Health

Fewer Children Died in 2020, Despite the COVID-19 Pandemic

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Since the global pandemic began, one of the grimmer features of daily life has been watching the coronavirus death count tick up and up as the months have gone by. With so much unnecessary death in 2020, it’s surprising that in many countries, at least according to preliminary numbers, there was one significant group that actually saw its death rates fall: children.

Data from the Human Mortality Database, a research project run by a global team of demographers, suggest that COVID-19 did not reverse years-long declines in child mortality, despite a mortality surge in the general population. Demographers, pediatricians and public-health experts say it’s possible that lockdowns and quarantines have prevented children from succumbing to deadly injuries and illnesses. But they also point out that other effects of the pandemic, such as lower vaccination rates and reduced prenatal care may increase childhood mortality rates going forward.

The database, jointly maintained by the University of California, Berkeley, the Max Planck Institute for Demographic Research in Rostock, Germany and the French Institute of Demographic Studies in Aubervilliers, France, publishes mortality figures for 38 countries on a weekly basis. As expected, the so-called “excess mortality”—the number of deaths in a population above a normal baseline—was consistently high throughout each country’s pandemic period. (There were a few exceptions like Australia and New Zealand, which managed to contain the virus with early and aggressive lockdown measures.)

When broken out by age, however, the data show that fewer children under age 15 died in 2020 compared with prior years, even after accounting for COVID-19-related deaths. Take the U.S., for example, where about 26,000 child deaths in 2020 have been recorded so far. That’s well below the average in recent years, as shown in the chart below:

 

At this point, it’s impossible to say with certainty how extreme an outlier 2020 was. Between January and mid-November, about 2,500 fewer children in the U.S. died last year compared with the average of the three years prior—a drop of about 9%. However, demographers caution that the 2020 tally is almost certainly undercounted due to lags in reporting. As the death records get updated in the coming weeks, the second half of 2020 will likely start to look more like the first half of the year, which clocked a 7% drop. That would put the yearly deficit at about 2,000 deaths below the 2017 to 2019 average.

It’s possible that, as longer death investigations begin to settle in the coming months and years, the gap between 2020 and previous years will shrink in terms of overall child mortality. But presuming 2020 child mortality remains lower than prior years once the data dust settles, it would be an extension of recent trends, says Magali Barbieri, the Human Mortality Database’s associate director. “One thing that’s happening is that mortality has been declining for the zero-to-14 group,” she says. “If you compare 2019 to previous years, you’ll see a deficit, as well.”

In any other year, a continuing decline in child mortality would be good news, but not unexpected. In a year like 2020, it’s astonishing. Given the deadliness of COVID-19 in so many demographics, it’s incredibly fortunate that children have been largely spared due to their effective immune system response to the virus that causes the disease. In the U.S., just over 100 children under age 15 died from COVID-19 in 2020. They account for 0.03% of the 376,000 COVID-19 deaths since the virus hit the country last spring and less than 0.5% of the 26,000 total child deaths from all causes. In a year characterized by catastrophe, that’s one small grace.

Explaining the drop in child mortality

“We are in a privileged historical position that, barring terrible tragedies, children live to grow up,” says Dr. Perri E. Klass, a New York pediatrician and author of the 2020 book A Good Time To Be Born: How Science and Public Health Gave Children a Future. Citing U.S. data, she notes that “most child deaths are in the first month of life, and they are linked to premature gestation and reasons that are connected to the circumstances right around their birth. We aren’t losing nearly as many children to the things that used to kill two- and three- and eight-year-olds, like diphtheria, sepsis, scarlet fever or polio.”

Indeed, the leading cause of childhood mortality in the U.S., after the newborn stage, is unintentional injury—things like drownings, car accidents, pedestrian fatalities and accidental suffocations, according to 2018 numbers from the U.S. Centers for Disease Control and Prevention.

The agency’s cause-of-death data for 2020 (with the exception of pneumonia, influenza and COVID-19-related deaths) won’t be available until the end of 2021. In the meantime, child health experts can only speculate how the pandemic is shaping the numbers. Several who spoke to TIME said it’s possible that lockdowns, quarantines and social distancing measures are keeping kids safer from physical and biological harm, even as they threaten social, emotional, and mental well-being. “If those data hold, and if it’s true that 2020 mortality was down, then it may well turn out to be around issues of safety, and of people moving less and driving less,” says Klass.

Some early reports support that idea: the U.S. Department of Transportation has estimated there was a 2% drop in motor vehicle traffic crashes during the first half of 2020 compared with the same time period in 2019. National drowning data are difficult to come by, but statistics compiled by Total Aquatic Programming, an aquatics consultancy that has tallied drownings since 2008, tabulated fewer child drownings in 2020 compared to 2019. Warm-weather places that publish running tallies of children who drowned, like Texas, Florida and Phoenix, Ariz., show similar numbers or modest decreases compared with recent prior years.

In addition to curbing injury rates, it’s possible the pandemic has kept young kids from getting severely ill. Influenza and pneumonia are leading causes of death among toddlers and young children, but last spring, researchers found that influenza, respiratory syncytial virus and other common respiratory viruses died out quickly in response to lockdown measures designed to target COVID-19—and they have not resurged, despite the onset of cold and flu season. (Klass points out that health protocols like wearing masks and washing hands don’t just prevent COVID-19 but other viruses, as well.)

Why it isn’t all good news

The problem, though, is that, in future years, we may see child mortality increase on a global scale due to the pandemic lockdowns of 2020 (and, perhaps, 2021). For instance, water safety advocates say that declined enrollment in swim programs coupled with a surge in demand for private pools could lead to more drownings. Also, delays in vaccinations for things like measles, fueled by school closures and suspended immunization campaigns in dozens of countries, could cause outbreaks of serious but otherwise preventable diseases. And reduced access to prenatal care during the shutdown could negatively affect fetal health.

On top of those concerns, stressors such as income losses, social isolation and ongoing health problems also could have lasting effects. “One cannot rule out the fact that the economic and social consequences of the pandemic on women of reproductive ages and their children had a detrimental impact on their health,” says Barbieri, whose preliminary research suggests that child mortality around the time of the 2008 economic recession increased among the poorest segments of the population.

Taken together, all these issues may end up setting back child mortality on a global scale. The outcome could be most dire in less developed countries, where health care infrastructure was already fragile, says Li Liu, associate professor at Johns Hopkins Bloomberg School of Public Health.

“Potentially, cases like preterm birth and congenital abnormalities may actually be going up, once we have all the data in,” she says. “We can speculate and come up with theories but we have to wait until data are available to test those theories.”

And therein lies the one sure thing among the uncertainty: Because COVID-19 has not led to many childhood fatalities, but has upended the lives of children and pregnant women in significant ways, researchers are seizing a unique opportunity to study child wellbeing and survival. That new knowledge can be used to develop public health practices that can keep children mentally sound and physically healthy and safe when life returns to normal.

Contact us at letters@time.com.

Johnson & Johnson’s 1-Shot COVID-19 Vaccine Shows Promise

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Johnson & Johnson’s experimental one-shot Covid-19 vaccine generated a long-lasting immune response in an early safety study, providing a glimpse at how it will perform in the real world as the company inches closer to approaching U.S. regulators for clearance.

More than 90% of participants made immune proteins, called neutralizing antibodies, within 29 days after receiving the shot, according to the report, and all participants formed the antibodies within 57 days. The immune response lasted for the full 71 days of the trial.

“Looking at the antibodies, there should be good hope and good reason that the vaccine will work,” in the company’s late-stage clinical trial that’s soon to report results, J&J Chief Scientific Officer Paul Stoffels said Tuesday in an interview.

The one-shot vaccine generates more neutralizing antibodies than a single dose of other front-runner Covid-19 vaccine, all of which are two-shot regimens. But when compared with two shots of these rivals, the response to J&J’s single shot is in the same range, Stoffels said.

Interim results from the phase 1/2 trial of 805 participants ages 18 and older were published Wednesday in the New England Journal of Medicine. The data expanded on more limited findings J&J first published in September.

Shares of the New Brunswick, New Jersey-based drugmaker rose 1.3% in post-market trading on Wednesday. Moderna Inc., which makes a two-dose Covid vaccine that’s been authorized for emergency use, fell 0.6% after U.S. markets closed.

J&J’s progress is being closely watched by top infectious disease experts because its vaccine has the potential to become the first that can protect people after just one shot, making mass-vaccination campaigns much easier. The company expects to get definitive efficacy data from a final-stage study by early next month, potentially leading to regulatory authorization by March.

Efficacy Ambitions

The U.S. has granted emergency-use authorizations to two vaccines, one developed by Pfizer Inc. and its partner BioNTech SE, and the other by Moderna Inc. Both employ a technology called messenger RNA that has never before been used in an approved product, and each showed more than 90% efficacy against Covid-19 symptoms.

Those results were better than expected. U.S. government officials had earlier said any vaccine with greater than 50% efficacy would be considered a success. Based on that guidance, J&J aimed for 60% effectiveness, Stoffels said, but “we hoped and we planned for 70%.”

Within weeks, J&J will learn how its vaccine performed in a late-stage trial of 45,000 volunteers. Stoffels now thinks it has the potential to be even higher than 70% effective, based on the early-stage findings and other factors.

