escape a host of specific monoclonal antibodies. As is clear from Figure one, the later Omicron viruses evade monoclonal antibodies much more effectively than early strains.

Immediately, we note that five antibodies: adintrevimab, bamlanivimab, casirivimab, etesevimab, and imdevimab failed to neutralize any of the three Omicron sublineages. Casirivimab and imdevimab, as well as etesevimab and bamlanivimab, are designed to be used in tandem in an antibody cocktail, yet their combination antibodies were just as ineffective. Adintrevimab is intended for individual use, meaning its neutralization potency for the strains circulating today is nonexistent. These were among the first monoclonal antibodies developed, rationalizing why they are so ineffective against recent strains.

This leaves five individual monoclonal antibodies. Regdanvimab, sotrovimab, and tixagevimab did not neutralize the previously circulating BA.2 and the currently circulating BA.4/5. However, the three effectively neutralized the BA.2.75 pseudovirus. This suggests that if BA.2.75 became the dominant strain in the coming weeks and months, these three monoclonal antibodies could be effective treatments for those suffering from Covid due to this strain.

Of the two remaining antibodies, cilgavimab poorly neutralized BA.2 and BA.4/5 but was 24.4-fold worse against BA.2.75. Although bebtelovimab effectively neutralized BA.2 and BA.4/5, it again was much worse against BA.2.75, this time 21.2 to 25.6-fold. Despite poorly neutralizing BA.2.75 compared to BA.4/5, bebtelovimab still neutralized the strain better than any other antibody.

Even newer generations of viruses recently detected in South Africa with more extensively mutated Spike proteins, against which bebtelovimab and others may perform even more poorly.

New variants evading monoclonal antibodies should come as no surprise. After infection, the convalescent sera of a recovered patient contains many antibodies designed to inhibit the virus the host just overcame. For the virus to reinfect, it must mutate considerably to evade the convalescent antibodies. Monoclonal antibodies are effectively the same as convalescent antibodies on an individual scale. They are designed to overcome a virus by binding to specific amino acids on the Spike. If the virus mutates enough, the monoclonal antibody can no longer bind. This is how the cat and mouse game of developing antibodies and the virus mutating has continued for two and a half years.

What then can be done? The search is on for monoclonal antibodies that recognize regions of the virus that are critical to the virus lifecycle and therefore are resistant to most mutations. In other words, scientists worldwide are rushing to identify and develop antibodies with broadly neutralizing capabilities, i.e., antibodies that recognize highly conserved sequences of the Spike protein that may overcome all viral variants.

The good news is that many such antibodies have already been identified. We recently described the Cv2.1169 antibody discovered by scientists at the Pasteur Institute and will continue to detail others as data is released. Whether these antibodies recognize and neutralize the latest variants such as BA.2.75 remains an open question.

A second potential solution is to use extensive combinations of functional monoclonal antibodies. While many fail to neutralize, some retain neutralizing capability against the latest variants, and new monoclonal antibodies are constantly advancing. Combining two, three, or four antibodies into a single treatment may suppress infection. Our hope remains high for monoclonal antibodies as a short-term relief for those infected and, in the long run, as a prophylactic against infection in the first place.

Source : Forbes

Study of Sleep in Older Adults Suggests Nixing Naps, Striving for 7-9 hours a Night

Laura Williamson wrote . . . . . . . . .

Napping, as well as sleeping too much or too little or having poor sleep patterns, appears to increase the risk for cardiovascular disease in older adults, new research shows.

The study, published Tuesday in the Journal of the American Heart Association, adds to a growing body of evidence supporting sleep’s importance to good health. The American Heart Association recently added sleep duration to its checklist of health and lifestyle factors for cardiovascular health, known as Life’s Essential 8. It says adults should average seven to nine hours of sleep a night.

“Good sleep behavior is essential to preserve cardiovascular health in middle-aged and older adults,” said lead author Weili Xu, a senior researcher at the Aging Research Center in the department of neurobiology, care sciences and society at the Karolinska Institute in Stockholm, Sweden. “We encourage people to keep nighttime sleeping between seven to nine hours and to avoid frequent or excessive napping.”

Prior research has shown poor sleep may put people at higher risk for a range of chronic illnesses and conditions affecting heart and brain health. These include cardiovascular disease, dementia, diabetes, high blood pressure and obesity. According to the Centers for Disease Control and Prevention, nearly 35% of U.S. adults say they get less than seven hours of sleep, while 3.6% say they get 10 or more hours.

Previous sleep duration studies show that sleeping too much or too little both may raise the risk for cardiovascular disease. But whether napping is good or bad has been unclear.

