“By some estimates, about 40 percent of the population of the United States will have been infected with the omicron variant of Covid-19 by the time the current wave fully subsides. The WHO estimates that half of Europe will have been infected as well. And nearly all of those infections will have occurred between mid-December and the beginning of February.
It’s hard to say for sure, but there’s good reason to think that never before have so many people been infected with an emerging virus in such a short timespan. For most of history, diseases traveled much slower, carried by travelers on boats or horses.”
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“We are incredibly lucky that omicron seems to be milder than previous strains of Covid-19 and that both vaccinations and previous exposure have built up immune resistance. The massive spike in cases around the world — while badly taxing health care systems — hasn’t been matched by an equal spike in hospitalizations and deaths.
I think it’s hard to appreciate what a massive bullet we dodged: If omicron had been substantially more deadly, there is very little we could have done to stop the death toll.”
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“Earlier strains of the virus were successfully contained in some countries by maintaining strong border controls, aggressively quarantining people, and using traditional epidemiological tools like contact tracing.
China quashed a large initial outbreak with unprecedented measures, including surveillance, sealing off cities, locking people in their homes, and other policies more extreme than those employed even in other countries that successfully suppressed the virus, like New Zealand.
Nothing the world has tried works as effectively against a variant as contagious as omicron.”
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“Forty percent of the US in two months. That would have been apocalyptic if the viral variant were a deadly one. If we press the snooze button on this wake-up call, we might not get another one.”
“The so-called “freedom convoy” is nominally protesting a vaccine mandate for truckers, implemented in mid-January on both sides of the US-Canada border. But the demonstrations have swiftly ballooned into a broader far-right movement, with some demonstrators waving Confederate and Nazi flags. Protester demands include an end to all Covid-19 restrictions in Canada and the resignation of Prime Minister Justin Trudeau.
The demonstrators, which have included as many as 8,000 people at their peak, have terrorized Ottawa: blockading streets, harassing citizens, forcing business closures, and honking their extremely loud horns all night. Ottawa police, who have proven some combination of unwilling and unable to restore order, have even set up a special hotline to deal with a deluge of alleged hate crimes stemming from the protests. In the first week of February, it received over 200 calls.
Ottawa Mayor Jim Watson has declared a state of emergency, and Trudeau’s government has deployed hundreds of Royal Canadian Mounted Police to the protests. As the situation in Ottawa continues, the freedom convoy movement has expanded across the country. Demonstrators have shut down at least two border crossings between Canada and the United States.
But while the protests are generating a lot of noise and attention, the eruption actually points up a counterintuitive fact: The Canadian far right is weak and ineffectual, especially when it comes to pandemic restrictions.
Canada’s provinces have generally employed strict Covid-19 measures such as school mask mandates and vaccine passports, including during the recent omicron surge. They have enjoyed broad public support in doing so; even the strictest restrictions are less controversial in Canada than in the US. The current demonstration is quite unpopular with the general public, divisive even inside the center-right Conservative party.
This doesn’t mean the movement will accomplish nothing. It has already contributed to a revolt against the Conservative party’s leader and is serving as an important organizing node for far-rightists. The border crossing blockage is putting more stress on the US-Canada supply chain, costing (by one estimation) $300 million a day in economic damage. Internationally, the freedom convoy has inspired copycat efforts in both the United States and France.
But it’s important to understand the broader context in Canada. News coverage of the convoy, especially from sympathetic anchors on Fox News, may lead Americans to believe that Canada is in the midst of a far-right popular uprising. In reality, the mainstream consensus in Canada about Covid-19, and the nation’s institutions in general, is holding. The so-called trucker movement is on the fringe, including among Canadian truckers — some 90 percent of whom are vaccinated.”
“How the virus spreads among wildlife is a black box that scientists try to peer into through the tiniest of pinpricks. But what they do know is that when the coronavirus establishes itself in wildlife, it creates for itself a sort of insurance policy. We may be able to get the pandemic among humans under control, but the virus is likely to lurk in other species, making it that much harder to monitor and defeat.