When the antibody response to J&J’s shot is compared to others that have been through final stage trials “there’s a good reason to believe we can get into very high levels of efficacy,” Stoffels said. “Will it be north of 90%? I don’t know. The data will tell us.”

Moncef Slaoui, the chief scientific adviser to the U.S.’s Operation Warp Speed vaccine development and distribution effort, said Wednesday that he anticipates J&J’s one-shot vaccine will show 80% to 85% effectiveness against Covid-19. J&J and its government partners can’t see the data for the time being, a standard measure to prevent bias.

One-Dose Advantage

Experts have said that a single-shot vaccine offers advantages: ease of distribution and administration. Vaccines from Moderna, AstraZeneca Plc, and the Pfizer-BioNTech partnership all require two shots, which means repeat shipping and clinic visits. While Moderna and Pfizer-BioNTech’s shots must be frozen, J&J’s shot can be stored at refrigerator temperatures for three months.

“A single dose is going to be so much more effective in the world,” Stoffels said. “We are very confident that it works,” but another trial J&J is conducting of its vaccine plus a booster shot “will give us a backup.”

The study released Wednesday also found that a second dose of J&J’s shot, administered two months later, led to a three-fold increase in neutralizing antibodies. Stoffels said that’s positive news, as the drugmaker is still evaluating how long immunity from the single-shot will last, and whether higher antibody levels will be needed to combat new strains of the virus.

J&J kicked off the separate late-stage study of its two-dose vaccine regimen in November. Stoffels said the company is likely to finish enrolling the 30,000 participants before the end of first quarter, likely in March or April, and expects a data readout come summer.

Underlying Platform

J&J’s vaccine candidate is made from a cold virus, called an adenovirus, that’s modified to make copies of the coronavirus’ spike protein, which the pathogen uses to enter cells.

Though the altered virus can’t replicate in humans, it induces an immune response that prepares the body for an actual Covid-19 infection. It was first developed with researchers at Harvard University who have spent years working on the adenovirus platform, which is also used in J&J’s Ebola vaccine, as well as its Zika, RSV, and HIV investigational vaccine candidates.

The NEJM report showed the vaccine was well-tolerated across the study participants. There was no difference in the immune response in younger participants and the elderly, which is important given older populations are most vulnerable to the disease. The most frequent side effects were fever, fatigue, headache, muscle pain and injection-site pain.

Contact us at letters@time.com.

U.K. Coronavirus Third Wave, New Variant: What to Know

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Dr Rachel Clarke never dreamed that in her medical career, she would say out loud that hospitals in Britain are running out of oxygen. Yet some hospitals in the U.K. are now in that critical situation, as doctors say the U.K.’s third wave of the coronavirus pandemic is pushing the country’s National Health Service to its limits. “We’re seeing younger patients, we’re seeing sicker patients, and we’ve never really recovered from the first wave,” says Clarke, who works on an acute medical ward in a hospital in Oxfordshire, England, and also in an in-patient hospice setting. “You can’t sugarcoat the situation currently in the NHS in Britain. It is unimaginably bad.”

The U.K. is currently enduring a painful third wave of COVID-19, far worse than its European neighbors like Spain, France, Italy and Germany. (The Republic of Ireland currently has the world’s highest number of confirmed new COVID-19 cases per capita.) On Wednesday Jan. 13, the U.K. reported a record high of 1,564 deaths within 28 days of a positive COVID-19 test—the biggest figure reported in a single day since the pandemic began, bringing total deaths to more than 84,000.

Experts say that the current situation in the U.K., and particularly in London—which declared a state of emergency on Jan. 8 is a cautionary tale. They say the crisis is a result of both the struggle to deal with a new variant estimated to be up to 70% more transmissible, and because of a failure in decisive and strong government leadership.

Read More: A New, More Contagious COVID-19 Strain Has Been Reported in the U.K. Is It Headed for the U.S.?

One of those failures, they say, was that the U.K. government did not act on the scientific advice that recommended a short “circuit breaker” lockdown in September to halt rapidly rising transmissions after the easing of lockdown restrictions in the summer. Although a second round of national restrictions were introduced in November, it was eased in December and cases rapidly climbed throughout the month. On Jan. 4, Prime Minister Boris Johnson announced a third national lockdown in England, with people only allowed to leave their homes for a select few reasons and non-essential shops and businesses closing. (Wales, Scotland and Northern Ireland each have their own healthcare rules and have also instructed national lockdowns).

The U-turns in policy and the failure to enact a national lockdown early enough this autumn have likely had deadly consequences. Clarke is now seeing patients who caught the COVID-19 virus from a family member who spent Christmas Day with them (as permitted by government rules in certain parts of the country), resulting in entire families becoming infected. “When I see now people dying of COVID-19, who I know might not have caught it had the government been braver and more willing to stand up and put lives first—I find that heartbreaking,” she says.

The picture inside U.K. hospitals

Government officials said Monday that the U.K. is at the “worst point” of the pandemic, with 50% more coronavirus patients in hospital now compared to April last year. The same day, Johnson acknowledged oxygen shortages in some places, and reports emerged of hospital mortuaries reaching capacity in one south-eastern region, leading to bodies being stored at a temporary mortuary. “Off the scale” waiting and queuing times for ambulances have been reported in London and parts of the south-east, and many are warning that the worst is yet to come.

“The hospitals are full. The intensive care units are full,” says John Ashton, a former regional director of public health for north west England and the author of Blinded by Corona: How the Pandemic Ruined Britain’s Health and Wealth. “People will not be admitted, and will be very sick and dying at home, that’s what’s going to happen over the next two or three weeks.”

Clarke remembers watching in disbelief the scenes of the first wave of COVID-19 unfolding in New York City. “That’s what we are going through in Britain at the moment,” she says. “We have ambulances trapped, queued up outside hospitals for six, eight, ten hours at a time because they can’t physically offload their patient and actually get them into hospital at the moment.”

Data from Public Health England indicates that there are more people of all ages in hospital in the U.K. with COVID-19 now than in the first wave of spring 2020, including the young and the old. Infections have been highest in teenagers, students, and people in their 20s and 30s in recent months, and the highest hospital admission rate for confirmed COVID-19 has been in the over-85s. There has also been a steep rise in the number of 65-74 year olds and 45-64 year olds admitted to intensive care units.

Read More: The U.S. and U.K. Were the Two Best Prepared Nations to Tackle a Pandemic—What Went Wrong?

The overwhelming burden on the National Health Service is affecting other patients who do not have COVID-19, but who also are in pain and need treatment or other surgeries. At the north London hospital where spinal surgeon Dr. Hilali Noordeen is based, seven out of the nine operating theaters have been repurposed and made into intensive care units for COVID-19 patients. “The whole of our hospital now, save two male beds and two female beds, are not available for us because they are either full of COVID-19 patients or waiting for COVID-19 patients,” says Noordeen, author of the forthcoming book Letters to a Young Doctor, adding that his hospital is now down to 60% nursing capacity as staff have had to self-isolate at home. A letter earlier in January from the chair of the British Medical Association to its members said that over 46,000 hospital staff were off sick with COVID-19. The lack of capacity, both in terms of facilities and staff, means that on the day Noordeen speaks to TIME, he initially had a list of three pediatric patients with severe spinal deformities to attend to—all those appointments had to be canceled. “I don’t know how many months it’s going to be able to take us to deliver these treatments now,” he says.

For junior doctor Kieran Killington, who was redeployed from general practice to a west London hospital, the biggest change he’s noticed is the exhaustion of staff. During the first wave, he heard many colleagues say that it would be hard to cope with the same level of stress again, and yet they now feel they’ve been thrown into a situation where they have to. Clarke too shares that same sense of disappointment, that the mistakes made in the government’s delayed response to the first wave have been replicated now. “The fact that this is the second time round makes it so much more inexcusable and so much harder for staff,” she says. Results from a new study published in the British Medical Journal on Jan. 13 indicated that nearly half of NHS critical care staff surveyed who worked in intensive care units through the first wave reported symptoms of post-traumatic stress disorder, severe depression or anxiety. Of those surveyed, more than one in seven clinicians and more than one in five nurses working in ICUs reported thoughts of self-harm or suicide.

Members of the public receive vaccinations at a drive-through vaccine center in Hyde, near Manchester, U.K., on Friday, Jan. 8, 2021.

Members of the public receive vaccinations at a drive-through vaccine center in Hyde, near Manchester, U.K., on Friday, Jan. 8, 2021.

Anthony Devlin/Bloomberg via Getty Images

How did England end up here and how can other countries avoid it?

The new variant of COVID-19 first reported in mid-December is partly to blame for the grave situation in England, experts say. Mutations in the virus make this new strain 50%-70% more transmissible than others, scientists estimate. According to the U.K. government the new strain was likely present in the country as early as September. At least 50 more countries have now reported cases, according to the WHO.

British officials have repeatedly said that without the emergence of the new variant, social distancing measures which have been in place across most of England since mid-October, including bans on most indoor gatherings, would have been enough to contain COVID-19.

