The list includes Rick Bright, the former head of the vaccine-development agency BARDA ousted by the Trump administration in April; Atul Gawande, the surgeon, writer, and recently departed CEO of Haven, the joint JP Morgan Chase-Berkshire Hathaway-Amazon health care venture; and Luciana Borio, a former Food and Drug Administration official and biodefense specialist.
Biden has cast the escalating Covid-19 crisis as a priority for his incoming administration. The task force, he said, would quickly consult with state and local health officials on how to best prevent coronavirus spread, reopen schools and businesses, and address the racial disparities that have left communities of color harder hit than others by the pandemic.
Ensure all Americans have access to regular, reliable, and free testing.
Fix personal protective equipment (PPE) problems for good.
Provide clear, consistent, evidence-based guidance for how communities should navigate the pandemic — and the resources for schools, small businesses, and families to make it through.
Plan for the effective, equitable distribution of treatments and vaccines - because development isn’t enough if they aren’t effectively distributed.
Protect older Americans and others at high risk.
Rebuild and expand defenses to predict, prevent, and mitigate pandemic threats, including those coming from China.
Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.
This looks like what the plan should have been from the beginning. Of particular note, under the point about testing:
Stand up a Pandemic Testing Board like Roosevelt’s War Production Board. It’s how we produced tanks, planes, uniforms, and supplies in record time, and it’s how we will produce and distribute tens of millions of tests.
Establish a U.S. Public Health Jobs Corps to mobilize at least 100,000 Americans across the country with support from trusted local organizations in communities most at risk to perform culturally competent approaches to contact tracing and protecting at-risk populations.
Over the past week, as Americans voted and then held their breath for the results of the election, over 750,000 Americans tested positive for Covid-19. Based on the current case fatality rate of 2.4%, over 18,000 of those people will die in the days and weeks ahead. Many more will suffer long-term health effects because of the disease and struggle emotionally, financially, and spiritually in the months ahead. I really really hope there’s enough of a spirit of togetherness and cooperation left in America for a science-based plan like this to work in controlling a disease that’s killed almost 230,000 people. We — all Americans — need this so so much.
In a press release (and not a paper in a peer-reviewed journal) based on a preliminary outside review of data from its phase 3 trial, Pfizer says its Covid-19 vaccine was more than 90% effective in preventing the disease.
The company said that the analysis found that the vaccine was more than 90 percent effective in preventing the disease among trial volunteers who had no evidence of prior coronavirus infection. If the results hold up, that level of protection would put it on par with highly effective childhood vaccines for diseases such as measles. No serious safety concerns have been observed, the company said.
I really hope this analysis holds up when more data from the study is released:
The data released by Pfizer Monday was delivered in a news release, not a peer-reviewed medical journal. It is not conclusive evidence that the vaccine is safe and effective, and the initial finding of more than 90 percent efficacy could change as the trial goes on.
The world, and the United States, could really really use some good news like this about the pandemic.
Pfizer’s first analysis was planned for 32 events, which they pushed back after discussions with FDA. But by the time they analyzed the data, 94 had accrued. This shows how quickly trials can generate results when placed in hotspots (and how much transmission is ongoing!).
These vaccines are tested until a certain number of infections happen. So you have this interesting paradoxical situation where if a potential vaccine is more successful at curbing infection, the longer it takes for the study to conclude. You get a better vaccine but wait longer for it. Countering that are the rising transmission counts in the US — more community transmission will get you to the target number of infections more quickly.
Update: From virologist Dr. Florian Krammer, a thread about what Pfizer and other companies will be looking for in terms of the efficacy of vaccines in a number of different situations. Overall, he is optimistic about these preliminary results. And here’s a FAQ about the vaccine from the NY Times.
Another open question is whether children will get protection from the vaccine. The trial run by Pfizer and BioNTech initially was open to people 18 or older, but in September they began including teenagers as young as 16. Last month, they launched a new trial on children as young as 12 and plan to work their way to younger ages.
The NY Times has a fantastic visualization on how face masks help keep us safe from catching Covid-19 by taking readers on a journey through a mask to see how they block aerosols and droplets.
A lot of the pushback around the efficacy of masks from non-scientists focuses on the size of the droplets and aerosols (super tiny) compared to the gaps between the fibers in the masks (relatively large). Intuitively, it seems like masks don’t stand a chance of stopping anything. But as this visualization shows, multiple layers of fibers do the job quite well. Masks don’t work like sieves, which will let every particle smaller than the holes through the mesh. Instead, imagine shooting a BB gun into a thick stand of trees — no one tree stands a good chance of getting hit by the BB but the forest will stop it eventually.
N95, KN95, and masks made from polypropylene have an extra weapon against particles: the fibers carry an electrostatic charge that attracts particles to trap them. Picture our BB flying through a forest of magnetic trees — it’s got a much better chance of being captured that way.
The visualization also touches on the importance of making sure your mask fits properly. The best masks fit tightly around the edges and include a space around your nose and nostrils. Masks with unfiltered valves should not be used — you’re just breathing virus out into the air. It’s been 8-9 months now that we’ve been dealing with the pandemic and there will be many more months of wearing masks. If your mask is fits poorly around your nose, your straps aren’t tight enough, you need to fuss with it after putting it on, have a mask with a valve, or (god forbid) are still just wearing a bandana, please please do yourself and others a favor and upgrade your mask. High-quality, well-made masks are much easier to find now than 6-8 months ago.1 If you can’t afford a proper mask, email me and I’ll buy you one. Masks are one of the most successful low-tech interventions we can do to prevent the spread of Covid-19, and the better our masks, the more effective they will be.
