tag:theconversation.com,2011:/us/topics/coronavirus-2021-99162/articlesCoronavirus 2021 – The Conversation2022-02-17T13:12:05Ztag:theconversation.com,2011:article/1756252022-02-17T13:12:05Z2022-02-17T13:12:05ZWant better child care? Invest in entrepreneurial training for child care workers<figure><img src="https://images.theconversation.com/files/445730/original/file-20220210-1970-unavhe.jpg?ixlib=rb-1.1.0&rect=20%2C0%2C6689%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Entrepreneurial leadership values expertise from providers, educators and parents. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/license/886934186?adppopup=true"> SDI Productions/E+ via Getty Images</a></span></figcaption></figure><p>Christine Heer – a veteran preschool teacher – had long harbored a passion to run a nature-based preschool. So in 2015 she opened <a href="https://www.growbloomandthrive.com/">Sprouts Farm and Forest Kindergarten</a> in central Massachusetts.</p>
<p>Diana Stinson did something similar in 2018 when she co-founded <a href="https://www.massaudubon.org/get-outdoors/wildlife-sanctuaries/long-pasture/programs-classes-activities/nature-preschool">Nature Explorers Preschool</a>, which is housed on a wildlife sanctuary on Cape Cod.</p>
<p>Five months into the COVID-19 pandemic, <a href="https://blogs.umb.edu/earlyed/2020/07/08/building-community/">Dottie Williams</a>, a Boston child care provider, was invited to testify before Massachusetts lawmakers. She spoke about how child care providers were <a href="https://www.salemnews.com/news/state_news/covid-19-forcing-innovation-at-child-care-centers/article_b608ff39-c7ef-5e78-b7fa-20f7c3b11305.html">helping children adapt</a> during the pandemic.</p>
<p>In the fall of 2021, as very young children exhibited anxiety about playing with other children without a mask – something they had previously been taught was unsafe – <a href="https://blogs.umb.edu/earlyed/2021/11/08/teaching-young-children-about-post-pandemic-social-interaction/">Emilee Johnson</a> wrote a <a href="https://blogs.umb.edu/earlyed/2021/11/08/teaching-young-children-about-post-pandemic-social-interaction/">children’s book</a> about <a href="https://eyeonearlyeducation.org/2021/07/27/a-book-for-young-children-on-the-pandemics-new-normal/">how to stay safe</a>.</p>
<p>All of these early educators have one thing in common – they were all trained in entrepreneurial leadership.</p>
<h2>A different kind of leadership</h2>
<p>As a researcher who studies <a href="https://scholar.google.com/citations?user=58-4rKcAAAAJ&hl=en&oi=sra">how to develop effective leadership skills among early childhood educators</a>, I know that <a href="https://www.tcpress.com/leading-for-change-in-early-care-and-education-9780807758359">entrepreneurial leadership training</a> is not like other kinds of leadership training. For instance, it doesn’t emphasize hierarchy. Rather than elevate the expertise of administrators and authorities, it recognizes the expertise of those who work directly with children – that is, the child care providers, educators and parents. </p>
<p>When directors and administrators of early learning centers are trained in entrepreneurial leadership, <a href="https://files.eric.ed.gov/fulltext/ED593623.pdf">innovation becomes a bigger part</a> of what they do. They build relationships that <a href="https://www.acf.hhs.gov/sites/default/files/documents/opre/ccl-report-summary-508_qc.pdf">value “curiosity, questions, and reflections about current practices,”</a> according to a 2021 federal report. Staff members contribute ideas to improve teaching practices, enhance program quality, implement strategies for improving workplace culture, promote equity and welcome feedback from parents. </p>
<h2>Benefits to children</h2>
<p>Children benefit when early educators are trained in <a href="https://doi.org/10.1186/s40723-022-00095-z">entrepreneurial leadership</a>, research <a href="https://www.acf.hhs.gov/sites/default/files/documents/opre/understanding-leadership-ECE-march-2021.pdf">shows</a>. This is largely because classroom quality is <a href="https://doi.org/10.1080/02568543.2012.739589">connected to</a> the improved workplace culture, parental engagement and support for experimentation – all things brought about by entrepreneurial leadership. The quality of leadership and the organizational climate set by early educational leaders are “<a href="https://doi.org/10.1080/02568540709594621">critical variables</a>” for the quality of early education.</p>
<p>Entrepreneurial leadership training transforms how early educators think. It leads them to <a href="https://doi.org/10.1007/s10643-017-0871-9">redefine leadership</a>. They begin to see leadership as collaborative and purpose-driven rather than hierarchical.</p>
<p>Some early educators use their new skills and confidence to open new schools, as Stinson and Heer did. Some develop new resources for educators, as Johnson did. Some become highly effective advocates, as Williams has. But most early educators trained in this form of leadership return to their programs to make <a href="https://doi.org/10.1186/s40723-022-00095-z">seemingly small but powerful changes</a> that result in better care and education for children.</p>
<h2>Opportunities limited</h2>
<p>Despite the positive effects of entrepreneurial leadership training, it’s not widely available. One survey found only <a href="https://goffinstrategygroup.com/wp-content/uploads/2021/10/2021-Early-Care-and-Education-Leadership-Development-Compendium.pdf">35 leadership programs</a> for early educators in the entire country. Of those, 32 focus on the “positional responsibilities” of directors and administrators.</p>
<p>As the pandemic continues to <a href="https://www.tbf.org/news-and-insights/reports/2021/dec/when-the-bough-breaks-20211213">disrupt early care and education programs</a>, with <a href="https://edpolicy.umich.edu/sites/epi/files/uploads/BPS_ECE_COVID_Policy_Brief.pdf">reduced student enrollment</a> and teachers <a href="https://www.washingtonpost.com/business/2021/09/19/childcare-workers-quit/">leaving the profession</a> because of fears of exposure to COVID-19, resources must be used wisely. Investing in entrepreneurial leadership training for early educators is one way to make sure that happens.</p>
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<p class="fine-print"><em><span>Anne Douglass receives funding from the Massachusetts Department of Early Education and Care, and the Office of Planning, Research, and Evaluation at the Administration for Children and Families in the U.S. Department of Health and Human Services, as well as the Robert Wood Johnson Foundation and The Boston Foundation.
Anne Douglass designs, implements, and evaluates leadership development programs in the early care and education sector.
</span></em></p>When early childhood education providers become more entrepreneurial, the quality of their programs improves, research shows.Anne Douglass, Professor of Early Care and Education Leadership, Policy, and Practice, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1714572022-01-10T13:39:02Z2022-01-10T13:39:02ZWatch for these conflicts over education in 2022<figure><img src="https://images.theconversation.com/files/439216/original/file-20220103-37443-15i668j.jpg?ixlib=rb-1.1.0&rect=10%2C21%2C3631%2C2402&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Louisiana residents object to mask mandates at a state Board of Elementary and Secondary Education meeting in August 2021.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakLouisiana/63969424eeb445a0bd0a8c217e038a34/photo">AP Photo/Melinda Deslatte</a></span></figcaption></figure><p>At school board meetings across the country in 2021, parents engaged in <a href="https://www.nytimes.com/2021/11/14/us/loudoun-county-school-board-va.html">physical altercations</a>, <a href="https://www.npr.org/sections/back-to-school-live-updates/2021/08/30/1032417970/school-board-members-hostile-meetings-mask-mandates-politicized">shouted at</a> school board members and <a href="https://www.nytimes.com/2021/11/16/podcasts/the-daily/school-boards-mask-mandates-crt-bucks-county.html">threatened them as well</a>.</p>
<p>These disagreements entered state politics, too, such as the 2021 <a href="https://www.nytimes.com/2021/10/12/us/politics/virginia-governor-republicans-schools.html?referringSource=articleShare">Virginia governor’s race</a>, which was largely shaped by conflicts over the <a href="https://www.baconsrebellion.com/wp/yes-virginia-there-is-critical-race-theory-in-our-schools/">how issues of race and racism are taught in the K-12 curriculum</a>, and <a href="https://www.virginiamercury.com/2021/10/29/in-2020-the-legislature-passed-a-transgender-students-rights-law-it-largely-hasnt-been-enforced/">transgender student rights</a>. </p>
<p>Our September 2021 article in <a href="https://doi.org/10.1177/08959048211042567">Educational Policy</a> explains that the short-term conflicts that generate media attention – such as about <a href="https://www.edweek.org/leadership/schools-face-fears-of-critical-race-theory-as-they-scale-up-social-emotional-learning/2021/12">critical race theory</a> across the nation – are part of long-standing ideological debates about education. These conflicts are about issues such as who deserves academic opportunity, what the parameters of public education are and whether schools and universities ought to promote a positive image of the U.S. or explore its shortcomings. </p>
<p>As <a href="https://scholar.google.com/citations?user=nezgztgAAAAJ&hl=en&oi=ao">researchers</a> who <a href="https://scholar.google.com/citations?user=OomuRokAAAAJ&hl=en&oi=ao">study conflicts in education</a>, we see clashes like these continuing into 2022.</p>
<h2>1. Virtual education</h2>
<p>In 2022, expect conflicts over virtual school offerings to intensify, especially as the omicron variant surges and as some states push toward <a href="https://edsource.org/2021/california-school-vaccine-mandate-coming-soon-but-questions-remain/662985">vaccine mandates</a> for all students. At stake is whether parents should have control over how public funds are spent on educating their children, and the potential effects of diverting those funds away from traditional public schools. </p>
<p>In fall 2021, U.S. school leaders largely <a href="https://www.edweek.org/leadership/most-schools-are-teaching-in-person-this-school-year-latest-fed-data-say/2021/12">shifted their services back to in-person instruction</a> <a href="https://theconversation.com/school-year-off-to-a-rocky-start-4-ways-parents-can-help-kids-get-back-on-track-167609">after shutdowns and remote instruction</a> dominated the initial response to the coronavirus pandemic. </p>
<p>However, demand for home-schooling and virtual schooling <a href="https://www.edworkingpapers.com/sites/default/files/ai21-463.pdf">has risen</a>, as some parents discover that these forms of education offer greater flexibility in scheduling, control over curriculum and safety from the coronavirus. In Washington state, for example, enrollments in publicly funded virtual schools operated by for-profit companies have increased dramatically, such as Washington Virtual Academies, which <a href="https://www.seattletimes.com/education-lab/washingtons-for-profit-online-schools-attract-nearly-6000-more-students-this-school-year/">expanded enrollments by an estimated 85%</a> between the 2019-2020 and 2020-2021 school years. Similar <a href="https://www.edweek.org/leadership/covid-19-fuels-big-enrollment-increases-in-virtual-schools/2020/09">trends happened</a> in school districts across the country.</p>
<p>Enrollment data for the 2021-2022 school year are still emerging, but some school choice <a href="https://www.hks.harvard.edu/centers/taubman/programs-research/pepg/events/school-choice">experts</a> have argued that parental demand for virtual education is here to stay. However, in another research project, one of us found that students who switch to online schools <a href="https://doi.org/10.3102/0013189X20909814">experience substantial learning losses</a> in reading and math during each of the three years after switching. That evidence has forced policymakers to consider <a href="https://www.wfyi.org/news/articles/state-committee-recommends-big-shift-for-virtual-charter-school-rules">greater regulation</a> of online schools, even as more parents consider taking their children out of traditional public schools and putting them in virtual ones.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Students sit at computers, separated by clear plastic barriers" src="https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439217/original/file-20220103-117041-1ln4m7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Schools’ decisions to provide in-person or virtual education sparked concern and conflict in 2021.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak-SchoolDropouts/4fa2bc85087940e9b78914cac886b780/photo">AP Photo/Charlie Riedel</a></span>
</figcaption>
</figure>
<h2>2. Affirmative action</h2>
<p>Affirmative action and similar policies in college admissions have always generated controversy, and 2022 will likely be no different. This year, a case that began in 2014 will reach the U.S. Supreme Court. That case, <a href="https://docs.justia.com/cases/federal/district-courts/massachusetts/madce/1:2014cv14176/165519/386">Students for Fair Admissions vs. Harvard University</a>, alleges that Harvard’s race-conscious admissions policies discriminate against Asian applicants. </p>
<p>The case has worked its way through the court system with a <a href="https://www.nytimes.com/2017/11/19/us/affirmative-action-lawsuits.html">national roster of affluent plaintiffs</a>. This group has filed multiple unsuccessful lawsuits across the U.S., including an October 2021 loss in a similar case over admissions at the <a href="https://www.reuters.com/world/us/university-north-carolina-defeats-challenge-race-based-admissions-policies-2021-10-19/">University of North Carolina at Chapel Hill</a>.</p>
<p>Similar lawsuits have also sprung up in <a href="https://www.sfchronicle.com/sf/article/Lowell-High-lottery-admission-likely-to-remain-16705599.php">San Francisco</a> and <a href="https://www.bostonglobe.com/2021/09/26/metro/secrecy-around-exam-school-admission-data-prompts-lawsuit/">Boston</a> over school districts’ efforts to make access to academically selective public schools more representative of student populations. These suits reflect broader ideological tensions over who deserves a well-funded, elite education and the government’s responsibility to protect that access.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A student works at a desk while a teacher sits in the background" src="https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439219/original/file-20220103-25-k4qe4b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Teachers unions wielded significant power over how schools responded to the coronavirus pandemic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/first-grade-student-alexis-tenorio-works-on-an-english-news-photo/1232327829">Genaro Molina / Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<h2>3. Teachers unions</h2>
<p>In 2022, look to teachers unions to continue to assert themselves in the face of ongoing efforts by <a href="https://californiaglobe.com/articles/ca-parents-seek-to-abolish-the-california-teachers-association/">parent</a> and <a href="https://teacherfreedom.org">advocacy groups</a> to limit their power.</p>
<p>Over the past year teachers unions effectively negotiated the implementation of health safeguards against the spread of COVID-19
in <a href="https://www.nbcnews.com/news/us-news/teachers-union-approves-deal-chicago-schools-return-class-n1257247">Chicago</a>, <a href="https://www.nationalreview.com/news/de-blasio-agrees-to-delay-school-reopening-to-avoid-teacher-strike/">New York City</a> and <a href="https://www.dailynews.com/2021/09/22/lausd-strikes-deal-with-teachers-union-to-provide-quarantine-instruction/">Los Angeles</a>. These unions secured protective measures such as virtual instruction, priority vaccine access for teachers, medical and personal leave related to COVID-19, explicit metrics to determine when schools would close, district-provided personal protective equipment for teachers and classroom air filtration systems. </p>
<p>While the pandemic dominates union activity at present, and <a href="https://www.edworkingpapers.com/ai20-304">many unions have not negotiated significant concessions</a>, these wins signal unions’ strategic and legal capacity to negotiate around issues such as compensation and working conditions. Given <a href="https://www.bbc.com/news/world-us-canada-59687947">current shortages of qualified teachers</a>, unions’ negotiation power may intensify. </p>
<h2>4. Gifted programs</h2>
<p>In 2022, gifted education may become a national debate. So far it has been prominent in New York City, but that may spread.</p>
