Saturday, January 22, 2022

Thunderstruck as Never Before

Thunderstruck by AC/DC has been in our repertoire for a very long time. But, wait till you see this version

Thursday, January 13, 2022

Federal authorities are again investigating Harold Schaitberger, the former general president of the IAFF.

WASHINGTON — Federal authorities are ramping up their investigation into Harold Schaitberger, the former general president of the International Association of Fire Fighters (IAFF).

Politico reported that a subpoena was signed in on Nov. 29, 2021, for IAFF records detailing information related to the former president and internal IAFF policies. Specifically, the subpoena ordered the organization appear before a grand jury in December, plus “a series of documents pertaining to Schaitberger including his ‘personnel file’ as well as those related to employment records, travel, expenses, use of IAFF debit or credit cards or use of IAFF landline or cell phone numbers. It also requested documents related to IAFF policies on financial practices and use of union credit or debit cards.”

Federal authorities are again investigating Harold Schaitberger, the former general president of the IAFF. (AP Photo/Andrew Harnik)

The latest probe comes over a year after IAFF officials accused Schaitberger of financial misconduct. Then-IAFF treasurer Edward Kelly alleged Schaitberger took $1 million from union pension coffers despite still working there, and failed to pay taxes on millions of dollars in income over the past two decades, in addition to apparently using union funds to cover personal expenses. An IAFF internal review later found no financial misconduct on Schaitberger’s part for issues related to retirement payments.

The federal investigation in 2020 stalled, but as Politico reports, “the new subpoena is much broader than the original, according to someone with direct knowledge of the case, suggesting that authorities are either ramping up the investigation or are attempting to jump-start an investigation into Schaitberger again.”

IAFF attorney G. Zachary Terwilliger indicated that the association intends to cooperate fully with the investigation, “given that the organization's status, if any, is that of a victim,” he said.

Leading up to the 2020 election, Schaitberger served as one of Joe Biden’s key allies, and the IAFF endorsed Biden, a move that ignited a heated debate among firefighters throughout the country, with some unions even breaking rank to support Donald Trump.

Monday, January 10, 2022

Exercise Alters Brain Chemistry to Protect Aging Synapses

Enhanced Nerve Transmission Seen in Older Adults Who Remained Active

When elderly people stay active, their brains have more of a class of proteins that enhances the connections between neurons to maintain healthy cognition, a UC San Francisco study has found.

This protective impact was found even in people whose brains at autopsy were riddled with toxic proteins associated with Alzheimer’s and other neurodegenerative diseases.

“Our work is the first that uses human data to show that synaptic protein regulation is related to physical activity and may drive the beneficial cognitive outcomes we see,” said Kaitlin Casaletto, Ph.D., an assistant professor of Neurology and lead author on the study, which appears in the Jan. 7 issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

The beneficial effects of physical activity on cognition have been shown in mice but have been much harder to demonstrate in people.

Casaletto, a neuropsychologist and member of the UCSF Weill Institute for Neurosciences, worked with William Honer, MD, a professor of psychiatry at the University of British Columbia and senior author of the study, to leverage data from the Memory and Aging Project at Rush University in Chicago. That project tracked the late-life physical activity of elderly participants, who also agreed to donate their brains when they died.

“Maintaining the integrity of these connections between neurons may be vital to fending off dementia, since the synapse is really the site where cognition happens,” Casaletto said. “Physical activity – a readily available tool – may help boost this synaptic functioning.”
More Proteins Mean Better Nerve SignalsLead author Kaitlin Casaletto, Ph.D., assistant adjunct professor of Neurology at the UCSF Memory and Aging Center at the UCSF Weill Institute for Neurosciences. Image by Susan Merrell

Honer and Casaletto found that elderly people who remained active had higher levels of proteins that facilitate the exchange of information between neurons. This result dovetailed with Honer’s earlier finding that people who had more of these proteins in their brains when they died were better able to maintain their cognition late in life.

To their surprise, Honer said, the researchers found that the effects ranged beyond the hippocampus, the brain’s seat of memory, to encompass other brain regions associated with cognitive function.

“It may be that physical activity exerts a global sustaining effect, supporting and stimulating healthy function of proteins that facilitate synaptic transmission throughout the brain,” Honer said.
Synapses Safeguard Brains Showing Signs of Dementia

The brains of most older adults accumulate amyloid and tau, toxic proteins that are the hallmarks of Alzheimer’s disease pathology. Many scientists believe amyloid accumulates first, then tau, causing synapses and neurons to fall apart.

Casaletto previously found that synaptic integrity, whether measured in the spinal fluid of living adults or the brain tissue of autopsied adults, appeared to dampen the relationship between amyloid and tau, and between tau and neurodegeneration.

“In older adults with higher levels of the proteins associated with synaptic integrity, this cascade of neurotoxicity that leads to Alzheimer’s disease appears to be attenuated,” she said. “Taken together, these two studies show the potential importance of maintaining synaptic health to support the brain against Alzheimer’s disease.”

Authors: Additional authors on the study include Anna VandeBunte of UCSF. For other authors, please see the study.

Funding: This work was supported by NIH grants R01AG17917, K23AG058752, R01AG072475 and UCSF ADRC P30AG062422, as well as the Alzheimer’s Association AARG-20-683875.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.

Tuesday, January 4, 2022

“Major Reforms Have Been Driven by Crisis”

A moderately-long, but incredibly well-developed discussion of where we are with regard to COVID 

By Jeremy Farrar, Molly Galvin

Jeremy Farrar, the director of the Wellcome charitable foundation in the United Kingdom, discusses the state of the COVID-19 pandemic and what society must do to prepare for future global crises.