The spread of SARS-CoV-2 in wildlife is not the most pressing issue of the pandemic right now. Humans are still catching the virus from each other and dying from it. Still, these wildlife risks, if they are realized, could have serious consequences. Scientists want to be vigilant about dangers that could emerge from the wilderness.”
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“Infections have turned up in cats, dogs, lions, tigers, pumas, ferrets, mink, certain rodents, snow leopards, and others. The CDC even has guidelines to protect pets from Covid-19. When a virus jumps from animals to humans and then back to animals, scientists call that spillback.
Most of these infections in animals appeared to be self-contained. An infected house cat presumably stays in the house when infected — it doesn’t start a chain of transmission. “They were all isolated cases,” Suresh Kuchipudi, a Penn State infectious disease researcher who collaborated with Kapur, says of known cases in animals.
The deer infections were different. “This is first time that a completely free-living animal species in the wild has been found to be infected, and that infection is widespread,” Kuchipudi says.
How the deer got infected in the first place remains a mystery, but researchers believe the outbreak came from humans. The virus circulating in the deer had similar genetic sequences to the virus circulating in humans at the time that they got it.”
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“Whatever happened to start the deer outbreaks, it appears to have happened many times. The genetic analysis in the PNAS paper finds evidence of several separate jumps from humans into animals. Further research needs to be done to identify the exact pathway, and hopefully to prevent the next leap.
Once the virus jumps into the deer, they are also spreading it to each other, the studies find. “There was not just human-to-deer spillover, but there was also deer-to-deer transmission, as evidenced by genomic changes that would confirm that,” Kuchipudi says.”
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“The pandemic in humans is much more urgent than Covid-19 in animals. All of the scientists I spoke to agreed about that. The coronavirus is still killing thousands of people every day, and that’s the problem that should get the bulk of our attention and resources.”
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“On the other hand, the scientists say they want more visibility into what’s happening in the animal world. “We need wildlife surveillance,” Olson says, meaning more testing of animals for coronavirus antibodies — a sign they have been exposed — or active infections. “We just don’t have the tools to begin to understand the system, to even start mapping what’s going to happen here, because our ability to see it is so opaque right now.””
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“Covid-19 outbreaks in animals are not situations we can plausibly control. Rather, they’re something to monitor in case they start to look like pressing problems.”
“pediatric hospitalizations are occurring almost exclusively among kids who are not vaccinated. Most school-age children are eligible to have been vaccinated, but most school-age children have not yet been vaccinated. Depending on what numbers you look at, only around 50 to 60 percent of kids ages 12 to 17 have been fully vaccinated, and only around 25 percent of kids ages 5 to 11.”
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“today is not the day to remove mask mandates in schools. Rather, you want to wait until case rates are much lower than they are today. Not simply for the sake of kids, but also so that children aren’t bringing the disease home. But governors are up against political pressures.
The important thing to highlight here is that many of the governors who have lifted mask mandates in the last couple of days have said that the mandates will be lifted for schools three or four weeks in the future, not today. And three or four weeks in the future, chances are that case rates will be lower, so by then it actually will be much safer to remove the mask mandates without putting kids and communities at high risk, just because there won’t be a lot of circulating COVID.”
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“There are a number of observational studies showing that communities and schools that have universal masking have lower rates of COVID-19 among kids in the school, and a couple of studies suggesting higher rates of transmission within schools that forego masking. And of course, there are many more studies in adults and kids in general — really, the preponderance of evidence supports that masks work, and they work for kids as well as for adults.”
“Underlying that split is the question of whether and when COVID-19 counts as a workplace hazard, justifying regulation by the Occupational Safety and Health Administration (OSHA), as opposed to a general risk that Americans face throughout the day, which goes beyond that agency’s statutory mission. All of the justices agreed that OSHA does not have a general license to protect public health, and all of them agreed that the agency does have the power to address COVID-19 in the workplace. But while the dissenters were willing to let OSHA define that problem in general terms, justifying a broad solution covering 84 million employees, the majority thought the agency was obliged to be more specific and discriminating.”
