“More than a million Americans have died of Covid-19, and the World Health Organization estimated this Thursday that the global death toll is around 15 million — a horrifying, and largely unnecessary, tragedy.
But for all that the world has lost in the last few years, the history of infectious disease has a grim message: It could have been even worse. That appalling death toll resulted even though the coronavirus kills only about 0.7 percent of the people it infects. Imagine instead that it killed 30 percent — and that it would take centuries, instead of months, to develop a vaccine against it. And imagine that instead of being deadliest in the elderly, it was deadliest for young children.
That’s smallpox.”
…
“Before modern vaccine development, humans had to get creative in slowing the spread of infectious disease. It was known that people who’d survived smallpox didn’t get sick again. In China, as early as the 15th century, healthy people deliberately breathed smallpox scabs through their noses and contracted a milder version of the disease. Between 0.5 percent and 2 percent died from such self-inoculation, but this represented a significant improvement on the 30 percent mortality rate of the disease itself.
In England, in 1796, doctor Edward Jenner demonstrated that contracting cowpox — a related but much milder virus — conferred immunity against smallpox, and shortly after that, immunization efforts began in earnest across Europe. By 1813, the US Congress passed legislation to ensure the availability of a smallpox vaccine that reduced smallpox outbreaks in the country throughout the 1800s.”
…
“By 1900, smallpox was no longer quite as much of a scourge in the world’s richest countries. In the 1800s, about 1 in 13 deaths in London were caused by smallpox; by 1900, smallpox caused only about 1 percent of deaths. Several countries in Northern Europe had also declared the disease eradicated. Over the next few decades, more of Europe, and then the US and Canada, joined them.
But as long as smallpox ravaged other parts of the globe, continual vaccination was necessary to make sure it wasn’t reintroduced, and millions of people continued to die of it. Data is spotty — this is before there was any international authority on infectious disease statistics worldwide — but it is estimated that 10 to 15 million people caught smallpox annually, with 5 million dying of it, during the first half of the 20th century.
It was not until the 1950s that a truly global eradication effort began to appear within reach, thanks to new postwar international institutions. The World Health Organization (WHO), founded in 1948, led the charge and provided a framework for countries that were not always on friendly terms to collaborate on global health efforts.”
…
“A 1947 outbreak in New York City, traced back to a traveler from Mexico, resulted in a frantic effort to vaccinate 6 million people in four weeks. Europe, Henderson says, repeatedly saw the virus reintroduced by travelers from Asia, with 23 distinct importations (different occasions of someone bringing smallpox into the country) in five years.
As we face down Covid-19, with effective vaccinations finally in hand, we’re encountering the same challenge that the world faced with smallpox in the 1950s: It doesn’t matter if a vaccine exists unless there also exists the international will and creativity to get it to all the people who need it, many of whom will be reluctant and skeptical.”
…
“features of smallpox made it easier to eradicate than many other diseases. For one thing, it didn’t have animal reservoirs; that is, unlike diseases like Ebola, smallpox doesn’t live in animal populations that can reintroduce the disease in humans. That meant that once it was destroyed in humans, it would be gone forever. And, once a person has survived it, they are immune for life. Only one vaccine is needed for immunity in almost all cases.
Additionally, it largely doesn’t have asymptomatic transmission and has a fairly long incubation period of about a week. That made it possible for public health officials to stay on top of the disease with a strategy of “ring vaccination” — whenever a case was reported, vaccinating every single person who may have come into contact with the affected person, and ideally everyone in the community could keep the disease at bay.”
…
“Humanity’s triumph over smallpox should stand out as one of our proudest moments. It called on scientists and researchers from around the world, including collaborations between rival countries in the middle of the Cold War.
Unfortunately, we’ve never replicated that success against another virus that affects humans. With some, such as polio, we’re drawing close. Wild polio has been eradicated in Africa and remains only in conflict-torn regions of Afghanistan and Pakistan. “Ring vaccination,” as practiced in the smallpox battle, has been successfully used in public health efforts against other diseases, most recently with the new Ebola vaccine, used against outbreaks in the Democratic Republic of Congo.
