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The Big COVID Question for Hospitals This Fall

The Atlantic

www.theatlantic.com › health › archive › 2023 › 09 › covid-infection-surge-universal-masking-return › 675239

Back in the spring, around the end of the COVID-19 public-health emergency, hospitals around the country underwent a change in dress code. The masks that staff had been wearing at work for more than three years vanished, in some places overnight. At UChicago Medicine, where masking policies softened at the end of May, Emily Landon, the executive medical director of infection prevention and control, fielded hate mail from colleagues, some chiding her for waiting too long to lift the requirement, others accusing her of imperiling the immunocompromised. At Vanderbilt University Medical Center, which did away with masking in April, ahead of many institutions, Tom Talbot, the chief hospital epidemiologist, was inundated with thank-yous. “People were ready; they were tired,” he told me. “They’d been asking for several months before that, ‘Can we not stop?’”

But across hospitals and policies, infection-prevention experts shared one sentiment: They felt almost certain that the masks would need to return, likely by the end of the calendar year. The big question was exactly when.

For some hospitals, the answer is now. In recent weeks, as COVID-19 hospitalizations have been rising nationwide, stricter masking requirements have returned to a smattering of hospitals in Massachusetts, California, and New York. But what’s happening around the country is hardly uniform. The coming respiratory-virus season will be the country’s first after the end of the public-health emergency—its first, since the arrival of COVID, without crisis-caliber funding set aside, routine tracking of community spread, and health-care precautions already in place. After years of fighting COVID in concert, hospitals are back to going it alone.

A return to masking has a clear logic in hospitals. Sick patients come into close contact; medical procedures produce aerosols. “It’s a perfect storm for potential transmission of microbes,” Costi David Sifri, the director of hospital epidemiology at UVA Health, told me. Hospitals are on the front lines of disease response: They, more than nearly any other place, must prioritize protecting society’s vulnerable. And with one more deadly respiratory virus now in winter’s repertoire, precautions should logically increase in lockstep. But “there is no clear answer on how to do this right,” says Cameron Wolfe, an infectious-disease physician at Duke. Americans have already staked out their stances on masks, and now hospitals have to operate within those confines.

When hospitals moved away from masking this spring, they each did so at their own pace—and settled on very different baselines. Like many other hospitals in Massachusetts, Brigham and Women’s Hospital dropped its mask mandate on May 12, the day the public-health emergency expired; “it was a noticeable difference, just walking around the hospital” that day, Meghan Baker, a hospital epidemiologist for both Brigham and Women’s Hospital and Dana-Farber Cancer Institute, told me. UVA Health, meanwhile, weaned staff off of universal masking over the course of about 10 weeks.

Most masks at the Brigham are now donned on only a case-by-case basis: when a patient has active respiratory symptoms, say, or when a health-care worker has been recently sick or exposed to the coronavirus. Staff also still mask around the same subset of vulnerable patients that received extra protection before the pandemic, including bone-marrow-transplant patients and others who are highly immunocompromised, says Chanu Rhee, an associate hospital epidemiologist at Brigham and Women’s Hospital. UVA Health, meanwhile, is requiring masks for everyone in the hospital’s highest-risk areas—among them, certain intensive-care units, as well as cancer, transplant, and infusion wards. And although Brigham patients can always request that their providers mask, at UVA, all patients are asked upon admission whether they’d like hospital staff to mask.

Nearly every expert I spoke with told me they expected that masks would at some point come back. But unlike the early days of the pandemic, “there is basically no guidance from the top now,” Saskia Popescu, an epidemiologist and infection-prevention expert at the University of Maryland School of Medicine, said. The CDC still has a webpage with advice on when to mask. Those recommendations are tailored to the general public, though—and don’t advise covering up until COVID hospital admissions go “way high, when the horse has well and truly left the barn,” Landon, at UChicago, told me. “In health care, we need to do something before that”—tamping down transmission prior to wards filling up.

More specific advice could still emerge from the CDC, or individual state health departments. But going forward, the assumption is that “each hospital is supposed to have its own general plan,” Rhee told me. (I reached out to the CDC repeatedly about whether it might update its infection-prevention-guidance webpage for COVID—last retooled in May—but didn’t receive a response.)

Which leaves hospitals with one of two possible paths. They could schedule a start to masking season, based on when they estimate cases might rise—or they could react to data as they come in, tying masking policies to transmission bumps. With SARS-CoV-2 still so unpredictable, many hospitals are opting for the latter. That also means defining a true case rise—“what I think everybody is struggling with right now,” Rhee said. There is no universal definition, still, for what constitutes a surge. And with more immunity layered over the population, fewer infections are resulting in severe disease and death—even, to a limited extent, long COVID—making numbers that might have triggered mitigations just a year or two ago now less urgent catalysts.

[Read: The future of long COVID]

Further clouding the forecast is the fact that much of the data that experts once relied on to monitor COVID in the community have faded away. In most parts of the country, COVID cases are no longer regularly tallied; people are either not testing, or testing only at home. Wastewater surveillance and systems that track all influenza-like illnesses could provide some support. But that’s not a whole lot to go on, especially in parts of the country such as Tennessee, where sewage isn’t as closely tracked, Tom Talbot, of Vanderbilt, told me.

Some hospitals have turned instead to in-house stats. At Duke—which has adopted a mitigation policy that’s very similar to UVA’s—Wolfe has mulled pulling the more-masking lever when respiratory viruses account for 2 to 4 percent of emergency and urgent-care visits; at UVA, Sifri has considered taking action once 1 or 2 percent of employees call out sick, with the aim of staunching sickness and preserving staff. “It really doesn’t take much to have an impact on our ability to maintain operations,” Sifri told me. But “I don’t know if those are the right numbers.” Plus, internal metrics are now tricky for the same reasons they’ve gotten shaky elsewhere, says Xiaoyan Song, the chief infection-control officer at Children’s National Hospital, in Washington, D.C. Screening is no longer routine for patients, skewing positivity stats; even sniffly health-care workers, several experts told me, are now less eager to test and report.

