Your ‘Surge Capacity’ Is Depleted — It’s Why You Feel Awful

By Tara Haelle

It was the end of the world as we knew it, and I felt fine. That’s almost exactly what I told my psychiatrist at my March 16 appointment, a few days after our children’s school district extended spring break because of the coronavirus. I said the same at my April 27 appointment, several weeks after our state’s stay-at-home order.

Yes, it was exhausting having a kindergartener and fourth grader doing impromptu distance learning while I was barely keeping up with work. And it was frustrating to be stuck home nonstop, scrambling to get in grocery delivery orders before slots filled up, and tracking down toilet paper. But I was still doing well because I thrive in high-stress emergency situations. It’s exhilarating for my ADHD brain. As just one example, when my husband and I were stranded in Peru during an 8.0-magnitude earthquake that killed thousands, we walked around with a first aid kit helping who we could and tracking down water and food. Then I went out with my camera to document the devastation as a photojournalist and interview Peruvians in my broken Spanish for my hometown paper.

Now we were in a pandemic, and I’m a science journalist who has written about infectious disease and medical research for nearly a decade. I was on fire, cranking out stories, explaining epidemiological concepts in my social networks, trying to help everyone around me make sense of the frightening circumstances of a pandemic and the anxiety surrounding the virus.

I knew it wouldn’t last. It never does. But even knowing I would eventually crash, I didn’t appreciate how hard the crash would be, or how long it would last, or how hard it would be to try to get back up over and over again, or what getting up even looked like.

In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.

“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic?

By my May 26 psychiatrist appointment, I wasn’t doing so hot. I couldn’t get any work done. I’d grown sick of Zoom meetups. It was exhausting and impossible to think with the kids around all day. I felt trapped in a home that felt as much a prison as a haven. I tried to conjure the motivation to check email, outline a story, or review interview notes, but I couldn’t focus. I couldn’t make myself do anything — work, housework, exercise, play with the kids — for that whole week.

Or the next.

Or the next.

Or the next.

I know depression, but this wasn’t quite that. It was, as I’d soon describe in an emotional post in a social media group of professional colleagues, an “anxiety-tainted depression mixed with ennui that I can’t kick,” along with a complete inability to concentrate. I spoke with my therapist, tweaked medication dosages, went outside daily for fresh air and sunlight, tried to force myself to do some physical activity, and even gave myself permission to mope for a few weeks. We were in a pandemic, after all, and I had already accepted in March that life would not be “normal” for at least a year or two. But I still couldn’t work, couldn’t focus, hadn’t adjusted. Shouldn’t I be used to this by now?

“Why do you think you should be used to this by now? We’re all beginners at this,” Masten told me. “This is a once in a lifetime experience. It’s expecting a lot to think we’d be managing this really well.”

It wasn’t until my social media post elicited similar responses from dozens of high-achieving, competent, impressive women I professionally admire that I realized I wasn’t in the minority. My experience was a universal and deeply human one.

An unprecedented disaster

While the phrase “adjusting to the new normal” has been repeated endlessly since March, it’s easier said than done. How do you adjust to an ever-changing situation where the “new normal” is indefinite uncertainty?

“This is an unprecedented disaster for most of us that is profound in its impact on our daily lives,” says Masten. But it’s different from a hurricane or tornado where you can look outside and see the damage. The destruction is, for most people, invisible and ongoing. So many systems aren’t working as they normally do right now, which means radical shifts in work, school, and home life that almost none of us have experience with. Even those who have worked in disaster recovery or served in the military are facing a different kind of uncertainty right now.

“I think we maybe underestimate how severe the adversity is and that people may be experiencing a normal reaction to a pretty severe and ongoing, unfolding, cascading disaster,” Masten says. “It’s important to recognize that it’s normal in a situation of great uncertainty and chronic stress to get exhausted and to feel ups and downs, to feel like you’re depleted or experience periods of burnout.”

Research on disaster and trauma focuses primarily on what’s helpful for people during the recovery period, but we’re not close to recovery yet. People can use their surge capacity for acute periods, but when dire circumstances drag on, Masten says, “you have to adopt a different style of coping.”

