Thanks for listening: have we reached peak podcast? | The Week UK

The number of podcasts launched in the last year fell by 80%, according to new industry statistics.

The figures suggest “the podcast balloon has burst”, said The Observer, with analysts asking whether podcasting was just a passing trend or a maturing industry that is settling into a more stable rhythm.

Analysts at Chartr uncovered the dramatic drop using international data supplied by the podcast engine Listen Notes. The number of new shows launched last year was 219,000. That is down from 729,000 in 2021, and 1,109,000 in 2020 at the height of global lockdowns.

For some context, however, the number of podcasts started in 2019 was 337,099 – substantially lower than during the pandemic, but still higher than current figures.

Similarly, survey data from Edison Research shows that the number of people in the US who said they had listened to a podcast in the last month was 38% last year, down from 41% in 2021.

‘Difficult second album moment’

“It feels like we’re in that ‘difficult second album’ moment now, and of course there’s a lot to worry about,” Kate Taylor, an award-winning producer, told The Observer. She said the industry is experiencing “the jitters”, and attributes some of the drop to sponsorship deals being harder to come by, and investors not appreciating how much is needed to make content well.

“Roughly everyone launched a podcast in the Covid-19 pandemic’s nadir, and a big part of the decline is an after-effect of that,” said NiemanLab. So maybe the surplus in 2020-21 was “always destined to recede” – but the size of the drop does indicate there might be other factors here.

The “defining” problem of the industry is “podcast discovery” – how we find out about podcasts, especially in a crowded market with few barriers to entry. The industry seems to be facing a paradoxical problem which is that it “has become so crowded that fewer people want to enter it”.

This view seems to be backed up by statistics examining how listeners are rating podcasts. Both the average star ratings for podcasts in general and new podcasts launching are have been gradually decreasing for several years, said Rephonic. In fact, “podcast satisfaction, as measured in listener ratings, peaked in 2016”.

‘Flexible and relatively cheap’

We shouldn’t “write the podcast industry off” just yet, though, said Prolific North. Ad revenue for the podcast industry in the UK was estimated to be worth £40m in 2022 by consultancy PWC, which also predicted growth to £64m by 2025. In 2016, the industry was valued at £4m.

According to the Reuters Institute, 72% of publishers will also be putting more resources into podcasts and digital audio in the future.

Last month, reported Deadline, a panel of podcast executives told the UK’s Royal Television Society that “while it remains difficult to break into the important top ten on those charts, the flexibility of podcast-making in terms of subject matter and episode length, the relative cheapness of the exercise and the fact that anyone with a microphone can do it still makes it an attractive proposition”.

The panel also pointed out that while the money that can be made from hosting a podcast is comparatively little, “the [Intellectual Property] they generate can become valuable for adaptation by film and TV makers”.

Fact check: Testosterone levels have dropped in recent decades ...

The claim: Testosterone levels have dropped almost 50% in the past two decades

A viral Twitter post from April 9 claims testosterone levels have dropped by almost 50% over the past 20 years.

"Here's a cheery Friday fact," reads the post. "An average 22 year-old (sic) male today has roughly the same testosterone levels as a 67 year old (sic) had in the year 2000. Average testosterone has fallen close to 50% in the last 2 decades, and nobody is talking about it."

The post was screenshotted and shared by various Facebook accounts, amassing over a thousand shares and 3,000 interactions altogether.

While testosterone levels have fallen in recent years, the rate is more modest than 50%, experts say.

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The original poster could not be reached for comment. USA TODAY reached out to the Facebook pages spreading the screenshotted Twitter post.

Testosterone has dropped, but not by 50%

The first part of the tweet quotes a 2021 article from American Greatness, a popular right-wing site:

As we crossed into the new millennium, the average American male (controlled for age and other relevant factors) had a total testosterone reading of 605 nanograms per deciliter. A scant 20 years later, and the average level has plummeted by 27 percent to just 450 nanograms per deciliter. That means the average 22-year-old man today has an average testosterone level roughly equal to that of a 67-year-old man in 2000.

The article refers to data from studies in 2007 and 2021, both of which looked at the testosterone levels of men in the United States.

Fact check: Experts say diet, exercise – not hormones – are primary drivers of weight gain

Both studies observed significant reductions in testosterone levels over time. In the 2007 study, testosterone decreased by about 22% when comparing 1985-1987 levels to those from 2002-2004. In the 2021 study, researchers found a roughly 25% decrease between 1999 and 2016.

These numbers mean that the claim in the Twitter post isn't true, according to Dr. Ranjith Ramasamy, a urologist at the Miami University Miller School of Medicine and author of the 2021 study.

"Neither of these studies assessed men over the last two decades, and the percent change was not close to 50%, so it is inaccurate to say that average testosterone has fallen almost 50% over the last 2 decades," Ramasamy wrote in an email.

It's possible that the 50% number came from adding the 25% and 22% from the two studies. However, Ramasamy said that since there's a possibility of overlap between participants in both studies, the percentages can't be added.

Adding the studies also creates a time span of three decades, not two as referenced in the post.

Increased prevalence in obesity and changes in measurement methods are two possible explanations for the changes, he added.

"I think we should be worried about increasing prevalence of obesity, metabolic syndrome and diabetes combined with a sedentary lifestyle – all of which can contribute to testosterone deficiency," Ramasamy wrote.

If men are experiencing symptoms of testosterone deficiency, he said, they should speak with their doctors for next steps. And if a man has low testosterone, he and his doctor should talk about natural methods to raise those levels before utilizing medications.

Our rating: Partly false

Based on our research, we rate PARTLY FALSE the claim that testosterone levels have dropped almost 50% over the past two decades. The most recent data is from 1999 to 2016, not the past two decades. That data showed a drop of about 25%. A separate study of an earlier time period shows a drop of 22%, but the studies together cover a total of three decades and in any case can't simply be added together, according to the author of one study.

Our fact-check sources:

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or electronic newspaper replica here.

Our fact-check work is supported in part by a grant from Facebook.

Mass tech layoffs are growing in 2023 with Affirm, Google, Microsoft

Tech jobs feel like they're vanishing quicker than steam from a pot of boiling water lately.

Buy now, pay later company, Affirm, announced it's cutting 19% of its workforce after it reported wider-than-expected losses last quarter. Google's parent company Alphabet recently laid off 12,000 workers, equivalent to 12% of its workforce. Meta cut an even bigger share of its staff. Even IBM, which has been in business for 111 years, is cutting thousands of jobs.

Since the start of the year, 297 tech companies laid off nearly 95,000 workers, according to data compiled by Layoffs.fyi, a website that's been tracking tech layoffs since March 2020. If that rate continues, the industry could cut more than 900,000 jobs in 2023. That's nearly six times the total for the industry in 2022, according to the site.