But in other cases, like HIV and Covid-19, we’ve let new diseases grow to pandemic proportions. And while those diseases have had devastating effects, it’s worth keeping in mind that they could have been even worse. Some viruses with the potential to escape laboratories or make the jump from animals to humans are as deadly and transmissible as smallpox, and Covid-19 has made it clear that we’re not prepared to handle them.”
…
“The devastation of Covid-19 has hopefully made us aware of the work public health experts and epidemiologists do, the crucial role of worldwide coordination and disease surveillance programs (which are still underfunded), and the horrors that diseases can wreak when we can’t control them.
We have to do better. The history of the fight against smallpox proves that we’re capable of it.”
“the primary is plenty interesting on its own. First of all, it will winnow a field of 48 candidates(!) down to four. Why four and not two? Because following the passage of an election-reform ballot measure in 2020, Alaska now uses a unique top-four primary system whereby all candidates (regardless of party) run on the same ballot and the top four finishers advance to the general election. (In a further twist, the general election will also use ranked-choice voting.) “
“John Lee is the new chief executive of Hong Kong. The 64-year-old ran the only approved campaign to succeed Carrie Lam, the embattled head of the Chinese territory who oversaw a dramatic degradation to democratic institutions throughout 2019’s pro-democracy protests. Lee’s tenure will likely bring more of the same: a former deputy chief of Hong Kong’s police force, he was instrumental in the brutal crackdowns on pro-democracy activists.
As the sole Beijing-approved candidate to replace Lam, Lee’s victory was all but assured as soon as he announced his candidacy. While Hong Kong doesn’t have what Americans would recognize as a democratic electoral system, previous elections have seen multiple candidates vie for Hong Kong’s top job. But this year, Lee was the only person Beijing apparently deemed sufficiently loyal to China’s Communist Party under its new electoral policies for Hong Kong, unveiled last March. He won handily with 99 percent of the votes from the 1,500-member electoral commission.”
“In 2020, the general fertility rate in the US hit its lowest level on record, and provisional data for the first six months of 2021 showed a 2 percent decline in the number of births compared to the same time period in the previous year.
And what’s happening in the US is taking place in much of the rest of the world, as people are slower to marry and slower to have children.
That trend has helped contribute to what will be one of the dominant themes of the 21st century: the slowdown of population growth, especially in developed countries, and the eventual shrinking of the number of human beings on the planet.”
“an economy the magnitude of Russia’s, the 11th largest in the world, has never been sanctioned so comprehensively. Going after a central bank of this size, a major economy’s connections to international banking systems, and many of its sectors, is indeed unprecedented. And to target an economy that large unleashes unintended consequences on Russia, the US, and the globe.
Russia is a major energy exporter, and energy prices are rising and sending inflation even higher. Russia also exports significant amounts of grains, cooking oils, and fertilizer. So sanctioning the country — even with carve-outs and waivers for humanitarian purposes — could have a devastating impact on vulnerable people in poor countries. The United Nations says that economic sanctions will impact Russian and Ukrainian food production, which is exacerbated by the war and Russia’s blockade of Ukrainian ports. One possible outcome, the UN reports, is that “the global number of undernourished people could increase by 8 to 13 million people in 2022/23.””
…
““We all worry about the overuse of sanctions, but I think that this is clearly not a case of overuse,” an administration official who spoke on condition of anonymity told me. “This is a case of responding to a clear and egregious violation of basic tenets of international law and human rights. I think this is a case of indisputable agreement that the world needs to respond and sanctions are an appropriate tool.””
“Over 1 million Americans have now died from Covid-19. It isn’t a random group of people: one preprint paper found that working-class Americans were five times more likely to die from Covid-19 than college-educated Americans. Working-class Hispanic men had a mortality rate 27 times higher than white college-educated women. Another study analyzed Covid-19 mortality rates in over 219 million American adults and found that if racial and ethnic minorities between 25 to 64 years old had faced the same mortality rate as college-educated white Americans, there would have been 89 percent fewer deaths.”
