Look at the dates: 1890-1918; 1878-1918; 1896-1918; 1917-1918 … Every person buried on this snowy slope in Barre, Vt, died within days, weeks of each other. “It’s pretty humbling,” said Brian Zecchinelli.
Nearly 200 died that Fall during that other pandemic, the 1918 so-called Spanish Flu.
Zecchinelli and his wife, Karen, own the nearby Wayside Restaurant now. It’s become a Vermont institution. “Effie Ballou opened the Wayside in July of 1918, and two months later the pandemic hits Barre,” he said.
Zecchinelli has never stopped thinking about how little he knew about the 1918 flu – and the fact that the grandfather he never met was one of its victims. He died at 35, on October 10 of that terrible year. Germinio Zecchinelli, like so many other Italian stone cutters, had moved to Barre to quarry granite, to carve the nation’s gravestones (and often each others’, as it turned out).
“The Spanish Flu is often referred to as the ‘forgotten flu,'” Zecchinelli told correspondent Martha Teichner. “And if we had anything to do with it, it wasn’t gonna be forgotten, Germinio and all the others. We wanted to do something to memorialize him and the 50 million others worldwide that died.”
Because, to his astonishment, there was no substantial monument – anywhere – in spite of the staggering number of dead. The forgotten pandemic, indeed.
So, in 2018, a century after the fact, Zecchinelli commissioned this one. “It is unbelievable that nothing else had been done,” he said.”
Brian Zecchinelli, with correspondent Martha Teichner, at the memorial for those who died in the 1918 influenza pandemic, at Hope Cemetery in Barre, Vt.
CBS News
Six-hundred-seventy-five thousand Americans died in that pandemic. We’re at nearly a million and counting dead from COVID.
Has history taught us anything?
Tulane University scholar John Barry, who wrote the definitive history of the 1918 flu, “The Great Influenza,” said, “This time around it confirmed the lesson from 1918: you tell the truth.
“You heard things like – this is all about the 1918 virus – ‘This is ordinary influenza by another name,’ which of course, it wasn’t. It’s crystal clear that Trump himself knowingly said things that weren’t true” (such as his February 27, 2020 statement: “It’s going to disappear. One day it’s like a miracle, it will disappear”).
Penguin
And what did confusion over the constantly-evolving science do to trust and compliance? (Dr. Anthony Fauci’s March 8, 2020 statement, “There’s no reason to be walking around with a mask,” vs. Fauci’s Oct. 29, 2020 support for community COVID protocols, “the flagship of which is wearing a mask.”)
“You know, trust, truth, they’re all interconnected,” Barry said.
Teichner asked, “Was the result the same then and now?”
“Well, clearly people who might otherwise have been alive, died in 1918,” he replied. “And clearly this time around, people didn’t believe the truth when they were told the truth. The misinformation, the active attacks on vaccines, there’s no question it’s killed people.”
Martha Lincoln, a medical anthropologist at San Francisco State University, sees 1918 amnesia happening again. “We’re already forgetting, even before the pandemic is over. We’re already forgetting the pandemic. I foresee, at best, a long struggle about whether we will remember, really, at all, and if we remember, what that memory will be.”
For example, our entertainment, Lincoln said, is like some parallel universe where COVID is invisible, or long gone.
Not everyone is choosing to forget. In Barre, Vt, the self-proclaimed granite center of the world, the monument business is booming. “We’re up 25-30% depending on product lines; I think all domestic manufacturers are up,” said Rob Boulanger, who manages the huge Rock of Ages plant. “People are pre-buying, so people are looking at their mortality, right? And wanting to take care of those final arrangements before something happens.”
Teichner asked, “Has COVID influenced that?”
“Oh, absolutely.”
The longing to remember – and be remembered – a catalyst.
“I think that if we don’t manage to properly memorialize those that have been lost in this pandemic, it says that people like my dad, his life, didn’t matter,” said Kristin Urquiza. She never got to say goodbye to her father, Mark Urquiza, who died on June 30, 2020, isolated, on a ventilator, in an Arizona hospital. It was pre-vaccine. Cases were rising, but Arizona had opened back up.
“Sure, maybe he should have said no to coming together with his friends to celebrate the ‘end’ of the pandemic,” Urquiza said. “He was given false information upon which he made choices, and that cost him his life.”
Urquiza founded a non-profit, Marked by COVID, advocating for permanent memorials and a CVOD Memorial Day. In Congress there’s been limited support. She said, “Our elected officials would much rather move on, and I’m here to say we’re not going to let you.”
Barry said, “I wouldn’t be surprised if there weren’t really many memorials.”
“But a million dead? Are they invisible?” Teichner asked.
“Well, which party is gonna take credit for that, you know?” he laughed. “There’s been an effort to create a COVID commission, like the 9/11 commission, which, unfortunately, nobody seems eager to accept.”
For Barry, the 1918 flu should be justification enough – proof of the cost in human lives of forgetting.
“There will be another pandemic,” he said. “If we allow the lessons that could be learned from this not to be learned, then we are really fools.”
See also:
For more info:
John Barry, School of Public Health and Tropical Medicine, Tulane University
“The Great Influenza: The Story of the Deadliest Pandemic in History” by John M. Barry (Penguin), in Trade Paperback, Large Print, eBook and Audio formats, available via Amazon and Indiebound
Martha Lincoln, Department of Anthropology, San Francisco State University
The Wayside Restaurant, Bakery & Creamery, Montpelier, Vt.
Rock of Ages, East Barre, Vt.
Marked by COVID
Story produced by Dustin Stephens. Editor: Mike Levine.
Two decades after surviving an influenza pandemic that devastated the United States, Katherine Anne Porter recounted her experiences in one of the best-known accounts of the period—the 1939 novella Pale Horse, Pale Rider.
In her story, Porter describes how many young people felt as though their lives were threatened by the dual strike of a deadly virus and World War I. Miranda, the main character, recovers from influenza, but sinks into depression as she attempts to rejoin society. The novella ends on a note of optimism, however, where Miranda dreams of a world with no war and no more plague, and she’d have time for “everything.”
Historians say it’s unclear when the 1918 flu actually did end—and that’s partly because Americans were as tired of the flu as they are now after two years of COVID-19. Although cases continued to spike in 1920 and beyond, much of the historical record of the pandemic is from its first two years. Porter’s novella is one of the few written accounts of its enduring trauma and formal efforts to document the disease ultimately failed because Americans in the early 20th century simply wanted to forget the flu.