Understanding ambiguous loss

It’s not surprising that, as a lifelong overachiever, I’ve felt particularly despondent and adrift as the months have dragged on, says Pauline Boss, PhD, a family therapist and professor emeritus of social sciences at the University of Minnesota who specializes in “ambiguous loss.”

“It’s harder for high achievers,” she says. “The more accustomed you are to solving problems, to getting things done, to having a routine, the harder it will be on you because none of that is possible right now. You get feelings of hopelessness and helplessness, and those aren’t good.”
That’s similar to how Michael Maddaus, MD, a professor of thoracic surgery at the University of Minnesota, felt when he became addicted to prescription narcotics after undergoing several surgeries. Now recovered and a motivational speaker who promotes the idea of a “resilience bank account,” Maddaus had always been a fast-moving high achiever — until he couldn’t be.

“I realized that my personal operating system, though it had led to tremendous success, had failed me on a more personal level,” he says. “I had to figure out a different way of contending with life.”

That mindset is an especially American one, Boss says.

“Our culture is very solution-oriented, which is a good way of thinking for many things,” she says. “It’s partly responsible for getting a man on the moon and a rover on Mars and all the things we’ve done in this country that are wonderful. But it’s a very destructive way of thinking when you’re faced with a problem that has no solution, at least for a while.”
That means reckoning with what’s called ambiguous loss: any loss that’s unclear and lacks a resolution. It can be physical, such as a missing person or the loss of a limb or organ, or psychological, such as a family member with dementia or a serious addiction.

“In this case, it is a loss of a way of life, of the ability to meet up with your friends and extended family,” Boss says. “It is perhaps a loss of trust in our government. It’s the loss of our freedom to move about in our daily life as we used to.” It’s also the loss of high-quality education, or the overall educational experience we’re used to, given school closures, modified openings and virtual schooling. It’s the loss of rituals, such weddings, graduations, and funerals, and even lesser “rituals,” such as going to gym. One of the toughest losses for me to adapt to is no longer doing my research and writing in coffee shops as I’ve done for most of my life, dating back to junior high.

“These were all things we were attached to and fond of, and they’re gone right now, so the loss is ambiguous. It’s not a death, but it’s a major, major loss,” says Boss. “What we used to have has been taken away from us.”

Just as painful are losses that may result from the intersection of the pandemic and the already tense political division in the country. For many people, issues related to Covid-19 have become the last straw in ending relationships, whether it’s a family member refusing to wear a mask, a friend promoting the latest conspiracy theory, or a co-worker insisting Covid-19 deaths are exaggerated.

Ambiguous loss elicits the same experiences of grief as a more tangible loss — denial, anger, bargaining, depression, and acceptance — but managing it often requires a bit of creativity.


A winding, uncharted path to coping in a pandemic

While there isn’t a handbook for functioning during a pandemic, Masten, Boss, and Maddaus offered some wisdom for meandering our way through this.

Accept that life is different right now
Maddaus’ approach involves radical acceptance. “It’s a shitty time, it’s hard,” he says. “You have to accept that in your bones and be okay with this as a tough day, with ‘that’s the way it is,’ and accept that as a baseline.”

But that acceptance doesn’t mean giving up, he says. It means not resisting or fighting reality so that you can apply your energy elsewhere. “It allows you to step into a more spacious mental space that allows you to do things that are constructive instead of being mired in a state of psychological self torment.”

Expect less from yourself

Most of us have heard for most of our lives to expect more from ourselves in some way or another. Now we must give ourselves permission to do the opposite. “We have to expect less of ourselves, and we have to replenish more,” Masten says. “I think we’re in a period of a lot of self discovery: Where do I get my energy? What kind of down time do I need? That’s all shifted right now, and it may take some reflection and self discovery to find out what rhythms of life do I need right now?”

