These decisions are based on assessments of personal risk, community risk and exposure riskand the steps one can take to take to mitigate them. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Getting vaccinated and boosted protects against death, hospitalization and, to a lesser extent, catching and spreading the virus. In the graphics that follow, Scientific American presents detailed explanations, current as of mid-June, into how SARS-CoV-2 sneaks inside human cells, makes copies of itself and bursts out to infiltrate many more cells, widening infection. The letter to the FDA got an enormous response from many who agreed T cell measurements should be essential for future vaccine studies, Wherry says. And will we, as a global population, let our governments treat us this way? But immunologists still need more answers. So what gives?. health care workershimself includedgetting infected from their patients while wearing a well-fitting N95 is extraordinarily low. One cell can release hundreds of virus copies. Some politicians fought to keep it that way, The poor, no matter where they live, will suffer the greatest lasting toll, Instructing our cells to make specific proteins could control influenza, autoimmune diseases, even cancer, From brave exploration to just another playground for the 0.0000001 percent, But society is not prepared for the growing crisis of long COVID, Visualizing ongoing stories of loss, adaptation and inequality, People realized their jobs dont have to be that way, Different methods of drug delivery give us more tools to fight disease, COVID energized the Black Lives Matter movementand provoked a dangerous backlash, Those with the most at stake were heard the least, Virus origin stories have always been prone to conspiracy theories. And the T cells did not succumb to exhaustiona dysfunctional state that can arise with chronic stimulation and that some scientists feared might occur with repeated vaccinations. I will say its taken a lot of time for me to be comfortable with that, she says. Breathing heavily produces up to 10 times more aerosol particles that carry viruses than breathing normally, according to Richard Corsi, an expert on indoor air quality and dean of the College of Engineering at the University of California, Davis. Knowledge awaits. Political and economic gains overrode public health interests. As virologists learn more, we will update these graphics on our Web site (www.scientificamerican.com). They were all wearing masks. Create your free account or Sign in to continue. While there have been preliminary studies of the rates of long COVID, including risks of developing cardiovascular complications, Wachter says many of these involved unvaccinated people or infections with variants prior to Omicron. When community transmission is low, Chowell says he may feel comfortable removing his N95 at parties in some situations, such as to have a drink. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Measuring T cells is difficult, Wherry says, but he elucidated several new approaches in a March 24 Science Immunology viewpoint article. Create your free account or Sign in to continue. It compares ones risk of death from the disease to such risk posed by other activities, including driving. Jetelina recommends using the New York Times tracker to look up community transmission for your county. Using data from the U.S. Centers for Disease Control and Prevention, she estimates that even vaccine-boosted people ages 50 to 64 are more than 10 times more likely to die from a severe breakthrough case than 18- to 49-year-olds with the same vaccination status. Ranu Dhillon, a physician at Brigham and Womens Hospital in Boston, who advises governments on infectious disease outbreaks, says he is seeing some patients with a constellation of different types of symptoms after acute COVID infection, including young, boosted and relatively healthy people. Antibody levels start dropping in a few months. We need vaccines that give broader protection and last longer, and theres important work ahead, said Ofer Levy, one of the letters signees, in a recent Harvard Medical School press briefing. Marr says that talking in bars expels a similar number of respiratory particles as coughing, so its like everyones in there coughing together. Craig uses smoking as an analogy for aerosols exhaled during breathing and talking. Thanks for reading Scientific American. Discover world-changing science. This releases fusion machinery, part of the spike's stem that is compressed in a springlike state. The adaptive immune system gears up for a greater response. 