But the sky isn't exactly falling in the tech industry, or at least not yet.

Here's why:

Tech jobs were growing before the pandemic

Before the pandemic, the tech industry was steadily growing. As investments in cybersecurity, cloud computing and artificial intelligence poured into companies, their need for employees grew.

In the five years leading up to the pandemic, the tech industry added 1.3 million workers, according to an analysis of Bureau of Labor Statistics data by CompTIA, an information-technology trade group.

Tracking tech layoffs:Why companies like Amazon and Meta cut jobs in 2022

Who decides who gets cut?:Layoffs in a likely recession this year could be determined by software programs

The earlier hiring wasn't as widely publicized as the hiring that occurred in 2021. That resulted in a "perception issue that there was so much more demand during the past two years compared to previously," said Tim Herbert, chief research officer at CompTIA.

The perception that tech hired an unprecedented level of workers also may have misled people to believe that recent layoffs were heftier.

The pandemic forced companies to layoff workers

When COVID-19 swept across the country, consumers quickly tightened their purse strings, resulting in massive job losses.

And even though demand for tech workers was strong leading up to the pandemic, like almost every industry, tech was not immune to layoffs during the crisis. In August 2020 tech unemployment peaked at 4.6% while the nation's overall unemployment rate was 8.4%.

'I was too ambitious':Spotify CEO announces layoffs among 6% of employees as tech job cuts continue

‘A huge windfall’:Automakers look to hire tech talent from job cuts in Silicon Valley

Tech goes on a hiring spree as economic conditions improve

Economic conditions improved in the fall of 2020, much faster than tech companies anticipated. Demand for electronics like computers, gaming systems and smartphones exploded as the government issued stimulus checks and enhanced unemployment benefits.

But to get products to consumers, tech companies had to navigate broken supply chains and transform themselves into more e-commerce-driven businesses.

To succeed and seize the opportunity to profit from unprecedented demand, tech companies needed more manpower and they needed it immediately, said Herbert.

To meet the unprecedented demand tech went on a hiring spree.

Why are there tech layoffs? Interest rates went up, eating into tech profits

When the Federal Reserve started hiking interest rates in March 2022 to get inflation under control, tech companies felt the pain because they're more reliant on outside funding than other industries. When interest rates increase, it’s more expensive for them to borrow money.

Meanwhile, many consumers stopped buying electronics after they depleted their stimulus money. Tech stocks got crushed in the months after the Fed's March rate hike.

The companies that went on hiring sprees did a 180 degree turn and began cutting. Apple, though, which hired the least number of new workers among the other four big-tech companies, has avoided layoffs so far.

While the layoffs are alarming, they represent a relatively small share of tech companies' workforces in 2022. And even with the layoffs, all five big-tech companies have bigger workforces now than before the pandemic.

Laid-off tech workers are finding new jobs

Even though tech layoffs are growing, the tech unemployment rate is dropping. In January the tech unemployment rate fell to 1.5% from 1.8% in December, according to CompTIA's analysis.

That indicates that "many of the laid-off workers were quickly reabsorbed back into the tech workforce," said Herbert.

The hiring is most likely coming from small and mid-size companies that are still facing worker shortages because they couldn't previously compete with the salaries and perks traditional Silicon Valley tech companies used to lure in new talent, he added.

Relative to the entire industry, big tech accounts for a relatively small share of the entire tech workforce. Small and mid-size companies make up the bulk of the industry. They, for the most part, are doing OK for now.

But the future is a big question mark.

"At some point, we probably should prepare to see some of these (tech) layoffs show up in the numbers," Herbert said.

Elisabeth Buchwald is a personal finance and markets correspondent for USA TODAY. You can follow her on Twitter @BuchElisabeth and sign up for our Daily Money newsletter here

Adnan Syed: Baltimore prosecutors drop all charges against 'Serial ...

CNN —

Baltimore prosecutors on Tuesday dropped all charges against Adnan Syed, the man who spent over two decades behind bars for the 1999 killing of his ex-girlfriend Hae Min Lee and whose murder case was featured in the landmark podcast “Serial.”

Baltimore City State’s Attorney Marilyn Mosby said Tuesday she instructed her office to dismiss the charges after results of advanced DNA testing of Lee’s shoes, skirt, pantyhose and jacket ruled out Syed.

“The items that we tested had never before been tested,” Mosby said. “We used advanced DNA to determine that it was not Adnan Syed.”

Prosecutors will continue to investigate Lee’s death and prosecute whoever is responsible. As for Syed, “this case is over,” she said.

Mosby said the responsibility for the conviction belonged to past administrations, though she still apologized to Lee’s family as well as to Syed and his family.

“Equally heartbreaking is the pain and sacrifice and trauma that has been imposed not just on (Lee’s) family, but Adnan and his family, who together spent 23 years imprisoned for a crime as a result of a wrongful conviction,” she said.

Syed was freed from prison last month after prosecutors without warning moved to vacate his murder conviction, saying the state “lacks confidence in the integrity of the conviction” but stopped short of declaring his innocence. Prosecutors had 30 days to decide whether to pursue a new trial and were waiting on DNA analysis to determine their next steps.

The decision to drop charges comes about 23 years after the disappearance of Lee, Syed’s ex-girlfriend and high school classmate. Her strangled body was discovered in a city forest three weeks later.

Syed, who was 17 at the time of her death, was charged with her killing, convicted in 2000 of first-degree murder, robbery, kidnapping and false imprisonment and sentenced to life in prison.

Yet he has long maintained his innocence, and his story was featured in the “Serial” podcast that raised questions about the conviction and his legal representation. The podcast reached a huge audience and set off a true-crime podcasting boom as well as further examinations of the case, including the HBO docuseries, “The Case Against Adnan Syed.”

Last month, prosecutors announced that a nearly yearlong investigation revealed evidence about the possible involvement of two suspects other than Syed that was not properly turned over to defense attorneys, prosecutors said. The reinvestigation also raised questions about the reliability of cell phone data records, which were used to corroborate testimony of a witness who said he helped Syed dig a hole for the victim’s body.

Based on the prosecution’s motion, a judge last month vacated the conviction and freed Syed, who walked out of the courthouse to cheers and applause from supporters.

Lee’s family appealed that decision and a Maryland Court of Special Appeals ruled the appeal can move forward. The appeal will be scheduled for consideration in February, the four-judge panel said in their ruling.

Syed’s attorney praises dismissal as long overdue

Erica Suter, Syed’s attorney and director of the Innocence Project Clinic, praised the decision to drop charges as long overdue.

“Finally, Adnan Syed is able to live as a free man. The DNA results confirmed what we have already known and what underlies all of the current proceedings: that Adnan is innocent and lost 23 years of his life serving time for a crime he did not commit,” she said in a statement.