She says people are having to live their lives without the support of so many systems that have partly or fully broken down, whether it’s schools, hospitals, churches, family support, or other systems that we relied on. We need to recognize that we’re grieving multiple losses while managing the ongoing impact of trauma and uncertainty. The malaise so many of us feel, a sort of disinterested boredom, is common in research on burnout, Masten says. But other emotions accompany it: disappointment, anger, grief, sadness, exhaustion, stress, fear, anxiety — and no one can function at full capacity with all that going on.

Recognize the different aspects of grief

The familiar “stages” of grief don’t actually occur in linear stages, Boss says, but denial, anger, bargaining, depression, and acceptance are all major concepts in facing loss. Plenty of people are in denial: denying the virus is real, or that the numbers of cases or deaths are as high as reported, or that masks really help reduce disease transmission.
Anger is evident everywhere: anger at those in denial, anger in the race demonstrations, anger at those not physically distancing or wearing masks, and even anger at those who wear masks or require them. The bargaining, Boss says, is mostly with scientists we hope will develop a vaccine quickly. The depression is obvious, but acceptance… “I haven’t accepted any of this,” Boss says. “I don’t know about you.”

Sometimes acceptance means “saying we’re going to have a good time in spite of this,” Boss says, such as when my family drove an hour outside the city to get far enough from light pollution to look for the comet NEOWISE. But it can also mean accepting that we cannot change the situation right now.

“We can kick and scream and be angry, or we can feel the other side of it, with no motivation, difficulty focusing, lethargy,” Boss says, “or we can take the middle way and just have a couple days where you feel like doing nothing and you embrace the losses and sadness you’re feeling right now, and then the next day, do something that has an element of achievement to it.”

Experiment with “both-and” thinking

This approach may not work for everyone, but Boss says there’s an alternative to binary thinking that many people find helpful in dealing with ambiguous loss. She calls it “both-and” thinking, and sometimes it means embracing a bit of the irrational.

For the families of soldiers missing in action in Vietnam that Boss studied early in her career, or the family members of victims of plane crashes where the bodies aren’t recovered, this type of thinking means thinking: “He is both living and maybe not. She is probably dead but maybe not.”

“If you stay in the rational when nothing else is rational, like right now, then you’ll just stress yourself more,” she says. “What I say with ambiguous loss is the situation is crazy, not the person. The situation is pathological, not the person.”

An analogous approach during the pandemic might be, “This is terrible and many people are dying, and this is also a time for our families to come closer together,” Boss says. On a more personal level, “I’m highly competent, and right now I’m flowing with the tide day-to-day.”

It’s a bit of a Schrödinger’s existence, but when you can’t change the situation, “the only thing you can change is your perception of it,” she says.

Of course, that doesn’t mean denying the existence of the pandemic or the coronavirus. As Maddaus says, “You have to face reality.” But how we frame that reality mentally can help us cope with it.

Look for activities, new and old, that continue to fulfill you

Lots of coping advice has focused on “self-care,” but one of the frustrating ironies of the pandemic is that so many of our self-care activities have also been taken away: pedicures, massages, coffee with friends, a visit to the amusement park, a kickboxing class, swimming in the local pool — these activities remain unsafe in much of the country. So we have to get creative with self-care when we’re least motivated to get creative.

“When we’re forced to rethink our options and broaden out what we think of as self-care, sometimes that constraint opens new ways of living and thinking,” Masten says. “We don’t have a lot of control over the global pandemic but we do over our daily lives. You can focus on plans for the future and what’s meaningful in life.”

For me, since I missed eating in restaurants and was tired of our same old dinners, I began subscribing to a meal-kit service. I hate cooking, but the meal kits were easy, and I was motivated by the chance to eat something that tasted more like what I’d order in a restaurant without having to invest energy in looking through recipes or ordering the right ingredients.

Okay, I’ve also been playing a lot of Animal Crossing, but Maddaus explains why it makes sense that creative activities like cooking, gardening, painting, house projects — or even building your own imaginary island out of pixels — can be fulfilling right now. He references the book The Molecule of More, which explores how dopamine influences our experiences and happiness, in describing the types of activities most likely to bring us joy.

