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Sudan security forces skirmish with demonstrators after protest deaths

A Sudanese anti-coup protester clashes with security forces during a demonstration against military rule, in Khartoum on June 30, 2022.

Guns overtake car crashes as leading cause of US trauma-related deaths, study says

The study found that suicides accounted for most of the deaths by firearms.

‘Lurching Between Crisis and Complacency’: Was This Our Last COVID Surge?

A woman receives a COVID-19 vaccination at the Unidos En Salud community vaccination and testing site in San Francisco on Aug. 1, 2021. (Mike Kai Chen/The New York Times)
A woman receives a COVID-19 vaccination at the Unidos En Salud community vaccination and testing site in San Francisco on Aug. 1, 2021.

After a brutal summer surge, driven by the highly contagious delta variant, the coronavirus is again in retreat.

The United States is recording roughly 90,000 new infections a day, down more than 40% since August. Hospitalizations and deaths are falling, too.

The crisis is not over everywhere — the situation in Alaska is particularly dire — but nationally, the trend is clear, and hopes are rising that the worst is finally behind us.

Again.

Over the past two years, the pandemic has crashed over the country in waves, inundating hospitals and then receding, only to return after Americans let their guard down.

It is difficult to tease apart the reasons that the virus ebbs and flows in this way and harder still to predict the future.

But as winter looms, there are real reasons for optimism. Nearly 70% of adults are fully vaccinated, and many children younger than 12 are likely to be eligible for hoka shoes their shots in a matter of weeks. Federal regulators could soon authorize the first antiviral pill for COVID-19.

“We are definitely, without a doubt, hands-down in a better place this year than we were last year,” said Dr. Nahid Bhadelia, director of the Center for Emerging Infectious Diseases Policy and Research at Boston University.

But the pandemic is not over yet, scientists cautioned. Nearly 2,000 Americans are still dying every day, and another winter surge is plausible. Given how many Americans remain unvaccinated and how much remains unknown, it is too soon to abandon basic precautions, they said.

“We’ve done this again and again, where we let the foot off the pedal too early,” Bhadelia said. “It behooves us to be a bit more cautious as we’re trying to get to that finish line.”

Crushing the Curve

When the first wave of cases hit the United States in early 2020, there was no COVID vaccine, and essentially no one was immune to the virus. The only way to flatten the proverbial curve was to change individual behavior.

That is what the first round of stay-at-home orders, business closures, mask mandates and bans on large gatherings aimed to do. There is still debate over which of these measures were most effective, but numerous hey dude studies suggest that, collectively, they made a difference, keeping people at home and curbing the growth of case numbers.

These policies, combined with voluntary social distancing, most likely helped bring the early surges to an end, researchers said.

“And then the measures would be lifted, maybe memories would fade,” said Jennifer Nuzzo, a public health researcher at Johns Hopkins University.

Eventually, cases would rise again, and similar patterns would play out. Businesses and local governments would reimplement restrictions, while people who had begun venturing out into the world again would hunker down and mask up.

During last winter’s surge, for instance, the percentage of Americans who reported going to bars or restaurants or attending large events declined, according to the U.S. COVID-19 Trends and Impact Survey, which has surveyed an average of 44,000 Facebook users daily since April 2020.

“The curve is shaped by public awareness,” Nuzzo said. “We’re sort of lurching between crisis and complacency.”

Delta arrived during a period of deep pandemic fatigue and at a moment when many vaccinated Americans felt as if they could finally relax. Data suggests that the new variant prompted less profound behavioral change than previous waves.

In mid-July, just 23% of Americans said that they always wore a mask in public, the lowest percentage since March 2020, according to the Institute for Health Metrics and Evaluation at the University of Washington, which compiles data from several sources.

By Aug. 31, the peak of the delta wave, that figure had risen to 41%, although it remained far below the 77% of people who reported wearing masks during the winter surge.

“If you just look around, people are much more living a normal life or a pre-COVID life,” said Dr. Christopher Murray, director of the institute.

Still, even modest changes in behavior can help slow transmission, especially in combination, and delta prompted changes at both the individual and organizational levels. Schools adopted new precautions, companies postponed reopenings, and organizations canceled events, dr martens boots giving the virus fewer opportunities to spread.

Meanwhile, more temperate autumn weather arrived, making it possible for Americans in many regions of the country to socialize outside, where the virus is less likely to spread.

“We’re in a shoulder season, where it’s cooler in the South than it is in the middle of the summer and it’s warmer in the North than it is in the middle of the winter,” said David O’Connor, a virus expert at the University of Wisconsin-Madison.

