Jun 27, 2020

Axios Future

By Bryan Walsh
Bryan Walsh

Welcome to Axios Future, where the surge in coronavirus cases is being met by a surge in coronavirus content in this newsletter, which is all pandemic. And toilet paper.

  • If you haven't subscribed, now is the time, and this is the place.
  • Send feedback and tips to bryan.walsh@axios.com or hit reply.
  • For those who wrote in asking to see evidence about the effectiveness of masks, thanks very much! And see item #4.

Today's Smart Brevity count: 1,614 words or about 6 minutes.

1 big thing: Why coronavirus contact tracing is failing

Illustration: Aïda Amer/Axios

Government virus expert Anthony Fauci told reporters in a press briefing on Friday that contact tracing efforts to contain the coronavirus are "not working."

Why it matters: Without a vaccine, contact tracing of cases is the best tool available to stem the spread of an outbreak. But understaffed public health agencies, privacy concerns, disappointing technology, and the sheer size of the pandemic are limiting the technique's effectiveness.

By the numbers: The public health standard is that a state should have at least 30 contract tracers — public health employees dedicated to investigating the contacts of positive cases — for every 100,000 people during a pandemic. According to a June 25 report by Nephron Research, however, just seven states have met that standard.

  • Another seven have near-term plans to sufficiently increase contact tracing capacity.
  • Many of the states experiencing the biggest surges in cases are well below the recommended number of tracers and have no near-term plans to reach that level.
  • Centers for Disease Control and Prevention Director Robert Redfield testified that there are 27,000 to 28,000 people doing contact tracing work. That's up from 11,000 at the start of the pandemic, but it is well below the minimum 99,000 tracers that the Association of State and Territorial Health Officials estimated are necessary for the U.S. to safely reopen.

Even those states that have sufficiently beefed up their contact tracing systems are struggling to get people who have tested positive to report whom they were in contact with — or, in some cases, to even pick up the phone.

Early hopes that app-based smartphone contact tracing might help have largely gone unfulfilled.

  • At least 60% of the population would need to download such apps for them to be effective, but according to a recent study, just 29% of Americans would consider downloading one.
  • Privacy concerns are a major obstacle to successful contact tracing. South Korea's success in controlling outbreaks was partly due to its use of phone GPS records, credit card transactions and even security camera footage to augment its contact tracing — methods that would likely not fly in the U.S.
  • Black Americans are being infected and dying of COVID-19 at higher rates, but a long history of discrimination — including by doctors — has made them "less willing to line up and trust a public agency right now, public health included," writes Katelyn Esmonde, a postdoctoral fellow at the Johns Hopkins Berman Institute of Bioethics.

The bottom line: More than four months after the first recorded U.S. COVID-19 cases, the virus is still outpacing our ability and willingness to track it.

2. A blueprint for managing colleges during coronavirus

A single student walks on the UCLA campus. Photo: Robyn Beck/AFP via Getty Images

As colleges look to adjust to a lasting pandemic, they'll need to find new ways to service students in person and offline.

Why it matters: Colleges were forced to suddenly switch to online learning when COVID-19 struck and are now focusing on figuring out how to reopen safely. But the realities of the pandemic will demand an innovative mix of distance services and physical transformation.

What's new: Gensler, the world's biggest architectural firm, recently put out a series of guidelines for college reopening that are the result of more than 400 conversations with administrators, students and experts around the country.

  • The scale of what needs to be done can't be underestimated. "A university might be the most complex organization to reopen, on par with a city," says David Broz, principal at Gensler. "It has housing, it has food, it has retail, it has large assembly spaces and sports. And it's a 24/7 environment."

Details: Those schools that aim to physically reopen to students in the fall will need to design housing, classrooms, and more in a way that limits total capacity and supports physical distancing.

  • That includes prioritizing single-occupancy housing — which may require contracting with nearby hotels for additional space — and potentially keeping students in common pods to reduce their number of contacts.

The catch: Besides the challenge of getting teens and 20-somethings to follow social distancing rules — which is apparently not working too well in the real world — successfully implementing them would fundamentally change the college experience.

  • Being kept in small groups "is like high school or grade school," says Broz. "You go to a university for a more diverse experience."
  • Partially as a result, colleges need to continue to add to online learning options.

Yes, but: Colleges will be hard-pressed to find the money to transform their campuses and improve online learning, as this Wall Street Journal story notes.

3. Pandemic shrinks planned family sizes

A pregnant woman wearing a surgical mask. Photo: Pavlo Gonchar/SOPA Images/LightRocket via Getty Images

A new report shows that the COVID-19 pandemic has led a third of U.S. women surveyed to report that they want to delay childbearing or have fewer children.

Why it matters: Natural disasters and economic recessions often lead to a decline in fertility rates, and COVID-19 has aspects of both. With the pandemic and lockdown policies already putting enormous pressure on working parents, reproduction could take a major hit.