“There are two ways the brain deals with the world: the future and things we need to go after, and the here and now, seeing things and touching things,” Maddaus says. “Rather than being at the mercy of what’s going on, we can use the elements of our natural reward system and construct things to do that are good no matter what.”
Those kinds of activities have a planning element and a here-and-now experience element. For Maddaus, for example, it was simply replacing all the showerheads and lightbulbs in the house.

“It’s a silly thing, but it made me feel good,” he says.

Focus on maintaining and strengthening important relationships

The biggest protective factors for facing adversity and building resilience are social support and remaining connected to people, Masten says. That includes helping others, even when we’re feeling depleted ourselves.

“Helping others is one of those win-win strategies of taking action because we’re all feeling a sense of helplessness and loss of control about what’s going on with this pandemic, but when you take action with other people, you can control what you’re doing,” she says. Helping others could include checking in on family friends or buying groceries for an elderly neighbor.

Begin slowly building your resilience bank account

Maddaus’ idea of a resilience bank account is gradually building into your life regular practices that promote resilience and provide a fallback when life gets tough. Though it would obviously be nice to have a fat account already, he says it’s never too late to start. The areas he specifically advocates focusing on are sleep, nutrition, exercise, meditation, self-compassion, gratitude, connection, and saying no.

“Start really small and work your way up,” he says. “If you do a little bit every day, it starts to add up and you get momentum, and even if you miss a day, then start again. We have to be gentle with ourselves and keep on, begin again.”

After spending an hour on the phone with each of these experts, I felt refreshed and inspired. I can do this! I was excited about writing this article and sharing what I’d learned.
And then it took me two weeks to start the article and another week to finish it — even though I wanted to write it. But now, I could cut myself a little more slack for taking so much longer than I might have a few months ago. I might have intellectually accepted back in March that the next two years (or more?) are going to be nothing like normal, and not even predictable in how they won’t be normal. But cognitively recognizing and accepting that fact and emotionally incorporating that reality into everyday life aren’t the same. Our new normal is always feeling a little off balance, like trying to stand in a dinghy on rough seas, and not knowing when the storm will pass. But humans can get better at anything with practice, so at least I now have some ideas for working on my sea legs.

https://elemental.medium.com/your-surge-capacity-is-depleted-it-s-why-you-feel-awful-de285d542f4c

UCSF Researchers Discover How Coronavirus Makes ‘Zombies’ Of Human Cells, Causes Them To Sprout Tentacles

Fluorsecence microscopy image of human epithelial cells form the colon and infected with the novel coronovirus shows production of filopodia (white) extending our from the cell surface and containing viral particlea.

Most of us have already absorbed the idea that the coronavirus does some weird and sinister things to the human body that are unlike most other respiratory viruses known to man. But now a new study finds yet another unsettling thing that the virus appears to do to help spread from cell to cell.

A new study by an international team led by UC San Francisco finds that cells infected with SARS-CoV-2 quickly begin to grow new arms or dendrites — referred to clinically as filopodia — which are themselves studded with fresh virus particles. These filopodia then seek to reach into and through the walls of neighboring cells, thereby infecting them. And this appears to be a second mode that the virus has for replicating and spreading itself in the body.

As the LA Times reports via the study, up until now, researchers believed that this virus spread itself like most other viruses, by docking itself onto healthy cells, invading, and then turning those cells into copying machines. A team in UCSF’s Quantitative Biosciences Institute led by systems biologist Nevan Krogan launched a project in February to rapidly identify existing drugs and compounds that might treat or slow the spread of the coronavirus. They published initial findings in late April pointing to 10 existing drugs and experimental compounds that showed promise in lab settings when it came to targeting the human proteins this virus most needs to survive.

The latest study is an extension of that work, and Krogan is one of the lead authors of the paper published today in the journal Nature. The important new finding, Krogan and the team hope, will lead to some rapid study of several existing cancer treatments that themselves inhibit the growth of filopedia — thereby shutting down this second means that the virus is using to invade cells.

“It’s just so sinister that the virus uses other mechanisms to infect other cells before it kills the cell,” Krogan says, speaking to the LA Times.