But public health experts say government strategy on COVID-19 contributed both to the surge in cases, and to the emergence of the new variant itself. Many have criticized the government’s decision to considerably loosen restrictions over summer after the first lockdown in spring in order to try to revitalize the economy. Researchers at the University of Warwick found that a government-backed food voucher scheme, dubbed “Eat Out to Help Out,” which encouraged people to dine at restaurants by subsidizing a portion of their meal, drove new infections up by 8% to 17% and accelerated a second wave in the fall. The scheme cost taxpayers almost $1.2 billion.

The emergence of the new variant of the virus, says Ashton, the former public health official, was made more likely by the wide spread of infections. “The more people the virus goes through, each generation of people it infects—that gives the virus an opportunity to adapt and get better at doing its deadly work,” he says.

Read More: How the U.K. Mismanaged Its Coronavirus Response

Government messaging around Christmas may also have driven transmission in December. Initial plans allowed for five days of mixing of up to three households indoors—far more than other European countries. Those plans were scrapped just a few days before Christmas as the spread of the new variant became clear, with new local measures allowing either no indoor mixing or only one day of mixing with two households. But Ashton says restrictions were not introduced early enough to stop rapid spread over the Christmas period. In a survey by the U.K.’s Office of National Statistics, 44% of adults admitted to forming a “bubble” with up to two other households on Dec. 25. “This is the beginning of the Christmas wave,” Ashton says. “We’re still in the foothills of what’s in the pipeline to come from Christmas and New Year.”

The U.K.’s overall strategy for combating COVID-19 appears to have been driven by a different understanding of the virus compared to other countries with lower death tolls, said Devi Sridhar, professor and chair of Global Public Health at the University of Edinburgh’s Medical School, speaking at a session of parliament’s Health and Social Care Committee to examine the effectiveness of previous lockdowns in November. The U.K.’s heavy toll “comes down to an early decision to treat this like a flu-like event, that would pass through the population, [with] an uncontrollable spread that you would try to mitigate through building enough hospitals and medical care,” she said. “Rather than treating this like a SARS-like event, which is what East Asian countries have done, as well as the Pacific, Australia, New Zealand, as well as some countries in Europe, like Norway, Finland, Denmark, who are diverting from that flu model and trying to keep their numbers as low as possible.”

Ashton agrees that the U.K. failed to “follow through [with successful early lockdowns] like they’ve done in other countries,” because of a focus on the economy. “The way we’ve handled it, we’re going to have the worst of both worlds: the biggest economic impact, and the worst health impact, both in terms of deaths, and people suffering with long COVID,” he says. “That’s because we haven’t been decisive.” Though national economic output bounced back as restrictions were lifted during the second and third quarters of 2020, that recovery proved short-lived, with the economy contracting again in the fourth quarter. By the end of 2020, the U.K. economy was 10% smaller than at the end of 2019.

How long will England’s lockdown last?

There’s no clear end in sight for England’s lockdown. Although the government has tentatively set a date of mid-February to begin easing measures, the legislation on the new restrictions lasts until March 31. Transmission is so high that, according to government estimates, 1 in 50 people in England currently have COVID-19. In the capital, the average is 1 in 30, or 1 in 20 in “hot spot” areas, London mayor Sadiq Khan said on Friday.

As a result, the prime minister is pinning hopes for loosening restrictions on the ability to rapidly vaccinate the 15 million people in the government’s four priority groups: care home residents and their carers, people over 70, frontline health and social care workers, and those considered “clinically extremely vulnerable.” If things go well, Johnson said on Jan. 4, those groups will all receive at least their first dose of a vaccine by the middle of February. Only then could some restrictions be relaxed, as vaccines continue for the rest of the population.

Read More: mRNA Technology Gave Us the First COVID-19 Vaccines. It Could Also Upend the Drug Industry

It’s unclear if it will be possible to roll out the vaccine that quickly, though. Since vaccines began to be administered on Dec. 8, only 2.4 million people have received a first dose. The U.K. has so far approved three COVID-19 vaccines: those produced by Pfizer-BioNTech, AstraZeneca-Oxford, and most recently Moderna. The AstraZeneca-Oxford vaccine, which can be stored at normal fridge temperatures and of which the U.K. has ordered 100 million doses, is expected to speed up the rollout.

But given the immense pressures on health service staff and resources, ramping up the necessary level of 2 million doses a week by the end of January will be extremely difficult, Ashton says. “I fully expect this vaccination program will be the next casualty of over promising and under delivering. It’s unbelievable.”

In the meantime, the outlook for England’s hospitals looks bleak. According to a report by health service news outlet HSJ, the NHS expects London’s hospitals to be short of some 2,000 beds by Jan. 19, even under a “best case scenario” of lowering transmission rates and emergency hospital facilities being opened.

Clarke, the doctor in Oxfordshire, is steeling herself for the coming weeks. “Knowing that the population is being vaccinated is pretty much the only thing that is stopping me wanting to dissolve and crumble right now,” she says. “Vaccines are the one chink of light to hold on to.”

Write to Ciara Nugent at ciara.nugent@time.com.

More Women Are Freezing Their Eggs During COVID-19 Pandemic

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If she found the right guy, Kari Arenberg could see herself having kids. But her work was never conducive to dating, let alone to freezing her eggs in hopes of leaving her options open. The 31-year-old event producer traveled constantly between New York City and Los Angeles, with long days lifting heavy boxes and running around venues.

Then, in 2020, Arenberg was furloughed, and the egg-freezing process became, for the first time in her life, logistically possible. She moved in with her family in Chicago and visited a clinic. Soon she was giving herself as many as three shots a day to stimulate her ovaries, and visiting the clinic every few days for bloodwork and an ultrasound to determine when the eggs would be ready for retrieval. She was able to freeze 21 eggs, a feat that likely would have been impossible if she had had to give herself shots while stuffed into airplane bathrooms or trying to schedule visits to the clinic around the national events, like Comic Con, that she produces. “I love my work and want to prioritize it,” Arenberg says. “So it’s ironic that my career also kept me from doing this earlier.”

When the coronavirus pandemic hit, fertility clinics braced themselves for a downturn. People have been avoiding the doctor’s office since the spring, first because they feared exposure to the virus and later because many people who have been laid off or furloughed cannot afford the medical bills. Fertility treatments are expensive, and the cost of egg freezing ranges from $6,000 to $20,000. (Arenberg’s was $12,000—an especially daunting cost after losing work.)

But clinics across the country are reporting an uptick in women freezing their eggs during the pandemic. Though no organization in the U.S. collects national data, 54 clinics across major American cities including Denver, Atlanta and Seattle told TIME that the number of women freezing their eggs has increased year-over-year—an impressive stat considering most of those clinics were forced to shut down and suspend fertility treatments in the early months of the pandemic. An additional five clinics reported the same number of egg freezing cycles in 2020 as in 2019 despite being closed anywhere from one to three months in 2020. Only two clinics told TIME they had seen a decrease in the number of women freezing their eggs since 2019. “We didn’t know what to expect,” says Colleen Wagner Coughlin, the founder of OVA Egg Freezing Center in Chicago. “If anything we expected a downturn. But we’ve seen a huge increase—several hundred more new patients [in 2020].”

At some clinics, the changes have been robust. When TIME collected data in November, Shady Grove Fertility, which runs 36 clinics across the Eastern seaboard, had seen a 50% increase in women freezing their eggs since 2019. Doctors at NYU Langone saw a 41% year-over-year increase in women fertilizing their eggs. And Seattle Reproductive Medicine had conducted 289 egg-freezing cycles in 2020, compared with 242 in 2019, a nearly 20% jump.

Unable to see friends in person during the pandemic, Kari Arenberg, bottom right, relieved her nerves about self-administering hormone injections by sharing the process with friends over video chat The hormone shots cause “a lot of bloating and cramping and emotions,” says Arenberg. “It’s not exactly conducive to getting work done. It literally feels like you’re carrying around a sack of eggs.

Unable to see friends in person during the pandemic, Kari Arenberg, bottom right, relieved her nerves about self-administering hormone injections by sharing the process with friends over video chat The hormone shots cause “a lot of bloating and cramping and emotions,” says Arenberg. “It’s not exactly conducive to getting work done. It literally feels like you’re carrying around a sack of eggs.”

Courtesy of Kari Arenberg.

Sharon Covington, a therapist who provides counseling services at Shady Grove Fertility Clinic, is “busier than ever” offering mental health support to women considering fertility treatments, including egg freezing. She says the women she sees are freezing their eggs because of the pandemic, not in spite of it. Women who normally travel for work, like Arenberg, are grounded. Those with busy social lives are alone at home. Their schedules are open. But that time in isolation has also afforded space for reflection. “Everybody had to take a hard stop in their lives,” Covington says. “And I think what happened with that is that it gave people the time and the space to kind of reassess their priorities and the directions that they’re taking in their life.”

Many single people feel as if they’ve fallen a year behind on their life plans. Dating was almost impossible at the beginning of the pandemic. Even now, near-strangers must negotiate a difficult social dance with one another when they agree to meet up for a distanced drink—when can they hug, kiss or even just go indoors together? When will they feel safe with one another? “I actually went on a few dates,” says Arenberg, “but sitting outside shivering in Chicago in the winter is not conducive to finding someone.”