[Read: What COVID hospitalization numbers are missing]

For hospitals that have maintained a more masky baseline, scenarios in which universal masking returns are a little easier to envision and enact. At UChicago Medicine, Landon and her colleagues have developed a color-coded system that begins at teal—masking for high-risk patients, patients who request masked care, and anyone with symptoms, plus masking in high-risk areas—and goes through everyone-mask-up-everywhere red; their team plans to meet weekly to assess the situation, based on a variety of community and internal metrics, and march their masking up or down. Wolfe, of Duke, told me that his hospital “wanted to reserve a little bit of extra masking quite intentionally,” so that any shift back toward stricter standards would feel like less of a shock: Habits are hard to break and then reform.

Other hospitals that have been living mostly maskless for months, though, have a longer road back to universal masking, and staff members who might not be game for the trek. Should masks need to return at the Brigham or Dana-Farber, for instance, “I suspect the reaction will be mixed,” Baker told me. “So we really are trying to be judicious.” The hospital might try to preserve some maskless zones in offices and waiting rooms, for instance, or lower-risk rooms. And at Children’s National, which has also largely done away with masks, Song plans to follow the local health department’s lead. “Once D.C. Health requires hospitals to reimplement the universal-masking policy,” she told me, “we will be implementing it too.”

Other mitigations are on the table. Several hospital epidemiologists told me they expected to reimplement some degree of asymptomatic screening for various viruses around the same time they reinstate masks. But measures such as visiting restrictions are a tougher call. Wolfe is reluctant to pull that lever before he absolutely has to: Going through a hospital stay alone is one of the “harder things for patients to endure.”

A bespoke approach to hospital masking isn’t impractical. COVID waves won’t happen synchronously across communities, and so perhaps neither should policies. But hospitals that lack the resources to keep tabs on viral spread will likely be at a disadvantage, and Popescu told me she worries that “we’re going to see significant transmission” in the very institutions least equipped to handle such influx. Even the best-resourced places may hit stumbling blocks: Many are still reeling from three-plus years of crisis and are dealing with nursing shortages and worker burnout.

Coordination hasn’t entirely gone away. In North Carolina, Duke is working with the University of North Carolina at Chapel Hill and North Carolina State University to shift policies in tandem; in Washington State, several regional health-care organizations have pledged to align their masking policies. And the Veterans Health Administration—where masking remains required in high-risk units—has developed a playbook for augmenting mitigations across its many facilities, which together make up the country’s largest integrated health-care system, says Shereef Elnahal, the undersecretary of Veterans Affairs for health. Still, institutions can struggle to move in sync: Attitudes on masking aren’t exactly universal across health-care providers, even within a hospital.

The country’s experience with COVID has made hospitals that much more attuned to the impacts of infectious disease. Before the pandemic began, Talbot said, masking was a rarity in his hospital, even around high-risk patients; many employees would go on shifts sick. “We were pretty complacent about influenza,” he told me. “People could come to work and spread it.” Now hospital workers hold themselves to a stricter standard. At the same time, they have become intimately attuned to the drawbacks of constant masking: Some have complained that masks interfere with communication, especially for patients who are young or hard of hearing, or who have a language barrier. “I do think you lose a little bit of that personal bonding,” Talbot said. And prior to the lifting of universal masking at Vanderbilt, he said, some staff were telling him that one out of 10 times they’d ask a patient or family to mask, the exchange would “get antagonistic.”

[Read: The pandemic’s legacy is already clear]

When lifting mandates, many of the hospital epidemiologists I spoke with were careful to message to colleagues that the situation was fluid: “We’re suspending universal masking temporarily,” as Landon put it to her colleagues. Still, she admits that she felt uncomfortable returning to a low-mask norm at all. (When she informally polled nearly two dozen other hospital epidemiologists around the country in the spring, most of them told her that they felt the same.) Health-care settings aren’t meant to look like the rest of the world; they are places where precautions are expected to go above and beyond. COVID’s arrival had cemented masks’ ability to stop respiratory spread in close quarters; removing them felt to Landon like pushing those data aside, and putting the onus on patients—particularly those already less likely to advocate for themselves—to account for their own protection.

She can still imagine a United States in which a pandemic-era response solidified, as it has in several other countries, into a peacetime norm: where wearing masks would have remained as routine as donning gloves while drawing blood, a tangible symbol of pandemic lessons learned. Instead, many American hospitals will be entering their fourth COVID winter looking a lot like they did in early 2020—when the virus surprised us, when our defenses were down.

The Fight Over Fukushima’s Dirty Water

The Atlantic

www.theatlantic.com › health › archive › 2023 › 09 › fukushima-radioactive-wastewater-ocean-release-plan › 675233

The numbers were climbing on a radiation dosimeter as the minibus carried me deeper into the complex. Biohazard suits are no longer required in most parts of Japan’s Fukushima Daiichi power plant, but still, I’d been given a helmet, eyewear, an N95 mask, gloves, two pairs of socks, and rubber boots. At the site of the world’s worst nuclear disaster since Chernobyl, you can never be too safe.

The road to the plant passes abandoned houses, convenience stores, and gas stations where forests of weeds sprout in the asphalt cracks. Inside, ironic signs, posted after the disaster, warning of tsunami risk. In March 2011, a 9.0-magnitude earthquake struck off Japan’s Pacific coast and flooded the plant, knocking out its emergency diesel generators and initiating the failure of cooling systems that led to a deadly triple-reactor meltdown.

Now, looking down from a high platform, I could see a crumpled roof where a hydrogen explosion had ripped through the Unit 1 reactor the day after the tsunami hit. The eerie stillness of the place was punctuated by the rattle of heavy machinery and the cries of gulls down by the water, where an immense metal containment tank has been mangled like a dog’s chew toy. Great waves dashing against the distant breakwater shook the metal decks by the shore. Gazing out across this scene, I felt like I was standing at the vestibule of hell.

A dozen years after the roughly 50-foot waves crashed over Fukushima Daiichi, water remains its biggest problem. The nuclear fuel left over from the meltdown has a tendency to overheat, so it must be continuously cooled with water. That water becomes radioactive in the process, and so does any groundwater and rain that happens to enter the reactor buildings; all of it must be kept away from people and the environment to prevent contamination. To that end, about 1,000 dirty-water storage vats of various sizes blanket the complex. In all, they currently store 343 million gallons, and another 26,000 gallons are added to the total every day. But the power plant, its operator claims, is running out of room.