Krogan says that while other viruses — including HIV and the family of viruses that cause smallpox — also use filopedia as mechanisms of spreading infection, the way this virus so rapidly prompts the growth of these tentacles is highly unusual. And the shape of them, branching off the cell and each other like trees, is also apparently strange. Other infectious diseases like HIV don’t cause these kinds of prolific, mutant growths.

Expanding the earlier list of promising drugs, the latest study points to seven cancer drugs already in use that could prove effective against COVID-19. Those include a drug already being used to treat acute myeloid leukemia called Xospata (generic name: gilteritinib); the experimental drug Silmitasertib, which is being studied as a treatment for bile duct cancer and one form of childhood brain cancer; and ralimetinib, another cancer drug which was developed by Eli Lilly to treat multiple forms of cancer.

“We’ve tested a number of these kinase inhibitors and some are better than remdesivir,” Krogan says, via the Milwaukee Journal-Sentinel.

Another experimental drug called Dinaciclib was found by the research team to stop the virus’s assault on a family of kinases called CDKs, which are responsible for cell growth and dealing with DNA damage.

Other infectious disease researchers are just waking up to the revelations of the paper, but most reactions seem fairly excited. While much research is being done on shutting down virus proteins, Krogan’s field of study, called proteomics, instead focuses on the less-likely-to-mutate human proteins involved in helping the virus do its dirty work.

“This paper shows just how completely the virus is able to rewire all of the signals going on inside the cell,” says University of Wisconsin-Madison medical professor Andrew Mehle to the Journal-Sentinel. “That’s really remarkable and it’s something that occurs very rapidly (as soon as two hours after cells are infected).”

And Lynne Cassimeris, a professor of biological sciences at Lehigh University, calls the latest findings “an amazing leap.” “We know that the virus has to be manipulating these human proteins,” Cassimeris says. “Now we have a list of what is changing over time.”

While Krogan’s lab at UCSF got this research off the ground just as the pandemic was emerging in February, there were 70 authors listed on the latest paper, with Krogan as the lead. The work was also done by scientists at Mt. Sinai Hospital in New York, Rocky Mountain Labs in Montana, the Pasteur Institute in Paris, and the University of Freiburg in Germany

https://sfist.com/2020/06/26/ucsf-researchers-discover-how-coronavirus-makes-zombies-of-human-cells-causes-them-to-sprout/

Thanks to Kebmodee for bringing this to the It’s Interesting community.

Cleveland Ohio company invents ‘Second Breath,’ a ventilator that will save lives during coronavirus pandemic


Second Breath will help save lives during coronavirus pandemic

It’s called “Second Breath,” and this piece of equipment will save lives.

“Without this ventilator there are a lot of folks who might not have a chance at a breath,” said Dr. Mada Helou, from University Hospitals.

Three Cleveland organizations put their innovative skills, knowledge and can-do attitude together to create and manufacturer a breathing pump that will alleviate some of the demand for ventilators, all across the country.

“We like to respond to things, and more importantly the team likes to respond. There were eight engineers that developed this and these guys wanted to do something and they came to me,” said Dan T. Moore, president and CEO, Dan T. Moore Co.

It collaborated with several other organizations and in three weeks, designed “Second Breath.”

“Coronavirus’ main target is the lungs. It effects many organs, but it has a profound effect on our ability to hold oxygen within our blood,” said Dr. Helou.

Experts said an average ventilator costs anywhere from $20,000 and up to $100,000. Second Breath costs about $6,000.

Dan T. Moore Co. has made about 36 ventilators and they’re ready to ship out around the world. Engineers told 19 News they can design about a hundred ventilators a day.

The team tells 19 News they are proud.

