- There was no pressure from Adani Group to sell Mumbai airport: GVK’s Sanjay Reddy Deccan Herald
- Adani vs Hindenburg: India market crisis is a political issue for Modi Business Insider
- Adani issue: GVK refutes Rahul Gandhi’s claim on pressure to sell Mumbai airport Times of India
- Sanjay Jha writes on Rahul Gandhi’s speech in Parliament: Questions the Congress leader has raised need answers, not political rhetoric and whataboutery The Indian Express
- Protesters in India demand investigation into Adani Group fraud allegations NBC News
- View Full Coverage on Google News
Tag Archives: Sanjay
Dr. Sanjay Gupta: 6 keys to keeping sharp in 2023
Editor’s Note: CNN Chief Medical Correspondent Dr. Sanjay Gupta is a practicing neurosurgeon and the author of the new book, “12 Weeks to a Sharper You: A Guided Program.”
CNN
—
At least once a year, we read a sparkling headline about some promising new drug that might help patients with Alzheimer’s disease. And at least once a year, we also hear about failed drug trials and reversals of promises that a cure-all is in sight. I wrote a book about how to keep your brain sharp that came out two years ago. Since then, not much has changed in our understanding of how we can preserve our memories, and the lessons remain as relevant as ever. But one thing has become abundantly clearer: Preventing and even treating forms of dementia are largely driven by lifestyle and the choices we make daily. You are not necessarily doomed to whatever fate you think sits stuck in your genes. If there’s one fact that’s increasingly apparent in scientific circles, it’s that our lifestyle choices contribute mightily to our aging process and risk for disease, likely as much – or perhaps even more – than our genetics.
Indeed, your everyday experiences – including what you eat, how much you move, with whom you socialize, what challenges you face, what gives you a sense of purpose, how well you sleep, and what you do to reduce stress – factor much more into your brain health and overall wellness than you might imagine. We may never have a drug that everyone can take to avoid, let alone cure, dementia and other neurodegenerative diseases. But we all can access the same toolkit proven to help stack the deck in our favor for a sharp brain for life. The program I outline in my book, and which informed the interactive workbook I have coming out this week – “12 Weeks to a Sharper You: A Guided Program” – features all the practical tools you need to implement in your life today. They can help stave off brain decline, and also help you feel less anxious, sleep better, improve energy, think more clearly, make better decisions, become more resilient to daily stress, and even lose weight and boost immunity – all resolutions most of us aim to make at the transition to a new year filled with hope and high expectations. We all know that change is a challenge, and changing long-established habits takes effort. But it doesn’t have to be tortuous, and it is really not that hard to do. Let me give you six things that will help you in 2023 – your keys to the kingdom of mental sharpness.
Skip the crash diet and simply work on following the S.H.A.R.P. protocol: Slash the sugar and salt; Hydrate smartly; Add more omega-3 fatty acids from dietary sources; Reduce portions; and Plan ahead. The S.H.A.R.P. protocol is the easiest way to gravitate toward healthier foods in general and minimize the amount of processed, brain-busting junk. And if you need just one single thing to focus on here, start with the sugar. The average American consumes nearly 20 teaspoons of added sugar daily, most of that in the highly processed form of fructose, derived from high-fructose corn syrup. My guess is that a lot of this sugar intake comes in the form of a liquid – soda, energy drinks, juices and flavored teas. Swap sugar-laden drinks with water and you’ll take on two steps. That’s how to hydrate smartly.
Physical exertion is the only thing we’ve scientifically documented to improve brain health and function, and it may even slow memory loss. It’s the brain’s only superfood. And it needn’t be formal or require equipment. Walk more, take the stairs, and get up for light activity for two minutes every hour. According to the US Centers for Disease Control and Prevention, cognitive decline is almost twice as common among adults who are inactive compared to those are active. In 2022, a large international study that tracked the health of more than half a million people showed that the simple act of performing household chores like cooking, cleaning and washing the dishes can cut the risk of dementia by a stunning 21%. That put chores as the second biggest protective activity behind more obvious things such as riding a bike. In this same study, regular movement was shown to reduce risk of dementia by 35%, followed by meeting up with friends and family (a 15% lower risk). Again, simple things with huge payoffs.
On a scale of 1 to 10, with 10 being the most extreme, how would you rate your stress level? What if I told you that stress is now considered a trigger for silent neurodegeneration, which occurs years before symptoms develop? Scores of well-designed studies routinely show that chronic stress can impair your ability to learn and adapt to new situations, and subtly erode your cognition. More specifically, stress destroys cells in the hippocampus, the brain site responsible for memory storage and retrieval. So, by reducing stress, you not only help preserve cells vital to memory but you also improve focus, concentration and productivity. Don’t let toxic stress get in the way of keeping sharp. Take breaks during the day to engage in an activity that’s peaceful, meditative and stress-reducing. It can be as easy as walking in nature, journal writing, spending time with a pet, or even daydreaming. Download an app today that will give you a guided tour through a deep breathing exercise you can practice daily. I have a trusty meditative routine that calms me down in 90 seconds or less. I simply close my eyes, pay close attention to my breath, and picture my worries in clear bubbles directly in front of me that float weightlessly up and away.
Find what works for you and make it a part of your day – every day.
Are you getting restorative sleep? Contrary to popular belief, sleep is not a state of neural idleness. It is a critical phase during which the body replenishes itself in a variety of ways that ultimately affect every system, from the brain to the heart, the immune system, and all the inner workings of our metabolism. You can think of sleep as your brain’s rinse cycle for clearing out junk that could contribute to decline and disease. Prioritize sleep as you would anything else important. And start with your bedtime routine. Stop looking at screens a full hour before bed – your smartphone included – and prepare for a good night’s sleep. I bumped my pre-sleep prep time from 30 minutes to an hour and it has made all the difference in my energy and productivity the next day.
Are you learning something new every day that’s cognitively stimulating? Staying mentally challenged is vital, so much so that studies show that someone who retires at age 65 has about a 15% lower risk of developing dementia compared with someone retiring at 60, even after other factors are taken into account. Retire late, or never at all. Choose different routes to familiar destinations. Brush your teeth with the non-dominant hand. Skip the solitary games and crossword puzzles and pick up a new hobby that involves other people. Which brings me to the final key …
We are social creatures who need social connection to thrive, especially when it comes to brain health. Call a friend today. Invite a neighbor over for dinner. Go for a walk with a buddy and talk about your problems. Cherish those relationships. The strength of our connections with others can predict the health of both our bodies and our brains as we go through life. Good relationships protect us. They are a secret sauce to a long, sharp life.
As of 2022, scientists have documented a total of about 75 genes connected to the development of Alzheimer’s disease, but carrying these genes is not a one-way ticket to decline. How those genes express themselves and behave may depend largely on your daily habits. Remember that a disease like Alzheimer’s is multifactorial, made up of different pathological features. Which is why prevention and treatments are increasingly becoming personalized – individualized to a person’s biochemistry, from basic parameters like cholesterol levels, blood pressure and blood sugar balance, to the state of one’s oral health and gut microbiome, relics of past infections, and even how well you can see and hear. To that end, it helps to keep your numbers in check. Fon’t let your cholesterol or blood pressure, for instance, run amok. Same goes for your vision and hearing. In recent years, hearing and vision impairment have been added to the list of modifiable risk factors for cognitive decline.
Your DNA provides your body’s core language, but how that DNA behaves tells the story. In the future, interventional therapies that include a combination of lifestyle habits and drugs may help those stories end well. You’ll also track your risk for cognitive decline over time in the future using a simple app on your smartphone that can help you evaluate your physiology (and your memory) in real time and make suggestions tailored for you. Until we all have that technology at our fingertips, the six keys above afford you a great start and will give you a strong foundation.
The ultimate goal is to build what’s called cognitive reserve, which is what scientists call “brain resiliency.” With more cognitive reserve, you support cognitive function and can lower your risk of neurodegenerative issues. It’s like having a backup set of networks in your brain when one fails or, worse, dies and is no longer functional. In many aspects of life, the more backup plans we have, the more chances for success, right? Well, the same is true for our brain’s hard- and soft-wiring. And perhaps the most important key to establishing that reserve is to do so over time – years or even decades – before your risk for decline increases with advanced age.
Always remember this: Cognitive decline is not necessarily inevitable. Research suggests healthy habits you can incorporate into your daily life can help protect your brain health for the long term. Think of health as a “top-down” project. Focus on your brain and everything else will follow. Happy New Year!
Dr. Sanjay Gupta: 6 keys to keeping sharp in 2023
Editor’s Note: CNN Chief Medical Correspondent Dr. Sanjay Gupta is a practicing neurosurgeon and the author of the new book, “12 Weeks to a Sharper You: A Guided Program.”
CNN
—
At least once a year, we read a sparkling headline about some promising new drug that might help patients with Alzheimer’s disease. And at least once a year, we also hear about failed drug trials and reversals of promises that a cure-all is in sight. I wrote a book about how to keep your brain sharp that came out two years ago. Since then, not much has changed in our understanding of how we can preserve our memories, and the lessons remain as relevant as ever. But one thing has become abundantly clearer: Preventing and even treating forms of dementia are largely driven by lifestyle and the choices we make daily. You are not necessarily doomed to whatever fate you think sits stuck in your genes. If there’s one fact that’s increasingly apparent in scientific circles, it’s that our lifestyle choices contribute mightily to our aging process and risk for disease, likely as much – or perhaps even more – than our genetics.