Indeed, many of the current virus hot spots are in the northernmost parts of the country, from Alaska to Minnesota, where even cooler temperatures may be sending people back inside.

Increasing Immunity

Behavioral change is a temporary, short-term way to drive cases down. The true end to the pandemic will come through immunity.

The delta wave was the first major, national surge to occur after vaccines had become widely available, providing many adults with substantial protection against the virus. (Delta also probably led more Americans to get vaccinated.)

At the same time, the variant was so infectious that it spread rapidly through vulnerable populations, conferring natural immunity on many unvaccinated Americans.

Although neither vaccination nor prior infection provides perfect protection against the virus, they dramatically reduce the odds of catching it. So by September, the virus had a substantially harder time finding hospitable hosts.

“Delta is running out of people to infect,” said Jeffrey Shaman, an infectious disease public health researcher at Columbia University.

The fact that case numbers are falling does not mean that the country has reached herd immunity, a goal that many scientists now believe is unattainable. But the rising levels of vaccination and infection, combined with more modest behavioral changes, may have been enough to bring the surge to an end.

“It’s a combination of immunity but also people being careful,” said Joshua Salomon, an infectious disease expert and modeler at Stanford University.

Indeed, scientists said that a combination of factors, which might be different in different parts of the country, would ultimately determine when and why the virus waxed and waned.

“The different surges and waves depend on how big were the waves before that one, how many people have been vaccinated, when the schools reopened, the different variants,” said Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston.

There is some randomness involved, too, especially because small numbers of “superspreaders” seem to play a disproportionate role in setting off outbreaks. “About 10 to 20% of the people are responsible for 80 to 90% of the infections,” said Christina Ramirez, a biostatistician at the University of California, Los Angeles.

That means that two similar communities might find themselves on radically different trajectories simply because one highly infectious person happened to attend a crowded indoor event, fueling a major outbreak.

Some patterns still defy explanation. In March and April, for instance, Michigan was hit hard by the alpha variant, delta’s slightly less infectious predecessor.

Other states were largely spared, for reasons that remain unclear, Murray said. “Why was Michigan the only state with a large alpha surge in spring?” he said. “We have no idea.”

The Winter Forecast

What comes next is hard to predict, but cases may not necessarily continue their steady decline, scientists warned.

Britain and Israel, which both have higher vaccination rates than the United States, are still struggling with outbreaks.

“That should be a wake-up call,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Do not go back into the pre-Fourth-of-July mindset again where everybody thought it was done and over with.”

Most experts said they would not be surprised to see at least a small increase in cases later this fall or this winter as people begin spending more time indoors and traveling for the holidays.

But because the vaccines remain highly effective at preventing hospitalization and death, any coming winter spikes may be less catastrophic than last year’s.

“It’s not likely that it will be as deadly as the surge we had last winter, unless we get really unlucky with respect to a new variant,” Salomon said.

The emergence of a new variant remains a wild card, as does the possibility that the protection afforded by vaccination could start to wane more substantially.

Our own behavior is another source of uncertainty.

“Predicting an outbreak is not like predicting the weather, because you’re dealing with human behavior,” said Nicholas Reich, a biostatistician at the University of Massachusetts, Amherst. “And that’s a fundamentally really hard thing to predict: new policies that would come into force, people’s reactions to them, new trends on social media, you know — the list goes on and on.”

But our behavior is, at least, under our control, and it remains a critical variable as we head into the winter, scientists said. By and large, they did not recommend canceling holiday plans; many said they themselves would be celebrating with friends and relatives. But they did suggest taking sensible precautions.

There is still time to be vaccinated or encourage loved ones to be vaccinated before Thanksgiving. Wearing masks in certain high-risk settings, hosting events outdoors when the weather is nice and taking rapid COVID tests before holiday gatherings are all common-sense strategies for reducing risk, experts said.

“It doesn’t mean Lockdown Christmas No. 2,” said Angela Rasmussen, a virus expert at the Vaccine and Infectious Disease Organization at the University of Saskatchewan. “But it does mean that we should all just be mindful that this is not completely over yet.”

The Greatest Killer in New Orleans Wasn’t the Hurricane. It Was the Heat.

National Guard members distribute ice outside a community center in New Orleans on Sept. 1, 2021. The city was without power for days after Hurricane Ida made landfall. (Johnny Milano/The New York Times)
National Guard members distribute ice outside a community center in New Orleans on Sept. 1, 2021. The city was without power for days after Hurricane Ida made landfall.

NEW ORLEANS — In many ways, Iley Joseph’s one-bedroom apartment was an ideal place to ride out a hurricane. It was on the third floor — much too high to flood — of a building that was sturdy and new, part of a sleek, gated community for older residents like him.