<p><a href="https://www.nytimes.com/2021/10/15/nyregion/eric-adams-gifted-talented-nyc-schools.html">Mayor Eric Adams</a> said he intends to keep gifted programs in place. Gifted programs offer accelerated learning opportunities for students who score at the top of their class on standardized tests. Critics, such as the <a href="https://docs.wixstatic.com/ugd/1c478c_f14e1d13df45444c883bbf6590129bd7.pdf">School Diversity Advisory Group commissioned by former Mayor Bill de Blasio</a>, argue that gifted programs segregate students by race, since research has shown that <a href="https://doi.org/10.1177/2332858415622175">students of color are underrepresented</a> in these programs. </p>
<p>In California, policymakers have <a href="https://www.latimes.com/california/story/2021-05-20/california-controversial-math-overhaul-focuses-on-equity">unveiled a plan</a> to address this issue by grouping students of different mathematical ability in the same classrooms until their junior year. Only then will students be able to select advanced math courses, such as calculus or statistics. </p>
<p>This move may revive the 1980s’ so-called “<a href="https://www.brookings.edu/book/the-tracking-wars/">tracking wars</a>,” an intense debate over whether students should be offered different levels of curriculum based on their test scores. As other states and districts <a href="https://apnews.com/article/science-new-york-education-new-york-city-race-and-ethnicity-0f3d92179ff20b45c4747d3c84a026a2">consider overhauling their own gifted programs</a>, these short-term conflicts will likely add energy to the existing national fight concerning what role the education system should play in addressing inequality in the United States. </p>
<p>In all of these conflicts, be prepared in 2022 for policy advocates to use both conventional and unconventional strategies to advance their efforts. Further, expect those advocates to include politically and economically powerful actors as well as those who rarely have a voice in policy conversations. </p>
<p>In our research, which spanned the years 2010 to 2020, we saw conventional conflict actions such as <a href="https://www.npr.org/2019/02/19/695856032/w-va-teachers-go-on-strike-over-state-education-bill">teacher strikes</a>, <a href="https://denver.cbslocal.com/2015/02/19/months-after-protests-jeffco-board-scraps-ap-us-history-curriculum-review/">community protests</a> and <a href="https://www.washingtonpost.com/local/education/louisiana-gov-bobby-jindal-sues-obama-over-common-core-state-standards/2014/08/27/34d98102-2dfb-11e4-bb9b-997ae96fad33_story.html">lawsuits</a>. However, we also saw the successful use of less common efforts to challenge local, state and federal education policy, such as <a href="https://greensboro.com/news/local_news/deutsche-bank-cancels-job-expansion-in-cary-due-to-hb2/article_fea19dc6-e2c6-575d-adb9-d4a435d2863f.html">canceled business investments</a>, <a href="https://www.theatlantic.com/education/archive/2017/11/the-surprising-revolt-at-reed/544682/">classroom sit-ins</a>, <a href="https://www.nbcnews.com/news/us-news/jonathan-butler-how-grad-students-hunger-strike-toppled-university-president-n460161">a student hunger strike</a>, <a href="https://co.chalkbeat.org/2015/11/3/21093016/jeffco-school-board-members-who-pushed-controversial-changes-ousted-in-recall">school board recall votes</a>, <a href="https://www.charlotteobserver.com/news/nation-world/national/article163339228.html">teacher panhandling</a>, <a href="https://www.crainsnewyork.com/article/20180628/OPINION/180629917/stuyvesant-s-valedictorian-find-a-way-to-diversify-my-school">pointed valedictorian speeches</a> and even <a href="https://www.npr.org/sections/thetwo-way/2015/11/08/455216375/missouri-football-players-strike-to-demand-ouster-of-university-president">college football players’ threat to walk out on scheduled revenue-generating games</a>.</p><img src="https://counter.theconversation.com/content/171457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph J. Ferrare has received funding from the National Science Foundation, Alfred P. Sloan Foundation, Spencer Foundation, and U.S. Department of Education's Institute of Education Sciences. </span></em></p><p class="fine-print"><em><span>Kate Phillippo has received funding from the Spencer Foundation and the U.S. Department of Education.</span></em></p>Short-term disputes are really symptoms of deeper divisions in the US over who deserves academic opportunity, and how to present the nation’s history.Joseph J. Ferrare, Assistant Professor of Education Policy and Data Visualization, University of Washington, BothellKate Phillippo, Professor of Social Work and Education, Loyola University ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1657662021-08-11T13:50:32Z2021-08-11T13:50:32ZSARS-CoV-2 mutations: why the virus might still have some tricks to pull<figure><img src="https://images.theconversation.com/files/415622/original/file-20210811-13-1mn4zxd.jpg?ixlib=rb-1.1.0&rect=68%2C94%2C3339%2C2357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Sars-CoV-2 virus creates about half a mutation per infection. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/coronavirus-dna-virus-mutation-new-variant-1915990291">Adao/Shutterstock</a></span></figcaption></figure><p>The pandemic has enabled us to study the details of how evolution happens – in real time. Scientists have generated <a href="https://www.gisaid.org/">more than two million genome sequences</a> of the SARS-CoV-2 virus, allowing us to dissect the minutiae of evolutionary changes to a degree never previously possible for any replicating biological agent outside of the laboratory. </p>
<p>So what does this tell us about mutations and variants? Mutations are the <a href="https://theconversation.com/the-five-most-common-misunderstandings-about-evolution-54845">ultimate engine of evolution</a> and provide the raw material for natural selection to act. Some mutations are helpful for an organism and can become widespread in the species. Others are harmful or have little consequence. They arise due to errors when the genome is copied as a virus replicates, resulting in a single “base” (letter) being replaced with another.</p>
<p>The SARS-CoV-2 genome is made up of 30,000 individual bases. The rate at which mutations arise is typically expressed as the probability that any individual base will be erroneously replaced when the genome replicates. According to <a href="https://www.biorxiv.org/content/10.1101/2021.05.19.444774v1">recent experimental evidence</a> – which is yet to be published in a scientific journal – this is around three in a million.</p>
<p>Given this rate, we can ask how many mutations might arise every time someone gets infected. By multiplying 30,000 bases with the probability of 3/1,000,000, we get a total of about 0.1 mutations each time the genome replicates. </p>
<p>Peak infection lasts five to seven days, during which time the virus typically completes three to seven “<a href="https://www.immunology.org/public-information/bitesized-immunology/pathogens-and-disease/virus-replication">replication cycles</a>” (the steps from initial attachment to a host cell to the generation and release of newly synthesised virus particles). Five replication cycles would result in around 0.5 mutations (5x0.1), or one new mutation for every two people infected.</p>
<p>A different approach is to use genome sequence data. As each genome sequence is taken from a different infected person, this data allows us to calculate the rate at which mutations have accumulated in the global viral population, rather than within a single infection. By comparing the sequence data to an original “reference” genome (a very early virus genome) we can count how many mutations have accumulated in each genome. We can then see how quickly the number of mutations increases over time.</p>
<p>This tells us that the global population of viruses accumulates an average of about <a href="https://nextstrain.org/ncov/gisaid/global?l=clock">one mutation every two weeks</a> – a rate similar to that within a single infected person. </p>
<p>To put this mutation rate into context, human genomes experience the equivalent of around <a href="https://www.sciencedirect.com/science/article/abs/pii/S0959437X16301010?via%3Dihub">0.05 mutations every two weeks</a>. On the face of it, this is not so different from SARS-CoV-2 (only 20 times slower), until you consider that the human genome is 100,000 times larger, making the rate of mutation <em>per base</em> to be around two million times faster in the virus than in humans. </p>
<p>So SARS-Cov-2 has experienced roughly the same amount of mutational evolutionary change during the pandemic (proportional to genome size), as humans have since <em><a href="https://humanorigins.si.edu/evidence/human-fossils/species/homo-habilis">Homo habilis</a></em> first walked the Earth about 2.5m years ago. </p>
<h2>New variants</h2>
<p>The calculation described above refers to the number of mutations expected within a single line of descent (lineage) from one virus particle to the next, and so on. To work out the total number of mutations arising during an infection we also need to take into account all the virus particles produced, each of which follow their own mutational path.</p>
<p>The total number of infectious virus particles produced over the course of an infection is around <a href="https://www.pnas.org/content/118/25/e2024815118">300,000 and 300,000,000</a>. If each lineage accrues an average of 0.5 mutations, then the estimate of the total number of mutations during an infection in all the virus particles combined will be somewhere around 100,000 to 100,000,000 – being conservative, rather than exact.</p>
<p>The virus’s <a href="https://www.umassmed.edu/rti/biology/what-is-rna/">RNA code</a> contains four letters: G,C,U and A – there are 30,000 of them in the genome. Mutation might change any one of these letters to any of the other three letters in the code. This gives about 100,000 possible single mutations in total. </p>
<figure class="align-center ">
<img alt="DNA and RNA shown next to each other." src="https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398898/original/file-20210505-23-4eae6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">DNA and RNA is made up of four bases.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/structure-dna-rna-molecules-deoxyribonucleic-acid-1608843919">Ody Stocker/Shutterstock</a></span>
</figcaption>
</figure>
<p>It therefore follows that all possible single mutations are likely to arise during each single infection. So why did we not see new dangerous variants emerging until several months into the pandemic? </p>
<p>The overwhelming majority of these mutations will not have any meaningful consequences, or will even be harmful to the virus. What’s more, only a tiny fraction of virus particles within an infected person cause further infections. Almost all of the mutations that accumulate within a host will be lost once the infection is resolved. Also, because the time between infections is short, natural selection will have little opportunity to pick the “best” mutants with which to infect new hosts. </p>
<p>We should be extremely thankful for these tight genetic “bottlenecks” as the virus transmits from one host to another. It is sobering to reflect that countless new dangerous variants may have emerged within infected people across the world, but apart from the half dozen or so mutants lucky enough to get passed on and subsequently spread to become variants of concern, they have been quickly consigned to evolutionary oblivion.</p>
<h2>Evolutionary handicap?</h2>
<p>The fact that almost all the mutations arising within a single infection never make it out into the wider world confers a major evolutionary handicap on the virus. However, this can be compensated for if the total number of infections is very large. </p>
<p>At the time of writing, there were about 620,000 infections a day globally. If an infection passes on an average of 0.5 mutations, this means that globally around 300,000 new mutations are passed from one host to another each day. </p>
<p>Just as the overwhelming majority of mutants arising within a single infected person will never be passed on, so the vast majority of those that make it through one initial transmission event will not go on to spread more widely in the population. But recall that the maximum number of possible mutations is around 100,000. So it is conceivable that every possible single mutation in the viral genome is transmitted from one person to another every day. </p>
<p>This may give the impression, as some commentators <a href="https://www.theguardian.com/world/2021/aug/07/prof-francois-balloux-the-pandemic-has-created-a-market-for-gloom-and-doom">have recently opined</a>, that the virus may be running out of evolutionary options, and that the chance of new, dangerous types occurring is small.</p>
<p>However, some properties of the virus might not be determined by single mutations acting alone, but by the interaction of multiple mutations acting in concert on the same genome. For example, the effect of a specific mutation might be greatly enhanced if it happens to arise within a genome that has already been affected by other specific mutations. If such effects are common in SARS-CoV-2, then the virus may yet have some evolutionary tricks to pull.</p><img src="https://counter.theconversation.com/content/165766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ed Feil does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>SARS-Cov-2 has experienced roughly the same amount of evolutionary change during the pandemic as humans have since Homo habilis first walked the Earth about 2.5m years ago.Ed Feil, Professor of Microbial Evolution at The Milner Centre for Evolution, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1575382021-04-29T12:22:05Z2021-04-29T12:22:05ZPeople have had a hard time weighing pandemic risks because they haven’t gotten information they needed when they needed it<figure><img src="https://images.theconversation.com/files/395869/original/file-20210419-13-1i61nsf.jpg?ixlib=rb-1.1.0&rect=433%2C12%2C7815%2C4359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Misinformation and lack of information during the pandemic have made it even harder for people to assess risk. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/isolation-quarantine-coronavirus-covid-19-royalty-free-image/1213606250?adppopup=true">Xesai/Getty Images </a></span></figcaption></figure><p>The decision to <a href="https://www.cdc.gov/media/releases/2021/s0413-JJ-vaccine.html">pause and then restart the Johnson & Johnson vaccine</a> underscores how hard it is even for experts to gauge health risks. It’s been still harder for everyday people, most of whom have no medical background and little experience analyzing risks and benefits. </p>
<p>People have experienced confusion about mask-wearing, physical distancing, travel, remote work, financial assistance measures and more. <a href="https://absolutelymaybe.plos.org/2021/01/31/variants-3-new-covid-vaccines-and-contested-efficacy-claims-a-month-of-seismic-shifts-and-confusion/">Now people are weighing uncertainty about vaccines</a>. Further, some members of historically marginalized groups are skeptical of vaccine safety, as retired NFL star <a href="https://www.si.com/college/cal/news/marshawn-lynch-anthony-fauci">Marshawn Lynch detailed in a recent interview with Dr. Anthony Fauci</a>, chief medical adviser to President Biden. </p>
<p>We are <a href="https://researchers.anu.edu.au/researchers/henne-ke">informatics and regulation </a>researchers who study intersections among <a href="https://myeonglee.com">information</a>, <a href="https://scholar.google.com/citations?user=pb761jkAAAAJ&hl=en">policy and human behavior.</a> We have recently studied the intensive “risk work” individuals are doing amid the COVID-19 pandemic. Our research, which is scheduled to be published next month, provides insight into how people in the U.S. perceive pandemic-related risks and how they draw on information to assess and manage them. </p>
<h2>Worry beyond COVID-19</h2>
<p>To understand people’s perceptions of risk, we conducted interviews that allowed people to explain their beliefs and experiences in detail. We recruited this sample using nationwide group email lists and social media. Based on an initial short intake form, we selected participants to create a sample that was diverse in terms of age, geographic location and self-reported difficulties that people were facing during the pandemic. We conducted interviews with 40 people, and we paid them for their time.</p>
<p>These interviews revealed that people conceive of COVID-19 risks as more diverse and complex than popular narratives about managing “<a href="https://theconversation.com/data-from-45-countries-show-containing-covid-vs-saving-the-economy-is-a-false-dichotomy-150533">health versus the economy</a>” suggest.</p>
<p>Though illness and economic risks were dominant concerns of our interviewees, people also spoke about risks from secondary illness, threats to social and behavioral well-being and the erosion of key institutions. </p>
<p>Risk of COVID-19 illness included apprehension about the prospect of being unwell, suffering with a severe disease and dying. Participants worried about becoming severely sick with COVID-19, but they differed in their perceptions of who was more likely to become gravely ill. There was general agreement that elderly people and people who had underlying medical conditions were at higher risk. </p>
<p>Wanting to know which groups were especially “at risk” was very important for many people we interviewed. They talked about dangers of illness for “society,” “everyone,” “elderly people,” and “people in a certain socioeconomic group.” They also discussed risks to themselves or their close social contacts, such as references to “my dad who is elderly and sick” and “my son-in-law who is a deputy sheriff and encounters homeless people with COVID symptoms.” </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1372306413628833796"}"></div></p>
<h2>Concern about other illnesses and stress</h2>
<p>Participants associated “secondary” illness risks with health care resource shortages. Many described the increased likelihood of death from other serious conditions if the health care system became overrun with COVID-19 patients. They understood that an overstretched system would not be able to provide normal levels of care and that it also meant that patients would be more likely to suffer or die. </p>
<p>They described multiple interrelated threats to social and behavioral well-being. Social and behavioral risks included things like anxiety, depression, stress, damaged relationships and career setbacks. Mental illness, for example, emerged as a potential risk from widespread and personal social isolation, which could lead to <a href="https://www.medicalnewstoday.com/articles/alarming-covid-19-study-shows-80-of-respondents-report-significant-symptoms-of-depression">loneliness</a> and depression. </p>
<p>Interviewees understood estrangement in personal relationships as a risk for themselves and others. A grandmother who used to take care of her grandchild two days a week thought her personal relationship with her young granddaughter could fray through the lack of in-person contact during the pandemic. Other participants felt there was a risk in terms of delays in life trajectories – for example, careers derailed or set back years and developmental delays among children whose schooling was canceled or altered. </p>
<p>Economic risks spanned concerns about job and income loss, recession and the inability to find work. As with illness risks, participants framed economic risk both broadly in terms of society and specifically in relation to certain populations they perceived as being “at-risk,” such as recent graduates, <a href="https://www.wsj.com/articles/millennials-covid-financial-crisis-fall-behind-jobless-11596811470">millennials</a>, business owners and poor people. </p>
<p>Many participants characterized the wider economic implications as potentially disastrous, explaining the risks as similar to or greater than the virus itself. Some even described an economic threat that could dwarf the Great Depression of the 1930s or the global financial crisis of 2007-2008. They also mentioned specific threats, such as business closures, sweeping losses to retirement income and declines in home values.</p>
<figure class="align-center ">
<img alt="The ticket office for Broadway shows, with no one standing in line." src="https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=352&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=352&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=352&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=442&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=442&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395870/original/file-20210419-23-59o0d0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=442&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ticket office for Broadway shows closed March 13, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ticket-office-for-broadway-shows-closed-because-of-news-photo/1207088088?adppopup=true">Lev Radin/Pacific Press/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>Changes to institutions, and even the arts</h2>
<p>Another identified risk was crumbling institutions. Participants saw the pandemic as a threat to public health, the health care system, educational systems, <a href="https://www.usatoday.com/story/travel/2020/07/22/coronavirus-museums-fear-permanent-closing-pandemic/5490482002/">the arts</a>, the federal government and business. They believed that if these systems fell apart there would be long-term ramifications. As a 22-year-old resident of Arizona said, “I was more worried about the societal changes than the actual virus, if that makes sense.” </p>
<p>Many interviewees reflected on institutional failures. For example, one participant, interviewed in 2020, explained how the pandemic had led to a crisis of leadership for the country, with states left to fend for themselves to manage the effects of COVID-19 without adequate federal support. Others felt that institutions being at risk meant core rights and privileges that Americans typically enjoyed – such as <a href="https://journals.sagepub.com/doi/full/10.1177/0743915620929999">privacy</a> – were also at risk. </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p>
<h2>Helping people manage COVID-19 risks</h2>
<p>Our participants reported that most of the information about COVID-19 risks available to them addressed only COVID-19 illness and not other types of risks associated with the pandemic, and often contained conflicting recommendations. As a result, our participants said they received little helpful information about how to manage the multiple forms of risk they were perceiving. </p>
<p>According to our research, not having information to validate these other perceived risks had a spillover effect: It fueled a sense that authorities were not addressing urgent threats. Advice on managing COVID-19 illness that fails to acknowledge other risks contributes to a loss of trust and, in turn, may undermine compliance with guidelines. </p>
<p>Studies show that people perceive messaging about COVID-19 to be <a href="https://doi.org/10.1371/journal.pone.0240776">fragmented and conflicted</a>. This is dangerous, because past studies show that exposure to health messages that are conflicting leads to <a href="https://digest.bps.org.uk/2015/08/13/surprising-or-contradictory-health-news-stories-encourage-readers-to-be-sceptical-about-science/">decreased trust in authoritative sources of information</a>. Our findings led us to the same conclusion. They made clear that the issue is even broader, because people are receiving inadequate information about multiple pandemic risks, not just COVID-19 illness. </p>
<p>In addition, our participants said that authoritative sources of risk information tend to be too general. People said that they often turned to individuals in their social networks to help them obtain relevant information and better understand risk – for example, a cousin who is a nurse working on the front lines.</p>
<p>We found that these informal communications with experts are important but often overlooked. Acknowledging the informal work that these experts do and developing strategies to support this labor could inform individuals’ risk management. It could also alleviate anxiety during this uncertain time. </p>
<p>For example, clinicians receive information updates from local, state and national health agencies and the organizations where they practice. Clinicians often translate this information for their social contacts through informal communications. Alongside clinical updates, they could receive information sheets describing COVID-19 risks and risk management strategies that they could distribute via social media and other channels to their networks. Picture an easily understandable breakdown of the risks and benefits of the Johnson & Johnson vaccine that clinicians could share broadly with the click of a button to group chats and social media accounts.</p><img src="https://counter.theconversation.com/content/157538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Henne receives funding from the Australian National University Futures Scheme.</span></em></p><p class="fine-print"><em><span>Kathleen H. Pine and Myeong Lee do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have a hard time assessing risk in the best of times. Adding a world-changing pandemic with evolving and sometimes conflicting information has made personal risk assessment much harder.Kathleen H. Pine, Assistant Professor of Health Informatics, Arizona State UniversityKathryn Henne, Professor and Director, School of Regulation and Global Governance, Australian National UniversityMyeong Lee, Assistant Professor of Information Science, George Mason UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1583892021-04-13T12:42:36Z2021-04-13T12:42:36ZWhy student athletes need a new playbook to stay safe in the COVID-19 era<figure><img src="https://images.theconversation.com/files/394410/original/file-20210412-15-tg9yf8.jpg?ixlib=rb-1.1.0&rect=632%2C265%2C3822%2C2479&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">High school water polo player Cami Rowan gets to work out in the home pool in Corona, Calif. on Feb. 18, 2021.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/high-school-water-polo-player-cami-rowan-gets-to-work-out-news-photo/1231256506?adppopup=true">Frederic J. Brown/AFP/Getty images</a></span></figcaption></figure><p>Kids are eager to play ball, and parents are eager to be back on the sidelines supporting them. But <a href="https://www.washingtonpost.com/health/2021/04/06/youth-sports-outbreaks-covid-testing/">COVID-19 cases have risen</a> in places where kids have been playing sports, complicating the issue. </p>
<p>Michigan, where I live, is now the <a href="https://www.msn.com/en-us/health/medical/michigan-leads-us-with-highest-number-of-covid-19-cases-per-capita/vi-BB1fk41b">epicenter of COVID-19 cases</a> in the U.S. The resumption of youth sports activities has been widely implicated in Michigan’s latest COVID-19 surge, with <a href="https://www.cbsnews.com/news/covid-michigan-cases-spike-kids/">40% of new outbreaks</a> occurring in K-12 schools or youth programs.</p>
<p>Experts also blame Michigan’s unprecedented rise to the top on an unfortunate mixture of reopening, <a href="https://www.wilx.com/2021/04/07/covid-19-numbers-continue-to-surge-with-michigan-not-slowing-down/">virus variants and COVID-19 fatigue</a>.</p>
<p>As an <a href="https://education.wayne.edu/profile/gr7894">exercise scientist and clinician</a>, I believe that <a href="https://doi.org/10.1016/j.joep.2012.02.007">sports participation</a> – and <a href="https://doi.org/10.1186/s41256-018-0068-9">even watching sports</a> – has health and social benefits which far exceed winning and losing. My physiologist brain, however, argues that at this very moment, people should be focusing their energy not against each other, but rather toward defeating the world’s deadliest team: SARS-CoV-2, or, if you will, Team Coronavirus. </p>
<figure class="align-center ">
<img alt="Two teenagers practicing volleyball." src="https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/394415/original/file-20210412-23-tibnu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teens practiced volleyball in Gilbert, Ariz. on March 25, 2020, shortly after schools shut down there.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakArizona/a8fc51bb049a462b817d2618be427c7d/photo?Query=kids%20playing%20sports%20coronavirus&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=10&currentItemNo=5">Matt York/AP</a></span>
</figcaption>
</figure>
<h2>Humans as the underdog</h2>
<p>Parents in Michigan have started a group called <a href="https://www.msn.com/en-us/sports/more-sports/let-them-play-ca-settles-lawsuit-all-sports-allowed-to-return/ar-BB1efjnT">Let Them Play Michigan</a> to press the issue. Specifically, the group opposes mandatory weekly testing of student athletes, which the state requires, and quarantining of young athletes who test positive.</p>
<p>Recently, Let Them Play Michigan <a href="https://www.msn.com/en-us/news/us/youth-sports-lawsuit-could-cut-mandatory-testing-and-quarantine-from-michigan-schools/ar-BB1ftdTL">filed a lawsuit</a> against the state of Michigan to ease mandatory testing restrictions in high school athletes, arguing that the state health department does not have the authority to issue these restrictions.</p>
<p>I still consider myself an athlete, even though jogging three miles a day is a low performance bar. That’s why at an emotional level, the <a href="https://www.msn.com/en-us/sports/more-sports/let-them-play-ca-settles-lawsuit-all-sports-allowed-to-return/ar-BB1efjnT">Let Them Play</a> youth sports movement touches my heart, since athletes resent anything that keeps them off the field, court or pitch.</p>
<p>So I suggest public health experts, parents and other stakeholders consider the issue through the lens of sports – Team People against Team Coronavirus. Team Coronavirus is focused solely on winning (survival) and will seize upon any <a href="https://doi.org/10.1038/s41385-020-00340-z">mammal</a> with properly fitting <a href="https://doi.org/10.1038/s41593-020-00771-8">ACE2 (angiotensin converting enzyme 2), liver heparin or other receptors high in sialic acid</a>. Once Team Coronavirus invades a cell’s nucleus, the virus delivers instructions to replicate, particularly within lung and upper airway cells. </p>
<p>Once a person is infected, <a href="https://doi.org/10.1016/S1473-3099(20)30484-9">millions</a> of coronavirus particles can <a href="https://doi.org/10.1063/5.0026360">spew out</a> of an infected host’s <a href="https://doi.org/10.1016/S1473-3099(20)30484-9">nose and mouth</a> with every breath, cough, sneeze or word spoken. It can even exit through the <a href="https://doi.org/10.1093/gastro/goaa067">rectum</a>. The SARS-CoV-2 virus can also enter our bodies through the <a href="https://doi.org/10.1016/j.immuni.2021.01.017">mucous membranes of our eyes</a>, as fast as cutting an onion can make us cry. </p>
<p>A particularly daunting skill set of Team Coronavirus is its ability to change shape and <a href="https://doi.org/10.1016/j.cell.2021.03.013">evade the Team People’s defense, or immune, system</a>. So think of it like a new team taking the court after half-time. Not only have the players never seen this team, but the coaches haven’t seen the films. </p>
<p>The possibility that Team Coronavirus can hide undetected within tissue reservoirs, such as in the <a href="https://doi.org/10.1038/s41593-020-00771-8">brain</a>, <a href="https://doi.org/10.1016/j.tmaid.2020.101642">nervous system</a>, <a href="https://doi.org/10.1016/j.immuni.2021.01.017">eyes</a>, <a href="https://doi.org/10.1001/jamacardio.2020.3551">heart</a> or <a href="https://doi.org/10.1111/ajt.16532">lungs</a>, is another under-recognized skill of SARS-CoV-2. Scientists hypothesize that this ability may contribute to its persistence in both <a href="https://doi.org/%2010.1056/NEJMoa2001316">acute</a> and <a href="https://doi.org/10.1038/s41591-021-01283-z">chronic</a> disease states, such as long haulers’ COVID-19. </p>
<p>Given our current understanding of Team Coronavirus’ expanding playbook, is it possible to safely let kids play sports during a pandemic, without some restrictions?</p>
<h2>The NBA did it, but at a high cost</h2>
<p>The success of the <a href="https://www.forbes.com/sites/tommybeer/2020/10/20/report-nbas-bubble-prevented-15-billion-in-losses/?sh=1a0db5e43823">NBA Bubble</a> demonstrates that competitive sports can be performed safely – and without vaccines – by adhering to strict safety protocols. That includes rigorous – meaning daily – testing, isolation and quarantine measures. </p>
<p>The <a href="https://en.wikipedia.org/wiki/2020_NBA_Bubble">financial cost</a> of allowing 22 NBA teams to compete over about 100 days was about US$190 million, with additional, intangible <a href="https://www.msn.com/en-us/sports/nba/lebron-james-admits-he-s-thought-about-leaving-bubble/ar-BB18w5b2">mental health and emotional costs</a> experienced by players and coaches. </p>
<p>However, the bubble clearly showed that Team Coronavirus can be defeated, but with significant personal and financial sacrifice.</p>
<p>The irony of the youth sports movement, as detailed in the current <a href="https://www.wilx.com/2021/04/02/let-them-play-group-files-lawsuit-against-michigan-due-to-mandatory-athlete-testing/">Let Them Play Michigan lawsuit</a>, is the unsportsmanlike intention to cut corners on the evidenced-based safety measures in order for the kids to play. Adults filing the lawsuit on kids’ behalf are suggesting that weekly testing is too much, or that quarantining if an infection is found is too onerous. This parental response may be because kids are complaining. </p>
<p>Adults cannot let kids make these decisions. Despite the best of intentions, <a href="https://doi.org/10.1001/jamanetworkopen.2020.31509">adolescents are poor judges of health risks</a>. Sure, they may not want to accept weekly COVID-19 testing, but adults need to make sure they follow the rules. The NBA’s experience shows that testing should be an essential part of the rules.</p>
<p>One of Team Coronavirus’ most devastating offensive plays is its invisibility, or <a href="https://doi.org/10.1001/jamanetworkopen.2020.35057">asymptomatic spread</a>. Regular COVID-19 testing, as a major defensive strategy, identifies genetic material from Team Coronavirus so that any infected players can promptly be removed from play, limiting the spread of COVID-19 by removing their best players – superspreaders with high viral loads. This is why quarantining is so important. </p>
<p>Another highly effective defensive strategy against Team Coronavirus is covering both mouths and noses with masks to limit the airborne transfer of viral particles between players. The argument that masks are ineffective is true when face masks are not worn correctly (as widely seen around the chin).</p>
<p>If regular testing and wearing masks during games could save the life of a beloved <a href="https://www.nbcwashington.com/news/sports/nbcsports/college-football-player-jamain-stephens-jr-dies-after-complications-from-covid-19/2413981/">football player</a>, fellow <a href="https://www.nytimes.com/2020/09/29/us/college-student-dies-covid.html">basketball-playing exercise science student</a> or collegiate <a href="https://abcnews.go.com/Sports/alabama-basketball-fans-death-prompts-covid-19-contact/story?id=76860269">March Madness superfan</a>, how can parents and coaches not consider such minor inconveniences to save a coach’s, parent’s or teammate’s life?</p>
<p>Every COVID-19 death is preventable. Every loss, unconscionable. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/91RfrP9bosw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CDC Director Rochelle Walensky discusses youth sports and coronavirus spread.</span></figcaption>
</figure>
<h2>Going into overtime</h2>
<p>One scary consequence of COVID-19 is the potential for <a href="https://doi.org/10.1038/s41591-021-01283-z">long-lasting disability</a> in those infected with SARS-CoV-2. While people itching for normalcy may think of an attack by Team Coronavirus as a “one-and-done” affair, post-infective fatigue, mental debility, neuralgia and psychoses are just getting started in patients with long-haul cases. </p>
<p>A growing body of evidence suggests that recovery from asymptomatic or mildly symptomatic COVID-19 may be associated with residual <a href="https://doi.org/10.1001/jamacardio.2020.4916">inflammation around the heart</a>, <a href="https://doi.org/10.1152/ajpheart.00897.2020">impairment of blood flow</a>, <a href="https://doi.org/10.1101/2020.10.14.20212555">multi-organ impairment</a> (brain, lungs, kidney, liver, pancreas and spleen), <a href="https://doi.org/10.1101/2020.11.24.20238261">sustained fatigue and exercise intolerance</a>.</p>
<p>This post-COVID-19 syndrome is recognized as “<a href="https://doi.org/%2010.1001/jama.2020.17709">long-haulers</a>” syndrome worldwide and causes <a href="https://doi.org/10.1016/j.tins.2020.10.009">neurologic dysfunction</a> and debilitating fatigue in both <a href="https://doi.org/10.1371/journal.pone.0240784">young adults</a> and <a href="https://doi.org/10.1111/apa.15673">children</a>. </p>
<p>The SARS epidemic from 2003 provides a cautionary tale. In fact, 40.3% of patients who were diagnosed with SARS-CoV-1 faced chronic fatigue, and 42.5% experienced psychiatric illness <a href="https://doi.org/10.1001/archinternmed.2009.384">up to four years later</a>. </p>
<h2>Let them play, but with firm rules in place</h2>
<p>The question for parents, public health officials and school officials is: How do we let kids play and keep them safe? I believe there are ways to do this.</p>
<ul>
<li><p>Get tested regularly.</p></li>
<li><p>Wear masks properly – block virus transmission by covering both the mouth and nose.</p></li>
<li><p>Embrace shared sacrifice.</p></li>
<li><p>Support one another – sustained sacrifice is hard, so work together and check in regularly with teammates.</p></li>
<li><p>Play outside – or have adequate ventilation inside to disperse viral particles.</p></li>
<li><p><a href="https://doi.org/10.1016/j.cell.2020.09.040">Get vaccinated</a>. </p></li>
</ul>
<p>As current underdogs, athletes, coaches, parents and fans need to dig deep, embrace discomfort and beat this virus once and for all.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/158389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamara Hew-Butler does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kids want to play sports again, and who can blame them? An exercise scientist and physiologist explains why adhering to safety protocols is imperative.Tamara Hew-Butler, Associate Professor of Exercise and Sports Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1583602021-04-08T12:04:51Z2021-04-08T12:04:51ZHow worried should you be about coronavirus variants? A virologist explains his concerns<figure><img src="https://images.theconversation.com/files/393676/original/file-20210406-21-13p50y3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3982%2C2095&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A COVID-19 patient in an ICU unit in a hospital in Capetown, South Africa, in December 2020. A variant emerged in South Africa that has since spread to other parts of the world. Other new variants could emerge elsewhere.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/patient-with-the-covid-19-breaths-in-oxygen-in-the-covid-19-news-photo/1230343590?adppopup=true">Rodger Bosch/AFP via Getty Images</a></span></figcaption></figure><p>Spring has sprung, and there is a sense of relief in the air. After one year of lockdowns and social distancing, more than 171 million COVID-19 vaccine doses have been administered in the U.S. and <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">about 19.4% of the population is fully vaccinated</a>. But there is something else in the air: ominous SARS-CoV-2 variants. </p>
<p>I am a <a href="https://pathobiology.cahnr.uconn.edu/paulo-h-verardi/">virologist and vaccinologist</a>, which means that I spend my days studying viruses and designing and testing vaccine strategies against viral diseases. In the case of SARS-CoV-2, this work has taken on greater urgency. We humans are in a race to become immune against this cagey virus, whose ability to mutate and adapt seems to be a step ahead of our capacity to gain herd immunity. Because of the variants that are emerging, it could be a race to the wire.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fp-oG7ZWOJI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A variant in Brazil is overwhelming the country’s health care system.</span></figcaption>
</figure>
<h2>Five variants to watch</h2>
<p><a href="https://doi.org/10.2174/1389202916666150707160613">RNA viruses</a> like SARS-CoV-2 constantly mutate as they make more copies of themselves. Most of these mutations end up being disadvantageous to the virus and therefore disappear through natural selection. </p>
<p>Occasionally, though, they offer a benefit to the mutated or so-called genetic-variant virus. An example would be a mutation that improves the ability of the virus to attach more tightly to human cells, thus enhancing viral replication. Another would be a mutation that allows the virus to spread more easily from person to person, thus increasing transmissibility. </p>
<p>None of this is surprising for a virus that is a fresh arrival in the human population and still adapting to humans as hosts. While viruses don’t think, they are governed by the same evolutionary drive that all organisms are – their first order of business is to perpetuate themselves.</p>
<p>These mutations have resulted in several new SARS-CoV-2 variants, leading to outbreak clusters, and in some cases, <a href="https://www.nytimes.com/interactive/2021/04/06/us/variants-cases-spread.html">global spread</a>. They are broadly classified as <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html">variants of interest, concern or high consequence</a>. </p>
<p>Currently there are five variants of concern circulating in the U.S.: the B.1.1.7, which originated in the U.K.; the B.1.351., of South African origin; the P.1., first seen in Brazil; and the B.1.427 and B.1.429, both originating in California.</p>
<p>Each of these variants has a number of mutations, and some of these are key mutations in critical regions of the viral genome. Because the <a href="https://doi.org/10.1038/s41401-020-0485-4">spike protein</a> is required for the virus to attach to human cells, it carries a number of these key mutations. In addition, <a href="https://www.news-medical.net/health/What-are-Neutralizing-Antibodies.aspx">antibodies that neutralize</a> the virus typically bind to the spike protein, thus making the spike sequence or protein a key component of COVID-19 vaccines.</p>
<p><a href="https://www.businessinsider.com/double-mutant-coronavirus-variant-california-india-2021-4">India and California have recently detected “double mutant” variants</a> that, although not yet classified, have gained international interest. They have one key mutation in the spike protein similar to one found in the Brazilian and South African variants, and another already found in the B.1.427 and B.1.429 California variants. As of today, no variant has been classified as of high consequence, although the concern is that this could change as new variants emerge and we learn more about the variants already circulating.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1379358229138923530"}"></div></p>
<h2>More transmission and worse disease</h2>
<p>These variants are worrisome for several reasons. First, the SARS-CoV-2 variants of concern generally spread from person to person at least <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html">20% to 50% more easily</a>. This allows them to infect more people and to spread more quickly and widely, eventually becoming the predominant strain. </p>
<p>For example, the B.1.1.7 U.K. variant that was first detected in the U.S. in December 2020 is now the prevalent circulating strain in the U.S., accounting for an <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-proportions.html">estimated 27.2% of all cases by mid-March</a>. Likewise, the P.1 variant first detected in travelers from Brazil in January is now wreaking havoc in Brazil, where it is causing a collapse of the health care system and led to <a href="https://doi.org/10.1136/bmj.n879">at least 60,000 deaths in the month of March</a>.</p>
<p>Second, SARS-CoV-2 variants of concern can also lead to more severe disease and increased hospitalizations and deaths. In other words, they may have enhanced virulence. Indeed, a recent study in England suggests that the <a href="https://doi.org/10.1038/s41586-021-03426-1">B.1.1.7 variant causes more severe illness and mortality</a>. </p>
<p>Another concern is that these new variants can escape the immunity elicited by natural infection or our current vaccination efforts. For example, antibodies from people who recovered after infection or who have received a vaccine may not be able to bind as efficiently to a new variant virus, resulting in reduced neutralization of that variant virus. This could lead to reinfections and lower the effectiveness of current <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibody-treatment-covid-19">monoclonal antibody treatments</a> and vaccines.</p>
<p>Researchers are intensely investigating whether there will be reduced vaccine efficacy against these variants. While most vaccines seem to remain effective against the U.K. variant, one recent study showed that <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2102214">the AstraZeneca vaccine lacks efficacy in preventing mild to moderate COVID-19</a> due to the B.1.351 South African variant. </p>
<p>On the other hand, Pfizer recently announced data from a subset of volunteers in South Africa that supports <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-confirm-high-efficacy-and-no-serious">high efficacy of its mRNA vaccine against the B.1.351 variant</a>. Other encouraging news is that <a href="https://www.news-medical.net/health/What-are-T-Cells.aspx">T-cell immune responses</a> elicited by <a href="https://doi.org/10.1093/ofid/ofab143">natural SARS-CoV-2 infection</a> or <a href="https://doi.org/10.1101/2021.02.27.433180">mRNA vaccination</a> recognize all three U.K., South Africa, and Brazil variants. This suggests that even with reduced neutralizing antibody activity, T-cell responses stimulated by vaccination or natural infection will provide a degree of protection against such variants.</p>
<h2>Stay vigilant, and get vaccinated</h2>
<p>What does this all mean? While current vaccines may not prevent mild symptomatic COVID-19 caused by these variants, they will likely prevent moderate and severe disease, and in particular hospitalizations and deaths. That is the good news. </p>
<p>However, it is imperative to assume that current SARS-CoV-2 variants will likely continue to evolve and adapt. In a recent survey of 77 epidemiologists from 28 countries, the majority believed that within a year current vaccines could need to be updated to better handle new variants, and that low vaccine coverage will <a href="https://www.oxfam.org/en/press-releases/two-thirds-epidemiologists-warn-mutations-could-render-current-covid-vaccines">likely facilitate the emergence of such variants</a>. </p>
<p>What do we need to do? We need to keep doing what we have been doing: using masks, avoiding poorly ventilated areas, and practicing social distancing techniques to slow transmission and avert further waves driven by these new variants. We also need to vaccinate as many people in as many places and as soon as possible to reduce the number of cases and the likelihood for the virus to generate new variants and escape mutants. And for that, it is vital that public health officials, governments and nongovernmental organizations address vaccine hesitancy and equity both locally and globally. </p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/158360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paulo Verardi receives funding from NIH, USDA, DOD, and the University of Connecticut.</span></em></p>As the US vaccinates millions more people each day, the novel coronavirus works to survive. It does this by mutating. So far, several variants are worrisome. A virologist explains what they are.Paulo Verardi, Associate Professor of Virology and Vaccinology, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565522021-03-26T12:25:53Z2021-03-26T12:25:53ZDomestic air travel does not appear to have been an important vector for the spread of COVID-19 in the US, study suggests<figure><img src="https://images.theconversation.com/files/389330/original/file-20210312-22-7ywc1h.jpg?ixlib=rb-1.1.0&rect=17%2C133%2C3864%2C2438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Passengers board a plane in New York City on May 3, 2020. Air travel from such hot spots did not lead to surges to other cities, a study suggests.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/passengers-almost-all-wearing-facemasks-board-an-american-news-photo/1213388331?adppopup=true">Eleonore Sens/AFP via Getty Images)</a></span></figcaption></figure><p>Fear of flying and catching COVID-19 led to a <a href="https://www.forbes.com/sites/ginaheeb/2021/02/16/us-air-travel-dropped-60-in-2020-as-covid-19-hammered-airlines/?sh=21ca3f966978">massive decline in air travel</a> in 2020. But an interesting question emerges: How much did air travel contribute to the early, and uneven, spread of COVID-19 in the U.S.? </p>
<p>In a previous study currently undergoing peer review, we looked at the effect of air travel from Italy and China on the early spread of COVID-19 in the U.S. and <a href="http://dx.doi.org/10.2139/ssrn.3753069">found while flights from Italy were an important source of exposure, ones from China were not</a>.</p>
<p>Experts have offered many explanations for why the virus spread so unevenly in the U.S. and elsewhere, ranging from population density to public transportation. </p>
<p>We are economics <a href="https://scholar.google.com/citations?user=w19BmLkAAAAJ&hl=en">researchers</a> <a href="https://scholar.google.com/citations?user=X-fVoKwAAAAJ&hl=en">with experience</a> studying air travel. In a recent <a href="http://dx.doi.org/10.2139/ssrn.3786991">study</a> that is beginning the peer review process, we examine whether air travel from early COVID-19 hot spots in the U.S. spread the virus to other parts of the country. The answer is no. </p>
<figure class="align-center ">
<img alt="Airline passengers checking in at an airport." src="https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389836/original/file-20210316-22-sv5tpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Passengers check in for flights at Midway International Airport on Jan. 28, 2021 in Chicago, Ill.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/passengers-check-in-for-southwest-airlines-flights-at-news-photo/1299151020?adppopup=true">Scott Olson/Getty Images</a></span>
</figcaption>
</figure>
<h2>Ready for takeoff?</h2>
<p>The question has recently taken on added importance. With the pace of vaccinations increasing and COVID-19 cases falling, <a href="https://www.nytimes.com/live/2021/03/13/world/covid-19-coronavirus">air travel is increasing</a>. Nearly 15% more travelers flew in February than in January. </p>
<p>At the same time, the latest <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html">guidelines from the Centers for Disease Control and Prevention</a>, updated March 23, 2021, still recommend to delay air travel. This includes those who are vaccinated. The recommendation may be based on the fact that case numbers <a href="https://www.nytimes.com/live/2021/03/13/world/covid-19-coronavirus">increase after mass travel</a>, but it is not clear if this relationship is due to air travel per se. </p>
<p>To examine whether passengers from COVID-19 hot spots spread the virus to other parts of the U.S., we studied whether counties receiving more passengers from COVID-19 hot spots during the first quarter of 2020 experienced higher COVID-19 infection and death rates during the first wave of the pandemic than counties receiving fewer passengers from COVID-19 hot spots. For our purposes, we determined the first wave ended around May 31, 2020.</p>
<p>Our results show that passengers traveling from COVID-19 hot spots at the onset of the pandemic did not spread the virus across the country during the first wave of the pandemic. These results suggest to us that requiring negative COVID-19 tests for airline passengers may not be necessary. Indeed, they may be harmful, if they cause people to drive more. </p>
<p><a href="https://dx.doi.org/10.2139/ssrn.677563">Prior research</a> that one of us conducted showed that after 9/11, <a href="https://dx.doi.org/10.2139/ssrn.677563">increased airport security procedures reduced the demand for air travel</a>. The inconvenience from the additional security, combined with a fear of another terrorist attack on a plane, led many travelers to substitute driving for flying, <a href="http://dx.doi.org/10.2139/ssrn.677549">which resulted in an increase in driving fatalities</a>. </p>
<p>In addition, our results suggest that banning domestic air travel may not help to slow the spread of infections.</p>
<h2>Connecting flights to COVID-19?</h2>
<p>In our study, we link data on airline travel with county-level data on COVID-19 cases and deaths. We wanted to find out: Did counties with more arrivals from early COVID-19 hot spots – New York City, Boston, New Orleans and Detroit – experience more COVID-19 cases or deaths during the first wave of the pandemic? </p>
<p>There are two important challenges in trying to assess the relationship between airline travel and the spread of COVID-19. The first is something called reverse causality: The number of travelers to any area in the U.S. will likely be influenced by the number of confirmed cases and deaths in that metro area. Not many people want to travel to a location experiencing a COVID-19 outbreak. </p>
<p>The second concern is that areas that are generally more attractive to travelers may tend to have more COVID-19 cases and deaths, in addition to arrivals. For example, it may be that cities with more business activity or tourist attractions may both have more COVID-19 cases and attract more travelers.</p>
<p>We used data on passengers arriving from non-COVID-19 hot spots to help control for these factors. We also took into account other factors that can affect the virus’s spread and impact, such as population size and density, and demographics of the local area.</p>
<p>We were surprised to find no evidence that air travel from early COVID-19 hot spots helped to spread the virus across the U.S. Specifically, after controlling for arrivals from non-COVID-19 hot spots, we found no evidence that counties that received more passengers from the four COVID-19 hot spots during the first quarter of 2020 experienced more cases or deaths during the first wave of the pandemic, through May 31, 2020. In fact, we found some evidence that these counties actually experienced fewer cases and deaths. </p>
<p>At the same time, we find evidence that counties that received more passengers from areas with very low COVID-19 infection rates at the onset of the pandemic, including Atlanta, Charlotte, Cincinnati, Dallas, Denver, Houston, Minneapolis-St. Paul and Phoenix, experienced more cases and deaths, although not by very much.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wiEcV5deaRQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Calls are increasing for proof of vaccination before flying.</span></figcaption>
</figure>
<h2>What this means for flyers</h2>
<p>Based on our findings, we think that requiring all <a href="https://www.cnn.com/travel/article/us-domestic-covid-19-test-considered-air-travel/index.html">airline passengers to provide proof of a negative COVID-19 test</a> will do very little to slow the spread of the virus. That is based on our results, along with data showing that the odds of getting infected while flying are <a href="https://www.cnn.com/travel/article/odds-catching-covid-19-flight-wellness-scn/index.html">very small</a>.</p>
<p>Moreover, because of the <a href="https://www.prnewswire.com/news-releases/motor-vehicle-deaths-in-2020-estimated-to-be-highest-in-13-years-despite-dramatic-drops-in-miles-driven-301240410.html?fbclid=IwAR2zjAuP7YdsSqb9X1JejkpZjfq_c4TOrnZHuiTWz83zSyjpeoDTOsLr-q0">much higher risk of dying in an auto accident</a>, driving is much more dangerous than flying. Therefore, a policy that makes flying more difficult could lead to additional driving fatalities if travelers choose to drive rather than fly.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/156552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People are ready to travel, but health officials are advising against air travel. A recent study offers a surprising finding about whether planes spread COVID-19 from US hot spots last year.Jeff Prince, Professor and Chair of Business Economics and Public Policy, Indiana UniversityDaniel Simon, Associate Professor of Public Affairs, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1561692021-03-03T13:22:25Z2021-03-03T13:22:25ZTwo gaps to fill for the 2021-2022 winter wave of COVID-19 cases<figure><img src="https://images.theconversation.com/files/387358/original/file-20210302-13-m2e61t.jpg?ixlib=rb-1.1.0&rect=9%2C42%2C2019%2C1298&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A sign in County Kildare, Ireland. in March 2020. Epidemiologists around the world worked hard to try to stop big parties in the face of rising caseloads of what would come to be called COVID-19. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sign-anouncing-the-cancellation-of-a-st-patricks-day-parade-news-photo/1207443830?adppopup=true">Niall Carson/PA Images via Getty Images</a></span></figcaption></figure><p>Epidemiologists – like oncologists and climate scientists – hate to be proven right. A year ago this week, the communications rush began from epidemiologists in academia to the public and to local governments about the imminent dangers of the COVID-19 pandemic, in the face of a weak federal response. </p>
<p>St. Patrick’s Day parades were canceled with days to spare. Hospitals were turning suspected positive cases away because of a lack of tests. <a href="https://works.bepress.com/mcandrew/2/">Epidemiologists</a> <a href="https://www.cbsnews.com/news/coronavirus-infection-outbreak-worldwide-virus-expert-warning-today-2020-03-02/">predicted</a> <a href="https://theconversation.com/how-big-will-the-coronavirus-epidemic-be-an-epidemiologist-updates-his-concerns-133133">that</a> hundreds of thousands Americans would die over the following year, with the upper boundaries <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-9-impact-of-npis-on-covid-19/">above a million</a>. This was our country’s biggest challenge since 1941, and we did not meet it. </p>
<p>Despite the stream of bad news, a major success of 2020 was the pace of vaccine development. A 10-month sprint ending with completed phase 3 clinical trials for two vaccine candidates (and a <a href="https://www.fda.gov/news-events/press-announcements/fda-issues-emergency-use-authorization-third-covid-19-vaccine">third one</a> last week) is an incredible achievement. Uncredited here is the <a href="https://doi.org/10.1080/21645515.2017.1306615">experience</a> <a href="https://www.who.int/immunization/sage/meetings/2019/april/1_CEPI_Summary_WHO_SAGE_Meeting_April.pdf">gained</a> by the global health community during the rollout of <a href="https://doi.org/10.1016/S0140-6736(15)61117-5">clinical trials</a> in the West African Ebola epidemic in 2014-2015. Science during a crisis is difficult, and the scientific community responded in 2020 with an all-hands effort to design and initiate scores of trials on a moment’s notice.</p>
<p>But amid the scientific progress, what did we scientists neglect or get wrong? What will haunt us in eight months, when SARS-CoV-2 cases begin surging again, and we wonder if the winter epidemic trajectory will bring 30,000 or 300,000 more deaths? If vaccine efficacy drops, high death rates are a real possibility. </p>
<p>Our two big misses in 2020 were in behavioral modeling and real-time <a href="https://link.springer.com/chapter/10.1007/978-1-4899-7448-8_4">seroepidemiology</a>, the study of antibody measurements in blood samples. As an <a href="https://www.huck.psu.edu/people/maciej-f-boni">epidemiologist</a> with experience in the field, lab and modeling aspects of pandemic response, I believe that we must address these two gaps for the U.S. to have better forecasting, better communication and better management next winter. Even with effective vaccines, the new coronavirus will be with us for many years.</p>
<figure class="align-center ">
<img alt="Two medical workers transport a deceased patient." src="https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387337/original/file-20210302-17-m7c3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medical personnel move a deceased patient to a refrigerated truck serving as a makeshift morgue at Brooklyn Hospital Center on April 9, 2020, in New York City.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/medical-personnel-move-a-deceased-patient-to-a-refrigerated-news-photo/1209563693?adppopup=true">Angela Weiss/AFP via Getty Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Understanding human behavior</h2>
<p>First, scientists do not understand the general <a href="https://doi.org/10.1073/pnas.0810762106">feedback loop</a> between virus transmission and human behavior. When case and death numbers rise, people get fearful and comply more fully with common-sense recommendations like mask-wearing, distancing, hygiene, reduced contacts and no group events. But when these numbers fall, people feel safer and resume risky behavior, setting the stage for a new increase in cases.</p>
<p>In 2020, we public health experts missed an opportunity to quantify this dynamic and estimate the delay inherent in a population’s behavioral response. Even the recent decline in cases in January <a href="https://twitter.com/nataliexdean/status/1362100680492601350">was attributed</a> to behavioral change by process of elimination only: It did not seem to be caused by weather, vaccines or new restrictions and was thus credited to human behavior and social distancing. But we still lack statistical evidence for how or when this started.</p>
<p>Why did we miss this? Epidemiologists had been preparing for a deadly pandemic for two decades. Our anchoring bias came from experiences with past influenza pandemics and <a href="https://doi.org/10.1038/nature04017">hypothetical avian influenza pandemics</a>, which have <a href="https://twitter.com/SRileyIDD/status/1220464674476625921">infection fatality ratios</a> (IFR) of either a very low 0.05% or very high rates of more than 25%. No one prepared for an intermediate IFR of 0.5%, where a virus could circulate unnoticed long enough for researchers to miss the first clinical signals – or a virus not gruesome enough to induce an immediate state of emergency. </p>
<p>Throughout the COVID-19 pandemic in the U.S., society’s reaction has wavered from urgency to complacency and back. Epidemiologists were not able to accurately predict these trends.</p>
<p>Going forward, we must develop data-centered models of population behavioral responses that occur during COVID-19 epidemics. For example, does experience with wintertime influenza act as an anchor, driving people to be more or less cautious as case numbers rise above or below “normal” flu rates? If scientists and public health experts can understand this behavior, we will know better when and how to institute new nonpharmaceutical interventions, such as gathering size limits or work-from-home orders. Then we will have better and more scientific justifications for early lockdowns and early interventions, with public health messaging stating clearly that an early lockdown means a short lockdown.</p>
<p>Behavioral modeling can also unlock the power of <a href="https://doi.org/10.1126/sciadv.abd5393">rapid at-home tests</a>, a promising public health tool that received no coordinated support over the past year. How does someone react if others are infected? How do people <a href="https://doi.org/10.1073/pnas.2005241118">react</a> if they themselves are infected? Without the foundational behavioral analysis in place, we will not know how to deploy at-home tests to best facilitate more careful mixing behavior.</p>
<figure class="align-center ">
<img alt="A man getting a blood test for COVID-19." src="https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387340/original/file-20210302-23-rupwk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A laboratory technician takes an antibody test for COVID-19 at a community care center in New York City.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/laboratory-technician-takes-an-antibody-test-for-covid-19-news-photo/1214741188?adppopup=true">Lev Radin/Pacific Press/LightRocket via Getty Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Faster processing of antibody data</h2>
<p>Our second big miss was in real-time analyses of antibody data to gauge how many Americans have been infected with the coronavirus. Real-time <a href="https://coronavirus.jhu.edu/map.html">case numbers</a>, <a href="https://covidtracking.com/">hospitalizations</a> and <a href="https://www.covid19mobility.org/">mobility</a> data have been crucial for understanding the different phases of the COVID-19 pandemic. </p>
<p>But serum collection was not preplanned, routine or processed quickly. Seroprevalence results then <a href="https://doi.org/10.1001/jamainternmed.2020.4130">came</a> <a href="https://doi.org/10.1016/S0140-6736(20)32009-2">months</a> <a href="https://doi.org/10.1001/jamainternmed.2020.7976">late</a>, appearing in publications and preprints, but not aggregated in an easy-to-understand database. </p>
<p>With no universal standardization, misinterpretation of assay validations and serological thresholds was common. Scientists debated cross-sectional serology results, and study designs had no approach to correct for <a href="https://www.buzzfeednews.com/article/stephaniemlee/stanford-coronavirus-study-bhattacharya-email">sampling biases</a> generated from correlations between past symptoms and study participation.</p>
<p>Today, we still lack confidence in estimates of the total number of Americans who have been infected, which complicates efforts to use the vaccine scale-up to accurately state what fraction of the country is now immune, or to plan for the inevitable outbreaks of new variants this spring and summer.</p>
<p>The key studies to prepare for next winter involve standardizing serological assays and estimating <a href="https://doi.org/10.1126/sciimmunol.abf8891">antibody</a> <a href="https://wwwnc.cdc.gov/eid/article/27/3/20-4543_article">waning</a> <a href="https://doi.org/10.1038/s41467-020-20247-4">rates</a> – that is, how quickly one’s antibody levels go down after infection. Measuring the post-infection waning of antibody concentrations allows us to define antibody thresholds for <a href="https://www.taylorfrancis.com/chapters/inferring-time-infection-serological-data-maciej-boni-k%C3%A5re-m%C3%B8lbak-karen-krogfelt/e/10.1201/9781315222912-15">particular time points</a> after infection. </p>
<p>That’s a lot of jargon. Put more simply, if we know that antibodies wane to level X after three months, we can use this X to determine who has been infected in the past three months. This is not a true seroprevalence or attack-rate measurement, and that’s fine. It is a measure of the three-month attack rate or the six-month attack rate, depending on the threshold chosen, and it gives us an estimate of recent population-level infection rates. This new definition resolves the arbitrary threshold problem in serology, and allows studies to report the amount of recent population immunity, which is useful for public health decisions.</p>
<p>In my view, we should have learned in 2020 that it is never too early to start preparations for epidemic control. Summer 2020 was a missed opportunity to revamp our approach to health care and epidemic response. The U.S. cannot again squander an entire summer and fail to prepare for the possibility that SARS-CoV-2 has one more nasty winter in store for us.</p><img src="https://counter.theconversation.com/content/156169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maciej F. Boni receives funding from the National Institutes of Health and the Bill and Melinda Gates Foundation.. </span></em></p>The US was not ready for the coronavirus pandemic in 2020. What can public health leaders and policymakers do to make sure we don’t face another winter of rampant disease?Maciej F. Boni, Associate Professor of Biology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1551042021-02-11T13:16:17Z2021-02-11T13:16:17ZWhy you shouldn’t eat out for Valentine’s Day: An epidemiologist explains a few facts of life<figure><img src="https://images.theconversation.com/files/383646/original/file-20210210-21-qihbtw.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While Valentine's Day is typically a night to celebrate, it might be best to order takeout this year because of the pandemic.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/table-reservation-is-seen-inside-a-white-castle-restaurant-news-photo/56850564?adppopup=true">Tim Boyle/Getty Images</a></span></figcaption></figure><p><em>Editor’s Note: With another holiday approaching, it’s tempting to want a taste of freedom from COVID-19 social distancing. Who doesn’t want sweet nothings over a glass of Champagne and some chocolate cake? But it’s also important to remember that daily case numbers are still higher now than they were throughout most of 2020. The risk of catching COVID-19 is still extremely high in most parts of the country. Epidemiologist Ryan Malosh answers some questions about eating out and socializing.</em></p>
<h2>Why can’t I eat out for Valentine’s Day if I socially distance?</h2>
<p>Restrictions on indoor dining are some of the hardest to swallow. We all have our favorite restaurants, and the experience of eating out is a big part of feeling normal. In addition, many restaurants are cornerstones of our communities, and <a href="https://restaurant.org/manage-my-restaurant/business-operations/covid19/recovery">owners</a> and <a href="https://www.cnbc.com/2021/02/09/how-restaurant-industry-workers-are-navigating-covid-19.html">staff</a> have struggled throughout the pandemic. </p>
<p>But dining indoors remains <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm?s_cid=mm6936a5_x">a high-risk activity</a>. The most effective prevention strategies – <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html">ventilation</a>, physical distancing and <a href="https://theconversation.com/cdc-says-masks-must-fit-tightly-and-two-are-better-than-one-153778">wearing masks</a> – are challenging in this setting. Even when physical distancing is possible, scientists have found that <a href="https://doi.org/10.3346/jkms.2020.35.e415">long-range transmission</a> can occur. Restaurants are trying to innovate ways to determine how safe their spaces are - including <a href="https://www.washingtonpost.com/health/2021/02/10/carbon-dioxide-device-coronavirus/">using CO2 monitors</a> to gauge ventilation - but these technologies are far from guarantees of safety. </p>
<p>One recent study suggested that policies such as indoor dining restrictions <a href="https://news.umich.edu/strict-public-health-measures-during-holidays-likely-saved-lives-in-michigan-u-m-researchers-say/">may have saved nearly 2,000 lives</a> in Michigan in the past few months. Takeout and delivery are much safer options (and, I think, more romantic).</p>
<h2>Would it matter if I go at off-hours?</h2>
<p><a href="https://doi.org/10.1038/s41586-020-2923-3">Another study</a>,
using mobility data to examine community spread, found that capacity restrictions can reduce the number of new infections tied to indoor dining, but they do not eliminate the risk. </p>
<p>Further, with <a href="https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html">new SARS-CoV-2 variants circulating in a number of states</a>, sitting for hours, maskless and indoors, with anyone outside your own household becomes even riskier. Experts know these variants <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/scientific-brief-emerging-variants.html">spread more easily</a>. Case counts, hospitalizations and deaths are <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">starting to come down</a>, but those encouraging trends are unlikely to continue if we collectively decide to throw caution to the wind now. </p>
<h2>I’ve been vaccinated, so why can’t I burn my mask?</h2>
<p>First, the good news. The vaccines that have been authorized are marvels of medical science. The efficacy against symptomatic and severe infections <a href="https://doi.org/10.1056/NEJMoa2034577">is phenomenal</a>, as high as 95% for the Pfizer vaccine. They are a big part of how we get back to something approximating normal. And <a href="https://doi.org/10.1056/NEJMoa2035389">evidence</a> is emerging that vaccination can prevent asymptomatic transmission and <a href="https://doi.org/10.1101/2021.02.06.21251283">reduces viral load</a>, or the amount of virus people have inside them. These findings suggest that vaccination will also reduce transmission of the virus and contribute to herd immunity. </p>
<p>But the unknowns about how well vaccines work against these new variants mean we have to be careful just a bit longer – and we don’t yet know how long that will be. Plus, masks and other prevention strategies may also be lowering our risk of other serious illnesses, <a href="https://www.cnn.com/2021/02/09/health/coronavirus-flu-spread-cdc-wellness/index.html">such as influenza</a>.</p>
<h2>Everyone in my pod has been vaccinated. Is it safe to gather at someone’s house without masks?</h2>
<p>I think small gatherings where everyone has completed the vaccine regimens are probably going to be relatively safe. There isn’t much data to support this yet, because the proportion of people vaccinated in the U.S. is <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">still relatively low</a>. But the studies I mentioned above all suggest that once your “quaranteam” is fully vaccinated, it will likely be safe to reconnect in this way. And discouraging people from doing so might actually <a href="https://www.theatlantic.com/ideas/archive/2021/01/giving-people-more-freedom-whole-point-vaccines/617829/">discourage vaccination</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-8p0iDjAiwE?wmode=transparent&start=42" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A “Saturday Night Live” skit shows how everyone thinks they are being safe.</span></figcaption>
</figure>
<h2>Everyone I know says they are being safe but then I hear that they had brunch out with a group of friends. How can I best tell when my friends’ ideas of being safe align with my own ideas?</h2>
<p>Some <a href="https://www.washingtonpost.com/lifestyle/2020/10/28/pandemic-lies-family-friends/">studies</a> suggest people are downplaying the risks they’re taking. People do this <a href="https://www.sciencedaily.com/releases/2018/11/181130111608.htm">because they don’t want to be judged</a>. I can tell you from my personal experience that the best way to get honest answers is to be honest yourself. Talk about what level of risk you’re taking and what level you’re willing to accept. If someone is taking risks that you’re not comfortable with, it is OK to tell them you’ll see them after you get vaccinated. </p>
<p>The bottom line is that there is a lot to be hopeful about as vaccine distribution ramps up in the U.S. and cases come down. The major challenges over the next few months are to continue the progress we’re making on community spread and to ensure that vaccines are available to the most vulnerable communities in an equitable way.</p>
<p>[_<a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">The Conversation’s most important coronavirus headlines, weekly in a new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/155104/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ryan Malosh receives salary support from the Centers for Disease Control and the Simons Foundation. </span></em></p>What is Valentine’s Day without a romantic dinner out? It could be a COVID-19 catastrophe. Better to stay home and order in, writes an epidemiologist.Ryan Malosh, Assistant Research Scientist, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1540632021-02-08T13:42:41Z2021-02-08T13:42:41ZNo internet, no vaccine: How lack of internet access has limited vaccine availability for racial and ethnic minorities<figure><img src="https://images.theconversation.com/files/382808/original/file-20210205-13-13e47cp.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C2968%2C1908&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man fills out an online application during a job fair hosted by the city of Chicago in July 2012. The fair offered computer access to people who do not have internet access. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/john-binns-fills-out-an-online-application-during-a-job-news-photo/155937360?adppopup=true">Scott Olson/Getty Images</a></span></figcaption></figure><p>Racial and ethnic minority communities that lack internet access have been <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-covid-19-vaccinations-cases-deaths-race-ethnicity/">left behind</a> in the race to get a COVID-19 vaccine. The <a href="https://www.creditdonkey.com/average-internet-bill.html">average monthly cost of internet access, about US$70</a>, can be out of reach for those who can barely afford groceries. </p>
<p>Reporters and scholars have written about the effects of <a href="https://www.bloomberg.com/news/articles/2020-02-19/where-the-u-s-underestimates-the-digital-divide">lack of internet access</a> in <a href="https://www.govtech.com/network/How-Is-Georgia-Tackling-Rural-Internet-Service-Deserts.html/">rural areas in the U.S.</a> and <a href="https://www.worldbank.org/en/topic/digitaldevelopment/brief/connecting-for-inclusion-broadband-access-for-all">developing countries</a>, but they have paid less attention to the harm of lack of internet access in racial and ethnic minority communities in <a href="https://www.businessinsider.com/us-cities-with-lowest-share-of-computer-and-broadband-internet-2020-3">major cities</a>. </p>
<p>We are <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=tamra+burns+loeb&btnG=">researchers</a> who <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=arleen+f+brown&oq=arleen+f">study</a> <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=PB+adkins+jackson&btnG=">health disparities.</a> We are concerned that even when vaccinations are offered in these communities, those at greatest risk for COVID-19 may be unable to obtain appointments without the help of <a href="https://khn.org/news/article/older-adults-without-family-or-friends-lag-in-race-to-get-vaccines/">family or friends</a>. This includes <a href="https://www.theverge.com/22227531/covid-vaccine-website-appointments-accessible-seniors">racial and ethnic minority communities and older adults</a>, the age group that is currently being vaccinated. </p>
<p>Our research suggests that lack of internet access may be an important reason. And for the almost <a href="https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2017OlderAmericansProfile.pdf">13.8 million older adults</a> in the U.S. who live alone, asking for help may not be an option. </p>
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<h2>The computer as COVID-19 connector</h2>
<p>During the pandemic, the internet has been an indispensable health tool to millions. </p>
<p>Telehealth services have provided a <a href="https://www.healthaffairs.org/do/10.1377/hblog20200505.591306/full/">safe way</a> for patients to make appointments for COVID-19 testing and other types of <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html">medical care</a>. In fact, there was a <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm">154% increase in telehealth visits</a> during the last seven days of March 2020 compared to the same period in 2019. This was most likely due to public health mandates that required a shift away from in-person care. </p>
<p>In addition, patients receive communications from their providers through <a href="https://www.heart.org/en/news/2020/08/05/high-speed-internet-offers-key-connection-to-health-but-millions-lack-it">email and other messaging systems</a> that offer access to health care, health information and test results. And, <a href="http://publichealth.lacounty.gov/media/coronavirus/">departments of public health</a> and the <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">Centers for Disease Control and Prevention</a> have relied on their websites, online events and social media to educate the population about COVID-19. Access to the internet is essential during a pandemic.</p>
<p>This has been particularly true as the vaccine has been rolled out. Signing up for the vaccine has predominantly occurred <a href="https://www.theverge.com/22227531/covid-vaccine-website-appointments-accessible-seniors">online</a>. This means that far fewer older adults from underresourced racial and ethnic minority communities have been able to make appointments. </p>
<p>In 2018, more than <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768771">one in four Medicare beneficiaries</a> had no digital access at home. Those without digital access were more likely to be 85 years or older, members of racial or ethnic minority communities and from low-income households. </p>
<figure class="align-center ">
<img alt="A white doctor talks to a white patient through his laptop." src="https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382809/original/file-20210205-15-vlsdvc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Telehealth has been a lifesaver for many patients during the time of the coronavirus, but underresourced racial and ethnic minority communities do not benefit equally.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/medical-teleconsultation-with-senior-female-patient-news-photo/1041975974?adppopup=true">BSIP/Universal Images Group via Getty Images)</a></span>
</figcaption>
</figure>
<h2>How internet access can determine health</h2>
<p>Over the years, medical and public health experts have identified social factors – structural racism, a person’s neighborhood, access to fresh food, exposure to toxins, income and education – that play a major role in health. These factors are often called the <a href="https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health">social determinants of health</a>. Experts consider structural racism, or racism ingrained in social, business, educational and health policy and practice, to be one of the most damaging determinants. These factors in turn ultimately lead to <a href="https://doi.org/10.1037/trm0000292">more disease and death,</a> as they have with COVID-19. </p>
<p>Early data on the case numbers and deaths from COVID-19 showed that structural racism likely increased <a href="https://doi.org/10.1080/23748834.2020.1792069">exposure to the coronavirus</a> among racial and ethnic minority communities. And, racial gaps also impeded access to <a href="https://doi.org/10.1080/23748834.2020.1792069">testing</a> and affected <a href="https://doi.org/10.1016/j.jsat.2020.108214">quality of care</a>. </p>
<p>The pandemic has also illuminated the risk of infection to our <a href="https://doi.org/10.1080/01634372.2020.1779161">aging population</a>. However, <a href="https://doi.org/10.1080/01634372.2020.1779161">research</a> has placed less emphasis on how <a href="https://www.ama-assn.org/practice-management/digital/why-so-many-patients-still-can-t-connect-doctors-telehealth">aging</a> affects <a href="https://doi.org/10.1177/1090198120965513">some populations</a> more than others, such as the effects of structural racism and income.</p>
<p>Now, it appears that <a href="http://dx.doi.org/10.1037/trm0000292">internet access</a> is emerging as a new and troublesome <a href="https://www.amia.org/sites/default/files/AMIA-Response-to-FCC-Notice-on-Accelerating-Broadband-Health-Tech-Availability.pdf">determinant of health</a>. This appears to be particularly true for underresourced racial and ethnic minority communities and <a href="https://doi.org/10.1080/01634372.2020.1779161">aging populations</a>.</p>
<p>Although people can make appointments for a COVID-19 vaccine by telephone, call centers are frequently overwhelmed. <a href="https://www.nytimes.com/2021/01/14/nyregion/covid-vaccine-older-people-senior-citizens.html">Hold times</a> can be extremely long. Access to the internet, having an internet-enabled device and understanding how to use both have been necessary to sign up for the vaccine. Many advocacy groups and public health experts have begun to see internet access as a fundamental <a href="https://www.edweek.org/technology/internet-access-is-a-civil-rights-issue/2020/09">civil rights issue</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/U5QdRwflM9I?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">COVID-19 exposed health gaps caused by structural racism and social determinants of health.</span></figcaption>
</figure>
<p>During the fall of 2020, we looked at this issue in more depth with Black and Latino individuals who are <a href="https://doi.org/10.1016/j.pcad.2020.02.014">HIV positive and at risk for a cardiovascular event</a>. In <a href="https://medschool.ucla.edu/coronavirus-information/covid-19-research-grant-program">our research</a>, we found that 17 out of 30 patients had no internet, no computer or lacked knowledge of how to use the internet or a computer. They, like many people with health issues or from underresourced racial and ethnic minority communities, are affected by numerous social determinants that amplify the negative health consequences they experience. </p>
<p>While online health services could be used to increase access and retention in care among vulnerable groups, not having access <a href="http://dx.doi.org/10.1037/tra0000796">widens existing disparities</a>.</p>
<h2>Solutions exist, but they must be implemented</h2>
<p>To address the internet gap, we believe that policymakers must identify lack of internet access as a barrier and protect against its effects. This could include reserving vaccines in underresourced racial and ethnic minority communities for local residents and designating senior hours for those 65 and older. </p>
<p>Policymakers could also mandate timely reporting of demographic information, even within <a href="https://www.nytimes.com/2021/01/10/health/coronavirus-hospitals-vaccinations.html?searchResultPosition=1">medical settings</a>, to monitor equity. Public health administrators could also partner with organizations that work with vulnerable populations, such as Meals on Wheels, to deliver food and vaccines to individual homes. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Departments of public health also could work with organizations and trusted community leaders to produce culturally consistent multimedia information on vaccinations and other health topics. They could also arrange for billboards, freeway signs and posters at local restaurants. </p>
<p>In addition, health care professionals and organizations can help by teaching patients about <a href="https://www.highspeedinternet.com/resources/are-there-government-programs-to-help-me-get-internet-service">government subsidies and internet programs for low-income individuals</a> from internet service providers. They can also provide training on <a href="https://doi.org/10.1001/jamainternmed.2020.2666">how to use the internet</a>, which would be at least a good beginning for these vulnerable groups.</p><img src="https://counter.theconversation.com/content/154063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamra Burns Loeb receives funding from the UCLA David Geffen School of Medicine COVID-19 Research Award Program and the National Heart, Lung, and Blood Institute. </span></em></p><p class="fine-print"><em><span>Arleen F. Brown receives funding from the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>AJ Adkins-Jackson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early numbers show that people from racial and ethnic minorities have lower vaccination rates. Lack of internet access could be a reason.Tamra Burns Loeb, Adjunct Associate Professor - Interim; UCLA Center for Culture, Trauma, and Mental Health Disparities, University of California, Los AngelesAJ Adkins-Jackson, Research Fellow at Massachusetts General Hospital, Harvard Medical School, Harvard UniversityArleen F. Brown, Professor of Medicine, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538472021-01-27T20:47:03Z2021-01-27T20:47:03ZWhy the next major hurdle to ending the pandemic will be about persuading people to get vaccinated<figure><img src="https://images.theconversation.com/files/380556/original/file-20210125-17-146zu9n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maria Saravia, a worker at the University of Southern California's Keck Hospital, adjusts her mother's mask before her COVID-19 vaccination.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/maria-saravia-left-an-environmental-services-worker-at-keck-news-photo/1230785871">Genaro Molina/Los Angeles Times via Getty Images </a></span></figcaption></figure><p>Today, more Americans hope to receive a COVID-19 vaccine than current vaccine supply will <a href="https://www.axios.com/demand-coronavirus-vaccines-outstripping-supply-7314861f-d8f0-4ee8-8480-85fea99846f8.html">allow</a>. Consequently, although President Joe Biden’s initial <a href="https://www.npr.org/2021/01/22/959700058/100-million-shots-in-100-days-is-bidens-covid-19-vaccination-goal-achievable">promise</a> to dole out 100 million vaccine doses in 100 days would require a <a href="https://www.webmd.com/vaccines/covid-19-vaccine/news/20210120/bidens-covid-challenge-100-million-vaccinations-in-the-first-100-days-it-wont-be-easy#1">ramp-up</a> in vaccine allocation, <a href="https://www.vox.com/future-perfect/22243713/biden-covid-19-coronavirus-vaccine-goal-100-million-100-days">some consider</a> the promise to be insufficient to meet current levels of demand and put the pandemic’s spread into decline. </p>
<p>The current mismatch between vaccine demand and supply, however, may be short-lived. Despite <a href="https://www.nbcnews.com/news/us-news/pharmacies-say-they-could-do-more-distribute-vaccines-states-are-n1254016">concerns</a> <a href="https://www.nytimes.com/2021/01/11/podcasts/the-daily/coronavirus-variant-vaccine-pandemic.html?showTranscript=1">about</a> <a href="https://public.tableau.com/profile/benjamin.renton#!/vizhome/COVID-19VaccineAllocationDashboard/DosesAdministeredDashboard">lagging</a> vaccine allocation for front-line health care workers and other vulnerable groups, <a href="https://www.cbsnews.com/news/covid-vaccine-when-can-you-get/">health experts</a> are optimistic that public demand for a COVID-19 vaccine will remain high in coming months as more vaccine doses become available.</p>
<p>While it is clear that many political leaders expect public demand for a coronavirus vaccine to be strong, whether or not expectations can live up to reality is an open question. In fact, there is some evidence to suggest instead that large segments of both the <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">public</a> and <a href="https://www.npr.org/2021/01/01/952716705/some-health-care-workers-are-hesitant-about-getting-covid-19-vaccines">health care workers</a> do not intend to get vaccinated against COVID-19.</p>
<figure class="align-center ">
<img alt="President Joe Biden, wearing a mask." src="https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380565/original/file-20210125-21-10jq9l8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">President Biden’s 100-day plan to combat COVID-19 includes 100 million vaccinations. But a study says nearly one-third of Americans will not get vaccinated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-elect-joe-biden-takes-off-his-mask-as-he-arrives-news-photo/1296577430">Alex Wong via Getty Images</a></span>
</figcaption>
</figure>
<p>Figuring out whether or not some people are less likely to get vaccinated – and their reasons for not getting vaccinated – can help political leaders and health professionals better anticipate vaccine demand. If some social, political and other demographic groups are more (or less) likely to intend to get vaccinated than others, demand for a vaccine may be higher (or lower) in vaccine distribution networks that primarily service <a href="https://www.nbcnews.com/news/us-news/racial-disparities-create-obstacles-covid-19-vaccine-rollout-n1249627">vaccine-hesitant groups</a>.</p>
<p>Additionally, understanding why some individuals are more likely to refuse vaccination than others can help inform health communication efforts to increase vaccine uptake. For example, if some Americans intend to refuse to get vaccinated due to concerns that the vaccine is not safe, health communicators can target these groups with easy-to-understand information about how scientists determined that the vaccine is safe. </p>
<p>In a <a href="https://doi.org/10.1016/j.socscimed.2020.113638">recent peer-reviewed study</a>, we provide important insight into what public demand for a coronavirus vaccine could actually look like, once most Americans have the opportunity to get vaccinated. Just as important, we detail reasons certain Americans do not intend to get vaccinated.</p>
<figure class="align-center ">
<img alt="People line up in their cars to receive a second dose of the vaccine." src="https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=356&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=356&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=356&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=447&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=447&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380953/original/file-20210127-23-wb79pr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=447&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People line up in their cars to receive a second dose of the Moderna COVID-19 vaccine at a drive-thru vaccination site in Mount Dora, Fla.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-line-up-in-their-cars-to-receive-a-second-dose-of-news-photo/1230811372?adppopup=true">Paul Hennessy/NurPhoto via Getty Images</a></span>
</figcaption>
</figure>
<h2>Some Americans more likely to get vaccinated</h2>
<p>We studied Americans’ COVID-19 vaccination intentions in a large, demographically representative online survey of 5,009 U.S. adults, conducted in June 2020. We measured vaccination intentions by asking respondents whether or not they would pursue getting vaccinated for the coronavirus if a COVID-19 vaccine became available. </p>
<p>Our study found that almost a third (31.1%) of respondents did not intend to pursue vaccination. This is concerning, given that recent epidemiological estimates suggest that <a href="https://doi.org/10.1016/j.socscimed.2020.113638">up to 70% of Americans</a> must become immune to COVID-19 in order to put the pandemic’s spread into decline. </p>
<p>We also found strong differences in vaccination intention between key demographic groups. Notably, we found that 35.7% of women (vs. 26.3% of men), 42.9% of Black people (vs. 28.6% of white people), and 37.8% of conservatives (vs. 33.4% of independents and 24.1% of liberals) intended to forgo vaccination.</p>
<h2>Why will some people refuse a COVID-19 vaccine?</h2>
<p>Our study provides new insights into the reasons that some Americans do not intend to get vaccinated against COVID-19. We found that concerns about the safety and effectiveness of the vaccine were the most consistent reasons for forgoing vaccination. We also found that portions of the American public did not intend to pursue vaccination because they lack health insurance, lack the financial resources they believe they need to be vaccinated or because they have already had COVID-19. </p>
<p>Our study also found considerable evidence that the reasons for not vaccinating were not the same for everyone. For example, women were more likely than men to say they would forgo vaccination due to concerns about safety and effectiveness. Additionally, we found that Black people were more likely to skip vaccination than white people due to perceived safety and effectiveness issues as well as concerns related to the cost of vaccinating and a lack of health insurance. </p>
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<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<h2>What this all means for vaccine uptake</h2>
<p>Together, our findings point to two key takeaways as the U.S. pushes to rapidly vaccinate its population against COVID-19. First, political leaders and public health experts need to recognize that what appears to be considerable public demand for the COVID-19 vaccine right now may be more modest in the coming months, as more Americans have the opportunity to get vaccinated. In its place, experts will be faced with the new challenge of convincing hesitant groups to get vaccinated in order to reach herd immunity and end the pandemic.</p>
<p>Second, our results demonstrate that in these efforts to vaccinate the hesitant, a one-size-fits-all approach to health communications will be insufficient. While health communications aimed at emphasizing the safety and effectiveness of the vaccine will be important, for some groups, it will be just as important to emphasize that Americans can be vaccinated against COVID-19 for free, regardless of insurance status. Developing these communications and identifying appropriate messengers to deliver this information will be vital to stopping the pandemic.</p><img src="https://counter.theconversation.com/content/153847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Getting a vaccine is proving difficult for many older people now, but the mad rush for the vaccine won’t last long. Many people don’t want to get one at all, and that will impede herd immunity.Timothy Callaghan, Assistant Professor, Texas A&M University School of Public Health, Texas A&M UniversityMatt Motta, Assistant Professor of Political Science, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1539212021-01-27T16:44:23Z2021-01-27T16:44:23ZCoronavirus variants: are they really more deadly? Here’s what scientists know so far<figure><img src="https://images.theconversation.com/files/380877/original/file-20210127-19-1plcnnr.jpg?ixlib=rb-1.1.0&rect=50%2C0%2C5568%2C3692&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/infected-patient-quarantine-lying-bed-hospital-1704411607">Halfpoint/Shutterstock</a></span></figcaption></figure><p>One certainty during a pandemic is that the virus will mutate. SARS-CoV-2, which causes COVID-19, is no different. But how concerned should we be about the new variants of the virus that are arising in places such as the <a href="https://www.washingtonpost.com/health/interactive/2021/01/25/covid-variants/">UK, South Africa and Brazil</a>? Are they more lethal or more transmissible than the original virus?</p>
<p>In the UK, for example, Prime Minister Boris Johnson recently claimed that the new variant <a href="https://www.theguardian.com/world/2021/jan/22/new-uk-covid-variant-may-be-more-deadly-says-boris-johnson">may be 30%-40% more lethal</a> than the old one, though this has since been <a href="https://www.bbc.co.uk/news/uk-55779171">played down</a> by scientists. </p>
<p>Every time a virus enters a host and begins to replicate it quickly starts to make mistakes – that’s how mutations arise. Most of these mistakes are actually very harmful to the virus, while other mutations are neutral and don’t really affect it at all. In very rare instances, however, a mutation might confer an advantage over the original virus.</p>
<h2>Level of transmission</h2>
<p>At the end of December, <a href="https://virological.org/t/preliminary-genomic-characterisation-of-an-emergent-sars-cov-2-lineage-in-the-uk-defined-by-a-novel-set-of-spike-mutations/563">data started to emerge</a> about a variant of the COVID-19 virus, called B.1.1.7 – since dubbed the “British variant” or the “Kent strain”. </p>
<p>Initial epidemiological reports claimed that this variant was much more transmissible than the original SARS-CoV-2 virus, with some even reporting that <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00005-9/fulltext">transmission was 70% greater</a>. With evidence suggesting that this variant arose in September, this would help to explain the dramatic rise in cases that we’ve seen in south-east England since then. This initial estimate of 70% has, however, <a href="https://theconversation.com/coronavirus-variants-why-being-more-transmissible-rather-than-more-deadly-isnt-good-news-152863">been downgraded several times</a> since then in other studies.</p>
<p>Another explanation for the rapid rise of the Kent variant or indeed any virus variant is the “<a href="https://evolution.berkeley.edu/evolibrary/article/bottlenecks_01">founder effect</a>”. This is a phenomenon in evolution where a small group, which happens to be affected by a mutation, ends up spreading it more than other populations. This is down to chance rather than the mutation providing any advantage at all.</p>
<figure class="align-center ">
<img alt="Image of Aylesford village in Kent, England with medieval bridge and church." src="https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380878/original/file-20210127-23-feg46h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Aylesford village in Kent, England.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rural-kent-view-aylesford-village-england-398289955">Valery Egorov/Shutterstock</a></span>
</figcaption>
</figure>
<p>In theory, a person infected with a new variant in Kent could easily infect a large number of locals at the shop or pub – similar to a “super-spreader” event. In turn, these newly infected people could commute to London the next week on buses and trains and quickly spread this new variant to large numbers of fellow commuters who in turn spread it throughout London and beyond. This could make the variant common – through pure chance.</p>
<p>This is all possible without the mutations in B.1.1.7 providing increased transmission. Given that this virus is present across almost the whole planet, and we know the distances and frequency with which we can travel, it’s probable that the founder effect could result in variants becoming common in a few places. After all, we know super-spreader events happen with this virus.</p>
<p>In fact, a <a href="https://virological.org/t/phylogenetic-evidence-that-b-1-1-7-has-been-circulating-in-the-united-states-since-early-to-mid-november/598">recent study of the USA</a> found that the Kent variant has likely been in California and Florida since November, but it is still too early to tell if this trend toward increased transmissibility holds there too. Watch this space.</p>
<p>Unfortunately, only time will tell if any of the SARS-CoV-2 variants are more transmissible. As a lot of evidence is currently being collected on both the Kent and South African variants, we shouldn’t have to wait long.</p>
<h2>Lethality</h2>
<p>The UK government’s <a href="https://www.gov.uk/government/groups/new-and-emerging-respiratory-virus-threats-advisory-group">New and Emerging Respiratory Virus Threats Advisory Group</a> (NERVTAG) recently <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/955239/NERVTAG_paper_on_variant_of_concern__VOC__B.1.1.7.pdf">compiled a report</a> detailing the potential increased severity of the British B.1.1.7 variant. However, as they state, the conclusions at this stage are mixed.</p>
<p>Some studies have found no differences in lethality or even hospitalisation, between the new or old variant. Others, however, found an increase in mortality of around 30% between the viruses – the figure quoted by the government and its chief advisers. If this is the case, it could increase the case fatality rate within the UK from 2.7% to 3.5%.</p>
<p>But for the moment these studies are in no way complete, with NERVTAG stating that there are several limitations to this work, including inherent biases and a small sample of deaths. </p>
<p>Unfortunately, again we simply don’t have enough data at this stage to make a firm conclusion on the lethality of the British B.1.1.7 variant, or indeed any of the other variants we’re currently aware of, including the South African or Brazilian variants. In regard to the British variant, it simply could just have infected more people, thereby leading to more deaths.</p>
<h2>Immunity</h2>
<p>The pressing question as we begin large scale vaccination programmes across the world is instead whether the vaccines work against the new variants. Here we have some good news, because initial reports for the British and South African variants appear to show that vaccines do still protect us. A group from the University of Texas <a href="https://twitter.com/TheMenacheryLab/status/1341460341293723650">has reported finding</a> that a key mutation (N501Y) in the British variant doesn’t appear to affect the ability of the antibodies induced by the vaccine to bind to the virus and neutralise it.</p>
<p>Although this was just a single mutation, last week, Pfizer/BioNTech <a href="https://www.biorxiv.org/content/10.1101/2021.01.18.426984v1.full.pdf">released data testing their vaccine</a> against all mutations in the British variant and also found their vaccine can clearly and robustly neutralise it. And on January 26, <a href="https://www.biorxiv.org/content/10.1101/2021.01.25.427948v1.full.pdf">Moderna released their data</a>, again showing the same robust neutralisation of the British variant.</p>
<p>The South African variant is a slightly different story. The new study from Moderna found that mutations in the South African variant did affect the ability of vaccine-induced antibodies to incapacitate the virus – showing a <a href="https://www.biorxiv.org/content/10.1101/2021.01.25.427948v1.full.pdf">six times reduced</a> ability to do so. But this should not be a great concern for the moment. We know that all these vaccines elicit a huge amount of antibodies after both doses, so even with a six-fold reduction, vaccinated people will probably still have a significant level of immunity. This does however stress the importance of receiving both doses of the COVID-19 vaccines.</p>
<p>At present we still cannot definitively say whether any of the variants transmit better, or whether they are more deadly, because, unfortunately, the data just isn’t there yet. But we can say that the COVID-19 vaccines are protective against the current SARS-CoV-2 variants, so when your opportunity comes, please get your vaccine and protect yourselves and your community.</p><img src="https://counter.theconversation.com/content/153921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Courtney works at Queen's University, Belfast and receives funding from the European Research Council.</span></em></p>The UK government has claimed the new British variant of the coronavirus may be 30% more deadly.David Courtney, Postdocotoral Research Fellow in Molecular Virology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538762021-01-27T13:28:33Z2021-01-27T13:28:33ZCan Biden fix the vaccine mess? An expert says yes<figure><img src="https://images.theconversation.com/files/380576/original/file-20210125-17-27rsr0.jpg?ixlib=rb-1.1.0&rect=21%2C14%2C4766%2C3108&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Joe Biden, then president-elect, received his COVID-19 vaccination in December.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-elect-joe-biden-receives-a-covid-19-vaccination-news-photo/1292469234?adppopup=true">Joshua Roberts via Getty Images</a></span></figcaption></figure><p>When President Joe Biden was sworn in on Jan. 20, he inherited the raging COVID-19 pandemic, one of the most difficult crises any incoming president has ever faced. <a href="https://coronavirus.jhu.edu/map.html">More than 400,000</a> Americans have died from the coronavirus, and tens of thousands more will likely die before the virus is brought under control. </p>
<p>Vaccines are the ultimate solution for the COVID-19 crisis. If enough people are vaccinated, and the virus remains sufficiently stable, the country can hope to achieve control over the virus and people can hope to get back to something like normal life. We’re still a long way from that, however. While estimates vary, scientists believe that we will need to vaccinate <a href="https://www.npr.org/2021/01/01/952652356/dr-paul-offit-gives-updates-on-the-us-covid-19-vaccine-rollout">about 240 million people, which represents about 70% of the U.S. population</a>, to achieve that kind of control.</p>
<p>As an <a href="https://www.law.virginia.edu/faculty/profile/mf9c/1202931">expert in health law</a>, I am troubled by the unforced errors evident in the initial vaccine rollout. They include the refusal to use the full might of the federal government and the failure to learn from past pandemic planning. By ignoring the need for state funding, preparation and guidance in the fall, the previous administration set us up to suffer a more confused and protracted rollout this winter.</p>
<figure class="align-center ">
<img alt="A man receiving the COVID-19 vaccine." src="https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380579/original/file-20210125-21-1ygopti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A man receives the COVID-19 vaccine at a school gym.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/mike-brady-receives-his-covid-19-vaccine-administered-by-news-photo/1230602868?adppopup=true">Frederic J. Brown/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Scientists did their jobs</h2>
<p>On one hand, the news on vaccines is better than many people imagined it could be. The two vaccines that have received emergency use authorization in the United States, one developed by Moderna and the other by Pfizer and BioNTech, have efficacy rates that are in the range of 95%. (The Food and Drug Administration had set a minimum 50% efficacy rate requirement in its vaccine guidance.)</p>
<p>Even better, there are other promising vaccines in the pipeline, including one developed by Johnson & Johnson that is likely to obtain an emergency use authorization <a href="https://www.marketwatch.com/story/fauci-says-johnson-johnson-covid-19-vaccine-may-get-approval-in-two-weeks-11611443596">as soon as early February</a>. None of this should be taken for granted; after more than 30 years of trying, scientists have not been able to achieve an effective vaccine for HIV.</p>
<p>On the other hand, the vaccine rollout, begun in December while the Trump administration was still in office, has been frustrating. Vaccine <a href="https://www.bloomberg.com/news/articles/2021-01-12/patchwork-of-rules-sows-confusion-in-state-by-state-vaccine-rollout">supply falls far short of current demand,</a> and there is also considerable confusion about how and when individuals will be able to be vaccinated. </p>
<p>In early December, Operation Warp Speed, the name the Trump administration bestowed on its vaccine program, projected that 20 million Americans would be <a href="https://www.msnbc.com/andrea-mitchell-reports/watch/-the-biden-administration-is-inheriting-a-black-box-former-transition-advisers-discuss-new-covid-strategy-99885125947">vaccinated before the end of the month</a>. A spokesman for Operation Warp Speed soon walked back that projection; administration officials clarified that the projection was about the number of doses that would be available, <a href="https://www.statnews.com/2020/12/29/public-health-experts-grow-frustrated-with-pace-of-covid-19-vaccine-rollout/">not the number of people who would actually be vaccinated</a>. Both authorized vaccines require two doses per person. That distinction, doses available vs. people vaccinated, captures the most significant weakness in the Trump administration’s planning.</p>
<p>While the administration deserves praise for supporting the development of effective vaccines in record time, it <a href="https://www.washingtonpost.com/health/2020/10/29/covid-vaccine-states-need-money/">paid insufficient attention</a> — both in planning and funding — to the public health infrastructure necessary to get the vaccine into the arms of the American people. In President Donald Trump’s view, the federal government’s job was to deliver the vaccine to the states. After that, the states were largely on their own. And the <a href="https://www.ajc.com/news/coronavirus/amid-deadly-pandemic-georgia-not-increasing-public-health-spending/GJFLXJVKCZD6ZC4O4Z4XOSPEGQ/">cash-strapped states have been ill-prepared</a> to figure it out.</p>
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<h2>Unrealistic projections and unmet expectations</h2>
<p>The Trump administration also over-projected the amount of vaccine currently available. Operation Warp Speed had promised to deliver 300 million doses of vaccine by Jan. 1, 2021. The reality falls far short of that. The CDC said Jan. 26, 2021, that it has distributed <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">44.4 million doses of COVID-19 vaccines.</a> Pfizer-BioNTech and Moderna now project that they will be able to <a href="https://www.nytimes.com/2021/01/21/health/covid-vaccine-supply-biden.html">deliver 100 million doses each by the end of March</a>. </p>
<p>If the Johnson & Johnson vaccine receives authorization soon, <a href="https://www.cnbc.com/2021/01/21/jj-plans-to-have-100-million-vaccines-for-americans-by-spring-board-member-says.html">it may have as many as 100 million doses</a> as early as April. That vaccine may require only one dose. But all of these are best-case projections.</p>
<p>The Biden administration promised on Jan. 21 to deliver <a href="https://www.npr.org/2021/01/22/959700058/100-million-shots-in-100-days-is-bidens-covid-19-vaccination-goal-achievable">100 million shots in its first 100 days</a>. That plan is both very ambitious and, for some, not ambitious enough. Under pressure to commit to a faster rollout, Biden promised on Jan. 25 to <a href="https://www.nytimes.com/2021/01/25/us/politics/biden-coronavirus-vaccinations.html">try to vaccinate 1.5 million people a day</a>. Even if that is achieved by the end of March, we will be <a href="https://theconversation.com/how-many-people-need-to-get-a-covid-19-vaccine-in-order-to-stop-the-coronavirus-152071">well short of achieving herd immunity</a>. </p>
<p>To achieve even the 100 million-shot goal, more than 1 million people will need to be vaccinated each day, <a href="https://www.nytimes.com/interactive/2021/01/22/us/covid-vaccine-supply-projections.html">something that is just now happening</a>. Getting quickly to 1.5 million vaccinations daily will be even more of an achievement.</p>
<p>If the vaccine manufacturers meet their production goals and the necessary public health infrastructure is put in place, we will likely surpass the 100 million-shot goal. The Biden administration needs to build trust to deal with this crisis, and it is more likely to build trust by underpromising than by overpromising and failing. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/BE8iGthT5ns?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">President Biden speaks to the nation about his COVID-19 vaccination plan.</span></figcaption>
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<h2>A new man, a new plan</h2>
<p>In his first days in office, Biden has begun implementing the COVID-19 response recommended by the COVID-19 Task Force that he created as president-elect in November. A comprehensive <a href="https://www.whitehouse.gov/wp-content/uploads/2021/01/National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf">strategic plan</a> lays out, among other pandemic responses, how the administration intends to improve the vaccine rollout.</p>
<p>To deal with lagging vaccine supply, the administration intends to invoke the Defense Production Act to eliminate bottlenecks. That includes the vials, syringes, storage facilities and related products and materials necessary for delivery. Although the Trump administration invoked the use of the Defense Production Act for <a href="https://www.cnn.com/2020/04/02/politics/defense-production-act-ventilator-supplies/index.html">ventilator production early in the pandemic</a>, it was loath to use it much going forward. </p>
<p>The Biden plan also calls for a <a href="https://buildbackbetter.gov/wp-content/uploads/2021/01/COVID_Relief-Package-Fact-Sheet.pdf">US$20 billion</a> package to provide major assistance to states for vaccine delivery and administration, including federally run vaccination centers to augment state capacities, federal assistance for the costs of vaccine administration, federal data collection, and continued federal oversight for safety and efficacy.</p>
<p>The plan also calls on states to simplify their vaccine priority designations. This has been an instance where the perfect has been the enemy of the good; there have been reports of vaccines thrown away rather than administered when recipients at the designated priority level were not available. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p><a href="https://www.nytimes.com/2021/01/10/nyregion/new-york-vaccine-guidelines.html">Complexity has bred confusion</a>. At the same time, the administration has redoubled its efforts to make sure that vaccine distribution is equitable and meets the needs of underserved populations.</p>
<p>None of these plans is remarkable; they reflect much of the pandemic planning that was conceived, but not implemented, over the past decade. To beat COVID-19, we will have to pay for deferred public health infrastructure. Some of those funds have already been appropriated by Congress in the <a href="https://www.congress.gov/bill/116th-congress/senate-bill/3548/text">$900 billion COVID relief bill</a> passed in December; more will be needed. And it will take some months to implement.</p>
<p>But now, there is a fully achievable vaccination plan in place, and with it, hope for a way through the COVID-19 crisis.</p><img src="https://counter.theconversation.com/content/153876/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Riley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The COVID-19 vaccine rollout has fallen far short of President Trump’s promises. President Biden says he can fix that. Can he?Margaret Riley, Professor of Law, Public Health Sciences, and Public Policy, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.