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Johns Hopkins University

After three years of Covid-19, our medical analyst has learned these lessons -- and sees these priorities moving forward

CNN

www.cnn.com › 2023 › 01 › 26 › health › covid-variant-vaccine-omicron-health-wellness › index.html

It's been three years since the first Covid-19 case was diagnosed in the United States, on January 20, 2020. In the time since, nearly 1.1 million Americans have died from the coronavirus; the US has reported 102 million Covid cases, more than any other country, according to Johns Hopkins University. Both figures, many health officials believe, are likely to have been undercounted.

Why We Need Civics

The Atlantic

www.theatlantic.com › ideas › archive › 2023 › 01 › american-identity-democracy-civics-education-requirement › 672789

Throughout my career studying and practicing American foreign policy, I’ve frequently been asked, What keeps you up at night? Is it China? Russia? Terrorism? Climate change? Another pandemic? While these issues all demand our attention, in recent years, I have found myself saying something else: The most urgent threat to American security and stability stems not from abroad but from within, from political divisions that jeopardize the future of American democracy and even the United States itself.

The obvious follow-up question is what to do about it. My answer draws inspiration from the holiday of Passover, when Jews celebrate their liberation from ancient Egypt. The annual retelling of the Exodus story is inspired by a command in the Bible: “And thou shalt tell thy son in that day, saying: It is because of that which the Lord did for me when I came forth out of Egypt.” Jews are instructed to make sure that every generation understands both what it means to be a Jew and what being a Jew requires. Only through recounting their history have they been able to preserve their identity, despite millennia of persecution and, until recently, not having a homeland.

This article is adapted from Haass’s forthcoming book.

Passover offers everyone, not just Jews, an important lesson: No group of people should assume that its identity will be automatically inherited by the next generation. For a people to understand and appreciate its collective identity is a matter of teaching, not biology. This is no less true for nations than for religious communities.

[From the October 2018 issue: Americans aren’t practicing democracy anymore]

One major reason that American identity is fracturing is we are failing to teach one another what it means to be American. We are not tied together by a single religion, race, or ethnicity. Instead, America is organized around a set of ideas that needs to be articulated again and again to survive. It is thus essential that every American gets a grounding in civics—the country’s political structures and traditions, along with what is owed to and expected of its citizens—starting in elementary school and continuing through college. It should be reinforced within families and communities. It should be emphasized by our political and religious leaders, by CEOs and journalists.

Alas, that is not the world we live in. There is a good deal of talk about the budget deficit, but our civics deficit may be of even greater consequence. Only eight states and the District of Columbia require a full year of high-school civics education. One state (Hawaii) requires a year and a half, 31 require half a year, and 10 require little or none.

At the college level, the situation is arguably worse. According to a 2015 study of more than 1,000 colleges and universities, less than a fifth require any civics coursework. As Ronald J. Daniels, the president of Johns Hopkins University, has written, “Our curricula have abdicated responsibility for teaching the habits of democracy.”

It should come as no surprise, then, that Americans know little about the history, ideals, and practices of their own political system.

The best remedy to this problem is to require that all high schools and colleges have their students complete a course on American citizenship and democracy.

This is easier said than done. At the high-school level, educators and students have limited time and resources. Each academic subject competes for attention with every other subject, not to mention extracurriculars. And relatively few teachers are trained to teach civics well. On top of all this, the scale and decentralization of American public schools—consisting of roughly 13,000 districts, 130,000 schools, 3 million teachers, and tens of millions of students—make any kind of national commitment enormously difficult to implement.

[Ronald J. Daniels: Universities are shunning their responsibility to democracy]

In some ways, the challenge is even greater at the country’s approximately 4,000 two- and four-year colleges and universities. Resistance to a civics requirement would come from many directions. Professors tend to dislike teaching basic courses, preferring more specialized offerings that reflect their research interests. Students typically want maximum freedom to choose what they study; the priority for many, not surprisingly, is to pursue fields that promise the best professional prospects. Many students are pressured to specialize early, leaving little time for other pursuits. Administrations and boards of trustees, for their part, have failed to make civics a priority and largely shy away from introducing core curricula that in any way constrain their students.