2022 Scientific American, a Division of Springer Nature America, Inc. At present, the WHO does not recommend mass immunization for monkeypox. An Italian study of schools found that classrooms with ventilation systems that exchanged air six times per hour reduced infections by more than 80 percent, but many classrooms in the U.S. fail to meet this standard. Provisionally, he likens these risks to 20 years of untreated high blood pressure or smoking and points out that one cannot know the risk of long COVID among vaccinated and boosted individuals until long-term studies have concluded, which will take years. Politicians, for example, in the U.S. and Japan, did not let it go unnoticed. When infection begins, the innate immune system tries to immediately protect lung cells. According to Wachter, one of the most important factors in overall COVID risk is whether the person next to me has it. He acknowledges that if someone is both vaccinated and boosted, it is not irrational for that person to decide that the mental energy and angst of calculating risks and taking precautions is high enoughand the risks of getting sick or dying from COVID are low enoughthat they will go back to living like its 2019as people in many parts of the country already have. We dont know the answers to any of those questions because were not measuring memory T cells at scale in enough patients, Wherry says. In a study described in a January Cell paper, scientists at the La Jolla Institute for Immunology analyzed blood from 96 adults at various times after receiving a COVID vaccine. Unlike neutralizing antibodies, T cells recognize a broad set of targets on the virus. They should strengthen virus surveillance and work on deploying decentralized, privacy-preserving and encrypted contact tracing to avoid data breaches and to ensure trust within their communities. Spike decapitation allows the fusion machinery to unfold. The question is, how will we proceed this time? In fact, on April 21, Wherry and dozens of other researchers, physicians and biotech representatives sent a letter to the U.S. Food and Drug Administration urging the agency to monitor the abundance of T cellsalongside antibody levelsto better assess immunity at the city, state or national level to determine the effectiveness of new vaccines undergoing review by regulators. We explain some of the virus's surprising abilities, such as its capacity to proofread new virus copies as they are being made to prevent mutations that could destroy them. Each segment is presented on the cell surface by a set of scaffolding molecules called human leukocyte antigens (HLAs) that differ among individuals. The machinery inserts itself into the cell membrane and a channel forms, allowing N proteins and RNA (genetic instructions) to enter the lung cell. We are still in early days, and policy makers have a small window of opportunity to act quickly and put the right measures in place to stop monkeypox from turning into another disaster. And we show how drugs and vaccines might still be able to overcome the intruders. Countries must set up proper testing and molecular diagnostic facilities to detect cases early. So test positivity is typically higher than the infection rates among the people you might encounter in a cafe or grocery store, most of whom do not have any symptoms but could still be infectious. The SARS-CoV-2 genome is a strand of RNA that is about 29,900 bases long--near the limit for RNA viruses. (HLA typing is used to match patients and donors for blood or marrow transplants. We dont need the data to give us better ideas about what to do. Discover world-changing science. Data so far have focused heavily on a single parameter: neutralizing antibodies. I think theres some momentum., Esther Landhuis is a freelance science and health journalist based in the San Francisco Bay Area. Because the SARS-CoV-2 genome is so long, it can encode a huge amount of information, enabling the novel coronavirus to create more proteins and perhaps carry out more sophisticated replication strategies than other RNA viruses. In the U.K. and the U.S., for instance, government officials publicly tap-danced around scientists recommendations for physical distancing and even boasted about doing the opposite. Employers may also misuse such comparisons to compel employees to accept certain risks on the job, which is not exactly a choice. March 1, 2022 Amanda Montaez, Jen Christiansen, Sabine Devins, Mariana Surillo and Ashley P. Taylor, March 1, 2022 Christina Maslach and Michael P. Leiter, March 1, 2022 Stephan Lewandowsky, Peter Jacobs and Stuart Neil, March 1, 2022 Christine Crudo Blackburn, Introducing 21 Ways COVID Changed the World, How a Virus Exposed the Myth of Rugged Individualism, A High-Speed Scientific Hive Mind Emerged from the COVID Pandemic, March 1, 2022 Joseph Bak-Coleman and Carl T. Bergstrom. Vaccines prepare the immune system to quickly and effectively fight a future infection. The virus and lung-cell membranes fuse. Follow him on Twitter @sri_srikrishna. Community risk is the current likelihood of encountering COVID among members of ones community. In general, people should discuss personal COVID risk with their doctor; it depends, in part, on which medications they take. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. The number-one predictor of having a severe case of the disease is age, followed by the presence of comorbidities and immunocompromised status, according to Katelyn Jetelina, an epidemiologist who studies COVID risks at the University of Texas Health Science Center at Houston. These durable immune cells do not necessarily stave off infection but do keep mild symptoms from worsening. 