2020-11-01 National Geographic Interactive

11.2020 ISSUE

SPECIAL

How the pandemic is changing our lives

NEXT GENERATION Young adults fight back, again
DISCOVERY Scientists become our new superheroes
SOCIETY A virus and social unrest test our humanity
NATURE Let’s use this moment to help planet Earth



NATIONAL GEOGRAPHIC ON THE COVER

From a hospital in La
Louvière, Belgium, this
image shows a CT scan
of the chest area and
lungs of a 69-year-old
patient with COVID-19.

CÉDRIC GERBEHAYE

PROOF DATA SHEET DECODER At the Leo F. Kearns
Funeral Home in
LIFE WITH COVID-19 THE FIRST 100 DAYS CORONAVIRUS, EXPLAINED Queens, New York,
where he is a resident
The novel coronavirus How the virus spread How the virus attacks funeral director, Fran-
has changed how we across the globe. the human body. cisco James enters a
come into the world, refrigerated container
live in it, and leave it. BY MANUEL CANALES AND BY MANUEL CANALES AND filled with bodies—
I R E N E B E R M A N -VA P O R I S ALEXANDER STEGMAIER mostly of casualties
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 8 of the COVID-19
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 32 pandemic—awaiting
INTRODUCTION embalming or burial.
E S S AY THROUGH THE LENS
THIS DEVASTATING YEAR PETER VAN AGTMAEL,
LETTER TO MY GENERATION WHAT A COMMUNITY LOST MAGNUM PHOTOS
COVID-19 dominated
life in 2020 and left The pandemic has hit Larry Hammond’s death
many wondering, What 18- to 25-year-olds hard. resounds within the
will recovery look like? But don’t dismiss us as organizations he loved.
Generation Screwed.
BY CYNTHIA GORNEY BY WILL SUTTON; PHOTO BY
BY JORDAN SALAMA MAX AGUILERA-HELLWEG
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 19
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P. 36

NOVEMBER 2020 2 VOL. 238 NO. 5

dispatch 40 essay 56 dispatch 66

A CARE CRISIS: IN SCIENCE WE LIVES UPENDED:
BELGIUM MUST TRUST INDONESIA

Overextended medical After watching scientists The pandemic that filled
teams care for COVID-19 debate, restate, and learn graveyards also emptied
patients and listen to their streets. Still, people ventured
fears. “If I don’t do this,” one on the fly how to battle out for essentials: religious
nurse asks, “who will?” COVID-19, we should trust observances and food.

PHOTOGRAPHS BY their work even more. PHOTOGRAPHS BY

CÉDRIC GERBEHAYE BY MUHAMMAD FADLI

ROBIN MARANTZ HENIG

essay 76 dispatch 90 Data sheet 104

LET’S NOT WASTE LOCKDOWN PAIN: IMPOVERISHED
THIS MOMENT JORDAN BY COVID-19

Will the pandemic Strict isolation measures The pandemic has hit the
have a lasting effect on how held down the COVID-19 poor extremely hard and is
death toll but heightened projected to put 100 million
we treat planet Earth? joblessness and hardship, more in extreme poverty
It could—if it changes especially for refugees.
by the end of 2020.
our thinking. PHOTOGRAPHS BY
BY
BY MOISES SAMAN
ALBERTO LUCAS LÓPEZ
ROBERT KUNZIG

dispatch 110 essay 122 dispatch 132

A WEALTH GAP: THE TIMES TEST LOPSIDED LOSS:
KENYA OUR HUMANITY UNITED STATES

In Nairobi the virus looks We are reminded—by the In three hard-hit areas, a pho-
very different to the affluent pandemic and by social jus- tographer hears bereaved
in spacious compounds than tice demonstrations—of the people’s stories of losing
it does to the impoverished
global ills and inequities their loved ones to COVID-19
in crowded settlements. that need our attention. or its complications.

PHOTOGRAPHS BY BY PHOTOGRAPHS BY

NICHOLE SOBECKI PHILLIP MORRIS WAYNE LAWRENCE

Purina trademarks are owned by Société des Produits Nestlé S.A.

Farm raised beef is the #1 ingredient.

No artificial flavors or preservatives.
A great taste your dog will love.

Learn more at Beneful.com/recipes

FROM THE Contemplating a Remade World
EDITOR

6

BY SUSAN GOLDBERG PHOTOGRAPH BY CHRISTIAN K. LEE

In Killeen, Texas, relatives surround Demareyo Tittle, in March, I see colleagues’ young children in the
19, who wears part of the outfit he’d planned for background (and occasionally in the foreground). I
his high school’s prom last May. It was canceled worry about how being thrust into remote learning
because of COVID-19 concerns. will affect them academically.

S I N C E T H E B E G I N N I N G of the year, this Follow the But I worry more about youngsters I don’t see on
novel coronavirus has altered life as we scientists try- these calls: kids for whom schools provided decent
know it. Worldwide a staggering number ing to stop computers and internet access, and one meal (or
of people have contracted COVID-19, COVID-19— more) a day. I pray that aid will continue even if
and a still growing number have died. and the next schools stay closed, and hope those kids are resilient
No part of life is untouched: Work. pandemic— enough to bounce back.
School. Family life. Traditions such as in our new
graduations and, sadly, funerals, are documen- I think too about the young people who were just
changed nearly beyond recognition. tary Virus coming into their own when the pandemic landed,
Hunters. It upending so many dreams. These 18- to 25-year-olds
This special issue focuses on how the premieres on have weathered challenges from the start, growing up
pandemic has remade our world—and the National in the shadow of 9/11 and practicing active-shooter
how it might change our thinking and Geographic drills from elementary school onward. The Great
our actions even more in the future. Channel on Recession hit many families hard, so the students
November 1 shouldered mountains of debt to pay for college.
I think a lot about how this will affect at 9 p.m. And now they see internships canceled, job offers
kids. During video meetings we’ve held ET/PT. rescinded, an unintended “gap year.” It’s a rotten hand
since we began working from home to be dealt. “Generation Screwed,” some call them.

Not so fast. Recently I read an essay about 2020 by
Cate Engles, who graduated in May from a private
high school in Ohio. Like senior classes across the
United States, hers “was immediately thrust into a
world that didn’t care about senior traditions, cumu-
lative GPAs, and college plans,” she wrote. There was
no pomp, only unexpected circumstance.

She has delayed going to college for a year and
aims to make the best of it, as her class did when
its senior celebrations were canceled. “Instead of
worrying over dresses and dates and corsages,” she
wrote, “our high school generation dedicated their
weekends to fight for justice where it is long overdue.”

She hopes the result of that will be “newspaper
articles about the impact this generation had on the
world, rather than on the dance floor.”

I surely didn’t have that kind of grace or wisdom
when I was 18. You’ll find the same determination
reflected by other young people in an essay in this
issue. Here’s how writer Jordan Salama, himself just
23, describes this moment in history: “For those of us
at the beginning of our adult lives, the faltering start
caused by the pandemic means that our choices will
matter even more.”

Thank you for reading National Geographic. j

You’ve worked hard to save so that you can pursue
your hobbies. We’ll help you keep up the smart moves with

free financial seminars, expert advice and personalized Insights
in the U.S. Bank Mobile App.
Get started at usbank.com/insights.

Member FDIC. ©2020 U.S. Bank

NATIONAL GEOGRAPHIC8

Connection in the time of covid Social distancing has its limits. After more
than two months without any human touch, Mary Grace Sileo (left) and her daughter, Michelle Grant, and

D I S PATC H

The coronavirus has changed how we
come into the world, live in it, and leave it.
others in their family had a solution. They hung a clothesline and pinned a drop cloth to it in Sileo’s yard in
Wantagh, New York. With one on each side, they embraced through the plastic. PHOTO: AL BELLO, GETTY IMAGES

love in the time of covid When the state of lockdown was lifted in Italy, post-
poned rituals could take place. Marta Colzani and Alessio Cavallaro donned masks inside the Church of San

Vito in the town of Barzanò, near Milan, for one of Italy’s first post-lockdown weddings. The Vatican issued a
decree in March allowing bishops to use their discretion when planning religious services. PHOTO: DAVIDE BERTUCCIO

death in the time of covid When coronavirus deaths surged in Bergamo, one of
Italy’s hardest hit cities, its morgue and crematorium were overwhelmed. Italian Army troops were brought

in to transport coffins from Bergamo to several other cities in northern Italy. Here, workers in Novara carry
coffins from the army truck to the cemetery’s crematorium. PHOTO: ALEX MAJOLI, MAGNUM PHOTOS

Birth in the time of covid Life can’t always wait. In late April, Kim Bonsignore
had planned to have her second child in a hospital near her Manhattan home. The coronavirus’s effects on

hospitals changed her mind, and she delivered her daughter, Suzette, in her living room. The pandemic
and economic uncertainty may deter couples from having more children now, experts say. PHOTO: JACKIE MOLLOY

Resilience in the time of covid After 11 weeks in complete lockdown,
China’s Hubei Province relaxed the stay-at-home order for its more than 55 million people. Residents

trickled out of their homes, nearly all wearing masks, to return to activities once considered routine and
carefully reclaim small pleasures, such as dancing outdoors. PHOTO: GETTY IMAGES

Nurture their

loving hearts
with IAMS™

Large Breed

©2020 Mars or Affiliates.