Because of these and other challenges, establishing a national mandate for high-school and college civics courses will demand a wide array of support: from state governments that oversee high-school funding and requirements, from parents who pay for their children’s education, and from administrative bodies that certify institutions of higher education. For private schools that are less subject to public influence, requiring civics can and should be used as a selling point.

Perhaps the hardest challenge is to decide what, exactly, counts as “civics.” The battles between the “1619 Project” and the “1776 Project”—two divergent narratives about the arc of American history—and over how to teach matters relating to race demonstrate how politically charged it can be to determine what children learn. This is especially true for public high schools and publicly funded institutions of higher education.

But civics need not be all that controversial. An effective civics course would describe the foundational structures of American government: the nature of the three federal branches, and how they relate to one another and to state and local government. It would distinguish between representative and direct democracies, explain the two-party system, and cover fundamental matters such as checks and balances, judicial review, federalism, impeachment, filibusters, and gerrymandering. Teachers should emphasize both the rights and obligations of citizenship, and expose students to the basic texts of American democracy, including the Constitution, The Federalist Papers, and pivotal Supreme Court decisions.

[George Packer: Can civics save America?]

More difficult is deciding what to include in the way of history. What events to highlight? How to present them? As a rule of thumb, any single framing of American history should be avoided. Where there is disagreement, various perspectives should be presented.

Civics courses should not try to settle the most contentious contemporary or historical matters, or advocate for any particular party or policy. Instead, they should present facts, describe significant events, and lay out the major debates of our past and present.

Designing a civics curriculum that is both useful and broadly acceptable won’t be easy. But there is perhaps no more urgent task if American democracy—and identity—is to survive another two decades, much less another two and a half centuries.

This article has been adapted from Richard Haass’s new book, The Bill of Obligations: The Ten Habits of Good Citizens.

How Worried Should We Be About XBB.1.5?

The Atlantic

www.theatlantic.com › health › archive › 2023 › 01 › latest-covid-omicron-subvariant-xbb15 › 672646

After months and months of SARS-CoV-2 subvariant soup, one ingredient has emerged in the United States with a flavor pungent enough to overwhelm the rest: XBB.1.5, an Omicron offshoot that now accounts for an estimated 75 percent of cases in the Northeast. A crafty dodger of antibodies that is able to grip extra tightly onto the surface of our cells, XBB.1.5 is now officially the country’s fastest-spreading coronavirus subvariant. In the last week of December alone, it zoomed from 20 percent of estimated infections nationwide to 40 percent; soon, it’s expected to be all that’s left, or at least very close. “That’s the big thing everybody looks for—how quickly it takes over from existing variants,” says Shaun Truelove, an infectious-disease modeler at Johns Hopkins University. “And that’s a really quick rise.”

All of this raises familiar worries: more illness, more long COVID, more hospitalizations, more health-care system strain. With holiday cheer and chilly temperatures crowding people indoors, and the uptake of bivalent vaccines at an abysmal low, a winter wave was already brewing in the U.S. The impending dominance of an especially speedy, immune-evasive variant, Truelove told me, could ratchet up that swell.

But the American public has heard that warning many, many, many times before—and by and large, the situation has not changed. The world has come a long way since early 2020, when it lacked vaccines and drugs to combat the coronavirus; now, with immunity from shots and past infections slathered across the planet—porous and uneven though that layer may be—the population is no longer nearly so vulnerable to COVID’s worst effects. Nor is XBB.1.5 a doomsday-caliber threat. So far, no evidence suggests that the subvariant is inherently more severe than its predecessors. When its close sibling, XBB, swamped Singapore a few months ago, pushing case counts up, hospitalizations didn’t undergo a disproportionately massive spike (though XBB.1.5 is more transmissible, and the U.S. is less well vaccinated). Compared with the original Omicron surge that pummeled the nation this time last year, “I think there’s less to be worried about,” especially for people who are up to date on their vaccines, says Mehul Suthar, a viral immunologist at Emory University who’s been studying how the immune system reacts to new variants. “My previous exposures are probably going to help against any XBB infection I have.”