On August 24, that operator—the Tokyo Electric Power Company, or TEPCO—began letting the water go. The radioactive wastewater is first being run through a system of chemical filters in an effort to strip it of dangerous constituents, and then flushed into the ocean and potentially local fisheries. Although this plan has official backing from the Japanese government and the International Atomic Energy Agency, many in the region—including local fishermen and their potential customers—are frightened by its implications.

“The IAEA has said this will have a negligible impact on people and the environment,” Junichi Matsumoto, a TEPCO official in charge of water treatment, told reporters during a briefing at Daiichi during my visit in July. Only water that meets certain purity standards would be released into the ocean, he explained. The rest would be run through the filters and pumps again as needed. But no matter how many chances it gets, TEPCO’s Advanced Liquid Processing System cannot cleanse the water of tritium, a radioactive form of hydrogen that is produced by nuclear-power plants even during normal operations, or of carbon-14. These lingering contaminants are a source of continuing anxiety.

Last month, China, the biggest importer of Japanese seafood, imposed a blanket ban on fisheries’ products from Japan, and Japanese news media have reported domestic seafood chains receiving numerous harassing phone calls originating in China. The issue has exacerbated tensions between the two countries. (The Japanese public broadcaster NHK responded by reporting that each of 13 nuclear-power plants in China released more tritium in 2021 than Daiichi will release in one year.) In South Korea, the government tried to allay fears after thousands of people protested in Seoul over the water release.

Opposition within Japan has coalesced around potential harms to local fishermen. In Fukushima, where the season for trawl fishing has just begun, workers are worried that seafood consumers in Japan and overseas will view their products as tainted and boycott them. “We have to appeal to people that they’re safe and secure, and do our best as we go forward despite falling prices and harmful rumors,” one elderly fisherman told Fukushima Broadcasting as he brought in his catch.

Government officials are doing what they can to protect that brand. Representatives from Japan’s environmental agency and Fukushima prefecture announced last week that separate tests showed no detectable levels of tritium in local seawater after the water release began. But even if its presence were observed, many experts say the environmental risks of the release are negligible. According to the IAEA, tritium is a radiation hazard to humans only if ingested in large quantities. Jukka Lehto, a professor emeritus of radiochemistry at the University of Helsinki, co-authored a detailed study of TEPCO’s purification system that found it works efficiently to remove certain radionuclides. (Lehto’s earlier research played a role in the development of the system.) Tritium is “not completely harmless,” he told me, but the threat is “very minor.” The release of purified wastewater into the sea will not, practically speaking, “cause any radiological problem to any living organism.” As for carbon-14, the Japanese government says its concentration in even the untreated wastewater is, at most, just one-tenth the country’s regulatory standards.  

[From 1976: Richard Rhodes on the benefits, costs, and risks of nuclear energy]

Opponents point to other potential problems. Greenpeace Japan says the biological impacts of releasing different radionuclides into the water, including strontium-90 and iodine-129, have been ignored. (When asked about these radionuclides, a spokesperson for the utility told me that the dirty water is “treated with cesium/strontium-filtering equipment to remove most of the contamination” and then subsequently processed to remove “most of the remaining nuclides except for tritium.”) Last December, the Virginia-based National Association of Marine Laboratories put out a position paper arguing that neither TEPCO nor the Japanese government has provided “adequate and accurate scientific data” to demonstrate the project’s safety, and alleged that there are “flaws in sampling protocols, statistical design, sample analyses, and assumptions.” (TEPCO did not respond to a request for comment on these claims.)

If, as these groups worry, the water from Fukushima does end up contaminating the ocean, scientific proof could be hard to find. In 2019, for example, scientists reported the results of a study that had begun eight years earlier, to monitor water near San Diego for iodine-129 released by the Fukushima meltdown. None was found, in spite of expectations based on ocean currents. When the scientists checked elsewhere on the West Coast, they found high levels of iodine-129 in the Columbia River in Washington—but Fukushima was not to blame. The source of that contamination was the nearby site where plutonium had been produced for the nuclear bomb that the U.S. dropped on Nagasaki.

Concerns about the safety of the water release persist in part because of TEPCO’s history of wavering transparency. In 2016, for instance, a commission tasked with investigating the utility’s actions during the 2011 disaster found that its leader at the time told staff not to use the term core meltdown. Even now, the company has put out analyses of the contents of only three-fifths of the dirty-water storage tanks on-site, Ken Buesseler, the director of the Center for Marine and Environmental Radioactivity at the Woods Hole Oceanographic Institution, told me earlier this summer. Japan’s environmental ministry maintains that 62 radionuclides other than tritium can be sufficiently removed from the wastewater using TEPCO’s filtration system, but Buesseler believes that not enough is known about the levels of those contaminants in all of the tanks to make this claim. Instead of flushing the water now, he said, it should first be completely analyzed, and then alternatives to dumping, such as longer on-site storage or using the water to make concrete for tsunami barriers, should be considered.

It looks like that radioactive ship has sailed, however. The release that began in August is expected to continue for as long as the plant decommissioning lasts, which means that contaminated water will continue to flow out to the Pacific Ocean at least until the 2050s. In this case, the argument over relative risks—and whether Fukushima’s dirty water will ever be made clean enough for dumping to proceed—has already been decided. But parallel, and unresolved, debates attend to nuclear power on the whole. Leaving aside the wisdom of building nuclear reactors in an archipelago prone to earthquakes and tsunami, plants such as Daiichi provide cleaner energy than fossil-fuel facilities, and proponents say they’re vital to the process of decarbonizing the economy.

Some 60 nuclear reactors are under construction around the world and will join the hundreds of others that now deliver about 10 percent of global electricity, according to the World Nuclear Association. Meltdowns like the one that happened in Fukushima in 2011, or at Chernobyl in 1986, are very rare. The WNA says that these are the only major accidents to have occurred in 18,500 cumulative reactor-years of commercial operations, and that reactor design is always improving. But the possibility of disaster, remote as it may be in any given year, is ever-present. For instance, the Zaporizhzhia Nuclear Power Station, Europe’s largest, has been threatened by military strikes and loss of electricity during the war in Ukraine, increasing the chances of meltdown. It took just 25 years for an accident at the scale of Chernobyl’s to be repeated.

