For months, the winter forecast in the United States seemed to be nothing but viral storm clouds. A gale of RSV swept in at the start of autumn, sickening infants and children in droves and flooding ICUs. After a multiyear hiatus, flu, too, returned in force, before many Americans received their annual shot. And a new set of fast-spreading SARS-CoV-2 subvariants had begun its creep around the world. Experts braced for impact: “My biggest concern was hospital capacity,” says Katelyn Jetelina, who writes the popular public-health-focused Substack Your Local Epidemiologist. “If flu, RSV, and COVID were all surging at the same time—given how burned out, how understaffed our hospital systems are right now—how would that pan out?”

But the season’s worst-case scenario—what some called a “tripledemic,” bad enough to make health-care systems crumble—has not yet come to pass. Unlike last year, and the year before, a hurricane of COVID hospitalizations and deaths did not slam the country during the first month of winter; flu and RSV now appear to be in sustained retreat. Even pediatric hospitals, fresh off what many described as their most harrowing respiratory season in memory, finally have some respite, says Mary Beth Miotto, a pediatrician and the president of the Massachusetts chapter of the American Academy of Pediatrics. After a horrific stint, “we are, right now, doing okay.” With two months to go until spring, there is plenty of time for another crisis to emerge: Certain types of influenza, in particular, can be prone to delivering late-season second peaks. “We need to be careful and recognize we’re still in the middle,” Jetelina told me. But so far, this winter “has not been as bad as I expected it to be.”

No matter what’s ahead, this respiratory season certainly won’t go down in history as a good one. Children across the country have fallen sick in overwhelming numbers, many of them with multiple respiratory viruses at once, amid a nationwide shortage of pediatric meds. SARS-CoV-2 remains a top cause of mortality, with its daily death count still in the hundreds, and long COVID continues to be difficult to prevent or treat. And enthusiasm for new vaccines and virus-blocking mitigations seems to be at an all-time low. Any sense of relief people might be feeling at this juncture must be tempered by what’s in the rearview: three years of an ongoing pandemic that has left more than 1 million people dead in the U.S. alone, and countless others sick, many chronically so. The winter may be going better than it could have. But that shouldn’t hold us back from tackling what’s ahead this season, and in others yet to come.

Not all of this past autumn’s gloomy predictions were off base. RSV and flu each rushed in on the early side of the season and led to a steep rise in cases. But both viruses made rather hasty exits: RSV hit an apparent apex in mid-November, and flu bent into its own decline the following month. The staggered peaks “helped us quite a bit, in terms of hospitals being stressed,” says Sam Scarpino, the director of AI and life sciences at the Institute for Experiential AI at Northeastern University. In recent days, coronavirus cases and hospitalizations have been tilting downward, too—and severe-disease rates seem to be holding at a relative low. Just under 5 percent of hospital beds are currently occupied by COVID patients, compared with more than four times that fraction this time last year. And weekly COVID deaths are down by almost 75 percent from January 2022. (Death, though, has always been a lagging indicator, and the mortality numbers could still shift upward soon.) Despite some dire predictions to the contrary, the fast-spreading XBB.1.5 subvariant didn’t spark “some giant Omicron-type wave and crush everything,” says Justin Lessler, an infectious-disease modeler at the University of North Carolina at Chapel Hill. “In that sense, I feel good.”

[Read: How worried should we be about XBB.1.5?]

No one can say for sure why we dodged winter’s deadliest bullets, but the population-level immunity that Americans have built up over the past three years clearly played a major role. “That’s a testament to how vaccination has made the disease less dangerous for most people,” says Cedric Dark, an emergency physician at Baylor College of Medicine. Widespread immunization, combined with the fact that most Americans have now been infected, and many of them reinfected, has caused severe-disease rates to plunge, and the virus to move less quickly than it otherwise would have. Antiviral drugs, too, have been slashing hospitalization rates, at least for the meager fraction of recently infected people who use them. The gargantuan asterisk of long COVID still applies to new infections, but the short-term effects of the disease are now more on par with those of other respiratory illnesses, reducing the number of resources that health-care workers must marshal for each case.