As an infectious diseases specialist and director of Wellcome, Jeremy Farrar was among the first people in the world to learn about the emergence of COVID-19. Before helming Wellcome, one of the world’s largest philanthropic funders of science, he spent 18 years leading the clinical research unit at the Hospital for Tropical Diseases in Vietnam, where he contributed to pivotal advances in understanding tuberculosis, malaria, typhoid, dengue, and influenza. He is a member of the UK Vaccine Taskforce and the Principals Group of the World Health Organization’s (WHO) Access to COVID-19 Tools (ACT) Accelerator and the WHO’s R&D Blueprint Advisory Group, and until November 2021, he served on the UK government’s Scientific Advisory Group for Emergencies. His new book, Spike: The Virus vs. The People, written with Anjana Ahuja, provides a gripping account of how the pandemic unfolded. Issues in Science and Technology editor Molly Galvin recently spoke with him to get his thoughts on the future of the pandemic, the status of science in society, and the uniquely globalized challenges of COVID-19 and climate.

We’re now going on almost two years since the COVID-19 pandemic began. The vaccines have proven remarkably effective, and we have some promising antiviral treatments on the horizon. But of course, much of the world is still unvaccinated, and the new omicron variant is raising a great deal of concern—where are we in this process?

Farrar: Two years can seem like a very long time, given what we’ve all been through. But perhaps in the bigger picture, it is a very short time. We’re two years into the emergence of a brand new human pathogen. We know a lot more now than we did two years or 18 months ago, but there are still enormous unknowns. There is still uncertainty on the origins of the virus and its future evolution. We’re still learning about omicron, and there will be other variants that emerge. We need to learn more about the underlying pathogenesis of COVID and what drives the transmission, clinical severity, and immunity. All of this will inform our ability to make therapeutics and vaccines to provide long-term protection and reduce transmission. And we need to know more about the potential long-term consequences of infection and long-COVID.

What about the long-term outlook? When do you think COVID-19 will be viewed as an endemic disease, rather than as a global health emergency?

Farrar: Any talk that the pandemic phase is coming to an end is premature. We’re going through this highly variable period with waves that depend on the evolution of the virus, immunity, and access to vaccines. I think that this period will be quite protracted. Around the world, COVID’s impact will depend on access to the essential tools needed to lessen the impact, such as vaccines, tests, personal protective equipment, oxygen, and therapeutics.

And then gradually over time—certainly through 2022 and into 2023 and possibly beyond in some parts of the world—we will have a period of continued oscillations in the frequency of waves of infection, hospitalizations, and deaths.

I don’t think anybody thinks this infection is going away any time soon. It’s part of humanity now. And even in the transition to the endemic era, we will still have transmission and we will still, sadly, have some hospitalizations and deaths. However, we are not passive observers of this or how it pans out. Science has provided the tools, and those tools will get better. But the science and the tools are only fully effective if we share them equitably—and only politicians can make that happen.

Your book is a reminder of just how much, and how quickly, scientists had to learn about this novel virus. What are the biggest lessons for science in how to improve that process, particularly in times of crisis?

Farrar: One obvious lesson is the critical importance of science. And I don’t just mean vaccine development. I mean social sciences, biomedical science, immunology, virology, mathematical modeling, economics. You can’t just build that science when you think you need it: investment in people, teams, and infrastructure over years provides the bedrock that is so important in a crisis.

The vaccines were building off decades of investment in basic discovery science—such as in the RNA technology for cancer therapies, or the adenovirus vaccines for severe acute respiratory syndrome (SARS-1) and the Middle East respiratory syndrome (MERS) that were repurposed for COVID-19. And I think this is a huge lesson for all of us: investment in discovery science is absolutely critical. You can’t invent it in a crisis.

“You can’t just build that science when you think you need it: investment in people, teams, and infrastructure over years provides the bedrock that is so important in a crisis.”

Of course, we need to make sure that we’re prepared for the great threats that we might face. We need a trustworthy regulatory environment to consider novel interventions. We need vaccine manufacturing around the world—not just in some countries. So there are many lessons to be learned, but the fundamental one is, in a crisis, you build off what you’ve already got. And whether it’s fundamental science, or trust, or communication, or capacity in your public health or clinical systems, or the governance of your public health, or your political processes—the ability to respond to a crisis is determined by what people, infrastructure, and trust you have in place before it happens.

Although we’re still very much in the throes of this pandemic, many experts believe that other future pandemics are almost inevitable. Do you agree with that assessment?

Farrar: It’s not a question of whether pandemics will happen, but when. Their impact will be determined by how well prepared we are when they occur, and how we respond. Diseases like SARS-1 or COVID-19 are the symptoms and outcomes of key drivers in the twenty-first century, which include land use change, ecological and environmental change, climate change, change of the relationship between animals and humans, and change in how we interact with nature.

And then of course, there’s urbanization. Big urban centers are where these epidemics get amplified because of the proximity of people, as we found in Ebola in West Africa in 2014 and in Wuhan in 2019. With trade and travel, these interconnected cities can pass pathogens around the world within hours. We need to see SARS-1, Ebola, Zika, influenza, MERS, or COVID not as drivers, but as symptoms—they are the outcomes. And we would be well advised to focus on the drivers as well as on the pandemics themselves.

One bright spot in this pandemic is the speed at which the vaccines were developed. In your book, you note that the work done in 2014 on the Ebola vaccine really helped pave the way. Can you elaborate on that?

Farrar: We should remember that up until the Ebola crisis, almost no research had been done during epidemics. The 2014 outbreak was the first time in an epidemic crisis that really high-quality research was conducted in real-time, leading to the development of a vaccine and therapeutics.