But in the days after Hurricane Ida, his home began to feel like a trap. nike store The huge power failure that cut off electricity to New Orleans rendered Joseph’s air-conditioner useless and his refrigerator nothing more than a cupboard. Even worse, the outage froze the complex’s elevators in place, sealing him inside the building because his health problems prevented him from using the stairs.

Joseph, 73, insisted in telephone conversations with his sons that he was doing just fine. But in his apartment, No. 312, it kept getting hotter. On Sept. 2, the fourth day after the storm hit — the hottest yet — a friend found him lying still on the side of his bed.

“I call his name, he doesn’t respond,” said the friend, Jared Righteous. “I realized he was gone.”

Only in recent days, as the last lights flickered back on in New Orleans, have officials here discovered the true toll of Hurricane Ida. Unlike in the Northeast, where many who perished were taken by floodwaters and tornadoes, heat has emerged as the greatest killer in New Orleans.

Of 14 deaths caused by the storm in the city, Joseph’s and nine others are believed to be tied to the heat. Experts say there are probably more. And friends of those who died have begun to ask whether the government or apartment landlords could have done more to protect older residents before they died, often alone, in stiflingly hot homes.

“Heat is a hazard that we simply haven’t given sufficient attention to,” said David Hondula, a professor at Arizona State University who studies the effects of sweltering temperatures. “All cities are in the early stages of understanding what an effective heat response looks like.”

In New Orleans, officials set up air-conditioned cooling centers across the city and distributed food, water and ice around town. But for residents like Joseph who could not leave their buildings, the aid might as well have been worlds away.

All 10 people whose deaths have been tied to the heat were in their 60s and 70s, and they died over four broiling days, the last of which was Sept. 5, a full week after the storm.

Among the first was Corinne Labat-Hingle, a 70-year-old woman who had fled to Memphis during Hurricane Katrina but returned to New Orleans and was living at an apartment complex for older people near Saint Bernard Avenue, a short walk from the city’s largest park. She was found dead on Sept. 2, when the temperature reached 93 degrees outdoors and was most likely higher inside her apartment.

Two days later, another 93-degree day, four people were found dead, including Reginald Logan, 74, whose body was discovered after a neighbor saw flies in his window. On Sept. 5, the heat index reached 101, and one of the last victims of the heat was found dead:asics shoes Keith Law, a 65-year-old man who lived in the Algiers neighborhood.

Heat most likely contributes to more deaths each year than are officially recorded, Hondula said. Though the Centers for Disease Control and Prevention reports fewer than 700 heat-related deaths a year, some studies have estimated 5,000 to 12,000. Last month, The New York Times found that 600 more people died in Oregon and Washington in the last week of June, during a heat wave, than normally would have, a number three times the state officials’ estimates of heat-related deaths.

This comes as heat waves are growing more frequent, longer lasting and more dangerous. The 2018 National Climate Assessment, a major scientific report by 13 federal agencies, notes that the number of hot days is increasing, and the frequency of heat waves in the United States jumped from an average of two per year in the 1960s to six per year by the 2010s.

People who die from the heat may not recognize their symptoms as life-threatening, and heat-related deaths can also occur suddenly, with little warning. The most frequent cause is cardiovascular failure, when the heart cannot pump blood fast enough. Less frequent are deaths from heat stroke, when a person’s internal temperature rises by several degrees and the body cannot cool off, causing organs like the brain, heart or kidneys to fail.

Laura Bergerol, a 65-year-old New Orleans photographer, died on Sept. 5. She had planned to evacuate to Florida before the storm but told friends she had trouble finding a hotel room. By the time she arranged plans, it was too dangerous to leave. After the storm, an errant $400 charge on her bank account had left her without enough money to get out. She stocked up on candles and hunkered down in her second-floor apartment in an affordable complex built for artists in the Bywater neighborhood downriver from the French Quarter.

“Missed my window of opportunity,” she wrote on Twitter. “Curse you #HurricaneIda.”

Neighbors said Bergerol largely stayed in her apartment with the doors and windows closed. Still, she seemed to be surviving. On Sept. 3, she texted Josh Hailey,keen shoes  a neighbor, asking if she could visit his cat while he was out. “I have plenty of treats,” she wrote. The next day, she joined neighbors in the building’s courtyard for a showing of “Cinderella.”

On Sunday, Hailey let himself into her apartment when she did not answer the door. He found her lying on the floor and tried to resuscitate her, but it was too late. That evening, the neighbors played brass-band music in the courtyard and danced for Bergerol, recalling her vivid blue eyes and frequent, wide smile.