2022 Scientific American, a Division of Springer Nature America, Inc. To avoid infection, Wachter recommends wearing an N95 mask. Still, Robert M. Wachter, a professor and chair of the department of medicine at the University of California, San Francisco, says there is no test positivity threshold that separates safe from not safe because it also depends on other factors, such as whether the benefit outweighs the risk to you, personally, the number of people you will be exposed to, and the closeness and duration of exposure. Once a SARS-CoV-2 virus has infected a lung cell, an enzyme called polymerase starts to make copies of its RNA while another enzyme, ExoN, finds random mutations and expels these genetic mistakes from the copies. They should also be prepared to combat the tidal wave of a possible misinfodemic.. Continue reading with a Scientific American subscription. COVID risk goes up substantially with age and with being unboosted or unvaccinated. Proteins called "S" form spikes that extend from the surface and grab onto a human cell, hundreds of times larger, so the particle, or virion, can slip inside; the crown, or corona, appearance gives the virus its name. Getting those answers would require tracking thousands to tens of thousands of people, Wherry says. COVID has given nations worldwide a literal checklist of what not to do. Follow him on Twitter: @DrNoonMJ. It was one of the most homogenous types of responses Ive seen for anything, given how polarized we are these days. Once virus RNA is inside a cell, it presents about two dozen genes to the cell's ribosomes, which translate genes into proteins. San Diego (, "The Architecture of SARS-CoV-2 Transcriptome," by Dongwan Kim et al., in. This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American. Create your free account or Sign in to continue. More than two years into the COVID-19 pandemic, scientists are still scratching their head over a basic question: Is there something they could measure to tell if people are protected? Researchers are, in fact, working toward a streamlined T cell testing process. Corsi characterized current public health recommendations of four to six air exchanges per hour as a little bit anemic we can do better. He recommends owners or managers of crowded indoor spaces, such as classrooms, offices and bars, aim to filter or ventilate with fresh air at rates approaching 12 air exchanges per hour to reduce risks down to the level of an airborne isolation room in a hospital. The long genome also has accessory genes, not fully understood, some of which may help it fend off our immune system. Once transmission rates of those indicators start increasing a bit, Im putting my mask back on. Others suggest a slightly higher risk threshold of 10 daily (or 70 weekly) cases per 100,000 residents.*. Discover world-changing science. So such a theater may be less risky than other crowded indoor venues. Muhammad Jawad Noon is a medical doctor, currently working as a researcher in economic sciences at the University of Gttingen, Germany. One is an assay that would bypass laborious cell purifications and manipulations by detecting activated T cells in blood samples squirted into tubes premixed with bits of SARS-CoV-2 proteins. The need for many doses is not practical at a population level. Removing an N95 momentarily for a bite or sip carries some risk, but I think its pretty tiny if youre exposed for three seconds, Corsi says, unless an infected person is right in your face and shedding a lot [of virus]. Provided community risk is low or trending downward, Chowell, too, feels comfortable briefly removing his respirator to eat or drink at a party. Thanks for reading Scientific American. SARS-CoV-2 uses several tactics to thwart the immune systems response. When the risk is lower than that, Jetelinaa healthy, young boosted personfeels comfortable taking off her mask indoors. For a static version of this content as it appears in the July 2020 issue of, When a virus spike protein latches onto an ACE2 receptor, a protease enzyme slices off the spike's head. (ACE2 normally helps regulate blood pressure.). 2022 Scientific American, a Division of Springer Nature America, Inc. By six months after vaccination, levels of neutralizing antibodies had fallen substantially, whereas T cell responses remained strong even against Omicron. In places with inadequate ventilation, consider bringing a portable high-efficiency particulate air (HEPA) purifieror building your own using box fans and high-quality HVAC (heating, ventilating and air-conditioning) filtersto run nearby. How many are needed to stave off severe disease? That means that the reproduction numberthe expected number of secondary infections from each infected personmust be greater than one. Even in the absence of large-scale monitoring, researchers have been studying patients T cells throughout the pandemic. Thanks for reading Scientific American. I wondered if politicians would respond similarlydisjointedlyignoring public health messaging. Standardized assays can measure SARS-CoV-2-specific antibodies in tens of thousands of blood samples per day, and the process can be automated with robots. Experts are exploring at least six strategies for making vaccine versions of the virus. Some of the copies are utilized to make more viral proteins, such as the spike. Scientific American asked experts in epidemiology, medicine, risk assessment and aerosol transmission for advice on how to decide which risks we are willing to take. Furthermore, in another study, people showed evidence of high-quality T cell memory no matter how many times they were exposed to the virus through