“While the proceedings are not completely over, this is an important step for Adnan, who has been on house arrest since the motion to vacate was first granted last month,” she added. “He still needs some time to process everything that has happened and we ask that you provide him and his family with that space.”

Syed had been wearing an ankle monitor with location tracking, but he was taken off home monitoring on Tuesday, Suter said.

In the long-term, Syed plans to continue his college education and has dreams of going to law school, she said. Today, though, he plans to spend time with his loved ones without being on home detention.

“I think he’s just really elated to have the small, quiet, everyday joys of freedom that many of us take for granted,” she said.

Steve Kelly, attorney for Lee’s family, said the family learned about the dismissal of charges through the media and criticized the attorney’s office for not notifying them beforehand.

“The family received no notice and their attorney was offered no opportunity to be present at the proceeding,” Kelly said. “By rushing to dismiss the criminal charges, the State’s Attorney’s Office sought to silence Hae Min Lee’s family and to prevent the family and the public from understanding why the State so abruptly changed its position of more than 20 years. All this family ever wanted was answers and a voice. Today’s actions robbed them of both.”

Mosby said she reached out to Kelly on Tuesday morning to inform them of her decision, but she had not heard back.

Lee’s family has previously said they were not notified in a timely manner of the prosecution’s intent to vacate the charges last month. Young Lee, the victim’s brother, said he felt “betrayed” by the state.

“This isn’t a podcast for me, it’s real life,” Lee said during last month’s hearing.

Why prosecutors dropped charges

Video Ad Feedback Who is Adnan Syed? 00:59 - Source: CNN

The path to Syed’s release began in earnest last April, when attorneys for Syed brought the case to the attention of the Sentencing Review Unit. A recent piece of legislation had allowed people convicted of crimes as juveniles to ask for a modified sentence after they have served 20 years in prison, Mosby’s office said.

That review revealed deeper problems with the case against Syed, though.

In particular, the prosecution discovered alternate suspects who were known at the time of the original investigation “and were not properly ruled out nor disclosed to the defense,” according to Mosby’s statement. The state has not disclosed the names of the suspects but said that, according to the trial file, one of them said, “He would make her [Ms. Lee] disappear. He would kill her.”

The investigation also revealed that one suspect was convicted of attacking a woman in her vehicle, according to the statement. The second suspect was convicted of engaging in serial rape and sexual assault, the statement said.

Lee’s car was located “directly behind the house of one of the suspect’s family members,” the statement said.

Prosecutors said they will continue to fight for justice for Lee’s family.

“We truly empathize with Hae Min Lee’s family, who believed they had resolution and are now being re-traumatized by the misdeeds of the prior prosecutors,” Zy Richardson, director of communications for the Office of the State’s Attorney for Baltimore City, said in a statement.

“As administrators of the criminal justice system, our responsibility is to ensure that justice is done, and the right person is held accountable. We refuse to be distracted from this fundamental obligation and will never give up in our fight for the Lee family,” Richardson said.

Eric Levenson Brian Vitagliano
Eric Levenson
Brian Vitagliano

Adnan Syed released from Maryland prison after 22 years. Would ...

More than two decades after Adnan Syed was sentenced to life in prison and eight years after the shaky case against him became the center of the hit podcast "Serial," a Baltimore judge on Monday ordered that Syed’s conviction be vacated and he walked out of court a free man.

There were cheers inside the court as officers unleashed Syed's shackles.

Syed, 41 and imprisoned for over two decades, was led into the crowded courtroom in handcuffs Monday. But after Circuit Court Judge Melissa Phinn ordered that Syed’s conviction be vacated, his shackles were removed and he left wearing a white shirt with a tie. His mother and other family representatives left with him.

Phinn ruled that the state violated its legal obligation to share exculpatory evidence with Syed’s defense. She ordered him released from custody and placed in home detention with GPS location monitoring. She also ordered the state to decide whether to seek a new trial date or dismiss the case within 30 days.

The move came after prosecutors said they no longer have faith in their original case – something that many followers of “Serial” have been saying for years.

The first season of the podcast, spanning 12 episodes, spawned investigations into Syed's conviction, books, documentaries and national media attention. The podcast concluded with host, Sarah Koenig, saying she was unsure who killed Hae Min Lee, Syed's ex-girlfriend.

That ambiguity captured national attention as Koenig examined glaring problems with both Syed's defense and the prosecution's case, exploring shoddy cellphone data, inconsistent timelines, ignored witnesses and other possible suspects.

Syed was sentenced to a lifetime in prison, plus 30 years after he was convicted of the 1999 murder. He has maintained his innocence since age 17.

Despite public attention, legal representation, and mass advocacy pushing to overturn Syed's conviction, multiple appeals were denied and it took prosecutors admitting errors years later to reach this point.

Experts say the vast majority of prisoners don't have such opportunities, making their struggle even more difficult.

LAST WEEK:Prosecutors move to vacate Adnan Syed's 'Serial' conviction

EARLIER THIS YEAR:Effort to exonerate Adnan Syed may get boost with DNA testing

Syed's case, and the doubts around it, captured national attention

The true-crime frenzy around Syed is one of the most high-profile examples of podcasts, TV shows and media reports casting serious doubts about previously obscure convictions. But until recently, Syed remained in jail with few legal options left.

That changed when Baltimore’s state’s attorney filed a motion to vacate the conviction judgment against him Wednesday, saying a lengthy investigation uncovered new evidence that could undermine his 2000 murder conviction.

Syed had already been fighting his conviction for years when a family friend and lawyer connected him with Koenig, the future host of what would become "Serial."

Koenig essentially revived the case in 2014, tracking down old friends of Syed and Lee, sorting through thousands of documents and court hearings, and ultimately developing an investigation that appeared to uncover multiple problems with Syed's trial.

Deirdre Enright, a law professor and founder of the Innocence Project at the University of Virginia School of Law, said Syed would have had few options to try and overturn his conviction without the public attention.

"Adnan Syed would be nowhere if Sarah Koenig hadn't stepped in and turned him into a national spectacle," Enright said. "Like most, he would have been on his own."

A 2021 Maryland law allowing for people convicted of crimes as juveniles to seek new sentences after 20 years in prison also helped move his case forward, said Enright, who was featured on several episodes of "Serial."

Prosecutors said a yearlong investigation into Syed's case revealed two alternate suspects and "significant reliability issues" with evidence used to convict him.

Prosecutors asked for a new trial, at the minimum. The state is awaiting DNA analysis to decide whether they want to pursue a new trial or drop the case, Marilyn Mosby, state’s attorney for Baltimore City, said at a press conference following the hearing.

“We’re not yet declaring that Adnan Syed is innocent,” she said. “But we are declaring that in the interest of fairness and justice, he is entitled to a new trial.”

'Unfortunate ... not uncommon': Syed's lengthy process to overturn conviction

The long battle Syed faced isn’t unique, said Amanda Vicary, chair and professor of psychology at Illinois Wesleyan University.