In the new study, researchers analyzed sleep patterns for 12,268 adults in the Swedish Twin Registry. Participants were an average of 70 years old at the start of the study, with no history of major cardiovascular events.

A questionnaire was used to collect data on nighttime sleep duration; daytime napping; daytime sleepiness; the degree to which they considered themselves a night person or morning person, based on the time of day they considered themselves most alert; and symptoms of sleep disorders, such as snoring and insomnia. Participants were followed for up to 18 years to track whether they developed any major cardiovascular problems, including heart disease and stroke.

People who reported sleeping between seven and nine hours each night were least likely to develop cardiovascular disease, a finding in keeping with prior research. Compared with that group, those who reported less than seven hours were 14% more likely to develop cardiovascular disease, and those who reported more than 10 hours were 10% more likely to develop cardiovascular disease.

Compared with people who said they never napped, those who reported napping up to 30 minutes were 11% more likely to develop cardiovascular disease. The risk increased by 23% if naps lasted longer than 30 minutes. Overall, those who reported poor sleep patterns or other sleep issues – including insomnia, heavy snoring, getting too much or too little sleep, frequent daytime sleepiness and considering themselves a night person – had a 22% higher risk

Study participants who reported less than seven hours of sleep at night and napping more than 30 minutes each day had the highest risk for cardiovascular disease – 47% higher than those reporting the optimal amount of sleep and no naps.

The jury is still out on whether naps affect cardiovascular risk across the lifespan, said Marie-Pierre St-Onge, center director for the Sleep Center of Excellence and an associate professor at Columbia University in New York City. She noted that the new research, which she was not involved in, was restricted to older adults.

Rather than trying to recoup sleep time by napping, people should try to develop healthier sleep habits that allow them to get an optimal amount of sleep at night, St-Onge said. This includes making sure the sleep environment is not too hot or cold or too noisy. Reducing exposure to bright light before going to sleep, not eating too late at night, getting enough exercise during the day and eating a healthful diet also help.

“Even if sleep is lost during the night, excessive napping is not suggested during the day,” Xu said. And, if people have persistent trouble getting enough sleep, they should consult a health care professional to figure out why, she said.

Source: American Heart Association

Can You Totally Avoid Catching COVID? These “NOVIDs” Share Their Secrets.

Hannah Docter-Loeb and Emma Wallenbrock wrote . . . . . . . . .

Well over half the U.S. population had caught COVID by February 2022. That majority has only gotten bigger in the months since as contagious, immune-system-evading variants continue to circulate.

Yet, despite COVID’s pervasiveness, there are some people who have managed to avoid it—the “NOVIDs.” We know because their number includes some of our colleagues. We found other people via social media who claim to have avoided infection with the virus to the best of their knowledge. Many of the people whom we spoke to had one thing in common: the ability to work from home. They also tended to be cautious, though many also do plenty of socializing.

While there’s some—or a lot—of plain and simple chance involved in staying negative, those who have done so offer us a look at what it takes to remain uninfected (for now), as the pandemic wears on.

* * * * * * *

I have a fairly weak immune system since I live with a chronic illness (imagine the sickly kid who missed a lot of school, catches every cold), so I have been cautious from the start.

My mask is on any time I go into a store, ride public transportation, or am generally indoors with strangers. I eat at restaurants or go to bars if there is an outdoor space or decent ventilation, like big open windows or those garage-style doors some places have, but I skip places that don’t fit that criteria. I have visited a few friends’ homes, usually to spend time outside.

I think a lot about the variables of where I am going and who else is going to be there, and then make decisions. In 2021, I went to Disney World. Disney was limiting capacity to 30 percent and using its serious hospitality skills to enforce masking, but I drove down from Brooklyn because there wasn’t any vaccination requirement to fly. Months later, I felt comfortable flying to the U.K. because everyone had to have tested negative within 72 hours to be on the flight.

I did have one morning where I woke up convinced that I had finally caught COVID. It was Jan. 2 and I was still feeling terrible after partying too hard (outdoors) in Edinburgh on New Year’s Eve. Turned out I was just hungover, dehydrated, and too old to party that hard anymore. — Daisy Rosario, senior supervising producer, Slate

* * * * * * *

The main reason I think I have avoided it is relative physical isolation. I live alone and I was 100 percent at home for the first 18 months [of the pandemic], then the 10 months or so since then have been at about 80 percent at home, so my physical proximity to people has been limited. Until a few months ago I would be masked whenever in a public building, but now I only do so in medical settings. I was vaccinated from around March 2021 and have since had a second jab and booster. I think I am probably due for another booster anytime now.