By then, city health officials had begun to realize the danger that older residents were facing. A day before Bergerol’s death, they evacuated eight apartments for older residents, including several where people had died. Now, city officials are considering mandating, during natural disasters, that subsidized apartments serving older or disabled residents have generators, conduct welfare checks or have a building manager on the property at all times, a spokesperson said.

The proposed measures are gaining momentum partly because of deaths like that of Joseph, the man stuck in apartment 312.

Joseph was well known at Village de Jardin, a relatively affordable complex in New Orleans East for people 55 and older. It is owned by the Louisiana Housing Corp., a state agency, and managed by Latter & Blum, a large real estate company that manages properties across several states. The housing agency said Latter & Blum had encouraged tenants to evacuate and then, after the storm, brought cooling buses to the property and supplies to tenants who chose to stay.

Joseph had retired years ago from a job selling car parts. He frequently chatted with neighbors, and his routine included grabbing coffee and beignets around town. He was known for his faith, his love of his family and, to some, his trademark reply, “Yes, indeed,” which led his grandchildren to call him Grandpa Yes Indeed. Many more people knew him for his humor, which is how he became friends with Righteous, 45, who was drawn to Joseph when he was cracking jokes at an event hosted by the Franklin Avenue Baptist Church.

In the days after the hurricane, neighbors looked out for Joseph, who was subsisting on peanut butter and jelly sandwiches. One friend brought him a warm plate of food. A neighbor across the hall charged Joseph’s phone using a car battery and an inverter.

But Sept. 2 was the most grueling day yet. Around 1:45 p.m., the heat index was nearing 103, and Joseph’s phone had died again. He poked his head outside his door and motioned for a woman in the hallway to come closer. The woman, Rhonda Quinn, thought he looked unwell and asked if he needed some air. He brushed her off, joking that after days in the heat, he smelled too bad to go out, she said.

What he did need, he said, was to charge his phone to make a call. Quinn found someone to help, but when she tried to return the phone sometime before 3 p.m., he did not answer her repeated knocks. She assumed he had gone out, and she left.

Shortly after, Joseph’s friend from church, Righteous, pulled into the complex’s parking lot with a bag of oatmeal cream pies and other snacks. He, too, received no answer after knocking on Joseph’s door. When he opened it, he found Joseph slumped to the side of the bed, as if he had been sitting on its edge and looking out the window.

His death has left his two sons grief-stricken and stunned, unable to understand how their father could make it through the hurricane’s wrath without a scratch only to perish in the heat that followed.

“He didn’t die from flooding, he didn’t die from a lightning bolt,” said his oldest son, Iley Joseph Jr., 45. “It’s just, he’s gone.”

For scientists, path to covid endgame remains uncertain

Tourists visit the National Mall in Washington, D.C., the United States, on Aug. 18, 2021. The United States will begin administrating COVID-19 booster shots next month as new data shows that vaccine protection wanes over time, top U.S. health officials announced Wednesday.

It’s basically over already. It will end this October. Or maybe it won’t be over till next spring, or late next year, or two or three years down the road.

From the most respected epidemiologists to public health experts who have navigated past disease panics, from polemicists to political partisans, there are no definitive answers to the central question in American life: As a Drudge Report headline put it recently, “is it ever going to end?”

With children returning to classrooms, in many cases for the first time in 18 months, and as the highly contagious delta variant and spotty vaccination uptake send case numbers and deaths shooting upward, clarks shoes uk many Americans wonder what exactly has to happen before life can return to something that looks and feels like 2019.

The answers come in a kaleidoscopic cavalcade of scenarios, some suggested with utmost humility, others with mathematical confidence: The pandemic will end because deaths finally drop to about the same level we’re accustomed to seeing from the flu each year. Or it will end when most kids are vaccinated. Or it will end because Americans are finally exhausted by all the restrictions on daily life.

Innumerable predictions over the course of the pandemic have come up lame. Some scientists have sworn off soothsaying. But as they learn more about the coronavirus that bestowed covid-19 on mankind, they build models and make projections and describe the hurdles that remain before people can pull off the masks and go about their lives.

The good news is there is some fuel for optimism.

“I truly, truly think we are in the endgame,” said Monica Gandhi, an infectious-disease specialist and professor of medicine at the University of California at San Francisco. “The cases will start plummeting in mid-to-late September and by mid-October, we will be in a manageable place, where the virus is a concern for health professionals, but not really for the general public.”