Introduction D U R I N G T H I S Y E A R —“this devastating
year,” as Robin Marantz Henig writes in
We’ll Move On the pages that follow—a man in Central
From This Java assembled a barrier from bam-
boo poles, painted LOCKDOWN onto a
Devastating Year. piece of vinyl, and blocked the entrance
But How? To What? to a village road. A Belgian undertaker
began dressing for work in a hazmat
Say novel coronavirus, or SARS-CoV-2, suit. A child in Detroit complained of
or COVID-19. By any name, it has seized headache; a month later, during the
memorial service that only 12 people
2020, mocking our defenses and were permitted to attend, her parents
dominating our existence. In this issue, grieved behind face masks.

National Geographic explores the Here’s what the year has demanded
pandemic’s implications for science, we understand: that a single phenome-
for the environment, and for cultures non connects these people, these places,
this sorrow, this fear. Most of us are nei-
throughout the world. ther epidemiologists nor Spanish flu
survivors; for most of us, before 2020 the
BY 19 word “pandemic” belonged to history,
dystopian fiction, or books of warning
CYNTHIA GORNEY from science journalists like Henig. The
effort to comprehend, to grasp the new
coronavirus as the actual global event
it has become, is exhausting.

Trying to follow the science alone
can overwhelm even the practiced
observer, as Henig points out in one
of this special issue’s examinations of
the pandemic: “Even for a science geek
like me, it has been unsettling to watch
[scientists] debate, disagree, pivot, and
reassess. I’ve been wishing instead that
some lab-coated hero would just swoop
in and make it go away.”

To call the essays and images col-
lected here a record of the pandemic
is an act of hubris and of hope; a record
is a thing you look at afterward, in ret-
rospect. When do we get to afterward?
We will move on because we must, but
how? To what? And what has changed
us during this devastating year? These
are some of the questions the writers
and photographers in this issue set
out to explore.

I N H E R T RO U B L E D reflection on the
perception of scientific research in a
coronavirus future, Henig wonders
at the hyperspeed of the work, much
of it conducted with unprecedented
openness before a public also desperate
for a lab-coated hero.

“Maybe our unfiltered view will turn
out to be a good thing,” she writes.
“Maybe, in a weird way, watching sci-
entists try to build a plane while they’re
flying it—as some have described coro-
navirus research—will be good for

20

NATIONAL GEOGRAPHIC

PHOTOGRAPH BY DANNY WILCOX FRAZIER

our overall understanding of the 1. Pandemic-side-effect optimism wafted by, to be
scientific process.” Another sure, some of it merited. The dolphins returning to
debunked the Venice canals ( 1 ) —sorry, not true, though we
Maybe. We are an impatient, self- tale claimed ardently wished it were. The Punjabis who could see
obsessed species, we human beings, that during the Himalaya for the first time in decades, because
capable of magnificent heroism and the pan- economic slowdown reduced pollution so much—
unbelievable stupidity. The odds of us demic, 14 yes, that was true, like the cleaner-air reports from
learning a sustainable way through this elephants Bangkok and São Paulo.
calamity? Teetering, it seems, from one broke into
month to the next, one day to the next. a Chinese There was a weirdly poetic phrase, “cessation of
village, got movement,” amid Kenyan president Uhuru Ken-
While we were mastering the drunk on yatta’s declarations as he ordered his country’s first
vocabulary of quarantine and the corn wine, pandemic lockdowns. It did seem for a while as
20-second handwashing, the plan- and passed though the whole world stilled in 2020, one region
et’s temperature continued to climb. out in a tea
garden.

2. at a time. Those empty boulevards.
About The shuttered businesses. A Barcelona
half of U.S. quartet playing Puccini to an opera
workers— house full of potted plants.
in retail,
transport, But even those able to hole up
and other indoors could see how wrong it was to
service imagine that movement had ceased.
jobs—can’t Ambulances were rolling, emergency
work from rooms and ICUs frenzied. A massive
home, so swath of working and poor people
they’ll likely still face coronavirus contagion daily
fall behind because they have no other choice. ( 2 )
those who
can, says As Robert Kunzig writes in his essay
Stanford about the pandemic’s repercussions
University for the environment, air pollution is
economist rebounding now, and this year the
Nicholas Siberian tundra burned. “Will the expe-
Bloom. rience of COVID-19 change in some
He warns lasting way how we treat this planet, as
that the nearly eight billion humans scramble
situation is to make a living on it?” Kunzig asks.
like “a time “What would it look like if the econ-
bomb for omies of the world were stewarded
inequality.” within limits set by nature?”

In retirement Chester pandemic rules only 10 The devastating year made some of
Lovett of Detroit, a for- people at a time could us into more insistent deniers, espe-
mer mail carrier, hoped attend his funeral. After cially in the United States, which by
to spend time with his the service, Jerry Lovett mid-April registered the world’s highest
10 children. Then Lovett released a dove to sym- COVID-19 death toll, and by the end of
died of COVID-19 com- bolize his brother Ches- August reported some 180,000 deaths,
plications, and under ter’s spirit taking flight. about 50 percent more than the next
closest nation, Brazil. The year made
new warriors too, as writer Phillip Mor-
ris and others in this issue remind us—
people willing to put on the damn face
masks and do what they can to lead, to
console, to care for people around them.

What would it look like if, the
infinitely variable speculation begins—
and 2020 takes it from there:

If we replaced the applause for work-
ers suddenly labeled “essential” with
higher pay, better protections, and guar-
anteed health benefits. If we forced our-
selves to read infection numbers not to
keep reassessing our personal risks, but
to take in the disproportionate misery
the pandemic is bringing this country’s
Black, Latino, and Native American
families. If we studied up close the faces
of COVID-19 bereaved, when it’s more
comfortable to avert our eyes.

That child in Detroit? Her name was
Skylar Herbert. Her mother is a police
officer, her father a firefighter. She was
five years old. j

Cynthia Gorney is a National Geographic
contributing writer. She wrote about

human closeness and social distancing in

the July 2020 issue.

21

FROM GENERATIONS TO COME:
THANK YOU.

If you are one of the many members
of the Alexander Graham Bell Legacy
Society thank you for your critical
support. Your investment is helping
us identify the scientist, explorers,
educators, and storytellers who are
changing our world for the better.
We invite you to create a legacy of
your own and help us sustain our
momentum by preparing the next
generations to do even more to care
for the planet. Won’t you join us?

Dominique Gonçalves a Mozambican Ecologist and National
Geographic Fellow, is focused on elephant conservation in
Gorongosa National Park.

CREATE A LEGACY OF YOUR OWN

Yes! Please send me information on leaving a gift to the Mail to: National Geographic Society
National Geographic Society. Office of Planned Giving
1145 17th Street, N.W.
The National Geographic Society has already been Contact: Washington, D.C. 20036-4688
included in my estate plans.
[email protected]
I would like to speak to someone about making a gift. (800) 226-4438
Please call me. natgeo.org/give/future-gifts

NAME
ADDRESS

PHONE EMAIL

The National Geographic Society is a 501(c)(3) non-profit organization. Our federal tax ID number is 53-0193519 20PGAD11
PHOTO: Charlie Hamilton James. Copyright 2020 National Geographic Society

DATA S H E E T 86,000
cases
23 per day

How the COVID-19 outbreak BY APR. 3
grew from a few cases in More than a
MANUEL CANALES & million total
China to a global pandemic IRENE BERMAN-VAPORIS cases are
in less than three months confirmed
worldwide.
Leaked reports cite what health officials FEB. 24
describe as cases of viral pneumonia New cases of 43,000
in Wuhan, China. Not even three weeks COVID-19 outside
later, similar cases are confirmed China surpass the
in Thailand, Japan, and South Korea. number inside China
The U.S. and Europe follow soon after. for the first time.