I have had a few close calls. Each time I have taken a test to check and it has come back negative. A couple of times I have taken PCR tests at the local testing center, but more often I took the lateral flow tests that were given out for free by the NHS and took these before going to places where I might be in contact with others. I feel fortunate to have avoided this so far, but the isolation and uncertainty over the past few years have certainly taken a negative toll on my mental health. — Charles Ward, from Hemel Hempstead, England (as told to Emma Wallenbrock)

* * * * * * *

As a college student, it feels almost inevitable that you’ll catch COVID-19. Think 300-person lecture halls peppered with fits of coughing. Think poorly ventilated parties with suffocating peer pressure to unmask. And think about the countless casual interactions—in the dining hall, library, or gym—where you might reasonably forget to keep your guard up. I can’t think of a single close friend who hasn’t caught the virus. But I’ve somehow managed to slip through the cracks, probably because of my “responsible dumb luck.”

I try to be careful. I’m double-vaccinated and boosted. I almost always mask up indoors. I avoid large group settings as best I can. But I’ve also had so many close calls that I wonder when my luck will finally run out. My college roommate tested positive for COVID the day after I moved out. A close friend stayed at my house for two days, and we ate indoors at a restaurant, drove in the same car, and watched a movie together. He tested positive on day three. A girl I chatted with for four hours on a date texted me a few days later that she was positive. And these are just the close calls that I’m aware of! —Simar Bajaj, from Fremont, California (as told to Emma Wallenbrock)

* * * * * * *

We live in an affluent suburb of D.C., a very expensive neighborhood, but we live here comfortably by virtue of my father’s post as a bureaucrat at the Pentagon since the early ’80s, when housing prices were much more reasonable. There is ample outdoor space, public parks, and quiet tree-lined streets. I’ve always just accidentally had very good mental health and the ability to be content with a small social circle. We took the pandemic seriously from the beginning and all our friends did the same. We updated our behaviors when public health guidance changed.

With all these privileges, the pandemic has felt like a bit of a blessing. I work at a progressive company with excellent benefits and the ability to work remotely productively, even more productively than at the office. I now have more time to spend by myself and with my family and greater autonomy in how I do my work. —Jonathan Zuckerman, website developer, Slate

I do COVID research for a living. I still take COVID very seriously because I see the impact of it. My stance now is that if people want to take on personal risks, that’s their choice to make but they have an obligation not to pass their infections on to other people. I still wear a high-grade mask when I’m in grocery stores or the post office—community spaces where people have to be and are at high risks of COVID—to limit my risk to other people. I will go to restaurants or the occasional bar, depending on how I’m feeling or if I have events coming up that I want to make sure I’m negative for. I’ve definitely put myself in situations where I could have been exposed to COVID and as far as I’m aware I haven’t gotten it yet. I have volunteered for a lot of studies that look at antibody levels, and no one has seen any unexplained spikes in my antibody levels that could have been explained by an infection that wasn’t detected.

I definitely feel like I’m waiting for the other shoe to drop. When we have these huge waves of COVID, I always tell people, “You’re not guaranteed to get it in this wave, but in our lifetime I think everyone will very likely get COVID unless we make drastic changes about transmission.” I feel like it is inevitable but I try to be really conscientious of it. I won’t risk passing it on to other people should I get infected.

The joke that I and other people who work in health care make is that, being in the hospitals all the time before vaccines were available, we were “microdosing COVID.” If I have had a COVID infection, it’s never manifested as symptoms or a positive test.

I think, having worked on so many COVID-related studies, there is some aspect of COVID we’re yet to learn about that will explain situations like mine or those of other people who are befuddled as to why they haven’t gotten infected. I look forward to learning those things, but for now I’m going to keep operating the way I’ve been operating. — Laurel Bristow, from Atlanta (as told to Hannah Docter-Loeb)

* * * * * * *

I don’t do things anymore. I work from home, and I don’t go anywhere on a regular basis beyond the park and the grocery store. Since the start of the pandemic, I have been to a movie theater a total of two times. I occasionally go out to a restaurant but almost exclusively ask for outdoor seating. I wear a KN95 mask every time I step out of my apartment and diligently test myself before going anywhere where I’ll be around people outside of my household.

I’ve been lucky to evade catching COVID so far. I know for many people it isn’t that easy, whether they have a medical emergency, are raising children, or just don’t have the option to work remotely. Even so, I don’t feel lucky. Mostly, I feel tired. Seeing strangers at the grocery store without a mask, talking about their vacation plans, coughing and sneezing without covering their mouths (seriously, adults are doing this), it makes me feel like I’m spending all this energy for no reason.