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“OSHA has previously issued regulations that addressed communicable diseases. In 1990, it issued a nonemergency standard dealing with bloodborne pathogens, and last June it published a COVID-19 ETS for the health care industry. But both of those rules aimed to protect employees who faced special hazards because of the nature of their work (handling blood samples and treating COVID-19 patients, respectively), and neither of them encouraged or required employers to make vaccination mandatory. That is something OSHA, which has existed for more than half a century, has never done before—a point that the justices emphasized during oral arguments last week and again in yesterday’s decision.
“OSHA has never before imposed such a mandate,” the Court notes. “Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here….The most noteworthy action concerning the vaccine mandate by either House of Congress has been a majority vote of the Senate disapproving the regulation on December 8, 2021.”
In a joint dissent, Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan argue that OSHA’s unprecedented rule is justified by the unprecedented threat that COVID-19 poses”
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“Even as Breyer et al. emphasize the society-wide threat posed by COVID-19, they suggest the risk is especially acute in the workplace, where employees typically gather inside for eight hours a day. That basic fact, the dissenters argue, justifies OSHA’s broad approach, because the coronavirus “spreads mostly without regard to differences in occupation or industry.””
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“More generally, the majority says, OSHA has failed to draw appropriate distinctions between different work situations that pose widely varying risks of virus transmission. “Although COVID-19 is a risk that occurs in many workplaces, it is not an occupational hazard in most,” the Court says. “COVID–19 can and does spread at home, in schools, during sporting events, and everywhere else that people gather. That kind of universal risk is no different from the day-to-day dangers that all face from crime, air pollution, or any number of communicable diseases. Permitting OSHA to regulate the hazards of daily life—simply because most Americans have jobs and face those same risks while on the clock—would significantly expand OSHA’s regulatory authority without clear congressional authorization.””
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“The majority nevertheless concedes that OSHA has the authority to address COVID-19 in certain contexts:
“Where the virus poses a special danger because of the particular features of
an employee’s job or workplace, targeted regulations are plainly permissible. We do not doubt, for example, that OSHA could regulate researchers who work with the COVID–19 virus. So too could OSHA regulate risks associated with working in particularly crowded or cramped environments. But the danger present in such workplaces differs in both degree and kind from the everyday risk of contracting COVID–19 that all face. OSHA’s indiscriminate approach fails to account for this crucial distinction—between occupational risk and risk more generally—and accordingly the mandate takes on the character of a general public health measure, rather than an “occupational safety or health standard.”””
“Residents of Fort Mill, South Carolina, had to wait 18 long years for construction to start on a hospital that state regulators determined in 2004 was necessary—and then proceeded to hold up in an absurdly long legal battle that eventually went all the way to the state Supreme Court.
Hopefully, that saga won’t ever be repeated.
The state Senate voted 35–6 on Tuesday to repeal most of South Carolina’s Certificate of Need (CON) regulations that require hospitals and other health care providers to obtain permission from the state before expanding facilities, buying new equipment, or offering new services. Often, those regulations gave de facto veto power to existing providers, which lobby health policy bureaucrats to block the approval of new competition.
That’s exactly what happened in Fort Mill, where plans for a new 100-bed hospital were tied up for more than a decade and a half, in part because a rival hospital wielded the state’s CON laws in an attempt to block the new facility, as Reason previously reported.”
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“If the bill becomes law, the Charleston Post and Courier reports, it would clear the way for 28 projects that are currently tied up in legal battles despite having won preliminary CON approval. Another 34 projects awaiting review by the state’s Department of Health and Environmental Control would be able to proceed as well. The paper estimates that those delayed projects represent more than $1 billion in health care investment in the state.”
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“that doesn’t include the loss of projects that never materialized in the first place.”