First cases
reported

DEC. 31, 2019 JAN. 30, 2020 FEB. 13 MAR. 11
Wuhan has The World Health A spike in The WHO
27 pneumonia Organization China includes classifies the
cases of declares a global previously spreading crisis
unknown cause. health emergency. suspected cases. as a pandemic.

Asia Europe North America
Australia and Oceania Africa
South America

GLOBAL CASES CONFIRMED IN THE FIRST FEB. 26
100 DAYS. CONFIRMED CASES ARE ONLY A Within 58 days,
PORTION OF THE TRUE NUMBER OF CASES. cases are confirmed
on every continent
THE WORLD’S RESPONSE except Antarctica.

Many countries issued health and containment MAR. 22 0
policies to curb the spread of COVID-19. The U.S. has the
Ninety-two percent of countries had implemented greatest number
significant lockdown measures by April 8. of daily cases.

100%

No measures Few measures Significant measures

0 February March April
January 2020

SOURCES: OXFORD COVID-19 GOVERNMENT RESPONSE TRACKER; EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL

COVID-19 hit countries at different times, and not all NEW ZEALAND
governments took swift action in the 100 days following The island nation’s fast,
their first case. From no restrictions to stringent lockdowns, decisive action kept the
no approach was guaranteed to suppress the contagion. virus largely under control.

Feb. 28

23

LOCKDOWN LEVELS First case reported
Feb. 1
This index assesses
the intensity of a govern- BELGIUM
ment’s response across For many of its first 100 days,
11 containment and health Belgium had the world’s high-
measures, including est per capita mortality rate.
school and work closures,
stay-at-home orders, Feb. 4
and travel restrictions.

No clear method for success Mar. 7 40
Policy strictness and deaths in 9
the 100 days after a country’s
first confirmed case

Government response

None Significant Strict SOUTH AFRICA Mar. 6
The country rapidly adopted
strict measures and deployed
the army to enforce them.

Number of days before a country
implemented significant measures

Daily deaths Jan. 31
(seven-day
average)

Day 1 100 24

Jan. 13, 2020

THAILAND Feb. 26
Over one million village health
volunteers went door-to-door, 23
helping to keep deaths low. 59

Jan. 21 March

128

Dec. 31, 2019*

27

january 2020 February

*IN MARCH, THE SOUTH CHINA MORNING POST REPORTED THAT CHINA’S FIRST CASE MAY HAVE BEEN ON NOVEMBER 17, 2019.

P O P U L AT I O N

Highest number SWEDEN 4,783,062
of daily deaths Sweden didn’t close schools
or businesses; it saw more COUNTRIES
2,725 deaths than neighboring WITH
countries under lockdown. 5 M+
107
171
333 Never reached significant

response threshold

PERU
Despite one of the world’s quickest
and strictest lockdowns, Peru saw
COVID-19 deaths continue to climb.

822 50 M+

21 63

UNITED STATE S I TA LY 993
Individual states set a The initial crisis
broad range of policies overwhelmed hos-
74 in the absence of a uni- pitals in northern
fied national approach. Italy, but the
country gradually
flattened its curve.

BRAZIL The speed of a
In cumulative country’s response
number of deaths, was critical.
Brazil was second Policies that were
only to the U.S. proactive—rather
than reactive—
often were more
successful.

100 M+

CHINA 1,000 M+
After the virus emerged in Wuhan, China
imposed an unprecedented lockdown
on the entire city for 76 days.

April M ay June

MANUEL CANALES, IRENE BERMAN-VAPORIS, TAYLOR MAGGIACOMO, AND TED SICKLEY, NGM STAFF. SOURCES: THOMAS HALE, LAURA HALLAS, AND TOBY PHILLIPS,
OXFORD COVID-19 GOVERNMENT RESPONSE TRACKER, BLAVATNIK SCHOOL OF GOVERNMENT; EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL

KEYTRUDA IS A BREAKTHROUGH IMMUNOTHERAPY.

FOR TODAY FOR THE FUTURE

KEYTRUDA is a potential first Ongoing clinical trials are
treatment for 3 out of 4 patients exploring if KEYTRUDA can
with advanced non–small cell help treat more patients.
lung cancer (NSCLC).

KEYTRUDA is also used
to treat more patients
with advanced lung cancer
than any other immunotherapy.

KEYTRUDA may be your first treatment for advanced NSCLC, either in
combination with chemotherapy or used alone as a chemotherapy-free option.

Ask your doctor if KEYTRUDA is right for you.

KEYTRUDA is a prescription medicine used to treat IMPORTANT SAFETY INFORMATION
a kind of lung cancer called non–small cell lung
cancer (NSCLC). KEYTRUDA is a medicine that may treat certain cancers by working with your
immune system. KEYTRUDA can cause your immune system to attack normal
KEYTRUDA + CHEMOTHERAPY, NONSQUAMOUS organs and tissues in any area of your body and can affect the way they work.
It may be used with the chemotherapy medicines These problems can sometimes become severe or life-threatening and can lead
pemetrexed and a platinum as your first treatment to death.These problems may happen any time during treatment or even after
when your lung cancer has spread (advanced your treatment has ended.
NSCLC) and is a type called “nonsquamous” and
your tumor does not have an abnormal “EGFR” or Call or see your doctor right away if you develop any symptoms of
“ALK” gene. the following problems or these symptoms get worse:

KEYTRUDA + CHEMOTHERAPY, SQUAMOUS • Lung problems (pneumonitis). Symptoms of pneumonitis may include
It may be used with the chemotherapy medicines shortness of breath, chest pain, or new or worse cough.
carboplatin and either paclitaxel or paclitaxel protein-
bound as your first treatment when your lung cancer • Intestinal problems (colitis) that can lead to tears or holes in your
has spread (advanced NSCLC), and is a type intestine. Signs and symptoms of colitis may include diarrhea or more bowel
called “squamous.” movements than usual; stools that are black, tarry, sticky, or have blood or
mucus; or severe stomach-area (abdomen) pain or tenderness.
KEYTRUDA USED ALONE, PD-L1 POSITIVE
It may be used alone as your first treatment when • Liver problems, including hepatitis. Signs and symptoms of liver
your lung cancer has not spread outside your chest problems may include yellowing of your skin or the whites of your eyes,
(stage III) and you cannot have surgery or nausea or vomiting, pain on the right side of your stomach area (abdomen),
chemotherapy with radiation, or your NSCLC has dark urine, or bleeding or bruising more easily than normal.
spread to other areas of your body (advanced
NSCLC), and your tumor tests positive for “PD-L1” • Hormone gland problems (especially the thyroid, pituitary, adrenal
and does not have an abnormal “EGFR” or glands, and pancreas). Signs and symptoms that your hormone glands are
“ALK” gene. not working properly may include rapid heartbeat, weight loss or weight gain,
increased sweating, feeling more hungry or thirsty, urinating more often than
KEYTRUDA AFTER CHEMOTHERAPY, PD-L1 POSITIVE usual, hair loss, feeling cold, constipation, your voice gets deeper, muscle
It may also be used alone for advanced NSCLC if you aches, feeling very weak, dizziness or fainting, or headaches that will not go
have tried chemotherapy that contains platinum and away or unusual headache.
it did not work or is no longer working and, your
tumor tests positive for “PD-L1” and if your tumor has • Kidney problems, including nephritis and kidney failure. Signs of
an abnormal “EGFR” or “ALK” gene, you have also kidney problems may include change in the amount or color of your urine.
received an “EGFR” or “ALK” inhibitor medicine that
did not work or is no longer working. • Skin problems. Signs of skin problems may include rash, itching, blisters,
peeling or skin sores, or painful sores or ulcers in your mouth or
PD-L1 = programmed death ligand 1; in your nose, throat, or genital area.
EGFR = epidermal growth factor receptor;
ALK = anaplastic lymphoma kinase. • Problems in other organs. Signs and symptoms of these problems
may include changes in eyesight; severe or persistent muscle or joint pains;
severe muscle weakness; low red blood cells (anemia); swollen lymph nodes,
rash or tender lumps on skin, cough, shortness of breath, vision changes,

Important Safety Information is continued on the next page.