“Even just a small difference in a reef’s height can make a big difference in risk, according to a study published last year in the journal Nature. Flood risk is often measured by what’s called the 100-year-flood zone — an area in which the chance of a flood in a given year is 1 percent. If coral reefs in the US lose 1 meter of height, that zone in the US would grow by 104 square kilometers (or about 26,000 acres), putting about 51,000 more people at risk of flooding, the study found.
That’s a big reason why losing reefs is so frightening. “These losses could escalate flood risk in just years to levels not anticipated by sea-level rise for decades or a century,” the authors of the Nature study wrote.”
…
“Ultimately, protecting and restoring coral reefs is about much more than protecting coastal cities. Though they cover less than 1 percent of the world’s oceans, reefs sustain about one-quarter of all marine life and half of all federally managed fisheries. It’s hard to think of a better example of how helping an ecosystem is also helping ourselves.”
“important research published in 2020 that compared the fates of women who were forced to carry pregnancies to term versus those who were provided abortions. The influential Turnaway Study, as it’s commonly referred to, found that, among other things, women who were denied an abortion endured more serious pregnancy complications, more chronic pain, and more short-term anxiety.”
…
“more unwanted pregnancies would be carried to term if the court were to negate a federal right to abortion.”
…
“The Turnaway Study began in 2007 and followed more than 1,000 women for five years to assess how their lives had been altered, if at all, by the provision or the denial of an abortion. Some of the women had an abortion shortly before reaching the gestational limit set by their state or provider, while others had just passed that limit and were denied an abortion as a result. The differences in the women’s experiences from that critical moment onward were the purview of the study.
“We find no evidence abortion hurts women,” Foster writes in the 2020 book The Turnaway Study that covered the research’s findings. “For every outcome we analyzed, women who received an abortion were either the same or, more frequently, better off than women who were denied an abortion.”
The mental health of women who received an abortion was better immediately after the procedure than that of women who were denied one. Their physical health fared better over the longer term. Their subsequent children developed better.
Foster presents a nuanced picture, noting, for example, that after the five-year period of the study, almost none of the women who ended up carrying an unwanted pregnancy to term said that they still wished they’d had an abortion. But Foster is nevertheless unequivocal in her conclusions about what being denied an abortion meant for the women involved: “We find many ways in which women were hurt by carrying an unwanted pregnancy to term.””
…
“The most unexpected and tragic outcome noted in the Turnaway Study was that two of the women died because of childbirth complications. It came as a shock to Foster, who wrote that she “did not expect to find even one maternal death in a study of 1,000 women.” The US maternal mortality rate is 1.7 per 10,000, meaning the odds of two women in 1,000 dying were exceedingly low.
Foster was careful not to be definitive about this finding, writing that a much larger sample size would be necessary to draw any firm conclusions about the relationship between being denied an abortion and maternal mortality. The implications remain grim, however: “This level of maternal mortality is shocking,” she wrote.
Short of death, women who are denied an abortion are more likely to have serious complications than women who received an abortion. The Turnaway Study found that 6.3 percent of the women who had given birth suffered life-threatening complications versus about 1 percent of women who had complications from an abortion.
Women who were denied an abortion also saw a higher risk of gestational hypertension, which increases their risk for cardiovascular disease later in life. The study found that 9.4 percent of women who gave birth experienced hypertension during the pregnancy versus 4.2 percent of women who had second-trimester abortions and 1.9 percent of those who had first-trimester abortions.
The women who gave birth also experienced slightly higher rates of chronic head pain and joint pain afterward. On self-reported health, a metric shown to be a strong indicator of future health and mortality, 27 percent of women who carried their pregnancies to term after being denied an abortion said they were in fair or poor health versus 21 percent of women who had second-trimester abortions and 20 percent of women who had an abortion in the first trimester.
“To the extent that there were differences in health outcomes,” Foster wrote, “they were all to the detriment of women who gave birth.””
…
““We found no mental health harm from having an abortion.””