[Read: Reckoning with the legacy of the nuclear reactor, 75 years later]

“We are faced with a difficult choice, either to continue using nuclear power while accepting that a major accident is likely to occur somewhere every 20 or 30 years, or to forgo its possible role in helping slow climate change that will make large swaths of the globe uninhabitable in coming decades,” says Azby Brown, the lead researcher at Safecast, a nonprofit environmental-monitoring group that began tracking radiation from Fukushima in 2011.

The Fukushima water release underscores the fact that the risks associated with nuclear energy are never zero and that dealing with nuclear waste is a dangerous, long-term undertaking where mistakes can be extremely costly. TEPCO and the Japanese government made a difficult, unpopular decision to flush the water. In the next few decades, they will have to show that it was the right thing to do.

The Thrill of Defeat

The Atlantic

www.theatlantic.com › ideas › archive › 2023 › 09 › detroit-lions-nfl-football-fan-defeat › 675220

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Even now I can still see him, the man in gold and white, streaking down the sideline all alone.

And then the ball was in the air. It hung up there for what felt like my entire childhood, spiraling in slow motion, traveling 50 yards in total. I remember gasping. Just a few minutes earlier, my favorite team—my first true love—the Detroit Lions, had taken a three-point lead over the hated Green Bay Packers. It was the first round of the 1993 NFC playoffs, and it was my first time at a Lions game. The sound of the 80,000 souls crammed into the Pontiac Silverdome—a glorified warehouse in the blue-collar suburbs of Detroit—was deafening, a roar of humanity unlike anything I’d ever heard, the decibel level shaking the cement beneath our bleacher seats. But now, with less than one minute remaining, as the football dropped into the hands of Sterling Sharpe, the man in gold and white, there was silence. The Packers’ unproven young quarterback, Brett Favre, had just made the most spectacular touchdown throw of his career and eliminated the Lions from the playoffs.

I was inconsolable. The Lions had been the better team; even a kid could see that. We’d out-gained the Packers, out-converted them, out-played them. But we’d lost anyway—in dramatic, dream-shattering fashion. It was too much for my 7-year-old emotions to process. So, I wept. First in the stands as time expired, then in the swarming, beer-soaked concourse as my family searched for the exit, and for the entire hour-long car ride home. Finally, as we pulled into our driveway, my dad spun the radio knob leftward, turning down the postmortem show. “It’s just a game,” he said, smiling gently. “We’ll win the next one.”

It was the only lie my dad ever told me.

A year later, the Lions met the Packers again in the playoffs—and, again, the Lions lost. The next time they reached the postseason, they lost. And the time after that. And the time after that. Since falling to Green Bay that ill-fated night, the Lions have appeared in seven playoff games. They have lost every single one. This streak of futility, going more than 30 years without a playoff win, is unmatched in the annals of the National Football League. But the historical context is even worse. Since winning an NFL championship in 1957—a decade before the first Super Bowl was played—the Lions have won just one playoff game, in the 1991 season, against the Dallas Cowboys. That’s right: one playoff victory since the Eisenhower administration.

Every loss I’ve witnessed has been painful, but none more than that Packers game. The Lions were stacked with elite talent: linebacker Chris Spielman, offensive tackle Lomas Brown, return specialist Mel Gray. And of course, the most electrifying player in football, running back Barry Sanders. The team was poised to become one of the league’s best. But that loss to the Packers broke them. Suddenly, Favre and his Green Bay squad were ascendant, racking up division titles and conference championships and winning a Super Bowl. Meanwhile, the Lions fell apart. In the summer of 1999, on the eve of training camp, Sanders floored the football world by announcing his retirement. Despite being in the prime of his career—one season away from breaking Walter Payton’s rushing record—he was worn down by the losing. Two years later, the Lions brought in Matt Millen to rebuild the team as president and CEO. What ensued was the most disastrous tenure the football world had ever seen: The Lions went 31–97 during the eight seasons Millen oversaw the roster, solidifying our reputation as the laughingstock of professional sports. In 2008 we made history, going winless with a record of 0–16.

[Samuel G. Freedman: A football memoir, with tears]

It was the worst season an NFL team had ever played—and I didn’t miss a single snap. Every Sunday that fall, during my last semester at Michigan State University, I watched, yelled, seethed, prayed, and ultimately witnessed the Lions come up short. A few minutes later, as predictable as a late-game turnover, the phone would ring. My dad wanted to check on me. We would commiserate for a little while, then talk about other things. Every conversation ended the same way. “We’ll win the next one,” he would say.

The author and his father during a 2001 visit to the Pro Football Hall of Fame (Courtesy of Tim Alberta).

By then I was old enough to realize something: Dad didn’t actually believe we’d win the next one. He wasn’t predicting a breakthrough victory. He was teaching me how to handle defeat; he was urging me not to give up hope. He was assuring me that, no matter what, we’d talk again the following Sunday.

A few summers ago, the day after Dad died, I stood outside a funeral home with my brother Brian. Our father’s passing had been sudden and shocking; both of us were in a daze. After standing there in silence for a while, my brother let out a sigh. “Man,” he said, “Pop never got to see the Lions win.”

Brian was right: For all those decades of fanhood, for all those Sunday-evening pep talks, for all those life lessons drawn from watching his team lose, Dad had never been rewarded with a real winner.

I thought about that when I moved my own family back to Michigan shortly after the funeral. I thought about it when I bought season tickets. I thought about it last summer, when my wife and I took our son Lewis to his very first Lions game. He was almost 7 years old—the age I’d been when my heart was broken that night against the Packers. This was just a preseason game, but it delivered thrill after thrill. The Lions pulled away late; the home stadium, now Ford Field in downtown Detroit, pulsated with cheers. Lewis looked euphoric.

And then a familiar turn of events. The Lions, unforced, fumbled the ball away. The Atlanta Falcons, on a fourth down with 90 seconds remaining, scored a miraculous touchdown. The stadium fell into a hush. Lewis looked up at me. “What just happened?” he asked, his voice quivering. “Did we lose?”

On the car ride home, after we’d pacified Lewis with candy and a stuffed mascot from the stadium, my wife turned to me. Her tone was serious. As a practicing child therapist—and as the wife of a die-hard Lions fan—she knew what emotional trauma looked like. She was worried about our son.