Roger is a
real patient

keytruda.com/lung

IMPORTANT SAFETY INFORMATION (continued) Use effective birth control during treatment and for at least 4 months after
the final dose of KEYTRUDA. Tell your doctor right away if you think you
or eye pain (sarcoidosis); confusion, fever, muscle weakness, balance may be pregnant or you become pregnant during treatment with KEYTRUDA.
problems, nausea, vomiting, stiff neck, memory problems, or seizures If you are breastfeeding or plan to breastfeed, tell your doctor. It is not known
(encephalitis); pain, numbness, tingling, or weakness in the arms or legs; if KEYTRUDA passes into your breast milk. Do not breastfeed during treatment
bladder or bowel problems including needing to urinate more frequently, with KEYTRUDA and for 4 months after your final dose of KEYTRUDA.
urinary incontinence, difficulty urinating, or constipation (myelitis); and Tell your doctor about all the medicines you take, including
shortness of breath, irregular heartbeat, feeling tired, or chest pain prescription and over-the-counter medicines, vitamins, and
(myocarditis). herbal supplements.
Common side effects of KEYTRUDA when used alone include feeling tired;
• Infusion (IV) reactions that can sometimes be severe and pain, including pain in muscles, bones, or joints and stomach area (abdominal)
life-threatening. Signs and symptoms of infusion reactions may pain; decreased appetite; itching; diarrhea; nausea; rash; fever; cough;
include chills or shaking, shortness of breath or wheezing, itching or shortness of breath; and constipation.
rash, flushing, dizziness, fever, or feeling like passing out. Common side effects of KEYTRUDA when given with certain chemotherapy
medicines include feeling tired or weak; nausea; constipation; diarrhea;
• Rejection of a transplanted organ. People who have had an organ decreased appetite; rash; vomiting; cough; trouble breathing; fever; hair loss;
transplant may have an increased risk of organ transplant rejection if inflammation of the nerves that may cause pain, weakness, and paralysis in
they are treated with KEYTRUDA. the arms and legs; swelling of the lining of the mouth, nose, eyes, throat,
intestines, or vagina; and mouth sores.
• Complications, including graft-versus-host disease (GVHD), in These are not all the possible side effects of KEYTRUDA. Tell your doctor if you
people who have received a bone marrow (stem cell) transplant have any side effect that bothers you or that does not go away. For more
that uses donor stem cells (allogeneic). These complications can be information, ask your doctor or pharmacist.
severe and can lead to death. These complications may happen if you Please read the adjacent Important Information About KEYTRUDA
underwent transplantation either before or after being treated with and discuss it with your oncologist.
KEYTRUDA. Your doctor will monitor you for the following signs and You are encouraged to report negative side effects of prescription drugs to the FDA.
symptoms: skin rash, liver inflammation, abdominal pain, and diarrhea. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Having trouble paying for your Merck medicine?
Getting medical treatment right away may help keep these Merck may be able to help. www.merckhelps.com
problems from becoming more serious. Your doctor will check you
for these problems during treatment with KEYTRUDA. Your doctor may Copyright © 2020 Merck Sharp & Dohme Corp., a subsidiary of
treat you with corticosteroid or hormone replacement medicines. Your Merck & Co., Inc. All rights reserved. US-LAM-01022 08/20
doctor may also need to delay or completely stop treatment with KEYTRUDA
if you have severe side effects.

Before you receive KEYTRUDA, tell your doctor if you have immune
system problems such as Crohn’s disease, ulcerative colitis, or lupus;
have had an organ transplant or plan to have or have had a bone marrow
(stem cell) transplant that used donor stem cells (allogeneic); have lung
or breathing problems; have liver problems; or have any other
medical problems.

If you are pregnant or plan to become pregnant, tell your doctor. KEYTRUDA
can harm your unborn baby. If you are able to become pregnant, your
doctor will give you a pregnancy test before you start treatment.

Important Information About KEYTRUDA® (pembrolizumab) injection 100 mg. Please speak with
your healthcare professional regarding KEYTRUDA (pronounced key-true-duh). Only your healthcare professional knows

the specifics of your condition and how KEYTRUDA may work with your overall treatment plan. If you have any questions
about KEYTRUDA, speak with your healthcare professional. ONLY

What is the most important information I should know Kidney problems, including nephritis and kidney failure.
about KEYTRUDA? Signs of kidney problems may include:

KEYTRUDA is a medicine that may treat certain cancers by • change in the amount or color of your urine
working with your immune system. KEYTRUDA can cause your
immune system to attack normal organs and tissues in any area Skin problems. Signs of skin problems may include:
of your body and can affect the way they work. These problems
can sometimes become severe or life-threatening and can lead • rash
to death. These problems may happen anytime during treatment • itching
or even after your treatment has ended. • blisters, peeling or skin sores
• painful sores or ulcers in your mouth or in your nose, throat,
Call or see your doctor right away if you develop any
symptoms of the following problems or these symptoms or genital area
get worse:
Problems in other organs. Signs and symptoms of these
Lung problems (pneumonitis). Symptoms of pneumonitis problems may include:
may include:
• changes in eyesight
• shortness of breath • chest pain • new or worse cough • severe or persistent muscle or joint pains
• severe muscle weakness
Intestinal problems (colitis) that can lead to tears or holes • low red blood cells (anemia)
in your intestine. Signs and symptoms of colitis may include: • swollen lymph nodes, rash or tender lumps on skin, cough,

• diarrhea or more bowel movements than usual shortness of breath, vision changes, or eye pain (sarcoidosis)
• stools that are black, tarry, sticky, or have blood or mucus • confusion, fever, muscle weakness, balance problems,
• severe stomach-area (abdomen) pain or tenderness
nausea, vomiting, stiff neck, memory problems, or
Liver problems, including hepatitis. Signs and symptoms of seizures (encephalitis)
liver problems may include: • pain, numbness, tingling, or weakness in your arms or legs,
or bladder or bowel problems, including the need to urinate
• yellowing of your skin or the whites of your eyes more often, leaking of urine, trouble urinating, or constipation
• nausea or vomiting (myelitis)
• pain on the right side of your stomach area (abdomen) • shortness of breath, irregular heartbeat, feeling tired, or chest
• dark urine pain (myocarditis)
• bleeding or bruising more easily than normal
Infusion (IV) reactions that can sometimes be severe and
Hormone gland problems (especially the thyroid, pituitary, life-threatening. Signs and symptoms of infusion reactions
adrenal glands, and pancreas). Signs and symptoms that your
hormone glands are not working properly may include: may include:

• rapid heart beat • chills or shaking • dizziness
• weight loss or weight gain • shortness of breath or wheezing • fever
• increased sweating • itching or rash
• feeling more hungry or thirsty • feeling like passing out
• urinating more often than usual
• hair loss • flushing
• feeling cold
• constipation Rejection of a transplanted organ. People who have had an
• your voice gets deeper organ transplant may have an increased risk of organ transplant
• muscle aches rejection. Your doctor should tell you what signs and symptoms
• feeling very weak you should report and monitor you, depending on the type of
• dizziness or fainting organ transplant that you have had.
• headaches that will not go away or unusual headache
Complications, including graft-versus-host-disease (GVHD),
in people who have received a bone marrow (stem cell)
transplant that uses donor stem cells (allogeneic). These
complications can be severe and can lead to death. These

Continued on next page.

complications may happen if you underwent transplantation • Your doctor will decide how many treatments you need.
either before or after being treated with KEYTRUDA. Your • Your doctor will do blood tests to check you for side effects.
doctor will monitor you for the following signs and symptoms: • If you miss any appointments, call your doctor as soon as
skin rash, liver inflammation, stomach-area (abdominal) pain,
and diarrhea. possible to reschedule your appointment.

Getting medical treatment right away may help keep What are the possible side effects of KEYTRUDA?
these problems from becoming more serious. Your doctor KEYTRUDA can cause serious side effects. See “What
will check you for these problems during treatment with is the most important information I should know
KEYTRUDA. Your doctor may treat you with corticosteroid or about KEYTRUDA?”
hormone replacement medicines. Your doctor may also need to
delay or completely stop treatment with KEYTRUDA, if you have Common side effects of KEYTRUDA when used alone
severe side effects. include: feeling tired, pain, including pain in muscles, bones or
joints and stomach-area (abdominal) pain, decreased appetite,
What should I tell my doctor before receiving KEYTRUDA? itching, diarrhea, nausea, rash, fever, cough, shortness of
Before you receive KEYTRUDA, tell your doctor if you: breath, and constipation.