Indeed, your everyday experiences – including what you eat, how much you move, with whom you socialize, what challenges you face, what gives you a sense of purpose, how well you sleep, and what you do to reduce stress – factor much more into your brain health and overall wellness than you might imagine. We may never have a drug that everyone can take to avoid, let alone cure, dementia and other neurodegenerative diseases. But we all can access the same toolkit proven to help stack the deck in our favor for a sharp brain for life. The program I outline in my book, and which informed the interactive workbook I have coming out this week – “12 Weeks to a Sharper You: A Guided Program” – features all the practical tools you need to implement in your life today. They can help stave off brain decline, and also help you feel less anxious, sleep better, improve energy, think more clearly, make better decisions, become more resilient to daily stress, and even lose weight and boost immunity – all resolutions most of us aim to make at the transition to a new year filled with hope and high expectations. We all know that change is a challenge, and changing long-established habits takes effort. But it doesn’t have to be tortuous, and it is really not that hard to do. Let me give you six things that will help you in 2023 – your keys to the kingdom of mental sharpness.
Skip the crash diet and simply work on following the S.H.A.R.P. protocol: Slash the sugar and salt; Hydrate smartly; Add more omega-3 fatty acids from dietary sources; Reduce portions; and Plan ahead. The S.H.A.R.P. protocol is the easiest way to gravitate toward healthier foods in general and minimize the amount of processed, brain-busting junk. And if you need just one single thing to focus on here, start with the sugar. The average American consumes nearly 20 teaspoons of added sugar daily, most of that in the highly processed form of fructose, derived from high-fructose corn syrup. My guess is that a lot of this sugar intake comes in the form of a liquid – soda, energy drinks, juices and flavored teas. Swap sugar-laden drinks with water and you’ll take on two steps. That’s how to hydrate smartly.
Physical exertion is the only thing we’ve scientifically documented to improve brain health and function, and it may even slow memory loss. It’s the brain’s only superfood. And it needn’t be formal or require equipment. Walk more, take the stairs, and get up for light activity for two minutes every hour. According to the US Centers for Disease Control and Prevention, cognitive decline is almost twice as common among adults who are inactive compared to those are active. In 2022, a large international study that tracked the health of more than half a million people showed that the simple act of performing household chores like cooking, cleaning and washing the dishes can cut the risk of dementia by a stunning 21%. That put chores as the second biggest protective activity behind more obvious things such as riding a bike. In this same study, regular movement was shown to reduce risk of dementia by 35%, followed by meeting up with friends and family (a 15% lower risk). Again, simple things with huge payoffs.
On a scale of 1 to 10, with 10 being the most extreme, how would you rate your stress level? What if I told you that stress is now considered a trigger for silent neurodegeneration, which occurs years before symptoms develop? Scores of well-designed studies routinely show that chronic stress can impair your ability to learn and adapt to new situations, and subtly erode your cognition. More specifically, stress destroys cells in the hippocampus, the brain site responsible for memory storage and retrieval. So, by reducing stress, you not only help preserve cells vital to memory but you also improve focus, concentration and productivity. Don’t let toxic stress get in the way of keeping sharp. Take breaks during the day to engage in an activity that’s peaceful, meditative and stress-reducing. It can be as easy as walking in nature, journal writing, spending time with a pet, or even daydreaming. Download an app today that will give you a guided tour through a deep breathing exercise you can practice daily. I have a trusty meditative routine that calms me down in 90 seconds or less. I simply close my eyes, pay close attention to my breath, and picture my worries in clear bubbles directly in front of me that float weightlessly up and away.
Find what works for you and make it a part of your day – every day.
Are you getting restorative sleep? Contrary to popular belief, sleep is not a state of neural idleness. It is a critical phase during which the body replenishes itself in a variety of ways that ultimately affect every system, from the brain to the heart, the immune system, and all the inner workings of our metabolism. You can think of sleep as your brain’s rinse cycle for clearing out junk that could contribute to decline and disease. Prioritize sleep as you would anything else important. And start with your bedtime routine. Stop looking at screens a full hour before bed – your smartphone included – and prepare for a good night’s sleep. I bumped my pre-sleep prep time from 30 minutes to an hour and it has made all the difference in my energy and productivity the next day.
Are you learning something new every day that’s cognitively stimulating? Staying mentally challenged is vital, so much so that studies show that someone who retires at age 65 has about a 15% lower risk of developing dementia compared with someone retiring at 60, even after other factors are taken into account. Retire late, or never at all. Choose different routes to familiar destinations. Brush your teeth with the non-dominant hand. Skip the solitary games and crossword puzzles and pick up a new hobby that involves other people. Which brings me to the final key …
We are social creatures who need social connection to thrive, especially when it comes to brain health. Call a friend today. Invite a neighbor over for dinner. Go for a walk with a buddy and talk about your problems. Cherish those relationships. The strength of our connections with others can predict the health of both our bodies and our brains as we go through life. Good relationships protect us. They are a secret sauce to a long, sharp life.
As of 2022, scientists have documented a total of about 75 genes connected to the development of Alzheimer’s disease, but carrying these genes is not a one-way ticket to decline. How those genes express themselves and behave may depend largely on your daily habits. Remember that a disease like Alzheimer’s is multifactorial, made up of different pathological features. Which is why prevention and treatments are increasingly becoming personalized – individualized to a person’s biochemistry, from basic parameters like cholesterol levels, blood pressure and blood sugar balance, to the state of one’s oral health and gut microbiome, relics of past infections, and even how well you can see and hear. To that end, it helps to keep your numbers in check. Fon’t let your cholesterol or blood pressure, for instance, run amok. Same goes for your vision and hearing. In recent years, hearing and vision impairment have been added to the list of modifiable risk factors for cognitive decline.
Your DNA provides your body’s core language, but how that DNA behaves tells the story. In the future, interventional therapies that include a combination of lifestyle habits and drugs may help those stories end well. You’ll also track your risk for cognitive decline over time in the future using a simple app on your smartphone that can help you evaluate your physiology (and your memory) in real time and make suggestions tailored for you. Until we all have that technology at our fingertips, the six keys above afford you a great start and will give you a strong foundation.
The ultimate goal is to build what’s called cognitive reserve, which is what scientists call “brain resiliency.” With more cognitive reserve, you support cognitive function and can lower your risk of neurodegenerative issues. It’s like having a backup set of networks in your brain when one fails or, worse, dies and is no longer functional. In many aspects of life, the more backup plans we have, the more chances for success, right? Well, the same is true for our brain’s hard- and soft-wiring. And perhaps the most important key to establishing that reserve is to do so over time – years or even decades – before your risk for decline increases with advanced age.
Always remember this: Cognitive decline is not necessarily inevitable. Research suggests healthy habits you can incorporate into your daily life can help protect your brain health for the long term. Think of health as a “top-down” project. Focus on your brain and everything else will follow. Happy New Year!
Dr. Sanjay Gupta: After two years of Covid-19 vaccines, here’s why they’re still vital
CNN
—
In the United States, approximately 658 million Covid-19 vaccine doses have been administered since they were first distributed exactly two years ago Wednesday.
Framing the significance of preventive measures like vaccines can be challenging, which is why a new report from the Commonwealth Fund and Yale School of Public Health made headlines: According to their modeling of disease transmission across all age demographics and taking into account the existing health conditions in so many Americans, Covid vaccines prevented an estimated 3.2 million deaths and 18.5 million hospitalizations from their introduction in December 2020 to November 30, 2022.
That is why it is surprising to hear, according to a Kaiser Family Foundation analysis of data from the US Centers for Disease Control and Prevention, that from April through August – the last month included in the analysis – there were more vaccinated than unvaccinated people dying of Covid. The vaccinated categories include people who were vaccinated with the primary series and people who had been vaccinated and received at least one non-bivalent booster.
According to a CNN analysis of additional CDC data for September, 12,593 people died of Covid. A CDC sample of the deaths found 39% were unvaccinated, and 61% were vaccinated.
This phenomenon has many people – especially vaccine skeptics, but even stalwart vaccine supporters – confused and wondering if Covid vaccines and boosters are still effective and warranted.
The short answer is yes – but understanding why requires a crash course in statistics. We enlisted the help of Jeffrey Morris, a professor and the director of the Division of Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, who helped us define three key reasons more vaccinated than unvaccinated people are dying of Covid.
One of the main reasons we see more vaccinated than unvaccinated people dying of Covid is a basic one. At this point in time, there are simply many more people who are vaccinated.
Think of it like this: If we round the September deaths to 13,000 and use the CDC sampling percentages, approximately 7,800 were vaccinated and approximately 5,200 were unvaccinated. The conclusion might be that you are far more likely to die if you are vaccinated. And, mathematically that would be true based on the raw numbers alone. If you stopped your analysis at this point, you will have committed a statistical error known as a base rate fallacy.
If instead, you take the extra step of accounting for the total number of fully vaccinated adults 18 and older in the United States (around 203 million) versus the total number of unvaccinated adults (around 55 million), a very different picture emerges.