Similarly, two years into the COVID-19 pandemic, fatigue has grown—alongside arguments about when to loosen public health measures like mask and vaccine mandates. But historian Nancy Bristow, who wrote about the novella in her book American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic, says that while going back to a pre-pandemic normal may be appealing, history shows it could have harmful implications both for this pandemic—and the next one.
“That drive to not have to do what we’ve been doing carries with it a great potential to forget,” she says. “The ways in which Americans continue to think that these kinds of things won’t happen to us, that kind of American exceptionalism, you can only do that if you are a nation that is very, very capable of forgetting moments of its past.”
Fatigue sets in over public health measures
Flu historians like Bristow point out that these two pandemics can’t quite be neatly compared. The world was dramatically different in the early 20th century—war was widespread, there were no influenza vaccines, and the U.S. didn’t have as robust a health care infrastructure to care for those who fell ill then. The virus also targeted younger populations and the pandemic response wasn’t politicized nearly as much as it has been now.
But there are some similarities. During the early waves of the 1918 flu, there was a patchwork of public health responses from states and local authorities—and the outcomes of their various approaches to flattening the curve was clear. Cities like New York that implemented public health measures early had low death rates. Meanwhile, cities like Philadelphia that waited to implement health measures—and those like San Francisco that relaxed their measures too early—had higher death rates. (Here’s how U.S. cities flattened the curve during the 1918 flu pandemic.)
Then, like now, there was also confusion about when to change or relax measures, says Thomas Ewing, a historian based at Virginia Tech. In Denver, Colorado, officials rescinded their mask mandate in November 1918 when the first outbreak of influenza had tapered down, but then a second wave hit the city, causing many to question if the mandate should be reinstated.
“In both pandemics, there’s been a lot of confusion, there’s been uncertainty, there’s been resistance, there’s been conflicting, contradictory recommendations,” Ewing says.
For example, in December 1918, the U.S. Public Health Service—the government agency in charge of the pandemic response—worried that the public was relaxing its attitude toward the pandemic despite resurgences. In response, the Surgeon General issued a reminder to take precautions like masking and social distancing.
At the time, plenty of individual people flouted mask mandates but there wasn’t much organized opposition to masking. One exception was the Anti-Mask League in San Francisco, which was formed in early 1919 after the city reinstated a mask mandate a mere two months after lifting it. The league held at least one public meeting with nearly 2,000 attendees to denounce the ordinance, according to the University of Michigan Center for the History of Medicine’s Influenza Encyclopedia.
Bristow says that most of the pushback to public health measures was largely economic rather than political. Some city public health officials and politicians pointed to one another’s policies to curry favor in midterm elections, but the debates were largely over details like whether to reopen businesses before churches, rather than opposition to the measures as a whole.
Still, as the influenza pandemic dragged on, public health interventions became even patchier. Masking policies were rescinded even as the country continued to see occasional spikes in cases—including when several cities recorded death rates in 1920 comparable to the first wave in 1918. Then, like now, there was some resistance to bringing back public health measures, like mask mandates.
But by the end of 1920, the influenza pandemic had begun to ebb. Although the nation saw yet another small wave of cases and deaths in 1922, there was far less attention paid to those deaths because, unlike COVID-19, historians say that the influenza pandemic hadn’t been in the headlines every day for years. Meanwhile, physicians and public health experts also expressed optimism that future bouts would be less severe.
Bristow wonders if resistance to public health measures would have grown to the extent the U.S. has seen in the COVID-19 pandemic had they been allowed to continue.
“Here we’re seeing that played out,” she says of the COVID-19 pandemic. “Americans don’t like to be told what to do.”
Fatigue leads to forgetting
Living with the constant worry of catching influenza during the early waves of the disease had proven taxing on society. Like Porter’s novella, blues songs from the era mourned the catastrophic scale and powerful impact the influenza pandemic had on American lives. One of the best known was Essie Jenkins’ “1919 Influenza Blues,” whose chorus lamented the virus killed the rich and poor, and would kill even more people as part of God’s plan.
That narrative resonated with those suffering the most from the pandemic, whose lives were remade by the experience.
But as the pandemic began to ebb, others began to feel an optimism for the future, and longed to move past it. Historians say this may be why formal efforts to research the causes of the pandemic and take steps to prevent the next one ultimately failed.
In the first year of the influenza pandemic, there was every indication that the U.S. Congress would do just that. Lawmakers at the state and federal level were concerned about future outbreaks and the public clamored for them to act. In 1919, Congress introduced a Flu, or Anti-Flu, Bill, which would have appropriated roughly $5 million for the investigation of the epidemic, with an eye to preventing future outbreaks.
The law, however, soon lost steam. By 1920, the amount lowered to $250,000 as politicians objected to sending more funds to the U.S. Public Health Service—which was largely seen as having failed. Ultimately, no appropriation was made, which Nichols says “is part of the larger takeaway that the U.S. did not enact meaningful public health changes in the wake of the pandemic.”
Likewise, the scientific community couldn’t sustain efforts to investigate the virus that caused the influenza pandemic. In 1922, an editorial published in the Journal of the American Medical Association argued that there was a need to continue this research. While some scientists remained dedicated to that cause, by 1925, another editorial in the same journal noted that the “intense general interest in influenza … died down rather quickly.”
Nichols argues the country could have learned lessons about the importance of providing social safety nets and addressing health care inequities had it followed through on this research. Marginalized communities were at higher risk of dying from influenza in 1918 just as they are now with COVID-19—and yet there remain gaps in the country’s health care infrastructure that leaves them vulnerable to disease.
Ewing agrees. He notes there was little attention to these vulnerabilities in 1918—but in 2020, the research is overwhelming, especially now as the lingering effects of COVID-19 start to manifest.
Will we return to normal?
The good news, Bristow says, is that it seems there’s one lesson the country has learned from the 1918 influenza pandemic and that’s in record-keeping.
There is very little historical record or archival information from 1918. There was no real attempt to memorialize those who died in the 1918 pandemic because people just wanted to get past the trauma. Bristow says she had to sift through primary accounts from journals and newspaper headlines to write her 2017 book.