But I’ve watched COVID ruin so many lives, including the lives of people I love. I know three people who are still dealing with long-term effects from COVID, one of whom has developed other chronic health conditions as a result. I also know plenty of people with unrelated health conditions that make getting COVID (and, for some of my friends, even getting vaccinated) especially risky. So I’d rather be this careful for the rest of my life than know I’m not doing my best to keep my community safe. — Shivani Ishwar, data and analytics designer, Slate

* * * * * * *

“The biggest change since COVID hit is how much smaller my life has gotten.” — Megan Chialastri

Even after my first round of COVID shots, I felt most comfortable in places that required proof of vaccination to enter, so my experience at many bars and restaurants was pretty limited. I switched to a more expensive gym that required vaccines. Over time, though, I’ve let my guard down further and further. Going to the movies is one of my favorite things in the world, and I’ve continued to do that with varying degrees of masking (because I love theater snacks). I just got back from a bus trip to NYC, where I saw three Broadway shows (and wore a mask in all theaters).

While I stay up on my vaccinations and mask up most of the time indoors, sometimes I forget, and my personal practices are only as good as the practices around me. Hardly anywhere requires vaccination anymore, so if I want to exist outside of my one-bedroom apartment, there’s inherently a risk.

The biggest change since COVID hit is how much smaller my life has gotten. Going out seems more exhausting. I get anxious in bigger crowds. I’ve had more of a tendency to keep to myself, which is possibly the reason I’ve stayed clear. — Megan Chialastri, from Philadelphia (as told to Emma Wallenbrock)

* * * * * * *

I’m retired, I’m in my late 60s, and my husband is 10 years older than me and is a cancer survivor. I’m living in a situation that’s of higher risk for somebody in my household. I’m also a retired nurse and have been pretty acutely aware of just how devastating this virus is from the very beginning. I myself had gallbladder surgery in my 50s and ended up with complications and in the ICU with severe lung impairment. I had a fear of any kind of severe respiratory illness. When COVID was exploding pre-vaccine, people were dying of severe lung injury. That set me up for being pretty paranoid about the possibility of contracting the virus.

We got vaccinated as soon as that option was available. I’ve masked from the beginning, and as we’ve learned more about the efficacies of different types of masks, I’ve gone from a variety of cloth masks to KN95s, and if I’m out at all in an indoor setting, I always wear a good N95 that is tight-fitting. I firmly believe that masking is your first line of protection.

But the strategies have primarily been social isolation. I’ve always had a tight circle of friends and we used to do carefree socializing, and we just don’t do that anymore. I have the ability at this point in my life to have my groceries delivered, to order in—I have enough financial security to make those things happen. I’m discouraged by our public health response and I think it’s unfortunate that people are forced into a self-protective mode. — Mary Herrick from Portland, Oregon (as told to Hannah Docter-Loeb)

* * * * * * *

I have no idea how my house (me, another adult, a 5-year-old) has avoided COVID. We’re up to date on our shots, but a lot of people who fit that description have had it! We live in a small college town located in a rural county and have not traveled much since the pandemic—none of us has gotten on an airplane. Neither of the adults in the family has a job that requires physical presence, and I think that might be the biggest factor here. However, the child has been back in preschool for about a year—sometimes masking, sometimes not, in accordance with the county’s reported transmission levels.

All in all, it seems like a crapshoot. I have thought so many times, “This is IT.” Somehow, it never has been. — Rebecca Onion, senior editor, Slate

* * * * * * *

The principles I lived by are all pretty much what we were told throughout: Wash your hands when you get home and all those other times. Don’t sweat outdoor transmission (I did wear my mask while biking around at first). I wear my mask indoors in every public space—grocery stores, bodegas, always on the subway. My one dicey exception was the gym, where enforcement was extremely lax once you were past the front desk, and then nonexistent from late summer ’20 onward except for one relapse in the bleak, bleak delta variant days. I’d skip the gym when infection rates went up and then would go back when they seemed to slow, weighing my deep moodiness that exercise could dispel against the possibility of getting sick. When I’d leave New York, I’d kind of watch for what people in L.A. or Colorado were doing (wearing masks less, as it was summer), so just living in a pretty well-masked place (masked up for good reasons—it’s crowded here) probably did most of it for me. I watched a lot of TV, saw people outside, let what I think constituted “my life” drain and then trickle back bit by bit. — Ben Richmond, senior director of operations for podcasts, Slate

* * * * * * *

I feel like we’re ducking and dodging it like Neo in The Matrix. My wife has become somewhat of a mask guru and knows how to find the highest-quality ones in bulk online. Our two kids (6 and 3) will wear them without argument. The general rule in our family at this point is to wear them indoors and in crowded spaces outdoors.