either vaccination or infection. This quality control is common in human cells and in DNA viruses but highly unusual in RNA viruses. Antiviral drugs generally stop a virus from attaching to a lung cell, prevent a virus from reproducing if it does invade a cell, or dampen an overreaction by the immune system, which can cause severe symptoms in infected people. The virus binds to that cell, slips inside and uses the cell's machinery to help make copies of itself. infections less likely or illness less likely to be severe, 50 times an hour with virus-trapping MERV-14 air filters, reduced infections by more than 80 percent, high-efficiency particulate air (HEPA) purifier. It sounded like an excerpt from 2020 when public health organizations made the same warnings about COVID. Create your free account or Sign in to continue. Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and one of the worlds leading experts on airborne transmission of viruses, says COVID risk in indoor spaces exists on a continuum. History is filled with examples of politicians able to get away with face-saving tactics, but how long are we going to tolerate this deceit? Donald Milton, a physician and clinical researcher who studies respiratory viruses at the University of Maryland, highlights recent research showing that, in households with a person who was infected with the Omicron variant (B.1.1.529) of the COVID-causing virus SARS-CoV-2, 43 to 64 percent of people became infected as well, depending on whether the initially infected person was boosted, fully vaccinated or unvaccinated. I worried monkeypox would turn into a sequel to COVID. When the trend is going up, youre seeing the transmission chains expand, Chowell says. A key source of protection for the previously infected, he and other experts suggest, are memory T cells. If it is increasing, thats probably the time when [one has the] highest risk of acquiring COVID in a social setting without a mask, he says. Wachter points out that, where available, wastewater surveillance may also give an early indication of COVID trends. Here is what experts say about managing these risks while maintaining some of the benefits of public life. The Remarkable and Mysterious Coronavirus Genome. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Doing the analyses at large scale would be hugely expensive, labor-intensive, and hard to control and standardize across different sites.. The virus uses its own RNA copying machine, called a polymerase, to make duplicates of RNA inside the vesicles. Places with rapid rates of ventilation and filtrationsuch as some subwaysare also much lower risk. Craig adds that such patients usually take precautions of their own accord, such as wearing high-filtration N95 masks, and if anything, I end up having to talk people down sometimes and be like Look, its okay to go to the grocery store. For some people, however, even this amount of exposure could be considered an unacceptable risk. The unfortunate cocktail of lies, fake news, politics, blame and incompetent governance during a highly lethal pandemic has put the public on the losing end. Even if some of the viral protein fragments targeted by T cells have evolved to evade immune attack, others remain unchanged as targets. Marr says one of the riskiest settings is an aerobic exercise studio: if somebody is infected, they are going to be exhaling more virus, and everyone else will be inhaling at a faster rate, too. But if it doesnt, government officials all over the world have a responsibility to learn from the mistakes of the COVID pandemic and not repeat them. Personal risk refers to the danger of contracting COVID faced by an individual and the members of their household. Discover world-changing science. Infected cells send out alarms to the immune system to try to neutralize or destroy the pathogens, but the viruses can prevent or intercept the signals, buying time to replicate widely before a person shows symptoms. Lessons from two years of emergency science, upheaval and loss, The pandemic didnt bring us together, but it did show us what we need to change the most, Humans evolved to be interdependent, not self-sufficient, The pandemic pushed researchers into new forms of rapid communication and collaboration, Its no longer possible to separate science and politics, COVID accelerated the development of cutting-edge PCR testsand made the need for them urgent, What happens when a deadly virus hits a vulnerable society, The need to reinvent the World Health Organization has become abundantly clear, Emergency managers are stuck reacting to a constant march of disasters, Residents learned what was possible. The WHO had declared COVID a public health emergency of international concern by the end of January. Create your free account or Sign in to continue. I still remember the early days of COVID confusion. In the U.S. alone, more than 200,000 children lost a parent or caregiver to COVID-19. Yet were not seeing hospitalizations go up as fast as antibodies are going down, says immunologist E. John Wherry of the University of Pennsylvania. In one study, scientists collected blood plasma from a set of macaques they had infected with SARS-CoV-2 and found that infusing the plasma into naive animals helped them resist subsequent infection. How can we balance these