“I think great innovation comes under pressure and when the COVID-19 surge showed up folks thought you know what, we need to respond to this quickly,” said Dr. Helou. “Everything about this says Cleveland. It speaks helping people and it speaks collaboration,” she said. “Cleveland, you’ve done this!”

https://www.fox19.com/2020/04/16/ohio-company-invents-second-breath-ventilator-that-will-save-lives-during-coronavirus-pandemic/

Blood from coronavirus survivors might save lives

Hospitals in New York City are gearing up to use the blood of people who have recovered from COVID-19 as a possible antidote for the disease. Researchers hope that the century-old approach of infusing patients with the antibody-laden blood of those who have survived an infection will help the metropolis — now the US epicentre of the outbreak — to avoid the fate of Italy, where intensive-care units (ICUs) are so crowded that doctors have turned away patients who need ventilators to breathe.

The efforts follow studies in China that attempted the measure with plasma — the fraction of blood that contains antibodies, but not red blood cells — from people who had recovered from COVID-19. But these studies have reported only preliminary results so far. The convalescent-plasma approach has also seen modest success during past severe acute respiratory syndrome (SARS) and Ebola outbreaks — but US researchers are hoping to increase the value of the treatment by selecting donor blood that is packed with antibodies and giving it to the patients who are most likely to benefit.

A key advantage to convalescent plasma is that it’s available immediately, whereas drugs and vaccines take months or years to develop. Infusing blood in this way seems to be relatively safe, provided that it is screened for viruses and other infectious agents. Scientists who have led the charge to use plasma want to deploy it now as a stopgap measure, to keep serious infections at bay and hospitals afloat as a tsunami of cases comes crashing their way.

“Every patient that we can keep out of the ICU is a huge logistical victory because there are traffic jams in hospitals,” says Michael Joyner, an anaesthesiologist and physiologist at the Mayo Clinic in Rochester, Minnesota. “We need to get this on board as soon as possible, and pray that a surge doesn’t overwhelm places like New York and the west coast.”

On 23 March, New York governor Andrew Cuomo announced the plan to use convalescent plasma to aid the response in the state, which has more than 25,000 infections, with 210 deaths. “We think it shows promise,” he said. Thanks to the researchers’ efforts, the US Food and Drug Administration (FDA) today announced that it will permit the emergency use of plasma for patients in need. As early as next week, at least two hospitals in New York City — Mount Sinai and Albert Einstein College of Medicine — hope to start using coronavirus-survivor plasma to treat people with the disease, Joyner says.

After this first rollout, researchers hope the use will be extended to people at a high risk of developing COVID-19, such as nurses and physicians. For them, it could prevent illness so that they can remain in the hospital workforce, which can’t afford depletion.

And academic hospitals across the United States are now planning to launch a placebo-controlled clinical trial to collect hard evidence on how well the treatment works. The world will be watching because, unlike drugs, blood from survivors is relatively cheap and available to any country hit hard by an outbreak.

Scientists assemble

Arturo Casadevall, an immunologist at Johns Hopkins University in Baltimore, Maryland, has been fighting to use blood as a COVID-19 treatment since late January, as the disease spread to other countries and no surefire therapy was in sight. Scientists refer to this measure as ‘passive antibody therapy’ because a person receives external antibodies, rather than generating an immune response themselves, as they would following a vaccination.

The approach dates back to the 1890s. One of the largest case studies occurred during the 1918 H1N1 influenza virus pandemic. More than 1,700 patients received blood serum from survivors, but it’s difficult to draw conclusions from studies that weren’t designed to meet current standards.

During the SARS outbreak in 2002–03, an 80-person trial of convalescent serum in Hong Kong found that people treated within 2 weeks of showing symptoms had a higher chance of being discharged from hospital than did those who weren’t treated. And survivor blood has been tested in at least two outbreaks of Ebola virus in Africa with some success. Infusions seemed to help most patients in a 1995 study in the Democratic Republic of the Congo, but the study was small and not placebo controlled. A 2015 trial in Guinea was inconclusive, but it didn’t screen plasma for high levels of antibodies. Casadevall suggests that the approach might have shown a higher efficacy had researchers enrolled only participants who were at an early stage of the deadly disease, and therefore were more likely to benefit from the treatment.

Casadevall corralled support for his idea through an editorial in the Wall Street Journal, published on 27 February, which urged the use of convalescent serum because drugs and vaccines take so long to develop. “I knew if I could get this into a newspaper, people would react, whereas if I put it into a science journal, I might not get the same reaction,” he says.