It hasn’t been perfect, though. We had some close calls, especially in 2021. We traveled as a family to places like Florida (to see my parents) and Hawaii (a nonrefundable trip purchased in 2019 that we had already rescheduled once) right before delta came raging in. My wife and I took a weekend trip to San Francisco just for a quick change of scenery and were back in the safe confines of our home before omicron exploded. And then there was the carnival of sinus and ear infections this spring that accosted our entire household and got so bad that we couldn’t believe it wasn’t COVID. (It wasn’t. The amount of rapid and PCR tests we took was insane.) My most recent trip was a solo weekend excursion to Las Vegas to provide moral support to my brother in the World Series of Poker. I figured if there was ever gonna be a place for it to finally happen, it would be there. Masks don’t exist in Vegas for the most part. I still wore mine. I PCR-tested a few days after returning home and was in the clear. — Derreck Johnson, designer, Slate

* * * * * * *

As far as I know, I’ve never had COVID, mostly because, at every turn, I’ve been both lucky and privileged. Lucky that I was a senior in high school in 2020 and never found myself a pawn in the politics of K–12 school reopening and masking policies. Privileged that the college I started at in September 2020 has kept up a mask mandate and a testing program of twice-weekly PCRs for all students. Lucky that I haven’t caught COVID from working my food service jobs. Privileged that I don’t have to rely on those jobs for my livelihood, that my parents work white-collar office jobs and have been able to work from home for two years.

I’ve been fairly conscientious too; I wear a mask in all public indoor spaces, including public transportation. When omicron hit I abandoned cloth masks for KN95s. And I just plain don’t get out much. But I know people who’ve been just as privileged and conscientious as me who’ve nevertheless gotten it. I’ve avoided it. It’s just plain, dumb luck. (Knock on wood.) — Anna Kraffmiller, from Waltham, Massachusetts, as told to Emma Wallenbrock

* * * * * * *

When I think about why I haven’t had COVID yet, I tend to bounce between three explanations. At the “self-congratulatory” side of the spectrum, I feel proud of myself: I have been cautious, and not getting sick is my reward. In the middle is “I’m just lucky.” Maybe some people are immune to COVID. And then at the other side of the scale is: I’m just really unpopular. Everyone else testing positive at the same time is a little bit like seeing a group of friends post photos to social media from a hangout you weren’t invited to.

All of this, of course, comes with a caveat: I haven’t had COVID so far as I know. I’ve been sick a couple of times in the pandemic — once I even lost my sense of smell. But I persistently tested negative, and other respiratory viruses can interfere with your ability to smell too.

But I suspect I’ll test positive the day this article is published.

Source : Slate

What Causes Long COVID? Canadian Researchers Think They’ve Found a Key Clue

Teresa Wright wrote . . . . . . . . .

Olympic gold medallist Alex Kopacz may be used to being out of breath when pushing a bobsled, but last year after he was hospitalized for COVID-19, he experienced a very different kind of breathlessness.

He was put on oxygen for two months and experienced a number of other health setbacks in the months following his COVID-19 infection, including blood clots in his lungs and throughout his body.

“It was hard to breathe and pretty much it was just going to be a matter of time to see if my body was going to heal from it,” Kopacz said.

It took him almost four months before he was back on his feet and breathing normally again. But without even an official diagnosis of so-called long COVID, the then-31-year-old didn’t have answers about what was happening to him.

That’s how he became involved in a new Canadian research trial looking at patients suffering from post-COVID syndrome — a study that has identified a potential key culprit causing some people to continue experiencing breathing issues months after contracting COVID-19.

A team of researchers based at five centres across Ontario have zeroed in on a microscopic abnormality in the way oxygen moves from the lungs and into the blood vessels of long COVID patients in their trial.

This abnormality could explain why these patients feel breathless and are unable to perform strenuous activities, says lead researcher Grace Parraga, Tier 1 Canada research chair in lung imaging at Western University’s Schulich School of Medicine & Dentistry.

“Those feelings of breathlessness are completely consistent with our finding that we’re not moving the oxygen as efficiently as we should,” she said.

Many long COVID sufferers have been stumping doctors as to what’s wrong with them, because routine clinical tests and chest exams come back with normal readings.