“The ability to respond to a crisis is determined by what people, infrastructure, and trust you have in place before it happens.”

And there is no doubt that the lessons learned in that crisis helped the response to COVID. It is remarkable that, before 2014, essentially no clinical research was done during an epidemic. It was considered too difficult. Some people even questioned the ethics of doing research in an epidemic. Research was something that took you three years to set up, and then a few years to conduct the studies, and then it took two more years to report results. That changed with the Ebola vaccines. The experience led to the creation of the WHO R&D Blueprint, the Social Science in Humanitarian Action Platform, the International Severe Acute Respiratory and emerging Infection Consortium, and the global Coalition for Epidemic Preparedness Innovations to ensure that research was integral to all future epidemic prevention and responses.

And that became a huge component in the ability to conduct research in the COVID pandemic. You can, and in fact, you must conduct research in an epidemic.

Public-private partnerships have played a big role in helping to develop vaccines, diagnostics, and therapeutics. How important will such partnerships be in future global health preparedness efforts?

Farrar: Industry is absolutely critical to research and development, the manufacturing and distribution of vaccines and therapeutics, and diagnostic testing. That capacity does not exist within the public sector, nor should it.

But when we’re talking about epidemics or drug-resistant infections, we need to recalibrate what the public sector asks or mandates from the private sector. I don’t like analogies with the military, but effectively, the public sector tells industry, “We need fighter jets. We need aircraft carriers.” If the government doesn’t set priorities, why would industry make a remedy for something that may never happen?

We’re going to have to change the incentives to encourage industry to develop a vaccine for an epidemic disease that may not happen or for an antibiotic that may never be used, because at some point society will desperately need them.

Wellcome is one of the biggest nongovernmental funders of science and research in the world. What role do you see for Wellcome and other philanthropies in shaping science?

Farrar: We shouldn’t overstate the scale of philanthropy. The numbers seem big, but compared to what governments and industry can bring to bear, philanthropy is not at the same scale. Philanthropy’s role is not to be the biggest player in the room, but to do things that the commercial sector and the government may not or cannot do.

There is an inherent conservatism in using taxpayers’ money to fund science, and that’s absolutely right. And in the commercial world, of course, there are very strong commercial drivers. Philanthropy doesn’t have those constraints. I think that is philanthropy’s key role: to be that catalytic disruptor in a positive, constructive way. Its role is to take greater risks than some others should or can and to push forward innovation, to ask questions, to do things differently, and to use their independence to challenge the status quo.

Last year you announced that Wellcome is going to focus not just on discovery research but also goal-oriented research to tackle infectious diseases, climate change and health, and mental health. What inspired that decision?

Farrar: They are all key issues for the twenty-first century, and they will especially impact people in marginalized communities around the world as well as younger generations. There are also features that go across all of these challenges. We’ve talked about climate being a driver of epidemic diseases; it’s also a driver of where mosquitoes fly, where ticks locate, and where animal vectors might go. There is also a great deal of inequality in the way climate will affect lives around the world and, I am afraid, mental health—particularly young people’s mental health issues, which have been neglected and stigmatized for too long. I also believe that science can and will play a role in addressing these challenges. But it must be science that is committed to ensuring that everybody has equitable access to its benefits, and science that is part of the societies that sustain, support, and—I hope—trust it. So I think these are distinct challenges, but they overlap.

“I think that is philanthropy’s key role: to be that catalytic disruptor in a positive, constructive way.”

They also overlap with discovery science. Wellcome remains absolutely committed to the freedom of discovery science—the bedrock of innovative of ideas which will change the world tomorrow, or in 50 years’ time.

There is a lot of discussion among the scientific community about why there’s so much misinformation about COVID. What observations do you have on that?

Farrar: Over the last two years, we’ve been faced with an enormous global challenge. We need to acknowledge that the vast majority of people in the world have trusted science—perhaps more than they trust politicians—and have been willing to accept science, including accepting a vaccine that was developed in 10 months into their bodies.

In many countries, majorities have accepted wearing a mask. They’ve accepted working from home. They’ve accepted that their schools will have to adjust, their workplaces will have to adjust. And the role of science in society is larger today than probably at any point in my life, with the possible exception of the late 1960s and the era of the moonshot.

Science is on the front page of every newspaper. More people than not are able to understand the difference between a vaccine and a drug and can define what a virus is.

However, there will always be people who question science, doubt it, and challenge it. This has been true throughout history. We need to recognize that there will be some people who one may never persuade. And there is probably a much larger group of people who are just not sure—for perfectly understandable personal reasons. They are not convinced but are not totally against it, and they will listen to evidence.

What we can’t expect is that everybody will trust us or see the world as we do. That level of trust is not built in a crisis. It’s built over years before any crisis hits. Do people basically trust the scientific process, their political system, the public health system, and the doctor or the nurse in front of them? That’s built up over years or decades. And you then rely on it when there is a crisis.

And how do scientists or public health officials build that trust?

Farrar: I think scientists have done a lot more in the last two years to build trust. And I think that is the sort of thing all of us are going to have to keep doing in the future. The things that help build trust are transparency, humility, and communication—honest communication, both of what you know and what you don’t know. And I think that trust is built up over years through personal communications, but also through our education system, from primary school through university and technical college, through the workplace, and yes, through the media. Trust is something that builds over time in a society. And of course, you can lose it in an hour.

Throughout this pandemic, you and so many other scientists and public health experts have been the focus of some intense vitriol and anger over lockdowns and other public health measures. Did you envision this level of anger five years ago?