Gandhi bases her optimism on the fact that all previous epidemics of respiratory viruses have ended through the acquisition of immunity, whether by vaccination or natural infection. Although viruses do keep changing, potentially circumventing people’s defenses, “they mutate quickly, at a cost to themselves,” weakening over time. Gandhi said she believes the delta variant that has hit the United States so hard that this summer will mark the peak of this virus’s strength.

But Gandhi warns she has been wrong before: In February 2020, she said the United States would not tolerate a disease that killed 100 Americans a day; people would come together to do whatever it took to stop that. That didn’t happen.

The bad news is there is too much cause for doubt.

“We’re in a moment of uncertainty, and humans don’t do well with uncertainty,” said Ezekiel Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania. “Telling people it’s going to be two or three more years of this is really hard, but I don’t think anyone can be comfortable hoka shoes with the current state, with a lot of kids ending up in the hospital and a thousand deaths a day. That’s not returning to normal.”

Emanuel, too, notes that his crystal ball has suffered occasional cloudiness: In March 2020, he said the country would get back to normal around November 2021. For that, his friends dubbed him “Mr. Pessimist.” Now, his message is at least as unwelcome: It’s going to be at least spring 2022 and possibly much longer before most people are ready to resume normal activities, because of the spread of the delta variant, continuing resistance to vaccines and widespread anxiety, especially about children who are not yet eligible to get vaccinated.

Despite the disparities in experts’ opinions, there is a consensus bottom line about the biggest question: Pandemics do end, sort of. (Though there are exceptions, such as malaria.) Only smallpox has been effectively eradicated by human intervention. But many pandemics become endemic, meaning they morph into something that is no longer an emergency, but rather an annoyance, an ugly, even painful fact of life that people simply learn to cope with, like the flu or common cold.

The question is when and how we get to that point.

Some of the nation’s most prominent epidemiologists and public health experts say we are already there – for different reasons.

“The emergency phase of the disease is over,” said Jay Bhattacharya, a professor of medicine and health economist at Stanford University. “Now, we need to work very hard to undo the sense of emergency. We should be treating covid as one of 200 diseases that affect people.”

The pivotal engine driving a return to normal life for Bhattacharya has been the vaccines, “which really do protect against death,” he said. “It’s a miraculous development, and we should just be celebrating it.” By driving down deaths and hospitalizations, especially for the most vulnerable populations – the elderly and people with preexisting health problems – “we have greatly succeeded, and to me, that’s the endpoint of the epidemic because we really can’t do better than that.”

The virus will continue to mutate and there will continue to be outbreaks, both seasonal and in geographic clusters, but “panicking over case numbers is a recipe for continuing unwarranted panic,” he said.

Bhattacharya is ready to resume most pre-pandemic activities. He recently made his first overseas trip, to England, “and it was wonderful,” he said, “even with a mask.”

Gandhi, too, has concluded that as scary and dangerous as the delta variant has been, “we’re sort of at the peak of the pandemic because the delta variant is causing immunity like crazy. Delta comes in like a hurricane, dr martens boots but it leaves a lot of immunity in its wake.”

Although its rapid spread and severe impact on some people are scary, the delta version has a hidden benefit: It makes future variants less likely to be more lethal, Gandhi said.

Covid isn’t going away – “we’re going to get it,” Gandhi said – but as immunity increases, the virus will cause less harm. People will come to terms with it as they have with the common cold or the flu.

“Unless you just sit in your room, you’re going to get it in your nose,” she said, “but at least in this country, it will be manageable.”

The big problem now, Gandhi said, is fear, “excessive fear of the pandemic on both sides,” she said. “Democrats overestimate the death rate and Republicans underestimate it.”

That produces the psychological and political hurdles that are preventing a return to normal life, she said. Recent polling indicates most Americans’ perception of the pandemic has shifted markedly this summer, as the delta variant swept away the optimism of springtime. In NBC News polls in April and August, the percentage of Americans saying that the worst of the coronavirus is behind us collapsed from 61% to 37%.

Gandhi said the trouble lies with some Democrats resisting resuming activities they take part in during flu season without hesitation and some Republicans refusing to take the vaccine or wear masks in crowded indoor spaces.

“I live in the bluest city in one of the bluest states, and I see this profound fear of the virus leading to extraordinary acceptance of lockdowns and keeping schools closed,” she said. But Gandhi says those hesitations can melt away quickly as case numbers fall.

Julie Swann views Gandhi as overly optimistic about how and when normal life might return. “She’s wrong,” said Swann, a systems engineer at North Carolina State University who advised the Centers for Disease Control and Prevention on the H1N1 pandemic. “And I hope it takes longer than she’s saying because that will be much safer.”