“Are you sure,” she asked me, “that you want to do this to him?”

I had never considered it optional. The Lions were in my DNA. Some of my earliest, most vivid memories—formed at no older than age 3—are of my dad and older brothers erupting with screams inside our cramped living room, often frightening me to tears. I would peek in and find them whooping and high-fiving around the small television set, almost always in response to some laws-of-physics-defying maneuver and subsequent touchdown sprint by Barry Sanders. Dad hadn’t grown up a big football fan. But the year we moved to Michigan was the same year the Lions drafted Sanders; before long he and my brothers were hooked, and eventually I was too. Sundays became sacrosanct: Dad preached at our church in the morning, then raced home to meet us for the afternoon kickoff. We scampered outside afterward to re-create the action, pretending to be our favorite players, then came in for dinner and rehashed the results. I can scarcely remember feeling so content.

Of course that fandom would be passed down to my three sons. A framed photo of Sanders had hung over the crib in our kids’ nursery; the walls of their room were painted Honolulu Blue, the singular shade of Detroit’s home uniform. My boys would grow up obsessing over every draft pick, every free-agent acquisition, every coaching change, just like I had. We would watch the games together when they were young, and once they ventured out into the world, we would talk on Sunday evenings.

The author and his friends at MetLife Stadium in 2014 for “The Mane Event” (Courtesy of Tim Alberta).

My wife knew what she’d signed up for. Back when we started dating, I had to explain to her the moral prerequisite of “The Mane Event,” an annual road-trip extravaganza with three of my closest childhood friends, in which we drained our meager bank accounts to watch the Lions play (and almost always lose) an away game. When my wife and I got married, the place cards for the reception were refashioned Lions tickets. The next day, for our honeymoon, we hosted a massive tailgate outside Ford Field. (In fairness, we lacked the funds to go anywhere else.) She was a great sport about it, wearing a veil to match her Ndamukong Suh jersey, proving that I married the most amazing woman in the world.

Over the years, however, her patience waned. The night Lewis was born, I was glued to the NFL draft inside the delivery room, a distraction that for some reason she found irksome. Minutes after Lewis emerged, I carried him over to the television, swaddled in blankets, and together we watched the Lions select Taylor Decker, an offensive tackle from Ohio State University. It was a polarizing pick: We don’t like Buckeyes much in Michigan, and plus, the Lions desperately needed talent on the defensive side of the ball. I cradled my newborn in one hand and traded angry texts with friends and family in the other, baptizing Lewis into a life he never asked for.

Some seven years later, after that preseason loss to the Falcons, I wrestled with my wife’s question. Rooting for the Lions had given me some wonderful memories, but also some punishing ones. This wasn’t merely about picking a favorite team for my children; this was about passing down a painful existence. Every team wins some games and loses others, but not every team is a national punch line and annual bottom-dweller. Was it really fair, I wondered, to force that on someone?

I decided to back off. If Lewis and his brothers were to become fans, it wouldn’t be their dad’s dictate. They needed to choose the Lions on their own. Frankly, I didn’t see that happening anytime soon. The regime that took over in 2021—head coach Dan Campbell and general manager Brad Holmes—had inherited the worst roster in the league. In their first season, they’d won just three games. In 2022, after my paternal moment of clarity, the team started the year by losing six of its first seven games. At this rate, I figured, it would be easy to abstain from pushing Detroit football on my boys.

But then the strangest thing happened: The Lions started winning.

The offense had shown signs of being explosive; now, midway through the season, it was unstoppable, soaring toward the top of the league leaderboard in yards and points per game. The defense had been dreadful; now it was scrappy, tenacious, improving every week. Campbell, the Hercules-size coach who’d played 10 years in the league as a tight end, had splashed a new, one-word team motto—GRIT—all across the Lions facility, even printing it on hats and shirts for the players to wear. Some fans viewed this as a token rebranding effort. But as the season progressed, our franchise transformed into something unrecognizable. These Lions didn’t give an inch to their opponents. They were mentally tough; they played with swagger, expecting to dominate every time they took the field. Detroit became the most dangerous team in football, winning seven of its last nine games and somehow, despite the awful start, sneaking into playoff contention. It would all come down to the season finale, a prime-time game in Green Bay against the Packers.

I had held firm on my promise not to indoctrinate the boys. But I couldn’t contain my own exhilaration: After booking our tickets for Sunday night, January 8, 2023, at fabled Lambeau Field, my “Mane Event” crew traveled north.

The Packers had owned this rivalry my entire life. First it was Favre, the Hall of Fame quarterback, who had killed us; then it was his successor, Aaron Rodgers, a future Hall of Famer himself. During one stretch, Detroit lost 24 consecutive games in Green Bay, the longest road losing streak in NFL history. Getting beaten was bad enough. Worse still was the “Same Old Lions” narrative we couldn’t seem to escape, owing to legendary choke jobs and unjust endings: the “completing the process” non-catch in Chicago, the 10-second runoff against Atlanta, the picked-up pass-interference flag in Dallas. And no team in the NFL seemed to benefit from our curse quite like the Packers.

Minutes before kickoff in Green Bay, a third playoff contender, the Seattle Seahawks, won their game following several atrocious fourth-quarter calls, eliminating the Lions from playoff contention but keeping Green Bay alive. All the Packers had to do was win, on their home field, to get in. The champagne bottles began popping around us at Lambeau. The Lions, most people assumed, would mail it in.

[Read: Angry football fans keep punching their TVs]

But they didn’t. In the gutsiest performance I’d ever seen from my team, Detroit smacked Green Bay around inside its own house. Despite having nothing to play for but pride—and the chance to keep their nemesis out of the postseason—the Lions hounded Rodgers all night, sacking him twice and sealing his career in Green Bay with an interception on his final drive. As the Packers faithful emptied out of the stadium, my friends and I joined thousands of Lions fans in rushing toward the lower bowl, forming a ring of Honolulu Blue around the field, dancing and singing and hugging strangers in the snow. It was the best moment of my life as a Lions fan.

Riding the momentum from their late-season surge, the Lions became a league darling headed into the 2023 campaign. Several top free agents signed on to play for Campbell. National pundits picked Detroit to win the NFC North—something we have yet to do since the NFL realigned its divisions 20 years ago. Oddsmakers in Las Vegas took more bets on the Lions to make the Super Bowl than they did on any other team in the conference.