• have immune system problems such as Crohn’s disease, Common side effects of KEYTRUDA when given with
ulcerative colitis, or lupus certain chemotherapy medicines include: feeling tired or
weak, nausea, constipation, diarrhea, decreased appetite,
• have received an organ transplant, such as a kidney or liver rash, vomiting, cough, trouble breathing, fever, hair loss,
• have received or plan to receive a stem cell transplant that inflammation of the nerves that may cause pain, weakness,
and paralysis in the arms and legs, swelling of the lining
uses donor stem cells (allogeneic) of the mouth, nose, eyes, throat, intestines, or vagina, and
• have lung or breathing problems mouth sores.
• have liver problems
• have any other medical problems Common side effects of KEYTRUDA when given with axitinib
• are pregnant or plan to become pregnant include: diarrhea, feeling tired or weak, high blood pressure,
liver problems, low levels of thyroid hormone, decreased
• KEYTRUDA can harm your unborn baby. appetite, blisters or rash on the palms of your hands and soles
of your feet, nausea, mouth sores or swelling of the lining of the
Females who are able to become pregnant: mouth, nose, eyes, throat, intestines, or vagina, hoarseness,
rash, cough, and constipation.
• Your doctor will give you a pregnancy test before you start
treatment with KEYTRUDA. In children, feeling tired, vomiting and stomach-area
(abdominal) pain, and increased levels of liver enzymes and
• You should use an effective method of birth control decreased levels of salt (sodium) in the blood are more common
during and for at least 4 months after the final dose of than in adults.
KEYTRUDA. Talk to your doctor about birth control methods
that you can use during this time. These are not all the possible side effects of KEYTRUDA. For
more information, ask your doctor or pharmacist.
• Tell your doctor right away if you think you may be
pregnant or if you become pregnant during treatment Tell your doctor if you have any side effect that bothers you or
with KEYTRUDA. that does not go away.

• are breastfeeding or plan to breastfeed. Call your doctor for medical advice about side effects. You may
report side effects to FDA at 1-800-FDA-1088.
• It is not known if KEYTRUDA passes into your breast milk.
• Do not breastfeed during treatment with KEYTRUDA and General information about the safe and effective use
of KEYTRUDA
for 4 months after your final dose of KEYTRUDA.
Medicines are sometimes prescribed for purposes other than
Tell your doctor about all the medicines you take, including those listed in a Medication Guide. If you would like more
prescription and over-the-counter medicines, vitamins, and information about KEYTRUDA, talk with your doctor. You can ask
herbal supplements. your doctor or nurse for information about KEYTRUDA that is
written for healthcare professionals. For more information, go to
Know the medicines you take. Keep a list of them to show your www.keytruda.com.
doctor and pharmacist when you get a new medicine.
Based on Medication Guide usmg-mk3475-iv-2006r032 as revised June 2020.
How will I receive KEYTRUDA?
Copyright © 2020 Merck Sharp & Dohme Corp., a subsidiary of
• Your doctor will give you KEYTRUDA into your vein through an Merck & Co., Inc. All rights reserved. US-LAM-01022 08/20
intravenous (IV) line over 30 minutes.

• In adults, KEYTRUDA is usually given every 3 weeks or 6 weeks
depending on the dose of KEYTRUDA that you are receiving.

• In children, KEYTRUDA is usually given every 3 weeks.

E S S AY

A Letter to My Generation

26

We’re entering adulthood in the shadow of COVID-19, economic BY
and social upheaval, and climate change. We don’t really feel like
Gen Z or millennials—and some like to call us Generation Screwed. JORDAN SALAMA

We say: Don’t underestimate our ability to overcome.

PHOTOGRAPHS BY JACKIE RUSSO

W H O K N E W T H AT stay-at-home orders Screwed. Yet the unavoidable fact is that Charlie Coburn—here
could bring so much displacement? we’re at a critical turning point in our with Amy Hudson in
personal lives at a time when the world his San Francisco apart-
That’s how the spring of 2020 felt seems to be imploding in so many ways. ment—wrote in June
for many in our generation—we who that “I feel more called
were just starting to get a glimpse of As lockdowns were spreading ear- to action than I have
independence and adulthood before lier this year, hardly any of us seemed at perhaps any other
the pandemic came crashing down. to stay where we were, racing instead point in my life.”
to seek safer ground. I know where
Maybe we need a name, those of us many friends sought refuge, because
who are currently 18 to 25 years old, I’ve spent much of my time in quaran-
instead of remaining just a purgatorial tine writing letters—the classic long,
generation: feeling like we’re too young handwritten letters—and that meant
to be millennials but not young enough gathering mailing addresses.
for Gen Z. I’m not sold on any of the
names I’ve heard us called—Rainbow I’ve kept track of which friends fled
Generation, zillennials, Generation as college campuses emptied. I knew

Your antioxidant armor.

Protect thyself in the fight against free radicals. With more antioxidant power
on average than red wine, blueberry juice, or green tea, P∂M Wonderful
100% Pomegranate Juice is your body’s knight in shining armor.

© 2020 POM Wonderful LLC. All Rights Reserved. POM, POM WONDERFUL, ANTIOXIDANT SUPERPOWER, the accompanying logos, and
the Bubble Bottle Design are trademarks of POM Wonderful LLC or its affiliates. PJ200827-05

Kasia Vargo finished nursing school during the kinds of thoughts and feelings—sentiments that
height of the pandemic. weren’t expressed in texts or on group Zoom calls
(which we still used, of course). Something about
who left their first real apartments to 1. writing a letter seemed to draw out emotions and
move back into their childhood bed- When 2020 vulnerabilities in a way that many of us hadn’t really
rooms, who was locked down in the university experienced before. And suddenly there was so
mountains or by the beach, and whose grad Elle much to feel.
socioeconomic backgrounds gave them O’Brien sur-
no choice but to stay in cities hit hard veyed her Depending on our circumstances, the tone of letters
by the plague. I knew whose jobs were peers on ranged from anxious to reflective, fearful to calm, frus-
safe, whose siblings needed looking Instagram, trated to stirred. Friends wrote of their greatest prides,
after, and whose boyfriends and girl- 91% said such as a brother graduating early from medical school
friends were suddenly an agonizing they “feel to join the front lines of the pandemic—and of unex-
distance away. What few seemed to anxious or pected joys, like rediscovering a passion for books,
realize at first was how long it would stressed which had been lost amid schedules and screens.
last and how normal it would become. about how
COVID- Standing by the mailbox one afternoon, I had the
My pen pals knew where I was too. 19 has heartbreaking experience of learning bad news by
They knew that when my dad, an impacted mail for the first time. “My grandparents (mom’s
infectious-disease doctor at Elmhurst our post- side) are both in the hospital with COVID, sadly,” my
Hospital in Queens, N.Y., saw what grad plans friend wrote. (A few weeks later her grandparents
was coming, we’d decided it would be and jobs.” died, just hours apart from each other.)
safer for our family to stay apart for
a while. That I’d left New York with As the pandemic wave washed over the United
my college-age brothers, my mother, States, it became clear that the undertow was drag-
and my ailing grandmother and hun- ging people our age out to sea. Many were already
kered down in North Carolina. That the struggling: wracked by debt from paying $20,000,
guilt we felt not being by my father’s $40,000, $60,000 a year for school. Priced out by the
side was overpowering, and we missed sky-high rents in major American cities. Exasperated
him tremendously. by years of speaking out against systemic racism and
gun violence and climate change, only to find corrupt
IN THE LETTERS my friends and and destructive politicians unwilling to act. The
I exchanged, we shared those pandemic ripped the ground out from under all of us.

We are, after all, a generation raised on post-9/11
dread and active-shooter drills in our elementary
schools. If the future of the world looked grim to us
before, what might it hold now?

New uncertainties hang over what should be every-
day experiences—living on our own, going back to
school, going on dates, hugging our grandparents.
It seems to be all we’re talking about these days,
the pounding of the waves deafening, dominating
every conversation.