Read More: The Coronavirus Is Changing How We Date. Experts Think the Shifts May Be Permanent

Arenberg first heard about egg freezing when the winner of the Bachelor’s 2015 season, Whitney Bischoff Angel, revealed that she froze her eggs. Egg freezing has steadily grown more popular in the years since the American Society of Reproductive Medicine (ASRM) removed the “experimental” label from the procedure in 2012. Many women were already freezing their eggs for medical reasons, either because they were going through a medical procedure like chemotherapy that could reduce their fertility or had a medical condition like endometriosis that could negatively impact ability to conceive. But with the change in labeling came the rise of what doctors call “social egg freezing”—women who freeze their eggs simply because they aren’t ready to have a child yet. In 2009, just 475 women froze their eggs, according to the Society for Assisted Reproductive Technology. By 2018, 13,275 women did so, an increase of 2,695%.

The spike comes thanks in part to celebrities like Chrissy Teigen, Michaela Coel and Emma Roberts sharing their own egg-freezing stories. Kourtney Kardashian went so far as to film her egg freezing preparation on Keeping Up With the Kardashians, and Amy Schumer shared pictures of her bloated and bruised stomach as she took the shots this summer to freeze her eggs as part of her IVF process. They’ve demystified a process that was little known just a few years ago, including, in Schumer’s case, the most uncomfortable aspects.

René Hurtado, a 28-year-old in Scottsdale, Ariz., knew that she might have to stay home in the weeks before her egg retrieval in case she suffered side effects like cramping or headaches, and believed the pandemic would be the ideal time to nurse those pains without missing meetups with friends. “On day five of injections, I couldn’t even walk. I only felt good if I was lying flat on my bed,” she says. She had to take several days off from her job at WeWork while she recovered. “In an alternate world, I was supposed to be in Miami for a bachelorette party that week. Thank God I did this during COVID so I didn’t have to see anyone or go anywhere because I was in so much pain.”

René Hurtado, 28, took a selfie before a doctor retrieved her eggs at a clinic in Arizona

René Hurtado, 28, took a selfie before a doctor retrieved her eggs at a clinic in Arizona

Courtesy of René Hurtado.

Hurtado’s offered egg freezing as part of the company’s benefits package, a perk that’s become increasingly popular among startups as a means of attracting women workers (or, in critics’ eyes, pressuring workers to prioritize work over family). But the trendiness of egg freezing in Silicon Valley may be reaching its peak. Some doctors have cast doubt as to whether companies will continue to offer this costly benefit when many organizations are choosing between cutbacks and layoffs. Wagner Coughlin, the founder of OVA in Chicago, said that her organization is already looking into a new payment structure in anticipation of companies’ dropping the benefit.

Michael Jacobs, a doctor at the IVF Center of Miami, believes that moment has already arrived. He was one of the few doctors who told TIME his clinic was seeing a downturn in egg-freezing rates. “In cities like New York and Los Angeles, maybe there are more people who can afford the cost of egg freezing right now,” he says. “But I think a lot of people here are just worried about paying their bills.”

The high price of egg freezing has long meant only a specific subset of patients—mostly upper class, and mostly white—pursue the process: a study of nearly 30,000 egg retrievals by ASRM found that just 4.5% of the women who underwent the procedure described themselves as Hispanic and 7% identified as Black.

Read More: Women Are Deciding Not to Have Babies Because of the Pandemic. Why That’s Bad for All of Us.

Pavna Brahma, a doctor at the Shady Grove clinic in Atlanta, theorizes that this may be the boom period before a bust. “People are coming in who are worried about losing their job or their coverage or their insurance,” Brahma says. “They want to take advantage of the moment when they know they have coverage and economic stability in their job.”

She stresses to her patients that waiting until they receive the vaccine to freeze their eggs is a viable option: “Two to six months rarely makes a huge change in their fertility. I don’t want women to feel pressured by the pandemic.”

Bryn Woznicki, who lives in Los Angeles, decided to dedicate the money she had saved for a move to New York City to freezing her eggs last year

Bryn Woznicki, who lives in Los Angeles, decided to dedicate the money she had saved for a move to New York City to freezing her eggs last year

Courtesy of Bryn Woznicki.

Still, pandemic or not, time remains a key driver in women’s family-planning decisions. As a general rule, the younger you are, the more eggs you have, and the more likely an egg-freezing process will be successful. Many women fear the benchmark of 35 years old. Loss of eggs and risks to pregnancy happen gradually over time, not all at once, but 35 is when doctors begin calling pregnancies “geriatric” to reflect increased risks. It’s also the age at which fertility doctors will advise freezing more eggs, often through several procedures to harvest as many eggs as possible and improve the chances that one can be fertilized later.

Bryn Woznicki, a 33-year-old filmmaker who lives in Los Angeles, has always known she wants to be a mother, “but every year,” she says, “it’s a ticking time bomb working against your biological clock.” When filming work dried up last spring and dating became more difficult, she took stock of what turning 34 during a pandemic could mean. “Say I met someone today,” she says. “Say I really liked them and we got married. By the time I did that and enjoyed my partner and we decided to take on this huge responsibility of having kids, that’s another few years down the line.”

With her work and social life on pause, she decided to divert some of her savings towards a potential future family. “I had some money saved to try to move to New York this fall and then, you know, COVID happened,” she says. “Meanwhile I was feeling the pressure from my biology telling me that time was running out, and I was like this is the one thing I can control in an unpredictable year.”

For Arenberg, being able to freeze her eggs was a “silver lining” of the pandemic. “As unfortunate as it is that I’m technically unemployed, this really gave me the mental capacity to look ahead for the first time,” she says. “I don’t know if I want kids, but maybe if I meet the right person some day, this just provided a nice comfort level where I can make some decisions about dating and kids and work when things get back to normal.”

Write to Eliana Dockterman at eliana.dockterman@time.com.

What We Must Do to Curb COVID-19 Before Vaccines Roll Out

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On Jan. 7, 2021, the U.S. hit another grim milestone, for the first time recording over 300,000 new cases of COVID-19 and over 4,000 deaths from the infection in one day. Across the country, hospitals and intensive care units are now under enormous strain trying to treat so many sick people. And if a new, more transmissible variant of SARS-CoV-2, the virus that causes COVID-19, were to take hold in the U.S. as it has in the U.K., as seems plausible, our health system could pass its breaking point.

It’s all too easy to become numb to the toll and accept these daily figures as a new normal while waiting for the vaccine rollout to have an impact. Since the first vaccines were approved in Dec. 2020, we seem to have stopped talking about the rising cases and deaths. But we must not just accept this level of infection, suffering, and devastation for months on end while we wait until we reach vaccine herd immunity sometime in the summer or fall.

COVID-19 is a preventable illness. Many countries, like Australia, China, New Zealand and Taiwan, have practically ended community transmission of the virus and returned to a near-normal life, and they did so without using a vaccine. If we continue to see rising transmission, it will make it all the more challenging for vaccines to act as a tool that ends the U.S. pandemic.

There are five key actions we can—and should—take urgently to drive down viral transmission.

First, we need to get every American a high-filtration mask

Widespread mask wearing across the community is linked with lower transmission rates; face masks reduce viral transmission in two ways. First, they prevent infected people from spreading the virus to others (masks act as “source control”). This effect is particularly important for people who are infected but don’t yet have symptoms—they feel fine and so may be unaware that they are infectious. Second, masks can also help protect the wearer from inhaling virus-laden droplets or aerosols.

However, not all masks are equally effective at filtering out the particles that carry the virus. One recent study, for example, found that some masks (e.g. N95 masks and masks comprising two woven nylon layers and a nonwoven filter insert) do a better job than commonly used cloth and surgical masks. So, we need to urgently get these more effective “high-filtration” masks to all Americans. Dr. Abraar Karan at Harvard Medical School and his colleagues argue that the incoming Biden administration should invoke the Defense Production Act to urgently mass manufacture high-filtration masks and fund research to develop new mask designs.

We can learn from the remarkable success of South Korea and Singapore, where governments early on manufactured and distributed high-filtration masks (e.g. K-94 masks, the Korean equivalent of N95 masks) to all at no cost to its citizens. In Singapore, you can even get a high-filtration mask for free from vending machines. Why can’t the U.S distribute masks in this way to Americans too?

Second, schools and workplaces need to be made safer

On Jan. 20, 2021, it will be exactly one year since the first case of COVID-19 was confirmed in the U.S. It is unconscionable that in all this time we have still not made the necessary investments into schools and workplaces to make these settings safer. The science is clear on the steps that need to be taken—including ventilation, air filtration, spacing between people, universal masking, and reducing the density of people.

Third, we must protect our essential workers

It is a moral stain on this country that so many essential workers—including in clinics, hospitals, nursing homes, grocery stores, schools, factories, farms, and warehouses—have been infected and so many have died. While there is no accurate database on health worker infections, by Nov. 15, 2020, the CDC estimated that there had been 216,049 health care worker infections in the U.S. An investigation by Kaiser Health News and the Guardian found that nearly 3,000 U.S. health workers had died as of Dec. 23, 2020, of which around two-thirds were people of color. We’ve witnessed terrible scenes in which nurses and doctors have had to improvise their own personal protective equipment (PPE) out of trash bags, pool noodles, and snorkel masks.