“It's unfortunate, but it's not uncommon at all that even people who are actually innocent may be in prison for 20 years before they find someone to represent them and before all of the appeals and everything make their way through the court system,” Vicary said.

In the U.S., 375 people have been exonerated by DNA testing since 1989 in various types of cases, according to the Innocence Project, a nonprofit focused on freeing innocent people and preventing wrongful convictions. On average, those people served an average of 14 years per person before they were released.

Syed was granted new DNA testing in 2022 with procedures that weren't available when he was put on trial over 20 years ago. Most of the testing yielded inconclusive or non-useful results, the motion filed Wednesday says. Prosecutors are awaiting additional DNA analysis.

'I FEEL FREE':Teen framed for 1985 murder becomes 3,000th person exonerated

Erica Suter, director of the University of Baltimore’s Innocence Project Clinic, thanked Syed's supporters and the court after the hearing for "doing the right thing."

“When prosecutors do not do their duty, when they do not disclose evidence as they are supposed to, the result can be that innocent people like Adnan waste decades of their lives for crimes they did not commit," she said.

Despite his long wait to overturn his conviction, Syed has been given chances most people in the criminal justice system have not, experts say, along with a heavy dose of publicity.

One avenue to seek an overturned conviction is through a post-conviction lawyer, something Syed has employed. But once someone's been convicted, it's difficult to hire one, especially for those without money or family.

“Once you go to prison, you don't get a lawyer – you're on your own,” Vicary said.

Without a post-conviction lawyer, the other viable option to overturn a conviction is to seek help from organizations like the Innocence Project – but even UVA's, which has more staff than others, has a waiting list of hundreds, according to Enright.

Allowing outside influence into a courtroom directly conflicts with American judges' code of conflict. But in a case broken wide open to the public, like Syed’s, public influence may be all but unavoidable.

“They might not want to admit it, or they may not even be consciously aware of it, but I think it would be hard to say that (public attention is) not affecting things in some way,” Vicary said.

EXONERATIONS:They're out of prison, but still fighting to prove their innocence: 'I feel like I'm not free'

'Serial' ushered in a new era of true crime but left victims behind

When Koenig came to Enright with the idea of turning "Serial" into a full-length podcast, the law professor's first thought was that no one would care.

"I've been doing these cases for years ... I was like, 'nobody cares about that,'" Enright said. "That's why I have to keep doing this."

But to Enright's surprise, she was proven wrong – and happily so. "Serial" is one of the most celebrated podcasts of all time: it's widely cited as the most listened-to podcast in the world with over 300 million downloads, according to "This American Life," which produced the podcast.

Americans have had a fascination with true crime for hundreds of years, beginning in the 1800s when newspapers started hiring crime reporters and printing sensational trials on their front pages, said Adam Golub, a professor of American Studies at California State University, Fullerton.

And there's "no question" that "Serial" inaugurated a new cycle of that fascination, Golub said.

"What something like 'Serial' did is it turned all of us into de facto jurors or investigators – we get to be these armchair experts on these crimes who then feel like we can make up our own mind about it," he said.

But Serial – and many other true-crime productions – overwhelmingly focuses on the perpetrator and not the victim.

"This is really about the murder of someone," he said. "Hae Min Lee has kind of been overshadowed by all of this."

During the hearing, Lee's brother Young Lee spoke to the court, saying he feels betrayed by prosecutors since he thought the case was settled.

“This is not a podcast for me. This is real life,” he said.

In a statement Monday, Lee's family said they continue to "have questions in its pursuit of justice."

"For 22 years the family and the world have been told that Adnan Syed murdered Hae Min Lee. Now the Court and prosecutors have a different view," the statement reads. "They are disappointed that today’s hearing happened so quickly and with virtually no notice, and they do not understand why the court acted the way it did and why the prosecutor’s office has made the recommendation they did."

OPINION:Who's to blame for wrongful convictions? Accountability demands more than finger-pointing.

Contributing: The Associated Press

CDC data shows COVID-19 numbers on cruises after vaccine rules ...

Many cruise lines dropped COVID-19 vaccine requirements and further eased testing rules in early September.

CDC data show the number of new positive cases following the rule changes.

The numbers did not show a consistent pattern among major lines.

David Hancock spent his September vacation doing things he'd never done. He went on a cruise for the first time, hugged a sloth at an animal park in Honduras, and at some point during the trip, likely contracted COVID-19.

The 36-year-old firefighter had avoided infection for two years, but tested positive the morning after he and his wife, Melissa, who had been celebrating their 15th wedding anniversary, returned home to Savannah, Tennessee.

But not even COVID-19 could put a damper on their Royal Caribbean International sailing. "I went all that time since COVID began without getting it ... so I went and got it on a cruise ship," he told USA TODAY.

Dr. Sanjay Gupta: Is America ready to take the next step in its Covid ...

CNN —

As we reach the second anniversary of the World Health Organization acknowledging Covid-19 as a pandemic on March 11, 2020, we appear to be standing on the edge of the endemic phase of this global health crisis. For many, that’s the moment when we hope we can get back to our regular lives.

Several times during this pandemic, I have written essays about America as if the country was my patient. The current situation has me thinking along those lines again.

Doctors, like anyone else, love to give good news. We see the value of hope but also recognize that honesty must be our North Star. I would love to be the good guy here and tell my patient that it’s time to be discharged from this chapter of our lives. But a doctor’s job is to fully assess the situation and lean into the nuance, as opposed to simple axioms.

Time for a physical

So let’s examine America, the patient. On the one hand, the numbers are going down. Cases of Covid-19 are more than a third lower this week than they were last week and the lowest they’ve been since July, according to the latest data from Johns Hopkins University. And the number of people hospitalized is about a fifth of what it was during the country’s mid-January peak. Even deaths, the so-called lagging indicator, have been falling; they’re at their lowest point in two months.

All 50 states are in the process of lifting restrictions. On March 26, Hawaii will become the last state to end its indoor mask mandate.

At the federal level, the US Centers for Disease Control and Prevention made big changes in late February. Instead of primarily using levels of coronavirus transmission within a community as the key metric for determining mask guidance, the agency recommends that three data points be considered instead: new Covid-19 hospitalizations, hospital capacity and Covid-19 cases.

So now, instead of a transmission map that paints most of the country an “inflamed” red, the community levels map shows a lot of cooler green and yellow, with a bit of orange – the new low, medium and high categories. Since that change, there has been a big drop in the percentage of Americans living under masking recommendations, from 99% under the old metrics to just about 2% now.

And at the start of the month, the White House unveiled its National Covid-19 Preparedness Plan. The new plan focuses on “vaccines, treatments, tests, masks,” White House Covid-19 response coordinator Jeff Zients said. “These tools are how we continue to protect people and enable us to move forward safely and get back to our more normal routines.”