“It’s very exciting for us to actually find something that’s wrong — that it’s in the patient’s lungs and not in their head,” Parraga said.

The study, which was funded by the Ontario COVID-19 Rapid Research Fund, looked at 34 patients — 12 who had been hospitalized with COVID-19 and 22 others who had not been hospitalized.

The patients were evaluated about nine months after their infection started and were still experiencing a number of debilitating symptoms.

Using an MRI technique developed by Western University that is five times as sensitive and has five times the spatial resolution of a CT scan, the researchers were able to see how tiny branches of air tubes in the lungs were moving oxygen into the red blood cells of their patients.

Red blood cells are responsible for transporting oxygen from the lungs to the rest of the body. Any disruption in the flow of this oxygen to red blood cells will trigger the brain to say, ‘breathe more’ — resulting in a feeling of breathlessness, Parraga explained.

All 34 of the patients who participated in the study were experiencing problems in the level of oxygen being absorbed by their red blood cells.

And they all had the same result, regardless of the severity of their symptoms or whether they had been hospitalized for COVID-19 — another key find, Parraga said.

“All these patients had this abnormality. They all had really serious symptoms, so their exercise scores were low, they were breathless when they exercised and when we measured the oxygen levels in their blood in the tips of their fingers after exercise, that was also low.”

And these external measurements corresponded to the abnormality the researchers found in their MRI measurement of the lungs, she said.

“The takeaway is that now we know what’s wrong.”

The reason why this anomaly is happening is not yet known. But identifying this as a possible trigger for these patients’ symptoms is an important step in trying to learn more, Parraga said.

“I think now that we know what’s going on, we can move on to why. And I think the important part is why some people and why not others? How can we predict who is going there and who isn’t? So, that’s going to take a little bit more time for us to get there.”

Dr. Michael Nicholson, a respirologist with the post-acute COVID-19 program at St. Joseph’s Hospital in London, Ont., who co-authored the study, says the findings give patients an identifiable reason why they are still experiencing symptoms months after getting COVID-19.

Up until now, normal tests performed on these patients have not picked up what’s happening to them, so they’re often left to feel as if they’re imagining their illness, he said.

“There’s nothing that’s absolutely obvious. And so these individuals are now given an answer that actually there is something at this very particular site down the pathway that is abnormal,” Nicholson said.

“For these other individuals, that now we can say, ‘I understand your symptoms, I think we have a better appreciation of what’s happening. We don’t necessarily know it completely.’… That’s a positive for them.”

The research team acknowledges the sample size of this study, which has been peer-reviewed, is small and therefore that results should be considered “exploratory and hypothesis-generating.”

But that hasn’t tempered their excitement at the prospect of making headway in understanding long COVID and taking one step closer to understanding how to treat it.

“I think it’s a nice, scientific Pandora’s box, so to speak, of opening up and saying, ‘OK, now we have to focus on why this is happening,’” Nicholson said.

Source : Global News

Read also at Western News

Innovative lung-imaging technique shows cause of long-COVID symptoms . . . . .

America Was in an Early-Death Crisis Long Before COVID

Ed Yong wrote . . . . . . . . .

Jacob Bor has been thinking about a parallel universe. He envisions a world in which America has health on par with that of other wealthy nations, and is not an embarrassing outlier that, despite spending more on health care than any other country, has shorter life spans, higher rates of chronic disease and maternal mortality, and fewer doctors per capita than its peers. Bor, an epidemiologist at Boston University School of Public Health, imagines the people who are still alive in that other world but who died in ours. He calls such people “missing Americans.” And he calculates that in 2021 alone, there were 1.1 million of them.

Bor and his colleagues arrived at that number by using data from an international mortality database and the CDC. For every year from 1933 to 2021, they compared America’s mortality rates with the average of Canada, Japan, and 16 Western European nations (adjusting for age and population). They showed that from the 1980s onward, the U.S. started falling behind its peers. By 2019, the number of missing Americans had grown to 626,000. After COVID arrived, that statistic ballooned even further—to 992,000 in 2020, and to 1.1 million in 2021. Were the U.S. “just average compared to other wealthy countries, not even the best performer, fully a third of all deaths last year would have been prevented,” Bor told me. That includes half of all deaths among working-age adults. “Think of two people you might know under 65 who died last year: One of them might still be alive,” he said. “It raises the hairs on the back of my neck.”