He sent his article to dozens of colleagues from different disciplines, and many joined his pursuit with enthusiasm. Joyner was one. Around 100 researchers at various institutes self-organized into different lanes. Virologists set about finding tests that could assess whether a person’s blood contains coronavirus antibodies. Clinical-trial specialists thought about how to identify and enroll candidates for treatment. Statisticians created data repositories. And, to win regulatory clearance, the group shared documents required for institutional ethical-review boards and the FDA.

Tantalizing signs

Their efforts paid off. The FDA’s classification today of convalescent plasma as an ‘investigational new drug’ against coronavirus allows scientists to submit proposals to test it in clinical trials, and lets doctors use it compassionately to treat patients with serious or life-threatening COVID-19 infections, even though it is not yet approved.

“This allows us to get started,” says Joyner. Physicians can now decide whether to offer the therapy to people with very advanced disease, or to those that seem to be headed there — as he and other researchers recommend. He says hospitals will file case reports so that the FDA gets a handle on which approaches work best.

Researchers have also submitted to the FDA three protocols for placebo-controlled trials to test the plasma, which they hope will take place at hospitals affiliated with Johns Hopkins, the Mayo Clinic and Washington University in St. Louis, along with other universities that want to take part.

Future directions

The US tests of convalescent plasma aren’t the first. Since early February, researchers in China — where the coronavirus emerged late last year — have launched several studies using the plasma. Researchers have yet to report on the status and results of these studies. But Liang Yu, an infectious-disease specialist at Zhejiang University School of Medicine in China, told Nature that in one preliminary study, doctors treated 13 people who were critically ill with COVID-19 with convalescent plasma. Within several days, he says the virus no longer seemed to be circulating in the patients, indicating that antibodies had fought it off. But he says that their conditions continued to deteriorate, suggesting that the disease might have been too far along for this therapy to be effective. Most had been sick for more than two weeks.

In one of three proposed US trials, Liise-anne Pirofski, an infectious-disease specialist at Albert Einstein College of Medicine, says researchers plan to infuse patients at an early stage of the disease and see how often they advance to critical care. Another trial would enrol severe cases. The third would explore plasma’s use as a preventative measure for people in close contact with those confirmed to have COVID-19, and would evaluate how often such people fall ill after an infusion compared with others who were similarly exposed but not treated. These outcomes are measurable within a month, she says. “Efficacy data could be obtained very, very quickly.”

Even if it works well enough, convalescent serum might be replaced by modern therapies later this year. Research groups and biotechnology companies are currently identifying antibodies against the coronavirus, with plans to develop these into precise pharmaceutical formulas. “The biotech cavalry will come on board with isolating antibodies, testing them, and developing into drugs and vaccines, but that takes time,” says Joyner.

In some ways, Pirofski is reminded of the urgency she felt as a young doctor at the start of the HIV epidemic in the early 1980s. “I met with medical residents last week, and they are so frightened of this disease, and they don’t have enough protective equipment, and they are getting sick or are worried about getting sick,” she says. A tool to help to protect them now would be welcomed.

Since becoming involved with the push for blood as a treatment, Pirofski says another aspect of the therapy holds her interest: unlike a pharmaceutical product bought from companies, this treatment is created by people who have been infected. “I get several e-mails a day from people who say, ‘I survived and now I want to help other people’,” she says. “All of these people are willing to put on their boots and brush their teeth, and come help us do this.”

https://www.nature.com/articles/d41586-020-00895-8?utm_source=fbk_nnc&utm_medium=social&utm_campaign=naturenews&fbclid=IwAR08dlcqj_ixR5eJxFxrlI4UikMrTpBLLA4_aYTxfD5CfjRLi8lli2DB3gI&utm_source=Nature+Briefing&utm_campaign=7fdc8b2aa7-briefing-dy-20200325&utm_medium=email&utm_term=0_c9dfd39373-7fdc8b2aa7-44039353

Truckers are the unsung heroes of this pandemic


The roads may have fewer cars on them these days, but for many truckers, the journey feels a lot longer.

by CHRISTIAN COTRONEO

There’s no shortage of people facing extraordinary adversity to help us maintain some semblance of civilization in these pandemic times.