SO ALTHOUGH SOME like to call us Generation
Screwed—and sometimes it might feel that
way—I think that’s too negative. We’ve been
battered and shaken up, but we’re certainly
not going down easy.
“This is just not what we thought life would look
like,” says Elle O’Brien, a recent Colgate University
graduate. She’s used social media to survey people
(many of them our age) about their feelings and expe-
riences during the pandemic. (1) For several months,
starting in April, O’Brien posted survey questions on
her Instagram and blogged about the results. Hun-
dreds of people took her surveys, O’Brien wrote, and
she was struck by the similarities: “We’re a compli-
cated mix of scared and hopeful, a lot of us laughing
in the same days we’re crying.” Here’s how O’Brien
described our generation’s bottom line to me: “It’s a
s****y hand we’ve been dealt. But we’re speaking up.”
On all those counts, I think O’Brien represents how

Trademarks owned by Société des Produits Nestlé S.A., Vevey, Switzerland.

we’re feeling. A movement is beginning, Fedjounie Philippe, an immigrant from Haiti and 2020 Princeton
and in my circles, at least, it’s no longer University graduate, was the first in her family to attend college.
acceptable to stay silent. Ironically, it
took months of social distancing to help PHOTO: JORDAN staying. Its death was likely humans’ fault, a boat
spark this remarkable level of engage- SALAMA strike or a net tangling. Because the virus kept most
ment in society, especially among tourists off the beach, the buried carcass was left
young people. 2. there, and nature had its way.
About 41%
Such large and diverse crowds of of Ameri- On my regular beach walks I observed the changes
young adults joined the protests of the cans who to the whale’s spine, the only part protruding from
killing of George Floyd in part because said they the sand. One week it was covered in buzzing black
of what the pandemic was revealing recently
about the systemic inequalities in our attended flies. A few days later it had been scav-
country. We saw Black friends and class- a protest enged by coyotes, judging from the fresh
mates whose family members were focused tracks. And then, after what felt like a
disproportionately falling ill from the on race are world-ending storm—the house shook,
coronavirus. We saw first-generation younger the winds howled, the rains flooded the
and lower-income students struggling than 30, beach grass—I found that the pound-
more with the transition to virtual according ing waves had revealed a clean vertebra
learning. We saw recent graduates of to June (at left) for the taking.* Through the weeks of lock-
color lacking the resources and con- survey data down, I scrubbed and polished the bone. I keep it
nections to succeed in an increasingly reported as a reminder of the pandemic—of the uprooting it
uninviting job market. How could we by the Pew caused, of the many lonely and untimely deaths, of
not seek change? Research the natural world and our place in it.
Center. For those of us at the beginning of our adult lives,
Humanity is in for a similarly urgent the faltering start caused by the pandemic means that
reckoning, I suspect, about the conse- our choices will matter even more. We need remind-
quences of mistreating our planet. As ers so we don’t forget what it felt like: Some suffered
the virus does now, the global climate far more than others, but all of us were plunged into
emergency has long alarmed our gen- a period of questioning, of reevaluating, of trial.
eration. Maybe the label Generation It’s only natural at times to feel as though we’re
Climate Change fits us, as it’s the great- Generation Screwed—but I want to think that we’re
est existential threat to us all. By com- shaping up to be Generation Renewed. We will not
parison, previous generations failed to go down without a fight. And what will define us far
act with urgency about melting gla- more than our struggles in this moment is what we’ll
ciers, polluted air, slaughtered rain- do when we come out the other side.
forests, rising seas—perhaps because
they’re not the ones who’ll have to live All my best,
in that world. Jordan

The devastation from this pandemic Jordan Salama is a writer whose work has appeared in the New
was once unfathomable. But it likely York Times, National Geographic, Smithsonian, and more. His first
pales in comparison with the environ- book, Every Day the River Changes, a journey down the Magda-
mental catastrophes to come. lena River in Colombia, will be published by Catapult in 2021.

The weight of all these matters was
apparent in a June letter from one of
my college roommates. “I am sad. I am
conflicted. I am frustrated and upset,
as much with myself and my own
complicity/inaction as anything else,”
Charlie Coburn wrote. After he’d spent
months holed up in silence, something
in him was boiling over. “I’m furious
with the response of the federal gov-
ernment,” he wrote. “And I feel more
called to action than I have at perhaps
any other point in my life.” ( 2 )

I N M Y OW N L E T T E R S to friends
early in the quarantine, I wrote
about a young whale that
washed up on the North Caro-
lina coast not far from where we were

*AS REQUIRED BY LAW, SALAMA CONTACTED THE U.S. MARINE MAMMAL STRANDING PROGRAM ABOUT THE VERTEBRA HE FOUND. HE REGISTERED
THE SPECIMEN AND WAS TOLD HE COULD KEEP IT BECAUSE THE WHALE IS NOT ON THE LIST OF SPECIES WHOSE BONE POSSESSION IS PROHIBITED.

Make your home more comfortable than ever

“To you, it’s the perfect lift chair.

To me, it’s the best sleep chair I’ve ever had.”

— J. Fitzgerald, VA

NOW

also available in
Genuine Italian Leather

(and new Chestnut color)

Three Chairs
in One

Sleep/Recline/Lift

Pictured: Italian Leather chair ACCREDITED
chestnut color. Chestnut color
also available in DuraluxTM fabric BUSINESS A+

You can’t always lie down in bed and and muscle pain. The overstuffed, oversized
sleep. Heartburn, cardiac problems, hip biscuit style back and unique seat design will
or back aches – and dozens of other cradle you in comfort. Generously filled, wide
ailments and worries. Those are the nights armrests provide enhanced arm support when
you’d give anything for a comfortable chair to sitting or reclining. It even has a battery
sleep in: one that reclines to exactly the right backup in case of a power outage.
degree, raises your feet and legs just where you
want them, supports your head and shoulders White glove delivery included in shipping
properly,and operates at the touch of a button. charge. Professionals will deliver the chair to
the exact spot in your home where you want it,
Our Perfect Sleep Chair® does all that unpack it, inspect it, test it, position it, and even
and more. More than a chair or recliner, it’s carry the packaging away! You get your choice
designed to provide total comfort. Choose of Genuine Italian leather, stain and water
your preferred heat and massage repellent custom-manufactured DuraLux™ with
settings, for hours of soothing the classic leather look or plush MicroLux™
relaxation. Reading or watching TV? Our microfiber in a variety of colors to fit any decor.
chair’s recline technology allows you to pause New Chestnut color only available in
the chair in an infinite number of settings. And Genuine Italian Leather and long lasting
best of all, it features a powerful lift mechanism DuraLux™. Call now!
that tilts the entire chair forward, making it
easy to stand. You’ll love the other benefits, The Perfect Sleep Chair®
too. It helps with correct spinal alignment and
promotes back pressure relief, to prevent back 1-888-648-9638

113814 w .

REMOTE-CONTROLLED Chestnut
EASILY SHIFTS FROM FLAT TO
Genuine Italian Leather
A STAND-ASSIST POSITION
classic beauty & durability
Footrest may
vary by model Long Lasting DuraLux™ Chestnut Burgundy Tan Chocolate Blue
Burgundy Cashmere Chocolate Indigo
stain & water repellent

MicroLux™ Microfiber

breathable & amazingly soft

B wy v. 46552

© 2020 first TREET B By I .

ALVEOLUS

SARS- VIRAL INVASION Type II Capillary
CoV-2 cell
Coronavirus spreads Responsible for the
Lungs mainly through respira- Type I Alveolus exchange of oxygen
Alveolus tory particles in the air. cell cavity and carbon dioxide in
Infection occurs in the the blood, the alveoli
nasal passage and can O2 are ground zero for
travel to the deepest part ENLARGED the virus’s attack on
of our lungs, the alveoli. CO2 BELOW our cells (#1 below).

32 INSIDE THE CELL

BY MANUEL CANALES & ALEXANDER STEGMAIER 4 Builds an army
Particles are reassem-
Experts are still trying to decode how the novel coronavirus bled into more virus and
infiltrates the body and how the immune system can released back into the
overreact—with deadly consequences. Here’s how an infection alveolus cavity; host cells
can begin: SARS-CoV-2, the virus that causes COVID-19, are destroyed.
targets ACE-2 proteins that line the surface of many important
human cells, including type II alveolar cells in the lungs. 3 Takes command
The virus hijacks the
SARS-COV-2 TYPE II ALVEOLAR CELL MEMBRANE host cell and forces
it to create copies of
RNA its biological code.