It’s equally difficulty to quantify with certainty how many grocery or warehouse workers have been impacted by the virus, but Amazon says that from March 1 to Sept., 19, 2020, 19,816 of its frontline Amazon and Whole Foods Market employees tested positive or were presumed positive.

Enough is enough: every single essential worker in America deserves to be protected from COVID-19 with the highest quality PPE combined with the other measures described above to improve building safety.

Fourth, we need to urgently build a functioning nationwide “test, trace, isolate, support” (TTIS) system

The nations that have successfully controlled viral transmission, like Australia, China, Hong Kong, New Zealand, Singapore and Taiwan, have at least one thing in common: they have systems in place to efficiently identify infected and exposed people. This is crucial for controlling transmission, because it means infected people know they need to isolate (isolation means an infected person keeps away from others) and exposed people know they need to quarantine (quarantine means someone who might have been exposed stays away from others). The U.S. needs to emulate, not ignore, this success. The “support” component of TTIS is critically important—people need financial support to isolate or quarantine to replace any lost wages. North Carolina, for example, has such a support program in 29 counties, called the COVID-19 Support Services program, which provides money and delivers meals, medications, face masks, and hand sanitizers to people isolating or quarantining.

One powerful tool that could help control transmission in the U.S. would be widespread, frequent and accessible rapid antigen testing. These tests can identify contagious people before they get symptoms. I was one of over 50 U.S. public health experts who signed a Dec. 15 open letter to the federal government, led by Dr. Michael Mina at the Harvard T.H. Chan School of Public Health, to fund aggressive deployment of such tests, in order to “protect public health, allow safe in-school instruction, and to restore our economy.” The good news is that the letter has bipartisan support in Congress and is being seriously considered by the incoming Biden Administration as an effective public health initiative to stop the spread of the virus. Rapid Tests, the all-volunteer group directed by Mina advocating for rapid tests to be made legal and widely available, is working on pilot programs in various cities and states and is advising the CDC/HHS teams on the right testing strategy—with frequent, fast antigen testing as a national policy.

Fifth, the U.S. needs a “circuit breaker” to break the chains of transmission

I think it was a mistake for President-elect Joe Biden to rule out instituting a nationwide “circuit breaker”—that is, a short-term, national stay-at-home order. At the very least, we need circuit breakers at the state and city level in the highest transmission states.

Great Britain and Israel have recently instituted such circuit breakers in conjunction with their vaccination campaigns (the circuit breaker in Great Britain has already driven down transmission everywhere except North West England). There is strong scientific evidence and consensus that community-wide physical distancing can drive down transmission rates, particularly if adherence is high.

In many situations where COVID-19 is out of control, there is typically strong public support for stay-at-home orders—this is not surprising, given that people want to be protected from illness and death. In Great Britain, for example, a Jan. 5, 2021 public poll conducted by the public opinion and data company YouGov found that 85% of the public endorse the current lockdown, which was announced on Jan. 4, and 77% think it should have happened sooner. Nevertheless, research has shown that people living in low-income households are much less likely to be able to work from home under such restrictions, pointing to the critical importance of accompanying stay-at-home orders with financial and social support.

In July 2020, when daily new cases in the U.S. were just a quarter of what they are now, over 150 scientists, public health experts, and health workers signed a letter urging the country’s federal government to institute a nationwide circuit-breaker. The letter stated: “Right now we are on a path to lose nearly 300,000 American lives by December 1st. Yet, in many states people can drink in bars, get a haircut, eat inside a restaurant, get a tattoo, get a massage, and do myriad other normal, pleasant, but non-essential activities.”

We’ve now lost 380,000 Americans. The toll will keep rising unless we start treating COVID-19 as a national emergency that warrants aggressive public health actions.

 

Contact us at letters@time.com.

Trump Team Announces New COVID-19 Vaccine Distribution Plan

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(WASHINGTON) — The Trump administration is asking states to speed delivery of COVID-19 vaccines to people 65 and older and to others at high risk by no longer holding back the second dose of the two-dose shots, officials said Tuesday.

Health and Human Services Secretary Alex Azar said that “the administration in the states has been too narrowly focused.”

As a result, he said, the Trump administration is now asking states to vaccinate people age 65 and over and those under 65 with underlying health conditions that put them at high risk. He said the vaccine production is such that the second dose of the two-shot vaccine can be released without jeopardizing immunization for those who got the first shot.

“We now believe that our manufacturing is predictable enough that we can ensure second doses are available for people from ongoing production,” Azar told ABC’s “Good Morning America.” “So everything is now available to our states and our health care providers.”

Each state has its own plan for who should be vaccinated, based on recommendations from the federal Centers for Disease Control and Prevention. The CDC recommendations give first priority to health care workers and nursing home residents.

But the slow pace of the vaccine rollout has frustrated many Americans at a time when the coronavirus death toll has continued to rise. More than 376,000 people have died, according to the Johns Hopkins database.

Azar said it was now time to move “to the next phase on the vaccine program” and expand the pool of those eligible to get the first dose.

That also means expanding the number of places where people can be vaccinated by adding community health centers and additional drug stores.

“We’ve already distributed more vaccine than we have health care workers and people in nursing homes,” Azar said. “We’ve got to get to more channels of administration. We’ve got to get it to pharmacies, get it to community health centers.”

He said the federal government “will deploy teams to support states doing mass vaccination efforts if they wish to do so.”

U.S. Surgeon General Jerome Adams said hundreds of thousands of people are getting vaccinated every day across the nation, but the pace of inoculations needs to improve.

“We’re in a race against this virus and quite frankly, we’re behind,” Adams told “Fox & Friends.” “The good news is that 700,000 people are getting vaccinated every single day. We’re going to hit 1 million people and we need to continue to pick up that pace.”

President-elect Joe Biden is expected to give a speech Thursday outlining his plan to speed vaccines to more people in the first part of his administration. His transition team has vowed to release as many vaccine doses as possible, rather than continuing the Trump administration policy of holding back millions of doses to ensure there would be enough supply to allow those getting the first shot to get a second one.

The Pfizer-BioNTech vaccine requires a second shot about three weeks after the first vaccination. Another vaccine, this one produced by Moderna, requires a second shot about four weeks afterward. One-shot vaccines are still undergoing testing.

Contact us at letters@time.com.

How It Will Improve Learning – Credihealth Blog

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Personalized learning refers to the practice of customizing the focus and pace of instruction or learning to accommodate every student’s skills, needs, and interests. Every student gets to learn, depending on how they learn best and what they already know. In personalized learning, there is no one mode of instruction that fits all the students. Instead, the teacher guides every student in an individualized learning journey. The students may get the same sets of skills but at different paces, although the learning plan remains the same to help them meet and reach the education system’s standards to meet a diploma or certificate. 

Both the teacher and the student collaborate to set short term and long term goals, which helps students take charge of their learning. But, teachers have to make sure that each student’s learning plans lead towards developing the skills they need to achieve throughout the education process. It should also align with the academic requirements of that particular education system. Let’s look at how personalized learning will improve learning.

More Engagement

One way personalized learning will improve learning for the better is by increasing engagement in the classroom. It is every instructor’s dream to keep their students more engaged and attentive in the classroom. As a result, each student enjoys learning, spends more of their time learning, and digests more of the knowledge imparted. Personalized learning can take many forms. For instance, it can be as simple as a teacher giving students a paper writing assignment in literature based on how they understood a particular story. It also includes asking students to decide what courses they would like to progress going to more complex ones. It boosts the student’s active involvement in the learning process.

More Motivation

Personalized learning will increase students’ motivation to learn. Since they can establish a learning plan with their teacher that suits them, it gives them a reason to invest more in their learning. Nothing is worse than having an instructor deal with unmotivated students. Such students are lazy, they don’t have a reason to study, and are troublesome, which leads to failure. But, motivated students are eager to learn, which leads to more progressive grades.

Reduce Time Wastage

With personalized learning, the instructor first assesses the student to determine what they already know and what they don’t, for instance, through quizzes or oral questions to gauge the learner’s skills. The conventional learning modes involve linear courses and training programs that need students to go through more and more information before beginning to study the content they need at the moment. That results in a lot of time wastage and compromises the engagement of the students. Everyone gets bored with learning the same thing over and over again unless it leads to something new. But, personalized learning will reduce time wastage as the instructor delivers the exact content the student needs depending on the first assessment outcome.

Improve Performance

Personalized learning will improve performance. How? Since the students are more engaged in learning, they invest more time learning, acquiring information, and absorbing it. Following that, they are more motivated and prepared to perform whatever task or exam comes at them, resulting in better outcomes.

Personalized learning and creative thinking go hand in hand. It also integrates project-based learning, which pushes students to interact, encounter, research more about a particular topic or subject. Personalized learning increases engagement allowing students to retain more knowledge and understand the curriculum more than traditional classroom situations. It enables teachers to customize student research and group projects based on each learner’s capabilities, skills, interests, cultural background, and learning needs. That is unlike group learning that does not recognize that every learner has unique skills.

Enhance Differentiated Learning

In traditional classroom learning, the teacher introduces new content, and then the students show their understanding of the content by taking a test. Then the lesson moves forward regardless of how many students have actually mastered the content. As a result, slow learners lag behind while fast learners and gifted learners get bored. That’s because they are quicker at mastering content than their colleagues. One goal of personalized learning is to give a student a chance to explore subjects that interest them and learn in ways that work best for them. That way, learners can shine in unique ways and showcase their skills using strategies that highlight their abilities rather than disabilities. 