The virus, too, was more merciful than it could have been. XBB.1.5, despite its high transmissibility and penchant for dodging antibodies, doesn’t so far seem more capable of causing severe disease. And the fall’s bivalent shots, though not a perfect match for the newcomer, still improve the body’s response to viruses in the Omicron clan. Competition among respiratory viruses may have also helped soften COVID’s recent blows. In the days and weeks after one infection, bodies can become more resilient to another—a phenomenon known as viral interference that can reduce the risk of simultaneous or back-to-back infections. On population scales, interference can push down surges’ peaks, or at the very least, separate them, potentially keeping hospitals from being hit by a medley of microbes all at once. It’s hard to say for sure: “Many things go into when an epidemic wave happens—human behavior, temperature, humidity, the biology of the virus, the biology of the host,” says Ellen Foxman, an immunologist at Yale. That said, “I do think viral interference probably does play a role that has not been appreciated.”

None of the experts I spoke with was ready to issue a blanket phew. Overlapping waves of respiratory illness have already led to nonstop sickness, especially among children, draining resources at every point in the pediatric caregiving chain. Kids were kept out of school, and parents stayed home from work; after a glut of COVID-related closures in New Mexico, schools and day cares running low on teachers had to call in the National Guard. Inundated with illnesses, pediatric emergency rooms overflowed; adult-care units had to be repurposed for children, and some hospitals pitched tents on their front lawns to accommodate overflow. Local stopgaps weren’t always enough: At one point, a colleague of Miotto’s in Boston told her that the closest available pediatric ICU bed was in Washington, D.C.

[Read: The worst pediatric-care crisis in decades]

By any metric, for the pediatric community, “it’s been a horrible season, the worst,” says Yvonne Maldonado, a pediatrician at Stanford. “The hospitals were bursting, bursting at the seams.” The flow of fevers has ebbed somewhat in recent weeks, but remains more flood than trickle. “It’s not over: We still don’t have amoxicillin in general, and we still struggle to get fever medication for people,” Miotto said. A parent recently told her that they’d gone to almost 10 pharmacies to try to fill an antibiotic prescription for their child. And pediatric providers across the country are steeling themselves for what the coming weeks could bring. “I think we could still see another surge,” says Joelle Simpson, the division chief of emergency medicine at Children’s National Hospital. “In prior years, February has been one of the worst months.”

The season’s ongoing woes have been compounded by preexisting health-care shortages. Amid a dearth of funds, some hospitals have reduced their number of pediatric beds; a mass exodus of workers has also limited the resources that can be doled out, even as SARS-CoV-2 testing and isolation protocols continue to stretch the admission and discharge timeline. “Hospitals are in a weaker position than they were before the pandemic,” says Joseph Kanter, Louisiana’s state health officer and medical director. “If that’s the environment in which we are experiencing this year’s respiratory-virus season, it makes everything feel more acute.” Those issues are not limited to pediatrics: Now that COVID is a regular part of the disease roster, workloads have increased for a contingent of beleaguered clinicians that, across the board, seems likely to continue to shrink. In many hospitals, patients are getting stuck in emergency departments for several hours, even multiple days—sometimes never making it to a bed before being sent home. “It seems like hospitals everywhere are full,” Dark told me, not just because of COVID, but because of everything. “The vast majority of the work I do, and that I bet you what most of my colleagues are doing, is taking place in waiting rooms.”

The U.S. has come a long way in the past three years. But still, “the cumulative toll of these winter surges has been higher than it needs to be,” says Julia Raifman, a health-policy researcher at Boston University. Had more people gone into winter up to date on their COVID vaccines, the virus’s mortality rate could have been driven down further; had more antiviral drugs and other protections been prioritized for the elderly and immunocompromised, fewer people might have been imperiled at all. If relief is percolating across the country right now, that says more about a shift in standards than anything else. “Our threshold for what ‘bad’ looks like has just gotten so out of whack,” Simpson told me. This winter could have been as grim as recent ones, Scarpino told me, with body-filled freezer trucks in parking lots and hospitals on the brink of collapse. But an improvement from those horrific lows isn’t much to brag about. And this winter—three years into combatting a coronavirus for which we have shots, drugs, masks, and more—has been nowhere close to the best one imaginable.