Swann said Gandhi’s argument that the delta variant will create so much immunity that life can return to normal “is a really apocalyptic way of getting there. Do you want delta to burn through the population, creating immunity at a very high cost, or would you rather just wear a mask?”

The key factor for Swann as she creates models projecting how the virus is likely to play out is the role children play in spreading the disease. The path to normal life is through getting children vaccinated, she said, and that is not likely to happen in large numbers until early next year.

“Children transmit viruses to each other, to their families, to their communities,” Swann said. “The first step toward normalcy is getting children vaccinated, at least for ages 5 and up. Right now, unfortunately, what we’re seeing in Florida is many, many children getting infected.”

Swann sees several possible routes back to normal life, including letting the virus burn through the population, focusing on masking and hybrid schooling, or a return to lockdowns. But her preferred pathway is mass vaccination of children – which can only happen after the vaccines are approved for the 5-to-11 age group, a step that’s not expected until at least later this year – along with masking and increased testing.

Ten years from now, the coronavirus “will be like influenza – it can cause death, but nothing like what we see now,” Swann said. But in the next year or so, the best Americans can hope for is a partial return to normalcy, with hospitals no longer being crushed with covid patients and occasional surges of covid in communities with low vaccination rates.

“We are not New Zealand,” she said. “We neither have the will nor the ability to asics shoes control every case coming into our country. But if we can vaccinate most kids, we will get to a point where we no longer need masks in schools, and we’ll have a return to normalcy, though it will look different in different places.”

For now, Swann has started traveling again domestically, though she can’t imagine taking a foreign trip or going to a party until after her child has been vaccinated, probably around next February. “That changes the whole ballgame,” she said.

The wild card, as it has been for adults, is how quickly and widely children are vaccinated.

And the national divide over vaccines, masks and other such politicized public health measures could well end up being the reason the pandemic persists in the United States, said Alex Berenson, a novelist and former New York Times reporter. Berenson’s agitation against the vaccine has become a popular source of succor for many who have refused to get the shot, but it also got him permanently banned from Twitter for what the company called “repeated violations of our COVID-19 misinformation rules.”

“I don’t know how we get there politically,” Berenson said of the quest for an endgame. “We are at a very confused moment.”

He said his readers “are long done with covid. And personally, I have not worn a mask for months, and no one has challenged me anywhere about whether I am vaccinated or not.” (He’s not.)

But “obviously some large number of Americans feel differently,” he said. “They are happy to live under government strictures indefinitely. . . . These two populations cannot comfortably exist. This is not a medical problem. . . . This is a political and social problem and it will have to be resolved politically, I suppose.”

Berenson said he believes Americans can return to normal life right now, without mask mandates, contact tracing or vaccine passports. But “can” and “will” are different, and he expects it might be late 2023 or later – perhaps after the next presidential election – before any consensus might develop about returning to normal life.

Any consensus on ratcheting down the fear and anxiety that the virus has spawned is more likely to emerge from public health campaigns than political campaigns, said Bhattacharya, the Stanford professor. It’s up to public health officials to persuade Americans that if they are vaccinated, they can return to many pre-pandemic activities, he said.

Bhattacharya, for example, is looking forward to teaching in person this fall and said he will happily meet with students, as Stanford is requiring vaccinations for everyone on campus.

In contrast, as Emanuel returns to teach at Penn, “I’m nervous,” even with vaccination and mask mandates, he said. “I’ll be testing myself and students will be tested, and I’m bringing a HEPA [air] filter into the classroom, and I’m still a little nervous about long covid. We’re still unclear on the direction of this thing. It’s plausible that we’ve hit the peak, but it’s also plausible that other mutations will be even more efficient.”

Emanuel will know it’s time to resume normal behavior “when this thing looks like a flu, when the health-care system is operating normally, when my friends aren’t constantly asking me, ‘What can I do to stay safe?’ ”

That time will come only after there’s more data about how and when people get long covid, about what happens when people mix different vaccines, about the pace and character of the virus’s mutations.

“People are pretty burned out 18 months into this thing,” Emanuel said. “And the exhaustion has been made worse by the rapid seesaw we’re having – take your masks off, put them back on. It’s all very confusing, but we have to be honest: We don’t know when, we don’t know how. We don’t know.”

‘Those deaths were preventable’: Unvaccinated parts of country are driving the pandemic now

WASHINGTON — Virtually all deaths from COVID-19 in the United States are now among people who have not received their coronavirus vaccine. And those deaths are highly concentrated in counties — many of them in the Midwest and Southeast — where vaccination rates are precariously low.