When learners shine in their unique ways, the classroom culture grows to a more positive note, and they push themselves to do better on each project. According to different studies, differentiated classrooms do a better job of improving learners of all abilities. The fast learners stay challenged more, and students with average learning abilities get the opportunity to showcase their competence in sectors that interest them.

The Bottom Line

Personalized learning is an educational approach that can help students become further engaged in the classroom and their learning when implemented.

Disclaimer: The statements, opinions, and data contained in these publications are solely those of the individual authors and contributors and not of Credihealth and the editor(s). 

Call +91 8010-994-994 and talk to Credihealth Medical Experts for FREE. Get assistance in choosing the right specialist doctor and clinic, compare treatment cost from various centers and timely medical updates

How to Get a National Provider Identifier (NPI) Online – Credihealth Blog

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Under the Health Insurance Portability and Accountability act, there is a provision that all healthcare providers that fall into the bracket of a covered entity be equipped with a national provider identifier (NPI). The latter is a standard ten-digit number and can be applied online.

Note that you can perform an NPI lookout for a health organization or provider in several ways. NPPES NPI Registry is the official NPI lookout website. You can begin the search using the NPI number or name.

What is the Importance of a National Provider Identifier?

The National Provider Identifier is essential in that it’s in line with HIPAA standards. It’s meant to simplify billing. NPI is an identification number that’s acknowledged by health plans. With the NPI number, one doesn’t have to report, maintain, and even track several provider identification numbers.

To get an NPI number, you should complete a paper application online or via an organization. Providers can use any of the acceptable options. NPI Online application is preferred in that it is fast and economical when tracking the status. Note that there are no charges applied when applying for the NPI number. Below are the steps to follow when applying for one.

Visit the NPPES website

In the national plan and provider enumeration system website, navigate to the NPI webpage, and look under how to apply for an NPI for individual providers. Create a login through the identity and access management system.

 

Follow the instructions on the application

There is a help tab option at the top right of the pages where you can get assistance online. You just have to click on the new NPI application, and then you read the terms and then submit the new NPI application.

Provider profile

Fill in the provider profile information and then answer “NO” to the question, ‘is the provider a sole proprietor?’

Enter your residency program address and residency phone number. Accept the standardized option under the business mailing address standardization. Other identification numbers may be required to be filled like the UPIN provider numbers, but you can proceed to the next step if you do not have one.

Taxonomy/ License information

There are more than 175 taxonomy codes, and you are required to choose only one taxonomy code. For the non-licensed, select provider type code 39, select students in an organized health care training program. Click on save. While for a licensed physician, click provider type code 20. For licensed dentists, select 12, then enter the license numbers and states where you are permitted. Finish by clicking on save.

List yourself as the contact person as you can respond to your application in case of any inquiry. You can add your home phone number and address under the more information.

Certification statement

A certification statement will be generated and once you have read it, click on submit. Your application will now be processed. Also, an email concerning your NPI will be issued within a period of close to two weeks.

Since NPI is mandatory and in accordance with the HIPAA, one can apply for his or her NPI online at the comfort of his home. The online application is relatively cheap and an efficient means of getting the NPI by following the earlier listed steps.

Disclaimer: The statements, opinions, and data contained in these publications are solely those of the individual authors and contributors and not of Credihealth and the editor(s). 

Call +91 8010-994-994 and talk to Credihealth Medical Experts for FREE. Get assistance in choosing the right specialist doctor and clinic, compare treatment cost from various centers and timely medical updates

 

Gorillas at San Diego Zoo Test Positive for COVID-19

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(SAN DIEGO) — Several gorillas at the San Diego Zoo Safari Park have tested positive for the coronavirus in what is believed to be the first known cases among such primates in the United States and possibly the world.

The park’s executive director, Lisa Peterson, told The Associated Press on Monday that eight gorillas that live together at the park are believed to have the virus and several have been coughing.

It appears the infection came from a member of the park’s wildlife care team who also tested positive for the virus but has been asymptomatic and wore a mask at all times around the gorillas. The park has been closed to the public since Dec. 6 as part of the state of California’s lockdown efforts to curb coronavirus cases.

Veterinarians are closely monitoring the gorillas and they will remain in their habitat at the park, north of San Diego, Peterson said. For now, they are being given vitamins, fluid and food but no specific treatment for the virus.

“Aside from some congestion and coughing, the gorillas are doing well,” Peterson said.

While other wildlife has contracted the coronavirus from minks to tigers, this is the first known instance of transmission to great apes and it is unknown if they will have any serious reaction.

Wildlife experts have expressed concern about the coronavirus infecting gorillas, an endangered species that share 98.4 percent of their DNA with humans and are inherently social animals.

The gorillas infected at the San Diego safari park are western lowland gorillas, whose population has declined by more than 60% over the last two decades because of poaching and disease, according to the World Wildlife Fund.

The safari park tested feces of the troop of gorillas after two apes began coughing Jan. 6. Positive test results were confirmed by the U.S Department of Agriculture National Veterinary Services Laboratories in three gorillas. Feces from all eight in the troop are being taken for testing.

Zoo officials are talking to experts who have been treating the coronavirus in humans in case the animals’ develop more severe symptoms. They will remain together since separating them could be harmful to the gorillas that live in tight-knit groups.

“This is wildlife, and they have their own resiliency and can heal differently than we do,” Peterson said.

The safari park on Monday added more safety measures for its staff, including requiring face shields and eye goggles when working in contact with the animals.

The confirmation that gorillas are susceptible to the coronavirus contributes to information about how the pandemic may affect these species in their native habitats where they come into contact with humans and human materials, the park officials said.

San Diego Zoo Safari Park plans to share what it learns with health officials, conservationists and scientists to develop steps to protect gorillas in the forests of Africa.

Contact us at letters@time.com.

How mRNA Technology Gave Us the First COVID-19 Vaccines

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“No!” The doctor snapped. “Look at me!”

I had been staring her in the eyes, as she had ordered, but when a doctor on my other side began jabbing me with a needle, I started to turn my head. “Don’t look at it,” the first doctor said. I obeyed.

This was in early August in New Orleans, where I had signed up to be a participant in the clinical trial for the Pfizer-BioNTech COVID-19 vaccine. It was a blind study, which meant I was not supposed to know whether I had gotten the placebo or the real vaccine. I asked the doctor if I would really been able to tell by looking at the syringe. “Probably not,” she answered, “but we want to be careful. This is very important to get right.”

I became a vaccine guinea pig because, in addition to wanting to be useful, I had a deep interest in the wondrous new roles now being played by RNA, the genetic material that is at the heart of new types of vaccines, cancer treatments and gene-editing tools. I was writing a book on the Berkeley biochemist Jennifer Doudna. She was a pioneer in determining the structure of RNA, which helped her and her doctoral adviser figure out how it could be the origin of all life on this planet. Then she and a colleague invented an RNA-guided gene-editing tool, which won them the 2020 Nobel Prize in Chemistry.

The tool is based on a system that bacteria use to fight viruses. Bacteria develop clustered repeated sequences in their DNA, known as CRISPRs, that can remember dangerous viruses and then deploy RNA-guided scissors to destroy them. In other words, it’s an immune system that can adapt itself to fight each new wave of viruses—just what we humans need. Now, with the recently approved Pfizer-BioNTech vaccine and a similar one from Moderna being slowly rolled out across the U.S. and Europe, RNA has been deployed to make a whole new type of vaccine that will, when it reaches enough people, change the course of the pandemic.

Drs. Ugur Sahin and Ozlem Tureci, Co-founders, BioNTech. In January 2020, before many in the Western world were paying attention to a new virus spreading in China, Dr. Ugur Sahin was convinced it would spur a pandemic. Sahin, who in 2008 co-founded the German biotech company BioNTech with his wife Dr. Ozlem Tureci, went to work on a vaccine and by March called his contact at Pfizer, a much larger pharmaceutical company with which BioNTech had previously worked on an influenza vaccine using mRNA. Less than a year later, the Pfizer-BioNTech COVID-19 vaccine became the first ever mRNA vaccine available for widespread use. Even so, Sahin, BioNTech’s CEO, and Tureci, its chief medical officer, maintain that BioNTech is not an mRNA company but rather an immunotherapy company. Much of the couple’s work—both at BioNTech and at their previous venture, Ganymed—has focused on treating cancer. But it is mRNA, and the COVID-19 vaccine made possible by the technology, that has pushed the famously hardworking couple into the ­limelight—and helped them become one of the richest pairs in Germany, though they reportedly still bicycle to work and live in a modest apartment near their office.