These counterfactuals puncture two common myths about America’s pandemic experience: that the U.S. was just one unremarkable victim of a crisis that spared no nation and that COVID disrupted a status quo that was strong and worth restoring wholesale. In fact, as one expert predicted in March 2020, the U.S. had the worst outbreak in the industrialized world—not just because of what the Trump and Biden administrations did, but also because of the country’s rotten rootstock. COVID simply did more of what life in America has excelled at for decades: killing Americans in unusually large numbers, and at unusually young ages. “I don’t think people in the United States actually have any awareness of just how poorly we do as a country at letting people live to old age,” Elizabeth Wrigley-Field, a sociologist at the University of Minnesota, told me.

Although Bor’s study has yet to be formally reviewed, Wrigley-Field and five other independent researchers vouched for its quality to me. “The paper is extremely important, and the researchers who produced this know what they’re doing,” Steven Woolf, a population-health expert at Virginia Commonwealth University, told me. “It builds on, and considerably expands, what we’ve already known.”

Several studies, for example, have shown that America’s life expectancy has tailed behind other comparable countries since the 1970s. By 2010, that gap was already 1.9 years. By the end of 2021, it had grown to 5.3. And although many countries took a longevity hit because of COVID, America was once again exceptional: Among its peers, it experienced the largest life-expectancy decline in 2020 and, unlike its peers, continued declining in 2021. But Bor says that people often misinterpret life-expectancy declines, as if they simply represent a few years shaved off the end of a life. Someone might reasonably ask: What’s the big deal if I die at 76 versus 78? But in fact, life expectancy is falling behind other wealthy nations in large part because a lot of Americans are dying very young—in their 40s and 50s, rather than their 70s and 80s. The country is experiencing what Bor and his colleagues call “a crisis of early death”—a long-simmering tragedy that COVID took to a furious boil.

In every country, the coronavirus wrought greater damage upon the bodies of the elderly than the young. But this well-known trend hides a less obvious one: During the pandemic, half of the U.S.’s excess deaths—the missing Americans—were under 65 years old. Even though working-age Americans were less likely to die of COVID than older Americans, they fared considerably worse than similarly aged people in other countries. From 2019 to 2021, the number of working-age Americans who died increased by 233,000—and nine in 10 of those deaths wouldn’t have happened if the U.S. had mortality rates on par with its peers. “This is a damning finding,” Oni Blackstock, the founder and executive director of Health Justice, told me.

The crisis of early death was evident well before COVID. As many studies and reports have shown, since the turn of the 21st century, “midlife ages are where health and survival in the U.S. really go off the rails,” Wrigley-Field told me. “The U.S. actually does well at keeping people alive once they’re really old,” she said, but it struggles to get its citizens to that point. They might die because of gun violence, car accidents, or heart disease and other metabolic disorders, or drug overdoses, suicides, and other deaths of despair. In all of these, the U.S. does worse than most equivalent countries, both by failing to address these problems directly and by leaving people more vulnerable to them to begin with.

Consider how many years the missing Americans would have collectively enjoyed had they survived—all the birthdays and anniversaries that never happened. In other rich countries, the total “years of life lost” have flatlined for the past five decades. In the U.S., they have soared: In 2021 alone, the 1.1 million missing Americans lost 25 million years of life among them. That number doesn’t account for the events that preceded many of these deaths—the “years of disability, illness, and loss of human potential, creativity, and dignity,” Laudan Aron, a health-policy researcher at the Urban Institute, told me. And, especially in the case of middle-aged deaths, they left behind young dependents, whose own health might suffer as a result. The sheer number of missing Americans, and the “profound ripple effects” of their absence, are “really hard to wrap one’s head around,” Aron said.

These staggering numbers also help contextualize COVID’s toll. The coronavirus caused the largest single-year rise in mortality since World War II, becoming the third leading cause of death in the U.S., after only heart disease and cancer. But this enormous tragedy unfolded against an already tragic backdrop: The number of missing Americans from 2019 is larger than the number of people who were killed by COVID in 2020 or 2021. This isn’t to minimize COVID’s impact; it simply shows that in the Before Times, America had “very successfully normalized to an extremely high level of death on the scale of what we experienced in the pandemic,” Justin Feldman, a social epidemiologist at Harvard, told me. And when COVID drove those levels skyward, America proved that “we’ll accept even more deaths compared to our already poor historical norms,” Feldman said.

Such deaths, though obvious on a graph, are hidden from Americans with social privilege. In the summer of 2020, Bor remembers having an outdoor barbecue with a friend who grew up in a low-income housing project. “At that point, six months in, he knew six people in his close circle who had been killed by COVID,” Bor told me. “I still don’t.” The fact that half of the working-age Americans who died last year should still be alive “isn’t visceral if you haven’t lost anyone,” he said.