That seems not to be the case this time around. From the beginning of the COVID-19 pandemic, libraries, historical societies, and local organizations began working to collect any and all records. Those records include individual testimonies, as well as efforts to find out how entire communities have been affected through interviews with grocery store workers, volunteer COVID-19 testers, children and their parents grappling with virtual learning, and more. There have also been a few temporary memorials to honor the victims of COVID-19.
That attention to collecting records could be useful for making policies in the future that could help the country cope with the inevitable next pandemic. Or it could just collect dust if Americans again want the trauma from the pandemic to disappear from memory.
Ewing predicts the strong desire to get past the pandemic will translate to a lack of commemoration or change, but Bristow tends towards optimism.
“No one has escaped completely unscathed,” she says. “But will that make us more humane with one another, more caring of one another? My hope is that trauma that everyone has experienced at some level will make for a more robust reckoning in the aftermath than we saw in 1918.”
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Russo was hoping the Delta wave that slammed into upstate New York this fall would subside in early 2022. But then another variant crept in, one that is far less lethal, but much more transmissible.
“Omicron showed up,” Russo continued. “Then I said, ‘Ah, Omicron is going to prolong this.’ ”
For this installment of Pandemic Lessons, we asked epidemiologists to project how much longer Omicron will grip us, and what life will look like when it’s done.
The answer depends on your own health status, where – and with whom – you spend your days, and who else is going. It becomes even trickier when you consider that many infected individuals may not show symptoms.
The projections from when it emerged last month are proving to be true. It is extremely contagious, generally (but not always) mild, and because it impacts so many people quickly, Omicron is loading up hospitals.
Almost 4,000 people tested positive in Erie County on Jan. 5, which is a record – and a misleading number, because it doesn’t include unreported at-home tests.
State officials reported on Jan. 7 that across New York, cases among teenagers have multiplied by 10 in the last few weeks, while adult cases have more than doubled. Pediatric hospital cases for Covid-19 have nearly quadrupled since Christmas, rising from 150 to 570, most of them unvaccinated.
While the vast majority of people infected with Omicron aren’t hospitalized, the spike is still causing people to miss school and work and prompting cancellations and closures. The continued spread also puts people who are immunocompromised or have other health conditions at increased risk, and it is further delaying our ability to reclaim any semblance of the freedom, openness or normalcy that we crave.
After a period of falling Covid-19 illness rates, the recent spread of the delta variant of SARS-CoV-2 was a major disappointment and necessitated a reexamination of some previous assumptions. This reconsideration may, at least in part, be a correction to overly optimistic views of what highly effective SARS-CoV-2 vaccines could accomplish. Some observers had hoped the vaccines could eliminate transmission of the virus, the ultimate goal of reaching herd immunity.1 A more likely picture of our future with this virus comes into focus if we examine the well-known infection patterns of another respiratory virus, influenza, both in and outside pandemics. That experience can help us reset expectations and modify goals for dealing with SARS-CoV-2 as it further adapts in global spread.
Early results from the clinical trials and observational studies of mRNA vaccines against SARS-CoV-2 indicated that not only were they highly effective at preventing symptomatic infection, but they were also effective in preventing asymptomatic infection and therefore transmission.2 The basic criterion used for emergency use authorization by the Food and Drug Administration was a standard one: prevention of laboratory-confirmed clinical infection meeting a case definition. The effect on asymptomatic infections was a welcome surprise, because it has been thought that most vaccines for respiratory illnesses, including influenza, are “leaky” — that is, they allow some degree of asymptomatic infection and are better at preventing symptomatic infection.
The initial data on inapparent SARS-CoV-2 infection strengthened the hope that, at a certain level of vaccination, transmission would cease completely. To many of us, this hope appeared overly optimistic, and it seems even more so now; the highly transmissible delta variant causes asymptomatic infections and sometimes illnesses (albeit usually mild) in vaccinated people, probably because of increased growth potential, as well as because of waning immunity, which also involves decreasing IgA antibody levels. Elimination of an illness by means of herd immunity works best when the agent has low transmissibility, and it requires the absence of pockets of susceptible people. Eliminating Covid-19 seemed theoretically possible, because the original 2002 SARS virus ultimately disappeared. That virus, however, did not transmit as well as even the initial strain of SARS-CoV-2. It occurred in limited regions and was characterized by focal spread, including superspreading events. Such a pattern, which was also seen in the early days of SARS-CoV-2, is called “overdispersion” — 10% of cases, for example, may be responsible for 80% of transmission.3 These dynamics explain why there were great differences in antibody prevalence within a given city and spotty global spread early in the pandemic. Overdispersion was thought to be an unstable trait that would disappear, with transmission becoming more uniform and higher overall. That transition appears to have occurred as newer variants take over.
Given the parade of variants, their varying transmissibility, and continuing concern about antigenic changes affecting vaccine protection, I believe it should now be clear that it is not possible to eliminate this virus from the population and that we should develop long-term plans for dealing with it after the unsupportable surges are fully controlled. Pandemic and seasonal influenza provide the most appropriate models to aid in developing strategies going forward.
As with SARS-CoV-2, when a novel pandemic influenza strain appears, its spread can overwhelm the health care system. Waves of infection go through a city in weeks and a country in months, but there is scant evidence that superspreading events occur. Thereafter, the pandemic virus persists as a new seasonal strain, and antigenic changes occur — albeit probably not as quickly as we are seeing with SARS-CoV-2. The new strain joins the other seasonal influenza types and subtypes that reappear each year. The goal of vaccination becomes managing the inevitable outbreaks and reducing the rates of moderate-to-severe illness and death. Preventing mild disease, though important, is less critical.
Summary of World Health Organization (WHO) Process of Virus Selection for Annual Influenza Vaccines.
Readministration of influenza vaccine has become an annual event for much of the population, in response to both waning immunity and the appearance of variants, termed antigenic drift, necessitating updated vaccines. Even when there is no substantial drift, revaccination is recommended because of waning immunity. But antigenic drift is a constant issue and is monitored globally, with vaccine composition updated globally twice a year on the basis of recommendations from a World Health Organization consultation.4 As outlined in the table, various criteria are considered in decisions about which strains to include in vaccines. Vaccine effectiveness against laboratory-confirmed symptomatic infection is never higher than 50 to 60%, and in some years it is much lower. Thus, the value of influenza vaccines, now given to as many as 70% of people in some age groups, lies not in eliminating outbreaks but in reducing them and preventing severe complications.
