These Covid-19 vaccine candidates could change the way we make vaccines — if they work

March 28, 2022 KANKENNEWS

As urgency mounts for a Covid-19 coronavirus vaccine, a key question for scientists is whether this pandemic will be the watershed moment for two new technologies that have never before seen widespread use in humans. If proven effective, these approaches could dramatically speed up the development of other new vaccines and drastically lower costs, heralding a new era in the fight against infectious disease.

The main technologies gaining traction are vaccines that use an adenovirus vector and mRNA. Rather than construct a new vaccine from scratch, the idea behind these technologies is to use a standard set of parts, like a repurposed virus or a nanoparticle, to carry genetic material into a cell. That material — DNA or RNA — can then code for specific proteins from a virus.

Once one of these delivery platforms are proven safe, it’s just a matter of tweaking DNA and RNA strands. That’s much faster than conventional vaccines, which involve culturing large quantities of viruses that are then weakened, inactivated, or separated into tiny fragments and purified — processes that require years of cumbersome trial-and-error and safety testing.

“If the new platforms work in a way, that may actually change how other vaccines are produced,” Rahul Gupta, senior vice president and chief medical and health officer at the March of Dimes, told reporters during a National Press Foundation webinar on August 7. “So we may be at the cusp of very much a new technology that we’re going to see for the first time in over a century, basically.”

Researchers using these new platforms have recently posted some encouraging results. On Thursday, the pharmaceutical giant Pfizer published results of its phase 1 and phase 2 clinical trials for its mRNA-based vaccine platform in the journal Nature. Moderna is now entering phase 3 trials for its mRNA platform for Covid-19.

Meanwhile, Oxford University’s Jenner Institute is partnering with AstraZeneca to develop a vaccine using an adenovirus vector platform. It has also published some early promising results.

But there is a lot of competition, with more than 200 coronavirus vaccine candidates under investigation around the world. Two dozen are undergoing testing in humans, and six are in phase 3 clinical trials as of August 13.

A vaccine effort of this scale is astonishing for a disease that was discovered less than a year ago. But the immense health and economic devastation of the Covid-19 pandemic has prompted an unprecedented level of collaboration among scientists, as well as funding from governments, private companies, and philanthropists. That’s why some scientists expect there will be enough data proving the safety and efficacy of a Covid-19 vaccine in record time, possibly by the end of the year or early 2021. An effective, widely available vaccine would be a major step toward ending the pandemic.

However, there is no guarantee that any of these candidates will succeed, let alone whether a new vaccine technology will triumph over tried-and-true methods. Although companies working with the new platforms have readily cleared the earlier stages of clinical trials, they are now at the mercy of larger, slower phase 3 trials, where a lot can happen to derail their progress.

That’s why it’s important to understand how these novel strategies for preventing infection work, what they bring to the table, and the critical caveats to consider.

How most older vaccines work

Vaccines work by coaching the immune system to fight off a specific pathogen. When you get one, your white blood cells are being introduced to a potential threat, such as a virus or bacterium. That gives the immune system time to start mounting a response so that if the pathogen shows up another time, the body can quickly neutralize it.

Vaccines have been around in various forms for centuries, but the 20th century saw a boom in new ones for diseases such as polio, anthrax, pneumonia, meningitis, Hepatitis A, and influenza.

The conventional strategies for constructing vaccines that offer strong, long-lasting immunity involve mimicking the target. One of the most effective ways to do this is with a live attenuated vaccine. Here, a live form of the virus or bacterium is cultivated in such a way that it is weakened when given to a human. The pathogen can reproduce somewhat, but rarely enough to make the recipient sick. The most common vaccines — against smallpox, measles, mumps, and rubella — use live attenuated viruses.

Vaccines can also target toxic products of a bacterium or virus. Toxoid vaccines, like those for diphtheria and tetanus, are stable and safe but often require multiple doses.

Another approach is to use an inactivated version of the pathogen, usually a live pathogen that has been deliberately killed by heat or with a chemical treatment. This is the approach behind vaccines for diseases like Hepatitis A and rabies. Inactivated pathogen vaccines also often require more than one dose or boosters to retain immunity.

But instead of using whole-virus or bacterium particles, scientists can also use purified fragments of a pathogen — known as antigens — to trigger an immune reaction. These subunit vaccines tend to be stable, but they’re tricky to do right and often generate a weaker immune response than whole-pathogen vaccines.

Developing a vaccine using any of these methods, however, is time-consuming, often taking more than a decade to demonstrate that they’re safe and effective. That’s far too long during a pandemic like the one sweeping the world right now.

The new Covid-19 vaccine platforms harness human cells to make key components

Both mRNA vaccines and adenovirus vector vaccines build on the idea of a subunit vaccine. In the case of SARS-CoV-2, the virus that causes Covid-19, the most common subunit of interest is the spike protein.

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This protein is the business end of the virus. It’s what the coronavirus uses to dock with the ACE2 receptor on a human cell in order to enter the cell, make copies of itself, and then spread to other cells.

Scientists reason that they can coax the immune system to generate antibodies to this spike protein. Antibodies are proteins made by the immune system that attach to specific parts of a pathogen, thereby disabling it or marking it for destruction by other immune cells. If antibodies bind to the spike protein of a live SARS-CoV-2 virus, they could prevent it from causing an infection.

But with these new platforms, it’s not the spike protein of the virus that’s being injected, it’s the genetic instructions for making it. The main differences between mRNA vaccines and adenovirus vector vaccines are the genetic material they use and how they get it into the cell. The mRNA vaccines use mRNA, while adenovirus vaccines use DNA.

Once the instructions are inside the cell, the cell’s machinery reads them to manufacture the spike protein of the virus. The newly minted spike proteins are either secreted from the cell or attached to its surface, where other cells from the immune system can identify the spike protein and begin manufacturing antibodies to it.

The process ends up not only mimicking a key structure of the virus but also imitating how the virus works during an infection, which could potentially generate a stronger immune response and yield better protection compared with other approaches. And because these proteins are produced from within cells rather than injected from the outside, they may be less likely to provoke adverse reactions in the recipient.

How mRNA vaccines work

On August 11, President Donald Trump announced that the US government would buy 100 million doses of Moderna’s mRNA coronavirus vaccine in a deal valued at $1.53 billion, bringing the country’s total investment in the company to $2.48 billion. (The Department of Health and Human Services previously said it would buy 100 million doses of Pfizer’s mRNA vaccine.)

These are just a couple of the big bets the federal government has placed on different vaccine manufacturers, but the fact that it’s investing so much in a new approach like mRNA signals how much promise it holds.

mRNA stands for messenger ribonucleic acid. It’s a molecule that’s copied from DNA in a cell’s nucleus and used as the code for making a specific protein. If you think of the DNA in the nucleus as a giant cookbook containing all the recipes for all the meals you’ll ever eat, mRNA is the notecard you use to jot down instructions for making your favorite banana bread.

Compared to DNA, mRNA is shorter in length, less stable, and designed to be disposable. Your cells are making and breaking down mRNA strands all the time.

With an mRNA vaccine, the idea is to get a segment of mRNA that codes for a specific viral protein into a cell. For vaccine developers, that means that instead of going through the tedious process of isolating and purifying subunits of a virus, they can just change the code in a strand of mRNA. That makes the development process much faster than conventional approaches, which can take months or years.

“mRNA can literally be completed in days to weeks to create a brand-new vaccine,” said Drew Weissman, a professor of medicine at the University of Pennsylvania. He noted that it took only 66 days from when the genome of the SARS-CoV-2 virus was sequenced to when the first patient was injected with an mRNA-based Covid-19 vaccine.

One of the challenges with using mRNA is that your body can perceive it as a threat, as many viruses use RNA to encode their genomes. There are a lot of enzymes in the body that can readily digest RNA before it gets into a cell. (There are even RNA-digesting enzymes on your skin.) Free-floating mRNA strands in the body can trigger inflammation, so to shield the mRNA until it gets into a cell, developers encase it inside a lipid nanoparticle — a tiny oil bubble. The RNA strand itself is also modified to make it less inflammatory.

Once the mRNA is coded, modified, and encapsulated, it can then be injected. “All modified RNA vaccines for Covid are given intramuscularly, just like old-fashioned flu shots,” Weissman said.

While mRNA is getting a lot of attention, similar approaches are also undergoing tests. Inovio is developing a coronavirus vaccine that uses a double-stranded ring of DNA known as a plasmid. It requires a hand-held device to induce an electric current near the injection site, causing pores within the cell to open, which allows the plasmid to enter. The instructions in the plasmid can then be used to make viral proteins. The company expects to start phase 3 trials in September.

How recombinant adenovirus vector vaccines work

The other new vaccine platform technology for Covid-19 is the adenovirus vector. This is the approach companies such as CanSino Biologics and Johnson & Johnson are using for their vaccines. It’s also the basis for the famous vaccine candidate from Oxford University’s Jenner Institute, which is being developed with AstraZeneca and is now in phase 3 clinical trials.

The Russian government announced this week that it has an adenovirus vector vaccine for Covid-19, too. Dubbed Sputnik V, the vaccine has been registered for use, though many researchers outside of Russia are concerned that the vaccine gained approval without going through the full battery of clinical trials.

Adenoviruses are a family of viruses that usually cause mild illnesses with symptoms resembling those of a common cold or influenza, though an infection can be dangerous for people who have compromised immune systems or certain preexisting conditions.

“This suggests that they are less pathogenic and they can inherently induce protective immunity through nasal routes for respiratory infections,” University of Alberta Faculty of Medicine and Dentistry professor Babita Agrawal, who studies the immune system, said in an email. “Therefore, a vaccine based on [an adenovirus vector] could be certainly a good vaccine candidate against SARS-CoV-2.”

The virus itself is usually less than 100 nanometers in diameter and shaped like an icosahedron — a 20-sided shape with triangle faces, similar to D20 dice. At its corners, it has fibers that stick out.

The adenovirus is very efficient at getting into cells. Researchers have experimented with the adenovirus for years as a tool for gene therapy but are now applying it to vaccines.

Scientists figured out they could modify the virus to harness its breaking-and-entering skills without causing an infection. Instead, the virus can deliver a piece of genetic material inside a cell, serving as a vector.

In the case of Covid-19, researchers are again looking at getting the instructions for making the spike protein of SARS-CoV-2 into the cell.

The way it works is that researchers take the genome of the adenovirus and cut out the section that allows it to reproduce. Then they splice in a section of DNA that codes for the spike protein, turning the adenovirus into a recombinant vector.

Because the adenovirus is a DNA virus, it has to get its genetic material not just into a cell but into the cell’s nucleus.

“It goes into the nucleus, but it does not insert into the genome,” said Hildegund C.J. Ertl, a professor at the Wistar Institute’s Vaccine & Immunotherapy Center. “It’s a fairly transient effect.”

Once in the nucleus, the DNA coding for the spike protein is transcribed into mRNA and then transported out of the nucleus into the cell’s cytoplasm, where it’s translated into protein.

So if the modified virus can’t reproduce, how do scientists make more of them? William Wold, chair of the molecular microbiology and immunology department at the Saint Louis University School of Medicine, explained that recombinant viruses are cultured in cell lines that provide the missing hardware to allow them to make copies of themselves. “It’s easy to make large batches of the virus,” said Wold. But without these engineered cells, the virus can’t spread.

However, there are some drawbacks. Because versions of the adenovirus spread in humans, there are many people who have immunity. To get around this, groups like the team at Oxford are using a chimpanzee adenovirus as a vector, which is different enough from human adenoviruses that most people’s immune systems won’t react to it right away.