This was no longer some cute, try-hard Cinderella story. When the NFL released its 2023 schedule, the opening game of the season—Thursday, September 7, in prime time, all the buildup and all the eyeballs—featured the Kansas City Chiefs, the defending Super Bowl champions, playing at home. Their opponent: the Detroit Lions.

On the first day of training camp this July, Campbell told reporters that the “hype train” surrounding his team was “out of control.” But it wasn’t the hype that scared me. It was something else—a feeling I couldn’t make sense of. With some trepidation, I decided to check out training camp myself.

Barry Sanders doesn’t have the moves he once did. The immortal running back, whose jukes and spins and stop-and-start cuts left a generation of linebackers searching for their jockstrap, couldn’t shake the mob of people seeking an audience. It was a sweltering August afternoon and Sanders, now 55 years old, had dropped in on Lions headquarters in Allen Park. The Lions were hosting the New York Giants for a joint scrimmage ahead of their preseason game later in the week, and a crowd of several thousand fans swarmed the practice facility. When word got around that Sanders was here, everyone—players and coaches from both teams—lined up, pointing and whispering like little kids, waiting to shake his hand. By the time Sanders got to me, under a shaded pavilion next to giant metal tubs filled with ice, he looked exhausted.

Barry Sanders playing against the Green Bay Packers in 1993 (John Biever / Sports Illustrated / Getty).

Nothing was forcing Sanders to be here—no sponsorship agreement, no contractual obligation with the club. He was happy to visit with everyone, to sign autographs and snap selfies. But really, he’d come to watch football. He’d come to see his team.

Given the circumstances of his departure years earlier—the retirement letter he faxed into a newspaper, the buzz around his feud with the organization, the distance he kept in the aftermath—one might assume that he’d want nothing to do with the Lions. It’s hard to overstate just how devastating his retirement was to the franchise. Every hard-core Lions fan can remember where they were when they found out. I was inside a Denny’s, eating eggs with my dad, when a guy sprinted inside, having just heard the breaking news over the car radio. “Barry’s retiring! Barry’s retiring!” he cried. We sat there in disbelief.

Sanders heard these sob stories in the years that followed. But it wasn’t until his children reached a certain age that he truly understood the emotion behind them. He had made southeast Michigan his home, putting down roots and raising his kids there. He had never pressured them to watch any particular sport, cheer for any particular club. Yet they became football fans. They became Lions fans. And so did he. The Hall of Famer could no longer help himself: Every Sunday in the Sanders house now centered on the team he’d left behind. He saw his sons crushed in all the familiar ways; he watched them mourn the shocking retirement of another Lions superstar, wide receiver Calvin Johnson, bringing the experience full circle. Yet all the while, Sanders and his family continued to cheer.

“It’s something that I grapple with, and it’s just hard to explain,” Sanders told me. “This team matters to us. You know what I mean?”

I asked whether he and his sons had ever considered switching allegiances. Sanders cocked his head to the side, rumpling his brow.

“No. No, no, no,” he said. “These people who have been loyal, people who have been there every step of the way—that’s the beauty of the game, I think. There are no guarantees. But they still believe.”

Sometimes that beauty gives way to torment. On the far end of the practice field, a man with a fancy job title—special assistant to president/CEO and chairperson—stalked the sideline with a notepad in his right hand. Most front-office types wear suits and ties. But this man was dressed in all black: workout pants, hooded sweatshirt, 50-pound weighted vest, all of it made more conspicuous by the mid-80s heat. It was Chris Spielman.

The anchor of Detroit’s defense in the 1990s, Spielman played brief stints in Buffalo and Cleveland before retiring because of injuries. He went into the broadcast booth and spent the next two decades providing color commentary for college and NFL games. He was happy, making a fine living, freed from the weekly stresses of a win-loss record. And then the call came. It was late 2020, and the Lions were coming off their third consecutive last-place finish. The team’s owner, Sheila Ford Hamp—great-granddaughter of Henry Ford and daughter of William Clay Ford Sr., who’d purchased the franchise outright in 1964—told Spielman the Lions needed a culture change. She was searching for a new coach and general manager, but first she needed a football consigliere, someone who could help guide those hires, who could connect the front office to the locker room to the X’s and O’s on the field. His mind was made up before she’d finished the pitch.

“Loyalty to this organization was probably the only thing that could have drawn me out of the booth,” Spielman told me.

There was more to it than loyalty, though. As we spoke, and he drifted back to his playing days in Detroit, I sensed a lack of peace about the man. He talked about “letting down the fan base.” He said the losses—especially to Green Bay in the playoffs—“always haunt me.” At one point, he gazed off in the distance, choking back emotion as he muttered, “My career was a failure.”

Professional athletes are sometimes thought to be indifferent to the plight of fans—millionaire mercenaries who collect a paycheck and move on to a new city for an even bigger one. Yet here was Spielman, a god of the gridiron—the first high-school player ever to appear on a Wheaties box; a two-time All American in college; a four-time Pro Bowler in the NFL—still distraught, 30 years later, about what could have been. And it wasn’t simply because he never won. It was because he never won here.

“I have so much respect for the folks who’ve hung in there. I felt I owed them something,” Spielman said of his decision to return to Detroit. He called it “unfinished business.”

Today the budding star of the Lions defense is Aidan Hutchinson, a second-year pass rusher who led all rookies in sacks last season and looks poised to become one of the league’s premier defensive players. He’s a local kid, born and raised in Plymouth, drafted out of the University of Michigan. He calls it “divine timing” that the Lions lost 13 games the season before he turned pro, allowing them to snag him with the No. 2 overall selection in last year’s draft.

There is just one hitch in Hutchinson’s homecoming story: He didn’t root for the Lions as a kid.

“I mean, it was hard to be a Lions fan growing up,” the 23-year-old told me after practice one day, a sheepish grin spreading across his face. “The boys were always struggling.”

Hutchinson knows that the Lions are something of a religion in southeast Michigan. His friends loved them. He grew up 20 minutes from team headquarters. And yet, he chose to cheer for the New England Patriots—the winningest franchise in the modern history of the NFL.