Among the vaccinated population, 7,800/203 million died in September, which equals a rate of 38 deaths for every 1 million people. For the unvaccinated population, 5,200/55 million died, which equals a rate of 95 deaths for every 1 million people. That means an adult who is unvaccinated is roughly 2.5 times more likely to die than one who is vaccinated.
“You have to take into account the size of those groups,” explained Morris, who also publishes a blog, COVID-19 Data Science, to “just communicate what the emerging data suggest.”
There is another important difference when looking at the vaccinated versus unvaccinated populations in the United States. The vaccinated population skews older and has more health conditions. These are the same groups that are much more likely to have worse outcomes, like hospitalization and death, when infected with SARS-CoV-2, the virus that causes Covid-19. For example, CDC data show more than 90% of deaths through mid-November have been in those 65 or older.
“So those things lead to a higher risk of death and also a higher probability of being vaccinated,” Morris said. “That’s the key: if the vaccine uptake of those high-risk groups is high enough, then we can have a majority of the hospitalized or fatal cases be higher in the vaccinated population.”
You are more likely to die if you are older, and also more likely to be vaccinated if you are older. It does not mean vaccination is more likely to lead to death.
So if age isn’t taken into account when assessing vaccine efficacy, it can lead to something known as Simpson’s paradox, where a trend can appear to be the opposite of reality.
Morris said those kinds of errors not only result in a serious underestimation of the benefit of vaccines but also to downright wrong conclusions, even flipping the results – in this case, making it appear that vaccines increase the risk of death.
This happened in August 2021, with a study out of Israel – a highly vaccinated country – showed 60% of those hospitalized with severe Covid were fully vaccinated, causing misinterpretation and raising questions about the continued value of vaccination.
Morris said he has also seen Simpson’s paradox when people look at the rate of Covid deaths before vaccines were rolled out in 2020 versus since then, or comparing countries with higher vaccination rates to countries with lower vaccination rates.
“It’s a lot more subtle, but the pandemic has provided a number of pure examples of it. So the bottom line with all of that is, we can’t accurately assess the effects of vaccines from simple summaries,” Morris said, however “seemingly intuitive” they may appear.
A more telling and accurate comparison is between the death rate per 100,000 among unvaccinated people compared to the death rate of vaccinated people, adjusted for age.
CDC data show that for the week of September 25, people age 12 and older who were unvaccinated had a death rate of 1.32 per 100,000. Those who were vaccinated (but without an updated, bivalent booster) had a death rate of 0.26 per 100,000. And those who were vaccinated and boosted had a death rate of 0.07 per 100,000.
Broken down further by age, the numbers are even starker: The death rate during that week for those in the oldest age group, 80 and above, was 14.16 per 100,000 for the unvaccinated, 3.69 for those who were vaccinated but had not received the bivalent booster, and 0.0 for those who were vaccinated and boosted.
Overall, the CDC estimates that for the whole month of September, among those 12 and older, there was an almost 15 times lower risk of dying from Covid-19 for the vaccinated and boosted compared to the unvaccinated.
Unfortunately, uptake of the booster is low: Only 13.5% of the US population 5 and older is vaccinated and has gotten the new updated (bivalent) booster. Among those 65 and older, that percentage is 34.2%.
It’s not to say that vaccines are entirely risk free. For example, in people – especially males – between the ages of 5 and 39, there were 224 verified cases of myocarditis or pericarditis, inflammation of the heart and lining, reported to the CDC after vaccination with an mRNA vaccine between December 14, 2020, and May 31, 2022. But that was out of almost 7 million vaccine doses administered.
A study examining those figures found myocarditis/pericarditis occurred within seven days approximately 0.0005% of the time after the first dose, 0.0033% of the time after the second dose of the primary series, and 0.002% after the first booster – but it varied by age and sex, and was much more common among 16- to-17-year-old males after a second shot or a booster.
According to a separate analysis of nearly 43 million people in England, the researchers found that for younger men, the Moderna vaccine in particular had the highest rates of post vaccine myocarditis – although this number was still very low, 97 per million people exposed (0.0097%) – leading some to suggest a different vaccine for that age group or a longer interval between vaccine doses.
Statistical optical illusions aside, the fact is, there are more so-called breakthrough cases among the vaccinated. They have always existed. Since December 2020, we have known these vaccines are not 100% effective at preventing severe illness and death, let alone infection. When vaccines were first introduced, their efficacy was estimated to be an astonishing 95% against severe illness and death. They even protected people at a very high rate against infection.
But the efficacy keeps ticking downward. Part of it is waning immunity: Over the course of several months, antibody levels fade away – that’s just how the body works – even though there is still some protection, thanks to B cells and T cells. Getting boosted – or catching Covid – can help increase antibody levels for a few months at least. Between those two options, it’s far safer and less disruptive to get a booster than to risk illness.
Meanwhile, new variants keep cropping up, and they are increasingly able to evade our immune system. Unlike earlier variants, including the highly transmissible Delta variant, descendants of the Omicron lineage are escape artists.
“The emergence of Omicron at the end of 2021 was a game changer, as Omicron and its subsequent subvariants demonstrated strong immune evasion properties, with mutations in the spike protein and especially the [receptor binding domain] that reduced the neutralizing ability of the vaccine-induced antibodies,” Morris noted. The result is a great reduction in vaccine efficacy against infection, as well as against severe and fatal disease.
This actually means it’s more important to get boosted, especially if you are in a high-risk category, and as the weather gets colder and we gather indoors to spend time together.
The newest booster – the bivalent booster – is designed to protect against the original SARS-CoV-2 virus and against the more recent Omicron subvariants, although how much and for how long is still unknown.
Covid cases, and deaths have slowed down in recent months, but those numbers are trending up like they’ve done during the holidays in previous pandemic years. For the week of December 7, weekly new cases topped 65,000 and Covid claimed the lives of almost 3,000 people. Both represent an increase of around 50% from the week before, according to CDC data.
All of this is happening at a time when hospitals are already full of patients sick with the flu and RSV.
I know we’re all tired of hearing that we need to roll up our sleeves and get yet another Covid-19 booster.
But remember, many of us get the flu shot every year: We don’t assume we are protected from a flu vaccine a year ago. We get the shot even in seasons when the flu vaccine is much less effective than the Covid vaccine (the latest one appears to be a good match). We don’t call it a booster – it’s just the annual flu vaccine. And we don’t track the rate of so-called breakthrough flu infections; unlike Covid, we don’t routinely test people for flu unless they are demonstrably sick, so we have no way of knowing how many people, vaccinated or not, are infected and asymptomatic or mildly ill.
For some diseases, like measles, a single vaccine or a previous infection provides us with a near lifetime of protection. Even though we hoped for a one-and-done scenario when the Covid vaccines rolled out two years ago, the virus didn’t lend itself to that. Newer vaccines are being studied that could offer far more durable protection.
Analyzing all of this data without falling into the trap of a base rate fallacy or Simpson’s paradox isn’t easy, as you can see. And it is also clear the overall effectiveness of the vaccines have waned over time and with new variants.
However, two years later, a more thorough statistical analysis of vaccine effectiveness shows they are still cause for celebration.
Dr. Sanjay Gupta: While monkeypox cases rise, why are we waiting for the cavalry to rescue us?
The pandemic, which has held the United States and almost every other country in its grip, should have taught us valuable lessons about how to manage a public health emergency, but it seems we are making some of the same mistakes we made not even three years ago, when the SARS-CoV-2 virus started to spread.
As I have learned over the past few years, there is a significant difference between preparedness and response, even though the two are often conflated. The United States is extraordinarily prepared, ranked No. 1 for pandemic preparedness in the 2021 Global Health Security Index.
Instead, we are leading in a different way. As of today, we have the most confirmed cases of monkeypox on the planet, more than 5,000. That is almost 25% of the global numbers, even though we are just under 5% of the world’s population.
It is now clear: Preparedness alone does not guarantee a rapid response. With Covid-19, and now monkeypox, we were too slow to respond. It was as if we are sitting in a turbo-charged Ferrari, capable of massive acceleration, but instead only idling in the driveway.
Cavalry culture
Over the past three years, we have witnessed something counterintuitive. It was predominantly wealthy countries that were hit hardest during the Covid-19 pandemic. They had some of the highest death rates, despite their enormous resources.
While there are many reasons for this, including misinformation, lack of public trust, and the entangling of public health and politics, I think there is something else, as well: We have adopted what I call a “cavalry culture.” We wait for the cavalry to ride in and rescue us, instead of taking smaller preventive steps — such as establishing modern and reliable data systems, mastering our supply chain along the way, and acting early to head off the outbreak in the first place.
If that sounds familiar, it’s because we too often do the same with our personal health matters. According to research published in The Lancet Public Health, nearly half of chronic disease in the United States is mostly preventable, with lifestyle changes. Even knowing that, however, the medical system is set up for the cavalry to come in with expensive medications and high-tech interventions, instead of providing equitable access and incentives for preventative care.
There are a couple of important axioms in public health. One is, by the time you think you must act to contain an outbreak, it is already too late. And, if you think you are overreacting, you are probably reacting just the right amount. In the case of Covid, and now monkeypox, we seem to have forgotten those basic public health principles. And, the real question now seems to be: When will the government finally hit the gas pedal on our highly tuned Ferrari?