By the numbers: This week the Guttmacher Institute released a survey of over 2,000 cisgender women of childbearing age who were asked about how the pandemic has affected their sexual and reproductive health.

  • 34% of women surveyed said they wanted to delay childbearing or have fewer children because of the affects of the pandemic.
  • Those numbers were higher for Black and Hispanic women, who have been infected by COVID-19 at higher rates than white women and absorbed a bigger economic hit because of the recession.

Be smart: While these changes in fertility preferences rival those seen after the Great Recession of 2008, COVID-19 has additional elements that could make a possible baby bust even more long-lasting.

  • A recent study from the CDC found that pregnant women may be at higher risk of severe illness if they contract COVID-19, and on Thursday the agency added pregnant women to the list of those most at risk from the disease.
  • Lockdowns and fears of infection made it harder for pregnant women to get prenatal care or even have partners and family members with them during delivery.
  • With schools and many day care centers around the U.S. still closed because of coronavirus, working parents face enormous uncertainty about the future of accessible child care.

Go deeper: Deep dive: Kids + coronavirus

4. Where the science stands on face masks

Illustration: Sarah Grillo/Axios

Scientific evidence shows face masks can help to control the spread of the coronavirus, but the nuances and changes in messaging about their use are complicating public health efforts, my Axios colleagues Alison Snyder and Eileen Drage O'Reilly write.

What's known: Wearing face masks "could result in a large reduction in risk of infection," according to a recent review of 172 studies looking at the effectiveness of masks in reducing the spread of SARS-CoV-2 and other coronaviruses.

Where it stands: The World Health Organization and the Centers for Disease Control and Prevention recommend mask use in health care settings, if you or someone you live with is sick, and where social distancing is difficult (for example, in stores or on public transit).

  • N95: These masks, which block 95% of small particles (0.3 microns or larger) when properly fitted, protect the person wearing it and those nearby. But there are ongoing shortages of these masks, and the CDC says they should still be reserved for health care workers.
  • KN95: These masks are similar to N95 ones but are produced in China under the country's standards. The FDA shortened its list of approved KN95 manufacturers after some were found to be faulty.
  • Surgical masks: They're meant to stop large droplets of saliva coming from the person wearing the mask, but about 75% of droplets may be blocked from entering, too.
  • Cloth masks: The many configurations of cloth masks catch the droplets that spread the virus and may also block 30–60% of particles, according to the same preprint study that assessed surgical masks.
  • The WHO recommends a mask with three layers — an absorbent cotton inside, a filter and a nonabsorbent outer layer.

"Cloth masks protect everyone around you, first and foremost," says Werner Bischoff of Wake Forest University School of Medicine. "They can filter out some of the viruses you breathe, but that is not what they are there for."

Read the full story.

5. Worthy of your time

Inside the social media cult that convinces young people to give up everything (Emilie Friedlander and Joy Crane — OneZero)

  • A truly bonkers (technical journalism term) feature story about the DayLife Army, a social media-influence cult that took over members' lives.

Pandemic-proofing the planet (Economist)

  • There are programs in place that could help prevent pandemics from ever occurring — and they desperately need support.

CRISPR gene editing in human embryos wreaks chromosomal mayhem (Heidi Ledford — Nature)

  • A rash of recent studies show that technology isn't remotely ready for the use of gene-editing tools on human embryos.

How the U.S.’ massive failure to close digital divide got exposed by coronavirus (Will Carless — Reveal)

  • An investigation into America's yawning digital divide, and the poor students who fell into it when the pandemic forced education online.
6. 1 toilet thing: The issue is tissue

Remember when toilet paper was going to be our new currency? Photo: Jeremy Hogan/SOPA Images/LightRocket via Getty Images

The environmental damage caused by our toilet paper-buying habits has worsened during the pandemic.

Why it matters: Most at-home toilet paper is made from virgin material produced by clear-cutting forests, unlike the office toilet paper, which is usually made from recycled fibers. As a result, the shift to doing business at home hasn't been good for forests.

What's new: This week the environmental group Natural Resources Defense Council (NRDC) released a new report detailing the link between major U.S. toilet paper manufacturers and the destruction of Canada's boreal forest.

  • NRDC found that while a number of companies have seen growth in toilet paper from recycled materials, the top manufacturers still depend on 100% virgin forest fiber, feeding what the group calls a "tree-to-toilet pipeline."

But there's a reason why many toilet paper makers still use virgin fiber: it's a lot softer, which many consumers not surprisingly prefer when buying their own supply.

  • Office buildings, by contrast, usually fill their bathrooms with recycled fiber toilet paper, either for the environmental effect or because it's cheaper.

The bottom line: We seem to value our bottoms more than the planet.

Bryan Walsh