Lipid
membrane

Spike ACE 2
protein receptors

RNA is
released.

1 Gains entry 2 Trips the alarms
Like a key in a lock, The cell alerts the immune
the coronavirus uses its system to call for help.
unique, crown-shaped But experts believe the
spike protein to infiltrate virus may suppress these
a cell and replicate. distress signals.

Interstitial Permeable BODY RESPONSE
space capillary
Fluid builds up in
ENLARGED the lungs as the body Fluid Alveolar damage and
BELOW defends itself (#5 below), excess inflammation
resulting in shortness of White can lead to acute
breath and pneumonia. blood cells respiratory distress
The virus continues to syndrome, abnormal
attack more cells. blood clotting, organ
failure, and death.

I N S I D E T H E A LV E O LU S C AV I T Y

5 Provokes a defense TYPE II 6 Faces resistance
Immune cells known as ALVEOLAR CELL An influx of
macrophages release cyto- white blood cells
kines, proteins that dilate TYPE I ALVEOLAR CELL attacks infected
blood vessels and recruit and healthy cells,
virus-fighting cells. causing inflammation.

Cytokines SPACE

Macrophage

L

A
Y

NTERSTITI
CAPILLAR

I
E

L

B

A

E

M

R

White E
blood
cell P

INFL A M M A T O R Y R E S P O NSE White
blood
The cavity fills cell
with fluid and
debris, impairing
lung function.

Blood
plasma

7 Scrambles the system Weakened blood
In severe cases the vessels leak
immune system over- plasma into the
reacts, contributing interstitial space,
to multi-organ failure further stressing
and septic shock. the alveoli.

TAYLOR MAGGIACOMO AND EVE CONANT,
NGM STAFF. ART: ANTOINE COLLIGNON

SOURCES: HOWARD M. HELLER, HARVARD
MEDICAL SCHOOL; DANIEL S. CHERTOW, NIH

CLINICAL CENTER AND NIH NIAID

Jan 2020 Development BY DIANA MARQUES &
ALEXANDER STEGMAIER
Phase I Previous research into other
trial coronaviruses such as SARS Experts suggest it may take the
Phase II and MERS is helping scien- development of multiple vaccines,
trial tists in their race now. and two doses of vaccine for each
person, possibly annually, to begin
Phase IIIMay Clinical trials the process of protecting the
trialMar world’s population from COVID-19.
A multistep testing process No vaccine is 100 percent effective,
Sepmust demonstrate a vaccineand once a vaccine is approved, there
Julis safe and effective beforeare still many hurdles to overcome
it can get governmental and before a shot can be made widely
international approvals. available. Governments and scientists
have set different, overlapping time
Large-scale lines in order to achieve a vaccine.
production Here is one ambitious scenario.

Vaccines can have complex
biological and engineered
ingredients; mass production
could be the largest bottle-
neck in the process.

Jul Potential
emergency
authorization

Jan 2021 Mar

Sep

Nov

WE ARE Emergency May
HERE use

Estimated global vaccine Limited quantities of a
annual supply and demand vaccine could become avail-
able for priority or high-risk
15.8 billion groups, such as first respond-
doses needed ers and the elderly.

(2 doses 13.5 14.1 Worldwide
per person) shipping
billion
doses

7.4 An extensive network of refrig- Potential
erated systems will be required approval
to deliver vaccines from their
1.3 manufacturing sites to countries
Dec around the globe.
2020
Dec Dec Dec
2021 2022 2023

PROTECTING THE HERD Distribution Nov

To make COVID-19 harder to spread, Once the product is on the ground, Jan 2022
experts believe as much as 70 percent local authorities will be responsible
of the population may need to have for storing it and shipping it to
recovered from the disease or be communities in need.
protected by vaccination; the remaining
populace would still be susceptible to Vaccination
the disease. If an early vaccine is only campaign
50 percent effective—the FDA’s current
minimum threshold—a 100 percent A country’s size, resources, and
vaccination rate alone would not achieve people’s willingness to vaccinate
herd immunity but could offer protection will drive strategy; syringes,
from more severe impacts of the virus. protective equipment, and health
workers will be in high demand.

DATA AS OF AUGUST 2020

SOURCES: PRASHANT YADAV, CENTER FOR GLOBAL DEVELOPMENT AND INSEAD; MARGARET A. LIU,
INTERNATIONAL SOCIETY FOR VACCINES; JOHN J. DONNELLY, VACCINOLOGY CONSULTING, LLC.; UNICEF; WHO



The crown from Larry
Hammond’s 2007
reign as Zulu king
rests on a chair at his
New Orleans home.

P H OTO G R A P H BY MAX AGUILERA-HELLWEG

E S S AY F RO M T H E T I M E they began dating,
Lillian Phillips realized Larry Ham-
What COVID-19 mond was different from other boys she
Took From This knew in their New Orleans high schools.
Black Community “He had charisma,” she says. “He was
always there. He was always kind.”
Across the United States the virus
has been disproportionately deadly Lillian and Larry married, had a
to African Americans. In New Orleans family, and built friendships. Just as
that meant the loss of a family man, in high school, Larry joined group after
fraternity brother, church usher, and group, including the Zulu Social Aid
youth mentor who was also a king and Pleasure Club, a community orga-
of the Krewe of Zulu at Mardi Gras. nization whose Krewe of Zulu members
and floats have appeared in Mardi Gras
This is Larry Hammond’s story. parades for more than a century.

BY 37 The Larry Hammond that I and many
others came to know over decades
WILL SUTTON was the same man Lillian met in high
school: charismatic, helpful, kind. He
was like that through 47 years of mar-
riage: In June the two planned to cele-
brate their 48th wedding anniversary.

That didn’t happen.
Lillian Phillips Hammond lost the
man of her dreams to COVID-19 on
March 31. Larry’s sudden death shook
Lillian, their family, and the village that
surrounded Larry, 70, a retired post
office employee.
Lillian can’t believe Larry’s gone.
And she’s saddened that COVID-19
is taking the lives of so many Afri-
can Americans.
But like others in Black commu-
nities, Lillian Hammond knows that
we’ve been particular targets of the
virus based on underlying conditions
such as hypertension and diabetes.
A highly respected, personally
admired member of the Krewe of Zulu,
Larry served as Zulu king in 2007. Early
in the pandemic, on the heels of Mardi
Gras, several members of the krewe fell
ill. Then Larry did.
Within a matter of weeks, COVID-19
caused the deaths of several of Larry’s
fellow Zulu members, the leader of
Larry’s cherished fraternity chapter,
and Larry himself.
New Orleans city councilman Jay
Banks, a former Zulu king and one of
Larry’s Omega Psi Phi Fraternity broth-
ers, has seen too many friends get sick
and die. Earlier this year, Banks told
me he knew at least a dozen Black peo-
ple who had died. A few weeks later,
the number was 30.

” THE STATISTIC S ARE REAL . The fact that
this disease is disproportionately affect-
ing people in our community cannot be

Now Rechargeable!

BUY 1 FREE

Only 299GET 1
Reg: $599.98 99

$

Each When You Buy a Pair – LIMITED TIME ONLY!

How can a rechargeable hearing SHOP AT HOME!
aid that costs only $29999 Skip the Clinic with Remote Care

be every bit as good as one that sells

for $2,400 or more?

The answer: Although tremendous CHARGE AT NIGHT AND GO ALL DAY

strides have been made in Advanced Digital
Hearing Aid Technology, those cost
reductions have not been passed on
to you. Until now...

The MDHearingAid® VOLT uses the
same kind of Advanced Digital RECHARGEABLE
Hearing Aid Technology incorporated into

hearing aids that cost thousands more at a

small fraction of the price.

Over 350,000 satisfied MDHearingAid

customers agree: High-quality, CHARGING READY
digital, FDA-registered rechargeable
hearing aids don’t have to cost 45-DAY RISK-FREE TRIAL!
a fortune. The fact is, you don’t need to
spend thousands for a hearing aid. If you are not completely satisfied with
MDHearingAid is a medical-grade digital your MDHearingAids, return them
within 45 days for a FULL REFUND!

rechargeable hearing aid offering For the Lowest Price Call Nearly Invisible
sophistication and high performance, and
works right out of the box with no 1-800-450-1705
time-consuming “adjustment”
appointments. You can contact a licensed www.MDVolt.com

hearing specialist conveniently online or Use Code KG32
by phone — even after your purchase at
no cost. No other company provides such and get FREE Shipping
extensive support. Now that you know...
why pay more?