Though there may be similarities between SARS-CoV-2 and influenza, there are also meaningful differences. The most obvious difference is the efficacy of SARS-CoV-2 vaccines, which is currently much higher than we can achieve with influenza vaccines. Whether that degree of efficacy will continue is one of the many open questions that can only be answered over time. It is clear, however, that revaccination will be necessary, for the same reasons that influenza revaccination is necessary: antigenic variation and waning immunity. Data on the frequency of reinfection with seasonal coronaviruses may not be relevant, but they suggest that protection is relatively short term even after natural infection.5 Revaccination frequency and consequences will need to be determined.
Let us hope that certain problems with the influenza vaccine — such as the failure of vaccination, in some years, to produce the desired increase in protection in previously vaccinated people — do not occur with the SARS-CoV-2 vaccines. Other issues, such as the variant to be targeted by vaccines, will need to be addressed. The successful public–private collaboration in selecting influenza strains offers a model for dealing with such issues. SARS-CoV-2 vaccines will be used globally, and the strain or strains contained in future vaccines will need to be chosen globally, in consultation with the manufacturers.
Most predictions about the shape of the post–Covid-19 world have been inaccurate — a reflection of rapid changes in knowledge. But we can now see a picture emerging in which use of effective vaccines will continue to be critical over the long term. Increases in asymptomatic infections and mild illnesses in vaccinated people will nonetheless continue to be possible, as variants continue to emerge. Counts of hospitalizations and deaths may be more important in monitoring the overall impact than numbers of cases, as long as the vaccines continue to be largely effective at preventing severe illness. The possibility of severe illnesses in a small proportion of vaccinated people does emphasize one of the greatest unmet needs we currently face: continued emphasis on better therapeutics and antiviral agents, which will not be affected by molecular changes in the virus as much as vaccines are.
The future timing and composition of booster vaccine doses will need to be determined on the basis of observational studies. We currently have few data on non-mRNA vaccines, particularly protein-based vaccines, which may have characteristics different from those of mRNA vaccines, especially in terms of duration of immunity.
Overall, the situation will be fluid, but we will require the continuing use of vaccines to avert severe consequences, even if milder illnesses still occur at a low frequency. We need to learn to live with these illnesses, just as we have learned to live with influenza.
But Robby Walker is alive — a feat some doctors didn’t expect two months ago. And while the 52-year-old struggles to speak long sentences, he’s now using his voice to try to prevent others from suffering the way he did.
Then a doctor in Connecticut saw Susan’s emotional interview and decided to help.
Now, after three weeks on ECMO and a month learning how to walk again, Robby returned to Florida this week — with a new mission.
A different life after Covid-19
Before Robby fell ill in July, he was a strong and sturdy construction business owner who worked out at the gym and ran 5 miles every day.
“Fifty-two years, I’ve done pretty much whatever I wanted,” Robby told CNN. “Now, I’m very limited.”
Scarred lungs and reduced lung capacity means he can only speak in short, choppy sentences before having to catch his breath. He also lost more than 50 pounds while hospitalized as his muscles eroded.
Even brushing his teeth is now a struggle.
“Sitting in a chair, it’s probably a 5- or 6-minute ordeal,” Robby said.
“If I stand, then I have to take a break between. So it’s a little longer,” he said.
“It takes a lot more energy to hold yourself up. I can go from sitting in a chair to standing, and my heart rate will jump 20, 30 beats a minute.”
After his ECMO treatment at Connecticut’s Saint Francis Hospital, Robby spent a month in physical therapy at Gaylord Speciality Healthcare about 30 miles away.
He relearned how to walk and practiced basic self-care with the help of an assistant. But he still needs a walker to move around, and small tasks can be draining — even after taking a break.
“Once your heart rate comes down and your breathing gets straight, you’re still just exhausted,” he said. “Physically. It just takes a lot of energy to do.”
But the fact he’s even alive is worth celebrating.
‘They told me he was dying’
Robby called his wife on July 25 from his hospital bed in Florida and told her he had made a gut-wrenching decision.
“He had signed the papers to be intubated,” Susan said.
Some Covid-19 patients who get put on ventilators don’t survive the disease. Their final calls to their families before intubation are their last.
“He cried and just told me how regretful he was of not getting the shot,” Susan said. “And he begged me to go get vaccinated.”
She did. But it was too late to protect her husband, whose condition kept deteriorating.
“They told me he was dying,” Susan said. And the ECMO treatment Robby needed wasn’t available.
Susan told her story to CNN in August. Hours later, a doctor 1,200 miles away was checking his Facebook feed and saw a CNN post with a video clip of Susan’s interview.
“I just clicked on it and watched it and … it was pretty compelling,” said Dr. Robert Gallagher, chief of cardiothoracic surgery at Trinity Health of New England.
Cardiothoracic surgeons operate on diseases in the chest, including in the heart and lungs. By the time Covid-19 patients reach Gallagher, they’re usually in dire condition — and often in need of ECMO.
He forwarded Susan’s interview to the chief perfusionist, who runs the ECMO machines. And she immediately wanted to help.
“I said, ‘OK, how are we going to find this family?'” Angela Sakal, the chief perfusionist at Saint Francis Hospital in Connecticut, told CNN.
She contacted a friend in Florida who’s savvy on social media. “And within a couple of hours, she had Susan’s phone number,” Sakal said.
Within two days, Susan hired a medical evacuation team to fly Robby from Florida to Connecticut — intubated, sedated and near death.
When Sakal first saw Robby, she wasn’t sure he would survive.
“I can’t guarantee you an outcome,” she recalled telling Susan. “I don’t know what the future is going to be. But I can promise you that we’re going to do the best that we can for him.”
ECMO is sometimes used as a last resort for critically ill Covid-19 patients with failing lungs. It removes blood from the body, eliminates carbon dioxide and adds oxygen to the blood, then pumps the blood back into the body so the lungs might have a chance to recover.
Gallagher inserted the ECMO tubes in Robby’s neck. And over the next 22 days, Sakal oversaw Robby’s ECMO treatment.
Younger Covid-19 patients are needing ECMO
Robby isn’t the only previously healthy Covid-19 patient Sakal has seen needing ECMO.
With the rise of the Delta variant, Sakal said some ECMO patients have been in their 20s.