risks with the benefits of socializing and being with others? Prevent the Virus from Entering the Cell: A vaccine exposes the immune system to a safe version of a virus so it can practice making antibodies that will stop the pathogen and commit the exercise to memory so it is ready to fight the real virus during an infection. Knowledge awaits. Some of those proteins stretch the endoplasmic reticulum, creating protective vesicles, or sacs. Monkeypox is so far less deadly than COVID. And importantly, government officials must refrain from stigmatizing people who have monkeypox. The WHO struggled in the beginning to be consistent in its messagingas what we were learning changed in real time and there was a lack of clear evidence on the dynamics of COVID transmission. One such immunosuppressive drug, rituximab, knocks out your ability to make antibodies against new viral exposures and impairs your ability to make a response to a vaccine, he says. And exposure risk accounts for the increased chances of catching COVID at a particular venue based on airflow characteristics of the space itself and other peoples behavior. Although the virus is thought to be transmitted primarily through the air, there have been a few documented cases of surface transmission, so it remains a good idea to wash your hands frequently, Marr says. If the virus tries to evade your T cells and then gets transmitted to me, all that evasion and all that evolution it has done is not useful because my immune system is showing a different target, Barker says. In addition, governments should accelerate the monkeypox research agenda and share anonymized data with the WHO using its standardized protocol, so that data can be compared across countries and regions. Interferon also recruits T cells, which can destroy viruses and also kill infected cells before viruses inside them burst out. In 2.5 years of this pandemic (no, the pandemic is still not over), with mismanagement of prevention measures and a vaccine effort plagued with misinformation, millions of people have died, many millions more have been sickened and a sizable portion are living with long COVID, and vaccination rates in some countries are dismal. Thanks for reading Scientific American. A SARS-CoV-2 particle enters a person's nose or mouth and floats in the airway until it brushes against a lung cell that has an ACE2 receptor on the surface. What is known about exposure risk in different settings, such as bars or movie theaters? Knowledge awaits. What is the risk of taking your mask off in a restaurant or bar to take a sip or bite? Recent epidemics provide clues to ways the current crisis could stop, How Doctors and Nurses Manage Coronavirus Grief, In their own voices, health care workers from across the country reflect on coping with the pandemic, Interviews by Jillian Mock and Jen Schwartz, Genetic Engineering Could Make a COVID-19 Vaccine in Months Rather Than Years, Candidates are speeding toward human trials, Virus Mutations Reveal How COVID-19 Really Spread, Sources: Lorenzo Casalino, Zied Gaieb and Rommie Amaro, U.C. The transcript of the last 2.5 years is right in front of them. Normally, sensor proteins recognize incoming viruses as foreign and tell the cell nucleus to turn on genes for making messenger RNA molecules. In movie theaters, there is risk of exposure from those seated immediately around you, but because of limited talking and, typically, a high ceiling, there is a lot more dilution of the air. Currently, risk calculators provide estimates based on retrospective data and may be unable to reliably weigh long-term complications of COVID. This was the precursor to the official declaration of a pandemic a few weeks later. These findings were published April 5 in Nature Immunology. It is believed that reducing the amount of virus inhaled (i.e., the inhalation dose) makes infections less likely or illness less likely to be severe. Thanks for reading Scientific American. He says people also have to decide whether to wear a high-quality mask when they are around those at higher risk, such as the elderly or immunocompromised, or around other people in general, such as at a party. 2022 Scientific American, a Division of Springer Nature America, Inc. Its really hard for a virus to evolve around T cells.. With that larger cohort, the analyses in each person could be much simplerresearchers could find out how many SARS-CoV-2-specific T cells people have and where in a range of T cell measures they fall. Thanks for reading Scientific American. (A base is a pair of compounds that are the building blocks of RNA and DNA.) Monkeypox is spreading: there have been more than 3,000 confirmed cases of this virus in over 40 countries, and the actual number is likely much higher. How can one further reduce the risk of getting COVID from everyday activities? Thanks for reading Scientific American. Because of these large uncertainties in test coverage, Gerardo Chowell, a professor of mathematical epidemiology at Georgia State University, prefers to look at the general trend in daily COVID cases, hospitalizations and deaths, or percent positive. A SARS-CoV-2 virus particle wafting into a person's nose or mouth is about 100 nanometers in diameter--visible only with an electron microscope.
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