But once a vaccine is delivered using a chimpanzee adenovirus, it’s likely that many people would develop immunity to the new vector. That would make it difficult to use the same platform again for another vaccine.

The new Covid-19 vaccine platforms still face the same hurdles as conventional approaches: Phase 3 clinical trials and manufacturing

While new vaccine approaches have helped speed up early development, they are now entering phase 3 trials, where tens of thousands of people are randomly selected to receive either the vaccine or a placebo. Simply recruiting enough suitable participants can take weeks. Many vaccine candidates, including those using the new platforms, require two doses, often several weeks apart. Concluding the trials depends on waiting and seeing how the virus spreads among those who received the vaccine and those who didn’t. That can take months.

“The one thing you can’t truncate are these phase 3 trials,” Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told reporters during the National Press Foundation webinar. “The proof is in the pudding. Phase 3 is the pudding.”

The main challenge will be demonstrating that the vaccines actually provide protection against the coronavirus. In clinical trials, researchers have found that both mRNA and adenovirus vaccines can make the body produce antibodies to the virus and trigger a response from immune cells.

Those are good signs, but they don’t guarantee that the vaccine recipient is shielded from infection. For Covid-19, the specific combination of responses from the body that indicate whether someone is immune to the virus remains unknown. This combination is called the correlate of protection, or the correlate of immunity.

Without knowing the correlate of protection for Covid-19, researchers can find out if a vaccine is effective only when it’s tested against the actual virus. That means waiting to see how vaccinated people respond when they’re exposed.

Phase 3 trials also provide an important final safety check. Most side effects related to these new vaccine platforms — fever, muscle pain, soreness, chills — have been pretty minor in early clinical trials. But more significant and less-frequent complications could emerge during large-scale testing, when people with imperfect health or preexisting conditions start receiving the vaccines. It’s important to ensure that such problems are rare, since a Covid-19 vaccine would potentially have to be given to billions of people.

If a new vaccine platform does get approval, making enough vaccines will be the next challenge. The world has decades of experience producing conventional vaccines, but companies are still learning how to manufacture the new platforms in large quantities.

“The starting line is a little further back. We don’t have the reassurance from the widespread use of the same technology in a different vaccine,” said Jesse Goodman, a professor of medicine at Georgetown University and former chief scientist at the Food and Drug Administration. “For example, when we had the 2009 [H1N1] influenza pandemic, those vaccines were made using the technology and facilities and manufacturing processes that we used every year for flu vaccines.”

It’s one thing to make small batches of an mRNA or adenovirus vaccine in a laboratory. It’s quite a different endeavor to make billions of doses on multiple assembly lines in different parts of the world. Such large-scale production would need a global supply chain and validation to ensure that the facilities provide a consistent product. That infrastructure has yet to be built.

And since the majority of the world remains vulnerable to the disease, any coronavirus vaccine will need to be deployed on a much larger scale than existing vaccines in order to limit the spread of the virus.

That’s pushing governments and institutions to take some unprecedented steps to prepare. “The one thing that’s happened with this vaccine that I’ve never seen happen before is that pharmaceutical companies have already started making vaccines for people, even if they haven’t been approved yet,” Weissman said.

But there’s still no guarantee that any coronavirus vaccine will come to fruition. The first vaccine across the line may not be the best one; multiple vaccines for different population subsets, such as the elderly, will likely be needed. So even if an mRNA vaccine or adenovirus vaccine for Covid-19 gains approval, it may be prudent to continue pursuing a conventional vaccine as well.

And vaccines alone are not enough. Ending the Covid-19 pandemic will still demand measures like social distancing until sufficient numbers of people are vaccinated to create herd immunity. Although the timing of when a phase 3 trial for a Covid-19 vaccine might conclude is largely out of our hands, we can set the stage for the end of the pandemic now by limiting the spread of this deadly disease.

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A simpler, more useful way to tax carbon

March 28, 2022 KANKENNEWS

For most of the 21st century, putting a price on carbon dioxide emissions (either a carbon tax or a cap-and-trade system) has been seen as the serious person’s climate-change policy, preferred by economists, claimed to have bipartisan appeal, and backed relentlessly by tribunes of Beltway conventional wisdom like the Washington Post editorial board.

In the past few years, though, carbon pricing has fallen out of favor with activists. These days, the left has aligned around standards, investments, and justice: sector-specific emissions standards, large-scale public spending on low-carbon infrastructure, and an overarching focus on the most vulnerable and hardest-hit communities.

Nonetheless, it would be wrong to say that the bulk of climate opinion has turned against carbon pricing. Relatively few people think it’s a bad or entirely useless policy. They just see it as one tool in the policy toolbox, a complement to, not a replacement for, the many other policy tools available. Climate campaigners would prefer a carbon price with more modest aspirations, designed as part of a policy portfolio.

Academia has heard this call and, lo, it hath delivered.

The latest issue of the journal Nature Climate Change contains a study that attempts to sketch out a new approach to pricing carbon, one that does not suffer from the arrogance and overreach of previous attempts. (The authors are Noah Kaufman and Peter Marsters of Columbia University’s Center on Global Energy Policy, Wojciech Krawczyk and Haewon McJeon of the University of Maryland, and Alexander R. Barron of Smith College — I’ll just call it the Kaufman paper.)

Rather than the conventional method of determining a carbon price, which involves wildly uncertain far-future climate projections from scientists and a whole range of social value judgments from economists, they advocate for a more modest approach, with prices tied to short-term goals and arrived at through democratic deliberation. It’s a refreshingly practical approach, a way to help policymakers rather than dictating to them.

Let’s look at the details. I’ll start with the big flaw of carbon pricing to date — the problem the authors are trying to solve — and then take a look at how they propose to solve it.

Carbon pricing has been arrogant in its pretensions and its aspirations

Cap-and-trade systems (which cap emissions and create tradable emissions credits) have largely lost their cachet. California’s system is faltering; the Northeast’s Regional Greenhouse Gas Initiative is still running smoothly, but its effects are modest. Policymakers and economists have come to fear that the markets cap-and-trade creates are subject to manipulation and that they can’t ratchet toward zero emissions fast enough.

And so, what carbon-pricing action there is these days is around carbon taxes. (There are several carbon-tax proposals floating around Congress.)

Traditionally, the more enthusiastic carbon tax advocates have leaned on two flawed assumptions. The first is that there is an “optimal” price for carbon, which perfectly captures the balance between the costs of climate damages and the costs of decarbonizing. The second is that, once that price is determined, a tax on carbon is the “first best” and only necessary policy; other carbon-reduction policies will just distort the perfect market balance struck by the price.

The “optimal” carbon price is known in the biz as the “social cost of carbon” (SCC). The pretense of the social cost of carbon is that economists will add up all the projected damages of climate change to determine the all-in marginal cost of an additional ton of emissions. The tax on carbon will be set at that amount, which means we will purchase exactly as much climate mitigation as is “worth it.”

However, economists cooking up an optimal carbon price and presenting it to policymakers as a fait accompli fails to meet the public’s needs in three big ways.

First, determining climate damages is a wildly complex undertaking. It involves models built on a whole panoply of assumptions and inputs, many of which, the Kaufman paper says, are “inherently uncertain, such as the appropriate discount rates, risk aversion levels, issues around inequality, and attempts to assign monetary values to non-economic climate damages.”

Because of the complexity and uncertainties, the range of values produced by economists for the social cost range widely. “Meta-analyses find recent SCC estimates that range from under US$0 per ton of CO2 to over US$2,000 per ton,” the paper writes. Even if the outliers are excluded, estimates still range by hundreds of dollars. That doesn’t give policymakers much to go on.

Second, all of those uncertain variables — equity, the value of future generations, the value of other species — are buried in models, where they are effectively invisible to policymakers. Assigning value to these variables involves social and ethical decisions, but those decisions are being made by economists rather than through democratic deliberation. Policymakers have no real way of knowing what kinds of considerations produce what kinds of prices.

And third, the values for the social cost of carbon spit out by models have no connection to the policy goals they are meant to serve. They are not designed to achieve particular ends and their effects are uncertain, which, again, isn’t very helpful for policymakers.

The social cost produced by this contentious and values-laden process is meant to capture all the damage done by carbon emissions, meaning it is designed to be the principle, even only, carbon-reduction policy. But that assumes that unpriced carbon is the only market distortion that needs addressing, which flies in the face of real-world experience. The best economic and political theory now suggests that a portfolio approach to climate change, a broad package of policies, has the best chances of success.

But a carbon tax designed around the social costs is designed to be totalizing — it offers no guidance for how to craft a carbon price meant to complement other policies.

There’s a better way to design a carbon tax

Kaufman and his co-authors propose an alternative design framework for a carbon tax: a near-term to net zero (NT2NZ) approach.

In a nutshell, rather than asking what the optimal carbon price is in some econo-metaphysical sense, the approach begins by asking: Given other policies in place and a reasonable set of assumptions, what price on carbon is required to drive emissions to net zero on schedule?

This approach has a number of advantages. It doesn’t require any complex calculations about the damages of climate change decades hence, so the biggest uncertainties are taken off the table and it can produce much more precise, actionable price estimates. It puts values-based decisions about social and ethical trade-offs in the hands of policymakers rather than economists. And it is reverse-engineered from specific policy goals, so it doesn’t require any guessing about its effects. In all these ways, it is much more tangibly useful to policymakers.

To see how these advantages play out, let’s look at the four steps the authors lay out for designing a near-term to net-zero carbon tax.

1) Pick a date to hit net zero

The climate situation is simple: either the world reaches net-zero carbon emissions or global temperatures keep rising forever. Every nation must reach net zero; the only choice is how fast. Different countries will move at different speeds depending on their individual circumstances, level of economic development, and risk valuations. These decisions should be made by policymakers, out in the open.

2) Craft an emissions pathway to the net-zero target

As the Kaufman paper notes, “an infinite number of pathways are conceivable between current emissions levels and a future net-zero target.” Some pathways emphasize near-term reductions. Others emphasize R&D aimed at larger reductions later. Some rely on electrification, some include biofuels, some include nuclear power, some include negative emissions. Some are “straight line” reductions, others show a peak and then a decline.

Again, decisions about the appropriate pathway should be made by policymakers, based on national circumstances and values.

3) Determine the carbon price consistent with the emissions pathway in the near term

Energy-economic models can be used to estimate a carbon price that will help meet the desired target. Unlike the models that estimate SCC, energy-economic models can integrate the effects of multiple policies, so they can show a carbon tax how to be a team player.

The models and their projections are built on assumptions about the future trajectory of energy technologies, consumer behavior, and policy. Those things are more difficult to predict the farther out in the future, so these kinds of models are generally most useful when planning for the short term, the next decade or so. Beyond that, the assumptions become educated guesses.

So Kaufman et. al recommend that the models be used to determine near-term carbon prices rather than to guess what prices might need to be in 2050. “Focusing on the near term,” they say, “means that CO2 price estimates should not be unduly influenced by assumptions about the highly uncertain long-term evolution of technologies and behavior.”

In short, they urge that plans be made based on what we can see immediately ahead of us, not hopes for technological miracles decades out.

4) Periodically repeat steps 1-3

Knowledge in the fields of climate, energy, and technology evolves rapidly; policymakers should periodically set new goals and craft new pathways based on the latest science and democratic opinion.

There are a variety of ways to do this kind of “adaptive management.” Carbon prices could be adjusted automatically based on predetermined metrics — boosted if interim emission targets are not being met, or lowered if energy prices rise too high. Or prices could be adjusted every five years through an inclusive stakeholder process.