As part of that, government testing and treatment initiatives are being streamlined and made more widely available.

A closer look

But in medicine, we cannot rely on lab results and a medical history. We need to perform a thorough and detailed exam. And when we do that, a more complete picture of the patient emerges.

Truth is, America, my patient still has an active infection. Although the numbers are falling, they are still painfully high: The country is averaging just under 37,000 new cases of Covid-19 a day. It’s as if saying the patient used to have a very high fever but now only has a moderately high fever. The point is, it’s still too high. We wouldn’t stop treating the patient’s infection at this point but rather complete the course of treatment and care.

There’s also the issue of understanding the effects the illness may have on my patient in the future. In this case, it means acknowledging an entirely new disease: long Covid.

Many Americans are enduring the lingering effects of a past infection, battling health conditions like fatigue, brain fog, shortness of breath, cardiac issues. The list of long Covid symptoms is lengthy and varied; there are no answers as to who and why, nor are there easy, one-size-fits-all treatments.

We are in the early days of this disease, but I was particularly struck by the recent paper indicating a previous Covid infection being a significant risk factor for future heart problems.

And, even more important, there are still about 30,000 Americans hospitalized for Covid and, on average, more than 1,250 deaths a day. That’s the equivalent of about two jumbo jets dropping out of the sky every day.

My patient still needs lots of care.

Other factors at play

Despite the less red and inflamed transmission map, it still shows there’s a lot of virus out there. If the virus came in the form of a raindrop, parts of our country would still be getting drenched.

I have often imagined how different things would be if we could have actually seen the virus – little green particles circulating around people’s noses and mouths and becoming airborne. What if we had been able to witness its destruction and journey into blood vessels and lungs? This invisible enemy circumvented our basic human ability to detect a threat and, as a result, made us more likely to ignore and even deny it.

I would remind my patient we have been here before. We experienced moments of genuine hope earlier and then witnessed how quickly things can change. In the summer of 2021, the Delta variant surprised us, and in December, Omicron blindsided us. Both times, the spikes caused by these variants followed declarations of victory heralding the end of the pandemic.

Currently, there is a subvariant of Omicron called BA.2 that may spread even faster than Omicron itself. According to the latest figures from the CDC, it now makes up about 11.6% of Covid cases in the US; the week before, 6.6%. BA.2 is the dominant variant in Denmark, the United Kingdom, India, South Africa and more than a dozen other countries. According to the World Health Organization, studies estimate it is 30% more contagious than the original Omicron (BA.1).

And while studies suggest that BA.2 is not more likely to lead to hospitalization than BA.1, another patient that I’ve been keeping an eye on, the United Kingdom, is seeing cases and hospitalizations starting to trend up again after declining steadily since mid-January. Sometimes, doctors gain a lot of information from watching how other patients are faring.

Again, I get it. I would love to look at these past two years in the rearview mirror as well, but we need to learn the lessons of this pandemic and apply that knowledge in real time. Today. Now.

Delta and Omicron represent two cautionary tales in the span of a few months. It would be shortsighted to ignore that reality, believing it will never happen again.

A blend of science and judgment

The International Epidemiology Association’s Dictionary of Epidemiology defines a pandemic as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.”

Two years ago, when we made the decision to use the word pandemic on CNN, before the CDC or WHO, it was fairly straightforward – fundamentally, it was an exercise in math and data analysis. My producers and I spent a lot of time looking at whiteboards where we kept tabs on the growing numbers and locations of Covid-19 cases. One day, I remember thinking, “If this isn’t the very definition of a pandemic, I don’t know what is. So why is no one else calling it that?”

And so we did.

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Although the line was clear entering the pandemic, it will be much fuzzier as we approach endemicity. A disease is considered endemic when it is a “constant presence … within a given geographic area or population group.” It would also be predictable in its rate of spread without causing the level of disruption it does in a pandemic.

But what is considered disruptive may be very different in one country compared with another, even from one person to the next. Progressing into this next phase will be based on a blend of science and judgment.

What the exam reveals

So if America were my patient, the question I would be asking: Is it really time to downgrade the country’s present-day condition from pandemic to endemic?

It’s analogous in some ways to deciding when to discharge my surgical patients to the general care floor from the intensive care unit.

I make rounds in the intensive care unit, carefully reviewing each patient’s chart – full of lab results, metrics and data. And then I sit at the bedside, watching, examining and understanding how they really feel. Can they stand on their own, put a fork to their mouth and a comb through their hair? Are their basic bodily functions returning to normal, and can they get by independently? It is a judgment call. Two people can have the same vital signs but be in very different places.

If America were my patient, what would I see when I sit at its bedside? Beyond 1,300 people dying a day, I would make note that almost 60,000 people died of Covid-19 during the month of February alone. In other words, more people died of Covid-19 in one month than die of the flu during a bad year.

So the question ultimately is: What is too disruptive? What are we willing to tolerate? At what point do we as a society throw up our hands and say, “We can’t do any better than this,” so let’s call this level of sickness and death “endemic,” accept the numbers and move on with our lives?

And of course, my patient, America, lives on a planet with lots of other patients, all part of an intricate ecosystem. We must realize that America’s health is dependent on the health of all the other patients on the planet: When any one of us is at risk, we are all at risk.

Finding a measure of peace and quiescence

None of this is easy. It’s why epidemiologist and author Dr. Larry Brilliant said that “endemic” is a terrible word.

“Smallpox was ‘endemic’ when it killed somewhere between a third and half a billion people in the 20th century. Malaria is endemic, and it’s killing millions. Tuberculosis is endemic. And HIV/AIDS was sort of thrown out of people’s consciousness by just labeling it ‘endemic,’ ” he said.

Brilliant, who is CEO of Pandefense Advisory and a senior adviser at the Skoll Foundation, was a key player on the WHO team that eradicated smallpox.

He pointed out that the technical definition of “endemic” is a disease that is generating an expected number of cases, to the expected community and the expected time. “And because [Covid-19] is a baby of a disease … it’s way too early to try to figure out what is endemicity. We have to wait for it to become a teenager and see how it behaves,” he said.

Brilliant prefers the term “quiescent.” “We want this thing to be quiet,” he said.

He recalled that in the early days of 2020, he and other epidemiologists and public health experts speculated that the illness would come in waves.

“A wave is a really good metaphor to think about this. Sometimes, the waves come in a bunch at a time, and sometimes there’s not a wave for hours, even days. Some waves are too small to really be called waves. But every once in a while, there’s a rogue wave, this tsunami.”

He explained, “what we want is the interval [between waves] to be long and the water in the waves to be quiescent. And that’s what we’re trying to say when people use the word ‘endemic.’ … To say that the pandemic has gone endemic is failure – it’s not success. We haven’t put it where we want it. So it’s the wrong way of thinking about it.”