Farrar: Five years ago, nobody could have predicted the level of vitriol, anger, and the personal threats. I’ve heard from friends in the Netherlands, Germany, Korea, China, the United States, and here in the UK who have had similar experiences with death threats aimed at us or our families—very personal abuse, as well as just general frustration and anger.

“What we can’t expect is that everybody will trust us or see the world as we do. That level of trust is not built in a crisis. It’s built over years, before any crisis hits.”

But none of us, including myself, could have predicted the scale of disruption to the whole of society that COVID has caused over the last two years. It’s not just a health issue. It’s an economic, political, social, education, and commercial issue. There is no sector of society in any country that hasn’t been affected. And I think, outside of war, when has that happened in the last hundred years?

We are living through history: 100 years from now, people will still be talking about COVID-19. When you read a history book about the 1918 flu pandemic, there’s almost a romantic sense of people banding together despite the fact that tens of millions of people died.

But the truth is, when you live through history being made, it’s awful. My father was a prisoner of war for five and a half years in the Second World War, and my mother was an army lorry driver. They lost friends, they lost family members. Their lives were disrupted. History, as it’s being made, is very painful to live through.

For at least the last two decades, you and many others have advocated for major global public health reforms such as disease surveillance and public health financing. Are you hopeful that global leaders will take heed and really make the reforms that are necessary?

Farrar: I’m not sure whether I’m optimistic or pessimistic. If you look back over the last 100 years or so, major reforms have been driven by crisis. After the Second World War, for instance, people said, “Never again. We’re going to create the United Nations. We’re going to create World Bank, the International Monetary Fund. We’re going to create the World Health Organization—because we know that we can’t go back to how it was before.”

“If you look back over the last 100 years or so, major reforms have been driven by crisis.”

And I think we’re at one of those moments in history. We have to ask ourselves if we don’t reform now, will we ever reform? Of course today, it’s extraordinarily difficult to do that because of geopolitical tensions, but that was also the case in 1945. And if we don’t, in a decade or two, we will be back where we are now. And that’s unacceptable. If not now, when?

Countries need to decide how they’re going to balance domestic pressures with international responsibilities. I think solving that problem is at the heart of whether we’ll be able to address the great challenges of the twenty-first century. For instance, the domestic pressure in this pandemic is to only offer vaccines to your own citizens, but the enlightened, self-interested choice is to offer them globally, as we can see with the emergence of new variants. After you come out of these crises, you are faced with a choice as a global community, and you either choose to reform, or you choose not to. It’s for all of us to decide what sort of world we want to live in. The global financial crisis of 2008 and now COVID are the first two real crises of the twenty-first century. They are transnational and they demand transnational action. Climate change is the same type of globalized crisis. It can’t be addressed by a single country. We’re going to have to find ways to work together or we will fail together, whether for pandemics or climate change, drug resistance, inequality, or access to energy and water—these are the great transnational challenges of our time. In the twenty-first century, the cost of failure is surely too high.

Sunday, January 2, 2022

10 Things to Love About America

By Peggy Noonan.............

Am­jad Masad came to Amer­ica in Jan­uary 2012. He was from Am­man, Jor­dan, and 24. He came be­cause his fa­ther, a Pales­tin­ian im­mi­grant to Jor­dan and a gov­ern­ment worker, bought him a com­puter when he was 6. Am­jad fell in love and dis­cov­ered his true lan­guage. He stud­ied the his­tory of the com­puter and be­came en­am­ored of the U.S. and Sil­i­con Val­ley. He imag­ined the lat­ter as a fu­tur­is­tic place with fly­ing cars and float­ing build­ings. He saw the 1999 movie “Pi­rates of Sil­i­con Val­ley,” about Steve Jobs and Bill Gates, and de­cided Amer­ica was the place he must be.

His mem­ory of ar­riv­ing at John F. Kennedy In­ternational Air­port is a jum­ble, but what he saw from the bridge go­ing into Man­hat­tan was un­for­get­table—the New York sky­line gleam­ing in the dis­tance. It was like a spir­i­tual ex­pe­ri­ence. He was here.

He set­tled in New York, worked at a startup, then moved west—he needed to be in Sil­i­con Val­ley. Five years ago he be­came co-founder and CEO of Replit, a com­pany that of­fers tools to learn pro­gram­ming. It em­ploys 40 peo­ple full-time and 10 con­trac­tors.

On Tues­day af­ter­noon Mr. Masad, who be­came a cit­i­zen in 2019, thought about the 10th an­niver­sary of his ar­rival. He was so grate­ful for three things: a com­pany, a fam­ily, a house. He and his wife and busi­ness part­ner, Haya Odeh, also from Jor­dan, started talk­ing about Amer­ica. At 3:56 p.m. ET, he posted a Twit­ter thread.

“I landed in the United States 10 years ago with noth­ing but credit card debt. Af­ter one startup exit, one big tech job, and one uni­corn, I gen­uinely be­lieve that it wouldn’t have been pos­si­ble any­where else in the world. Here are 10 things that I love about this coun­try:

“1. Work Ethic. First thing I no­ticed was that every­one re­gard­less of oc­cu­pa­tion took pride in do­ing a bang-up job, even when no one looked. I asked peo­ple: ‘why do you pour every­thing into a job even when it is seem­ingly thank­less?’ And it was like ask­ing fish ‘what is wa­ter?’

“2. Lack of cor­rup­tion. In the 10 years in the US, I’ve never been asked for a bribe, and that’s sur­pris­ing. When you know that you pre­dictably get to keep a size­able por­tion of the value you cre­ate and that no one will ar­bi­trar­ily stop you, it makes it eas­ier to be am­bi­tious.