There are the usual suspects — doctors, nurses, firefighters — who make courage under fire seem so routine.

And then there are truckers.

Rain, shine or pandemic, the U.S. relies on about 3.5 million truck drivers to keep goods — the lifeblood of an economy — in circulation.

That includes canned foods and non-perishables like tuna and rice and beans, bound for small stores and shops in every nook of the country. And yes, there’s always a need for more toilet paper on Aisle 12.

There’s also Amazon — and the unending stream of smart speakers, cordless vacuums and pretzel crackers that Americans feel they need at a time like this.

That’s to say nothing of essential medical supplies and the equipment that’s sadly emblematic of our times: masks, ventilators, disinfectant. It’s not just about distributing those goods to stores and homes, but getting the raw materials, like plastic and pulp, to the manufacturers.

All of it is literally a trucker’s burden to bear. And that burden has never been heavier.

Taking truck drivers for granted

“I think people, quite frankly, take truck drivers for granted when things are normal,” Todd Jadin, of Wisconsin-based Schneider, which boasts 14,000 drivers under its umbrella, tells USA Today. “The work they do every day is that much more important right now.”

Sure, driving is a little easier these days — thanks to the millions of Americans who are staying home and trying to social distance the coronavirus to death.

But for truckers, already accustomed to driving as many as 11 hours per day, the road has gotten even longer. That’s because, for all the miles a trucker logs, there’s always been a bright beacon at the side of just about every highway: the iconic truck stop.

Maybe it’s a diner, where a driver can get a meal and even take a shower. Or a parking lot, where the engines finally go silent, and truckers catch some much-needed shut-eye.

The thing is, as Wired reports, those gleaming lights are going dark. Side-of-the-road eateries are closing to discourage public gatherings. State authorities are even shuttering places that specifically cater to truckers — spots at turnpikes that offer showers, parking and bathrooms.

One of American’s biggest travel center operators, TA-Petro, recently closed all of its driver lounges and fitness centers, Wired also notes.

The few facilities still open are crowded and, as you might imagine, an increasingly risky proposition in these viral times.

But that’s one area where you can help. Follow the lead of police officers in Eufaula, Alabama, who help truckers who can’t fit their rigs through the drive-thru — often the only option when restaurant dining rooms are closed.

“We will either go get something for you or give you a ride to the nearest drive-thru (if you don’t mind riding in the back seat!” the department posted on Facebook. “If manpower is such that we cannot assist, we will secure someone that can.”


Truck stops are closing down, giving drivers fewer opportunities to take a load off.

Truckers are parents, too

And truckers face other hurdles unique to these times.

“If a school system closes down, our employees may not have child care,” T.J. O’Connor of Kansas-based trucking-and-logistics company YRC Worldwide, tells USA Today. “Or we have a driver go out there to make a pickup and there’s a sign on the door that says one of the employees tested positive and they’re closed. What do you do?”

But these days, too much is riding on a trucker’s cargo for them to simply stay home.

“Times like this, people need to realize that everything you have is brought to you by truck drivers. Right now, we’re the ones out there taking chances on our health and our safety to make sure there’s food in the grocery stores,” Robert Stewart, a Pennsylvania-based trucker tells CBS News.

In other words, they deserve our admiration now more than ever.

As Deb Labree, an independent owner-operator based in Missouri, tells the industry journal Freight Waves, “When this pandemic is over, I hope truckers who were a huge part of keeping America moving and the shelves stocked realize they have achieved hero status in my book.”

https://www.mnn.com/green-tech/transportation/stories/truckers-coronavirus-heroes-pandemic-economy?utm_source=Weekly+Newsletter&utm_campaign=cc33a3c162-RSS_EMAIL_CAMPAIGN_WED0325_2020&utm_medium=email&utm_term=0_fcbff2e256-cc33a3c162-40844241