Drs. Ugur Sahin and Ozlem Tureci, Co-founders, BioNTech. In January 2020, before many in the Western world were paying attention to a new virus spreading in China, Dr. Ugur Sahin was convinced it would spur a pandemic. Sahin, who in 2008 co-founded the German biotech company BioNTech with his wife Dr. Ozlem Tureci, went to work on a vaccine and by March called his contact at Pfizer, a much larger pharmaceutical company with which BioNTech had previously worked on an influenza vaccine using mRNA. Less than a year later, the Pfizer-BioNTech COVID-19 vaccine became the first ever mRNA vaccine available for widespread use. Even so, Sahin, BioNTech’s CEO, and Tureci, its chief medical officer, maintain that BioNTech is not an mRNA company but rather an immunotherapy company. Much of the couple’s work—both at BioNTech and at their previous venture, Ganymed—has focused on treating cancer. But it is mRNA, and the COVID-19 vaccine made possible by the technology, that has pushed the famously hardworking couple into the ­limelight—and helped them become one of the richest pairs in Germany, though they reportedly still bicycle to work and live in a modest apartment near their office.

Dina Litovsky—Redux for TIME

Up until last year, vaccines had not changed very much, at least in concept, for more than two centuries. Most have been modeled on the discovery made in 1796 by the English doctor Edward Jenner, who noticed that many milkmaids were immune to smallpox. They had all been infected by a form of pox that afflicts cows but is relatively harmless to humans, and Jenner surmised that the cowpox had given them immunity to smallpox. So he took some pus from a cowpox blister, rubbed it into scratches he made in the arm of his gardener’s 8-year-old son and then (this was in the days before bioethics panels) exposed the kid to smallpox. He didn’t become ill.

Before then, inoculations were done by giving patients a small dose of the actual smallpox virus, hoping that they would get a mild case and then be immune. Jenner’s great advance was to use a related but relatively harmless virus. Ever since, vaccinations have been based on the idea of exposing a patient to a safe facsimile of a dangerous virus or other germ. This is intended to kick the person’s adaptive immune system into gear. When it works, the body produces antibodies that will, sometimes for many years, fend off any infection if the real germ attacks.

One approach is to inject a safely weakened version of the virus. These can be good teachers, because they look very much like the real thing. The body responds by making antibodies for fighting them, and the immunity can last a lifetime. Albert Sabin used this approach for the oral polio vaccine in the 1950s, and that’s the way we now fend off measles, mumps, rubella and chicken pox.

At the same time Sabin was trying to develop a vaccine based on a weakened polio virus, Jonas Salk succeeded with a safer approach: using a killed or inactivated virus. This type of vaccine can still teach a person’s immune system how to fight off the live virus but is less likely to cause serious side effects. Two Chinese companies, Sinopharm and Sinovac, have used this approach to develop vaccines for COVID-19 that are now in limited use in China, the UAE and Indonesia.

Another traditional approach is to inject a subunit of the virus, such as one of the proteins that are on the virus’s coat. The immune system will then remember these, allowing the body to mount a quick and robust response when it encounters the actual virus. The vaccine against the hepatitis B virus, for example, works this way. Using only a fragment of the virus means that they are safer to inject into a patient and easier to produce, but they are often not as good at producing long-term immunity. The Maryland-based biotech Novavax is in late-stage clinical trials for a COVID-19 vaccine using this approach, and it is the basis for one of the two vaccines already being rolled out in Russia.

The plague year of 2020 will be remembered as the time when these traditional vaccines were supplanted by something fundamentally new: genetic vaccines, which deliver a gene or piece of genetic code into human cells. The genetic instructions then cause the cells to produce, on their own, safe components of the target virus in order to stimulate the patient’s immune system.

For SARS-CoV-2—the virus that causes COVID-19—the target component is its spike protein, which studs the outer envelope of the virus and enables it to infiltrate human cells. One method for doing this is by inserting the desired gene, using a technique known as recombinant DNA, into a harmless virus that can deliver the gene into human cells. To make a COVID vaccine, a gene that contains instructions for building part of a coronavirus spike protein is edited into the DNA of a weakened virus like an adenovirus, which can cause the common cold. The idea is that the re-engineered adenovirus will worm its way into human cells, where the new gene will cause the cells to make lots of these spike proteins. As a result, the person’s immune system will be primed to respond rapidly if the real coronavirus strikes.

This approach led to one of the earliest COVID vaccine candidates, developed at the aptly named Jenner Institute of the University of Oxford. Scientists there engineered the spike-protein gene into an adenovirus that causes the common cold in chimpanzees, but is relatively harmless in humans.

The lead researcher at Oxford is Sarah Gilbert. She worked on developing a vaccine for Middle East respiratory syndrome (MERS) using the same chimp adenovirus. That epidemic waned before her vaccine could be deployed, but it gave her a head start when COVID-19 struck. She already knew that the chimp adenovirus had successfully delivered into humans the gene for the spike protein of MERS. As soon as the Chinese published the genetic sequence of the new coronavirus in January 2020, she began engineering its spike-protein gene into the chimp virus, waking each day at 4 a.m.

Her 21-year-old triplets, all of whom were studying biochemistry, volunteered to be early testers, getting the vaccine and seeing if they developed the desired antibodies. (They did.) Trials in monkeys conducted at a Montana primate center in March also produced promising results.

Bill Gates, whose foundation provided much of the funding, pushed Oxford to team up with a major company that could test, manufacture and distribute the vaccine. So Oxford forged a partnership with AstraZeneca, the British-Swedish pharmaceutical company. Unfortunately, the clinical trials turned out to be sloppy, with the wrong doses given to some participants, which led to delays. Britain authorized it for emergency use at the end of December, and the U.S. is likely to do so in the next two months.

Johnson & Johnson is testing a similar vaccine that uses a human adenovirus, rather than a chimpanzee one, as the delivery mechanism to carry a gene that codes for making part of the spike protein. It’s a method that has shown promise in the past, but it could have the disadvantage that humans who have already been exposed to that adenovirus may have some immunity to it. Results from its clinical trial are expected later this month.

In addition, two other vaccines based on genetically engineered adenoviruses are now in limited distribution: one made by CanSino Biologics and being used on the military in China and another named Sputnik V from the Russian ministry of health.

There is another way to get genetic material into a human cell and cause it to produce the components of a dangerous virus, such as the spike proteins, that can stimulate the immune system. Instead of engineering the gene for the component into an adenovirus, you can simply inject the genetic code for the component into humans as DNA or RNA.

Let’s start with DNA vaccines. Researchers at Inovio Pharmaceuticals and a handful of other companies in 2020 created a little circle of DNA that coded for parts of the coronavirus spike protein. The idea was that if it could get inside the nucleus of a cell, the DNA could very efficiently churn out instructions for the production of the spike-protein parts, which serve to train the immune system to react to the real thing.

The big challenge facing a DNA vaccine is delivery. How can you get the little ring of DNA not only into a human cell but into the nucleus of the cell? Injecting a lot of the DNA vaccine into a patient’s arm will cause some of the DNA to get into cells, but it’s not very efficient.

Some of the developers of DNA vaccines, including Inovio, tried to facilitate the delivery into human cells through a method called electroporation, which delivers electrical shock pulses to the patient at the site of the injection. That opens pores in the cell membranes and allows the DNA to get in. The electric pulse guns have lots of tiny needles and are unnerving to behold. It’s not hard to see why this technique is unpopular, especially with those on the receiving end. So far, no easy and reliable delivery mechanism has been developed for getting DNA vaccines into the nucleus of human cells.

That leads us to the molecule that has proven victorious in the COVID vaccine race and deserves the title of TIME magazine’s Molecule of the Year: RNA. Its sibling DNA is more famous. But like many famous siblings, DNA doesn’t do much work. It mainly stays bunkered down in the nucleus of our cells, protecting the information it encodes. RNA, on the other hand, actually goes out and gets things done. The genes encoded by our DNA are transcribed into snippets of RNA that venture out from the nucleus of our cells into the protein-manufacturing region. There, this messenger RNA (mRNA) oversees the assembly of the specified protein. In other words, instead of just sitting at home curating information, it makes real products.

Scientists including Sydney Brenner at Cambridge and James Watson at Harvard first identified and isolated mRNA molecules in 1961. But it was hard to harness them to do our bidding, because the body’s immune system often destroyed the mRNA that researchers engineered and attempted to introduce into the body. Then in 2005, a pair of researchers at the University of Pennsylvania, Katalin Kariko and Drew Weissman, showed how to tweak a synthetic mRNA molecule so it could get into human cells without being attacked by the body’s immune system.

Stéphane Bancel, CEO, Moderna. Moderna’s COVID-19 vaccine was first tested in humans less than three months after news of the novel virus broke. But that lightning-fast development process belies the years of work that got Moderna to where it is today. The startup was founded in 2010 with the belief that mRNA technology, then still fairly new, could help treat any number of ailments. CEO Stéphane Bancel, pictured above, joined a year later. Moderna wasn’t originally focused on vaccines, but over time, its scientists began working toward vaccines against several infectious diseases as well as some forms of cancer. That experience came in handy when the COVID-19 pandemic arrived, leaving the world clamoring for a vaccine that could fight the deadly virus—and fast. Bancel’s company took the challenge in stride, using its mRNA platform to develop a vaccine around 95% effective at protecting against COVID-19 disease in less than a year.