On the other hand, transmission has effectively ceased in Northeastern and Western states where skechers outlet governors have made vaccination a top priority, and where resistance was low among residents from the start.

Rochelle Walensky
CDC Director Rochelle Walensky.

“We are seeing that communities and counties that have high vaccine coverage and low case rates are getting back to normal,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said during a Thursday briefing of the White House pandemic response team.

Walensky depicted a national scenario that has become highly fractured as a result of stark differences in vaccination rates. Those differences have to do with cultural, social, economic and political factors.

At the same time, the vaccines remain highly effective against every variant of the coronavirus, including the more transmissible golden goose sneakers Delta variant that Walensky said accounts for eight out of 10 new cases in parts of the Mountain West. Delta is now the dominant strain of the coronavirus in the United States.

Walensky said that in recent months, 99.5 percent of all deaths from COVID-19 in the U.S. were among unvaccinated individuals. “Those deaths were preventable with a simple, safe shot,” the CDC director said. President Biden has made much the same point, and he and his top public health officials look for ways to galvanize a stalled vaccination effort.

Although some vaccinated people do contract the coronavirus, it tends to lead only to mild sickness.

For weeks, the path of the pandemic has been steadily bifurcating, with parts of the country returning to normal and others seeming to slip back into rising case rates. Overall, case rates and hospitalizations are rising slightly, while deaths are continuing to fall. But those national trends are not indicative of more nuanced on-the-ground realities.

Jeffrey Rhodes
An undertaker in Tampa, Fla., tends to a man who died of COVID-19. 

In particular, Walensky singled out 173 counties with the highest incidence of new infections — 100 or more cases per 100,000 individuals over the last week. Of those 173 counties, 93 percent have vaccinated less than 40 percent of their respective populations, according to Walensky.

In recent days, parts of Missouri and Arkansas have seen a sharp rise in cases. So have parts of Colorado and Utah.

Meanwhile, the high-vaccination state of Maryland is recording about one new coronavirus death per day.

“Low vaccination rates in these counties coupled with high case rates and lax mitigation policies ecco shoes that do not protect those who are unvaccinated from disease will certainly and sadly lead to more unnecessary suffering, hospitalizations and, potentially, death,” the CDC director said.

Unvaccinated people are supposed to continue wearing masks, according to the most recent CDC guidance. Walensky and other top public health officials have said that rather than returning to wearing masks, people should get vaccinated.

“Widespread vaccination is what will truly turn the corner on this pandemic,” Walensky said on Thursday. According to the CDC, 47.6 percent of the American population is fully vaccinated. That is among the highest rates in the world, but not nearly enough, most epidemiologists believe, to declare that final corner turned.

‘No Victory Dance’: Veterans of Afghan War Feel Torn Over Pullout

Was it worth it?

After two decades of midnight watches and gut-twisting patrols down bomb-riddled roads, after all the deaths and bloodshed and lost years, that was the one inescapable question on Wednesday among many of the 800,000 Americans who have served in Afghanistan since 2001.

“There’s no easy answer, no victory dance, no ‘we were right and they were wrong,’” said Jason Dempsey, 49, who deployed twice to Afghanistan as an Army officer to train the Afghan forces who are now fighting a losing battle against the Taliban. For military leaders, Dempsey said, “the end of the war should only bring a collective feeling of guilt and introspection.”

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Across the country, when the news broke that President Joe Biden planned to withdraw virtually all U.S. troops from the country by Sept. 11 and end the longest war in American history, messages flashed on phones and veterans called old squadmates, some relieved and some on the edge of tears.

Few wanted the war to continue. But finally ending it posed questions that some have pondered for years without easy answers: How is it possible for the United States to win almost every battle and still lose the war? How could the countless sacrifices and small victories leave Afghanistan with no better promise of peace than it had a generation ago? What does leaving say about the value of the nearly 2,400 Americans who were killed? And what does it say about the nation as a whole?

“It’s confusing, it’s complicated,” said Elliot Ackerman, a former Marine and intelligence officer who deployed five times to Iraq and Afghanistan.

Ackerman arrived in Afghanistan for his first tour there in 2008, believing he had missed the war. He would soon be involved in a surge that sent more than 100,000 troops to the country.

Now a writer, Ackerman said he and many others had been forced to make their own individual peace with the war a long time ago. “A lot of us have tried to move on, and when we saw the news, it wasn’t a huge surprise,” he said. “The people who have served on the ground are the last people you need to tell that the war is going to end in tears.”

But that acceptance did not take the sting out of the news, he said. “For years I sat across from Afghans in shuras and looked them in the eye, and told them to ally themselves with America,” he recalled. “That was the first thing I thought about when I heard the news. What about these people who trusted us? Will this be seen as a great betrayal? How will the world now see us a nation and a people?”