“Pairing a long-term emissions target with a set of iterative near-term policies is not novel,” the paper says. “The United Kingdom, for example, has adopted a national target of net-zero GHG emissions by 2050 and sets five-year carbon budgets to act as stepping-stones.” This approach fits well with the Paris climate agreement, which requires countries to submit new nationally determined contributions (NDCs, or commitments to reduce greenhouse gases) every five years.

NT2NZ carbon taxes in the US would be high, but not ridiculously high

To illustrate, Kaufman et. al determine near-term to net-zero carbon prices for the US that would yield straight-line emission reductions to a series of net-zero targets.

The chart below tells the tale. On the left, you can see the emission pathways to net-zero in 2040, 2050, and 2060 respectively. On the right, you can see the carbon prices necessary to reach those targets: $32, $52, and $93 per metric ton in 2025, with prices almost double that in 2030.

The black bar lines on the right-hand chart represent the range of carbon tax proposals currently before Congress, revealing that the near-term to net-zero prices are roughly within the range of what lawmakers are discussing.

As the colored bars on the right show, each estimate is actually a fairly wide range. That has to do with the sensitivity of models to a variety of assumptions, from the cost of various energy sources to the rate of innovation to the success of complementary policies. If any of those variables unfold differently than Kaufman et al. have projected, then the carbon price estimates would change accordingly.

The chart below shows how much changes in these variables affect the final price estimates. As you can see, a great deal depends on the price of oil and the success of other policies, both of which are extremely difficult to predict.

Setting near-term to net-zero carbon prices is not easy. It still requires tons of judgment calls about future developments. But at least this approach puts those judgment calls on the table where policymakers can see them.

The politics of the near-term to net-zero approach

The near-term to net-zero model has a great deal to recommend it over the conventional social cost of carbon method. It is a more modest approach to carbon pricing, more iterative, cooperative, transparent, and democratic. It is much more concretely helpful to policymakers than the endless cosmic quest to determine a precise social cost.

In a sense, however, its strengths are also its vulnerabilities. All those value-laden decisions previously made by economists in spreadsheets would be open to public dispute and manipulation. Every time policymakers revisited the tax, it would be a chance for vested interests to make mischief and complicate it with exemptions and conditions.

Basically, the near-term to net-zero approach exposes carbon pricing directly to democracy. Whether you think that’s a good idea or not depends on your assessment of the health of the world’s big democracies. There is certainly a school of thought that says complex decisions like this should be made by experts — something like California’s model, where the state legislature sets broad targets and direction and the Air Resources Board carries them out.

But if the world is truly to reach net zero, all the world’s polities will eventually have to buy into the effort. It can’t be done successfully if driven purely from the top down. When polities and policymakers are ready, they will find a carbon price a helpful tool, and the modest approach is a helpful way of crafting one.

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Hurricane Laura hits Gulf Coast as an “extremely dangerous” storm

March 28, 2022 KANKENNEWS

The National Hurricane Center warned that Hurricane Laura will cause “life-threatening storm surge” reaching up to 40 miles inland and rising up to 20 feet as the storm made landfall in Texas and Louisiana.

Laura reached the Gulf Coast after midnight on Thursday morning at an “extremely dangerous” Category 4 strength, with winds reaching 140 mph. After landfall, it weakened to a still dangerous Category 2 storm.

During a Wednesday news conference, Louisiana Gov. John Bel Edwards said Laura’s storm surge would reach levels not seen since 1957’s Hurricane Audrey.

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“The storm surge flooding is starting now in Louisiana,” Edwards said. “It’s well ahead of the storm. It will just get worse over the next day or so.”

Texas Gov. Greg Abbott implored residents to evacuate. “The conditions of this storm are unsurvivable, and I urge Southeast Texans to take advantage of these final few hours to evacuate, secure their property, and take all precautions to keep themselves and their loved ones safe,” he said at a Wednesday press conference.

Laura is expected to cause flash floods and a life-threatening storm surge in areas from High Island, Texas, to the mouth of the Mississippi River, inundating places that rarely see such high water levels.

About 20 million people reside in the path of the storm and more than 500,000 have been ordered to evacuate, a task complicated by the Covid-19 pandemic.

“The combination of a dangerous storm surge and the tide will cause normally dry areas near the coast to be flooded by rising waters moving inland from the shoreline,” the NHC reported in its latest hurricane bulletin. Storm surge, where high winds push water inland several feet above high tide, is often the deadliest consequence of hurricanes.

Laura may also spawn tornadoes and drench the Gulf Coast with up to 10 inches of rainfall. Initially, Laura was projected to make landfall alongside Hurricane Marco, but Marco weakened to tropical storm strength and quickly fizzled out as it made landfall on Tuesday.

Laura, on the other hand, underwent rapid intensification, a hallmark of several recent major hurricanes. Rapid intensification is defined as a gain of 35 mph or more in wind speed over 24 hours. In Laura’s case, the storm went from below hurricane strength with 65 mph winds early Tuesday to Category 4 strength on Wednesday, then weakened somewhat to a Category 2 storm after hitting land, with winds still dangerously high. Further weakening is expected on Thursday.

The storm’s US landfall comes amid an unusually active hurricane season, one that the National Oceanic and Atmospheric Administration predicted back in May.

For Gulf Coast residents, Laura is stirring eerie echoes of past storms. Hurricane Harvey in 2017 swept over Texas at Category 4 strength and inundated Houston with a gargantuan amount of rain that left the city soaked for weeks.

Laura is also making landfall in the US around the 15th anniversary of Hurricane Katrina, a Category 5 storm that resulted in 1,200 deaths as it struck New Orleans. Both Harvey and Katrina are tied as the costliest storms on record. Laura is now the strongest August hurricane in the Gulf of Mexico since Katrina, Colorado State University meteorologist Phil Klotzbach told USA Today. The storm is believed to have killed at least 23 people in Haiti and the Dominican Republic.

The destruction recent storms caused was fueled by coastal development in vulnerable areas as well as climate change amplifying sea-level rise, and the damaging elements of extreme weather like heavy rainfall.

It’s likely Laura will also come with a high price tag. “I do expect this to be a multi-billion dollar disaster,” said meteorologist Jeff Masters on a conference call with reporters on Tuesday.

Forecasts show that Laura’s current course takes the storm far inland to states like Arkansas before hooking east on Friday.

How to follow Hurricane Laura:

The National Hurricane Center has a page updating every few hours with the latest watches and warnings for Laura. Check it out.
Follow the National Hurricane Center on Twitter; it will provide updates with all the latest forecasts, hazards, and warnings.
Follow the Capital Weather Gang’s Twitter account. These folks tend to live-tweet storm updates.
Here’s a Twitter list of weather experts via meteorologist and journalist Eric Holthaus. These experts will give you up-to-the-second forecasts and warnings.

New goal: 25,000

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What makes California’s current major wildfires so unusual

March 28, 2022 KANKENNEWS

Wildfires continue burning in California, with unhealthy air from smoke still cloaking some parts of the state. Combined with the Covid-19 pandemic, the fires are compounding risks that have been brewing for years.

Fire officials have grouped some of the smaller fires in an area into complexes to coordinate their response. The largest of these is the SCU Lightning Complex. It had burned more than 365,000 acres as of Wednesday across parts of the southern San Francisco Bay Area, including Santa Clara and Alameda counties. The SCU Lightning Complex was 25 percent contained as of Wednesday morning.

To the north, the LNU Lighting Complex near Napa has burned more than 357,000 acres and destroyed or damaged 937 structures. Thousands were forced to evacuate. The fire was 33 percent contained as of Wednesday morning, and officials anticipate the flames could spread further.

At least 650 wildfires have raged across the Golden State, burning more than 1.25 million acres, since August 15, leaving at least seven people dead, according to Cal Fire.

Many of the blazes were ignited by a massive dry lightning storm last week concentrated in the San Francisco Bay Area.

“We had close to 11,000 strikes in a matter of three days,” said Brice Bennett, a spokesperson for the California Department of Forestry and Fire Protection (Cal Fire). “With an already-warm weather pattern and very, very dry conditions here in California, with those lightning strikes coming through, over 367 new fires were started.”

Smoke, soot, and ash from the fires also shrouded Northern California in the dirtiest air in the world at several points last week.

Wildfires are nothing new for Californians, who have grown wearily accustomed to the destruction, smoke, and evacuations in recent years. But this summer’s blazes stand out for their scale, timing, locations, and intensity, even among recent record-breaking fire seasons. And as David Wallace-Wells writes for New York’s Intelligencer, “What is most remarkable about the fires of 2020 is that these complexes are burning without the aid of dramatic wind, which is typically, even more than the tinder of dry scrub and forest, what really fuels California fire.”

The wildfires are just one of several disasters affecting California right now. The state has been in a two-decade megadrought, and was scorched by a record-breaking heat wave in early August, with several days in a row of temperatures reaching triple digits in some places, even at night. Temperatures in Death Valley topped 130 degrees Fahrenheit. That heat led to rolling blackouts as utilities struggled to meet cooling demand.

All the while, the Covid-19 pandemic is still a threat, making the already difficult task of controlling wildfires even harder.

Here are the factors that have fueled the recent fires and are now complicating the efforts to control them.

Extreme heat, strange storms, and climate change set the stage for California’s fires

The lightning storm around the San Francisco Bay Area that sparked many of the current California fires was a rare event.

“The last time we had something like this was over a decade ago, actually,” said Bennett. The fact that lightning started these fires is also noteworthy. The vast majority of wildfires in California are ignited from human sources — power lines, arson, neglected campfires, and so on.

But the fires wouldn’t have been so bad were it not also for the extreme heat that’s been baking the state for weeks.

“This is a big, big, prolonged heat wave characterized not only by hot daytime temperatures but also record-warm overnight temperatures and an unusual amount of humidity,” said Daniel Swain, a climate scientist at the University of California Los Angeles and a researcher at the National Center for Atmospheric Research. “It turns out increased humidity plays a role in why there are so many fires right now.”

A decaying tropical storm earlier this month in the eastern Pacific Ocean sent a plume of moisture over California. Amid the scorching heat, the moisture formed clouds that generated immense amounts of wind, thunder, and lightning but very little rain. “The humidity was high enough to produce these thunderstorms, but not high enough to produce significant flooding rainfall that would mitigate fire risk,” Swain said.

Much of California’s vegetation was also parched and primed to burn, and concerns that this would be an exceptionally bad fire year started to emerge in February as the state emerged from one of its driest winters on record. This was then followed by an abnormally hot spring. “There were a number of unusually significant early-season heat waves this spring both in Northern and in Southern California,” Swain said.

And California is now experiencing the impacts of climate change, which is manifesting in fires. The weather in California is becoming more volatile. Temperatures are also rising, which is causing the state’s forests, grasslands, and chaparral to dry out even more. The state already has millions of dead trees stemming from years of drought and pests like pine beetles. More heat could stress these ecosystems even further.

“It’s not just how hot are the heat waves; it’s how hot is it the rest of the time,” Swain said. “What really matters is the sustained warming and drying over seasons and years.”

Some of California’s current fires are in areas that don’t regularly burn

It’s important to remember that fires are a normal part of the ecology in California, from the coniferous forests in the Sierra Nevada to the chaparral shrubland in the south. Periodic blazes clear out decaying vegetation, restore nutrients to the soil, and help plants germinate.

Humans, however, continue to make California’s wildfires worse at every step. By suppressing naturally occurring fires, fuel has accumulated in forests and shrublands, increasing the danger when fires do ignite. People are also building closer to areas that are prone to burn. That increases the likelihood of starting fires and raises the blazes’ damage toll. People have also introduced invasive plant species like eucalyptus trees, which have spread throughout California and readily ignite. And burning fossil fuels emits greenhouse gases that are warming the planet, increasing the amount of vegetation that can burn.