I am hesitant in recommending particular masks because I am not a doctor or scientist, but you might want to look at Airpop’s masks. I also recently bought some Vida KN95s (but have not worn one yet). My daily mask is this Allett mask that combines a cotton layer with a non-woven polypropylene layer (I wouldn’t wear this on a plane for 4 hours but for 10 minutes in the grocery store in Vermont where community transmission levels are low, it’s fine). It’s more comfortable than a straight KN95 and fits my face perfectly — no “bunching up” gap between the ear loops or around the nose. Disposable surgical masks are very easy to find — they are better than wearing a bandana, valved mask, or even a thin cotton mask.↩
Artists and writers producing work in the streets — including tags, graffiti, murals, stickers, and other installations on walls, pavement, and signs — are in a unique position to respond quickly and effectively in a moment of crisis. Street art’s ephemeral nature serves to reveal very immediate and sometimes fleeting responses, often in a manner that can be raw and direct. At the same time, in the context of a crisis, street art also has the potential to transform urban space and foster a sustained political dialogue, reaching a wide audience, particularly when museums and galleries are shuttered.
From El Pais, this is an excellent visualization of how Covid-19 spreads indoors via aerosols and what can be done to limit that spread. They go through simulations of three different indoor scenarios that are based on actual events — in a home with friends, in a bar at 50% capacity, and in a classroom — and see what happens when differing levels of precautions are applied: masks, ventilation, and limiting exposure time.
Six people get together in a private home, one of whom is infected. Some 31% of coronavirus outbreaks recorded in Spain are caused by this kind of gathering, mainly between family and friends.
Irrespective of whether safe distances are maintained, if the six people spend four hours together talking loudly, without wearing a face mask in a room with no ventilation, five will become infected, according to the scientific model explained in the methodology.
If face masks are worn, four people are at risk of infection. Masks alone will not prevent infection if the exposure is prolonged.
The risk of infection drops to below one when the group uses face masks, shortens the length of the gathering by half and ventilates the space used.
In all three scenarios, note that distancing is largely irrelevant when people gather indoors for longer periods in poorly ventilated areas. From the school example:
In real outbreaks, it has been noted that any of the students could become infected irrespective of their proximity to the teacher as the aerosols are distributed randomly around the unventilated room.
The only thing that’s disappointing about this piece is that it does not stress enough that finding alternatives to indoor activities with lots of people is the much safer course of action than just cracking a window or masking up. Safety step #1 is still being smart about non-essential activities — masks and ventilation are not magically going to protect you during risky activities. Educating our children is important and difficult (though not impossible) to do outside in many places, so yeah, let’s mask up and ventilate those classrooms. But your indoor birthday party with 10 friends or Thanksgiving dinner with the cousins and grandparents? Or dining out in a room full of strangers at a restaurant? Even with masks and ventilation, it’s not a great idea. Scale it down, move it to Zoom/FT, hold it outdoors (distanced, masked), or just skip it.
Paul Krugman writes about the harmful effects of “libertarianism gone bad, a misunderstanding of what freedom is all about” that have been made plain by the Covid-19 pandemic.
But you also see a lot of libertarian rhetoric — a lot of talk about “freedom” and “personal responsibility.” Even politicians willing to say that people should cover their faces and avoid indoor gatherings refuse to use their power to impose rules to that effect, insisting that it should be a matter of individual choice.
Which is nonsense.
Many things should be matters of individual choice. The government has no business dictating your cultural tastes, your faith or what you decide to do with other consenting adults.
But refusing to wear a face covering during a pandemic, or insisting on mingling indoors with large groups, isn’t like following the church of your choice. It’s more like dumping raw sewage into a reservoir that supplies other people’s drinking water.
Public health safety measures don’t have to be bureaucratic, dour, and oppressive. They can even be fun. This is a sign from my local hardware store here in Vermont reminding shoppers to social distance:
A spin studio (aka an indoor gym with stationary bikes) in Hamilton, Ontario is dealing with an outbreak of Covid-19 stemming from one asymptomatic patron that has resulted in 69 positive cases so far, even though the studio “followed the rules”. From the CNN report:
SPINCO, in Hamilton, Ontario, just reopened in July and had all of the right protocols in place, including screening of staff and attendees, tracking all those in attendance at each class, masking before and after classes, laundering towels and cleaning the rooms within 30 minutes of a complete class, said Dr. Elizabeth Richardson, Hamilton’s medical officer of health, in a statement.
Although Hamilton requires masks to be worn in most public settings, the law includes an exemption for anyone “actively engaged in an athletic or fitness activity.” In keeping with that policy, the studio, SPINCO, allowed riders to remove their masks once clipped into their bikes, and told them to cover up again before dismounting.