Plus, said Brilliant, saying that the pandemic is over means “we give up our duty of care.”

He believes we still have a duty of care to the immunocompromised, the elderly, the vulnerable and, yes, even the unvaccinated, because they are the ones disproportionately dying.

Life with an endemic disease

Humans are increasingly living side by side with pathogens that were once in the wild but then took hold among us. We might not like it, and sometimes the pathogen comes too close for comfort, but we learn to live with it.

Take the parasite malaria. For millennia, it killed off wide swaths of the global population. In fact, the mosquito, which transmits the parasite that causes disease, is one of the most prolific killers of humans worldwide.

Inarguably, the course of humanity has been shaped by malaria: It’s believed to have contributed to the fall of Rome, and for hundreds of years, it helped protect Africa from European colonization even as it infected the local population. (And it’s why the gene for sickle cell anemia, which is protective against malaria, never died off evolutionarily.) In this country, Presidents George Washington and Abraham Lincoln grappled with it. The disease stunted the physical and economic growth of the rural South through the 1930s, and it is why the precursor to the CDC was founded.

It’s an understatement to say man has been living with malaria for a very long time. And although we may not have eradicated it from the face of the Earth or completely tamed it, we have learned to coexist with it and reduced it to an endemic disease in a shrinking number of countries. The United States eradicated it in 1951.

How did we do that? By arming ourselves with knowledge. Through scientific research, we learned about where malaria comes from and how it is spread. We developed mitigation strategies and medications to blunt its impact.

And our work is still not done: In 2020, malaria killed an estimated 627,000 people, the vast majority of them children in sub-Saharan Africa.

Early detection, rapid response

Many experts, including Brilliant, are pretty sure that Covid-19 is here to stay. Like the common cold (also often caused by a coronavirus) or the flu, it’s expected to be part of our lives for the next 10, 50 or 100 years, and life will never be quite the same again.

But we can improve the situation and learn to live with it.

“We want the disease to occur in places that we expect it, in the numbers that we expect, so we know how to deal with it,” Brilliant said. “You can go to Hawaii on vacation and not worry. Your kids can go to school. And you don’t need to worry about going to dinner with your parents or your grandparents. Maybe it’s quiet and you have to still wear masks. Maybe it’s quiet and you still have to be tested before you go someplace. But it’s not on the front page every day.”

The key, said Brilliant, is two-part: early detection and rapid response.

For that to happen, we have to have good monitoring tools and be nimble going into and out of protective mode. Maybe that means we carry a mask in our coat pocket during wintertime, just like we take an umbrella when the forecast predicts rain; maybe we keep a box of rapid tests and a packet of antivirals in the bathroom cabinet for when we are under the weather; maybe we close a school but like we do with the flu – with surgical precision, using a scalpel instead of a chainsaw.

The good news, Brilliant said, is that moving forward, our tools – vaccines, surveillance, tests, treatments, prophylactics – will only get better.

The inescapable fact is that we live in the era of pandemics. There are simply more and more opportunities for a pathogen, like the SARS-CoV-2 virus, to come in contact with the human population, make the jump and take hold. It’s a dance we are increasingly doing because we are infringing more and more on the microbes’ territory. Population growth, deforestation, climate change all contribute to this.

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These pathogens are going to keep emerging in humans, but pandemics are not inevitable. Humans have evolved to create remarkable public health tools to prevent that, just as long we are smart and humane enough to use them.

My patient – America – is still in precarious health and will have to be careful moving forward to maintain all of the gains and continue making progress. Both the patient and doctors will have to remain vigilant and act quickly if there’s any new infection.

It’s just not time for my patient to completely drop their guard, however much we would all like that to happen. We can and should be hopeful, but honesty must lead the way, full and transparent.

US suicide rates rose in 2021, reversing two years of decline | CNN

Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the Suicide & Crisis Lifeline at 988 or 800-273-8255 to connect with a trained counselor, or visit 988lifeline.org.

CNN —

Last year, a landlord stopped by Patrick John’s home in the Salt Lake City area to replace a broken dishwasher. John was always a little shy with people he didn’t know well, but he welcomed his guest with the warmth that he was known and loved for.

In the process of replacing the dishwasher, they discovered that mice had found their way inside the house, likely because of nearby construction. But for John – a husband and father of four – the mess became a physical representation of his sense that he was failing his family.

A few years earlier, physical health challenges had made John unable to work. The change took a toll on him in many ways. That day, his worries spiraled into fears of eviction or homelessness, and he called his wife, Sabina, in a panic.

John had also struggled with depression and anxiety for years and was working hard to overcome his mental health challenges with regular therapy and medication. But his access to therapy was cut off in 2020 as the office closed to in-person visits amid the Covid-19 pandemic, and in early February 2021 – within hours of the landlord leaving – he died by suicide at age 32.

“It was everything leading up to that point that made such a small thing so big to him,” Sabina John said. “The day was just hard, in general, and I think that may have just tipped him over the edge to say ‘I can’t do this anymore.’ “

Patrick John was one of 47,646 people in the US who died of suicide last year, according to a new report from the US Centers for Disease Control and Prevention – one death every 11 minutes.

Suicide has long been a growing concern – rates have increased 31% over the past 20 years, CDC data shows – but experts were divided in their expectations of what the pandemic would bring. Isolation and other new stressors could take a heavy toll, for example, but the forced changes could also help people remove themselves from previous stressors and find solace in a shared crisis.

Patrick John, a husband and father of four, died by suicide in February 2021. Courtesy Stephanie Howell Photography

A dip in suicide rates in 2019 continued into 2020, but the CDC report, released Friday, shows that 2021 reversed most of that improvement and brought rates back to near-record levels – about 14 suicide deaths for every 100,000 people.

The pandemic may have introduced new difficulties into our lives, but experts say the many reasons a person may attempt suicide have a common core.

“There is individual difference that exists with what might make me lose hope versus you,” said Sarah Brummett, director of the National Action Alliance for Suicide Prevention’s executive committee. “But taking a step back, when we’re talking about the drivers for suicidal despair, we’re talking about pain and the loss of hope that things can get better.”

For some, like John, the path is long and winding before it reaches a breaking point. For others, it’s more direct.

“Traditionally, we thought of suicide as linear. First, you start having thoughts, and you maybe practice with attempts, and then you actually attempt. But people can jump these phases,” said Justin Baker, a psychologist and assistant professor at the Ohio State University College of Medicine. “This may be someone that has previously never struggled with suicide. So universal screening measures would have missed that kind of individual.”

In either case, it is often just a matter of minutes between the time a person decides to take their life and when a suicide attempt is made, experts say. But there’s usually a trigger – like a breakup, a financial crisis, violence or other trauma.