The concern now, experts told me, is that the U.S. might accept a winter like this one as simply good enough. Regular vaccine uptake could dwindle even further; another wild-card SARS-CoV-2 variant could ignite another conflagration of cases. If that did happen, some researchers worry that we’d be slow to notice: Genomic surveillance is down, and many tests are being taken, unreported, at home. And with so many different immune histories now scattered across the globe, it’s getting tougher for modelers like Lessler to predict where and how quickly new variants might take over.

The country does have a few factors working in its favor. By next winter, at least one RSV vaccine will almost certainly be available to protect the population’s youngest, eldest, or both. mRNA-based flu vaccines, which are expected to be far faster to develop than currently available shots, are also in the works, and will likely make it easier to match doses to circulating strains. And if, as Foxman hopes, SARS-CoV-2 eventually settles into a more predictable, seasonal pattern, infections will be less of a concern for most of the year and season-specific immunizations could be easier to design.

[Read: Should everyone be masking again?]

But no vaccine will do much unless enough people are willing and able to take it—and the public-health infrastructure that’s led many outreach efforts remains underfunded and understaffed. Kanter worries that the nation may not be terribly willing to invest. “We’ve fallen into this complacency trap where we just accept a given amount of mortality every year as unavoidable,” he told me. It doesn’t have to be that way, as the past few years have shown: Treatments, vaccines, clean indoor air, and other measures can lower a respiratory virus’s toll.

By the middle of spring, the U.S. will be in a position to let the public-health-emergency declaration on COVID lapse—a decision that could roll back protections for the uninsured, and ratchet up price points on shots and antivirals. This winter’s retrospective is likely to influence that decision, Scarpino told me. But relief can breed complacency, and complacency further slows a sluggish public-health response. The fate of next winter—and of every winter after that—will depend on whether the U.S. decides to view this season as a success, or to recognize it as a shaky template for well-being that can and should be improved.

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Millions of Americans say they regularly turn to medications for help falling or staying asleep, a practice that experts say can be dangerous for their health. A new study found that roughly 8% of US adults reported taking sleep medication every day or most days, with use more common among those who are female, who are older or who have a lower income level.

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The American economy is doing fine. So why are tech companies laying off tens of thousands of workers?

But first, here are three new stories from The Atlantic.

The trillion-dollar coin might be the least bad option. Are standardized tests racist, or are they anti-racist? A recession is not inevitable.

Copycats

Last Friday, Google’s parent company, Alphabet, laid off 12,000 of its employees—about 6 percent of its total workforce. Yesterday, Spotify announced layoffs for a similar percentage of its staff.

By now, you might be used to the steady drip of news about tech companies slashing jobs. About 130,000 people have been laid off from large tech and media companies in the past 12 months, according to one estimate. The reasons for this are not obvious. America’s overall unemployment rate is 3.5 percent, which ties for the lowest mark of the 21st century. And tech has long been one of the country’s most dynamic industries. So why is it struggling during an otherwise optimistic moment for America’s economy?

Our staff writers Annie Lowrey and Derek Thompson, who both recently published articles on the tech layoffs, offer several explanations for the trend. The first and most obvious is the Federal Reserve’s effort to ease inflation by raising interest rates sharply over the past year. As Annie writes:

Pretty much all American businesses across all business sectors are reliant on borrowed cash in one way or another … But many tech companies were especially conditioned to very low interest rates: Uber, an enormous and long-established business, for instance, loses money on many rides, and thousands and thousands of start-ups accrue huge losses and rely on their financiers to foot their bills while they grow.

But when inflation and then interest rates increased, these companies—which were making long-term promises at the expense of short-term profits—“got clobbered,” as Derek puts it.

The second reason: the pandemic. Annie reminds us what the economy looked like when Americans were in the thick of isolation:

People stopped going to theaters and started watching more movies and shows at home—hurting AMC and aiding Netflix and Hulu. Families stopped shopping as much in person and began buying more things online—depressing town centers and boosting Amazon and Uber Eats, and spurring many businesses to pour money into digital advertising. Companies quit hosting corporate retreats and started facilitating meetings online—depriving hotel chains of money and bolstering Zoom and Microsoft.