SARS-CoV-2’s evolution is still worth tracking closely through genomic surveillance—which is only getting harder as testing efforts continue to be pared back. But “variants mean something a little different now for most of the world than they did earlier in the pandemic,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, who’s been tracking the proportions of SARS-Cov-2 variants around the world. Versions of the virus that can elude a subset of our immune defenses are, after all, going to keep on coming, for as long as SARS-CoV-2 is with us—likely forever, as my colleague Sarah Zhang has written. It’s the classic host-pathogen arms race: Viruses infect us; our bodies, hoping to avoid a similarly severe reinfection, build up defenses, goading the invader into modifying its features so it can infiltrate us anew.

[Read: How long can the coronavirus keep infecting us?]

But the virus is not evolving toward the point where it’s unstoppable; it’s only switching up its fencing stance to sidestep our latest parries as we do the same for it. A version of the virus that succeeds in one place may flop in another, depending on the context: local vaccination and infection histories, for instance, or how many elderly and immunocompromised individuals are around, and the degree to which everyone avoids trading public air. With the world’s immune landscape now so uneven, “it’s getting harder for the virus to do that synchronized wave that Omicron did this time last year,” says Verity Hill, an evolutionary virologist at Yale. It will keep trying to creep around our defenses, says Pavitra Roychoudhury, who’s monitoring SARS-CoV-2 variants at the University of Washington, but “I don’t think we need to have alarm-bell emojis for every variant that comes out.”

[Read: The coronavirus’s next move]

Some particularly worrying variants and subvariants will continue to arise, with telltale signs, Roychoudhury told me: a steep rise in wastewater surveillance, followed by a catastrophic climb in hospitalizations; a superfast takeover that kicks other coronavirus strains off the stage in a matter of days or weeks. Omens such as these hint at a variant that’s probably so good at circumventing existing immune defenses that it will easily sicken just about everyone again—and cause enough illness overall that a large number of cases turn severe. Also possible is a future variant that is inherently more virulent, adding risk to every new case. In extreme versions of these scenarios, tests, treatments, and masks might need to come back into mass use; researchers may need to concoct a new vaccine recipe  at an accelerated pace. But that’s a threshold that most variations of SARS-CoV-2 will not clear—including, it seems so far, XBB.1.5. Right now, Hodcroft told me, “it’s hard to imagine that anything we’ve been seeing in the last few months would really cause a rush to do a vaccine update,” or anything else similarly extreme. “We don’t make a new flu vaccine every time we see a new variant, and we see those all through the year.” Our current crop of BA.5-focused shots is not a great match for XBB.1.5, as Suthar and his colleagues have found, at least on the antibody front. But antibodies aren't the only defenses at play—and Suthar told me it’s still far better to have the new vaccine than not.

In the U.S., wastewater counts and hospitalizations are ticking upward, and XBB.1.5 is quickly elbowing out its peers. But the estimated infection rise doesn’t seem nearly as steep as the ascension of the original Omicron variant, BA.1 (though our tracking is now poorer). XBB.1.5 also isn’t dominating equally in different parts of the country—and Truelove points out that it doesn’t yet seem tightly linked to hospitalizations in the places where it’s gained traction so far. As tempting as it may be to blame any rise in cases and hospitalizations on the latest subvariant, our own behaviors are at least as important. Drop-offs in vaccine uptake or big jumps in mitigation-free mingling can drive spikes in illness on their own. “We were expecting a wave already, this time of year,” Hill told me. Travel is up, masking is down. And just 15 percent of Americans over the age of 5 have received a bivalent shot.

The pace at which new SARS-CoV-2 variants and subvariants take over could eventually slow, but the experts I spoke with weren’t sure this would happen. Immunity across the globe remains patchy; only a subset of countries have access to updated bivalent vaccines, while some countries are still struggling to get first doses into millions of arms. And with nearly all COVID-dampening mitigations “pretty much gone” on a global scale, Hodcroft told me, it’s gotten awfully easy for the coronavirus to keep experimenting with new ways to stump our immune defenses. XBB.1.5 is both the product and the catalyst of unfettered spread—and should that continue, the virus will take advantage again.