“That individual can’t think their way through that situation or find an alternative strategy to get out. They’re just flooded and overwhelmed, and so they see suicide as the solution to that immense distress or pain,” Baker said.

But, he said, most people who survive suicide attempts say they didn’t really want to die – they just want help getting through that immediate pain.

Better lifelines

Although CDC data shows that suicides increased from 2020 to 2021, experts say it’s challenging to draw conclusions from one year of change. And rates are relatively stable compared with three years earlier.

In recent years, progress has been made on both critical fronts: better options for addressing the immediate crisis and building up support for broader mental health resources.

“Suicides did not skyrocket the way a lot of people thought they would” during the pandemic, partly because there were efforts by so many who were “trying to head off what we were afraid would happen,” said Doreen Marshall, a psychologist and vice president of mission engagement with the American Foundation for Suicide Prevention.

There was also a “growing awareness and learning on the part of the public about what mental health is and how to help someone who’s struggling,” she said.

Although John would often isolate himself during tough times, he did recognize the positive effects of talking things through with his therapist and family – and he was generous in offering that support to others.

He was an avid gamer and found respite in the online gaming community. After his death, one fellow gamer reached out to his wife to share the story of how talking with John – and the compassion and empathy he gave him in times of pain – helped save his own life.

The National Suicide Prevention Lifeline also recently transitioned to a three-digit hotline, the 988 Suicide and Crisis Lifeline, to make it easier for people to get help.

“The impulse to act is a very short, intense one. And so the goal is really to get people through those difficult moments,” Marshall said. “The shorter number is more accessible for people to remember in that time of crisis.”

And calls into the hotline jumped 45% after its launch over the summer, compared to the same time a year earlier, according to data from the US Department of Health and Human Services.

But critical challenges remain.

Managing risk factors

In 2021, the CDC report shows, the suicide rate among men in the US was four times higher than it was for women – a disparity that continues to grow. There were about 23 suicide deaths for every 100,000 men in 2021, compared with about 6 for every 100,000 women.

Some point to guns as the driving risk factor.

The new CDC report does not include data on suicide methods or attempts for 2021. But data from 2020 shows that for every person who died of suicide, there were eight suicide-related hospital visits and 27 suicide attempts. And firearms were used in more than half of suicide deaths.

Young women are most likely to present at an emergency room after a suicide attempt, but older men are most likely to die as a result of a suicide attempt – and that’s directly correlated to gun ownership, said Ari Freilich, state policy director for Giffords Law Center, a gun-control advocacy group.

“The population most at risk and most likely to attempt suicide in the United States is not the population most likely to die by suicide,” he said. “Firearms explain so much of that difference.”

Owning a gun does not make a person more likely to feel suicidal, but having access to one during a crisis can be a “really bad combination,” Brummett said. “We’re really talking about collaborative approaches that create time and distance between me, in the presence of a suicidal crisis, and my firearm.”

And with a record year of gun sales in 2020, the risk increases with more guns in more homes.

“Guns are so uniquely lethal compared to the most common other methods in the United States,” Freilich said. The vast majority – 9 out of 10 people – who attempt suicide using a gun die as a result, but about the exact opposite is true for those who attempt with other methods.

“Even if you were 0% effective at preventing people from attempting suicide, replacing the means – the access to firearms – would save the majority of people.”

But mental health struggles, including suicidal ideation, can affect anyone, experts say.

Suicide is a major contributor to premature death in the US overall, and it’s the second leading cause of death among people ages 10 to 34, according to the CDC.

Between 2020 and 2021, suicide deaths among girls ages 10 to 14 increased more than any other group, followed by teenage boys and young men ages 15 to 24, according to the new CDC report. And in 2021, the American Academy of Pediatrics declared a state of emergency concerning children’s and adolescents’ mental health.

“Now that we’ve made it easy to talk about mental health, we have to ensure that our infrastructure is able to withstand the additional referrals,” Baker said. “We need to now adjust to being able to absorb all the people who are wanting to actually address their mental health.

“In some ways, we’ve created a new problem,” he said.

Not a burden but a gift

Once John stopped therapy, Sabina said, it was tough for him to get back into it once services were available again and he often lamented the burden he felt that he put on his family.

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But for Sabina, he was anything but.

“He really thought I would be better off without him, but that’s just not the case,” she said.

“Whatever struggles we would have gone through, I would have rather gone through those together than have to struggle without him.”

She is proud of the qualities he instilled in their kids: curiosity, ambition, humor and compassion. Their oldest daughter talks with her hands like he did and has a laugh that sounds just like his, and it makes her smile.

And when his memory or the topic of suicide comes up, Sabina is sure to never shy away from it.

“It was really important for me that [the kids] knew the circumstances and the why,” she said. “I didn’t want to hide the fact that he committed suicide. I just explained that Daddy had been sick for a very long time, and his mind had also been sick for a very long time.”

That way, she said, they can remember him together with a focus on all of the good times, without letting him be defined by his death.

US life expectancy continues to fall, erasing 25 years of health gains

Average American life expectancy fell from 77 to 76.4 years last year, bringing U.S. figures back to where they were in 1996, according to federal data released Thursday.

That means all the medical advances over the past quarter century have been erased, said Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University, who was not involved in the new study.

For American men, life expectancy fell by more than eight months, and for women the loss was about seven months, the study found. Life expectancy, which is actually a measure of death rates, dropped in every age category over age 1.

Though the rate of decline in life expectancy wasn't as dramatic as in 2020, Woolf said, the fall-off in 2021 was actually worse because it came on top of that year's 17% decline.

The latest decline came as other wealthy countries saw a rebound after the first year of the pandemic, Woolf said. He blames a variety of factors, including low COVID-19 vaccination rates and the general poor health of Americans.

"The fact that the United States in 2020 and 2021 did so much worse than other countries is a warning sign that this health disadvantage that America has had for many years is really getting pretty bad," he said.

How many people died last year from ODs?:Nearly 107,000 drug overdoses, COVID deaths, push US life expectancy to lowest in 25 years

What's killing Americans?

Causes of death remained largely the same between 2020 and 2021, led by heart disease, cancer and COVID-19, all three of which occurred more often last year.

Eight of the top 10 causes of death saw statistically significant increases in 2021 over 2020, including unintentional injury and stroke. Only Alzheimer's disease and chronic lower respiratory diseases declined among the leading causes of death.

Death rates from chronic liver disease and cirrhosis, which are often alcohol-related, also rose during the pandemic, the data showed. Woolf said people might have turned to alcohol to reduce economic, social and other stresses of the previous two years.

Drug overdoses increased during the pandemic, but Woolf doesn't like the common term "deaths of despair" because many people start taking addictive painkillers on a doctor's orders after a surgery.

Death rate increasing at younger ages

Woolf said he's particularly concerned about the drop in life expectancy for people in middle age, who should be at the prime of their working years.