“My dad was never a big Lions fan. That’s where I didn’t get it,” Hutchinson said. “He grew up in Texas; he was always a Houston Oilers fan.” When that franchise moved to Nashville in the late 1990s, the elder Hutchinson—who starred at the University of Michigan himself, then stayed in the Detroit suburbs to raise his family—became a pigskin itinerant. He followed everyone, and although he rarely missed a Lions game, he couldn’t bring himself to invest in the home team. By the time Aidan was old enough to watch alongside him, a fellow Michigan alumnus named Tom Brady was establishing a dynasty in New England. And so the Hutchinsons became Patriots fans, reveling in Super Bowls from afar as their neighbors here hankered for a mere playoff win.

[Mark Leibovich: The quiet desperation of Tom Brady]

I asked Aidan, now that he’s a Lion, if he felt badly about not supporting his home team sooner.

“Not necessarily,” Hutchinson replied, fighting a smirk. “I’m happy I’m on the team now.”

The implication was obvious enough. Nothing was lost by ignoring the Lions all those years—the blooper-reel lowlights and the humiliating headlines—because in sports, winning is what makes fanhood worthwhile.

Lots of people believe that. I used to question my own sanity, wondering why I subjected myself to such assured misery Sunday after Sunday, season after season, decade after decade. More than once I fantasized about rounding up my memorabilia—the jerseys and autographs, the helmets and framed photos, the old programs and saved ticket stubs—then dousing it in gasoline and setting it ablaze, escaping this abusive relationship once and for all.

Why didn’t I?

For the longest time, I told myself it was because I’m cursed. I told myself that the moment I walked away from the Lions, they would start winning and winning big, driving me to an entirely different level of madness.

But that’s not the real explanation. Embedded in the psyche of a sports fan is a belief that these teams say something about us; that even though we can’t influence the outcomes—any more than we can control the weather or an economic downturn or a heart attack stealing a family member—we find in them a personal significance that echoes beyond the box score. There is a reason the Lions—not the Red Wings, or the Pistons, or the Tigers, all of whom have been winners in my lifetime—are the favorite sons of Detroit. In a city that can’t seem to catch a break, people find common cause in rallying around the team that best reflects their own story.

For Lions fans—and, I started to realize, for Lions players—all of the losing has formed bonds that winning never could.

“One hundred percent,” Taylor Decker, the left tackle whom the Lions had drafted when Lewis was approximately 15 minutes old, told me at training camp. “It makes you realize who you can rely on, who has your back, who you can trust.”

Now entering his eighth season—he is the longest-tenured player on the club—Decker told me, “I’ve become a man in the city of Detroit.” Part of that maturation owes to experiencing defeat: Coming from Ohio State, where he won a national championship before turning pro, Decker had never tasted the setbacks that would mark his first six years in Detroit. Strange as it might sound, he seems grateful for those setbacks now.

“In today’s society, I feel like quitting and taking the easy way out has been normalized,” Decker said, citing players who demand trades or refuse to re-sign with a struggling team. “I do think there’s something to be said for seeing it through and going through those hard times.”

[Scott Stossel: Winning ruined Boston sports fandom]

Hanging around the Lions facility this summer, talking with players, officials, and journalists who cover the organization, I thought about the irony of my tortured relationship with the Lions. Would I have talked with my dad every Sunday night if our team was steady, unspectacular, business-as-usual competitive? Would my brother Brian and I dissect every draft pick if our team was coming off back-to-back division titles? Would my friends and I bother with The Mane Event if our team had already won a Super Bowl?

Aidan Hutchinson felt sorry for us long-suffering Lions fans. But I started to feel sorry for him. Losing is hard and often harrowing. But it’s also inevitable. And what we take from these losses is precisely what’s necessary to win: resolve, perseverance, and, yes, grit. That’s what my dad taught me before I lost him. And that’s what I hope to teach my sons, who, one day, are going to lose me.

With the season opener in Kansas City drawing near, and my self-imposed ban on proselytizing the boys still in place, there was an uncomfortable truth to confront. Maybe I wasn’t afraid of them inheriting a loser. Maybe I was afraid of them inheriting a winner.

When I shared my epiphany with Brad Holmes, he was stone-faced at first. And then, slowly, he started to nod.

“I was doing a lot of research recently on heat exposure and cold exposure—like, deliberate heat exposure with your body. And a lot of research says that when your molecules suffer, it actually makes your molecules even stronger,” Holmes, the Lions’ general manager, told me one recent afternoon as the team practiced in a misting rain. “It’s kind of like when you’re growing wine. When the grapes are exposed to intense temperatures, it actually produces a better-quality wine. You know what I mean?”

Yes, I knew what he meant—not about the grapes or the molecules, necessarily, but about the metaphorical point he was making. Holmes had seen his share of adversity. Raised in a football family—his father played for the Steelers, his cousin played for the Rams, and his uncle, naturally, played for the Lions—Holmes became a defensive lineman at North Carolina A&T and briefly harbored NFL aspirations of his own. And then a violent car wreck after his sophomore season nearly killed him. Holmes spent a week in a coma, suffering a ruptured diaphragm and a stroke from the violence of the collision. Even though he battled back, eventually rejoining the football team and playing out his college career, the dream was over.

Holmes still wanted a piece of the NFL. He sent copies of his résumé to every organization, begging for an internship in someone’s scouting department. “And every team told me, ‘no, no, no, no, no,’” he recalled. Holmes took a job at Enterprise Rent-A-Car to pay the bills, but kept on pushing. “That’s just kind of how I’m wired,” he told me. “I embrace the darkness.”

After forcing his foot into the door with the Rams—Holmes started as an intern in the public-relations department—he eventually rose to become the director of college scouting, helping to assemble arguably the most talented roster in the league. That roster won a Super Bowl in 2022—but Holmes wasn’t there for it. He had, one year earlier, taken the top job in Detroit. The first move he made was trading the Lions’ all-time leading passer, Matthew Stafford, to the Rams. The torment was poetic: Detroit’s new general manager watched his mates celebrate a championship in his first year removed from his former franchise, while Lions fans watched their former quarterback hoist the Lombardi Trophy one year after requesting a trade from Detroit.