Proudly assembled in America!

DOCTOR DESIGNED | AUDIOLOGIST TESTED | FDA REGISTERED

disputed,” Banks told a radio audience
in the weeks after Larry’s death.

Across the United States, Black
people have suffered high rates of
COVID-19 sickness and death. Nation-
ally, some sources say we’re 2.5 times
as likely to die from COVID-19 as our
white counterparts. ( 1 )

In Louisiana, many were shocked
when spring data showed that more
than 70 percent of the state’s deaths
from COVID-19 were among African
Americans. That share of deaths sub-
sequently fell below 60 percent—but
in a state where nearly 33 percent of the
population is Black, that’s far too high.

LARRY LOVED NEW ORLEANS, Larry Hammond’s widow, Lillian (center), and other relatives
flanked his portrait at a drive-by funeral procession for him.
and the city loved him back.
His funeral service at Boyd 1. and remembrances about Larry. We would have
Family Funeral Home was lim- Halfway laughed and cheered. I can imagine Larry looking
ited to 10 people. Those who couldn’t through on with a smile. There would’ve been lots of waved
attend gathered at a shopping center 2020, the handkerchiefs, initially to dry tears and then to pierce
not far from the Hammond home. On COVID-19 the air with joy for his life. It was the life of a family
cue, we formed a procession and drove death rates man—a husband, a father, an uncle, a grandfather.
by the house in a slow-moving motor- in the U.S. His actions were those of a patriot, a believer, a hard
cade, expressing our sympathies with for Hispanic worker, an advocate. He graduated from Our Lady of
glances, waves, and honks. We were and Black Holy Cross College. He served in the U.S. Air Force.
his Omega fraternity brothers and his people were He worked many years for the U.S. Postal Service
fellow alumni of L.B. Landry High higher than before retiring. Then he did even more with groups
School, his fellow youth mentors of the rates such as the Silverbacks, who mentor boys in the
the Silverback Society, his fellow mem- for white community as they become young men.
bers of Beautiful Zion Baptist Church, and Asian
and many other friends and admirers. people in all Larry’s spirit was evident to all who met him, and
Those viewing the procession from age groups, in his home in New Orleans’ Algiers neighborhood.
the lawn included his widow, Lil- according to He cherished his relationships with different groups,
lian; his daughter, Nicole Hammond CDC data. proudly wearing their colors. On any given day, his
Crowden; his granddaughter, Kailyn family knew what he’d be doing based on what he
Hammond Gouch, whom he called chose to wear. A Beautiful Zion or Silverback Society
“K”; his brother Barry Hammond, and shirt. An Omega jacket. A Zulu cap. The mementos
niece Dominique Irvin. As we drove fill the home, reminders of what Larry considered
by, they waved at each of us, drying essential: friendship, scholarship, perseverance;
tears, laughing and shouting as they helping and uplifting others.
saw familiar faces. “We would think it
was over, and more cars would come As 2020 nears its end with the pandemic on an
by,” Irvin said. “There were hundreds. uncertain course, we can honor Larry Hammond and
I don’t think we knew how much he all he stood for by demanding equality in the COVID-
meant to so many people.” 19 response. We can work to eliminate disparities
If times were normal, there might in health-care access, to get more Black youth into
have been thousands. Larry was a king, health-care careers, and to combat the causes of Afri-
from his days playing the lead role in can Americans’ disproportionately high death rates.
his high school production of The King
and I to his final days. There’ve been That would be a fitting send-off for this king of a
only about 100 Zulu kings in the group’s man—not a COVID-19 statistic, but an example of
history, and a departing king gets a what’s best in our community. j
royal send-off. A jazz procession. Fes-
tive regalia. A second line, a uniquely New Orleans native Will Sutton is a columnist at his city’s
New Orleans celebratory parade at par- newspaper The Times-Picayune | The Advocate and a life
ties, weddings, and funerals. member of Omega Psi Phi Fraternity. Max Aguilera-Hellweg
We would have heard funny stories is a photographer and a medical doctor; he attended medical
school at Tulane University and loves New Orleans and gumbo.

PHOTO: CHRIS GRANGER

11.20

A WORLD GONE VIRAL

Stethoscope, visor,
body suit: These pan-
demic essentials were
discarded outside a
hospital in La Louvière,
Belgium, by a doctor
who stripped them off
between ambulance
and emergency room—
an effort to avoid
new contamination.

CÉDRIC GERBEHAYE’S WORK
WAS SUPPORTED IN PART BY THE
NATIONAL GEOGRAPHIC SOCIETY’S
COVID-19 EMERGENCY FUND
FOR JOURNALISTS.

D I S PATC H

In COVID-19 wards, weary medical
personnel care for the stricken and
hear their whispered fears. “If I don’t
do this,” one nurse asks, “who will?”

PHOTOGRAPHS BY 41

CÉDRIC GERBEHAYE

The toll of pandemic work shows in this technician’s shielded face as he helps prepare a patient for a CT
scan at a hospital in La Louvière. For a while last spring, Belgium registered the world’s highest per capita

COVID-19 death rate—resulting in more than 9,000 fatalities by late May, in a nation of 11.7 million. 43
The spread was curtailed, but midsummer numbers showed a worrisome new surge.

Dispatch:
belgium

BY CYNTHIA GORNEY

C É D R I C G E R B E H AY E dressed as advised by After trying to explain
the medical workers around him: face mask, obligatory COVID-19
face shield, body suit, double bags over his testing to a frightened
shoes, double gloves over his hands. The nursing home resident
outer gloves were plastic, taped to seal out in La Louvière, a nurse
virus. He learned to hold and work his camera reluctantly restrains
through plastic. In a Brussels nursing home him for the test. One
he watched an aged woman look into the reason offered for Bel-
eyes of the nurse who had come to test her gium’s high death rate:
for COVID-19. “J’ai peur,” the woman said. Many elderly patients
who died without for-
The nurse took her hands, leaned in close, mal COVID-19 diagno-
and said: I’m scared too. She and her team sis or treatment were
counted as pandemic
fatalities anyway.

44 were testing nearly 150 people on that day

alone. When she turned to Gerbehaye after-

ward, her voice was thick in a way that stays

NATIONAL GEOGRAPHIC with him still; she sounded broken, tough, grieving, and

furious, all at once. “No one else can come close to these

people,” she said. “If I don’t do this, who will?” BELGIUM EUR.

Gerbehaye is 43, the grandson of Belgian and Dutch

survivors of the Second World War. It is not uncommon

for him, as a photojournalist, to stand in the presence

of armed conflict and death. But as he lingered last

spring inside hospitals, eldercare facilities, and corpse-

transport vans, Gerbehaye understood that Belgians of OUTBREAK RESPONSE
his generation were witnessing for the first time, as their

grandparents had, their own nation in crisis and afraid. Belgium’s COVID-19
J’ai peur. Belgium’s pandemic numbers were famous outbreak dates from
February 4, when its
for a few March and April weeks, when the country’s per first confirmed case was
capita COVID-19 fatality rate looked to be the highest reported. A stay-at-home
in the world. Were Belgian authorities simply counting order was issued on day
more honestly, as some contended, than everyone else? 44. By day 100, 8,918 deaths
had been recorded.

In any case the casualties Gerbehaye saw, as he followed Day Government response
undertakers and hospital staff in Brussels and two smaller 1
cities, were also among the living: women and men at the None Strict

front, caring for the stricken, improvising, overwhelmed.

Outside a hospital in Mons two nurses sat near him one

afternoon, silent, slumped, smoking cigarettes on their

break. When one rested her head on the other’s shoul-

der, Gerbehaye thought of the phrase faire corps, which

literally means make a body, join together as one. They

reminded him of small animals curling into each other

for warmth. I have seen your sisters at clinics in Gaza

after bombings, he said to himself; like them you’re part Day
of history, even though you’re too tired to care. He raised 100
100 200 300
his camera. The nurses did not look up. j deaths*

*SEVEN-DAY AVERAGE

TAYLOR MAGGIACOMO AND IRENE BERMAN-VAPORIS, NGM STAFF. SOURCES: OXFORD COVID-19
GOVERNMENT RESPONSE TRACKER; EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL