ProPublica’s health reporter Caroline Chen explains what the conversation around asymptomatic coronavirus carriers is missing, and what we need to understand if we’re going to beat this nefarious virus together.
by Caroline Chen
Is the United States Prepared for COVID-19?
In the early days of the coronavirus outbreak in the U.S., around the last week of February, I joked to a colleague that maybe now, finally, people would learn how to wash their hands properly. My remark revealed a naive assumption I had at the time, which was that all we needed to do to keep the novel coronavirus contained was follow a few simple guidelines: stay home when symptomatic and maintain good personal hygiene. The problem, I thought, was that nobody was following the rules.
With articles about “silent spreaders” and “stealth transmission” flying across the internet, friends were starting to text me: Was it still OK to go for a walk with a friend, even 6 feet apart? Or should all interaction be avoided? Should we start wearing masks to the grocery store? At the same time, my colleagues were scrutinizing guidelines at various workplaces and agencies we cover: The New York City Fire Department told workers on March 19 they were to come to work, so long as they had no symptoms, even if they had had “close contact with someone who is a known positive COVID-19 patient,” according to a document obtained by ProPublica. Was that policy wise?
I decided to dive into the available data. What I discovered is that not only can people be infected and experience no symptoms or very mild symptoms for the first few days, but this coincides with when the so-called viral load — the amount of virus being emitted from an infected person’s cells — may be the highest. That makes the virus a truly formidable opponent in our densely packed, globally connected world. We’re going to have to be smarter than this virus to stay on top of it.
What does asymptomatic really mean?
Let’s start with the basics. Dr. Maria Van Kerkhove, head of the emerging diseases and zoonoses unit at the World Health Organization, told me that the WHO so far has found few truly asymptomatic cases, in which a patient tests positive and has zero symptoms for the entire course of the disease. However, there are many cases where people are “pre-symptomatic,” where they have no symptoms at the time when they test positive but go on to develop symptoms later.
“Most of the people who were thought to be asymptomatic aren’t truly asymptomatic,” said Van Kerkhove. “When we went back and interviewed them, most of them said, actually I didn’t feel well but I didn’t think it was an important thing to mention. I had a low-grade temperature, or aches, but I didn’t think that counted.”
The WHO sent a team to China and visited community centers, clinics and hospitals, and transportation hubs. Through their data collection, the team found that about 75% of people who were initially classified as “asymptomatic” went on to develop symptoms, she said. This matches up with the CDC’s findings at the nursing facility in Washington. Of the 13 positive patients who initially reported no symptoms during testing,10 later developed symptoms.
But ultimately, the only way to really find out how many asymptomatic COVID-19 carriers are out there would be to conduct blood tests across large swaths of the population to look for antibodies, which are a type of protein that provide evidence that a person’s immune system did battle with the coronavirus. Tests that can look for these antibodies are now being developed in several countries.
For the purposes of containing the outbreak right now, however, Jeffrey Shaman, a professor of environmental health sciences at Columbia University’s Mailman School of Public Health, says the focus on asymptomatics is a bit of a red herring.
“In some sense, symptomatic versus asymptomatic isn’t really the appropriate dividing line” for us to be focusing on, he said. “The appropriate dividing line is documented versus undocumented infection.”
What Shaman means by “documented” is people who are identified as being infected, either because they were sick enough to go seek care or were tested through contact tracing, which is when public health officials track down all the contacts of someone who tested positive. The “undocumented” could be people who have symptoms but didn’t get tested, because of lack of access to testing, dislike of doctors or sheer stoicism — or more concerningly, people who had no symptoms or such mild symptoms that they decided to just carry on with their daily lives.
“Maybe they pop some ibuprofen, but still go to work, still get on public transportation, still do all the things we normally do, and the consequence of that is those people with mild infections — as well as if they’re truly asymptomatic — are taking the virus out into the community, and they’re spreading it far and wide,” Shaman said.
Shaman and colleagues published a study in the journal Science on March 16 in which, using a statistical model, they estimated that 86% of all infections in China were “undocumented” prior to Jan. 23, when Chinese authorities cut off Wuhan, canceling all planes and trains leaving the city. This would help explain the rapid spread of the virus across the country, they said, concluding that their findings “indicate containment of this virus will be particularly challenging.”
The disease IS spread by liquid “droplets.” But the human body has lots of ways of creating these minuscule, virus-laden flecks.
If there are thousands of asymptomatic or pre-symptomatic people out in public, how are they transmitting the disease, if they’re not coughing or sneezing? After all, as I’m sure many of us have heard, this disease spreads primarily via droplets.
The WHO’s Van Kerkhove said research so far shows that liquid droplets are necessary to transmit the virus, and they need to go from the infected person’s mouth or nose into someone else’s eyes, nose or mouth. (People can also get infected if they touch a contaminated surface where a droplet has fallen onto and then touch their eyes, nose or mouth.)
But sneezing and coughing aren’t the only ways droplets get transmitted.
“People clear their throat,” Van Kerkhove pointed out. “Some people spit when they talk.” I winced.
Angela Rasmussen, a virologist at Columbia’s Mailman School, provided more vivid descriptions for my mental tableau. “Droplets are not necessarily huge, like globs. We release respiratory droplets when we speak.”
“When you go outside and it’s really cold out and you see your breath fog — that’s respiratory droplets,” she said.
This doesn’t mean that the coronavirus is being transmitted as an “aerosol,” which is the term that many researchers use when virus particles remain suspended in the air for long periods of time. That applies to the measles virus, for example, which is why that microbe is so incredibly contagious.
However, it does mean that if you’re standing right next to someone who is infected and they’re talking to you, or, say, if you’re in a room full of singers who are projecting their voices in an enclosed space, there are going to be droplets in the air, and yes, you could inhale them.
What’s still fuzzy is exactly how far one needs to stand in order to be ideally protected from coronavirus droplets. The WHO says 1 meter, or 3.2 feet. The CDC says 6 feet. Lydia Bourouiba, a fluid dynamics expert at the Massachusetts Institute of Technology, published a paper last week that said that “peak exhalation speeds” can create “a cloud that can span approximately 23 to 27 feet.” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, later called the study “terribly misleading.”
While the exact measurements are being debated, the experts I spoke to said that if you have to leave home, staying outdoors is the safest bet, since open air can help to “dilute” any potential microbes that reach you. While, of course, this isn’t free of risk, one has to balance that risk against, for example, the mental and physical health benefits of going out for a run. So keep going out to exercise, the experts said. Maintain a 6 foot distance, at least.
You’re likely most infectious right after you contract the virus, possibly before you know you’re sick.
So we have a virus that can transmit from one person to another, standing a few feet apart, in the course of conversation, perhaps helped along by a few errant throat clearings, while the infected person either didn’t have any symptoms yet or had a few minor body aches they didn’t think much of.
That’s already a recipe for a bad outbreak, but this coronavirus has another aspect that’s helping to amp up its contagion factor. Studies are now finding that people are shedding more virus during early stages of the disease rather than the later stages.
The term “shedding” may bring to mind my cats, whose fluff seems to evade even my most ardent of vacuuming attempts, but it doesn’t actually mean that virus particles are being emitted off patients’ skin in an infectious cloud. It’s a term used by researchers measuring the amount of viral RNA from someone who is infected, from a sample gathered via a method like a throat swab.
When nurses at one Washington State hospital complained about having to use expired respirators, they allege that staff were ordered to remove stickers showing the equipment was years out of date.
A study of 94 patients in Guangzhou, China, found “the highest viral load in throat swabs at the time of symptom onset” and concluded that meant that patients would be most infectious right before or at the time when symptoms started appearing. That study was published online as a pre-print and has not yet been peer-reviewed, but lead author Dr. Gabriel Leung, dean of medicine at the University of Hong Kong, said it has been accepted for publication in the journal Nature Medicine. Another study, also conducted by researchers in Hong Kong and published in the journal Lancet last week, found that viral load, this time in a saliva sample, was “highest during the first week after symptom onset and subsequently declined with time.”
The authors of the Lancet paper noted that this profile contrasted with COVID-19’s coronavirus cousins SARS, where the peak viral load was around 10 days, and MERS, at the second week after onset of symptoms. COVID-19’s “viral load profile” actually appears to be more similar to the flu, the authors wrote, which also “peaks at around the time of symptom onset.” Viral load is thought to correlate with a patient’s ability to infect others, and when the peak comes later on during the course of disease, it’s more likely that a patient will have already sought care, been tested and either started treatment or gotten instruction to stay isolated.
The high viral load early on in the course of disease for COVID-19 patients “suggests that [the virus] can be transmitted easily, even when symptoms are relatively mild,” wrote the authors of the Lancet paper. This finding “could account for the fast-spreading nature of this epidemic.”
All of this makes it extra hard to set workplace standards.
Against this wily virus, it’s difficult to set comprehensive guidelines. “What we recommend is if you’re feeling unwell, stay home,” said the WHO’s Van Kerkhove. That sounds simple, but after our conversation, I was doubtful as to how to carry this out. What counts as “unwell”? If I wake up with a scratchy throat, how can I tell if that’s seasonal allergies or a potential early COVID-19 symptom? When’s a headache just a headache?
I’m fortunate that I’ve been able to work from home for the past month and rarely need to leave my apartment. But many aren’t that lucky. My colleague Michael Grabell recently wrote about workers in the meatpacking industry who often don’t have paid sick days and work shoulder-to-shoulder. Even if on paper, their employers say they “don’t want team members who feel sick to come to work,” it’s unclear what counts as “sick” enough that they won’t get in trouble.
I asked the CDC, given what its own studies are finding on asymptomatic transmission, how workplaces are supposed to set policies, and the agency directed me to this page, which says: “Employees who have symptoms (i.e. fever, cough, or shortness of breath) should notify their supervisor and stay home.”
Like the WHO instructions, that really doesn’t seem to address the questions posed by a virus that can be spread by people before they experience symptoms. But it’s also understandable why agencies are setting guidelines around black-and-white things like fevers (which are objectively measurable) and coughs (which is also a binary call). It’s pretty much impossible for the CDC to weigh in all the possible symptoms that this coronavirus might cause, especially the more subjective ones like mild headaches or fatigue, even if they could turn out to be early COVID-19 symptoms for some.
Dr. Raphael Viscidi, a professor of pediatrics at Johns Hopkins School of Medicine who worked on a vaccine for the SARS coronavirus, notes that there are different standards being asked of the general population and of essential workers, for good reason.
“On a population basis, the message has to be strong, it has to be consistent, and it has to be repeated: We have to exercise maximum social distancing,” he said. “But then you start saying, well, what about the people that have to go to work?”
Hospitals that are short-staffed don’t have the luxury of having conservative policies and telling staff to stay home and quarantine themselves before they exhibit symptoms, even if they’ve been exposed to someone who has a confirmed infection.
“The problem is we need the health care responders, because we have to care for the critically ill, so there’s probably going to need to be an exception,” said Columbia’s Shaman. “And they’re going to have to rely on their PPE, the personal protective equipment, to prevent them from spreading it to other people.”
Viscidi acknowledged: “You are giving one message to the people you’re asking to work and another message to the general population. For sure, some people are forced to take slightly greater risks.”
We’ve got to fight this virus with all we’ve got. Here’s how we do that.
Since symptoms-based policies alone cannot be perfect, we need to turn to other strategies to catch the people who slip through the gaps presented by a broad “If you’re feeling unwell, stay home”-type recommendation.
In recent days, there’s been a new enthusiasm for masks, with many calling for widespread use among the general public. The idea there is that masks could help prevent droplets from traveling far, particularly from an asymptomatic person who doesn’t yet realize they’re infected.
Leung, from the University of Hong Kong, is a fan of this idea. “Wear a mask, preferably universally in public spaces,” he said, when I asked him how to solve the problem of asymptomatic transmission. But he also pointed out that there’s a practical hurdle to this plan — “Of course this is not possible for some places where there are mask shortages even for hospital workers,” which would be most of the United States.
After months of saying that healthy individuals should not wear masks, administration officials are now considering guidance for much broader, communitywide use of masks, Fauci told CNN on Tuesday.
In an absence of an abundant supply of masks — which, by the way, also need to be worn properly to provide protection — both the WHO and CDC stressed how important social distancing was. “COVID-19 spreads between people who are in close contact with one another,” the CDC said in a statement. “That’s why the CDC recommends staying at least 6 feet away from other people, so someone doesn’t spread the disease if they are sick or are exposed through contact with someone who is sick.”
Not only can social distancing protect you as an individual, but the better the general public is at adhering to these guidelines and staying at home, the less virus will be circulating in the public to potentially infect paramedics, grocery store workers and public works employees and other essential staff.
For workers who absolutely have to turn up in person, Columbia’s Rasmussen explained to me that dose also matters. We understand this instinctively. If someone infected sneezes straight at you from a foot away, splattering your entire face with wet gunk, you’re going to feel more nervous about your likelihood of getting sick than if a single virus landed in your mouth.
“It’s not always as simple as you come into contact with a single infectious particle and you’re going to be infected,” Rasmussen said. “You usually have to have a certain number of those particles in order for them to evade the immune system, get past the mucus barrier that’s in your nose and throat, come into contact with a cell that has the virus receptor on it, and then get into the cell and start replicating.”
So increasing the chance that the virus will be “diluted” is important. That means workplaces like meatpacking factories and delivery warehouses should do whatever they can to space out their workers, and not have meetings en masse in indoor spaces, where droplets are likely to persist and don’t have a chance to be carried away by wind. And of course, companies should have generous sick leave policies, so workers can err on the side of caution if they do feel unwell.
And let us not forget about testing. Testing is critical, because it can let people know if they’re sick before symptoms emerge and prompt them to self isolate. At a big picture level, testing helps public health officials know where the disease is spreading and better allow them to direct resources and responses efforts.
I was wrong to ever think that curbing the novel coronavirus could be simple. It is truly a dastardly bug. But I’m confident we can be smarter. Even if COVID-19 doesn’t vanish and becomes a seasonal illness, if we give it all we’ve got, I think we stand a good chance of getting this stealthy virus under control.
What you learned to do isn’t working. 6 ways to begin to turn your life around.
We often struggle because our old coping styles no longer work.
Knowing your old dysfunctional patterns helps you know how to begin to run your life better.
Discover what you can’t do and experiment with acting differently.
Life can deliver its share of troubles and we step up and handle them as best we can. But, for some, their struggles seem never to end. While they, too, are doing their best, what often fuels their difficulties is how they are running their lives. They seem to repeatedly fall into the same potholes, replicate the same dysfunctional patterns, and react to problems in old ways that no longer work.
If this seems to be true for you, maybe it’s time to step back, stop doing what isn’t working, and begin replacing this outdated psychological software with upgraded versions. Here are some of the most common potholes and patterns to stop alongside their new-and-improved replacements. See which resonate most with you:
Stop being a victim
You’re upset because your partner always brings up that incident at Christmas that he knows makes you angry. You’re tired all the time because you’re always going a hundred miles an hour juggling work, kids’ demands, and everyday life. The core problem here is that you see yourself as a victim of others and their reactions, a victim of the life that you have created.
What to start doing: Yes, you can’t control your partner; you feel trapped in a lifestyle that drains you. But most of all you’re not taking responsibility—for your emotions and your reactions, for the choices you make even when you feel like you are not making choices.
Stop being emotionally driven
Being emotionally driven easily overlaps with feeling like a victim. What we’re talking about here is you running your everyday life based on how you feel. You’re tired, so you don’t mow the lawn or do your taxes; you’re overwhelmed about the new project at work, so put off tackling it; it’s already 2:00 pm, the day is shot, and so you mentally kick back and coast—you’ll tackle it tomorrow.
Folks who have high anxiety or who have AD/HD are often emotionally driven: They do what they do based on how they feel. The problem with this is that you understandably avoid what you don’t want to do, what is uncomfortable, and don’t follow through when the going gets tough.
What to start doing: The underlying problem is that your emotional brain is driving your life rather than your rational brain. It’s time to stop your rational brain from being a passenger and to allow it to become the driver: time to learn to act despite how you feel; time to develop some perseverance, some discipline so your feelings aren’t constantly derailing you from success.
Stop being passive
It’s okay; that’s fine; no problem; whatever. If you find yourself saying these often, you probably get kudos for being laid back and accommodating, and as an extra bonus, you avoid a lot of conflict and confrontation. But it comes at a cost: by going along and essentially letting others make choices for you, you are living the life of a child rather than an adult who shapes his life by making his own decisions. Periodically, you may find yourself feeling resentful; you may flare up and be self-destructive. Rather than living a life that reflects your unique purpose, the moral of your life is to not make waves, not get into trouble.
What to start doing: While those who are emotionally driven pay too much attention to their emotions, those who are passive tend to not pay enough attention to them. If you feel like it’s time to stop being passive, you have two skills to develop: One is listening to your gut, paying attention to what you don’t like, don’t want to; two is doing something with it.
Speak up, be assertive, tell others how you feel and think. Even if it takes three days to figure out how you feel, that’s fine; it’s okay to take baby steps. All you have to do is act. Not perfectly, not because you expect some magical outcome, not because it will make someone else happy. Simply speak up and act rather than leaning back and doing nothing.
Stop being a martyr
You volunteer for every committee; you’re always doing for others. That’s fine if that is part of your values, your vision of a good life. But all too often, it’s about anxiety, walking on eggshells. While the story you tell yourself is that you are just being a good person, you’re being over-responsible and being good so others like you, to avoid the conflict that may come from saying no. You can tell when you are losing control of your life when you get burned out, or, like those who are passive, you periodically feel resentful that others aren’t appreciating what you’re doing or are not pulling their weight. If this happens to you, your life is out of balance; you’re being a martyr.
What to start doing: Like the others, realize and acknowledge when this is happening. Next, do what you struggle to do. Keep your hand down when they call for volunteers; learn to say no. Change your expectations about what you expect from others in return. Use your burnout as a wake-up call to tell you that you are not living your life.
The vacation your partner planned was “okay.” The salary increase wasn’t what you expected but “understandable.” Good for you for not overreacting and being critical. But…if you are doing this a lot, if your life is an endless series of compromises and watered-down experiences, if you are always settling, eventually it’s going to back up on you. Yes, it is good enough, but like that poor woman who in old age regretted eating too many beans and not enough ice cream, do you too need to learn to slow down on the beans and try going for more ice cream?
What to start doing: Speak up and try not to rationalize that what you get is good enough, or that it’s probably what you should only expect. You deserve more than you think; you can get more than you believe you can. And you have to believe it and try living it to find out.
Stop cutting and running
The relationship isn’t working out—you ghost him. Your supervisor is awful, and you quit. Your mother makes some nasty comments about your partner, and you decide you’re done and never want to talk to her again.
This is about coping with hurtful situations by cutting them off—the situation, the pain, the person. The problem here is your anxiety and your coping style works so you keep doing it. But the downside is that your life becomes a series of emotional cutoffs and unresolved problems; the hurt isn’t ever really resolved. You never learn the lessons that life can teach you. You stay the victim; your life is an accumulation of problems swept under the rug.
What to start doing: Don’t run; talk. Don’t run; tackle the problem. Your supervisor may still be a monster, your mother sticks to her nasty ways, but you’ve pushed back. You’ve been that adult rather than the scared, angry 10-year-old who runs away. At some point, what you say will be heard and the problem will be fixed.
The theme here is clear: Figure out what you can’t do, where you settle, resign, go on auto-pilot, or avoid what is hard. Stop doing it. Try doing the opposite.
The NOLA Project theatre company is getting a new leading artistic
Ensemble member Brittany N. Williams (HARRY AND THE THIEF, SPARE MISSION 1) has
been tabbed as TNP’s first-ever Co-Artistic Director. She will assume the role in January of
“I’m thrilled to be joining The NOLA Project team as Co-Artistic Director,” Williams said.
“Working with this brilliant group of artists as an ensemble member has been wonderful and I’m
excited to help us grow and evolve as a company and as part of the greater New Orleans
Williams, is an actor, singer and writer. You last saw her on stage in TNP’s last in-person production,
HARRY AND THE THIEF (Vivian), at the Contemporary Arts Center in 2020. During the
pandemic, she penned one of the company’s four original PodPlays as well as provided her
voice for it and two others. Outside of TNP, Williams’ credits include Stage Door Songbook: Cole
Porter (Susan), Mary Full of Gray (Mary/writer) and she was the The National World War II
Museum’s 2019 Stage Door Idol winner.
Williams will share Artistic Director duties with current AD A.J. Allegra.
“I couldn’t be happier to announce the addition of Brittany N. Williams to our new shared
leadership model at The NOLA Project,” Allegra said. “She is a passionate, smart, and creative
theatre artist with an incredible depth of knowledge and experience. The pandemic-forced
pause in our work allowed our ensemble to look inward at ways in which we could strengthen
and improve our organization. And, I am so pleased that in the tradition of NOLA Project, and the
spirit of ensemble, we selected one of our own to co-lead the next era of The NOLA Project.”
Originally from Baltimore, MD, Williams performed across three continents – including a year
spent as a principal vocalist at Hong Kong Disneyland – and several US states prior to
relocating to New Orleans in 2017. Some favorite out-of-town credits include Universal Robots
(Helena), Margaret I (Joan of Arc), Bob Marley’s Three Little Birds (Nansi – Helen Hayes Award
nom.), Antony and Cleopatra (Soothsayer/Clown), and Lear (Cordelia/Fight Captain). Williams
holds a BFA in Musical Theatre from Howard University and an MA in Classical Acting from the
Royal Central School of Speech & Drama.
Last time we saw her
Williams’ latest work will be on display this fall when The NOLA Project and the New Orleans
Museum of Art present her new play, TELL IT TO ME SWEET, in the Besthoff Sculpture Garden.
For more information on the original outdoor production, running October 29-November 14, please visit
In an unprecedented move, two opponents endorse each other during an election
District “C” Councilmember Kristin Palmer and District “D” Councilmember Jared Brossett announced that they are taking the unprecedented step of endorsing each other for the Council At-Large before the November 13th Primary. Palmer and Brossett are running against each other in a four-way race for the Division 2 Council At-Large seat that includes former State Senator JP Morrell. Typically opponents in the same race do not endorse the other until after one loses.
Why would they do this?
The opponents see an opportunity to move voters away from their primary opponent JP Morrell. Polling shows Morrell making the runoff with either of them. For Palmer this is a political calculation. In addition to politics, the personal dispute between Brossett and Morrell just got revved up significantly.
Brossett and Palmer have worked together on the Council on multiple issues, including the $15 an hour minimum wage for city employees. They worked on the growing Airbnb problem. But this unforeseen action is not only shocking but politically risky for each of them.
We will see how or if this unprecedented move affects the primary.
Stop Me If You’ve Heard This One Before
Wait, the party out of power was complaining about the party in power trying to raise the debt ceiling? What year is it? I feel like we’ve been here before. Some would call this deja vu. Others would call it a glitch in the Matrix. But this is the debt ceiling debacle.
This episode played out predictably. I had trouble deciphering if it was a new one or just a re-run. At the heart of it all was the funding of President Biden’s $3.5 trillion Build Back Better budget.
Democrats, the party in power, we’re trying to rally two holdouts in the Senate. And Republicans were running around talking about how the budget would usher in the total ruination of the country. This all made for high drama.
HOLDOUTS 1 & 2
Senator Krysten Sinema, a Democrat from Arizona, also known as holdout #1, got jacked up in a bathroom by some citizens who still actually take national politics seriously. Not like literally jacked up, but you know, confronted, politely questioned in public about why she’s stalling President Biden’s budget.
Holdout #2, Senator Joe Manchin, a Republican who identifies as a Democrat, did what he usually does in highly partisan showdown. He got squeamish when Democrats started asking how he’ll be voting. Manchin subjected his fellow Democrats to a lot of public foot stomping over the green energy policies included in the budget. This shouldn’t be surprising. He’s a Democrat from West Virginia, a coal mining state that has voted Republican in every presidential election since 2000.
Meanwhile, Republicans were dealing with their own internal drama. In one breath, it wouldn’t make proper partisan sense to be seen voting with the Democrats. But in another, it also wouldn’t make much political sense to sit back and watch the Democrats nuke the filibuster.
The filibuster is the only weapon a minority party in the Senate has to influence legislation. It takes 60 votes to break one, which is something no party in recent memory has had. So, a compromise is forced. Naturally, the threat of losing the filibuster scared the bee gee bees out of Mitch McConnell. So, he did the unthinkable: he rallied votes on behalf of the Democrats.
In the end, McConnell betrayed his party (their words) and did just enough to throw Democrats some cover fire until December. Instead of actually voting to raise the debt ceiling to cover the budget, Republicans and Democrats agreed to raise it just enough to cover the bills until December. The price – $480 billion.
People who try to make sense of this ask: why when they vote to spend money we don’t have, they just don’t also raise the debt ceiling to cover it?
The answer: because there’d be no incentive to curb spending. Imagine if every time you were about to max out your credit card, the bank just increased your credit limit. You know all the trouble you’d get into?
Right now, the federal government is in $28 trillion of trouble, mainly because it has just that – unlimited credit. The debt that incurs is usually only a problem to the party that’s not in control of spending.
Over the years, the rhetoric surrounding the budget and federal spending has degenerated to stomp speeches and red meat for constituents. You can look for this to intensify until one party, probably Republicans, actually do something crazy like block the other party from raising the ceiling. Then all catastrophes will break loose.
But the good people in Washington made sure that is something we won’t have to worry about until Christmas. Think of it as a premature lump of coal in your stocking. In a month and a half, we’ll actually see if they will take all the merry out of Christmas.
By TiOnka Writez
On September 9, 2021, President Biden signed the executive order to mandate the vaccination of all federal employees and employees operating with one hundred people within the private sector by 12/08/2021. The Safer Federal Workforce Task Force issued guidelines. Unvaccinated employees are to submit a negative COVID-19 test result every 72 hours before reporting for duty. In true American fashion, the edge of a life-altering event stirs dissent. We understand the need to stop the virus. But the plan of tampering with the working classes’ lively hood is a bit extreme.
The three most common vaccine questions are:
1) Are you vaccinated?
2) When will you get vaccinated?
3) Why won’t you get vaccinated?
Depending on who is asking, you may need to ere on the side of caution when preparing to answer. The decision to vaccinate or not is causing a rift in home and work environments worldwide. The unvaccinated now face hostility. How did we, as a “united” nation, get here?
Now, I know what you are thinking. This COVID-19 virus is no joke. Humans have never faced this before. And you cannot fathom why anyone would object to a scientifically formulated and tested solution. However, The unvaccinated have real issues to consider. Initially there was confusing and mixed messaging. For instance, medical professionals advise patients to take the “shot” to save lives. But a liability waiver is necessary to proceed with vaccine administering. And multiple contracting cases and deaths by COVID-19 are on record in vaccinated individuals. Warnings of use labels, of course, are available on all over-the-counter and prescribed medications. But the difference here is choice and the ability to proceed with informed consent.
The first amendment (“Freedom of Speech”) means freedom of expression. If individuals express their desire not to receive the vaccination, accept their decision. Amidst the debt ceiling debate, now is not the ideal time to threaten Americans’ job security. Stifling employee wage-earning potential and restricting medical coverage for COVID-19 testing is counterproductive to replenishing a depleted economy.
We should develop a solution that considers the position of all parties involved. The most relevant question here is, who or what constitutes a valuable person?” The answer is simple; every living person holds value. And their opinion matters. Don’t bully or shame people for staying strong in their conviction. Placing restrictions on employment is not the best create trust and cooperation with the citizens you are attempting to save.
To vaccinate more people, appeal to what matters to them. Implement a solution to address daily issues like the unstable workforce or unjustly inflated insurance rates in certain areas. Address their concerns without gaslighting them, overlooking how they perceive your message or threatening them with excessive force.
In my recent pandemic rant, I railed against adults, who, for no good reason, refused to get vaccinated. I argued that it constitutes reckless endangerment of our children. As I write this, yesterday (August 25), a baby and a 14-year-old football player died in Louisiana of COVID.
My daughter Rebecca, who is a physician and has a nine-year-old, thought my rant was spot on. My son, Jonathan, also a physician and whose 8-year-old just recovered from COVID, could relate to my frustration, but he thought I should be more understanding of the unvaccinated. And my unvaccinated friend V called me up to say I can’t just call her a baby killer. I didn’t, and yet . . . what do the facts say?
I know V extremely well and love her. But I can’t for the life of me see how she reaches her anti-vax conclusion. She’s not stupid. In fact, she is brilliant. She doesn’t buy conspiracy theories. She’s never been betrayed by doctors or the medical establishment. She’s generous and community oriented. But she’s not a Republican. And yet she’s one of those people I referenced in my rant that you can’t reason with.
I have to grant, therefore, that my son’s approach may be more useful. He had a patient last week, an elderly woman with underlying conditions, who refused to get the shot because she was sure that the Lord would take care of her. He affirmed her strong faith and said he wanted to tell her a story/joke. You know, the one about a person in dire straits who refuses three rescue offers because she believes God will save her. She dies and then takes God to task for not answering her prayers. And God says, but I sent you X, Y, and Z.
Jonathan, being a homeboy, gave it the New Orleans spin of a woman on a rooftop after Katrina. Boats and a helicopter came to the rescue, and she waved them away. His patient laughed uproariously and said she’d think about it. He had occasion to call her several times as a follow-up to their appointment asking various questions about her medical history. On the fourth call, she said she had some surprising news. She got the shot.
“Great!” he said. “What made you decide?” She said she shared the hilarious story with a friend. When Jonathan called, she said that was God’s second message to her. When he called again – that was God’s third message. “I got in my car,” she told him, “To drive to the Walgreens. And if nothing happens on the way, I’ll know that God wants me to get the shot.”
Jonathan is 1 for 0 on convincing people. I am 0 for 0. So I have to admit, as good and righteous as my rant felt – yes, his approach is proving more effective.
Breakthrough infections are to be expected, but it doesn’t mean the COVID-19 vaccines aren’t working.
by Linda Geddes
As a growing number of people in wealthy countries get fully vaccinated, questions are being asked about why some of them are still becoming infected with coronavirus, in some cases even being hospitalised with COVID-19. Such “breakthrough infections” are to be expected, but just how common are they, and what should you expect if you test positive for SARS-CoV-2 having been fully vaccinated?
No vaccine is 100% effective. Even the measles, mumps and rubella (MMR) vaccine – one of the most powerful disease prevention tools we have – is only 96% effective against measles after two doses, while the seasonal flu vaccine is only 45% effective. Still, it is estimated to prevent 130,000 flu deaths in the US alone each year.
COVID-19 vaccines can and do protect the majority of people from hospitalisation and death, which is why as many doses need to administered around the world as rapidly, and equitably, as possible.
Clinical trials of the Pfizer/BioNTech and Moderna vaccines found them to be 94-95% effective against all symptomatic COVID-19 disease after the second dose. This doesn’t mean that we’d expect 5-6 in every 100 people to develop COVID-19, but that there was a 94-95% reduction in new cases of the disease among people who had been vaccinated, compared to unvaccinated individuals. China’s Sinopharm vaccine was 78% effective and the Oxford/AstraZeneca vaccine was 67% effective in clinical trials. Protection against hospitalisation or death from COVID-19 was even higher.
With large numbers of people being vaccinated, and as almost all COVID-19 restrictions are lifted in some countries, it is inevitable that a small proportion of fully vaccinated individuals will become infected. An even smaller proportion will become seriously ill and die. What’s important is that the risk of a serious outcome is vastly lower for those who have been fully vaccinated against COVID-19, compared to those who have received no vaccine doses.
In the US, the Centres for Disease Control (CDC) has been quantifying the number of breakthrough infections, which it defines as cases in which SARS-CoV-2 is detected in a respiratory specimen 14 days or more after an individual has completed all recommended vaccine doses. Between 1 January and 30 April, 2021, 10,262 breakthrough infections were reported from 46 US states. At that time, 101 million people in the US had been fully vaccinated against COVID-19. For comparison, there were 11.8 million COVID-19 infections recorded during the same period – so these vaccine breakthrough infections represented only a tiny fraction of the total number. Also importantly, not all of these individuals reported feeling ill – 27% of those experiencing a breakthrough infection were asymptomatic.
Since 1 May, the CDC has only been identifying and investigating those breakthrough cases in which the individual was hospitalised or died due to any cause (i.e. not just as a result of COVID-19). As of August 2, 2021, more than 164 million people in the US had been fully vaccinated. In that time-span, the CDC identified 7,525 patients with a breakthrough infection who were hospitalised or died.
Shorter milder illness
Another recent analysis, published in the New England Journal of Medicine, analysed breakthrough infections among almost 4000 essential and frontline workers in Arizona, USA, vaccinated with either the Pfizer/BioNTech or Moderna vaccines. Of the 205 coronavirus infections identified, the majority occurred among unvaccinated workers – with only five fully and eleven partially vaccinated individuals testing positive between mid-December 2020 and mid-April 2021. Those who had received at least one vaccine dose had a 40% lower viral load (the amount of live virus a person carries) on average, a 66% reduced chance of testing positive for COVID-19 for more than a week on a PCR test, and a 58% lower risk of experiencing fever, compared to unvaccinated individuals. Their other symptoms also subsided about six days earlier and they spent two days fewer ill in bed, on average.
“The mechanisms by which vaccination attenuates COVID-19 are largely unknown, but the effect is probably due to recall of immunologic memory responses that reduce viral replication and accelerate the elimination of virally infected cells,” the researchers wrote.
The initial clinical trials of COVID-19 vaccines were conducted before the emergence and spread of new variants, such as Delta, which are able to overcome the immunity afforded by COVID-19 vaccines to some degree.
In a recent study, which has not yet been peer reviewed, researchers at the Indian Council of Medical Research explored the possible reason for an increased number of breakthrough infections reported across the country. They collected nose and throat swabs from 677 individuals who had tested positive for SARS-CoV-2 after receiving one or two doses or India’s Covaxin vaccine, the Oxford/AstraZeneca vaccine, or the Sinopharm vaccine. Genetic analysis revealed that in 86% of cases, the breakthrough infection was triggered by the Delta variant – although this could simply be a reflection of the variant’s prevalence at that time.
Other research also indicates that the vaccines may be less effective at preventing coronavirus infections in the face of the Delta variant. A recent study published in the New England Journal of Medicine found that two doses of the Pfizer/BioNTech vaccine were 88% effective at preventing symptomatic infections, whereas the Oxford/AstraZeneca vaccine was 67% effective. A single dose of either vaccine was only 37% effective, underscoring the importance of receiving both doses.
However, COVID-19 vaccines still appear to be highly effective at preventing hospitalisation and deaths from the disease. Data from Public Health England, where the Delta variant now accounts for most COVID-19 cases, suggested that the Pfizer/BioNTech vaccine was 96% effective against hospitalisation with Delta after 2 doses, while the Oxford/AstraZeneca vaccine was 92% effective after 2 doses.
Living with the virus
Most experts agree that COVID-19 is now effectively endemic, meaning it will continue to circulate in pockets of the global population and trigger outbreaks, although it may pose less a danger over time. Many had hoped that once a certain proportion of the population had been infected, or vaccinated against the disease, herd immunity would kick in, meaning those who hadn’t encountered the virus would be buffered from infection by those who were already immune to it. The spread of Delta, and other variants that can partially escape the immunity provided by vaccination or previous infection has raised the threshold for herd immunity, with some even questioning whether it can be achieved at all. However, COVID-19 vaccines can and do protect the majority of people from hospitalisation and death, which is why as many doses need to administered around the world as rapidly, and equitably, as possible.
Could New Public Board Do a Better Job?
In New Orleans, the city council regulates the power company. This is a unique occurrence. Everywhere else across the state, the state-run Public Service Commission regulates the power companies for local municipalities. The commission regulates insures that every district has safe and reliable power at reasonable rates. Utility regulation is complex and important. Utility commissions make life changing decisions. Should the city council regulate Entergy?
The state’s Public Service Commission has five commissioners that represent different parts of the state. In New Orleans, while the entire council must approve any regulation, the utility committee interacts directly with the power company. This unique authority provides citizens direct access to all of the regulators. That council members are the regulatory body, a heightened sense of politicization affects the policy decisions.
Is this the best solution?
The notion of local control seems great. Now, council members have direct management of the power company with access to the company executives circumvents excessive bureaucracy. And for the company, New Orleans officials directly hear their concerns. Win-win right?
The complexity of utility regulation is significantly high. Even the state’s commission hires advisors and experts to help it understand their choices. And the New Orleans City Council annually spends over a million dollars on utility consultants and attorneys. Finding the sweet spot – a financially strong and profitable power company that provides safe, reliable and affordable electricity – is an extreme challenge. Add in climate change and the stakes get higher. Our Hurricane Ida experience exposes our vulnerability. 100% of the metro was out of power.
The council is the legislative and partly administrative branch of city government. New laws, potholes, marijuana laws, city budget, crime, internet and cable TV, housing, water and land use are some of the important work done by the council. Our members serve four-year terms. The approve the city budget. The council has several subcommittees that meet regularly in addition to the normal every other Thursday regular meeting.
Entergy New Orleans(ENO) is a subsidiary of Entergy Corporation, the city’s only Fortune 500 company. ENO has been the power company in New Orleans for 99 years. And ENO is guaranteed a reasonable profit. They must provide always on electricity and gas to homes and businesses. Additionally, the company must maintain the power grid for the city. ENO attempts to maximize its’ profit through efficiency and minimizing expenses while continuing to provide high quality service.
The very nature of this business partnership requires informed and committed regulation. Business intends to make the most profit possible providing desired service or products. In the case of Entergy, cutting costs to increase profits might result in potential calamity. Some have claimed the tower that collapsed during the storm is a prime example. They say the rusted and twisted metal indicates lack of proper maintenance. Though not a part of ENO, this example provides insight into the difficulty regulators face. How to oversee the wide and complex power grid.
But the New Orleans City Council is much more than just a regulatory body. The city council must provide public policy, laws, budgets, and a host of other responsibilities. And the complexity of utility regulation is immense. Even our state commission hires consultants and law firms. Furthermore, none of the current council members is a utility expert. The field is a specialty that requires specific skills and knowledge. We ask too much of council members. They are already burdened with everyday city stuff to oversee a powerful company. Combine term limits to this equation and it’s no wonder that the same questions come up year after year.
Entergy is able to monetize our city government structure. Council members cycle off every eight years. New council members usually have no knowledge of the utility committee’s actions. Sometimes the new members’ campaigns were supported by ENO. Their ability to regulate may not be compromised. However, they may have more information about Entergy’s desires than the city’s position.
Therefore a diverse new board comprised not only of City Council members, but also citizens, independent industry experts, Entergy representatives, the New Orleans representative on the Public Service Commission, and university representatives should serve staggered 8-year terms. This board should only regulate ENO. This relieves burdened and inexperienced council members. This new board will ensure that the threats of climate change are mitigated. In other words, if we can not keep the lights on, then we no longer exist.
The new power and gas board of New Orleans means we have a strong city for another 100 years.
I’d like to speak to upper management. I don’t think the City Council’s Utilities Committee is making a big enough mess of its relationship with Entergy. Yes, I know, both sides have been throwing around the D word lately. But this is shaping up to be more of a public tantrum than a full-on split. I feel that any day now their beef will be settled behind closed doors with both sides vowing to never ever take each other for granted again. Public displays of affection will soon follow. And before we know it, the two will be back to old times. As responsible citizens we can’t allow this to happen. Can the city council be trusted to regulate Entergy?
The Committee is an abusive relationship with Entergy. It may or may not know this. But one thing remains clear: it is powerless to do anything about it. Entergy lies to the Committee at will. It subjects it to rounds of emotional and intellectual abuse. There was even a widely publicized bout of infidelity where it paid for a public display of affection.
Each time that this happens Entergy is either able to woo itself back into the Committee’s heart with words or money. Twice lately it has thrown a couple of million at the Committee, slapped it on the ass, and told it to go buy itself something nice. Afterwards, the cycle of abuse just starts all over again.
Clearly, the Committee is too compromised at the moment to be effective regulators of Entergy. As a result, we all to often find our homes reduced to dark, powerless caves, making it clear that we citizens are the ones caught in the middle. No more. But what are our solutions?
We can suggest the two seek counseling. An intermediary board can act as a go between, a regulator of the regulators. But then it’d become clear that the Committee’s role would be redundant. And the only logical thing to do at that point would be for the Committee and Entergy to split. That’s not going to happen. The Committee will never voluntarily breakup with Entergy. And despite all the hee-hawing and foot stomping, Entergy is never going to voluntarily breakup with the Committee either.
Maybe we can have a vote, some type of City Charter or City Council amendment to force a legal separation. Yes, the Committee would be hurt, and left feeling betrayed. But at this point, it may be the best thing for both parties. The Committee can disband, and the individual members can devote their time to areas they actually have expertise in. And we can find Entergy a new partner, an equal that will force it to be the best energy provider it can be. It’s a long shot, but who knows.
Meanwhile, a few suggestions for the Committee going forward:
If somebody tells you they can build a plant that’ll do this or that, as a regulator you should be able to look at the specs and determine if that’s the case beforehand. Yelling WTF afterwards is just not acceptable.
When hurricane season approaches, maybe, just maybe you should demand some type of state of the power grid report to identify any weak points that may need to be addressed. Otherwise, what exactly is being regulated?
Just do better. Somehow, someway. If Sean Payton can squeeze 7 touchdowns and 2 interceptions out of Jameis Winston, surely you can squeeze some type of consistent respect and energy out of your relationship with Entergy.
Hopefully, this makes its way to upper management. You know we citizens can be emotional too. And we tend to let that emotion out during elections. Don’t take that as a threat. Well…maybe you should. Or maybe you shouldn’t. I don’t know. Just find a way to keep the lights on.
You’ve likely heard this your entire life: Drinking water is one of the building blocks of good health. And, on a deeper level, proper hydration helps your brain stay alert, your cells function as they should, and your exercise performance operating at top gear.
And you know the dangers of dehydration: brain fog, feeling tired and/or dizzy, and that foul-smelling discolored nature of your urine—just to name a few.
But there’s another benefit to water, too, and it’s not one you might think of: weight loss.
Dietitians tend to recommend drinking water as one of the building blocks of a lifestyle that can lead to healthy weight maintenance. That said, the effective mechanism isn’t just water in, fat out.
“Oftentimes water is pushed to those seeking weight loss because there is a belief that water can ‘fill you up’ leading to eating less often or less volume come meal time,” says Kelly Jones, M.S., R.D.
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So because you’re filling up on water, the theory goes, you’ll be less likely to snack and can better control your hunger. Plus, when you are hydrated and eating foods that have high water content, you are more likely to have better hydration overall throughout the day to help manage weight.
“Poor hydration can mean that your body continues to seek out fluid through the foods you are eating though, which is why sometimes people feel as if they may eat less when they have water before or at a meal,” Jones says.
There’s some truth behind the claim that water can help you lose weight. That said, some so-called “experts” make it seem like H20 is an instant fat burner. Like, if you’re not carrying around a jug of water and drinking it at all times, weight loss is going to be a long, hard road for you.
Think of water more as a maintenance tool, not a magic bullet, for weight loss.
Rather than trying to use water to mask your hunger, sip water regularly throughout the day in an attempt to prevent feelings of thirst (a sign you’re already dehydrated) and then you may have a more regular appetite regulation throughout the day.
“Along with well balanced meals and snacks, adequate hydration may help you better listen to your hunger and fullness cues, helping your body reach the weight it is meant to be over time,” Jones says.
Still, though, beyond weight management, can water help you drop weight when you’re looking to slim down?
Can drinking water help you lose weight?
You’ve heard the old adage: “If you’re hungry, you might actually be thirsty.”
This is only sort of partially true.
Drinking water may help you curb your hunger in the short-term, but not so much long-term. “While volume of food and liquids puts pressure on the nerve cells in your digestive tract, sending some signals to your brain that you may be full, it doesn’t last for very long,” Jones says.
Jones continues:”Without intake of protein, fat, and fiber, proper satiety signals will not be released and if it doesn’t catch up to you very soon after once the water has left your stomach, it often will later in the day, leading to extreme hunger and potentially ease in overeating,” she adds.
So, in short, water can fill you up in a pinch, but only for a pinch.
How much water should you drink daily to help with weight loss?
On top of your baseline needs, experts recommend that you drink an additional 16 to 24 ounces of fluid starting around 3 hours before exercise, up to 1 liter an hour during exercise, and between 13 to 27 ounces per hour depending on conditions of your workout, says Jones.
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After your workout, you should replace whatever fluids you lost. By weighing yourself before and after your training session, you can calculate this need. “For every pound lost while moving, drink an additional 16 to 20 ounces on top of your baseline needs. Thirst is not a good indicator of hydration status and fluid needs,” Jones says.
Can you drink too much water?
It is possible.
“You drink more water than your kidneys can remove in your urine. This can cause too much water to collect in your bloodstream and an imbalance of fluids,” says Maggie Michalczyk, MS.., R.D.
While more risky for women than men, men can still over-do it with water, which can be life threatening.
“Excessive fluid intake occurs when the body has so much fluid that minerals such as sodium are diluted in the blood, leading to fluid imbalances in and out of cells,” Jones says.
“Known as hyponatremia, or low blood sodium, creates symptoms from nausea and fatigue to brain damage and death,” she says.
This is isn’t something to worry too much about—but it is a risk associated with excess water intake.
What about “water weight?” Can’t water make you weigh more?
Water weight is when the body retains fluids that would normally get filtered by the kidneys. “It’s usually temporary and doesn’t mean that you’ve gained weight, however can be discouraging for someone trying to lose weight,” says Michalczyk.
It might happen for a few reasons. “An increase in salt in the diet, and sitting for long periods of time (like on a long flight) can all be reasons why people gain water weight,” Michalczyk says.
Yet, you can help manage it. “Avoiding salty foods (like processed foods that usually contain a lot of salt), drinking enough water and exercising are all ways to prevent water weight and get it to go away,” Michalczyk says.
Carbs can also have an impact on fluid retention, because glycogen (storage form of carbohydrates) pulls in water.
“This explains why people on a crash diet with very little carbs lose weight right away but then tend to gain right back when they resume their normal,” Michalczyk says. It’s water weight that is being lost from the stored glycogen in our muscles—just another reason why slow, sustained weight loss is the way to go.
Do I have to drink water to lose weight?
Well, yes, everyone has to drink water, but we know what you’re getting at: Can’t you drink other things that aren’t water because water tastes so, well, boring?
Sure, but keep in mind that fluids that aren’t water (sports drinks, vitamin waters, flavored waters) often contain empty calories—the enemy of healthy diets.
One good non-water option is seltzer, which is usually no-calorie and extremely flavorful. That said, pounding seltzer after seltzer, might leave you feeling a little … bloated?
The Bottom Line
Overall, water can help you lose weight as a healthy lifestyle habit where you may control appetite better and go for less sugary drinks to quench your thirst, but pure water alone won’t really tip the scale for long-term changes.