The problem here is that while the studio may have followed the rules, they were not the right rules. This outbreak appears to be another clear-cut instance of Covid-19 spread by aerosols. A group of people indoors, without masks, breathing heavily, over long periods of time in what I’m guessing is not a properly ventilated room — this is exactly the sort of thing that has been shown over and over again to be problematic.1The science is there, but governments and public health agencies have not caught up with this yet. If you take the transmission by aerosols into account, the rules for gyms (and bars and restaurants) being open is that they should probably not be open at all — or if they are, they should be well-ventilated and the wearing of masks should be mandatory at all times.2 (via @DrEricDing)
To return once again to aerosol expert Jose-Luis Jimenez’s excellent smoke analogy, attending a spin class with an asymptomatic patron who is breathing heavily is like being in a room with someone who is furiously chain-smoking for an hour. Unless that room is extremely well-ventilated, everyone is going to be breathing in so much smoke.↩
And to compensate these businesses for their public service in remaining closed, they should be financially supported by the government. We cannot let these businesses, especially small businesses, and their owners go under, for people to lose their savings or go bankrupt, etc. as they help keep the rest of us safe. If we want to have bars and restaurants and gyms and movie theaters and concert venues on the other side of this pandemic, they have to be compensated for their sacrifice on our behalf.↩
We’re all so goddamned tired of this fucking pandemic and so people are looking at the development and distribution of a vaccine as the thing that’s going to get us out of this (and quick). But realistically, that’s not what’s going to happen. Carl Zimmer wrote about some of the challenges with Covid-19 vaccines.
The first vaccines may provide only moderate protection, low enough to make it prudent to keep wearing a mask. By next spring or summer, there may be several of these so-so vaccines, without a clear sense of how to choose from among them. Because of this array of options, makers of a superior vaccine in early stages of development may struggle to finish clinical testing. And some vaccines may be abruptly withdrawn from the market because they turn out not to be safe.
“It has not yet dawned on hardly anybody the amount of complexity and chaos and confusion that will happen in a few short months,” said Dr. Gregory Poland, the director of the Vaccine Research Group at the Mayo Clinic.
See also Dr. Fauci’s belief that our best case scenario for returning to something close to normal life in the US is late 2021.
On Twitter, Zimmer also commented on something that I hadn’t really thought about: that all of these vaccines in development in the US are only for adults:
I wrote last month that no trials for kids had started. Update: still no US trials for kids. The goal of having shots ready for them by fall 2021 may be slipping further away.
Only if researchers discovered no serious side effects would they start testing them in children, often beginning with teenagers, then working their way down to younger ages. Vaccine developers are keenly aware that children are not simply miniature adults. Their biology is different in ways that may affect the way vaccines work. Because their airways are smaller, for example, they can be vulnerable to low levels of inflammation that might be harmless to an adult.
These trials allow vaccine developers to adjust the dose to achieve the best immune protection with the lowest risk of side effects. The doses that adults and children need are sometimes different — children get smaller doses of hepatitis B vaccines, for example, but bigger doses for pertussis.
You probably hate reading these kinds of articles; I know I do. But facing up to the reality of our situation, particularly here in the US where our political leadership has utterly failed in protecting us from this virus, is much better than burying our heads in the sand — that’s just not mentally healthy.
This is a great piece from Carl Zimmer about how much scientists have learned about SARS-CoV-2 through imaging, including how the virus works and prospects for treatment and a vaccine.
Thanks to the work of scientists like Dr. Li, the new coronavirus, known as SARS-CoV-2, is no longer a cipher. They have come to know it in intimate, atomic detail. They’ve discovered how it uses some of its proteins to slip into cells and how its intimately twisted genes commandeer our biochemistry. They’ve observed how some viral proteins throw wrenches into our cellular factories, while others build nurseries for making new viruses. And some researchers are using supercomputers to create complete, virtual viruses that they hope to use to understand how the real viruses have spread with such devastating ease.
I’ve been watching the lectures for MIT’s online Covid-19 class and the thing that has struck me most is just how much scientists have learned about the SARS-CoV-2 virus in such a short amount of time. To be clear, there are many things that they still do not understand about it (and viruses in general), but scientists know this thing upside down and backwards. The depth and breadth of their knowledge is so impressive and I wish more people were aware of it.
In an article that The Atlantic classifies as “politics” rather than “science” or “medicine”, Olga Khazan explores why, more than 8 months into the pandemic, Americans still have little idea about the safety of gathering with others indoors.
For months now, Americans have been told that if we want to socialize, the safest way to do it is outdoors, the better to disperse the droplets that spew from our mouths whenever we do anything but silently purchase grapefruit. But in many parts of the country, this is the last month that the weather will allow people to spend more than a few minutes outside comfortably. And next month, America will celebrate a holiday that is marked by being inside together and eating while talking loudly to old people.
In a nutshell, the lack of federal support/guidance/action is the main reason why people are still so confused about what safety measures to take to reduce their Covid risk:
Still, Ranney says, this [Covid risk] app is the kind of thing the federal government really should have developed by now. It’s odd that in a wealthy, industrialized country, a random researcher is the one designing a tool to keep citizens safe from public-health threats, using data she scraped from a newspaper.
One thing that Khazan doesn’t really get into is the whole aerosols thing, which in my mind is something that most people are still not familiar with, many local & state governments are not taking into account w/r/t recommended safety measures, and requires different risk guidance about the safety of the indoors than if we were just dealing with fomites & droplets. Again, from the excellent Time magazine piece by aerosol chemist Jose-Luis Jimenez:
When it comes to COVID-19, the evidence overwhelmingly supports aerosol transmission, and there are no strong arguments against it. For example, contact tracing has found that much COVID-19 transmission occurs in close proximity, but that many people who share the same home with an infected person do not get the disease. To understand why, it is useful to use cigarette or vaping smoke (which is also an aerosol) as an analog. Imagine sharing a home with a smoker: if you stood close to the smoker while talking, you would inhale a great deal of smoke. Replace the smoke with virus-containing aerosols, which behave very similarly, and the impact is similar: the closer you are to someone releasing virus-carrying aerosols, the more likely you are to breathe in larger amounts of virus. We know from detailed, rigorous studies that when individuals talk in close proximity, aerosols dominate transmission and droplets are nearly negligible.