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“As part of his emergency order issued when COVID-19 first struck in March 2020, Gov. Henry McMaster (R) suspended enforcement of CON regulations—making South Carolina one of several states to do so because of the pandemic. When it became obvious that the sky wasn’t falling in the absence of those rules, some state lawmakers rightly began to question whether they were needed in the first place”
“The United States health system, more than any other in the developed world, forces patients to manage their health care on their own. They pay a lot of their own money for medical care. They have to make sure their specific doctor is covered by their specific insurer. And even if their doctor believes they need a certain treatment, patients must follow rules set by their health insurer, or risk delays in treatment or ultimately having their insurance claims denied.
Patients run into these obstacles all the time — with serious consequences for their well-being. A recurring finding in health care research is that when patients run into any friction, whether high cost-sharing, limited access to providers, or something else, they tend to receive less timely and appropriate care. Over time, that will make people more likely to develop serious health conditions and, ultimately, die younger than they would with proper care.
It starts with the sheer cost of health care to US patients. Out-of-pocket spending per person is higher in the US than in any other wealthy country save Switzerland, and roughly twice as much as in countries like the UK, the Netherlands, and Japan. Recent research has found that even small cost obligations, as little as $10 for a prescription, can discourage patients from taking their medicine as prescribed. A third of Americans have reported in public opinion surveys that they skip medications or other necessary medical care because of the cost.
But the US health system puts up other, subtler hurdles. Insurers don’t cover care at every doctor’s practice or hospital; they instead contract with certain providers to create provider networks, within which their patients must seek care for their treatment to be covered. These networks put the onus on patients to figure out where they can go for care, at the risk of incurring huge medical bills if they get it wrong. That problem came to the forefront in the recent debate over surprise billing: Many people were going to the hospital for an emergency, only to find out after the fact that either the hospital or a doctor who treated them was not covered by their insurer.
That has been a common experience for American patients: About one in four heart attacks lead to the patient being charged for out-of-network care in the emergency department or if they are admitted.
Networks also make shopping for health insurance more difficult. Patients have to try to figure out in advance whether their existing primary care doctor or specialists, or the local hospital, will be covered by their new plan.”
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“Patients can run into the same kind of problem with drug formularies, a list of approved drugs that health plans use to prioritize coverage for certain medications. If a drug is not on a plan’s formulary, customers must pay more of their money than they would for approved drugs. Sorting out which drugs are covered or preferred under a health plan’s formulary can be a headache, and research has shown that such restrictions lead to patients using fewer medications.”
“There are a few ways to think about these bureaucratic struggles. One, coined by Annie Lowrey in a 2021 Atlantic feature, is the “time tax” — the amount of time and energy that people waste interacting with the government. But my preferred term, popularized by the academics Donald Moynihan, Pamela Herd, and Hope Harvey is “administrative burden” — which refers not only to the concrete loss of time and money, but to the cognitive and psychological burdens of having to learn and comply with government rules.
It’s hard to say just how much administrative burden there is. There’s no attempt to synthesize information about it even at the federal level, let alone the state and local governments that are responsible for implementing most safety-net programs. The best way to understand it is to look at all the labor involved to access a specific program: unemployment benefits in North Carolina, for example.
The one overarching truth is that administrative burdens particularly harm people already marginalized because they’re most in need of assistance and because they’re most likely to have difficulty jumping through all the hoops. Maybe they don’t have a computer, maybe they don’t speak English or understand legalese, or maybe they have to forgo shifts at work just to go to the right office to submit a form.
By extension, any restriction on who is eligible for benefits increases administrative burden, not only for people who apply and are found ineligible but also those who have to do more work to prove eligibility in the first place. The Covid-19 test webpage could be easy because there were no restrictions; it didn’t need to ask about anything besides your address.
There’s also a second-order way that making programs universal fights administrative burden: When politically empowered, privileged Americans are inconvenienced by something, they’re more likely to make noise and get it to change.
But there is little if any political incentive to reduce the burden on people who politicians don’t typically listen to or need to court, such as noncitizens or people disenfranchised due to criminal records.”