Even with this backdrop, some of the fires in California stand out because they are raging in places that don’t burn very often.

“I think what’s key to understand is that different parts of California have very different normal fire seasons,” said Crystal Kolden, an assistant professor of fire science at the University of California Merced. “And that’s in part because California is such a big state. It has really variable topography and different vegetation or ecosystems across the state.”

Because the coastal forests are under the influence of marine weather systems, they are much cooler and retain more moisture than the pine forests of the Sierra Nevada and other inland areas. The coastal forests do burn periodically and are home to many species that have adapted to fire, but they rarely ignite during the summer.

That some portions of them have burned is remarkable, a product of high atmospheric pressure over the area that allowed heat to accumulate and overwhelm the cooling effect from the ocean. “Those coastal areas are incredibly dry, incredibly hot relative to normal, and that arid and hot condition had this potential to have really explosive fires,” Kolden said.

Covid-19 is adding a wallop to California’s fires

The Covid-19 pandemic has rattled every part of society, and firefighting efforts are not immune. “It definitely has affected our response, primarily in our inmate fire crews,” Bennett said.

California often relies on prison labor to bolster its firefighting efforts, with almost 200 inmate fire crews. Inmates are paid between $2 and $5 a day, plus $1 per hour when fighting a fire. But with severe Covid-19 prison outbreaks in the state, some inmates were released to relieve overcrowding. Others were hampered by infections, and many remain under quarantine. The number of available inmate fire crews has been nearly halved.

Anticipating a severe fire season, state officials did line up an additional 800 seasonal firefighters, but they have to take additional precautions. Fire crews are essentially staying in small bubbles, where they live and work with just each other, to help limit coronavirus transmission.

At base camps where fire crews rest and refuel, officials have designated more space for workers to maintain social distance.

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The state is also facing a budget crunch, with the economic slowdown because of the pandemic. That’s led some fire prevention maintenance measures — like clearing dry grass away from roads and buildings — to languish.

As for the Californians fleeing the fires, Covid-19 has made it harder to coordinate evacuations and shelters. The declining air quality from the wildfires is also a threat to people with Covid-19, since exposure to air pollution can damage airways and make people more susceptible to respiratory infection. Extreme heat also worsens the public health impact of Covid-19 as people spend more time in enclosed spaces together to avoid the heat.

And the current round of blazes may take weeks to extinguish, raising the concern that stiff autumn winds — the Santa Ana winds in the south and the Diablo winds in the north — may spread the flames again.

Hurricane Laura: The danger of storm surge, explained

March 28, 2022 KANKENNEWS

Hurricane Laura made landfall at 1 am ET Thursday in Cameron, Louisiana, as a fierce Category 4 hurricane with 150 mph winds. It has since downgraded to a Category 1 hurricane, with wind speeds of 75 mph, and is moving north.

But perhaps the most dangerous part of the storm may be the storm surge that still threatens coastal areas.

Storm surge, or coastal flooding, tends to be the deadliest aspect of hurricanes. It results from the storm’s winds pushing water onshore several feet above the normal tide, and it can trap people in their homes, wash away houses, and make rescue missions harrowing and slow. Rising sea levels linked to climate change have also increased the risk of storm surge and property damage in coastal cities and regions.

The National Hurricane Center (NHC) said Thursday morning a storm surge warning was still in effect from Sabine Pass, Texas to Port Fourchon, Louisiana; this kind of warning means a danger of life-threatening flooding. People located in these zones should follow evacuation and other instructions from local officials.

But so far, the highest storm surge reported seems is 9 feet, according to meteorologist Chris Gloninger:

But other meteorologists say it’s too soon to assess the total storm surge from Hurricane Laura. The water pushed on land by the winds could also still reach up to 40 miles inland “and flood waters will not fully recede for several days after the storm,” according to the NHC.

The larger the area with tropical storm-force winds, the more potential for those winds to push water onshore, and the greater the impact of storm surge, Colorado State University atmospheric scientist Chris Slocum says. Portions of Louisiana, Mississippi, and Arkansas could also see up to 6 to 12 inches of rain with isolated totals of 18 inches from Laura, which will add to the floodwaters.

The storm surge “is a life-threatening situation,” the NHC warns in its latest forecast. “Persons located within these areas should take all necessary actions to protect life and property from rising water and the potential for other dangerous conditions.”

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How to follow Hurricane Laura:

The National Hurricane Center has a page updating every few hours with the latest watches and warnings for Laura. Check it out.
Follow the National Hurricane Center on Twitter; it will provide updates with all the latest forecasts, hazards, and warnings.
Follow the Capital Weather Gang’s Twitter account. These folks tend to live-tweet storm updates.
Here’s a Twitter list of weather experts via meteorologist and journalist Eric Holthaus. These experts will give you up-to-the-second forecasts and warnings.

New goal: 25,000

Hurricane Laura was already a deadly storm before it reached the US

March 28, 2022 KANKENNEWS

Before Hurricane Laura made landfall in the United States, it had already proved to be a deadly storm in three Caribbean countries, bringing torrential downpours, flooding, power outages, and other damage that killed over 20 people and has made life dangerous for millions more.

As a tropical storm, Laura pummeled the Dominican Republic last weekend with heavy rains and winds, impacting the capital Santo Domingo and the rest of the nation’s 11 million people. According to the country’s United Nations office, a total of nine people died due to the conditions that also damaged around 2,000 homes and left about 700,000 without power and around 1.5 million people without access to water.

The Miami Herald reported that a 7-year-old, Darwin Frias, and his 44-year-old mother, Clarissa, were killed in Santo Domingo after their house collapsed.

Videos circulating online showed roads and city streets, including those of Santo Domingo, completely flooded due to rainfall and swollen rivers. But Dominican authorities have said the damage is much more widespread, with downed trees and power lines along with broken roads that make it hard to provide essential services to the millions of affected people.

New Dominican President Luis Abinader has toured the country to reassure citizens the nation will get back on its feet. “It will take us several years,” Abinader told one woman who lost her home last weekend. “We will relocate you to somewhere safe and help you with everything. The government is here for you.”

The situation is also severe in Haiti, located west of the Dominican Republic on the island of Hispaniola. Haitian authorities report 21 people were killed after the storm hit the country on Sunday with about eight inches of rain and 50-miles-per hour winds.

While the Haitian government is still assessing the extent of the damage, the capital Port-au-Prince saw raging floods, and hundreds of thousands across the country remain without power. That’s a problem on its own, but it’s exacerbated by officials’ need to communicate with people in areas near flooded rivers and dams.

One important dam that produces electricity and irrigates crops, Peligre, was overflowing so much that authorities had to release much of its water. That put the crops in nearby valleys at risk, but the government had difficulty getting in touch with those in harm’s way without power.

“All the radio stations that are here who can call the people of the Artibonite, tell them, ‘Attention!’ Secure their belongings because there is going to be a lot of water in the Artibonite Valley,” Public Works Minister Nader Joaseus said on Sunday.

The storm weakened by the time it made it to Cuba on Monday. The island nation did see heavy rains that contributed to flooding in parts of the country and high winds that knocked out power lines, but no deaths were recorded by the government. And despite concerns that it wouldn’t hold, the seawall in the capital Havana wasn’t breached.

Cuba still has some reeling communities, though. Tens of thousands were forced to evacuate, finding shelter in government facilities or in the homes of relatives. River flooding in the mountainous southeastern region of Granma cut off certain towns from one another, and fires instigated by the storm heavily damaged a school and farm in Santiago de Cuba. Many coastal towns are still digging out of streets full of debris and mud.

But considering the damage to the Dominican Republic and Haiti, Cuba avoided the worst of the storm. Altogether, though, some experts believe the toll the storm took on these three Caribbean nations means the US should step up efforts to support the region.

Laura “reminds us that vulnerable communities are hit the hardest,” said Rebecca Bill Chavez, who served as a top Pentagon official for the Western Hemisphere from 2013 to 2017.

The Caribbean’s experience may have some lessons for the US

As Hurricane Laura now batters Texas and Louisiana, local and federal officials can draw some takeaways from what just happened to America’s southern neighbors.

Broadly speaking, Chavez says storms like Laura — potentially powered by the effects of climate change — should make clear that major weather events can destabilize countries in the region. “It is an existential threat to our Caribbean neighbors,” she said. That could lead to further complications, such as a refugee crisis, governance failures, economic strain, and much more.

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Beyond the negative impact that would have on the people in those countries, it could also pose problems for the US, especially since it has extensive economic and security partnerships with Caribbean nations. Providing post-storm disaster relief and resilience assistance ahead of the next storm could minimize the risk of those problems.

More concretely, the Dominican Republic, Haiti, and Cuba are all dealing with coronavirus outbreaks of their own. As the storm approached, officials thought deeply about how to minimize the risk of further outbreaks. For example, Jose Antonio Torres Iribar, the head of the provincial defense council in Havana, Cuba, limited the amount of people who could live in shelters to wait out the storm.

“If under normal circumstances, these shelters could house 500 people, now this number must be reduced for the evacuation process not to become a problem in the context of the pandemic,” he said on Sunday.

In Haiti, however, many had nowhere to go but a shelter. “I’m particularly concerned about Haiti where the devastating floods means more demand for shelters,” Chavez said.

It seems that officials in Louisiana had similar concerns. Normally, impacted citizens would be placed in mega shelters. But worries about increased transmission led the state to reserve over a thousand hotel rooms instead.

“This is very, very different,” Gov. John Bel Edwards said on Wednesday. “We’re going to take advantage of all the space available at hotels and motels that we can contract.”

It’s unclear if Edwards’s team got the idea from precautions taken in the Caribbean, but it’s clear nations in that region led the way on how to safely protect people during Laura and the pandemic.

New goal: 25,000

Trump asked for fewer Covid-19 tests. Now the CDC is recommending less testing.

March 28, 2022 KANKENNEWS

A couple of months ago, President Donald Trump said he told federal officials to “slow the testing down, please.”

Now the Trump administration is taking a step that would, in effect, slow down testing.

On Monday, the Centers for Disease Control and Prevention (CDC) updated its testing guidelines to no longer recommend people get tested even when they’ve come into close contact with someone who’s infected.

The previous guidelines stated, “Testing is recommended for all close contacts of persons with SARS-CoV-2 infection. Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.”

The updated guidelines claim, “If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms: You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.”

CDC Director Robert Redfield said in a statement that “testing may be considered for all close contacts of confirmed or probable Covid-19 patients.” But that still doesn’t explicitly recommend testing for close contacts of people with Covid, as many experts say is needed.

When I asked the CDC about the changes earlier this week, they referred the question to the Department of Health and Human Services — which struck me as unusual, since it suggested the CDC wasn’t overseeing the guidelines. An HHS official told me that the recommendations were “revised to reflect current evidence and the best public health interventions.”

HHS didn’t provide or explain that evidence when pressed further, or explain why someone who’s been exposed to a person with Covid-19 shouldn’t always try to get tested. Experts widely agree that more testing is crucial to stopping the coronavirus pandemic, with some already calling the guidelines change misguided and dangerous.

The change appears to have come from the White House’s coronavirus task force. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told Sanjay Gupta at CNN he was under anesthesia for surgery when the task force met to finalize the changes.

He added, “I am concerned about the interpretation of these recommendations and worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact, it is.”

Testing is crucial to stopping outbreaks. But Trump has called for less of it.

We don’t know how involved Trump was in the guideline change, if he was at all. But we do know Trump has repeatedly complained about the US testing too much. He’s argued that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases.” The implication is that testing makes the US look bad, since it will have more confirmed coronavirus cases.

Experts counter that this is absurd: Whether testing confirms Covid-19 cases or not, those cases are there, leading to more infections, sickness, and deaths.

And it’s important to catch those cases. Paired with contact tracing, testing lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease. It’s been successfully deployed in Germany, New Zealand, and South Korea, among other countries, to control Covid-19 outbreaks.

Successful testing includes asymptomatic and presymptomatic people. People who don’t show any or serious symptoms can still spread the disease, and there’s no way to verify whether they’re potentially infectious without a coronavirus test.

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But the US has struggled to build its testing capacity to match the full scope of its outbreak. To gauge this, experts rely on the percentage of tests that come back positive. If a place tests enough, it should have a low positive rate because it should be testing lots and lots of people, including those who don’t have serious symptoms. High positive rates indicate that only people with obvious symptoms are getting tested, which suggests a need to ramp up testing to match the scope of an outbreak.

While the US has increased its testing capacity in the past few months, America’s positive rate for the past week was more than 6 percent — above the recommended 5 percent, and higher than the rates of Germany (less than 1 percent), New Zealand (less than 0.1 percent), and South Korea (about 2 percent). In some states, the positive rate is still above 15 percent or even 20 percent.

Given America’s ongoing testing problems, some experts have suggested that the US should be smarter about how it rations tests, which could include deprioritizing those who don’t have symptoms. But HHS said that’s not what’s going on here, telling the New York Times, “Testing capacity has massively expanded, and we are not utilizing the full capacity that we have developed. We revised the guidance to reflect current evidence and the best public health interventions.”

Brett Giroir, the administration’s testing czar, denied Trump’s involvement and said politics weren’t involved in the CDC’s new guidance. “We’re trying to get appropriate testing, not less testing,” he told reporters.

So we don’t really know exactly why the CDC changed its guidelines. But it conveniently accomplishes what Trump has asked for: potentially fewer people getting tested for Covid-19.

New goal: 25,000

Rapid $1 Covid-19 tests exist. Why can’t we get them?

March 28, 2022 KANKENNEWS

To get the US pandemic under control, a growing number of health and medical experts are making a clarion call for an additional testing approach to Covid-19.

What we need, they argue, are at-home rapid tests that look for antigens, proteins the live virus makes. These kits would allow anyone to test themselves for the coronavirus any time (and anywhere) for between $1 and $5, and get results in about 15 minutes. No doctors, labs, expensive machines, or special chemicals required.

“I see these [antigen] tests as a solution that’s literally sitting in front of us,” says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, who has led an effort to get these rapid tests authorized by the Food and Drug Administration. “We could be getting massive outbreaks down to nothing. … It’s a no-brainer to me.”

Back in April, Deborah Birx, the White House coronavirus response coordinator, actually called for just this sort of solution in an interview on Meet the Press. “We have to have a breakthrough innovation in testing,” she said. “We have to be able to detect antigen.”

Several small companies have been developing these simple tests, and the conglomerate 3M is working with MIT on another one. (The new BinaxNOW test from Abbott, authorized August 26, is different — it requires a health professional to administer it, and the patient must have symptoms to get a prescription.)

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And some of these at-home tests are ready to go. But they have been sitting on the shelf, unused, for months. Why?

The holdup is that rapid, over-the-counter antigen tests are not nearly as sensitive to the coronavirus as the molecular PCR (polymerase chain reaction) tests currently used for most Covid-19 testing. In fact, by PCR standards, some at-home antigen tests might catch only half or a third of people who test positive on a PCR test.

But that’s because they’re looking for different things in different ways. A PCR test, designed to diagnose an individual with infection, can catch very low levels of viral material before or after a person spreads the virus. An over-the-counter antigen test, meanwhile, relies on high levels of the virus to be able to detect it. These high levels, though, also happen to coincide with when a person is most likely to transmit the virus to others.

“The antigen test is maximally sensitive at the same time that you are maximally infectious,” says David Paltiel, a professor of public health and health policy at the Yale School of Public Health. “The antigen test is picking up the infections I want. Because I don’t care about infections, I care about infectiousness.”

Since at-home antigen tests would be fast and cheap, they could allow people to test themselves regularly. Currently, PCR testing is relatively expensive (about $100) and often experiences processing delays that hamstring efforts to stop transmission.

PCR tests’ sensitivity, however, is the current benchmark by which the FDA judges new tests for emergency authorization.

This pre-pandemic framework, Mina and others argue, is a problem as we look for the most effective tools to fight the coronavirus right now. So they are calling for a new way to evaluate these tests, one based in public health terms rather than individual diagnostic ones — in other words, widely accessible tests that are well tuned to find those who are most likely to spread the virus.

Let’s take a look at how and why this potential solution has gotten sidelined in the pandemic battle — and what might be done to get these tests off companies’ shelves and out to the public.

A test to find infectiousness, not infection

To understand the stalemate around antigen tests, it’s helpful to first understand what they are, how they differ from classic PCR tests, and the trajectory of coronavirus infections.

First: An antigen test looks for a particular protein from a live virus. (Not to be confused with an antibody test, which finds immune cells your body has made after mounting a defense against the virus.) These tests need a lot of viral material to generate a positive result.

Second: A PCR test looks for the virus’s genetic material — its RNA — making copies of itself until it reaches a detectable level. As a result, it has a fairly low (although not perfect) false-negative rate, or the proportion of time it would tell someone who has the virus that they don’t.

Finally: One of this new coronavirus’s superpowers is its ability to spread from people before they start to experience symptoms. In fact, people tend to carry the most live virus the day or so before they begin feeling sick, and the amount tends to quickly trail off in the several days after symptom onset.

So proponents of at-home antigen testing say that PCR tests, while useful in determining whether an individual is infected with Covid-19, are actually a poor tool in finding people who are most likely to spread the virus. That’s because PCR tests are so sensitive, they are excellent at picking up traces of the virus even after someone has beat it back and is no longer infectious.

Thomas Tsai, a health policy expert at the Harvard T.H. Chan School of Public health, compares the two types of testing this way: PCR tests are reactive tests, usually used for people who either have symptoms, a close contact with the virus, or other reason to think they are likely to have caught it. Rapid, widespread antigen tests are proactive tests, designed to find cases before they spread the virus more widely.

And as the Center for Evidence-Based Medicine noted earlier this month, “while an infectious stage may last a week or so because inactivated RNA degrades slowly over time, it may still be detected many weeks after infectiousness has dissipated.”

To look a little bit deeper at how this works, an August 7 preprint report which hasn’t been peer reviewed proposes that people with 10,000 copies of the virus detected in their airways are unlikely to spread the virus to someone else, even with sustained contact (according to their models, it would happen about 0.002 percent of the time). Once that viral load climbs to 10 million copies (which happens quickly, potentially in about a day), they have about a 40 percent chance of transmitting it to a close contact — and about 80 percent chance at 100 million viral copies (it’s worth noting that when they first reach this level they still might not have any symptoms).

By the time someone has had Covid-19 symptoms for several days (which might currently be about the time they receive results from a PCR test), however, the amount of virus in their system has likely waned to the point of actually being less transmissible. As the authors of the study note, “transmission after the first week of infection is quite rare.”

At that point, says Mina, it’s more likely that “they just have residual [virus] RNA hanging about.” So although many of these people would get a positive PCR test — and a negative at-home antigen test — they are much less likely to transmit the virus than someone who feels fine now but will develop symptoms in a day or two.

“The PCR is being fooled all the time,” Paltiel says. “The PCR is just picking up strands of viral junk.” If your goal is to slow an outbreak, he notes, this sort of data is not actually that useful. “Outbreak control is all about figuring out who’s actually spreading this stuff.”

This could also help explain why so many people continue to get positive PCR test results weeks after getting over most of their symptoms. One small JAMA study, for example, found that one in six former Covid-19 patients with no symptoms tested positive for the virus via PCR test four to 24 days after being discharged from the hospital. As an author of a commentary about that paper noted about these long-tail positive test results, “the clinical significance and infectivity are minimal. These PCR tests likely are responding to noninfective RNA fragments and do not represent detection of viable virus.”

Antigen tests, however, need a much higher level of the virus to register a positive result because they don’t rely on multiplying their target.

This, experts argue, make them well matched for finding people with Covid-19 at precisely their most infectious points rather than potentially long after symptoms have arrived and infectiousness has faded, as is more likely now with the long delays in PCR results and contact tracing. As Paltiel describes it, the concept is pretty simple: “The more viruses around your airway, the more likely you are to be a risk to others.”

According to an analysis from the June preprint (on which Mina was a co-author), this crucial time period is precisely where the antigen test is most sensitive: detecting viral load at around 10,000 copies, which is just before someone’s infectiousness skyrockets. PCR tests, on the other hand, can pick up about 1,000 copies of the virus, which gives them about a day’s head start at finding the virus. Although with a lag of more than a day in returning results, that benefit is lost.

To put it in other terms, these tests could be “superspreading detectors,” Mina says, locating many of those who would otherwise go on to unknowingly infect many other people before they know they have the virus.

“Their whole goal is to capture the 90 percent of people who might be transmitting the virus,” Mina says. So if they were to be evaluated in this population — those with high levels of the virus — he says, the sensitivity for these tests would soar from 30 or 50 percent (as measured against PCR) up to 95 percent. (They also have very low false-positive rates, in which they would tell someone they had the virus when they actually didn’t.)

Another selling point to antigen tests, proponents argue, is that they would give people their results much faster than PCR tests. Since delays of more than a day or so in getting PCR results back make containment and tracing much less effective, being able to have results back in 15 minutes or so would be a vast improvement.

Because these tests would be fast and affordable, people could also test frequently, which could help overcome worry about the tests being less sensitive than PCR — especially in the very small window early in an infection when a PCR test might catch the virus but an antigen test wouldn’t.

And such frequent testing would be far superior to the still relatively rare PCR testing that we’re currently doing, Paltiel says. “Of all the variables that we control, the frequency of screening is the most important,” he says. Even if the antigen-based test only caught half of all cases (regardless of infectiousness level), he says, if it’s “between a test that is missing 50 percent [but rapid and easy] and a test that is getting everyone that is so expensive or so cumbersome or has such a long turnaround time that it takes a week, I’ll take what’s behind door No. 1.”

In the June preprint study, the researchers found the sensitivity of a test made little difference in the rate at which it could bring viral transmission down. For example, running either of these tests, PCR or at-home antigen testing, on a population weekly could lower the spread of the virus by about 60 percent, they posit.

So, Mina suggests, we shouldn’t just be asking what level of sensitivity a test has, but rather, what it’s sensitive to. PCR tests are great at finding traces of the coronavirus but, he says, “it’s going to have a 0 percent sensitivity to detect elephants.” And if what we want is to start finding elephants — or people who are most infectious — we should look for new testing options, he argues.

The FDA’s job is to help keep us safe, but it might lack a pandemic public health protocol

One of the FDA’s essential responsibilities is to make sure dangerous medications, ineffective vaccines, or misleading diagnostic tests don’t make it to US consumers. So it applies rigorous standards to make sure new products are reliable before they are allowed on the market.

And the FDA has applied this same rubric when it has evaluated new tests for the coronavirus this year.

“Tests are still being considered first and foremost as diagnostic tools,” Mina says. This is evident in how the FDA has required antigen tests to perform at PCR-levels in detecting traces of the virus in people’s systems, he notes. For example, a new test might need to detect the virus in 80 or 90 percent of emergency room patients who’ve received a positive PCR test.

So when you compare the numbers and see a test that catches half or a third of the positive cases a PCR test does, it makes sense for the FDA to worry about a huge number of Covid-19-positive people thinking they are negative.

And Mina says he gets that. “If I’m a doctor, which I am, and I have a patient in front of me, I would want the absolute best and most sensitive molecular test to make sure I don’t miss something,” he says.

But he is also an epidemiologist. “For public health, it’s totally different. It requires a really different type of thinking.” One that targets minimizing spread of the virus among people.

“Unfortunately, the FDA just doesn’t have that,” he says. “They don’t even have a lens with which to think about it.”

And so, he says, they’re still evaluating at-home antigen tests as individual medical diagnostic tools rather than “as a virus control tool at the population level.”

The FDA has already authorized four antigen-based tests, including ones from Quidel (in May), BD Veritor (in July), LuminaDX (in August), and the new one from Abbott. To meet the FDA’s current sensitivity standards, however, the first three of these use proprietary machines to read results. (Some of these machines are now being allocated by the Centers for Medicare & Medicaid Services to nursing homes around the country.)

But an over-the-counter antigen test, the sort that Mina and others are advocating for, simply can’t be authorized under the current standards.

This gets at the essential tension between the FDA’s individual-based medical diagnostic framework and the broader public health needs of the pandemic. And, says Tsai, “We really need to shift gears.”

Concerns remain about at-home antigen testing

Beyond the sensitivity question, the FDA and others also have hesitations about these sorts of tests being done outside of the health care setting.

Current Covid-19 tests require a health care professional to order them and provide the results, allowing for them to give patients medical advice. If people are taking these tests on their own at home or before entering a business, a nurse won’t be on hand, for example, to advise them to isolate if necessary or take other steps to prevent spread.

“Due to the lack of healthcare professional supervision, FDA believes it is important for over-the-counter non-lab diagnostic tests to have a low rate of false negative results,” Emma Spaulding, a spokesperson for the FDA wrote to Vox in an email. “For example, an individual with a false negative result from an OTC diagnostic test may be less likely to quarantine despite symptoms, putting others in the community at risk,”

This is one reason they are recommending such tests catch 90 percent of the PCR-positive cases, she says. They would lower this to 80 percent if the tests required a prescription and were done under the supervision of a health care worker (such as via telemedicine).

Others worry about individual compliance. Rebecca Lee Smith, an epidemiologist at the University of Illinois, notes that this sort of testing would probably be most readily adopted by people who are already putting in the most effort to avoid catching and spreading Covid-19, such as those regularly wearing masks and practicing physical distancing.

“But the people who aren’t concerned about the virus may not choose to do at-home testing — they’re also the people who are not taking the precautions. So the same people we would absolutely want to be checking for the virus, then, would be the people less likely to do it at home.”

She also has concerns about at-home tests being used to clear people for work, school, or other activities. If someone needed to produce a negative test result, they could theoretically get someone else to take the test for them but still gain entry to, say, their college classes for the day. That was a point of discussion at her university, where they eventually opted for supervised (rather than collected-at-home) saliva-based PCR testing. “We decided that it was more important that we know, for sure, that the person who checked in for testing is the person giving the sample,” she says.

Administering these tests out in the community as a way to enter a workplace or a restaurant, for example, could also help alleviate this issue — as well as the concern about those with higher chances of contracting the virus not taking the test.

The newly approved Abbott test, BinaxNOW, is a step toward more accessible antigen testing. It doesn’t require a machine to read the results — and still, according to data presented to the FDA, has a 97 percent specificity level compared with PCR tests. It is also $5 for one test, and the company says they will be able to ship 50 million of them a month this fall.

The downside is it is only available with a prescription, and it needs to be given by a health care professional or other trained individual (such as a pharmacist or workplace health specialist). The test requires a nasal swab and a small amount of specialized chemicals known as reagents. And it is only to be used for people who developed Covid-19 symptoms within the past week, making it inapplicable for broader population-wide screening.

With an over-the-counter test, we might also lose a lot of important public health disease surveillance data. If people are testing positive at home — or even in a public setting — and not following up with a health care worker or public health department, their case might not get counted or their contacts traced. “You would need to have a link back to public health,” Smith says. They would also want to get information on the test that was performed so they could properly interpret the results.

This is where our existing PCR testing capacity could run backup. Smith explains that a positive antigen test result could be a trigger to get a PCR test to confirm the infection. It could also possibly reduce the number of PCR tests that are run, potentially speeding up delivery of those results as well.

“In a perfect world,” Smith says, “we would have this cheap, at-home test that anybody could take, as frequently as they want, that would give them a quick result. If there is a reason — if they have symptoms, if they’ve been exposed, or the at-home test comes back positive — then they report for PCR.”

Tsai agrees PCR tests would still be important. “It’s really thinking about how we use the pros and cons of all the different tests in a more comprehensive strategy,” he says. “Let’s put these pieces together.”

How could at-home antigen tests get authorized?

With over-the-counter antigen tests at a regulatory stalemate in the FDA’s current authorization system, experts are spitballing alternative routes to getting these tests to the public.

First and foremost, says Mina, government involvement in authorizing new tests is essential to make sure that those that do reach the market work in the way they are supposed to.

One route for this, he proposes, is a new standard by which the FDA could authorize tests, setting a different benchmark for test sensitivity at levels of the virus that are most likely to be transmissible rather than at very low detectable levels. In other words, he notes, the FDA could adjust their language from looking at sensitivity to the virus broadly to “sensitivity during peak infection.”

The FDA could also reframe the way it characterizes these tests, he says. Instead of being evaluated as an individual diagnostic test, he says, “it would essentially be indicated as a transmission-detecting test … [or] a public health diagnostic test, where the real reason of doing that diagnostic test is one of public health.”

Another option would be to designate these tests as surveillance tools rather than diagnostic tests. Under that category, they fall outside the FDA’s purview and would more likely be overseen by the CDC and local health departments.

This plan has a big hitch, though. Surveillance test results are aggregated and are not shared back with the individual taking the test. Diagnostic tests, on the other hand, are those which have results given back to the individual so that they might take a specific action. The latter is, of course, the goal here (to let people know, for example, if they need to start self-isolating).

“It’s this awful catch-22 that could easily be changed if there was a will,” Mina says. “There just doesn’t seem to be much of a will.” Or a regulatory framework for thinking about things differently — even in the midst of a pandemic, he says.

The FDA has recently conceded that they would consider authorizing a less sensitive test if it were part of a high-frequency testing plan, with each person being tested multiple times (which they call “serial testing”), Spaulding says.

This, to Mina and others, seems like a step in the right direction, and he is hoping the FDA will provide more detailed guidance on what this would look like in practice.

But the FDA also notes that it would require an application for this sort of serial testing to “include the capacity to manufacture a sufficient supply of tests with which to conduct multiple tests per person,” Spaulding says.

Mina suggests that this is an arbitrary ask. For other authorized tests, like those using PCR or machine-based antigen detection, the agency has not required makers to show manufacturing capacity — or even the supply chain to turn results around in a certain amount of time (which is a key aspect to slowing transmission of Covid-19). “They’re perfectly fine approving tests that might take a year to return results, but that’s a 100 percent useless test,” Mina says.

Mina also worries that as some of these companies with at-home antigen tests wait for the government to greenlight them, they will decide to make them more complex to meet the current (PCR-based) requirements for diagnostic viral detection.

He calls this going from the sort of “instant coffee model” of testing (where anyone can take a test, cheaply, pretty much anywhere) to the “Nespresso model” (where you need access to a specialized machine to get a result).

And slowdowns in rolling out these machine-based antigen tests are already happening. Both BD and Quidel, two companies making rapid antigen tests, are now facing supply chain issues as they try to fulfill orders for their machines and tests, the Wall Street Journal reported.

Tsai notes that public health officials in Florida have been advised to use the Quidel antigen tests only for symptomatic, older adults. Which, he says, makes sense in targeting those most at-risk for complications from the virus, but “in some ways also defeats the purpose of the frequent testing strategy.”

Mina has been challenging those who are still on the fence about rapid, at-home antigen testing to say whether, in hindsight, it would have been good to have five months ago.

“Almost all of them say, ‘yes, that would have been great.’ Compared to what has happened, of course it would have been great.” Now, he says, “we’re in an almost worse spot today, we’re hitting up against September and October, when coronaviruses can start spreading like crazy. We have to cut our losses and say, ‘okay, we didn’t do it five months ago, but we can do it today.’”

Like the old tree-planting aphorism: The best time to plant a tree may have been 20 years ago, but the second-best time is now. “We could potentially save ourselves from ourselves in the fall. But I don’t know if it’s going to happen, frankly,” he says.

Part of that reason, he notes, has to do with our general national mindset. “I think Americans, including policymakers, are having a hard time coming to terms with the idea that there’s actually something bad happening to us.”

Just adding this new type of testing on its own, however, won’t be enough to get us out of the pandemic. “We can’t test our way out of it,” Smith says. “We also need masks, we need distancing.”

But, she says, many presymptomatic and asymptomatic cases are not being detected with our current testing strategy. “And those people are able to spread the infection further without knowing it. If we can’t identify these cases, we are never going to get out of this.”

Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.

New goal: 25,000

How Trump let Covid-19 win

March 28, 2022 KANKENNEWS

As America, and even his own administration, woke up to the threat of Covid-19, President Donald Trump still didn’t seem to get it. Within weeks of suggesting that people social distance in mid-March, the president went on national TV to argue that the US could reopen by Easter Sunday in April. “You’ll have packed churches all over our country,” Trump said in March. “I think it’ll be a beautiful time.”

The US wasn’t able to fully and safely reopen in April. It isn’t able to fully and safely reopen in September.

The virus rages on, affecting every aspect of American life, from the economy to education to entertainment. More than 200,000 Americans are confirmed dead. Many schools are closing down again after botched attempts to reopen — with outbreaks in universities and K-12 settings. America now has one of the worst ongoing epidemics in the world, with the second most daily new Covid-19 deaths among developed nations, surpassed only by Spain.

America does not have the most Covid-19 deaths per capita of any rich country, but it’s doing worse than most. The US reports about seven times the Covid-19 deaths as the median developed country, ranking in the bottom 20 percent for coronavirus deaths among wealthy nations. Tens of thousands of lives have been needlessly lost as a result: If America had the same death rate as, for example, Canada, about 120,000 more Americans would likely be alive today.

The Easter episode, experts said, exemplified the magical thinking that has animated Trump’s response to the Covid-19 pandemic before and after the novel coronavirus reached the US. It’s a problem that’s continued through September — with Trump and those under him flat-out denying the existence of a resurgence in Covid-19, falsely claiming rising cases were a result of more tests. With every day, week, and month that the Trump administration has tried to spin a positive story, it’s also resisted stronger action, allowing the epidemic to drag on.

A pandemic was always likely to be a challenge for the US, given the country’s large size, fragmented federalist system, and libertarian streak. The public health system was already underfunded and underprepared for a major disease outbreak before Trump.

Yet many other developed countries dealt with these kinds of problems too. Public health systems are notoriously underfunded worldwide. Australia, Canada, and Germany, among others, also have federalist systems of government, individualistic societies, or both — and they’ve all fared much better.

Instead, experts said, it’s Trump’s leadership, or lack thereof, that really sets the US apart. Before Covid-19, Trump and his administration undermined preparedness — eliminating a White House office set up by the previous administration to combat pandemics, making cuts across other key parts of the federal government, and proposing further cuts.

Once the coronavirus arrived, Trump downplayed the threat, suggesting that it would soon disappear “like a miracle.” The Centers for Disease Control and Prevention (CDC) took weeks to fix botched tests, and the administration actively abdicated control of issues to local, state, and private actors.

“There was a failure to realize what an efficiently spreading respiratory virus for which we have no vaccine and no antiviral meant,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “From the very beginning, that minimization … set a tone that reverberated from the highest levels of government to what the average person believes about the virus.”

Several developed countries — including Belgium, France, Italy, and Spain — were caught off-guard by the pandemic and were hit hard early, suffering massive early outbreaks with enormous death tolls. But most developed countries took these crises seriously: adopting lengthy and strict lockdowns, widespread testing and contact tracing, masking mandates, and consistent public messaging about the virus. (Though parts of Europe are now seeing second waves, seemingly because they prematurely relaxed social distancing measures.)

America did not take the steps necessary, even after an outbreak spiraled out of control in New York. So the US suffered a wave of huge cases over the summer that other developed nations generally avoided, leading to new and continued surges in both cases and deaths. And while other developed countries have seen spikes in cases as fall neared, America also has seen cases start to rise once again.

“If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different,” Ashish Jha, dean of the Brown University School of Public Health, told me, emphasizing the failure to act after Covid-19 hit the US hard was a phenomenon driven by Trump.

Experts worry that things will again get worse: Colder weather is coming, forcing people back into risky indoor environments. So are holiday celebrations, when families and friends will gather from across the country. Another flu season looms. And Trump, experts lamented, is still not ready to do much, if anything, about it.

The White House disputes the criticisms. Spokesperson Sarah Matthews claimed Trump “has led an historic, whole-of-America coronavirus response” that followed experts’ advice, boosted testing rates, delivered equipment to health care workers, and remains focused on expediting a vaccine.

She added, “This strong leadership will continue.”

The US wasn’t prepared for a pandemic — and Trump made it worse

During the 2014 Ebola outbreak, President Barack Obama’s administration realized that the US wasn’t prepared for a pandemic. Jeremy Konyndyk, who served in the Obama administration’s Ebola response, said he “came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola,” which has a high fatality rate but did not spread easily in the US and other developed nations.

The Obama administration responded by setting up the White House National Security Council’s Directorate for Global Health Security and Biodefense, which was meant to coordinate the many agencies, from the CDC to the Department of Health and Human Services to the Pentagon, involved in contagion response.

But when John Bolton became Trump’s national security adviser in 2018, he moved to disband the office. In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then in May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and dismantled his global health security team. Bolton claimed that the cuts were needed to streamline the National Security Council, and the team was never replaced.

In the months before the coronavirus arrived, the Trump administration also cut a public health position meant to detect outbreaks in China and another program, called Predict, that tracked emerging pathogens around the globe, including coronaviruses. And Trump has repeatedly called for further cuts to the CDC and National Institutes of Health, both on the front lines of the federal response to disease outbreaks; the administration stood by the proposed cuts after the pandemic began, though Congress has largely rejected the proposals.

The Trump administration pushed for the cuts despite multiple, clear warnings that the US was not prepared for a pandemic. A 2019 ranking of countries’ disaster preparedness from the Johns Hopkins Center for Health Security and Nuclear Threat Initiative had the US at the top of the list, but still warned that “no country is fully prepared for epidemics or pandemics.”

A federal simulation prior to the Covid-19 pandemic also predicted problems the US eventually faced, from a collapse in coordination and communication to shortages in personal protective equipment for health care workers.

Bill Gates, who’s dedicated much of his Microsoft fortune to fighting infectious diseases, warned in 2017, “The impact of a huge epidemic, like a flu epidemic, would be phenomenal because all the supply chains would break down. There’d be a lot of panic. Many of our systems would be overloaded.”

Gates told the Washington Post in 2018 he had raised his concerns in meetings with Trump. But the president, it’s now clear, didn’t listen.

There are limitations to better preparedness, too. “If you take what assets the United States had and you use them poorly the way we did, it doesn’t matter what the report says,” Adalja said, referring to the 2019 ranking. “If you don’t have the leadership to execute, then it makes no difference.”

As Covid-19 spread, Trump downplayed the threat

On February 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters that Americans should prepare for community spread of the coronavirus, social distancing, and the possibility that “disruption to everyday life might be severe.”

Six months later, Messonnier’s comments seem prescient. But soon after the briefing, she was pushed out of the spotlight — though she’s still on the job, her press appearances have been limited — reportedly because her negative outlook angered Trump. (Messonnier didn’t respond to a request for comment.)

The CDC as a whole has been pushed to the sidelines with her. The agency is supposed to play a leading role in America’s fight against pandemics, but it’s invisible in press briefings led by Trump, Vice President Mike Pence, advisers, and health officials like Anthony Fauci and Deborah Birx who are not part of the organization. CDC Director Robert Redfield acknowledged as much: “You may see [the CDC] as invisible on the nightly news, but it’s sure not invisible in terms of operationalizing this response.”

University of Michigan medical historian Howard Markel put it in blunter terms, telling me the US has “benched one of the greatest fighting forces against infectious diseases ever created.”

Meanwhile, the president downplayed the virus. The day after Messonnier’s warning, Trump said that “you have 15 people [with the coronavirus], and the 15 within a couple of days is going to be down to close to zero.” This type of magical thinking appears to have driven Trump’s response to Covid-19 from the start, from his conviction that cases would disappear to his proclamation that the country would reopen by Easter.

This was deliberate. As Trump later acknowledged in recorded interviews with journalist Bob Woodward, he knew that the coronavirus was “deadly stuff,” airborne, more dangerous than the flu, and could afflict both the young and old. Yet he deliberately downplayed the threat: “I wanted to always play it down,” he told Woodward on March 19. “I still like playing it down, because I don’t want to create a panic.”

Trump has long said he believes in the power of positive thinking. “I’ve been given a lot of credit for positive thinking,” he told Axios reporter Jonathan Swan during a wide-ranging discussion about Covid-19 in July. “But I also think about downside, because only a fool doesn’t.” Pressed further, he added, “I think you have to have a positive outlook. Otherwise, you have nothing.”

The concern, experts said, is the signal this messaging sends. It tells the staffers under Trump that this issue isn’t a priority, and things are fine as they are. And it suggests to the public that the virus is under control, so they don’t have to make annoying, uncomfortable changes to their lives, from physical distancing to wearing masks.

It creates the perfect conditions for a slow and inadequate response.

The CDC botched the initial test kits it sent out, and it took weeks to fix the errors. The Food and Drug Administration (FDA) also took weeks to approve other tests from private labs. As supply problems came up with testing kits, swabs, reagents, machines, and more, the Trump administration resisted taking significant action — claiming it’s up to local, state, and private actors to solve the problems and that the federal government is merely a “supplier of last resort.”

South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country with more than six times the population.

Asked about testing problems in March, Trump responded, “I don’t take responsibility at all.” In June, Trump claimed that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases. So I said to my people, ‘Slow the testing down, please.’”

The testing shortfall was a problem few thought possible in the wealthiest, most powerful nation on earth. “We all kind of knew if a biological event hit during this administration, it wasn’t going to be good,” Saskia Popescu, an infectious disease epidemiologist, told me. “But I don’t think anyone ever anticipated it could be this bad.”

Trump also consistently undermined the advice of experts, including those in his administration. When the CDC released reopening guidelines, Trump effectively told states to ignore the guidance and reopen prematurely — to “LIBERATE” their economies. When the CDC recommended masks for public use, Trump described masking as a personal choice, refused to wear one in public for months, and even suggested that people wear masks to spite him. While federal agencies and researchers work diligently to find effective treatments for Covid-19, Trump has promoted unproven and even dangerous approaches, at one point advocating for injecting bleach. Trump’s allies have even held up CDC studies that could contradict the president’s overly optimistic outlook.

The most aggressive steps Trump took to halt the virus — travel restrictions on China and Europe imposed in February and March, respectively — were likely too limited and too late. And to the extent these measures bought time, it wasn’t properly used.

The federal government is the only entity that can solve many of the problems the country is facing. If testing supply shortfalls in Maine are slowing down testing in Arizona or Florida, the federal government has the resources and the legal jurisdiction to quickly act. Local or state offices looking for advice on how to react to a national crisis will typically turn to the federal government for guidance.

But the inaction, contradictions, and counterproductive messaging created a vacuum in federal leadership.

In the months after Trump’s prediction that coronavirus cases would go down to zero, confirmed cases in the US grew to more than 160,000. As of September 22, they stand at more than 6.8 million.

Months into the pandemic, Trump has continued to flail

After the initial wave of coronavirus cases began to subside in April, the White House stopped its daily press briefings on the topic. By June, Trump’s tweets and public appearances focused on Black Lives Matter protests and the 2020 election — part of what Politico reporter Dan Diamond described, based on discussions with administration officials, as an “apparent eagerness to change the subject.”

Then another wave of coronavirus infections hit beginning in June, peaking with more than 70,000 daily new cases, a new high, and more than 1,000 daily deaths.

America’s response to the initial rise of infections was slow and inadequate. But other developed countries also struggled with the sudden arrival of a disease brand new to humans. The second surge, experts said, was when the scope of Trump’s failure became more apparent.

By pushing states to open prematurely, failing to set up national infrastructure for testing and tracing, and downplaying masks, Trump put many states under enormous pressure to reopen before the virus was under control nationwide. Many quickly did — and over time suffered the consequences.

Rather than create a new strategy, Trump and his administration returned to magical thinking. Pence, head of the White House’s coronavirus task force, wrote an op-ed titled “There Isn’t a Coronavirus ‘Second Wave’” in mid-June, as cases started to increase again. Internally, some of Trump’s experts seemed to believe this; Birx, once a widely respected infectious disease expert, reportedly told the president and White House staff that the US was likely following the path of Italy: Cases hit a huge high but would steadily decline.

Trump trotted out optimistic, but misleading, claims and statistics. He told Axios reporter Jonathan Swan in July that the US was doing well because it had few deaths relative to the number of cases. When Swan, clearly baffled, clarified he was asking about deaths as a proportion of population — a standard metric for an epidemic’s deadliness — Trump said, “You can’t do that.” He gave no further explanation.

Seemingly believing its coronavirus mission accomplished, the Trump administration, the New York Times reported, moved to relinquish responsibility for the pandemic and leave the response to the states — in what the Times called “perhaps one of the greatest failures of presidential leadership in generations.”

“The biggest problem in the US response is there is not a US response,” Konyndyk, now a senior policy fellow at the Center for Global Development, told me. “There is a New York response. There’s a Florida response. There’s a Montana response. There’s a California response. There’s a Michigan response. There’s a Georgia response. But there is not a US response.”

When the coronavirus first hit the US, the country struggled with testing enough people, contact tracing, getting the public to follow recommendations such as physical distancing and masking, delivering enough equipment for health care workers, and hospital capacity. In the second wave, these problems have by and large repeated themselves.

Consider testing: It has significantly improved, but some parts of the country have reported weeks-long delays in getting test results, and the percentage of tests coming back positive has risen above the recommended 5 percent in most states — a sign of insufficient testing. The system once again appeared to collapse under the weight of too much demand, while the federal government failed to solve continuing problems with supply chains. Months after Congress approved billions of dollars in spending to deal with testing problems, the Trump administration has not spent much of it.

Some of Trump’s people seemed to listen to his calls to slow down testing: On August 24, the CDC updated its guidelines to suggest people exposed to others with Covid-19 don’t necessarily have to get tested — a move for effectively less testing that experts described as “dangerous” and “irresponsible.” Only after weeks of criticism did the CDC back down and, on September 18, once again call for testing people without symptoms.