Stéphane Bancel, CEO, Moderna. Moderna’s COVID-19 vaccine was first tested in humans less than three months after news of the novel virus broke. But that lightning-fast development process belies the years of work that got Moderna to where it is today. The startup was founded in 2010 with the belief that mRNA technology, then still fairly new, could help treat any number of ailments. CEO Stéphane Bancel, pictured above, joined a year later. Moderna wasn’t originally focused on vaccines, but over time, its scientists began working toward vaccines against several infectious diseases as well as some forms of cancer. That experience came in handy when the COVID-19 pandemic arrived, leaving the world clamoring for a vaccine that could fight the deadly virus—and fast. Bancel’s company took the challenge in stride, using its mRNA platform to develop a vaccine around 95% effective at protecting against COVID-19 disease in less than a year.

Cody O’Loughlin—The New York Times/Redux

When the COVID-19 pandemic hit a year ago, two innovative young pharmaceutical companies decided to try to harness this role played by messenger RNA: the German company BioNTech, which formed a partnership with the U.S. company Pfizer; and Moderna, based in Cambridge, Mass. Their mission was to engineer messenger RNA carrying the code letters to make part of the coronavirus spike protein—a string that begins CCUCGGCGGGCA … —and to deploy it in human cells.

BioNTech was founded in 2008 by the husband-and-wife team of Ugur Sahin and Ozlem Tureci, who met when they were training to be doctors in Germany in the early 1990s. Both were from Turkish immigrant families, and they shared a passion for medical research, so much so that they spent part of their wedding day working in the lab. They founded BioNTech with the goal of creating therapies that stimulate the immune system to fight cancerous cells. It also soon became a leader in devising medicines that use mRNA in vaccines against viruses.

In January 2020, Sahin read an article in the medical journal Lancet about a new coronavirus in China. After discussing it with his wife over breakfast, he sent an email to the other members of the BioNTech board saying that it was wrong to believe that this virus would come and go as easily as MERS and SARS. “This time it is different,” he told them.

BioNTech launched a crash project to devise a vaccine based on RNA sequences, which Sahin was able to write within days, that would cause human cells to make versions of the coronavirus’s spike protein. Once it looked promising, Sahin called Kathrin Jansen, the head of vaccine research and development at Pfizer. The two companies had been working together since 2018 to develop flu vaccines using mRNA technology, and he asked her whether Pfizer would want to enter a similar partnership for a COVID vaccine. “I was just about to call you and propose the same thing,” Jansen replied. The deal was signed in March.

By then, a similar mRNA vaccine was being developed by Moderna, a much smaller company with only 800 employees. Its chair and co-founder, Noubar Afeyan, a Beirut-born Armenian who immigrated to the U.S., had become fascinated by mRNA in 2010, when he heard a pitch from a group of Harvard and MIT researchers. Together they formed Moderna, which initially focused on using mRNA to try to develop personalized cancer treatments, but soon began experimenting with using the technique to make vaccines against viruses.

In January 2020, Afeyan took one of his daughters to a restaurant near his office in Cambridge to celebrate her birthday. In the middle of the meal, he got an urgent text message from the CEO of his company, Stéphane Bancel, in Switzerland. So he rushed outside in the freezing temperature, forgetting to grab his coat, to call him back.

Bancel said that he wanted to launch a project to use mRNA to attempt a vaccine against the new coronavirus. At that point, Moderna had more than 20 drugs in development but none had even reached the final stage of clinical trials. Nevertheless, Afeyan instantly authorized him to start work. “Don’t worry about the board,” he said. “Just get moving.” Lacking Pfizer’s resources, Moderna had to depend on funding from the U.S. government. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, was supportive. “Go for it,” he declared. “Whatever it costs, don’t worry about it.”

It took Bancel and his Moderna team only two days to create the RNA sequences that would produce the spike protein, and 41 days later, it shipped the first box of vials to the National Institutes of Health to begin early trials. Afeyan keeps a picture of that box on his cell phone.

An mRNA vaccine has certain advantages over a DNA vaccine, which has to use a re-engineered virus or other delivery mechanism to make it through the membrane that protects the nucleus of a cell. The RNA does not need to get into the nucleus. It simply needs to be delivered into the more-accessible outer region of cells, the cytoplasm, which is where proteins are constructed.

The Pfizer-BioNTech and Moderna vaccines do so by encapsulating the mRNA in tiny oily capsules, known as lipid nanoparticles. Moderna had been working for 10 years to improve its nanoparticles. This gave it one advantage over Pfizer-BioNTech: its particles were more stable and did not have to be stored at extremely low temperatures.

Katalin Kariko, Senior vice president, BioNTech. In 1995, after years of struggle, Hungarian-born Katalin Kariko was pushed off the path to full professorship at the University of Pennsylvania. Her work on mRNA, molecules she believed could fundamentally change the way humans treat disease, had stalled. Then, in 1997, she met and began working with immunologist Drew Weissman. In 2005, they published a study describing a modified form of artificial ­mRNA—a discovery, they argued, that opened the door to mRNA’s use in vaccines and other therapies. Eventually, Kariko and Weissman licensed their technology to the German company BioNTech, where Kariko, shown here in a portrait shot by a photographer working remotely, is now a senior vice president. Her patience paid off this year. The mRNA-based Pfizer-­BioNTech corona­virus vaccine, which Kariko helped develop, has been shown to be 95% effective at preventing COVID-19.

Katalin Kariko, Senior vice president, BioNTech. In 1995, after years of struggle, Hungarian-born Katalin Kariko was pushed off the path to full professorship at the University of Pennsylvania. Her work on mRNA, molecules she believed could fundamentally change the way humans treat disease, had stalled. Then, in 1997, she met and began working with immunologist Drew Weissman. In 2005, they published a study describing a modified form of artificial ­mRNA—a discovery, they argued, that opened the door to mRNA’s use in vaccines and other therapies. Eventually, Kariko and Weissman licensed their technology to the German company BioNTech, where Kariko, shown here in a portrait shot by a photographer working remotely, is now a senior vice president. Her patience paid off this year. The mRNA-based Pfizer-­BioNTech corona­virus vaccine, which Kariko helped develop, has been shown to be 95% effective at preventing COVID-19.

Dina Litovsky—Redux for TIME

By November, the results of the Pfizer-BioNTech and Moderna late-stage trials came back with resounding findings: both vaccines were more than 90% effective. A few weeks later, with COVID-19 once again surging throughout much of the world, they received emergency authorization from the U.S. Food and Drug Administration and became the vanguard of the biotech effort to beat back the pandemic.

The ability to code messenger RNA to do our bidding will transform medicine. As with the COVID vaccines, we can instruct mRNA to cause our cells to make antigens—molecules that stimulate our immune system—that could protect us against many viruses, bacteria, or other pathogens that cause infectious disease. In addition, mRNA could in the future be used, as BioNTech and Moderna are pioneering, to fight cancer. Harnessing a process called immunotherapy, the mRNA can be coded to produce molecules that will cause the body’s immune system to identify and kill cancer cells.

RNA can also be engineered, as Jennifer Doudna and others discovered, to target genes for editing. Using the CRISPR system adapted from bacteria, RNA can guide scissors-like enzymes to specific sequences of DNA in order to eliminate or edit a gene. This technique has already been used in trials to cure sickle cell anemia. Now it is also being used in the war against COVID. Doudna and others have created RNA-guided enzymes that can directly detect SARS-CoV-2 and eventually could be used to destroy it.

More controversially, CRISPR could be used to create “designer babies” with inheritable genetic changes. In 2018, a young Chinese doctor used CRISPR to engineer twin girls so they did not have the receptor for the virus that causes AIDS. There was an immediate outburst of awe and then shock. The doctor was denounced, and there were calls for an international moratorium on inheritable gene edits. But in the wake of the pandemic, RNA-guided genetic editing to make our species less receptive to viruses may someday begin to seem more acceptable.

Throughout human history, we have been subjected to wave after wave of viral and bacterial plagues. One of the earliest known was the Babylon flu epidemic around 1200 B.C. The plague of Athens in 429 B.C. killed close to 100,000 people, the Antonine plague in the 2nd century killed 5 million, the plague of Justinian in the 6th century killed 50 million, and the Black Death of the 14th century took almost 200 million lives, close to half of Europe’s population.

The COVID-19 pandemic that killed more than 1.8 million people in 2020 will not be the final plague. However, thanks to the new RNA technology, our defenses against most future plagues are likely to be immensely faster and more effective. As new viruses come along, or as the current coronavirus mutates, researchers can quickly recode a vaccine’s mRNA to target the new threats. “It was a bad day for viruses,” Moderna’s chair Afeyan says about the Sunday when he got the first word of his company’s clinical trial results. “There was a sudden shift in the evolutionary balance between what human technology can do and what viruses can do. We may never have a pandemic again.”

The invention of easily reprogrammable RNA vaccines was a lightning-fast triumph of human ingenuity, but it was based on decades of curiosity-driven research into one of the most fundamental aspects of life on planet earth: how genes are transcribed into RNA that tell cells what proteins to assemble. Likewise, CRISPR gene-editing technology came from understanding the way that bacteria use snippets of RNA to guide enzymes to destroy viruses. Great inventions come from understanding basic science. Nature is beautiful that way.

Isaacson, a former editor of TIME, is the author of The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race, to be published in March. After the Pfizer vaccine was approved, he opted to remain in the clinical trial and has not yet been “unblinded.”

This appears in the January 18, 2021 issue of TIME.

Contact us at letters@time.com.