If you are standing on the other side of the room, you would inhale significantly less smoke. But in a poorly ventilated room, the smoke will accumulate, and people in the room may end up inhaling a lot of smoke over time. Talking, and especially singing and shouting increase aerosol exhalation by factors of 10 and 50, respectively. Indeed, we are finding that outbreaks often occur when people gather in crowded, insufficiently ventilated indoor spaces, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gyms. Superspreading events, where one person infects many, occur almost exclusively in indoor locations and are driving the pandemic. These observations are easily explained by aerosols, and are very difficult or impossible to explain by droplets or fomites.
The science is there — it’s the lack of connection between scientists, public health experts & officials, and the government that continues to be a problem.
With a very effective vaccine ready in Nov/Dec, distributed widely, and if lots of people take it (i.e. the best case scenario), the earliest we could return to “normal life” in the world is the end of 2021.
At the New Yorker Festival earlier in the week, Michael Specter asked him about a return to normalcy and Fauci elaborated a bit more on this timeline (starts ~10:22 in the video).
When are we gonna get back to something that closely resembles, or is in fact, normal as we knew it?
We’re already making doses, tens and hundreds of millions of doses to be ready, first at least, in graded numbers at the end of the year in November/December. By the time we get to April, we likely will have doses to be able to vaccinate anybody who needs to be vaccinated. But logistically by the time you get everybody vaccinated, it likely will not be until the third or even the beginning of the fourth quarter of 2021.
So let’s say we get a 70% effective vaccine, which I hope we will get, but only 60% of the people get vaccinated. There are going to be a lot of vulnerable people out there, which means that the vaccine will greatly help us to pull back a bit on the restrictions that we have now to maintain good public health, but it’s not going to eliminate things like mask wearing and avoiding crowds and things like that.
So I think we can approach normality, but I don’t think we’re going to be back to normal until the end of 2021. We may do better than that; I hope so but I don’t think so.
Leaving aside what “normal” might mean and who it actually applies to,1 there’s some good news and bad news in there. The good news is, they’re already producing doses of the vaccine to be ready if and when the phase 3 trials are successful. Ramping up production before the trials conclude isn’t usually done because it’s a waste of money if the trials fail, but these vaccines are so critical to saving lives that they’re spending that money to save time. That’s great news.
The bad news is that we’re not even halfway through the pandemic in the best case scenario. We’re going to be wearing masks in public for at least another year (and probably longer than that). Large gatherings of people (especially indoors) will continue to be problematic — you know: movie theaters, concerts, clubs, bars, restaurants, schools, and churches — and folks staying within small pods of trusted folks will likely be the safest course of action.
A change in national leadership in both the executive branch and Senate could change the outlook for the better. We could get some normalcy back even without a vaccine through measures like a national mask mandate/distribution, a real national testing & tracing effort, taking aerosol transmission seriously, and easing the economic pressure to “open back up” prematurely. We’re never going to do as well as Vietnam or Taiwan, but I’d settle for Greece or Norway.
Topol: When do you think we’ll see pre-COVID life restored?
Rivers: I wish I knew. I’m thinking toward the end of 2021. It’s really hard to say with any certainty. We should all be mentally prepared to have quite a bit ahead of us.
It’s America. If we know anything by now about this country, it’s that access to healthcare and economic opportunity is going to apply unevenly to the people who live here. For instance, it’s likely that Black & brown communities, which have been disproportionately affected by the pandemic, may face difficulty in getting access to vaccines compared to wealthier, predominantly white communities.↩
Back in June, in a post called Jesus Christ, Just Wear a Face Mask!, I presented a bunch of evidence and arguments for wearing face masks to prevent the spread of Covid-19. Even then it was pretty clear that masks were working. In piece published by Nature yesterday, Lynne Peeples summarizes what the data and science currently says about the effectiveness of wearing face masks. Here is her one-sentence summary:
To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease.
And importantly, even ardently pro-mask scientists agree that masks should be worn in conjunction with taking other precautions: limiting large gatherings, maintaining distance, limiting the time you spend indoors with others, etc.
On Sunday in Washington DC, a group called Covid Survivors for Change set up 20,000 chairs in front of the White House to represent the 210,000 people who have died from Covid-19 in the United States.1 Each chair represents about 10 people who have died and their collective emptiness represents both the loss felt by the families & loved ones of those who have died and the feckless, hollow response of the federal government to the suffering.
I’m going to point out once again that whenever you see a number in the media for Covid-19 deaths, that’s the official count. But if you look at the excess mortality in the United States during the period in question, the true death toll is significantly higher. “For example, the US suffered some 260,000 more deaths than the five-year average between 1 March and 16 August, compared to 169,000 confirmed COVID-19 deaths during that period.”↩
In secrecy over the past several months, filmmaker Alex Gibney has been making a documentary film about the US government’s response to the Covid-19 pandemic called Totally Under Control. He and co-directors Ophelia Harutyunyan and Suzanne Hillinger interviewed “countless scientists, medical professionals, and government officials on the inside” to produce the film.
Academy Award-winning filmmaker Alex Gibney, directing with Ophelia Harutyunyan and Suzanne Hillinger, interrogates this question and its devastating implications in Totally Under Control. With damning testimony from public health officials and hard investigative reporting, Gibney exposes a system-wide collapse caused by a profound dereliction of Presidential leadership.
Gibney previously directed Enron: The Smartest Guys in the Room, Going Clear, and Zero Days (all excellent documentaries). The film comes out in theaters on October 13 and on Hulu on October 20.
A group of scientists who believe that WHO and the CDC are being too slow in acknowledging the role of aerosol transmission in spreading Covid-19 have written up a Google Doc of advice for the public: FAQs on Protecting Yourself from COVID-19 Aerosol Transmission.
The goal of these FAQs is to provide information to the general public in an efficient manner about how to prevent aerosol transmission of COVID-19, with the hope that this will allow more informed decision making by individuals or organizations. All of this information has been posted in Twitter and other forums, but can be difficult to find. Having multiple experts working together, and having the ability to update this information also improves its quality. These FAQs represent our best understanding at this time, and should always be similar or more stringent than information provided by CDC, WHO, and most regional & local health authorities. If your authority has a more stringent guideline than discussed here, follow that more stringent guideline.
The group was organized by chemist Jose-Luis Jimenez, who has been studying aerosols for 20 years. You may remember Jimenez from his excellent piece in Time magazine, where he used the analogy of smoke to explain aerosol transmission. Here’s a snippet from the FAQ, highlighting something I’ve been concerned about lately: people wearing face shields instead of masks and employees in stores not wearing masks behind plexiglass shields:
7.13. Are face shields and masks interchangeable? No, face shields do not offer much protection against aerosols (also see this video), while masks do. Face shields are good for blocking ballistic droplets released by the wearer or that might fly into the wearer’s face when close to others. Face shields are considered a supplement to masks for partial eye protection (but less useful than closed glasses, as discussed above), but not a substitute for them.
7.14. Are plexiglass barriers helpful?
Plexiglass barriers are generally useful to avoid direct droplet infection and direct aerosol transmission whenever people are in close proximity and distance cannot be kept. Therefore, it is recommended to use them as a direct transmission suppression tool at such places, such as a supermarket checkout.
However, as aerosols follow the air movements indoors, the protective effects of the plexiglas barriers against aerosols will be limited. Plexiglas barriers alone are not a sufficient approach to protect against aerosol transmission. Their installation alone cannot protect against indoor aerosol transmission and should not be regarded as safe and sufficient protection.
We update the document all the time. We’re effectively having to be a little WHO or CDC. We’re saying the things that they should be saying. This is frustrating, but it’s the situation we find ourselves in. These organizations have been flat-out refusing to consider if aerosol transmission is important, which leaves people unprotected. So we feel it’s our duty to communicate directly with the public.
Zeynep Tufekci says that we are paying too much attention to the R value of SARS-CoV-2 (basically the measure of its contagiousness) and not nearly enough attention to the k value (“whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once”).
There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious. Overdispersion and super-spreading of this virus is found inresearchacross the globe. A growing number of studies estimate that a majority of infected people may not infect a single other person. A recent paper found that in Hong Kong, which had extensive testing and contact tracing, about 19 percent of cases were responsible for 80 percent of transmission, while 69 percent of cases did not infect another person. This finding is not rare: Multiplestudies from the beginning have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of transmission, and that many people barely transmit it.
In an overdispersed regime, identifying transmission events (someone infected someone else) is more important than identifying infected individuals. Consider an infected person and their 20 forward contacts-people they met since they got infected. Let’s say we test 10 of them with a cheap, rapid test and get our results back in an hour or two. This isn’t a great way to determine exactly who is sick out of that 10, because our test will miss some positives, but that’s fine for our purposes. If everyone is negative, we can act as if nobody is infected, because the test is pretty good at finding negatives. However, the moment we find a few transmissions, we know we may have a super-spreader event, and we can tell all 20 people to assume they are positive and to self-isolate-if there is one or two transmissions, it’s likely there’s more exactly because of the clustering behavior. Depending on age and other factors, we can test those people individually using PCR tests, which can pinpoint who is infected, or ask them all to wait it out.
Part of the problem is that dispersion and its effects aren’t all that intuitive.
Overdispersion makes it harder for us to absorb lessons from the world because it interferes with how we ordinarily think about cause and effect. For example, it means that events that result in spreading and non-spreading of the virus are asymmetric in their ability to inform us. Take the highly publicized case in Springfield, Missouri, in which two infected hairstylists, both of whom wore masks, continued to work with clients while symptomatic. It turns out that no apparent infections were found among the 139 exposed clients (67 were directly tested; the rest did not report getting sick). While there is a lot of evidence that masks are crucial in dampening transmission, that event alone wouldn’t tell us if masks work. In contrast, studying transmission, the rarer event, can be quite informative. Had those two hairstylists transmitted the virus to large numbers of people despite everyone wearing masks, it would be important evidence that, perhaps, masks aren’t useful in preventing super-spreading.
Hannah Beech reports on how the United States1 is perceived by the outside world these days due to our poor response to the Covid-19 pandemic and the continuing failure of our political system.
Myanmar is a poor country struggling with open ethnic warfare and a coronavirus outbreak that could overload its broken hospitals. That hasn’t stopped its politicians from commiserating with a country they think has lost its way.
“I feel sorry for Americans,” said U Myint Oo, a member of parliament in Myanmar. “But we can’t help the U.S. because we are a very small country.”
The same sentiment prevails in Canada, one of the most developed countries. Two out of three Canadians live within about 60 miles of the American border.
“Personally, it’s like watching the decline of the Roman Empire,” said Mike Bradley, the mayor of Sarnia, an industrial city on the border with Michigan, where locals used to venture for lunch.
And I had to chuckle at this part:
“The U.S.A. is a first-world country but it is acting like a third-world country,” said U Aung Thu Nyein, a political analyst in Myanmar.
I made a similar observation after a trip to Asia in January: “America is a rich country that feels like a poor country.” I got a bunch of pushback on that statement but after the past eight months, the pandemic has laid America’s deficiencies bare for the whole world to see clearly.
Even the name of the damn country seems like a hilarious anachronism these days. States, sure. But united? Lol.↩
As winter approaches in North America and Europe, cities should be thinking about how to encourage and enable people to spend as much time outdoors as possible to help keep everyone sane and safe from Covid-19. From a great piece in CityLab by Alexandra Lange:
Dress in layers, invest in silk and wool long underwear, get over your prejudice against parkas. Many people do this as a matter of course when gearing up for a day of skiing or a turn around the ice rink. But in cities, people dress for the destination, not the journey. “People dress saying, I’m going from my home to this business. What’s the least amount of clothing I can wear for the tolerance of walking x feet?” says Simon O’Byrne, senior vice president of community development for global design consultancy Stantec. “We have to switch that, and dress to loiter.”
O’Byrne, who is also co-chair of the WinterCity Advisory Council, adds, “Stickiness encourages people outside. Moscow does year-round farmers markets. The artists’ community has been pulverized by Covid. As much as we can, we should embrace things to help the local artists, community.” He suggests commissioning visual artists to illuminate dark spaces, via murals or light installations, and hiring musicians for distanced outdoor concerts.
Cities should also invest in places to loiter. All of those outdoor restaurants that are supporting local businesses and bringing liveliness back to the streets? In New York City, at least, they are scheduled to shut down at the end of October, while the mayor and governor bicker over indoor dining. But cities need to catch up to ski areas, which long ago figured out how to make après ski activities like outdoor bars and music venues as much of an attraction as the slopes. Wind breaks (with openings above and below for ventilation), patio heaters and sun orientation can all take outdoor dining further into 2020. WinterCity’s Four Season Patio Design Tips also include higher insulation value materials, like wood or straw bales rather than metal seating, as well as simple solutions like blankets, which offer customers the winter equivalent of being able to reposition your chair in the sun — though that works year-round.
And indeed, NYC just announced that the increased outdoor dining that the city has allowed during the pandemic will become “permanent and year-round”.
Tens of thousands of parking spaces will be permanently repurposed from free private vehicle storage for use by the city’s struggling restaurant owners as part of a revolution in public space unleashed on Friday by Mayor de Blasio.
On WNYC’s “Ask the Mayor” segment, Hizzoner revealed that restaurants would be allowed to occupy curbside spaces - which more than 10,000 are already doing — for outdoor dining, not just through the coronavirus pandemic, but all year and, apparently, forever.
It may turn out to be the single biggest conversion of public space since, well, since car drivers commandeered the curbside lane for free overnight vehicle storage in the 1950s.
But whatever measures are taken, they need to be inclusive for the diverse populations that live in cities. Here’s Lange again, who spends several paragraphs in her piece on this issue:
Snow clearance has become an ongoing political issue for winter cities, with disabled people, the elderly, and parents and caregivers arguing that sidewalks and crossings deserve the same priority as cars, lest people be essentially trapped in their homes. Many physically disabled people have already had their mobility limited during quarantine due to pre-existing health risks, the inability to avoid using elevators and the difficulty of maintaining social distancing. Temporary urban design changes also need to be inclusive.
In the next day or two, the official number of people who have died from Covid-19 in the United States will pass 200,000 (the actual death toll passed 200,000 back in July). To mark the grim occasion yesterday, the Washington National Cathedral tolled its mourning bell 200 times in remembrance, once for each 1000 people who have died.
We toll this 12-ton bell for every funeral held at the Cathedral. Funerals mourn the loss, but they also celebrate the lives of our loved ones, and point us to the hope of resurrection.
This gesture cannot replace the lives lost, but we hope it will help each American mourn the toll of this pandemic.
The tolling goes on for more than 19 minutes and you hear a number of deaths equal to 9/11 every 17 seconds. I recommend listening as long as you are able, to remember those who have been lost, and to inspire action so that 200,000 more Americans don’t have to die before this is all over.
NY governor Andrew Cuomo enlisted actor Paul Rudd to do a public service announcement about the benefits of wearing a mask during the pandemic. Rudd, who often looks like he hasn’t aged a day in the past 20 years but is actually 51 years old, is in total “how do you do fellow kids” mode in this video, deploying some totally plausible youth lingo in an effort to get his fellow youths to mask up.
I’ve never read or seen any of the Dunes (Herbert’s book, David Lynch’s movie, or even Jodorowsky’s Dune) but I have very fond memories of the video game Dune II and will watch anything that Denis Villeneuve makes, so I’m definitely going to check this out when it’s released…let’s see….on December 18, 2020 in theaters? WTF?
Ok, so just watch the trailer if that’s what you’re here for, but I remain baffled that movie theaters are a) currently open (Tenet was showing in 2810 US theaters last weekend) and b) slated to still be open in December in a country trapped in a pandemic death spiral. Easy testing w/ quick results and contact tracing, the twin keys to controlling the virus, are still a mess. A safe & tested vaccine that’s distributed widely by the end of the year? I wouldn’t hold my breath. And you’re going to put a bunch of people who are laughing and gasping together in a room for two-plus hours with a virus that’s airborne1 and assume they’re going to stay properly masked up (except for when they are eating popcorn and nachos!) and properly distant from each other? (Have you met Americans?!) Even if you assume that movie theater screening rooms are huge & well-ventilated (some definitely are not) and capacity is restricted, I repeat: What The Fuck? And in terms of societal trade-offs, reopening places where people gather indoors for entertainment is more important than ensuring our kids can safely go to school? *extreme hair-tearing-out noise*
Update: Aaaaand the Dune release has been delayed until Oct 2021. Between the Trump debacle2 and the CDC acknowledging that the virus may spread through aerosols, I feel like people are coming around to the idea that indoor gatherings, entertainment, and dining are going to be problematic for several more months.
Along with the lack of testing and tracing, the evidence that the virus can be transmitted through aerosols is the important bit here. Most people and organizations are still acting as though it’s not airborne because the measures would be different if they were taking that into account. See this expert’s advice about movie-going for example — there’s not a single mention of aerosols in the entire piece, so it’s tough for me to take it seriously.↩
Coronation is a feature-length documentary film by Ai Weiwei about the lockdown in Wuhan, China, during the initial Covid-19 outbreak in early 2020. The trailer is not super compelling tbh, but it’s Ai Weiwei and the description sounds interesting:
The film showcases the incredible speed and power of China’s state machinery with its construction of massive coronavirus hospitals, deployment of roving sanitation-fogging robots, implementation of an exhaustive testing and contact-tracing protocol, and punctiliously engineered protective measures for health workers.
On the other side of the scale is the crushing bureaucracy of that same machine, its totalitarian decision-making, clear deception of ordinary citizens, the absence of civic communication, and perhaps, worst of all, a cold-eyed lack of empathy for those suffering loss and kept away from home.
Ai Weiwei paints a moving and revelatory portrait not just of China’s response to the pandemic but also of ordinary people in Wuhan, showing how they personally cope with the disaster.
For Vanity Fair, novelist Jesmyn Ward writes about losing her husband just before the pandemic descended on America. She begins:
My Beloved died in January. He was a foot taller than me and had large, beautiful dark eyes and dexterous, kind hands. He fixed me breakfast and pots of loose-leaf tea every morning. He cried at both of our children’s births, silently, tears glazing his face. Before I drove our children to school in the pale dawn light, he would put both hands on the top of his head and dance in the driveway to make the kids laugh. He was funny, quick-witted, and could inspire the kind of laughter that cramped my whole torso.
Too many view protective measures as all or nothing: Either we do everything, or we might as well do none. That’s wrong. Instead, we need to see that all our behavior adds up.
Each decision we make to reduce risk helps. Each time we wear a mask, we’re throwing some safety on the pile. Each time we socialize outside instead of inside, we’re throwing some safety on the pile. Each time we stay six feet away instead of sitting closer together, we’re throwing some safety on the pile. Each time we wash our hands, eat apart and don’t spend time in large gatherings of people, we’re adding to the pile.
If the pile gets big enough, we as a society can keep this thing in check.
The article was published before today’s news that three PSG players — Neymar, Angel Di Maria, and Leandro Paredes — have tested positive for Covid-19 after returning from a vacation on Ibiza, but this could have easily been written in response:
To keep the pile big enough, though, we need to be willing to trade some activities for others. If people want to play on a sports team, for instance, they should consider giving something up to do so. Increasing their risk by participating in a group activity should prompt them to reduce their risk the rest of the time.
But we aren’t very good at discussing trade-offs. We want it all. We want to eat in restaurants, crowd into houses, go to work and celebrate occasions en masse.
We could choose to engage in just some of those things. We could decide to get a massage or get our nails done or have a haircut — instead of demanding that all of these and more be available to us simultaneously.
And this is just generally true:
If Americans were willing to invest in bigger-picture solutions, we could all have nicer things.
And this. This. THIS!! (sorry) THISSSSS!!!!:::
Instead of asking why we can’t do certain activities, we might consider what we’re willing to give up to do them more safely. Even better, we might even consider what we’re willing to give up so others can do them, too.
MIT’s biology department is offering a new online class this fall called COVID-19, SARS-CoV-2 and the Pandemic. The class will be led by Richard Young and Facundo Batista and will include guest lectures by several leading authorities on Covid-19, coronaviruses, epidemiology, and immune systems like Anthony Fauci, Michael Mina, and Akiko Iwasaki. Here’s the course description and syllabus.
Lectures by leading experts on the fundamentals of coronavirus and host cell biology, immunology, epidemiology, clinical disease, and vaccine and therapeutic development.
The first class is today, Sept 1st, at 11:30am ET and meets on Tuesday through December 8. Lectures are via live video but will be archived if you miss a class. There’s no homework or outside reading (it’s just the lectures), no pre-requisites needed, and it’s a 1-credit pass/fail exploratory course, so despite the source and subject matter, it should be fairly accessible. I’m taking the course and will let you know how it goes! (thx, meg)
Update: Here’s an archive of the first lecture by Bruce Walker of the Ragon Institute.
The memorial will be located on the edge of an urban waterfront, accessible only by a long pedestrian walkway. At the center of the platform, an open void to the ocean beneath allows people to observe nature. It is designed to allow a high percentage of the structure to be pre-assembled for on-site assembly, minimizing the impact on the natural environment. The large, circular structure will serve as a “sensory experience that bridges the gap between the urban and natural worlds, creating an ideal environment for introspection.”
Chemist Jose-Luis Jimenez writing for Time magazine: COVID-19 Is Transmitted Through Aerosols. We Have Enough Evidence, Now It Is Time to Act. In it, he argues that while much of the early attention has been on fomites (surface contamination) and droplets as pathways for spreading Covid-19, tranmission by aerosols may be more significant. His analogy of smoke makes it quite easy to understand:
When it comes to COVID-19, the evidence overwhelmingly supports aerosol transmission, and there are no strong arguments against it. For example, contact tracing has found that much COVID-19 transmission occurs in close proximity, but that many people who share the same home with an infected person do not get the disease. To understand why, it is useful to use cigarette or vaping smoke (which is also an aerosol) as an analog. Imagine sharing a home with a smoker: if you stood close to the smoker while talking, you would inhale a great deal of smoke. Replace the smoke with virus-containing aerosols, which behave very similarly, and the impact is similar: the closer you are to someone releasing virus-carrying aerosols, the more likely you are to breathe in larger amounts of virus. We know from detailed, rigorous studies that when individuals talk in close proximity, aerosols dominate transmission and droplets are nearly negligible.
Thinking of smoke can help guide our actions:
The visual analogy of smoke can help guide our risk assessment and risk reduction strategies. One just has to imagine that others they encounter are all smoking, and the goal is to breathe as little smoke as possible. But COVID-19 is not very contagious under most situations, unlike, for example, measles: the CDC says that 15 minutes of close proximity to a COVID-19 infected person often leads to contagion, which provides an estimate of how much “exhaled smoke” one may need to inhale for infection. Inhaling a little whiff of “smoke” here and there is OK, but a lot of “smoke” for a sustained period of time and without a mask is risky. (To be clear, actual smoke does not increase the probability of infection.)
In thinking about aerosolized Covid, Jimenez recommends avoiding crowds & indoor spaces and cutting down on proximity & duration, among other things.
We should continue doing what has already been recommended: wash hands, keep six feet apart, and so on. But that is not enough. A new, consistent and logical set of recommendations must emerge to reduce aerosol transmission. I propose the following: Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration, Unmasked, Talking/singing/Yelling (“A CIViC DUTY”). These are the important factors in mathematical models of aerosol transmission, and can also be simply understood as factors that impact how much “smoke” we would inhale.
But what about masks? N95s can block most aerosols but cloth masks have “huge” holes in them relative to aerosol particles, right? They still work in lowering risk (but not eliminating it!) because your “smoke” doesn’t travel as far when you’re wearing a mask and it filters incoming smoke (if your mask fits correctly and you’re keeping your distance).
Second, masks are essential, even when we are able to maintain social distance. We should also pay attention to fitting masks snugly, as they are not just a parapet against ballistic droplets, but also a means to prevent “smoke” from leaking in through gaps. We should not remove masks to talk, nor allow someone who is not wearing a mask to talk to us, because we exhale aerosols 10 times as much when talking compared to breathing. Everyone should be careful to not stand behind someone with a poorly fitting mask, as the curvature of an ill-fitting mask can cause aerosols to travel behind the person wearing it.
Great article, full of common sense advice backed up by science.
Lauren Nichols has been sick with COVID-19 since March 10, shortly before Tom Hanks announced his diagnosis and the NBA temporarily canceled its season. She has lived through one month of hand tremors, three of fever, and four of night sweats. When we spoke on day 150, she was on her fifth month of gastrointestinal problems and severe morning nausea. She still has extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog. Even writing an email can be hard, she told me, “because the words I think I’m writing are not the words coming out.” She wakes up gasping for air twice a month. It still hurts to inhale.
As Yong says in a thread about the article: “The pandemic is going to create a large wave of chronically disabled people.” Once again for the people in the back: this is not just the flu. The flu does not incapacitate otherwise healthy people like this. I know at least two long-haulers personally and am astounded on a daily basis by how casually some Americans continue to regard Covid-19.
More than 90 percent of long-haulers whom Putrino has worked with also have “post-exertional malaise,” in which even mild bouts of physical or mental exertion can trigger a severe physiological crash. “We’re talking about walking up a flight of stairs and being out of commission for two days,” Putrino said. This is the defining symptom of myalgic encephalomyelitis, or chronic fatigue syndrome. For decades, people with ME/CFS have endured the same gendered gaslighting that long-haulers are now experiencing. They’re painfully familiar with both medical neglect and a perplexing portfolio of symptoms.
You can read Seabiscuit author Laura Hillenbrand’s excellent article on her chronic fatigue syndrome diagnosis and how difficult it is for people with chronic conditions like this to get the right diagnosis and to get family and friends to believe what’s going on.
Also, Yong should win all the awards this year for his pandemic coverage. It has been simply outstanding.
Isolation does funny things to people. Just ask designer Lydia Cambron, who recognized a certain kinship between the themes of her lockdown in Brooklyn this spring and Stanley Kubrick’s 2001: A Space Odyssey. Over the course of two months, Cambron meticulously recreated 2001’s ending scene in her apartment, not only shot-by-shot but nearly look-by-look, and produced a tiny masterpiece of her own.
The adapted version delineates the passing of time through wardrobe rather than age, identifying each phase of the character’s journey with a product of self care or PPE. Tools of private entertainment or self betterment are also used as props, questioning our confidence in products and productivity as anchors during times of uncertainty. Multitasking while #wfh, conjuring guilt or longing with unused exercise equipment, your entire being reduced to a measure of time — these scenes all illustrate the absurd comedy of trying to maintain control during this unprecedented and unpredictable time.
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