I don’t want to suggest any of this is easy. There are significant issues of uncertainty and unpredictability. Much like a hurricane forming at sea, we often don’t know exactly where or how hard it will hit. We want to be measured, calm in our response and to cause as little disruption as possible. We want to be thoughtful and gather as much information as is available.
And therein lies one of our biggest problems: basic data. I have often wondered, how is it that a numbers-driven, high-tech country like the United States can’t get basic data right?
Data disaster
As long as I’ve been reporting on the Covid pandemic, I have always had to offer the caveat that case numbers are probably off, sometimes wildly so. We have probably never had a clear vision on just how widely the virus was spreading at any given time in the United States, and going into the fall 2022, the situation isn’t really any better.
In early July, the Institute for Health Metrics, a research center at the University of Washington, released a model suggesting that actual Covid-19 cases are seven times higher than reported cases. At times, it seems the tech platforms for Snapchat and Twitter offer more data analytics than the patchwork of state and federal systems that underpin the public health of our country.
“First, there’s a lack of data access needed to understand where disease outbreaks are spreading. This is due to data collection limitations that Congress needs to fix,” said Dr. Tom Frieden, president and CEO of Resolve to Save Lives and a former director of the US Centers for Disease Control and Prevention.
He said there is also a need to update analog systems and connect them to each other — getting them to speak the same language. Right now, it’s the Tower of Babel.
“Second, we lack sufficient numbers and, in some cases, skills of people and systems at the federal, state and local levels that can deliver services and communicate effectively with communities. Finally, we are in perpetual panic and neglect funding cycles,” he said.
As a result of all of the things Frieden is describing, our current data collection and reporting system leaves important information fractured into dozens of states and territories, and thousands of county pieces for the CDC to puzzle together.
“I have been struck as we at CDC are now conquering another public health challenge — monkeypox — as to how little authority we at CDC have to receive the data,” CDC Director Dr. Rochelle Walensky told the Washington Post.
Walensky is talking about basic data, like where the vaccine has gone, who has been vaccinated, whether the vaccine is working, and even monkeypox case data like who is getting infected, their age and race/ethnicity. Why might this be so?
“States don’t routinely share vaccine doses administered data with the federal government — Covid was really the first time that we were able to successfully put data use agreements in place,” Claire Hannan, the executive director of the Association of Immunization Managers, told CNN. Part of the reason is because “states have laws in place to protect identifiable information.”
Some information has been getting to the CDC, but it is challenging to get and incomplete. The CDC director told the Washington Post, “We have been speaking to our state and local partners probably at least three times a week, all of them. … That is not how you synthesize data. We need … standardization of those data, and we need to have those data come to us in a standardized fashion so that they can be connected, we can compile them and rapidly report them out. We cannot at CDC collect the data and make informed decisions by calling 64 jurisdictions, and honestly, 3,000 counties.”
The CDC is currently working on agreements that would broaden the agency’s access to states’ data, as they successfully did with Covid. Hannan explained, “The need to quickly get the [monkeypox] vaccine out left no time to get data sharing agreements in place.”
But even if those agreements were in place, it still doesn’t mean the states’ ability to actually obtain vaccine doses would be made any easier. That’s because the states wouldn’t be using the same data system for ordering and tracking doses they generally use. Because the US Department of Health and Human Services and the Administration for Strategic Preparedness and Response are in charge of monkeypox vaccine distribution, there would be yet another data system involved.
“They were asking states to request the vaccine using paper forms and email,” said Hannan. “They were asking states to complete forms [with fillable fields] on those who were receiving the vaccine and return these forms to the federal government.”
The problem was there weren’t even the right fields for the specific questions being asked, such as reason for vaccination or type of exposure or risk, Hannan said. It wasn’t that the necessary forms weren’t being filled out, it was that they couldn’t be filled out because of disparate data platforms.
It is a baffling level of bureaucracy in the middle of an unfolding outbreak.
Testing, vaccines, therapeutics
As things stand now, the issues with data collection, testing, vaccines, treatments and communication are sounding a lot like the ones we experienced with Covid-19.
But, to be clear, monkeypox is not that much like Covid. For now, it seems to spread primarily through sores or lesions during close, personal touch and shared objects like towels and linens, as well as respiratory secretions during prolonged face-to-face contact.
The monkeypox outbreak is also different for another fundamental reason. Unlike with Covid, which was caused by a novel virus, the basic tools already exist either for monkeypox or its close relative, smallpox. We didn’t have to build them from scratch. That means we could have had them or put them to better use by now.
Take testing. At the start of the outbreak, testing capability was capped at about 6,000 tests per week, which meant that doctors really had to ration them to a narrow group of people — primarily a subset of men who have sex with men. Since then, the CDC has partnered with five labs to scale up our capabilities and we should soon be able to process up to 80,000 tests a week. But the tests are being underutilized, according to CNN reporting. Experts blamed the low uptake on several factors, including a lack of awareness among doctors about the virus and the fear of stigma among patients.
So, just as with Covid, the real scope of the monkeypox outbreak is probably underappreciated. Confirmed or probable cases stand around 5,000, according to CDC data, but the number could be several fold higher.
Another tool that could be tremendously helpful is testing of wastewater. As we have seen with Covid, it can better define the scope of the outbreak and where it will emerge next. Two months into the outbreak, we still aren’t doing this widely for monkeypox.
And then there are vaccines. Unlike Covid, where we spent upward of $20 billion to develop, test and distribute vaccines, we already have a vaccine specifically approved for monkeypox.
Supplies were limited and the initial US vaccination strategy focused on known monkeypox cases and their immediate contacts. But the outbreak continued to grow, and the strategy had to change. The count of people eligible for the two-dose Jynneos vaccine has now expanded to an estimated 1.5 million.
With that same cavalry culture, we are woefully behind in getting those doses to people who want them. At this time, only 336,710 doses have been shipped to states. Ordering only just began for about 800,000 more doses. This scarcity has created long lines in monkeypox hotspots like New York City, which has the highest number of cases in the country.
It also means that the vaccine, which can be given within 14 days of exposure (but preferably within four) to prevent or reduce the severity of disease, is currently being used more as a treatment — a post-exposure prophylaxis — rather than as a real preventive measure.
As National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci said on CNN, that focus will have to shift.
“It’s very clear with the spread of this that there now has to be a balance between vaccines available for those who clearly have been exposed, as well as those at risk,” Fauci said. “What you want to do is a balance between vaccinating those who clearly have had an exposure but go well beyond that.”
It’s a missed opportunity that won’t be rectified immediately, even with the soon-to-arrive 786,000 doses announced by HHS this week. Needs will still outstrip supply.
Finally, there is the issue of treatment. The CDC has made the antiviral smallpox treatment tecovirimat, called TPOXX, available to monkeypox patients who have or are at high risk of severe disease under an “alternate regulatory mechanism.”
There are 1.7 million courses of TPOXX stockpiled. But once again, getting the medication to patients who could immediately benefit has proven to be bureaucratically burdensome for both patients and providers.
“You’re talking about a five, six-day time lag to get that medication to you at a local doctor’s office, no matter where you are. And the paperwork, and all of the bureaucracy to make that happen is very cumbersome, takes a few hours of your time. And that’s the barrier,” Dr. Stacy Lane, founder of the LGBTQ-centered Central Outreach Wellness Center in Pittsburgh, told me recently.
Fortunately, those rules were loosened somewhat last week, allowing patients to get treated more quickly and reducing the amount of documentation needed. The CDC and the US Food and Drug Administration are working to further streamline the process.
In the meantime, though, patients are suffering. Even though most cases are “mild,” they are still uncomfortable, or downright painful, depending on where sores appear. Plus, there is a risk of long-term complications if the pox lesions develop in areas around the eye or GI tract.
All of these gaps have the hardest hit community on edge.
“Largely public health officials know how this has spread. They know how to vaccinate people … we know how to treat it, and we know how to prevent it,” says Samuel Garrett-Pate, managing director of external affairs of Equality California, the largest statewide LBGTQ+ civil rights organization.
“It unfortunately seems that despite two years of building up our public health infrastructure to prevent what happened with Covid-19 from ever happening again, despite the fact that we are better prepared in terms of already having a vaccine available, the CDC and FDA seem to be caught flat-footed once again. And I think as a result, you’re seeing very real and understandable fear anxiety among the LGBTQ community.”
Is it too late?
Dr. Scott Gottlieb, a former FDA commissioner and current board member of Pfizer, has been pessimistic about the trajectory of monkeypox in the United States.
“We’re now at the cusp of this becoming an endemic virus, where this now becomes something that’s persistent that we need to continue to deal with. I think the window for getting control of this and containing it probably has closed and if it hasn’t closed, it’s certainly starting to close,” he said on Face the Nation on July 17.
CDC’s Walensky pushed back on Gottlieb’s assessment calling it “misinformed and off base,” saying that while it’s true there is much work to do, the US has made dramatic progress on priorities like testing, vaccines and education.
There has been measurable progress in these areas, no doubt. But, I do worry that we once again waited too long. We sat idling in our Ferrari, perhaps not wanting to believe that somehow we had suddenly found ourselves in the middle of yet another outbreak.
I remember when I first saw a case of monkeypox — it was in 2008, in the Democratic Republic of the Congo, one of the handful of countries in Africa where the disease is endemic. To tell you the truth, I never thought I would see it in the United States. After all, it was a virus that hadn’t traveled much since it was first identified in DRC in 1970. My guess was that most of my medical colleagues in the United States would likely only see pictures of the distinctive pox lesions in textbooks.
The world, however, is changing, as we have been reminded of twice in the last few years. There are new pathogens emerging, and existing pathogens are more easily traveling the world.
We have learned painful lessons in the last few years, and we are now in the midst of our first significant test since the Covid pandemic began, to see if we do any better this time around.
There is no doubt we are capable, and we are prepared. The question is will we use all those remarkable resources and respond, or we will wait and suffer until the cavalry has to rescue us once again?
CNN Health’s Andrea Kane contributed to this report.
Ranbir Kapoor, Sanjay Dutt, Vaani Kapoor Movie Release Today Live Updates, Celebrity, Twitter Reactions, Critic Reviews Live
Shamshera movie review and release live updates: Ranbir Kapoor starrer Shamshera has hit theatres across India. The Karan Malhotra directorial also stars Vaani Kapoor and Sanjay Dutt. Shamshera is Ranbir’s first release after four years.
The movie has Ranbir Kapoor playing a double role of Shamshera and Balli. Speaking about shedding the image from his previous coming-of-age movies, Ranbir said Shamshera gave him an opportunity to play the quintessential Hindi film hero.
Ranbir told indianexpress.com, “Leaving aside the joy of playing the hero, it is a great script again as much as Barfi or Sanju was. It was catering to a larger audience. It had an array of emotions, amazing characters and some amazing action sequences. It was this larger than life film.”
Sanjay Dutt plays Daroga Shuddh Singh. The latter is reuniting with Karan Malhotra after Agneepath in 2012, where he played the main villain Kaancha Cheena. The actor said Shamshera is made for the masses. He told us, “Shamshera is an amazing film, most commercial film I have come across in recent times, it is made for the masses. This is kind of work I’ve done all my life, but it got somewhere forgotten in Bollywood.”
5 Ways to Avoid Dementia, Says Dr. Sanjay Gupta — Eat This Not That
Is dementia inevitable as we age? Not necessarily, says neurosurgeon Dr. Sanjay Gupta, CNN’s chief medical correspondent. “[The] first time I ever operated on the brain, you know, close to 30 years ago now, it was a mystical experience,” Dr. Gupta says. “You can’t believe that those three-and-a-half pounds are everything to us — all of our pain, all of our joy, all of our memories, all of our learning, everything.” Here are five ways to protect your brain and prevent dementia, according to Dr Gupta. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
Dr. Gupta recommends berries for brain health. “They always say, ‘Apple a day keeps the doctor away.’ I think when it comes to the brain, it’s berries,” says Dr. Gupta. “Berries, in terms of what they can do for the brain and some of these certain chemicals that they release, are probably gonna be one of your best foods.”
Want to keep your brain young? Learn new things. “The act of experiencing something new — or even doing something that’s typical for you, but in a different way — can all generate these new brain cells,” says Dr. Gupta. “We want to constantly be using new paths and trails and roads within our brain.”
Exercise is beneficial for every aspect of wellbeing—and especially brain health. “When you move, it’s almost like you’re signaling to the body and to the brain, ‘I wanna be here. I’m not ready to go!’ What the brain specifically releases [are] these things called neurotrophins; these good chemicals are sort of nourishing the brain,” Dr. Gupta says.
“What do we know about communities that have the best brain health in the world?” says Dr. Gupta. “They tend to be active, have rich social connections, and don’t hang on to their anxieties. Even communities that have failing grades on classic measures of health like cholesterol and smoking seem to be buffered in terms of brain health because of social connections… Taking brisk walks with a friend and talking about your problems is a reliable way to keep your brain healthy, both immediately and in the long run.”
Sleep is incredibly important for brain health and preventing dementia, so make sure to get the CDC-recommended amount of seven hours a night. “The brain is a remarkably complicated organ,” says Dr. Gupta. “When you go to sleep at night, it’s taking the experiences you had throughout the day and consolidating them into memory. Why do we even have experiences if we’re not going to do the things necessary to remember them, right? We’re learning that the brain is constantly sort of going through this ‘rinse cycle’ at night.” And to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.
Ferozan Mast
Ferozan Mast is a science, health and wellness writer with a passion for making science and research-backed information accessible to a general audience. Read more
Dr. Sanjay Gupta: Is America ready to take the next step in its Covid-19 recovery?
Doctors, like anyone else, love to give good news. We see the value of hope but also recognize that honesty must be our North Star. I would love to be the good guy here and tell my patient that it’s time to be discharged from this chapter of our lives. But a doctor’s job is to fully assess the situation and lean into the nuance, as opposed to simple axioms.
So let’s examine America, the patient. On the one hand, the numbers are going down. Cases of Covid-19 are more than a third lower this week than they were last week and the lowest they’ve been since July, according to the latest data from Johns Hopkins University. And the number of people hospitalized is about a fifth of what it was during the country’s mid-January peak. Even deaths, the so-called lagging indicator, have been falling; they’re at their lowest point in two months.
All 50 states are in the process of lifting restrictions. On March 26, Hawaii will become the last state to end its indoor mask mandate.
At the federal level, the US Centers for Disease Control and Prevention made big changes in late February. Instead of primarily using levels of coronavirus transmission within a community as the key metric for determining mask guidance, the agency recommends that three data points be considered instead: new Covid-19 hospitalizations, hospital capacity and Covid-19 cases.
So now, instead of a transmission map that paints most of the country an “inflamed” red, the community levels map shows a lot of cooler green and yellow, with a bit of orange — the new low, medium and high categories. Since that change, there has been a big drop in the percentage of Americans living under masking recommendations, from 99% under the old metrics to just about 2% now.
And at the start of the month, the White House unveiled its National Covid-19 Preparedness Plan. The new plan focuses on “vaccines, treatments, tests, masks,” White House Covid-19 response coordinator Jeff Zients said. “These tools are how we continue to protect people and enable us to move forward safely and get back to our more normal routines.”
As part of that, government testing and treatment initiatives are being streamlined and made more widely available.
A closer look
But in medicine, we cannot rely on lab results and a medical history. We need to perform a thorough and detailed exam. And when we do that, a more complete picture of the patient emerges.
Truth is, America, my patient still has an active infection. Although the numbers are falling, they are still painfully high: The country is averaging just under 37,000 new cases of Covid-19 a day. It’s as if saying the patient used to have a very high fever but now only has a moderately high fever. The point is, it’s still too high. We wouldn’t stop treating the patient’s infection at this point but rather complete the course of treatment and care.
There’s also the issue of understanding the effects the illness may have on my patient in the future. In this case, it means acknowledging an entirely new disease: long Covid.
Many Americans are enduring the lingering effects of a past infection, battling health conditions like fatigue, brain fog, shortness of breath, cardiac issues. The list of long Covid symptoms is lengthy and varied; there are no answers as to who and why, nor are there easy, one-size-fits-all treatments.
We are in the early days of this disease, but I was particularly struck by the recent paper indicating a previous Covid infection being a significant risk factor for future heart problems.
And, even more important, there are still about 30,000 Americans hospitalized for Covid and, on average, more than 1,250 deaths a day. That’s the equivalent of about two jumbo jets dropping out of the sky every day.
My patient still needs lots of care.
Other factors at play
Despite the less red and inflamed transmission map, it still shows there’s a lot of virus out there. If the virus came in the form of a raindrop, parts of our country would still be getting drenched.
I have often imagined how different things would be if we could have actually seen the virus — little green particles circulating around people’s noses and mouths and becoming airborne. What if we had been able to witness its destruction and journey into blood vessels and lungs? This invisible enemy circumvented our basic human ability to detect a threat and, as a result, made us more likely to ignore and even deny it.
I would remind my patient we have been here before. We experienced moments of genuine hope earlier and then witnessed how quickly things can change. In the summer of 2021, the Delta variant surprised us, and in December, Omicron blindsided us. Both times, the spikes caused by these variants followed declarations of victory heralding the end of the pandemic.
Currently, there is a subvariant of Omicron called BA.2 that may spread even faster than Omicron itself. According to the latest figures from the CDC, it now makes up about 11.6% of Covid cases in the US; the week before, 6.6%. BA.2 is the dominant variant in Denmark, the United Kingdom, India, South Africa and more than a dozen other countries. According to the World Health Organization, studies estimate it is 30% more contagious than the original Omicron (BA.1).
And while studies suggest that BA.2 is not more likely to lead to hospitalization than BA.1, another patient that I’ve been keeping an eye on, the United Kingdom, is seeing cases and hospitalizations starting to trend up again after declining steadily since mid-January. Sometimes, doctors gain a lot of information from watching how other patients are faring.
Again, I get it. I would love to look at these past two years in the rearview mirror as well, but we need to learn the lessons of this pandemic and apply that knowledge in real time. Today. Now.
Delta and Omicron represent two cautionary tales in the span of a few months. It would be shortsighted to ignore that reality, believing it will never happen again.
A blend of science and judgment
The International Epidemiology Association’s Dictionary of Epidemiology defines a pandemic as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.”
Two years ago, when we made the decision to use the word pandemic on CNN, before the CDC or WHO, it was fairly straightforward — fundamentally, it was an exercise in math and data analysis. My producers and I spent a lot of time looking at whiteboards where we kept tabs on the growing numbers and locations of Covid-19 cases. One day, I remember thinking, “If this isn’t the very definition of a pandemic, I don’t know what is. So why is no one else calling it that?”
And so we did.
Although the line was clear entering the pandemic, it will be much fuzzier as we approach endemicity. A disease is considered endemic when it is a “constant presence … within a given geographic area or population group.” It would also be predictable in its rate of spread without causing the level of disruption it does in a pandemic.
But what is considered disruptive may be very different in one country compared with another, even from one person to the next. Progressing into this next phase will be based on a blend of science and judgment.
What the exam reveals
So if America were my patient, the question I would be asking: Is it really time to downgrade the country’s present-day condition from pandemic to endemic?
It’s analogous in some ways to deciding when to discharge my surgical patients to the general care floor from the intensive care unit.
I make rounds in the intensive care unit, carefully reviewing each patient’s chart — full of lab results, metrics and data. And then I sit at the bedside, watching, examining and understanding how they really feel. Can they stand on their own, put a fork to their mouth and a comb through their hair? Are their basic bodily functions returning to normal, and can they get by independently? It is a judgment call. Two people can have the same vital signs but be in very different places.
If America were my patient, what would I see when I sit at its bedside? Beyond 1,300 people dying a day, I would make note that almost 60,000 people died of Covid-19 during the month of February alone. In other words, more people died of Covid-19 in one month than die of the flu during a bad year.
So the question ultimately is: What is too disruptive? What are we willing to tolerate? At what point do we as a society throw up our hands and say, “We can’t do any better than this,” so let’s call this level of sickness and death “endemic,” accept the numbers and move on with our lives?
And of course, my patient, America, lives on a planet with lots of other patients, all part of an intricate ecosystem. We must realize that America’s health is dependent on the health of all the other patients on the planet: When any one of us is at risk, we are all at risk.
Finding a measure of peace and quiescence
None of this is easy. It’s why epidemiologist and author Dr. Larry Brilliant said that “endemic” is a terrible word.
“Smallpox was ‘endemic’ when it killed somewhere between a third and half a billion people in the 20th century. Malaria is endemic, and it’s killing millions. Tuberculosis is endemic. And HIV/AIDS was sort of thrown out of people’s consciousness by just labeling it ‘endemic,’ ” he said.
Brilliant, who is CEO of Pandefense Advisory and a senior adviser at the Skoll Foundation, was a key player on the WHO team that eradicated smallpox.
He pointed out that the technical definition of “endemic” is a disease that is generating an expected number of cases, to the expected community and the expected time. “And because [Covid-19] is a baby of a disease … it’s way too early to try to figure out what is endemicity. We have to wait for it to become a teenager and see how it behaves,” he said.
Brilliant prefers the term “quiescent.” “We want this thing to be quiet,” he said.
He recalled that in the early days of 2020, he and other epidemiologists and public health experts speculated that the illness would come in waves.
“A wave is a really good metaphor to think about this. Sometimes, the waves come in a bunch at a time, and sometimes there’s not a wave for hours, even days. Some waves are too small to really be called waves. But every once in a while, there’s a rogue wave, this tsunami.”
He explained, “what we want is the interval [between waves] to be long and the water in the waves to be quiescent. And that’s what we’re trying to say when people use the word ‘endemic.’ … To say that the pandemic has gone endemic is failure — it’s not success. We haven’t put it where we want it. So it’s the wrong way of thinking about it.”
Plus, said Brilliant, saying that the pandemic is over means “we give up our duty of care.”
He believes we still have a duty of care to the immunocompromised, the elderly, the vulnerable and, yes, even the unvaccinated, because they are the ones disproportionately dying.
Life with an endemic disease
Humans are increasingly living side by side with pathogens that were once in the wild but then took hold among us. We might not like it, and sometimes the pathogen comes too close for comfort, but we learn to live with it.
Take the parasite malaria. For millennia, it killed off wide swaths of the global population. In fact, the mosquito, which transmits the parasite that causes disease, is one of the most prolific killers of humans worldwide.
Inarguably, the course of humanity has been shaped by malaria: It’s believed to have contributed to the fall of Rome, and for hundreds of years, it helped protect Africa from European colonization even as it infected the local population. (And it’s why the gene for sickle cell anemia, which is protective against malaria, never died off evolutionarily.) In this country, Presidents George Washington and Abraham Lincoln grappled with it. The disease stunted the physical and economic growth of the rural South through the 1930s, and it is why the precursor to the CDC was founded.
It’s an understatement to say man has been living with malaria for a very long time. And although we may not have eradicated it from the face of the Earth or completely tamed it, we have learned to coexist with it and reduced it to an endemic disease in a shrinking number of countries. The United States eradicated it in 1951.
How did we do that? By arming ourselves with knowledge. Through scientific research, we learned about where malaria comes from and how it is spread. We developed mitigation strategies and medications to blunt its impact.
And our work is still not done: In 2020, malaria killed an estimated 627,000 people, the vast majority of them children in sub-Saharan Africa.
Early detection, rapid response
Many experts, including Brilliant, are pretty sure that Covid-19 is here to stay. Like the common cold (also often caused by a coronavirus) or the flu, it’s expected to be part of our lives for the next 10, 50 or 100 years, and life will never be quite the same again.
But we can improve the situation and learn to live with it.
“We want the disease to occur in places that we expect it, in the numbers that we expect, so we know how to deal with it,” Brilliant said. “You can go to Hawaii on vacation and not worry. Your kids can go to school. And you don’t need to worry about going to dinner with your parents or your grandparents. Maybe it’s quiet and you have to still wear masks. Maybe it’s quiet and you still have to be tested before you go someplace. But it’s not on the front page every day.”
The key, said Brilliant, is two-part: early detection and rapid response.
For that to happen, we have to have good monitoring tools and be nimble going into and out of protective mode. Maybe that means we carry a mask in our coat pocket during wintertime, just like we take an umbrella when the forecast predicts rain; maybe we keep a box of rapid tests and a packet of antivirals in the bathroom cabinet for when we are under the weather; maybe we close a school but like we do with the flu — with surgical precision, using a scalpel instead of a chainsaw.
The good news, Brilliant said, is that moving forward, our tools — vaccines, surveillance, tests, treatments, prophylactics — will only get better.
The inescapable fact is that we live in the era of pandemics. There are simply more and more opportunities for a pathogen, like the SARS-CoV-2 virus, to come in contact with the human population, make the jump and take hold. It’s a dance we are increasingly doing because we are infringing more and more on the microbes’ territory. Population growth, deforestation, climate change all contribute to this.
These pathogens are going to keep emerging in humans, but pandemics are not inevitable. Humans have evolved to create remarkable public health tools to prevent that, just as long we are smart and humane enough to use them.
My patient — America — is still in precarious health and will have to be careful moving forward to maintain all of the gains and continue making progress. Both the patient and doctors will have to remain vigilant and act quickly if there’s any new infection.
It’s just not time for my patient to completely drop their guard, however much we would all like that to happen. We can and should be hopeful, but honesty must lead the way, full and transparent.
CNN’s Andrea Kane contributed to this report.
Dr. Sanjay Gupta: Why Joe Rogan and I sat down and talked — for more than 3 hours
I don’t think I have ever had a conversation that long with anyone. Seriously — think about that. We sat in a windowless podcast booth with two sets of headphones and microphones, and a few feet between us. Not a single interruption. No cellphones. No distractions. No bathroom breaks.
At a time when there is a desire for shorter, crisper content — responding to abbreviated human attention spans — one of the most popular podcasts in the country features conversations that last exceptionally long and go particularly deep.
Many friends cautioned me against accepting Joe’s invitation. “There is little room for reasonable conversations anymore,” one person told me. “He is a brawler and doesn’t play fair,” another warned. In fact, when I told Joe early in the podcast that I didn’t agree with his apparent views on vaccines against Covid, ivermectin and many things in between, part of me thought the MMA, former Taekwondo champion might hurtle himself across the table and throttle my neck. But, instead he smiled, and off we went.
OK, I am embellishing here, but Joe Rogan is the one guy in the country I wanted to exchange views with in a real dialogue — one that could potentially be among the most important conversations of this entire pandemic. After listening to his podcasts for a while now, I wanted to know: Was Joe simply a sower of doubt, a creator of chaos? Or was there something more? Was he asking questions that begged to be asked, fueled by necessary suspicion and skepticism?
Into the lion’s den
It wasn’t what Joe Rogan thinks that most interested me, it was how he thinks. That is what I really wanted to understand.
Truth is, I have always been a naturally skeptical person myself. One of my personal heroes, the physicist Edwin Hubble, said a scientist has a “healthy skepticism, suspended judgment and disciplined imagination, not only about other people’s ideas but also about their own.”
It’s a good way of thinking about the world — full of honesty and humility. I live by that, and I think Joe may to some extent as well. He will be the first to point out that he is not a doctor or a scientist who has studied these topics. Instead, he seems to see himself less a rapscallion and more of a sort of guardian of the galaxy, pointing out the missteps made by large institutions such as the government and mainstream medicine, and then wondering aloud if they can still be trusted to make recommendations or even mandates for the rest of us. To many, he represents a queen bee in a hive mind, advancing free will and personal liberty above all else.
The free will of your fist ends where my nose begins
When I said this to Joe, the MMA fighter, he paused, sat back and listened for a while. I asked him: Is it not possible to advocate strongly for personal freedoms, but also recognize the unique threat a highly contagious disease represents? He seemed to agree, but then quickly countered with a common misconception about the overall utility of the vaccines.
If vaccinated people transmit just as much as the unvaccinated, why are they really necessary?
It was like Joe and I were now in the octagon, circling one another. He stared at me intently now, eyebrows raised. I admitted that the vaccinated could still carry the virus at similar loads as the unvaccinated, but swiftly added — before he could claim victory — that there was more to the story.
I shared data with Joe showing the vaccinated were eight times less likely to become infected in the first place, and that their viral loads came down more rapidly if they did get infected — making them contagious for a shorter period and less likely to spread the virus.
Vaccines are not perfect, but he had to agree they are certainly a worthy tool to help control the spread of the virus. And, they are particularly effective at keeping people from getting severely ill or dying. They also may help prevent the development of long Covid, a chronic state of illness that some people develop after natural infection, even if their bout with the acute phase of infection was mild.
What he said next surprised me
So, it turns out that Joe Rogan nearly got vaccinated. That was a headline. It was a few months ago when he was in Las Vegas. He had an appointment scheduled but had logistical hurdles and couldn’t make it. He offered up this story as proof he is not necessarily “anti-vaccine,” even if he does consistently raise issues questioning their legitimacy.
It’s this sort of back and forth that makes it hard to pin Joe Rogan down, both in martial arts and a podcast interview.
For example: Even as he sometimes railed against masks, “The Joe Rogan Experience” masks emblazoned with his logo are available for sale on his website. I even bought one ahead of time and gave it to him as a gift. He looked surprised. (Incidentally, they are made in China.)
Despite a downplaying of Covid risks often heard on Joe’s podcast, his private studio prioritizes safety. A nurse was present to perform a rapid Covid test before we began. We were even checked for the presence of antibodies with a finger prick blood test.
Both of us carried antibodies — his from natural immunity, mine from the vaccine. I was vaccinated in December of last year and Rogan contracted Covid at the end of August. Even though this antibody test could only detect the presence of antibodies and not their strength, Joe took great pride in his test, insisting the thickness of his lines must mean stronger immunity. I am fairly certain he was joking. And, I didn’t have the heart to tell him that my antibody line was significantly thicker than his anyway.
The nuance of immunity
It bears repeating that no one should choose infection over vaccination. That is the concern many public health officials have had since the earliest days of the pandemic. If nothing else comes out of my conversation with Joe Rogan, I hope at least this point does. Far too many people have become severely ill and died, even after the effective vaccines became available. Just in the last three months, there have been more than 90,000 preventable Covid-19 deaths in the US among unvaccinated adults, according to a new analysis by the Kaiser Family Foundation.
At the same time, an Israeli study garnered a lot of attention after it appeared to show that natural immunity offered significant protection — even stronger than two doses of the Pfizer/BioNTech vaccine in people who had never been infected.”
So the question Joe raises, as do many others: Why should those who have previously had Covid still get the vaccine?
It’s a fair question, and one that I raised myself with Dr. Anthony Fauci back in early September. At the time, he told me there was no firm answer on this, and they were still looking into what the recommendations should be going forward and how durable natural immunity is in the long run.”
Part of the issue is that we still don’t have a clear idea of how many people have contracted Covid in the United States. The official number is around 45 million, but due to continued lack of sufficient testing, it remains uncertain. And many of the antibody tests that are currently available have high rates of both false negative and false positive results, oftentimes making them unreliable as proof of immunity.
Another issue with natural immunity is that it can vary substantially based on the age of the individual and just how sick they got in the first place. Milder illness in older people often resulted in fewer antibodies being produced.
Some studies have shown between 30 and 40 percent of people who have recovered from Covid did not have detectable neutralizing antibodies at all. That probably explains why a recent study showed that unvaccinated people who already had Covid were more than twice as likely to get reinfected as those who had also been vaccinated.
I told Joe that even in the study from Israel, the authors concluded with the recommendation that people who had recovered from Covid still get a vaccine. And when Joe pushed hard on the risk of myocarditis in kids who receive the vaccine, especially young boys, I countered back equally hard that the risk of myocarditis has been shown to be much higher for infected children under 16 years old compared to their uninfected peers. Those numbers dwarf the risk of myocarditis in kids who receive the vaccine (and, to be sure, most cases of myocarditis can be treated without hospitalization). For me, the risk-benefit analysis is clear: Vaccination is safer than infection.
I guess a small part of me thought I might change Joe Rogan’s mind about vaccines. After this last exchange, I realized it was probably futile. His mind was made up, and there would always be plenty of misinformation out there neatly packaged to support his convictions. Truth is though, I am still glad I did it. My three-hour-long conversation wasn’t just with Rogan. If just a few of his listeners were convinced, it will have been well worth it.
Dr. Sanjay Gupta: Simple steps for coexisting with the coronavirus
But things are also worse, mainly because the very contagious and possibly more dangerous Delta variant currently makes up about 99% of the coronavirus in circulation in the United States. The Delta variant has caused an uptick in infections, hospitalizations and, sadly, deaths, especially in parts of the country where vaccination rates are lagging. To add to this worrying trend, serious disease requiring hospitalization is affecting younger and healthier age groups, including children.
What’s becoming clear is that we, locally and globally, are not going to be able to stamp out the coronavirus completely. Experts predict it’s going to become endemic, possibly joining the other four or so common cold coronaviruses in circulation.
“We’re not going to eradicate this coronavirus like we’ve done with smallpox; it is something that I think is going to settle into a more seasonal pattern, like the flu and colds …” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and an expert in the transmission of infectious diseases via aerosols.
“But right now, because it’s novel and so many people are not immune to it, it’s really ripping through the population. But I think five years from now, we will have much greater immunity either through vaccination or natural infection,” she said.
That means we are going to have to learn to “dance” with the virus — a safe co-existence — without constantly stepping on each other’s toes.
Dancing with Covid-19
Like with other diseases, this requires tight control — giving the virus as little freedom as possible so as not to set the stage for the surge of sickness and death we experienced last winter.
It also means finding a balance between the extremes — on the one hand, lockdowns that trigger economic and personal chaos, and on the other, putting the rights of individuals above the good of society as a whole — and moving toward the middle. That way we can more safely enjoy all of life’s pleasures — family gatherings, live sports and arts events, travel, indoor dining — with only minor inconveniences, like vaccines and masks, during times of substantial viral spread.
“Let’s be creative with making adjustments to life, rather than saying it’s all or none, because that was kind of the feeling last year,” said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School.
So, what can and should we be doing now and into the fall to make sure we follow the path to living well with the virus? Over the past couple weeks, we spoke to experts in the world of pandemic preparedness, infectious diseases and virology to try and get guidance on how to best and most safely live our lives going into the fall. Many of these experts live with the same concerns as everyone else, including managing the safety of unvaccinated children, and balancing the risk, given the Delta variant, with a deep desire to live a more normal life.
While nearly everyone is reluctant to make predictions nowadays, there was agreement on five strategies to be put in place. I have included our conversations, their specific reasoning, and the evidence to bolster the claims.
First thing first: Vaccinations
At the top of the list for all our experts: vaccinations.
“We need to get as many people vaccinated as possible,” said Marr. “I know that kids 12 and under can’t get vaccinated, but when everyone else around them is vaccinated, it helps protect them too. But that’s the first thing.”
Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota and an epidemiologist, echoed the sentiment.
“The first thing is, we need to continue our programs of vaccination,” he said, adding that the current surge we are experiencing won’t be impacted by those efforts since it takes four to six weeks to develop full immunity. “But having said that, it is absolutely critical to get people vaccinated now, because … it’s very likely that we will see additional surges, whether this fall or this winter. And the way to minimize those is, in fact, get people vaccinated. So please do that.”
The government is also getting tougher in its efforts to get more people vaccinated. President Joe Biden announced on Wednesday that nursing homes will have to require their staff to be vaccinated or risk losing Medicare and Medicaid funding. Also Wednesday, government health officials from multiple agencies announced that booster shots will be offered starting the week of September 20 to Americans who are eight months or more beyond their second dose, due to concerns about waning immunity. That move comes on the heels of the US Food and Drug Administration last week authorizing a third vaccine dose for immunocompromised Americans.
Keep masks around, like an umbrella
Among our experts, masking up was seen almost as important as getting everyone vaccinated — especially with the ubiquity of the Delta variant. Unlike earlier variants of the coronavirus, Delta has been shown to exist in the nose and upper throat of infected people, vaccinated and not, in almost equal amounts, even though the viral load drops off much more quickly in the vaccinated, according to an as-of-yet unpublished study out of Singapore. (The vaccinated, however, get infected less frequently, develop severe symptoms much less frequently and almost always avoid hospitalization and death.)
“We need universal masking again. Because that … reduces the amount of virus that’s in the air around us [and] helps protect you individually from breathing virus in the air around you,” said Marr. “People can be spreading virus without any symptoms. So, we need this really until we can get the number of cases down.”