The current mortality crisis was long in the making. In terms of mortality, America’s peer countries—many of which had been hammered by World War II and its aftermath—began catching up with it in the mid-1970s before overtaking in the early 1980s. That was a pivotal era, when globalization, automation, and a growing service industry led to huge losses in mining, manufacturing, and other blue-collar sectors. The U.S. profoundly failed to protect its citizens from these changes. Its social safety net—state assistance for parents, or people facing job, food, or housing insecurity—was meager; its public-health system was languishing after decades of underinvestment; and unlike every other wealthy country, it lacked universal health care. These factors “privatized risk,” Bor and his colleagues wrote in their paper, “tying health more closely to personal wealth and employment.” As labor unions declined and minimum wages stagnated, more Americans had fewer resources to lean on if their health declined. Poorer Americans already lived, on average, shorter lives than rich ones, and that gulf started to widen.

Other particularly American choices exacerbated the stresses on the health of the country’s citizens, again weighing more heavily on less wealthy people. A growing mass-incarceration industry punished them. A deregulatory agenda that began with Ronald Reagan’s administration left them vulnerable to unhealthy foods, workplace hazards, environmental pollutants, guns, and opioids. “America basically says: If you’re poor, you don’t have access to safe choices,” Bor told me.

Factors like social inequalities and frayed social safety nets are the fundamental weaknesses of American society, which more specific problems like opioids, metabolic disorders, and COVID exploit. During the pandemic, for example, poor and minority groups were more likely to be infected because they lived in crowded housing, distrusted medical leaders, and couldn’t work from home or take time off when sick. And instead of addressing these foundational problems, policy makers instead focused on personal responsibility.

America’s drastic underperformance in health also stems from its history of segregation and discrimination. Racist policies have obviously harmed the health of minorities. But as the policy expert Heather McGhee and the physician Jonathan Metzl have independently argued, elites have long marshaled the racial resentment of poor white Americans to undermine support for public goods that would benefit everyone, such as universal health care. Per Frederick Douglass and other Black leaders, “They divided both to conquer each.”

COVID, for example, disproportionately killed Black, Latino, and Indigenous Americans—a trend that, when highlighted to white people, reduces their concern about the pandemic and their support for safety measures. But in 2021, young white Americans still died at three times the rate of the average resident of other peer nations, while young Black and Indigenous Americans died at rates five- and eightfold higher, respectively. “There are thousands of racial-disparity studies that compare Black people to white people—but white Americans are a terrible counterfactual,” Bor told me. They’re frogs in the same pot, boiling more slowly but boiling nonetheless. By using them as a baseline, we ignore how “everyone is harmed by the status quo in the U.S.,” Blackstock told me, while also underestimating how dire things really are for people of color. (The same problem applies to income inequality: White Americans living in the richest 1 percent of counties still have higher rates of maternal and infant mortality than the average residents of wealthy countries.)

So, “what happens now?” Bor asked me. “Are we going to have 1 million missing Americans a year, every year, going forward? Or more?” His study doesn’t suggest a reason for optimism, but it does provide a defense against nihilism. The entire concept of missing Americans is rooted in a comparison with other countries, which shows that these early deaths aren’t inevitable. The U.S. could at least start moving in the direction of its peers by adopting policies that work elsewhere, such as universal health care, minimum-wage increases, federally required paid sick leave, and better unemployment insurance.

But “the inability of our politics to generate policies that manage health threats is grim,” Bor said. None of the weaknesses that COVID exposed have been addressed; some, like the chasm-sized health gaps between rich and poor or white and Black, have been widened. Vaccines significantly reduce the risk of dying from COVID, but their power is blunted by low uptake, new variants, the lifting of almost all infection-thwarting protections, and the looming loss of COVID funding. Reactionary laws that hamstring what public-health departments can do in emergencies will make the U.S. vulnerable to the new viruses that will inevitably assault it in future years. America’s already underperforming health-care system has been badly battered by the pandemic, and weakened by waves of health-care-worker resignations. In recent months, the Supreme Court has constrained both gun and carbon-emission regulations, while clearing the road for states to restrict or ban abortions—a move that could easily boost America’s already sky-high maternal mortality rates. The climate is still changing rapidly, exposing people who have no choice but to work outside to the ravages of heat.

As much of the country returns to normal, Bor’s study makes plain what normal actually meant—and, as I wrote in 2020, that normal led to this. “A lot of Americans may be under the impression that we had a bad go of it during COVID, and once the pandemic is over, they can go back to having the best health in the world,” Woolf told me. “That is a gross misconception.”

Source : The Atlantic