Holmes vowed to use that heartache. He told himself that he would build Detroit’s organization around people who had suffered like him—people who knew how to use that suffering as fuel. He hoped to find a partner who embraced the darkness like he did.

And then he met Dan Campbell.

When he was introduced as Detroit’s new head coach, at a press conference in January 2021, Campbell went viral with a breathless speech promising bodily harm to opponents. “This team’s going to be built on—we’re going to kick you in the teeth. All right? And when you punch us back, we’re going to smile at you,” Campbell said. “And when you knock us down, we’re gonna get up. And on the way up, we’re gonna bite a kneecap off. All right? And we’re gonna stand up. And then it’s going to take two more shots to knock us down. All right? And on the way up, we’re gonna take your other kneecap. And then we’re gonna get up. And then it’s gonna take three shots to get us down. And when we do, we’re gonna take another hunk out of you.”

He concluded: “Before long, we’re gonna be the last ones standing.”

Campbell was rendered a caricature. All the national media could see was a macho former player flexing for the cameras; all they could hear was the Texas twang and the grisly imagery. But Lions fans saw and heard something else. We weren’t enamored of the kneecap spiel. What made us fall in love with Campbell—what turned him into the face of Detroit sports—was what he said immediately preceding that viral moment.

“This place has been kicked, it’s been battered, it’s been bruised. And I can sit up here and give you coach-speak all day long. I can give you, ‘Hey, we’re going to win this many games.’ None of that matters, and you guys don’t want to hear it anyway. You’ve had enough of that shit,” Campbell said. “Here’s what I do know: This team is going to take on the identity of this city. This city’s been down, and it’s found a way to get up.”

How does a guy who grew up in the one-stoplight-town of Morgan, Texas (population 457)—“actually, outside Morgan,” Campbell told me—become an avatar for the defiant spirit of Detroit?

Campbell played here. More to the point, he played here in 2008, when the Lions achieved infamy with their 0–16 season. He came aboard as a free agent with the charge of providing veteran leadership, helping a languid locker room to mature and compete. Instead, in his three years in Detroit the team lost 38 games and won just 10. The 2008 season was especially scarring. Campbell, who nursed injuries throughout training camp, fought his way onto the field in the season opener against Atlanta. In the second quarter, he caught a pass for 21 yards down the seam, getting crunched by three Falcons defenders on his way to the turf. Then he limped off the field.

“That was my last play ever,” Campbell murmured.

Dan Campbell playing against the New York Jets in 2006 (Brian Killian / NFL Photo Library / Getty).

We were sitting on the sidelines of the Lions’ indoor practice field. He closed his eyes, looking wistful. The cumulative toll of injuries sustained playing the game he loved—foot, elbow, knee, hamstring—finally caught up with him. He watched from the sidelines as his team lost every game that season. What happened next was just as excruciating: Campbell signed a one-year deal with the New Orleans Saints, determined to give his body a final go. He tore his MCL in camp and was placed on injured reserve, forfeiting eligibility to play. This time, instead of watching his teammates go winless, Campbell saw the Saints march all the way to a Super Bowl victory. But he didn’t get a ring. He hadn’t played a single down. History would not remember him as a champion. Campbell retired a short time later.

Detroit isn’t a prized destination for football coaches. But for Campbell, who went to work for the Miami Dolphins as an offensive intern the year after he retired, the Lions were his dream job. This wasn’t just a place where he played. This was a place where he hurt, where he grieved, where he lost something he would never get back—and where the fans understood what that meant.

“Man, to endure year after year, your hopes are back up and then it’s that. Your hopes are back up—‘This is gonna be the year’—and then it’s 0–16. But they just keep coming back for more,” Campbell said, shaking his head in amazement.

“The thought of being a part of bringing this place out of the ashes—”

He paused. “Man, it meant something to me.”

Campbell grew up a Dallas Cowboys fan. He watched every game with his dad, a diehard since the 1960s, and idolized the glamorous roster of the 1990s that won multiple Super Bowls. Now that he’s in Detroit, there’s a disconnect that’s hard to ignore. Those Cowboys had been dubbed “America’s Team,” yet most of America couldn’t relate to them. They were a group of hotshot players, led by a cocky coach and bankrolled by an ostentatious owner, who won in ways that were neither surprising nor inspiring. There was no grit about the Cowboys.

[Jemele Hill: The Jerry Jones photo explains a lot]

“That’s been ‘America’s Team,’” Campbell told me, emphasizing the nickname with air quotes. I could tell we were thinking the same thing: Imagine how endearing these Detroit Lions would be to the masses, football junkies and casual viewers alike, if they parlayed their losing past into a winning future.

Campbell motioned toward the field behind us. “Why can’t we be America’s team?”

When the NFL scheduled the Lions-Chiefs season kickoff for September 7, my immediate reaction was to text the Mane Event crew. We began looking at tickets, hotels, flights. Arrowhead Stadium, in prime time, against the champs—this was as close to a Super Bowl as anything we’d ever experienced. We had to go.

It hit me several hours later: September 7 was our wedding anniversary. Our tenth wedding anniversary. As much as my identity is wrapped up in Lions football, it’s even more wrapped up in family. There was no way I could ditch my wife. So I did what any good husband would: I asked her to come to Kansas City, too.

She actually agreed, but between our jobs and kids and logistics, we couldn’t find a way to make it work. She felt terrible about it. But I told her not to worry: The Lions would be playing a lot of big games in 2023. We would have plenty of chances. After all, we have four season tickets.

I thought about those four tickets throughout the summer. Purchasing them a few years ago after moving back to Michigan had been a means of establishing continuity between generations, passing down a family tradition, ensuring that my three boys would make Lions memories—good and bad—with their father the same way I had with mine.

That no longer seemed likely. I had stopped pushing the Lions on them last summer, following that awful preseason loss to Atlanta, and I hadn’t heard a word from them about football since. That was just fine. My sons and I would discover a different identity together, a different way of bonding. Sure, if I’m being honest, it was a disappointment. But I’ve learned to deal with those.

A few days before I finished writing this story—two weeks out from the season opener—my 7-year-old, Lewis, approached me, apropos of nothing.

“Dad,” he asked, “can we go to a Lions game this year?”

I was reminded of another virtue of losing: It makes victory that much sweeter.