This trend began a decade before the pandemic, but COVID-19 contributed, he said, particularly for people of color. A 40-year-old with multiple health problems was more likely to die of COVID-19 than someone of the same age in better health; in essence, poor health is making the American population look older than it is, he said.

It's not clear, he said, why deaths are increasing among younger adults and children, which had been declining before the pandemic.

The race gap reversed

The race gap reversed somewhat in 2021 as white people lost more ground than people of color, though they still live longer on average.

During the first year of the pandemic, Hispanic and Black populations experienced much higher death rates than their white counterparts. They were more likely to be exposed to COVID-19 and to die when they got infected, Woolf said.

But in 2021, "it's the white population that's done worse," he said. Death rates increased among people of color, but not as much as the 7% among white people.

American Indians and Native Alaskans continued the "tragic losses" seen in the first year of the pandemic, he said.

"The white population, which from a medical standpoint should not be experiencing higher death rates, did," Woolf said. Other data suggests that's because white people were more likely to avoid COVID-19 vaccination.

What can be done?

Woolf said he sees a clear path toward improving America's health, by providing what other wealthy nations provide: quality education, affordable housing, access to healthy food, reduced income inequality and greater regulation of industries that pollute or provide potentially dangerous products such as cars or guns.

"We need to make a decision as to whether we're just going to accept those losses and accept that Americans are going to be less healthy than people (in other wealthy countries) and live much shorter lives or we need to do something about it," Woolf said. "We don't lack solutions. We lack political will."

Woolf said he doesn't think it will take 25 years for Americans to regain the ground lost over the past two. Once COVID-19 deaths fall, life expectancy numbers should bounce back, he said.

"But the fact that we took a hit like that and were pushed that far back in time while other countries did not is very concerning."

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

U.S. airports increasingly dominated by 1 or 2 carriers

David Koenig and Scott Mayerowitz

AP Airline Writers

DALLAS (AP) — The wave of consolidation that swept the U.S. airline industry has markedly reduced competition at many of the nation's major airports, and passengers appear to be paying the price in higher fares and fees, an Associated Press analysis has found.

Over the past decade, mega-mergers reduced nine large U.S. airlines to four — American, United, Delta and Southwest — with the result that travelers are increasingly finding their home airport dominated by just one or two players.

Over the same period, domestic airfares rose faster than inflation, and analysts believe one leading factor is the decline in competitive pressure.

"Airlines aren't going at each other like they used to," said Mike Boyd, an aviation consultant frequently hired by airports. "They have their turf, and they very rarely go to the mattresses with one another."

At 40 of the 100 largest U.S. airports, a single airline controls a majority of the market, as measured by the number of seats for sale, up from 34 airports a decade earlier. At 93 of the top 100, one or two airlines control a majority of the seats, an increase from 78 airports, according to AP's analysis of data from Diio, an airline-schedule tracking service.

Overall, domestic fares climbed 5% over the past 10 years, after adjusting for inflation. And that doesn't include the $25 checked bag fee and other add-on charges that many fliers now pay.

To be sure, other factors have contributed to higher fares, among them a stronger economy, longer average flight distances and, for most of the past few years, some of the highest fuel prices in history. However, analysts believe consolidation freed airlines to charge more.

The strategy is paying off: In the past two years, U.S. airlines made a record $19.7 billion in profits, even though air travel is growing only modestly.

The airlines' main trade group, Airlines for America, said the fare increases reflect stronger demand for travel and are not solely a result of the mergers. The group noted that airlines have used their profits to buy new jets and update airport facilities.

American Airlines CEO Doug Parker rejected the notion that consolidation has hurt travelers.

"We have increased flying out of each of our hubs," Parker said. "We want to expand. That's good for consumers, not bad."

The Justice Department notified the four largest airlines on June 30 that it is investigating whether they are colluding to drive up fares by limiting the availability of flights and seats. Those four control more than 80% of the U.S. market.

There was a time — before deregulation in 1978 — when fliers had even fewer choices and paid higher fares than they do now. Back then, the U.S. government controlled which airlines flew to which cities and how much they could charge. Competition intensified in the 1980s. As new airlines entered the market, fares dropped precipitously.

After 9/11 and the recession that hit immediately afterward, major airlines were in financial shambles. Several restructured through bankruptcy, and a wave of deals starting in 2008 led to the combinations of Delta and Northwest, United and Continental, Southwest and AirTran, and American and US Airways.

Justice Department antitrust regulators let the deals go through but forced airlines in a few cases to give up some of their spots at key airports to try to encourage competition.

Still, "the airline industry is less competitive now than it used to be," said Seth Kaplan, managing partner of industry newsletter Airline Weekly. "Some of us used to have eight or nine airlines to choose from. Now we have maybe four or five, just as we have four or five cellphone companies to choose from."

The mergers have altered the competitive landscape at airports big and small.

— In Indianapolis, the two leading airlines controlled just 37% of the seats a decade ago, and domestic fares were 9% below the national average. Then the city's main airline, ATA, went bankrupt and was bought by Southwest, and its No. 2 carrier, Northwest, was absorbed by Delta. Now two airlines control 56% of the seats, and airfares are 6% above the national average.

— The Dayton, Ohio, airport was served by 10 airlines in 2005, and fares were 5% below average. Today, just four airlines fly there and prices are almost 10% above average.

— Big hub airports aren't immune. In 2005, US Airways controlled nearly 66% of the seats in Philadelphia. Now that US Airways has merged with American, the combined airline has 77% of the seats. Airfare has gone from 4% below average to 10% above it.

— Delta's hold on Atlanta, the world's busiest airport, increased during that same period from 78% of seats to just over 80%. At the same time, low-cost AirTran merged into Southwest and reduced flights there. Domestic airfares at the airport went from nearly 6% below average to 11% above.

— Some cities are actually seeing lower fares than they did a decade ago. Prices in Denver were once 5.6% higher than the national average. Now that United's market share there has dropped to 41% from 56%, fares are almost 15% lower than the rest of the country.

Recent deals indicate the big airlines intend to stick to a strategy of dominating one airport and forgoing marginal service elsewhere.

For instance, United announced in June that it will abandon Kennedy Airport and move its dwindling number of JFK flights to New Jersey's Newark airport, where it already controls 68% of the seats. At the same time, if regulators go along, Delta will further shrink its small presence at Newark and take over United's share at JFK, where Delta is already top dog.

One of the few competitive battles is taking place in Seattle, where Delta is mounting a fierce challenge to longtime No. 1 Alaska Airlines. Delta is building Seattle into a gateway to Asia and adding flights on domestic routes long dominated by Alaska. Seattle-based Alaska has responded by adding service.

The average fare at Seattle-Tacoma International Airport was $377 in the third quarter of 2014, $18 below the national average.