“What we’re finding is our Covid patients — even the young ones — are single organ failure (and) previously healthy,” Sakal said. “And the Covid is just destroying their lungs.”
Not everyone who goes on ECMO survives. But after three weeks of getting his blood extracted and returned, Robby’s lungs had recovered enough to support him again.
He was discharged from Saint Francis in mid-September and started a month of inpatient rehabilitation at Gaylord Specialty Healthcare.
“My lungs have gotten a little bit better, (but) my heart rate still races a little bit,” Robby said this week.
“I can walk by myself — somebody’s there just kind of making sure I’m staying straight. But I use a roller/walker, and I’m able to walk a decent distance,” he said.
“I mean, I’m not going to the mall or going shopping. But I’m able to walk some now. So it’s been a big improvement.”
After a month of difficult work relearning basic skills, Robby was released from rehab Wednesday. Most of his ECMO team from Saint Francis Hospital traveled to Gaylord to see him off to Florida.
Sakal was there. She fought back tears as she visited her former patient.
“I remember when he first got here,” she said Wednesday. “And I watched him today, standing up and talking and walking. It was amazing. It was just awesome.”
A new life filled with uncertainty and lessons learned
Robby’s two brothers rented an RV and drove up to Connecticut to bring him and Susan home. The drive would take more than 24 hours.
As he traveled back to Florida to restart his life, Robby said the first thing he wanted was his wife’s homemade chicken pot pie.
But many other aspects of his former life will be different.
It’s not clear when Robby might be able to go to work again, as he still needs months more of rehabilitation.
The family also has no idea how much of the $1.5 million in medical bills racked up so far in Florida and Connecticut they will owe — or how exactly they will pay it. A family friend set up a GoFundMe account to help with Robby’s medical expenses.
And Robby doesn’t know whether he’ll be able to return to all the activities he loved.
“My goal is to get hopefully 80% or 90% to where I was,” he said. But “they just don’t know enough about this to give any kind of definitive answers.”
For now, he won’t be able to go fishing or work out at the gym every day.
“I don’t have a lot of strength,” he said, joking about fishing: “I wouldn’t want anything to pull me over the reel.”
But what he lacks in physical ability, he’s gained in new wisdom — especially when it comes to Covid-19 and vaccines.
Robby’s ordeal has inspired more than 100 friends, relatives and acquaintances to get vaccinated — including some who were extremely hesitant, Susan said.
Robby said the reason he and Susan didn’t get vaccinated earlier was due to “a lack of education on our part.”
With countless rumors and claims spread on social media, “you don’t know what to believe anymore,” he said. “A lot of that was ignorance on our part, for not doing more research.”
“We thought that the vaccine was something that was created in a year or two. So we felt like there wasn’t enough information,” he said.
“But through this journey that I’ve had, we’ve discovered that (mRNA vaccine research) has actually been around for 20-plus years.”
He also wrongly assumed that he wouldn’t get severely sick.
“I just thought it would be like a flu. I thought that it was something that affected people with underlying conditions. I had none,” Robby said.
“But for whatever reason, it affected me differently. And if I had to do it over again, I would have gotten my vaccination when it was available to me.”
After he left the hospital, Robby received his first dose of the Moderna vaccine. He had some side effects for a day, he said, but they weren’t nearly as bad as his Covid-19 symptoms.
“There was a little fever … my first few days of Covid, I had a bigger fever than that,” Robby said.
“I just had no energy. I did run a fever for probably a day, day and a half. But nothing horrible compared to everything else I’ve gone through.”
As Elizabeth Holmes, founder and former CEO of Theranos, goes on trial on allegations of defrauding investors and patients, her health-care start-up may be a prime example.
Nearly a decade ago, investors, including media mogul Rupert Murdoch, former Education Secretary Betsy DeVos and the Walton family of Walmart fame, put more than $700 million into the company.
Prosecutors allege investors were swayed by misrepresentations of Theranos’ blood-testing technology.
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Here’s a look at other stories impacting the financial advisor business.
The company’s claims about its technology, as well as its business and financial performance were either exaggerated or false, according to the Securities and Exchange Commission.
“The Theranos story is an important lesson for Silicon Valley,” Jina Choi, director of the SEC’s San Francisco Regional Office, said at the time charges were filed.
“Innovators who seek to revolutionize and disrupt an industry must tell investors the truth about what their technology can do today, not just what they hope it might do someday.”
“There’s going to be a lot of attention on what did Elizabeth Holmes know and when did she know it, but a better question is what should the investment community know and when should we know it?” saidLen Sherman, professor of business at Columbia Business School.
Elizabeth Holmes (L), founder and former CEO of Theranos, leaves the courthouse with her husband Billy Evans after the first day of her fraud trial in San Jose on Sept. 8, 2021.
Nick Otto | AFP | Getty Images
Theranos isn’t the only bad apple out there, it’s just the most recent example of one.
Other black eyes for the industry include uBiome, which was investigated by the FBI for fraudulent billing, and Outcome Health, a health-care advertising company that provided misleading information to drugmakers on where their ads were showing up and how they performed.
Of course, fraud extends far beyond health care.
Corporate malfeasance comes in waves, Sherman said, from Enron and WorldCom to Bernie Madoff and now Theranos. “We are in another era that has conditions that are conducive to promoting fraud.”
How to spot a problem
“It’s important that we don’t assume that every company is like a Theranos, we just need to ask the right questions,” said Ruby Gadelrab, founder and CEO of MDisrupt, a medical diligence company for the health-tech industry, which aims to avoid making similar mistakes in the future.
“Health care, as a whole, is complex,” Gadelrab said. “It’s probably the hardest area to invest in.”
To help investors vet health-technology companies, Gadelrab suggests first establishing if the product is clinically and commercially viable.
“Investors do technical and financial diligence using experts, in health care we need to do medical diligence using health-care experts.”
Spend as much time looking at what’s in your portfolio as you would booking your next vacation.
Winnie Sun
managing director of Sun Group Wealth Partners
Then, determine if there’s evidence to back up the founders’ scientific claims.
The technology should be validated, Gadelrab said. “Show me the data.” For example, “does it actually pick up a disease or biomarker when its present and doesn’t pick it up when it’s not?”
“Not all data is created equal,” she added. Good data is done externally with scientists and research labs, great data is published in peer-reviewed journals and excellent data is published and replicated.
Finally, look at the team structure. “Do they have clinical experts in senior positions? On their boards, as their investors, in their C-suite?”
“Make sure health experts have a seat at the table and a voice in the process,” Gadelrab said.
The secrecy surrounding the Theranos technology and the intense attention given to its CEO was part of the mystique but also a major red flag, according to Sherman. “I hope the next time that kind of stuff happens, someone says ‘wait a sec.'”
Lessons learned
With any investment, you can do your due diligence, advised Winnie Sun, managing director of Sun Group Wealth Partners in Irvine, California.
For starters, Google the company and read consumer reviews, she said. In addition, check Twitter to see how customers are responding. “That’s going to factor in to whether you want to own that company,” Sun said.
If you are working with a broker or financial advisor, then you have an additional layer of protection — as long as that person meets a minimum level of credentials and background to work in the industry. (Check that financial advisors are licensed or registered with a firm through the SEC’s Investment Adviser Public Disclosure website or that the broker is listed on The Financial Industry Regulatory Authority’s resource, BrokerCheck.)
“If you are doing this on your own, you have to do a little more due diligence, especially if it’s an investment idea you heard about from a friend or on the internet,” Sun added. “Spend as much time looking at what’s in your portfolio as you would booking your next vacation.”
Otherwise, invest in an exchange-traded fund or mutual fund rather than picking individual stocks.
Most experts say diversifying with these asset classes is the best way to manage risk and improve long-term performance.
“As investors, it comes back to the core philosophy of diversification,” Sun said.
In an exclusive television interview with Fox News’ Jennifer Griffin, General Mark Milley said that one of the “lessons learned” from the U.S. withdrawal from Afghanistan was the pitfalls realized in the Afghan security forces.
“The Army itself – the army and the police forces were a mirror image in many ways – and we created and developed forces that looked like Western forces,” Milley explained. “I think one of the big lessons learned here is maybe those forces were not designed appropriately for the type of mission.”
MILLEY SAYS CIVIL WAR IN AFGHANISTAN ‘LIKELY’ AFTER US WITHDRAWAL, COULD LEAD TO ‘RECONSTITUTION OF AL QAEDA’
The general, who spoke to Fox News at the Ramstein Air Base in Germany, said the fall of the Afghan government occurred much sooner than officials had expected, despite thorough planning in the withdrawal of U.S. forces.
“The collapse of the Afghan army happened at a much faster rate and [was] very unexpected by pretty much everybody,” he said. “And then with that is the collapse of the Afghan government.”
“Afghanistan has always been a very difficult issue,” he later added.
The general told Fox News that a lack of faith in the government by Afghan citizens ultimately enabled the Taliban takeover.
“One of the fundamental issues I think clearly is the corruption in the government…the government itself not having the legitimacy in the eyes of the people,” Milley said. “You saw what happened at the end. The senior government elites, they all just literally bugged out.”
DEFENSE SEC LLOYD AUSTIN ORDERED BY HOUSE COMMITTEE TO SUBMIT AFGHANISTAN PLAN ON EVACUATIONS
Milley said that despite the frustration that Americans have expressed following what President Biden described as a “messy” withdrawal, the U.S. was still able to coordinate the rapid evacuation of 124,000 Americans and Afghans.
The administration has said it will continue its efforts to evacuate all Americans, Special Immigrant Visa (SIV) holders, and at-risk Afghans who wish to leave.
The general further sought to assure all service members and the families who lost loved ones in the War in Afghanistan that their efforts were not made in vain.
“War is a horrible, terrible thing,” he said. “But I can tell you with a high degree of certainty that the troops that have fought in this for 20 years – they made a difference.
“They protected the United States from a kind of terror, from a terrorist attack for two decades,” he added.
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Milley also recognized the 13 service members who were killed during a suicide bombing in Kabul during the final days of the evacuation.
“Those 13 that were killed the other day at Abbey Gate, they didn’t die in vain, they died so that others will live free,” he added.
Female New Zealand giraffe weevil. Credit: Christina Painting/ Wikimedia Commons / CC BY-SA 4.0
Nepalese craftsman, Chandra Bahadur Dangi, holds the record as the world’s shortest adult, at 54.6 cm (1 ft 9 ½ inches). The tallest human is Sultan Kösen, a Turkish farmer, almost five times taller at 2.52 meters (8 feet 3 ¼ inches). In nature, size differences among males of a single species are not uncommon, but in a new paper, a team from the Smithsonian Tropical Research Institute (STRI), The University of Auckland and the University of Arizona, discovered a case of male beetles that are not only extremely different in size, but also provide an answer to long-standing puzzle in evolutionary biology: how can larger animals afford the energetic cost of making and maintaining disproportionately large weapons?
Almost one in every four species in the world is a beetle: about 350,000 beetle species have been identified so far. Male New Zealand giraffe weevils, Lasiorhynchus barbicornis, were known to be the longest beetles in the world, but when researchers measured the differences in the weight of the smallest and largest beetles, they were in for a surprise:
“When I first saw the weights of the smallest and largest males, I thought someone had made a mistake,” said Ummat Somjee, Earl S. Tupper fellow at STRI. “But we weighed them again and got the same results. The largest males are 30 times larger than the smallest ones. This is the biggest adult size-range we know of any beetle species in the world.”
And like many other animals with fighting weapons (like elephants with tusks and antelopes with horns), the big males have snouts that are disproportionately larger than the snouts of tiny males. A big male lords over a female as she lays an egg, using his extra-long snout as a lance to fend off rivals as he fertilizes her. But as massive males vie for position above, one of the smallest males may be sneaking in underfoot to fertilize the female. Because both of these mating strategies result in offspring, both large and small males persist.
In tropical forests, every bit of energy expenditure may mean the difference between life and death. Somjee is fascinated by the economics of energy—and looks to insects for inspiration. The male giraffe weevils, literally embody energetic trade-offs. The snouts of big males are disproportionately larger than the snouts of their smaller counterparts: so at first glance it seems that big males invest relatively more materials and energy in their weapons than smaller males. But is this really the case?
Somjee teamed up with Chrissie Painting, now senior lecturer at the University of Waikato and local expert on these beetles in New Zealand, to take a closer look at the economics of beetle weaponry. To measure how much energy large and small males use they placed them each in little chambers and measured their oxygen consumption. They found that larger males pay lower, not higher, costs—in terms of energy—per gram of tissue in their bodies compared to smaller ones. How do these large males carry relatively larger weapons, and still pay lower relative metabolic costs?
“The big males are like very fuel-efficient cars—the Prius of the beetle world (58 miles per gallon)—and the small ones are more like Rolls Royce Phantom Coupes (14 miles per gallon). How can large males be so energy efficient and still bear the additional energy costs of a larger weapon?” Somjee said.
The secret, they discovered, lies in the architecture of the weapon itself. Small snouts are made up of a high proportion of living tissue, which is relatively more expensive to maintain—like our muscles—but big snouts are made a higher proportion of cuticle—like the keratin in our hair and fingernails, which is much cheaper to maintain. So the big males are actually using less energy to maintain their disproportionately big weapons, than the small males are using to maintain their small weapons.
The finding that large individuals often carry disproportionately large weapons has been a puzzle in biology for almost a century. These bizarre weevils demonstrate that large animals can cut the costs of large structures. Now Ummat is back in Panama looking for other insect species to find out if other insects with extreme structures also find creative ways to minimize their maintenance costs.
“It is precisely because of the Giraffe weevils unusually large size variation that we were able to answer this long-standing evolutionary question,” Somjee said. “Giraffe weevils don’t somehow find extra energy to sustain their giant heads, they change the architecture of their heads to make them more efficient and thus save energy.”
Drop your weapons! Autotomy, the shedding of a body part, reveals the hidden cost of conflict
More information:
Ummat Somjee et al, Exaggerated sexually selected weapons maintained with disproportionately low metabolic costs in a single species with extreme size variation, Functional Ecology (2021). DOI: 10.1111/1365-2435.13888
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Smithsonian Tropical Research Institute
Citation:
Is it cheaper to be bigger? Lessons from the extreme weapons of giraffe weevil warriors (2021, August 14)
retrieved 14 August 2021
from https://phys.org/news/2021-08-cheaper-bigger-lessons-extreme-weapons.html
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“Jeopardy!” contestant Matt Amodio’s impressive eight-game winning streak officially makes him one of the top 10 highest-grossing winners of the game ever.
Amodio’s streak ran for the entirety of “Star Trek” and “Reading Rainbow” star LeVar Burton’s entire guest-hosting run. He’s raked in a total of $291,200 in prize money after scoring his eighth win overall on Friday, which puts him in ninth place as the all-time highest “Jeopardy!” winner of all time for regular season play. If his streak continues, he’ll tie for tenth place for the highest consecutive winning streak of all time, thus earning him another accolade on the “Jeopardy” Hall of Fame.
Currently, the record for highest winnings and consecutive games won is none other than the famous “Jeopardy!” star Ken Jennings, who had an impressive 74-game streak in 2004. Right behind him in both categories is 2019 breakout, James Holzhauer, who ended his run on the show with $2,462,216, just shy of Jennings’ $2,520,700.
Speaking to Entertainment Weekly, Amodio notes that he has been a longtime “Jeopardy!” fan, but didn’t think he had what it takes to even be considered in the same conversation as Jennings and Holzhauer, who he considers titans of the quiz show. In fact, he told the outlet that he auditioned for the show reluctantly before going on his winning streak. Now he says he’s just trying to learn every lesson from the two “Jeopardy!” champs that he can.
‘JEOPARDY’ CONTESTANT BREAKS RECORD FOR LOWEST SCORE EVER DURING LEVAR BURTON’S FIRST APPEARANCE AS GUEST HOST
Matt Amodio has won eight consecutive games of ‘Jeoaprdy!’ and cracked the top ten highest winners of all time. (Jeopardy Productions, Inc.)
“I think that my strategy going in was watch Ken [Jennings], and try to do whatever Ken does. He’s done TED talks, he does podcasts and he drops a little bit of knowledge here and there, like, ‘When I was trying to get in on the buzzer I would just listen to the cadence of the voice and try and view it like a musical meter and get the rhythm and stuff,’” Amodio explained. “So I would just take any notes I could from him. And then also, James brought in a lot of probability-based analysis in terms of which clue selection to do. I just remembered how they did it, and I’m hoping that I’m imitating it as best as I can.”
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Although he’s won a total of eight games and continues his run on the show, Amodio is already thinking about the “Tournament of Champions,” which he solidified his place in after his fifth win. He notes that he’ll have his work cut out for him as the run of episodes, which brings back past champions on par with himself, will make for a significantly more competitive game than he’s used to.
Ken Jennings said an ‘Jeopardy!’ game between him and James Holzhauer is ‘inevitable.’ (Getty Images/AP)
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“I am [excited], with a combination of anticipation and dread. Because my competitors have been extremely smart, but on the other hand, in the ‘Tournament of Champions,’ you’ve filtered it so that you only get people who have won at least five games of ‘Jeopardy!.’ That’s going to be a more competitive stage than I’m prepared for mentally. So I’m quite worried about that. Hopefully, I’ll do well, but I’ll be shaking in my boots a little bit,” he told the outlet.
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All eyes are on Amodio as he seeks to win a ninth game of “Jeopardy!” and possibly make a place for himself in the consecutive wins category. Until then, he’ll just have to settle for being in the top 10 highest winnings category.
Dow Jones futures will open Sunday, along with S&P 500 futures and Nasdaq futures. The stock market rally was deceptively bullish last week. The major indexes fell slightly, but market internals improved somewhat while a number of leading stocks flashed buy signals.
X
Amazon.com (AMZN) was a big loser Friday, offering some key earnings lessons for investors. Roku (ROKU), Square (SQ) and Datadog (DDOG) are trading around buy points. But with earnings on tap, investors have big decisions to make.
Meanwhile, STLD stock is in a buy zone, with Steel Dynamics (STLD) earnings in the rear window.
Roku stock is on the IBD 50. STLD stock was Thursday’s IBD Stock Of The Day.
The video embedded in this article analyzes Amazon stock, Roku and Steel Dynamics.
Dow Jones Futures Today
Dow Jones futures will open at 6 p.m. ET, along with S&P 500 futures and Nasdaq 100 futures.
Remember that overnight action in Dow futures and elsewhere doesn’t necessarily translate into actual trading in the next regular stock market session.