Mask-wearing also remains polarized. While surveys show that the vast majority of Americans have worn masks in the past week, there’s a strong partisan divide. According to Gallup’s surveys, 99 percent of Democrats say they’ve gone out with a mask in the previous week, compared to 80 percent of Republicans. Leveraging surveys on mask use, the New York Times estimated that the percentage of people using masks in public can fall to as low as 20, 10, or the single digits — even in some communities that have been hit hard. Anti-mask protests have popped up around the country.

Testing and mask-wearing are two of the strongest weapons against Covid-19. Testing, paired with contact tracing, lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease — as successfully demonstrated in Germany, New Zealand, and South Korea, among others. There’s also growing scientific evidence supporting widespread and even mandated mask use, with experts citing it as crucial to the success of nations like Japan and Slovakia in containing the virus.

It’s not that other developed nations did everything perfectly. New Zealand has contained Covid-19 without widespread masking, and Japan has done so without widespread testing. But both took at least one aggressive action the US hasn’t. “While there’s variation across many countries, the thing that distinguishes the countries doing well is they took something seriously,” Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco, told me.

One explanation for the shortfalls in the US response is Trump’s obsession with getting America, particularly the economy, back to normal in the short term, seemingly before Election Day this November. It’s why he’s called on governors to “LIBERATE” states. It’s why he’s repeatedly said that “the Cure can’t be worse than the problem itself.” It’s one reason, perhaps, he resisted embracing even very minor lifestyle changes such as wearing a mask.

The reality is that life will only get closer to normal once the virus is suppressed. That’s what’s working for other countries that are more earnestly reopening, from Taiwan to Germany. It’s what a preliminary study on the 1918 flu found, as US cities that emerged economically stronger back then took more aggressive action that hindered economies in the short term but better kept infections and deaths down overall.

“Dead people don’t shop,” Jade Pagkas-Bather, an infectious diseases expert and doctor at the University of Chicago, told me. “They can’t stimulate economies.”

Click Here:
The window to avert further catastrophe may be closing

As cases and deaths climbed over the summer, and as the November election neared, Trump at times appeared to spring back into action — bringing back coronavirus press conferences and briefly changing his tone on masks (before going back to mocking them).

But Trump still seems resistant to focusing too much on the issue. He’s tried to change the subject to former Vice President Joe Biden’s supposed plans to destroy the “Suburban Lifestyle Dream.” He’s continued to downplay the crisis, saying on July 28, as daily Covid-19 deaths once again topped 1,000, “It is what it is.” His Republican convention continued to diminish the risks of Covid-19 and exaggerate Trump’s successes in fighting the virus. At a campaign rally in Ohio on September 21, Trump claimed the virus “affects virtually nobody.”

So while combating Covid-19 aligns with Trump’s political incentives (it remains Americans’ top priority), he and his administration continue to flounder. And White House officials stand by their response so far, continually pushing blame to local and state governments.

“There’s no national plan to combat the worst pandemic that we’ve seen in a century,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me.

The summer surge of Covid-19 has calmed now, although cases across the US flattened out at a much higher level than they were in the spring, likely a result of cities, counties, states, and the public taking action as the federal government didn’t. Still, cases have started to pick back up again.

Experts now worry that the country could be setting itself up for another wave of Covid-19. Schools reopening across the country could create new vectors of transmission. The winter will force many Americans indoors to avoid the cold, while being outdoors in the open air can hinder the spread of the disease. Families and friends will come together from across the country to celebrate the holidays, creating new possibilities for superspreading events. And in the background, another flu season looms — which could limit health care capacity further just as Covid-19 cases spike.

“The virus spreads when a large number of people gather indoors,” Jha said. “That’s going to happen more in December than it did in July — and July was a pretty awful month.”

There are reasons to believe it might not get so bad. Since so many people in the US have gotten sick, that could offer some element of population immunity in some places as long as people continue social distancing and masking. After seeing two large waves of the coronavirus across the country, the public could act cautiously and slow the disease, even if local, state, and federal governments don’t. Social distancing due to Covid-19 could keep the spread of the flu down too (which seemed to happen in the Southern Hemisphere).

But the federal government could do much more to push the nation in the right direction. Experts have urged the federal government to provide clear, consistent guidance and deploy stronger policies, encouraging people to take Covid-19 as a serious threat — now, not later.

“I’m really concerned that the window might be closing,” Kates said.

Without that federal action, the US could remain stuck in a cycle of ups and downs with Covid-19, forcing the public to double down on social distancing and other measures with each new wave. As cases and deaths continue to climb, America will become even more of an outlier as much of the developed world inches back to normal. And the “beautiful time” Trump imagined for Easter will remain out of reach.

Tropical Storm Laura’s flooding and other impacts on the ground: What we know

March 28, 2022 KANKENNEWS

Tropical Storm Laura, which has been downgraded from a hurricane, made landfall early Thursday morning in Cameron, Louisiana — just 35 miles east of the Texas-Louisiana border — as a Category 4 storm with 150 mph winds.

Already, pictures and videos of the storm from Lake Charles, Louisiana, a town about 50 miles north of Cameron, show torn-off roofs, downed power lines, blown-out windows, and dozens of trees ripped from the ground.

Louisiana Gov. John Bel Edwards said he’d received a report Thursday morning of the first American fatality from Laura, a 14-year-old girl from Vernon Parish who died when a tree fell on her home. Edwards later said a total of four people in his state have died — all as a result of fallen trees. Laura was also responsible for at least 23 deaths in Haiti and the Dominican Republic earlier this week.

There has been no official word of other injuries or deaths in the US since the storm made landfall. What we know is that about 20 million people reside in the path of the storm and 500,000 have been ordered to evacuate, a task complicated by the Covid-19 pandemic.

And so far, more than 740,000 homes and businesses are without power in Texas and Louisiana.

Louisiana and Texas residents were warned the storm surge could be “unsurvivable”

As a Category 4 hurricane, Laura reportedly became the strongest storm on record to make landfall along the western Louisiana and northern Texas coast. Although the storm has weakened since moving inland, prompting its downgrade from hurricane status, it is still sustaining winds of 52 mph.

Hurricane-force winds can cause normally dry areas near the coast to be flooded by rising waters. The National Hurricane Center (NHC) predicted that this phenomenon, referred to as “storm surge,” could result in up to 20 feet of flooding in places within 40 miles of shoreline where Laura made landfall, rendering some areas “unsurvivable” and resulting in “catastrophic damage.” However, it appears as if a slight change in wind direction may have spared the worst-hit areas from the feared 20-foot surge.

The NHC said Thursday the worst of the initial storm surge hit communities directly east of Cameron, which are experiencing surge of around 9 feet.

Some meteorologists, however, warn against jumping to premature conclusions about the extent of storm surge from Hurricane Laura, considering the limited number of data points currently available.

Heavy rain is also predicted to be widespread across the west-central Gulf Coast, with 5 to 10 inches falling over a broad area, and up to 18 inches locally. And this rain is expected to result in flash flooding throughout the region.

After making landfall Thursday morning, Laura tracked north across Louisiana throughout the day, and its center is expected to move into Arkansas overnight. The storm will then move through the Tennessee Valley and the mid-Atlantic from Friday into Saturday. As of now, the NHC predicts the storm will continue to give off heavy rain and sustain winds between 30 and 40 mph.

One of the most powerful storms in US history

Meteorologists categorize hurricanes based on the intensity of storms’ maximum sustained winds:

Category 1: 74-95 mph (a storm with winds below 74 mph is classified as a “tropical storm,” and below 38 mph is a “tropical depression”)
Category 2: 96-110 mph
Category 3: 111-129 mph
Category 4: 130-156 mph
Category 5: 157 mph or higher

Laura’s 150 mph winds at landfall made it a Category 4 hurricane and one of the most powerful in US history — as powerful as Hurricane Charley in 2004 and slightly less powerful than Hurricane Michael in 2018, but far more powerful than Hurricane Katrina (which clocked in at 125 mph at landfall) in 2005.

These categorizations are important in terms of assessing potential damage to life and property. From 1900 to 2005, US hurricanes that clocked in at category 3, 4, and 5 at landfall have been responsible for 85 percent of total hurricane damage, despite making up around a quarter of total hurricanes. That’s because relatively small changes in wind speeds can lead to exponentially more damage. For instance, hurricanes like Laura that make landfall at around 150 mph cause, on average, 256 times more damage than hurricanes less than half their speed, at 75 mph, would.

But wind speed alone doesn’t determine how deadly a hurricane will be. As my colleagues Brian Resnick and Eliza Barclay explain, storm surge, the coastal flooding that occurs when a storm’s winds push water onshore several feet above the normal tide, is particularly dangerous. Severe storm surge — like that expected with Laura — can trap people in their homes, wash away houses, and make rescue missions harrowing and slow.

So far, we don’t know what the damage from Tropical Storm Laura will be, but we do have reference points. Hurricane Rita, which hit the same area as Laura in 2005, produced up to 15 feet of storm surge, had Category 3 winds of 115 mph, and resulted in 97 to 125 deaths and $18.5 billion in damage. By comparison, Laura made landfall with Category 4 winds of 150 mph and is predicted to produce up to 20 feet of storm surge.

A record season for hurricanes

Laura is the 12th of as many as 25 named storms that the National Oceanic and Atmospheric Administration (NOAA) has predicted would form this hurricane season (which lasts from June 1 to November 30); seven to 11 of those storms, including Laura, were expected to become hurricanes. If NOAA’s predictions are correct, this will be a record-breaking season for hurricanes.

“This is one of the most active seasonal forecasts that NOAA has produced in its 22-year history of hurricane outlooks. NOAA will continue to provide the best possible science and service to communities across the Nation for the remainder of hurricane season to ensure public readiness and safety,” said Commerce Secretary Wilbur Ross, who oversees the agency. “We encourage all Americans to do their part by getting prepared, remaining vigilant, and being ready to take action when necessary.”

There are a few explanations for this record-breaking season, but chief among them are the above-average sea surface temperatures in the tropical Atlantic Ocean and Caribbean Sea, particularly in the region between West Africa and the Leeward Islands, which tends to be a prime development region for hurricanes.

These warmer-than-average waters are, in part, the result of climate change. A new study published earlier this year in the Proceedings of the National Academy of Sciences by a group of NOAA and University of Wisconsin Madison researchers found that from 1979 to 2017, the odds that a given tropical cyclone would become a Category 3, 4 or 5 hurricane increased about 8 percent per decade as the planet has warmed.

This finding builds on lots of previous research — like multiple academic studies demonstrating that Hurricane Harvey’s record-blasting rains were likely amplified by climate change.

“We’ve just increased our confidence of our understanding of the link between hurricane intensity and climate change,” James Kossin, the lead author of the new study, told the Washington Post. “We have high confidence that there is a human fingerprint on these changes.”

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In other words, Laura might be the most recent of the major hurricanes to reach US shores, but it certainly won’t be the last.

How to follow Tropical Storm Laura:

The National Hurricane Center provides updates every few hours, with projections and important warnings. Take a look here.
The National Hurricane Center’s Twitter account has similar updates, as well as the latest on forecast changes and public safety concerns.
Meteorologist and journalist Eric Holthaus has compiled a Twitter list of weather experts that’s a valuable repository of forecasts, data, and useful information on hurricanes in general.

Correction, August 26: An earlier version of this story misstated the relative strength of Hurricanes Michael and Charley.

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Tropical Storm Laura’s flooding and other impacts on the ground: What we know