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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
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plant lover, cookie monster, shoe fiend
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Another Covid wave
Another Covid wave has hit England, with recorded hospital admissions with Covid increasingly sharply over the last two weeks. While there has been lots written about the new subvariant XEC, it’s not nearly prevalent enough (yet) in England to be behind this wave. Instead, I think this is being driven by return to education and work combined with a cold and wet September.
This is now our fourth or fifth wave this year depending on how you count - and they are coming quickly enough that the troughs never reach the lows we saw in 2023. It’s enough to keep the risk of coming away from big events with Covid quite high (e.g current Fresher’s week or party conferences), enough to disrupt people’s jobs and lives, and enough to keep too high a number of people developing new Long Covid.
Prof Kevin Fong’s testimony at the Covid Inquiry
Prof Kevin Fong, an ICU clinician and academic, had a senior role in NHS England during the pandemic. As part of his role, he went on several visits to hospitals all across the country during the first 18 months of the pandemic, covering the devastating first two waves. Today, he testifed as a witness at the Covid Inquiry’s hearings.
Frequently on the verge of tears, his testimony was incredibly powerful. As he said “there is more to know than you can count”. There are lives and experiences behind every point on the above chart.
Prof Fong explained how traumatising the waves and deaths were for ICU staff, trying to care for dying patients separated from their family.
He explained how totally beyond any normal experience the sheer scale of deaths was, how it left staff traumatised with no time to recover and feeling that they could not give patients a dignified death. He later explained how smaller hospitals suffered in particular: as they filled up, more stable ICU patients were transferred to bigger hospitals (they had to be more stable to survive an ambulance trip), leaving the very sickest patients behind. Some hospitals experience more than 7 out of 10 ICU patients dying during the height of the pandemic. An unimaginable experience for staff.
Despite the line trotted out last November at the Inquiry by some such as Hancock saying the NHS coped, the NHS was dangerously overwhelmed. Prof Fong described visiting hospitals as close to collapse as he had ever seen, of the waves leaving staff broken by the summer of 2021, angry at how they ran out of everything during the peaks.
Watching his testimony reminded me yet again of how much we owe to NHS staff and other front line workers and how much we let them down.
The consequences of the NHS struggle of the first two waves
As the report from Module 1 of the Inquiry found, the UK went into the pandemic unprepared - we had much lower ICU capacity than most peer countries, and our stocks of PPE had been allowed to run far too low. We had never planned to prevent or mitigate the pandemic and so we were far too slow to reduce transmission - eventually resorting to the extreme of lockdown very late.
In a dangerous case of the tail wagging the dog, it seems as if lack of PPE contributed to the infamous “infection prevention cell” (IPC) refusing to adapt to Covid being airborne and downgrading required protective equipment for staff to the flappy blue surgical face masks (FSRMs). This piece by David Osborn digging into the decisions of the IPC and the consequences is a sobering must read. Hospital staff and patients were left far more exposed to infection than they should have been.
Overwhelmed hospitals contributed directly to the disastrous decision to discharge elderly patients into care homes without testing, where PPE was also lacking in the first wave. By the second wave, Boris Johnson was so obsessed with the feel good vibes of “saving Christmas” that he, and his government, ignored all the obvious and scary data about the surge of the new Alpha variant in December and didn’t lock down till early January. This delay, given all the learning from the first wave and the fact that we had literally just started vaccinating people, was and remains unforgiveable and criminal. Thousands died who could have lived had we been able to delay the spread of alpha until at least the most vulnerable had received a first vaccine dose.
The embrace of ‘freedom day’ in the summer of 2021, despite the rise of Delta, meant that an exhausted NHS had to cope with a high Covid burden for the rest of the year - and then into 2022 with the arrival of Omicron. NHS staff were depleted by Long Covid and burned out, with thousands leaving the NHS entirely . This directly contributed to the huge NHS waiting lists continuing to this day - the NHS never had the respite to cope with the backlog. It directly contributed to the collapse of NHS emergency services in the winter of 2022/23, as a triple wave of Covid, RSV and Flu broke the fragile system.
Refusal to learn
We seem stuck in a phase of denial about Covid - we don’t want to remember. We don’t want to think about it. People justify this deliberate forgetting by minimising what happened, what Covid is now (still here!), and what could happen in the future with new diseases.
Despite all the evidence on clean indoor air, there has been no push to improve the air quality of our buildings, private or public. This is particularly egregious in settings where clinically vulnerable people have no choice but to be: hospitals, pharmacies and care homes. We know that good quality masks work (when worn!), and we should be normalising their wearing within hospitals and health care settings.
Despite knowing that forcing people to go to work when sick is bad for their health and risks the health of others, there has been no push to improve statutory sick pay in the UK or encourage people (including children) to stay home when sick. The consequences of this shortsightedness will become even clearer when the next airborne pandemic hits us.
Finally…
The autumn vaccine booster campaign has started, and the NHS is using the latest version of the vaccine tuned to the JN.1 variant. Please do get a booster if you are eligible! If you are not eligible for an NHS booster, and are in a position to afford it (it’s up to £100 depending on provider), you could also consider getting a booster privately (there are many places that offer it, including Boots). Vaccines work - please avail yourself of them!
And - really encouragingly - the new generation of nasal spray vaccines are performing really well in trials and might provide us all with much longer lasting immunity within a few years.
Epiphyte City
Cohost closes this week. It’s too bad. I thought I’d found a home there. It was “posting, but better.” It was social media engineered to not break brains. It didn’t tell you how many people had liked or reblogged your posts, or how many followers you had. It only showed you posts from people you’d chosen to follow, in chronological order. Most importantly, nothing about the business model or the social structure required you to be on Cohost all the time. If you visited once a day, read all your friends’ posts in half an hour, wrote your own post in another half hour, and then logged the hell off – you weren’t missing anything, and nothing nagged you to come back. Cohost was designed to be non-addictive social media.
(Also, the community was almost entirely queer lefty geek weirdos. The features were nice but honestly, it was also just a place for a specific subculture that fit me very well.)
But Cohost was expensive to operate, hard to monetize, and lacked the big-money backing that got the big social media sites through their unprofitable years. I don’t want it to be remembered as a “go woke, go broke” story of a site that was kneecapped by its own leftist ideals; the truth is that it lasted longer and built a more solid community than most new social media sites ever manage to. Go woke, spend two years forging friendships and helping people develop a healthier relationship with the internet… go broke.
So where do I go now?
I go here.
If you only ever followed pervocracy.com, it probably looked like I almost completely stopped writing for ten years. I didn’t. I couldn’t have. I have written something just about every day. But for a while after the Blogosphere stopped being the hot thing online, I wrote on Tumblr. Then they banned me for posting porn (I had not posted porn), so I wrote on Twitter. Then there was that whole global public health catastrophe that made it very hard to think clearly, especially when you are working as a nurse through the whole thing, and I became addicted to Twitter. Then Elon Musk bought Twitter and the Nazi situation on there got so bad that I had to break my addiction. It took months but I finally got loose and started writing on Cohost. And then Cohost ran out of money.
And people on Cohost started asking each other “what social media are you moving to next?” Bluesky? Mastodon? Threads? (That one’s a joke. Nobody even mentioned Threads.) Pillowfort? Dreamwidth? And you know what, I’m sure a lot of those are just fine.
But I’m done. I’m done with “after reviewing your report, we found no rule violation” and I’m done with “due to payment processor rules we can no longer accept adult content” and I’m done with chasing the high of a viral post and I’m done with push notifications and I’m done with sponsored posts and I’m done with quote tweets and I’m done with cliques and vendettas and dogpiles and harassment. I’m done with pouring out my soul to make other people money.
I’m writing for me now.
I’ll probably end up using other sites for social/promotional purposes, blogging in 2024 is lonely work, but my “home” on the Internet? It’s here. On my own domain, under my own control. It’s a little more work, but it’s work that I get to keep and own, uncensored, with the only technical limitations being my own budget and skill. And it’s easier than ever to do CSS crime. Running your own site isn’t the easiest way to put words online and it won’t get you the biggest audience, but the freedom is heady.
So my new social network is The Pervocracy. It’s my blog, my digital garden, my archive. Any new writing or art or projects I do, will go here. A lot of my old projects from other sites will be reposted here. (I might even write about sex once or twice in a blue moon.) This is my digital home. I’ve owned it for a while, but today, I’m moving in.
Epiphyte City
Neither vaccinations nor immunity from infections seem to thwart SARS-CoV-2 for long. The frequency of new infections within a few months of a previous bout or a shot is one of COVID-19’s most vexing puzzles. Now, scientists have learned that a little-known type of immune cell in the bone marrow may play a major role in this failure.
The study, which appeared last month in Nature Medicine, found that people who received repeated doses of vaccine, and in some cases also became infected with SARS-CoV-2, largely failed to make special antibody-producing cells called long-lived plasma cells (LLPCs). “That’s really, really interesting,” says Mark Slifka, an immunologist at the Oregon Health & Science University who was not involved with the work. The study authors say their finding may indicate a way to make better COVID-19 vaccines: by altering how they present the spike surface protein of SARS-CoV-2 to a person’s immune cells.
Durability is an age-old bugaboo of vaccine designers. Some vaccines, particularly ones made from weakened versions of viruses, can protect people for decades, even life. Yet others lose effectiveness within months. “We really haven’t overcome this challenge,” says Akiko Iwasaki, a Yale University immunologist who is developing a nasal COVID-19 vaccine she hopes can be given often enough to get around the durability problem.
Just how long a shot can protect against SARS-CoV-2 is hard to assess because variants of the virus, able to evade existing immunity, frequently emerge. And new infections muddle attempts to assess vaccine durability because they provide a “boost” that keeps immunity from waning. Multiple immune actors also provide protection, including antibodies, T cells, and natural killer cells.
To get a clearer picture, the new study examined LLPCs, which are responsible for durable immunity to some other viruses. These cells, the offspring of B cells, primarily reside in the bone marrow. For some viruses, vaccination or infection generate LLPCs that can survive for decades, steadily producing “neutralizing antibodies” that can thwart new infections.
But not so with SARS-CoV-2, the new work indicates. Emory University immunologists Frances Eun-Hyung Lee, Doan Nguyen, and their colleagues enrolled 19 people who agreed to have their marrow aspirated, a procedure that carries little risk but can be painful because it means piercing bone. All had received between two to five doses of messenger RNA (mRNA) COVID-19 vaccines—which code for SARS-CoV-2’s spike—during the preceding 3 years. Five reported having had COVID-19, as well. The study subjects had also been vaccinated recently against influenza and had booster shots for tetanus, a bacterial disease.
Lee and her colleagues found that nearly all participants had LLPCs in their bone marrow that secreted antibodies against tetanus and flu. But only one-third had plasma cells generating the same defense against SARS-CoV-2. Even in those subjects, just 0.1% of the antibodies generated by their LLPCs were specific for SARS-CoV-2, an order of magnitude less than for tetanus and flu. “The paper is very informative,” Iwasaki says.
An earlier study of bone marrow from 20 people who had been infected with SARS-CoV-2 but never vaccinated against it also found that they were “deficient” in LLPCs specific to SARS-CoV-2 compared with those for tetanus. The new results “were really consistent with what we found,” says Mohammad Sajadi of the University of Maryland School of Medicine, whose team reported the data in the 25 July issue of The Journal of Infectious Diseases. “The big question is why?”
SARS-CoV-2’s surface features may offer an answer, Lee and her co-authors say. LLPCs emerge after “naïve” B cells encounter a virus or a piece of it, such as the spike protein. As B cells mature, they make more refined antibodies that better bind to the invader. After the initial infection, memory B cells continue to patrol the blood and a subset differentiates into plasma cells. Some of those cells migrate to the bone marrow, which provides safe haven for their long-term antibody production.
B cells carry Y-shaped receptors that attach to viral surface proteins when they identify a pathogen. If both branches of the Y bind to the same pathogen proteins, they trigger a phenomenon called “cross-linking,” which spurs B cells to transform into LLPCs. But electron microscopy of SARS-CoV-2 shows its spikes are about 25 nanometers apart, too distant for a single B cell receptor to readily bind to two at once.
Spike doesn’t just appear on the virus itself; it also protrudes from infected cells and cells stimulated by mRNA vaccines. Electron micrographs don’t show the proteins and their spacing, but immunologists suspect the SARS-CoV-2 molecules are widely spaced on these cells, as well. As a result, Lee and her co-authors suggest, B cells don’t become cross-linked, and LLPCs don’t develop.
Other kinds of vaccines might present spike more effectively. Slifka points to an approved vaccine against human papillomavirus, which consists of a “viruslike particle” (VLP) made from surface proteins of that pathogen. Those proteins self-assemble into something that resembles a soccer ball. “That’s a very rigid structure with great spacing and it induces incredibly durable antibody responses,” Slifka says.
Martin Bachmann, an immunologist at the University of Bern, has argued that VLPs for SAR-CoV-2 could space spike molecules more closely—about 5 nanometers apart—than the virus itself. “I am personally convinced that viruslike particles are the best platform,” says Bachmann, who published his proposal in a 2021 npj Vaccines paper.
Given the dominance of current shots, bringing a new one to market won’t be easy. Indeed, Medicago made a spike-based VLP vaccine for COVID-19 that regulators in Canada authorized for use in February 2022, but the company stopped making it a year later because it lacked a market and went out of business.
The Novavax COVID-19 vaccine approved in the United States and some other countries uses insect cells to produce spikes that link together and form “rosettes,” which might offer tighter spacing of the protein and therefore durability benefits, but Bachmann doubts the rosettes work as well as VLPs. “Such poorly organized structures are clearly inferior to highly organized surfaces,” he says. Lee would like to study the bone marrow of Novavax recipients for the long-lived plasma cells, “but there weren’t a large number, and it’s very hard to get patients to donate marrow,” she says.
Other COVID-19 vaccines in development use nanoparticles that display tightly spaced portions of spike. Neil King, a University of Washington biochemist whose team has developed one such COVID-19 vaccine now in human trials, says they do not have data on LLPCs or durability. “Spacing definitely matters, but it’s very difficult to set up controlled experiments,” King says.
Structural biologist Pamela Bjorkman at the California Institute of Technology, who has a similar nanoparticle COVID-19 vaccine in development, is more skeptical that spacing has a significant impact on vaccine’s durability. Influenza virus has tightly spaced surface proteins, she notes, and infection with it doesn’t lead to durable immunity.
Nguyen, however, thinks his team’s sobering findings require follow-up. “The bad news is the failure of SARS-CoV-2 mRNA vaccines themselves—with or without natural infections—to induce LLPCs in the bone marrow,” he says. “The good news is this failure itself provides a research opportunity to find a way to change the fate of short-lived vaccines.”
Epiphyte City
This post was written by Alison Green and published on Ask a Manager.
A reader writes:
I am a stay-at-home mom of very young children. My husband works from home one day per week, occasionally two. When he works from home, he watches our baby while I take the older ones to and from school/preschool. Other than that, he works in our home office and I rarely see him for more than a few minutes at a time. My point is that he is definitely working when he works from home.
Except sometimes we have sex while the baby naps. I feel like this is fine! But we were laughing about it recently because, well, if someone left work to go have sex, I think we would all question their judgment. I can’t explain why I don’t think there’s anything unethical about this. Am I alone in that? It’s not like we can check with his boss to see if he’s fine with this. We can’t ask any of his coworkers if they do this too because then we’re just asking about people’s sex lives.
To be clear, I don’t really care even if his boss or colleagues did have a problem with it. It’s none of their business! Or is it? Because it’s during the work day? What are your thoughts on sex while working from home?
Oh.
Hmmm.
I don’t think you should be having sex during the work day. But in purely practical terms, I can’t argue that sex while working from home is all that different from doing laundry while working from home (and I never thought I would compare sex and laundry). The laundry standard is that if it only briefly takes you away from your work, you’re getting all your work done and done well, and you’re available when your team needs you, no one needs to know.
So I suppose it depends on whether those things are true. Is this a lengthy encounter or a brief one? Is he doing well at his job? Does he return to his desk to find people were trying to reach him while he was otherwise occupied or do people find him appropriately accessible?
If the sex doesn’t add up to any more time away than, say, a couple of coffee breaks and chats in the office kitchen, I can’t give you any good reason why it’s more improper. Obviously it’s improper if people know about it, but it’s the knowing that would be far more improper than the act itself.
And of course, if it’s his lunch break, that’s his own time and you may get it on with impunity.
“I don’t think you should be having sex during the work day.”
I officially don’t trust ask a manager anymore
I officially don’t trust ask a manager anymore
Epiphyte City
Washington, DC
Serhiy Kraskov picked up a twig and poked at a small fish floating in the Desna River. “It’s a roach. It died recently. You can tell because its eyes are clear and not blurry,” he said. Hundreds of other fish had washed up nearby on the river’s green willow-fringed banks. A large pike lay in the mud. Nearby, in a patch of yellow lilies, was a motionless carp. “Everything is dead, starting from the tiniest minnow to the biggest catfish,” Kraskov added mournfully.
Kraskov is the mayor of the village of Slabyn, in Ukraine’s northern Chernihiv region. The rustic settlement – population 520 – escaped the worst of Russia’s 2022 full-scale invasion. But the war arrived last week in a new and horrible form. Ukrainian officials say the Russians deliberately poisoned the Seym River, which flows into the Desna. The Desna connects with a reservoir in the Kyiv region and a water supply used by millions.
A toxic slick was detected on 17 August coming from the Russian border village of Tyotkino. According to Kyiv, chemical waste from a sugar factory had been dumped in vast quantities into the Seym. It included ammonia, magnesium and other poisonous nitrates. At the time, fierce fighting was going on in the surrounding area. Ukraine’s armed forces had launched a surprise incursion into Russia and had seized territory in Kursk oblast.
The pollution crossed the international border just over a mile away and made its way into Ukraine’s Sumy region. The Seym’s natural ecosystem crashed. Fish, molluscs and crayfish were asphyxiated as oxygen levels fell to near zero. Settlements along the river reported mass die-offs. Kraskov got a call from the authorities warning him a disaster was coming his way. He spotted the first dead fish on 11 September. “There were a few of them in the middle of the river,” he said.
He returned the following weekend to find the Desna’s banks clogged with rotting fish, stretching out from the shore for three metres into the water. Volunteers wearing rubber boots, masks and protective gloves shovelled the fish into sacks. They found a metre-long catfish. “The stench was terrible. You could scarcely breathe. The river was quiet. Nothing moved apart from a few frogs,” Kraskov said. A tractor took the sacks to an abattoir that used to belong to the village’s Soviet-era collective farm. They were buried in a pit.
Serhiy Zhuk, the head of Chernihiv’s ecology inspectorate, described what had happened as an act of Russian ecocide. “The Desna was one of our cleanest rivers. It’s a very big catastrophe,” he said. Zhuk traced the slick’s route on a map pinned to his office wall: a looping multi-week journey along the Seym and Desna. “More than 650km is polluted. Not a single organism survived. This is unprecedented. It’s Europe’s first completely dead river,” he said.
In his view, the Kremlin was waging total war of a kind not seen since the last century. Vladimir Putin’s desire to eradicate Ukraine extended to the natural world, he suggested. “They are sending rockets through the air, burning our forests and threatening to blow us up with nuclear bombs. You can rebuild a bridge or a school. It takes longer, unfortunately, for wildlife to recover.”
As the contamination approached, Zhuk ordered the closure of Zolotyi Bank, the central beach in Chernihiv. A ban was imposed on fishing, swimming, and on using the river to water cattle or gardens. Scientists took samples, testing every 15-20km and bringing glass vials back to a laboratory. The results were hair-raising. In the city of Baturyn, a one-time Cossack capital on the Seym, oxygen content dipped to zero on 29 August. The next day it was 0.1 mg/dm³. At least 4 mg/dm³ is needed for fish to breathe.
Zhuk said it would take years for the river to recover. There was little prospect of this happening while fighting in Russia’s Kursk oblast continued, he said. Ukraine’s armed forces have blown up bridges over the Seym, adding fuel and debris to an already noxious mix. Around Chernihiv, local helpers – some in boats – collected about 44 tonnes of dead fish. “That’s what we recovered. There’s a lot more inside the river and on the bottom,” Zhuk said.
Emergency teams have used compressors to pump oxygen into the Desna, to give the remaining fish a better chance of survival. Recent rains dispersed some toxins. Zhuk was optimistic these measures would be enough to save Kyiv from the worst of the pollution. But he admitted the situation was grim. “There is a difference between a natural and man-made disaster. This was a diversionary act. Russia’s ecological genocide won’t stop until the war stops,” he said.
At the central beach, Olha Rudenko and her boyfriend Roman Svichkar strolled along the golden sands. A sign in red letters warned “Do not bathe”. “This is a huge eco-tragedy. The river smells weird,” Olha remarked. She noted that last year Russian troops blew up the Khakovka reservoir in Ukraine’s southern Kherson province, flooding villages and killing people and fish. “This is Russia again, 100%,” she said. “We used to drink water from the tap and buy fish from the market. Now we can’t.”
Svitlana Hrynchuk, Ukraine’s minister for environmental protection, said water consumption in Kyiv remained safe. Various special measures had been taken to get rid of the nitrates, she said, with 120 tonnes of cleaning agents imported and nets strung across the Desna to catch dead fish. In the Kyiv region, none had turned up. Additionally, water was routinely purified before it was extracted for household use, she said, adding: “We don’t have a fish plague.”
Hrynchuk said this latest episode was part of a dismal pattern. Russian troops had destroyed national parks in occupied areas, killed animals and mined thousands of hectares of forest. Explosions had caused wildfires, a problem exacerbated by recent hot weather. “Ukraine is fighting for its future. That future has to include nature. We need clean water, clean air, woods, everything,” she said. “We have a beautiful country. We have to save and protect it.”
She said the river was a part of Ukrainian culture. In 1956, the Soviet film-maker Oleksandr Dovzhenko published a novel called The Enchanted Desna. Reminiscing about his childhood, he wrote: “It would be long past sunset and the large catfish would leap in the Desna under the stars as we listened agog till we dozed off in the fragrant hay under the oaks. Grandpa regarded the tench as the best fish of all. He scooped them right out of the water with his bare hands like a Chinese magician.”
Back at Slabyn, Kraskov said that before he became village mayor he worked at Chornobyl nuclear power station. He was involved in the construction of a concrete sarcophagus designed to contain radiation from the reactor, which blew up in 1986. “I know how to bury dangerous substances,” he said wryly. “I also know how bureaucracy works. That’s why we acted quickly with the dead fish.” He continued: “If something goes wrong, officials like to find a scapegoat. So you better do everything correctly. Our life is like this.”
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