Even veterans who see the end as a relief say that pulling troops from Afghanistan does not mean the United States should take its focus off counterterrorism.

Tony Mayne was there at the beginning. As a 25-year-old Ranger, he parachuted into the night over Kandahar province five weeks after the terrorist attacks of Sept. 11, 2001. Many saw the routing of al-Qaida and the Taliban in the months that followed as a decisive victory, but military leaders found it necessary to continue sending soldiers like Mayne, who deployed three more times for counterterror missions as the Taliban returned in force.

Mayne, now 44, said the effort in Afghanistan was worthwhile. The world is full of violent extremists, he said: Better to fight them in places like Iraq and Afghanistan than let them attack the United States.

Some veterans who lost brothers and sisters in arms want the United States to stay until “all the terrorists are wiped out,” Mayne said, while others see a need for a different approach to the conflict. “Everyone has such a personal experience in Afghanistan that it cannot necessarily predict how a person will react to news of the withdrawal,” he said, “because of the scars that a lot of folks have left over there.”

Many veterans feel betrayed that a war they poured so much effort into had still been lost. One commanding general after another told the nation that progress was being made, and that the effort was turning a corner. Cynical troops noted that so many corners were turned that they were either going in circles or had wandered into a maze.

“It seemed like a lost cause when I got there — the leaders were talking about winning hearts and minds, but that’s not what we were doing,” said James Alexander, who was an Army private serving at a tiny infantry outpost in Kandahar near the height of the troop surge in 2012.

A few months into the tour, his squad leader, Staff Sgt. Robert Bales, massacred 16 villagers. “After that, I knew it was done — that we could never make progress, and this war would just keep chewing up people for as long as we fed it.”

Still, he said, the news of the end came as a disappointment. “We really did try to make a difference,” he said, “and now I’m afraid we are damning a generation of Afghans to nothing.”

Many veterans say they have to weigh feelings of guilt at abandoning allies against the prospect of more bloodshed.

“I didn’t even know how to feel — I had to text other vets I know for a gut check because it’s so confusing,” Ashleigh Byrnes, 37, said. She served as a field journalist for the Marine Corps in Afghanistan in 2009. Even during those more optimistic days, she said, it was clear that the training of Afghan troops was faltering and the U.S. effort was “a dark endless tunnel that wouldn’t end well.”

Byrnes now works for Disabled American Veterans, and sees people every day who were wounded in war. She said she thought pulling out was a hard choice, but the right choice.

“It’s tough to not get a little bit emotional when I think about it,” she said, apologizing as she held back tears. “We made a promise to the Afghan people. But this can’t be our perpetual reality. We have to stop. I have children now, and I can’t imagine this war still going on when they are old enough to join.”

Several veterans noted that Afghanistan was already engulfed in war before American forces invaded, and will probably still be after they are gone.

Brian Castner, 43, was an Air Force explosive ordnance disposal expert who defused roadside bombs, and has since written several books about the war. He said ordering the pullout by Sept. 11, 2021, means little in practical terms.

“But in terms of story, it’s genius,” he said. “The Biden administration figured out a way to give the withdrawal meaning: Do it on the anniversary of 9/11, remind people why we were there — say we stayed for 20 years, then chose to leave. Tell them we did our part, put your chin up.

“It’s a myth,” he said, “but at least it’s something.”

An end, even if long overdue and perhaps contrived, can still have real power, said Thomas Burke, who was 20 and a lance corporal at a firebase in a small Afghan village in 2009. He later went to Yale Divinity School and is now an assistant pastor in Connecticut.

During the war, generals often brought visiting dignitaries to his village to show the progress being made, he said, but small victories there were often followed by bloody losses. Friends were killed, Burke said, and he once had to pick up the pieces of village children who were dismembered by a rocket-propelled grenade. Eventually the American troops pulled out. The village is in Taliban hands now.

“Was it worth it? I could answer both ways,” he said. “Good people devoted their lives to this project, and a lot of them were destroyed. There has been so much suffering by the Afghan people. In that sense, it’s not worth it.

“But for individuals, there are experiences and realizations from Afghanistan that will always shape their lives,” he continued. “We think about them every day. They are who we are. And I can’t say that doesn’t have real value. There are experiences I treasure, people I love who I met there.”

If nothing else, he said, it is worth it to have an end. “It is important to have ceremony and rituals, times when we mark and remember things,” Burke said. “That’s what this is: We need an end. An end is how you grieve. We haven’t had a chance to do that yet.”