Right now, most of the country is being “showered” with virus, and masks, like an umbrella, can help protect us from getting drenched. When viral transmission is lower, it will be a lot safer to set aside our masks. Marr added we may not need to mask all the time. “We might want to use them in certain areas at certain times of year when there are outbreaks of colds and flus caused by respiratory viruses,” she added.
Osterholm called the controversy surrounding masking “terribly unfortunate.”
“Because the vaccines won’t have an immediate effect for those that are not vaccinated yet, we have to continue to emphasize protection …” he said.
This lines up with the recently updated mask guidance from the US Centers for Disease Control and Prevention that recommends everyone, regardless of vaccination status, mask indoors in areas with “substantial” and “high” levels of Covid-19, which, currently applies to about 99% of the country’s population.
Osterholm and Marr recommended good quality masks, such as an N95, KN95, KF94, or a cloth mask that has a dedicated filter layer in the middle. Osterholm added these masks should be in plentiful supply now, compared to early in the pandemic.
Masks + ventilation = Safer schools
Worrying public health experts is the fact that this fourth surge of coronavirus infections is coinciding with the reopening of schools and colleges throughout the country, causing parents, teachers, politicians and municipalities to clash in some states over basic public health measures, specifically vaccine and mask mandates.
“Anybody who tries to tell you, ‘Well, don’t worry about the kids; the virus won’t really bother them,’ — that’s not the evidence. And especially with Delta being so contagious, kids are very seriously at risk and it’s up to all of us to do everything we can to protect them,” Dr. Francis Collins, director of the National Institutes of Health, said Sunday on Fox.
Schools in some parts of the country are already struggling with quarantines and temporary closures as infections spread. Many parents are struggling too.
That’s why masking is especially important in schools, said Dr. Monica Gandhi, professor of medicine and associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital. “Remember, we were able to open schools safely in many parts of this country even prior to any vaccinations. We know the mitigation procedures that work, and they are masks and, frankly, ventilation,” she said.
Despite 63% of American parents favoring mask requirements for the unvaccinated in schools, and masks being shown to work in study after study, some states — including Florida and Texas — have limited or banned local school districts from requiring masks, leading to showdowns with school boards and sometimes parents.
“I know some states have said ‘No,’ but we do need masks during the Delta variant. And then, I believe we need off-ramps for when those masks can come off for kids, because not everyone wants their children masked, and I think that’s fair. But we need off-ramps when the community transmission rate is low,” said Gandhi.
“Things seem really scary right now, because cases are increasing rapidly. But this will not continue forever,” Osterholm predicted. “Things will settle down eventually.”
He said we can expect to see an uptick in cases as schools go back in session, with larger outbreaks in schools where they do not require masks — but we shouldn’t be surprised by some cases even in schools where appropriate precautions are being taken.
“We need to hang on and not freak out … After a few weeks, those will kind of [taper] off and then hopefully things will settle into a manageable pattern, in terms of cases in schools,” he said.
Osterholm once again emphasizes the point about the type of masks, saying that kids also need high-quality masks, like KN95, to effectively put the brakes on the “dynamic transmission in children” driven by the Delta virus.
And don’t forget about ventilation, stressed Marr.
“We need to focus on improving ventilation indoors in schools. And this can be as simple as opening the windows — even opening just one or two windows makes a big difference,” she said.
Even if classrooms don’t have windows, Marr said filtration can improve air quality fairly inexpensively. “There’s funding [provided by the federal American Rescue Plan] available to schools now … and a good way to spend that would be to invest in a portable HEPA air cleaner, which you can put one or two of these in a classroom and it can help reduce levels of virus that might be in the air, reducing everyone’s exposure and making a safer environment for everyone,” she said.
Passing the test
More rapid testing is something Faust would like to see.
“We should be integrating rapid testing into our daily lives — a lot more routinely,” he said. Faust is not talking about PCR tests, which are used for diagnosing, but antigen tests for the purpose of screening people. While a PCR test is the gold standard for detecting the presence of virus, the antigen tests can be quite useful in determining if an asymptomatic person is contagious. Anyone who is symptomatic should stay home regardless, but the antigen tests can be useful for someone who feels fine but wants to make sure they are not a silent spreader.
Faust said the Delta variant makes it particularly important. “That’s how I got scared about this: I started hearing about people testing positive on rapid [antigen tests] who were vaccinated, and I was, like ‘Whoa! That means not just that are they infected; they’re contagious potentially.'”
As a vaccinated person, Faust said he doesn’t want to inadvertently spread it to his child, who is unvaccinated, or an immunocompromised person who may not have mounted an adequate immune response.
“So Delta changes the equation in terms of, before I would have advocated [testing] for everyone who was unvaccinated. But now I’m advocating it for everybody,” he said.
Faust said that rapid tests got a bad rap early in the pandemic, even from public health experts, because people didn’t appreciate how to use them: They were believed to miss many infections and were considered subpar to PCR tests.
“People said that the statistics show that they miss a lot of cases. But that’s actually a misunderstanding of how these tests work. The rapid tests don’t diagnose whether you just got infected or whether you had an infection a week ago — which, by the way, the other tests do. The rapid test only tells you when you’re contagious,” he said.
“We can’t let the perfect be the enemy of the good,” he said, noting, “you’re going to miss a case once in a while because you did a rapid test, but in exchange you’re going to catch 50 sooner.” (Here is a list of FDA authorized rapid antigen tests.)
Osterholm agreed more “surveillance testing” needs to be done. “Obviously, knowing whether or not you’re positive, whether you’re infected, is so important in minimizing the risk to others by taking responsible actions on your part to limit the contact you have with others,” he said.
Marr also put testing on her top five list. “[Testing] is also important because it can catch people … who are infected — and maybe they don’t know it — and help isolate them and keep them from spreading the disease around to other people,” she said.
Reassess exposure risk
Faust said, given the dominance of the Delta variant, it’s time for Americans to reassess and adjust their risk of exposure if necessary, especially if they eased up on measures in the late spring and early summer.
“Delta has changed my risk calculator for myself — and I think it’s good for others [to do],” he said.
By way of example, Faust said he took “two completely frivolous trips” to New York City in June. “And I did indoor dining, because the case counts were low and I was vaccinated and regular infections weren’t really happening,” he said.
But, given the situation today, he said he would not do the same thing. “Now, my recommendation on travel is to only do travel when it’s really necessary,” he said.
That same mindset should be applied to all “risky” activities, from attending weddings and concerts and sporting events, to dining out and travel. And what’s “necessary” will vary from person to person.
“I mean, what’s actually really, really important to you — ask yourself: is it worth the risk? Really prioritize,” Faust recommends. There is no doubt we have more knowledge and tools now than this time last year, and with testing, masks and vaccinations, gatherings can be much safer. It comes down to a balance between the importance of the gathering and the tolerance of risk.
Osterholm said he, too, is reassessing and prioritizing. “I happen to be a grandparent of five wonderful young kids, none of them are vaccinated. And this has reoriented my thinking to how close contact I have with them,” he explained.
He said he doesn’t want to get them sick, so he has scaled back on activities like indoor gatherings with them. “We just have to acknowledge this is a tough time, there are no easy answers … I wish I had better information other than to say that, at least while this Delta variant is very common in our communities, now’s the time again to unfortunately go back to where we were, before the surge, in terms of how we address the issue of being with our kids and grandkids.”
Marr, too, said we should be once again setting limits. “If you are fully vaccinated, you are much better protected than you were before. But with Delta circulating … the vaccine is not a get out of jail free card; we still should be taking precautions like avoiding crowds … We still need to be doing these other precautions in order to get past this current wave,” she said, noting she, herself, is “wary” of indoor dining.
Beyond the fall
It’s hard to know if coronavirus infections caused by the Delta variant will peak and rapidly fall in the United States, like they did in the United Kingdom, or if they will remain stubbornly high.
“We are not sure how this is going to play out for the next four to six months,” said Osterholm, pointing out that we are in a critical stage of the surge. “If … the Delta variant follows this pattern that it’s taken in other countries, we can expect to see — particularly the Southern sunbelt states that are getting hit so hard right now — actually show a really rapid decline in cases probably in two to three weeks. The real challenge is what’s going to happen with all the other states where we’re seeing increases … If they too light up, then this surge could actually go on well into mid-September or later.”
Regardless of which way infection rates go, Gandhi said we should aim to reduce viral transmission by all means necessary, even in the setting of effective vaccines.
“[J]ust the fact that you have more circulating virus alone will make it more likely that you get a mild breakthrough infection. And the problem with a mild breakthrough infection is you can pass on to another and that other person, if they’re unvaccinated, can get sick,” she said.
We just have to find the common sense to implement the measures we know to be effective.
“Things are tough right now with Delta because we’ve heard how transmissible it is and how people who are vaccinated can carry high loads of virus in their noses. But I think we can be reassured that the vaccines still provide excellent protection against hospitalization, serious cases of illness … We know what works and, [even] with a more transmissible virus, those things still work: the masks, the distancing, ventilation, filtration and avoiding crowds,” said Marr. “We just need to make sure we are even more vigilant about them.”
And that is how we dance with the coronavirus. It’s that simple and we already have the tools at our disposal.
CNN Health’s Andrea Kane and Nadia Kounang contributed to this report.