Join IBD experts as they analyze actionable stocks in the stock market rally on IBD Live
Coronavirus cases in the U.S. have hit 35.68 million, with deaths above 628,000.
Stock Market Rally
The stock market rally lost ground on the major indexes but small caps and several sector ETFs advanced.
The Dow Jones Industrial Average and S&P 500 index dipped 0.4% in last week’s stock market trading. The Nasdaq composite retreated 1.1%. The small-cap Russell 2000 rose 0.7%, but hit resistance near its 50-day line.
Among the best ETFs, the Innovator IBD 50 ETF (FFTY) fell 1.25% last week, while the Innovator IBD Breakout Opportunities ETF (BOUT) dipped 0.6%. The iShares Expanded Tech-Software Sector ETF (IGV) sank 1.1%. The VanEck Vectors Semiconductor ETF (SMH) gained 2.3%, with AMD (AMD), Qualcomm (QCOM) and KLA (KLAC) all earnings winners.
SPDR S&P Metals & Mining ETF (XME) leapt 7% while the Global X U.S. Infrastructure Development ETF (PAVE) gained 2.4%. U.S. Global Jets ETF (JETS) dipped 0.5% while the SPDR S&P Homebuilders ETF (XHB) advanced 1.5%. The Energy Select SPDR ETF (XLE) and the Financial Select SPDR ETF (XLF) were up 1.8% and 0.8%, respectively.
Reflecting more-speculative story stocks, ARK Innovation ETF (ARKK) fell 2% and ARK Genomics ETF (ARKG) lost 1.5%. ARKK dipped back below its 200-day line on Friday. ARKG closed below its 50-day line, which is below the 200-day. Roku stock and Square are both top-five holdings across the ARK Invest ETFs.
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Amazon Stock Lessons
Amazon stock sold off Friday after sales and sales guidance came in light. Shares fell 7.6% to 3,327.59 on Friday, gapping far below the 3,524.96 buy point and below the 50-day line. AMZN stock skidded 9% for the week. Even if it didn’t trigger the 7%-8% sell rule for some investors, that still flashed some strong sell signals.
This is why IBD generally suggests having a cushion heading into earnings. How large depends on your investing style, the size of your position and your conviction in the stock.
Meanwhile, Amazon’s report also highlights the importance of paying attention to big earnings reports related to your holdings, especially if your stocks haven’t reported yet.
Amazon’s report is a bad sign for other e-commerce plays. Etsy (ETSY) plunged 7.8% on Friday and 12% for the week. EBay (EBAY) lost just over 7% for the day and week. Shopify (SHOP), which already beat views earlier in the week, fell a modest 1.6% on Friday, but slumped 8.7% for the week.
Roku Stock
Roku stock fell 4.7% on Friday and 9.6% for the week, closing at 428.31. below a 463.09 cup-with-handle buy point cleared a week earlier, according to MarketSmith analysis. The streaming media player is trying to find support at its 21-day moving average but has fallen back to an early entry as it broke the downtrend in its handle.
Anyone who bought as Roku stock cleared the traditional buy point is down at least 7.5%, triggering the 7%-8% automatic sell rule. Anyone who bought at the early entry has seen a double-digit gain erased, a strong sell signal as well.
Investors who bought off the 10-week line in late July around 391, or previously at resistance around 397, do still have a modest gain.
So current Roku stock investors have a decision to make, especially if they’re flat to down.
Other investors can watch, and wait, to see if there’s a post-earnings buying opportunity.
Square Stock
Square stock rebounded from its 50-day line on July 19, then raced up 11% for that week, clearing a 254.88 handle buy point. But this past week, SQ stock lost 6.3% to 247.26, with half of that decline coming on Friday.
Once again, recent SQ stock buyers have a decision to make, with Square earnings due Thursday night.
One possible tactic is to use an earnings options strategy. A Square earnings options strategy was discussed in this week’s Earnings Preview article. But investors could use that strategy for Roku and other upcoming earnings reports.
Investors could view 267.87 as a new handle entry.
Datadog Stock
DDOG stock swung up and down this past week, ultimately retreating 0.5% to 110.70 for Friday and the week. Datadog stock is still above a 110.34 buy point in a cup-with-handle base, but only by a fraction.
Datadog earnings are on tap Thursday night. It’s still possible DDOG stock will build a bigger cushion, letting investors keep at least a partial position. But you don’t want to head into results with a loss.
Steel Dynamics Stock
Steel Dynamics stock is a different story. Earnings are out of the way, taking that huge risk off the table. STLD stock rebounded from the low of the base on strong earnings. On Thursday, it cleared a double-bottom buy point of 63.28 amid strong results from several steelmakers. STLD stock fell slightly on Friday but remains in buy range.
Market Rally Analysis
The major indexes closed modestly lower last week after touching record highs. A lot of that had to do with the megacap techs. Apple (AAPL) and Microsoft (MSFT) fell slightly on earnings while Facebook (FB) retreated solidly and Amazon stock tumbled. The one exception was Google parent Alphabet (GOOGL), which rose slightly after pulling back from Wednesday’s highs.
More stocks participated in the rally, with housing and steel plays among the new leaders.
There were some clear earnings winners and losers, with reports spurring new buying opportunities.
Overall, the market rally had a pretty good week. It doesn’t look so close to extended. The Nasdaq, finding support just above its 21-day moving average, is only 2.9% above its 50-day line. The Nasdaq 100 is 4.4% above its 50-day vs. 6.7% a week earlier. Market breadth improved a little. It’s not great but at least its going in the right direction. And the number of buying opportunities and more-diverse leadership are good news for active investors.
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What To Do Now
Investors could have modestly boosted exposure last week, with some new buys perhaps partially offset by some sales before or after earnings.
The past week has shown the importance of having a strategy heading into earnings. Make sure you have a cushion.
There are still dozens of top stocks on tap next week so know the earnings dates of your holdings. With many big names out of the way, you don’t have to be quite as aware of rivals’ earnings dates.
But be ready to take advantage of top stocks breaking out on earnings or other news. Several recent breakouts quickly got extended. So within a broader watchlist have a “ready” list of stocks near buy points. Use alerts, such as in MarketSmith, so you don’t miss breakouts.
Read The Big Picture every day to stay in sync with the market direction and leading stocks and sectors.
Please follow Ed Carson on Twitter at @IBD_ECarson for stock market updates and more.
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