“3. Win-win mind­set. Peo­ple don’t try to screw you on deals, they play the long game, and align in­cen­tives in such a way that every­one wins. This is es­pe­cially ap­par­ent in Sil­i­con Val­ley where you can’t un­der­es­ti-mate any­one be­cause one day you might be work­ing for them.

“4. Re­ward­ing tal­ent. From sports to en­gi­neer­ing, Amer­ica is ob­sessed with prop­erly re­ward­ing tal­ent. If you’re good, you’ll get rec­og­nized. The mar­ket for tal­ent is dy­namic—if you don’t feel val­ued to­day, you can find a bet­ter place to­mor­row.

“5. Open to weirdos. Be­cause you never know where the next tech, sports, or arts in­no­va­tion will come from, Amer­ica had to be open to weird­ness. Weirdos thrive with­out be­ing crushed. We em­ploy peo­ple with the most in­ter­est­ing back-grounds—dropouts to artists—they’re awe­some!

“6. For­give­ness. Weird and in­no­v­ative peo­ple have to put them­selves out there, and as part of that, they’re go­ing to make mis­takes in pub­lic. The cul­ture here val­ues au­then­tic­ity, and if you’re au­then­tic and open about your fail­ures, you’ll get a sec­ond and a third chance.

“7. Ba­sic in­frastructure. Amer­i­cans take care of their pub­lic spa­ces. Parks are clean, sub­ways and busses run on time, and util­i­ties & ser­vices just work. Be­cause life can be liv­able for a time with­out in­come, it was pos­si­ble for us to quit our jobs and boot­strap our busi­ness.

“8. Op­ti­mism. When you step foot in the US there is a pal­pa­ble sense of op­ti­mism. Peo­ple be­lieve that to­mor­row will be bet­ter than to­day. They don’t know where progress will come from, but that’s why they’re open to dif­fer­ences. When we started up even un­be­liev­ers en­cour­aged us.

“9. Free­dom. Clearly a cliche, but it’s to­tally true. None of the above works if you’re not free to ex­plore & tin­ker, to build com­pa­nies, and to move freely. I still find it amaz­ing that if I re­spect the law and oth­ers, I can do what­ever I want with­out be­ing com­pelled/re­stricted.

“10. Ac­cess to cap­i­tal. It’s a lot harder to in­no­vate & try to change the world with­out cap­i­tal. If you have a good idea & track record, then some­one will be will­ing to bet on you. The re­spect for en­tre­pre­neur-ship in this coun­try is in­spir­ing. And it makes the whole thing tick.”

I was sent the thread by email and thought: Beau­ti­ful. So much on the list is what I see. Hard­work­ing: In my town every­one from bi­cy­cle de­liv­ery­men to mas­ters and mis­tresses of the uni­verse work them­selves like rented mules. And, some­how most mov­ing, that we’re open to weirdos: We al­ways have been; it’s in our DNA; it ex­plains a lot of our pol­i­tics and cul­ture; it’s good that it con­tin­ues. “This Is Us.”

At the end, Mr. Masad said he was speak­ing gen­er­ally, that char­ac­ter lim­its don’t in­vite nu­ance, that there’s no call to sit back self-sat­is­fied, that every­thing can be made bet­ter. But he added a warn­ing: “Many of the things that I talked about are un­der threat, largely from peo­ple who don’t know how spe­cial they have it. Amer­ica is worth pro­tect­ing, and re­al­iz­ing that progress can be made with­out de­stroy­ing the things that made it spe­cial.”

The thread went vi­ral and he was en­gulfed in feed­back. The re­ac­tion, he said Wednes­day by phone from his Palo Alto, Calif., home, “was over­whelm­ingly pos­i­tive.” Tellingly, “the ma­jor­ity of the real pos­i­tive, heart­warm­ing, ex­cited feed­back has been from other im­mi­grants. They add to the list what they ap­pre­ci­ate.” He noted the num­ber of na­tive-born Amer­i­cans telling him, “Wow, this is an out­side per­spec­tive that I don’t have.”

Mr. Masad got the most push­back on in­frastructure. He stood his ground. When he got to New York, Cen­tral Park was a beau­ti­fully main­tained gem, and on the streets he ap­pre­ciated “the mu­sic, the arts, free con­certs, ran­dom pop­ups—all for free and open to all.” By infrastructure, he also meant our sys­tem of laws and arrange­ments. “When we started the com­pany, we got our health in­sur­ance through Oba­ma­Care,” to keep costs down. It worked.

Any­way, the thread was a breath of fresh air.

The past few years, maybe decades, we’ve be­come an in­creas­ingly self-damn­ing peo­ple. As a na­tion we harry our­selves into a state of per­ma­nent de­pres­sion over our fail­ures and flaws and what we imag­ine, be­cause we keep be­ing told, is the in­nate wicked­ness of our sys­tem, which keeps jus­tice from hap­pen­ing and life from be­ing good.

Maybe we got car­ried away. Maybe we have it wrong. Maybe those who are new here and ob­serve us with fresh eyes see more clearly than we do. As long as our im­mi­grants are talk­ing like this, maybe we’ve still got it goin’ on. What a wel­come thought. Thank you, Am­jad Masad.

God bless all Americans, old and new, here by birth, belief or both, as we arrive together in an unknown place called 2022. Let’s keep our eyes fresh, shall we? 

Tuesday, December 28, 2021

Forecasting the Omicron winter: Experts envision various scenarios

(A fairly long, but pithy explanation of what we can look forward to for the future)
December 27, 2021

Since the Omicron variant was discovered four weeks ago, epidemiologists have been crunching data as fast as scientists on the front lines can produce it to scope out what the newest coronavirus variant means for the pandemic this winter beyond. While many uncertainties remain, disease modelers have cranked out several potential visions for what the first months of 2022 may have in store. Worst case — they could bring the deadliest phase of the pandemic yet. But even the most optimistic scenarios aren’t exactly pretty.

Which immediate future plays out will be a function of a few big unknowns — some already baked into Omicron’s biology and some that can be altered based on how people behave in the coming days and weeks. Further out, the models get fuzzier still. But though they differ in the details, all of them point to SARS-CoV-2 being here to stay.

“I think we may be in for a longer road than we had hoped,” said Jeffrey Shaman, an infectious disease forecaster at Columbia University’s Mailman School of Public Health.

What’s obvious about Omicron is its record-setting spread. Harder to grasp is the extent to which it is intrinsically more contagious than previous variants, versus the extent to which it’s simply better at infecting vaccinated and previously infected individuals.

In a preprint published this week, Shaman and his colleague Wan Yang tried to disentangle these two dynamics using data from South Africa, where the variant was first discovered. They found Omicron to be only about 35% more transmissible than Delta, a departure from the going estimate of twice to five times as infectious. The takeaway? The researchers believe that the majority of South Africans had been infected with SARS-CoV-2 before the Omicron wave, meaning the rapid spread was due more to the variant’s ability to erode the immunity conferred by previous infections or vaccines.

“That’s not something that should apply directly to other countries, like the U.S., because it’s very specific to the South African context,” said Shaman. Different strains took off there, leading to an immunological history not as relevant to the Northern Hemisphere. “How much immune erosion we can expect here will be hard to say,” said Shaman. “However, we’re talking about large numbers, so we could imagine it’s going to be pretty potent at running by the immunity of people who’ve already been infected or vaccinated in most places it shows up.”

That could be a recipe for the Omicron surge being the most devastating one yet. In one of the most comprehensive forecasts to date, researchers from the Covid-19 Modeling Consortium at the University of Texas, Austin, played out 18 different scenarios for how the new variant might hit the U.S.

In the report, which has not been peer-reviewed, the worst outcome arose when the researchers assumed Omicron to be no more transmissible than Delta but far better at evading immunity and more likely to cause severe disease — meaning requiring hospitalization. Combined with low booster uptake, this scenario resulted in cases peaking in early February, resulting in 342,000 deaths over the first six months of the year, a 20% spike over Covid-19 casualties in 2021.

In the most optimistic outcome — which assumes high transmissibility relative to Delta, little ability to evade immunity, slightly elevated severity, and high booster uptake — the researchers project the Omicron spike to lead to 50% fewer deaths compared to last year.

“Across all scenarios we expect to see cases that are at least as high as the Delta surge in September 2021, but that would be the minimum,” said Lauren Ancel Meyers, director of the UT Covid-19 Modeling Consortium. “At a maximum we could see a surge in cases that is even higher than our January 2021 surge, which would make it the biggest national surge seen to date.”

Whether these surges lead to equally calamitous casualties hinges hugely on that question of severity, an issue that has remained murky for weeks. On Wednesday, however, three separate teams of researchers, tracking Omicron’s advance through South Africa, Scotland, and England, reported new findings that suggesting the variant was less likely than Delta to send people to hospitals. Though preliminary, these studies are providing an injection of optimism that the worst-case scenarios won’t come to pass.
Looking overseas for clues

In South Africa, where the Omicron infection wave went steeply up and then sharply back down, particularly in Gauteng province, the peak of hospitalizations looks to be about half of the previous Delta wave. Deaths and ICU admissions appear even lower.

“That initial coming in really hot … is really scary, but what we saw in Gauteng, of its kind of crashing early, gives some hope here,” said computational biologist Trevor Bedford of the Fred Hutchinson Cancer Research Center, who was among the first U.S. experts to sound the initial alarm on SARS-CoV-2.

It’s a tricky thing though, to extrapolate the shape of that curve from South African provinces like Gauteng because the populations there look very different from either Europe or the U.S. People there tend to be younger, and therefore less prone to serious disease than in the U.S., where the population skews older and sicker, with more comorbidities like heart disease and diabetes. Another difference is that in South Africa, Omicron was a standalone surge. In contrast, here Omicron is hitting on top of Delta surges in the Northeast and Midwest, compounding the strain on health care systems.

Bedford is keeping an eye on London, where infections have exploded in recent days. Even by conservative estimates of detection rates, 1% of London is getting infected every day. That’s a big number. And even if the risk of hospitalization may be substantially lower per individual — a new analysis suggests that might be the case — that many infections would be markedly disruptive to society and to the functioning of health care systems. “So it really matters when that crests,” said Bedford. “If it crashes as early as it did in Gauteng, then it’s not so bad. But if it gets past that, then things get bad pretty quickly.”

Since Friday, Meyers’ team has updated its forecasts based on the increasing evidence that Omicron is becoming dominant in the U.S. even faster than expected. The researchers will continue to do so as more and better data on the severity question come in. But given how rapidly Omicron is advancing, the peak might arrive before firm answers do. Especially if a “less severe” narrative begins to take hold and people’s behaviors don’t change.

“Even in our most optimistic scenarios, the numbers are already surging to such high levels that we’re worried about what’s to come in the next couple of weeks in our hospitals,” said Meyers.

The models might be noisy; assumptions and uncertainties abound when data is sparse, which happens when a new variant emerges. But they’re better than nothing. And right now, they’re telling us we’ve entered a high-risk period, said Meyers. “So if ever there was a time to err on the side of caution, it’s now,” she said. “If we all tap the brakes a little bit right now, that can help us to protect the integrity of our health care system and also prevent us from really having to slam on the brakes at some point in the future.”
‘A viral blizzard.’

On Tuesday, President Biden announced steps the White House is taking to curb Covid-19 as Omicron overtakes Delta, which was already causing 115,000 daily new infections at the beginning of December. Those steps included delivering 500 million at-home rapid tests to households, starting in January, and urging Americans to get vaccinated and boosted. “Your choice can be the difference between life and death,” Biden said.
The administration also announced it would deploy some 1,000 military doctors, nurses, and medics to support hospitals, as well as activate pop-up vaccination and testing units run by the Federal Emergency Management Agency. Some public health experts say it’s not enough to deal with the coming body blow to the American health care system.

“All of the surges we’ve had to date have been regional and time-limited in a way that meant you could allocate resources from one place to another as needed,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. When the first wave of 2020 slammed New York City, other states sent ventilators and personal protective equipment. Later that summer, supplies were shuttled to Florida and other southern states feeling their first surge. And on through 2021 as northern states felt the worst of the winter wave, and the south got smacked with Delta this past summer. But SARS-CoV-2 has never walloped everywhere all at once.

“We’re going to be in a viral blizzard nationwide these next two to eight weeks, and the impact of this perfect storm is going to be felt hardest by our health care systems,” said Osterholm. “It could very well represent the darkest days of the pandemic.”

The U.S. currently employs about 9.8 million doctors, nurses, and high-level medical technicians. Omicron’s ability to erode protections from vaccination and prior infections means that at least 10% of those health care workers are likely to become infected and have to isolate, even if their symptoms are mild. “That’s 900,000 people off the job at a time when we’re already hanging on by the skin of our teeth as it is,” said Osterholm. “The president’s plan does not really address that problem.”
A worldwide wave

It’s not just the U.S. being hit in every state simultaneously. For the first time since the start of the pandemic, modelers are expecting a rapid surge all over the world.

On Wednesday, the University of Washington Institute for Health Metrics and Evaluation released new projections, showing approximately 3 billion infections globally between now and the end of February. “We believe it will reach all countries quite soon,” the institute’s director, Chris Murray, told reporters at a briefing.

If the numbers are to be believed — critics have previously assailed the institute’s Covid-19 modeling as unreliable — then we’re talking about two years’ worth of infections cresting in the next two months. Murray’s team is projecting comparatively modest deaths during that staggering surge, fewer than the number caused by Delta, owing to a vast number of the infections being mild or asymptomatic. But stealth spread coupled with Omicron’s rapid replication rate causes other sorts of problems; traditional public health strategies like testing, contact tracing, isolation, and quarantine start to fall apart.

“There’s just not enough time to detect infections and act on that information,” said William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. That means even countries who’ve had very few cases, like New Zealand and many small Pacific Islands, may have a hard time holding off Omicron.

China, where most citizens have received either the Sinopharm or Sinovac shots, is particularly vulnerable to major disease and disruption. Both vaccines have shown particular weakness against Omicron in preliminary lab studies. Strict lockdowns in areas where many countries still outsource production of many pharmaceuticals and medical supplies could lead to new and more severe rounds of shortages.

“As countries experience surges, there’s going to be demand within those countries for a whole range of products and treatments, which limits the ability to get those to other countries that lack the manufacturing capacity themselves,” said Moss. “This pandemic, over and over, has exacerbated these inequalities, and a huge global surge will place the low-income and most vulnerable countries at a disadvantage yet again.”

He also worries about the long-term knock-on effects of massive disruptions to already fragile health care systems. Huge waves will likely mean pausing other medical services, like malaria and tuberculosis prevention, care for chronic disease patients, and routine childhood immunization. “I’m very afraid of huge measles outbreaks in the next year or two, particularly in sub-Saharan Africa,” said Moss. “We could be seeing ripple effects of Omicron for years.”
The long view

The newest variant has also inexorably altered the course of the pandemic. Although it’s still unclear how high and how fast the curves will climb (and how many people will get very sick or die in the process), Murray said when he and his team run their models further out, they see Covid-19 quieting down for much of 2022. “The thing Omicron will do because it’s going to infect 40% of the entire world in the next two months, is it will raise population-wide immunity for a while,” he said. After a massive Omicron wave passes through, transmission should drop to very low levels. Ongoing rollouts of vaccines should help keep it that way.

But forecasting is hard and gets harder the further out you go. And the one big caveat to every far-out-future scenario is how the coronavirus will evolve next. “The long-term prospects for 2022 and beyond are very much a function of what the next variant that comes along shows,” said Murray.

Next year should see the scaling-up of antiviral production, he also pointed out. As future variants drive new waves in infections, the wide availability of these treatments — especially Pfizer’s newly authorized pill, which the company expects to make 120 million courses of in 2022, should blunt hospitalizations and deaths further.

“We would be in a different place, at least temporarily, at the end of the current surge than we’ve been at any point since the beginning of the pandemic,” said UT’s Meyers.

The result could be something that starts to look like SARS-CoV-2 becoming an endemic coronavirus and joining a quartet of more ancient, cold-causing cousins. As Bedford has suggested, we might look back on the Omicron surge as the last wave of the pandemic. If, after all the dust settles, Omicron does turn out to cause milder disease, then its world domination could turn out to be a good thing in the very grand scheme of things.

But between variant evolution and waning immunity, that’s not to say the virus won’t still lead to significant casualties in that endemic future. “I could still easily imagine 100,000 people [in the United States] dying every year from Covid in the endemic state just because you have a very big number of infections, even if the infection fatality rate is quite low,” Bedford told STAT. In 2020, 385,000 Americans died from Covid-19, according to data collected by the CDC. By November of this year, deaths associated with Covid-19 in 2021 had already surpassed that.