Here’s Derek on how that played out:

Many people predicted that the digitization of the pandemic economy in 2020, such as the rise in streaming entertainment and online food-delivery apps and at-home fitness, were “accelerations,” pushing us all into a future that was coming anyway. In this interpretation, the pandemic was a time machine, hastening the 2030s and raising tech valuations accordingly. Hiring boomed across tech, as companies added tens of thousands of workers to meet this expectation of acceleration.

But perhaps the pandemic wasn’t really an accelerant. Maybe it was a bubble.

Consumer spending has normalized, and Americans have returned to paying for restaurants and hotels and flights. As a result, tech companies are seeing declining revenues in parts of their businesses, and some corporate officers have admitted that they grew too quickly. (Apple is an exception that might prove the rule: The company expanded more slowly than some of its counterparts and has thus far avoided layoffs.)

But even though tech companies are facing a hard dose of reality, many of them are still very profitable. And, as Annie notes, the future is brightening: “The Fed is likely to stop hiking interest rates soon. Artificial intelligence has started making amazing breakthroughs … Maybe a tech summer is just around the corner.”

Reporting in November on the tech industry’s apparent collapse, Derek used an entertaining and useful metaphor: The industry is having a midlife crisis. And that means once the crisis is over, a new era will begin. “One mistake that a journalist can make in observing these trends is to assume that, because the software-based tech industry seems to be struggling now, things will stay like this forever,” he writes. “More likely, we are in an intermission between technological epochs.”

Some argue that, as they wait out this intermission, CEOs are copying one another—laying off workers not simply as an unavoidable consequence of the changing economy, but because everybody else is doing it. “Chief executives are normal people who navigate uncertainty by copying behavior,” Derek writes. He cites the business professor Jeffrey Pfeffer, who told Stanford News: “Was there a bubble in valuations? Absolutely … Did Meta overhire? Probably. But is that why they are laying people off? Of course not … These companies are all making money. They are doing it because other companies are doing it.”

Pfeffer believes that this “social contagion” could spread to other industries. “Layoffs are contagious across industries and within industries,” he said in the Stanford News article. If so, the story of tech layoffs could end up being a much broader story about work in America.

Related:

Why everything in tech seems to be collapsing all at once The economy is improving in three major ways.

Today’s News

A gunman killed seven people and injured one other in a mass shooting at two locations in Half Moon Bay, California, just two days after the mass shooting at a Monterey Park dance hall. A lawyer for former Vice President Mike Pence found classified documents during a search of Pence’s Indiana home. The Senate Judiciary Committee held a hearing about the ticketing market, in which Ticketmaster’s parent company testified about the issues with Taylor Swift’s concert-ticket sales.

Evening Read

The Atlantic

Twitter Has No Answers for #DiedSuddenly

By Kaitlyn Tiffany

Lisa Marie Presley died unexpectedly earlier this month, and within hours, lacking any evidence, Twitter users were suggesting that her death had been caused by the COVID-19 vaccine.

The Twitter account @DiedSuddenly_, which has about 250,000 followers, also started tweeting about it immediately, using the hashtag #DiedSuddenly. Over the past several months, news stories about any kind of sudden death or grave injury—including the death of the sports journalist Grant Wahl and the sudden collapse of the Buffalo Bills safety Damar Hamlin—have been met with a similar reaction from anti-vaccine activists. Though most of the incidents had obvious explanations and almost certainly no connection to the vaccine, which has an extremely remote risk of causing heart inflammation—much smaller than the risk from COVID-19 itself—the idea that the shots are causing mass death has been boosted by right-wing media figures and a handful of well-known professional athletes.

Read the full article.

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P.S.

Layoffs are not an abstraction for the people who have lost their jobs. With that in mind, I’ll leave you with a piece of advice I read in New York magazine’s Dinner Party newsletter: Phoebe Gavin, who was laid off last week from her job as the executive director of talent and development for Vox, wrote on Twitter that though you might be tempted to reach out to a laid-off loved one or acquaintance as soon as it happens, that person will really need to hear from you two weeks later, when they’ve had time to process and are starting to figure out what’s next. So mark your calendar to check back in.

— Isabel