But guessing where exactly the next variant will arise and what problematic properties it will have is pretty much impossible, even for the sharpest Covid minds. Back in September, Bedford predicted that whatever came next would almost certainly be a twist of the then-dominant variant, Delta. But then Omicron materialized almost out of nowhere — its closest evolutionary relatives versions of the virus not seen since summer of 2020, leading some scientists to hypothesize that it might have come from an animal host.

If it could happen with Omicron, it could certainly happen again. SARS-CoV-2 is what’s known as a promiscuous virus. It gets around, and not just in humans. Scientists have found it in dogs and house cats. Tigers and lions. Gorillas. Mink. And it’s really taken off in whitetail deer.

Last month, researchers reported that up to 40% of deer populations in Illinois, Michigan, Pennsylvania, and New York had antibodies to the coronavirus. Another group found active SARS-CoV-2 infections in at least 30% of deer tested across Iowa in 2020. The findings suggest that the animals could become a long-term reservoir: a safe haven where the virus can circulate and evolve indefinitely, spilling back mutated versions of it to humans from time to time. While the virus doesn’t have an infinite capacity to mutate — it still needs to be able to bind to human receptors to get into our cells — this promiscuity will certainly complicate efforts to manage SARS-CoV-2 in the coming years and decades. And yes, you heard that right: decades.

“Whether or not it becomes endemic in six months or a year or five years from now, this virus is sticking around on Planet Earth, probably forever,” said Jeremy Kamil, a virologist at Louisiana State University Health Shreveport. “As long as humans and animals and rodents are around, it will continue to evolve and change and probably won’t be the threat it is today, but it’s not going away.”

Even if we accept that permanence, we still hunger to see around the corner. At the beginning of the pandemic, Osterholm and his colleagues attempted to predict its future course, using historical influenza pandemics as a guide. As STAT’s Sharon Begley wrote at the time, they envisioned three possible futures: a monster-wave followed by mini-waves every few months with placid times between, recurring small outbreaks, and constant crisis. What we’ve had in reality is something that doesn’t look exactly like any of these.

In the United States, SARS-CoV-2 was never really brought under control, so the successive viral surges of spring, then summer, then winter of 2020 weren’t really waved so much as humps in an ever-building coronavirus current. Vaccines brought a precipitous drop in the first few months of 2021, but then Delta emerged, and then Omicron, and now 2021 is looking like 2020 again, but bigger, with even more infectious energy behind it.

“At the time, we had no way to understand the power of these variants,” said Osterholm. “What has made this such a challenging pathogen to predict is that its mutational changes are really different than what we see with the flu virus. We thought it would behave somewhat like influenza, but it’s turned out to be a very different animal.”

Helen Branswell contributed reporting.

Correction: An earlier version of this story misstated Trevor Bedford’s view on when SARS-CoV-2 will enter the endemic phase. He says it will reach that point next year, after the Omicron wave.

Wednesday, December 15, 2021

Retiring not expiring...

Some of you may have already heard the rumors, but I’m making it official today. Yes, I’m retiring, but that doesn’t mean the Firefighter Challenge is too. In fact, the future has never been brighter for the program.

After much thought, I felt the Challenge in the United States would best continue and hopefully expand if placed under the umbrella of a nonprofit that aligns with its purpose. The First Responder Institute, a 501(c)(3) nonprofit organization, will become home to the Challenge effective in the early part of 2022. You’re probably unfamiliar with this group as they’ve worked quietly behind the scenes for many years focused on various research endeavors. However, I’m familiar with them as one of the founding members. Their mission perfectly aligns with that of the Challenge: to inspire First Responders to aim for the highest level of fitness, wellness, and safety.

Reflecting on my incredible journey, I vividly remember in 1974 when Chief David Gratz, Director of Fire/Rescue Services, Montgomery County, MD, walked into the Human Performance Laboratory at the Sports Medicine Center of the University of Maryland. He, accompanied with Dr. Leonard Marks, expressed the need for a validated test to use for new recruits. The mission: develop a physical ability test to determine whether a job applicant had the requisite capabilities to perform the essential job functions. As part of the study in 1976, my colleagues and I developed a physical testing course as a living laboratory. After witnessing the favorable response and proven results of the course, I launched the Firefighter Challenge in 1991.

Fast forward 30+ years, this endeavor has exceeded well beyond my original vision. It has allowed me the privilege of interacting with thousands of firefighters from around the world. Many are not just competitors in the Challenge but are ambassadors of the importance of proper and ongoing training in the fire service.

I am indebted to our competitors and sponsors for making the Firefighter Challenge a global sensation and look forward to the exciting future ahead for the US operations. Soon you’ll be introduced to Russell Jackson, the CEO of the nonprofit that myself and members of the board recruited to carry the program to the next level. His background in the nonprofit sector is extensive, and we are honored that he accepted our invitation to help. In the coming weeks, a few Zoom sessions will be held so you can meet him but more importantly, hear about some of the enhancements coming to the Challenge in 2022 and beyond.

Until then, as I’ve jokingly been saying, “I’m retiring, not expiring!” Now my time will be free to focus on my original intent in developing research endeavors and professional development programs specific to the fire service. Furthermore, as the owner of the authored work, trademarks, etc., I will continue to support the Firefighter Challenge programs in other countries as part of OnTarget Challenge.

I’m confident that our paths will continue to cross. The First Responder Institute will further the positive impact the Challenge has already made in the fire sector. Thank you for your friendship and support!

Watch this space for more exciting adventures.