From an April 17th Facebook post by Paul Field, a succinct summary of how the pandemic exposes American deficiencies. It’s tough to not just quote the whole thing, so here’s the beginning:
Everyone is entitled to their own opinion, but you need to know how silly you look if you post some variation of, “Welcome to Socialism…”
You are not seeing Socialism. What you are seeing is one of the wealthiest, geographically advantaged, productive capitalist societies in the world flounder and fail at its most basic test. Taking care of its people.
This crisis is not about the virus.
This crisis is about the massive failure of our, “Booming economy,” to survive even modest challenges. It is about the market dissonance of shortages in stores, even as farmers/producers destroy unused crops and products. This crisis is about huge corporations needing an emergency bailout within days of the longest Bull Market in our history ending and despite the ability to borrow with zero percent interest rates.
The pandemic has revealed that American democracy and our economic system is extremely fragile. Ok, unless you’re wealthy, in which case you’re going to be fine, all part of the plan, etc.
Several countries have had solid responses to the Covid-19 pandemic: Taiwan, South Korea, New Zealand, and Hong Kong. But Indi Samarajiva thinks we should be paying much more attention to Mongolia, a country of 3.17 million people where no one has died and no locally transmitted cases have been reported.1 Let’s have that again: 3.17 million people, 0 local cases, 0 deaths. How did they do it? They saw what was happening in Wuhan, coordinated with the WHO, and acted swiftly & decisively in January.
Imagine that you could go back in time to January 23rd with the horse race results and, I dunno, the new iPhone. People believe you. China has just shut down Hubei Province, the largest cordon sanitaire in human history. What would you scream to your leaders? What would you tell them to do?
You’d tell them that this was serious and that it’s coming for sure. You’d tell them to restrict the borders now, to socially distance now, and to get medical supplies ready, also now. You’d tell them to react right now, in January itself. That’s 20/20 hindsight.
That’s exactly what Mongolia did, and they don’t have a time machine. They just saw what was happening in Hubei, they coordinated with China and the WHO, and they got their shit together fast. That’s their secret, not the elevation. They just weren’t dumb.
When you go to World In Data’s Coronavirus Data Explorer and click on “Mongolia” to add their data to the graph, nothing happens because they have zero reported cases and zero deaths. They looked at the paradox of preparation — the idea that “when the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction” — and said “sign us up for the overreacting!”
Throughout February, Mongolia was furiously getting ready - procuring face masks, test kits, and PPE; examining hospitals, food markets, and cleaning up the city. Still no reported cases. Still no let-up in readiness. No one was like “it’s not real!” or “burn the 5G towers!”
The country also suspended their New Year celebrations, which are a big deal in Asia. They deployed hundreds of people and restricted intercity travel to make sure, though the public seemed to broadly support the move.
Again — and I’ll keep saying this until March — there were still NO CASES. If you want to know how Mongolia ended up with no local cases, it’s because they reacted when there were no local cases. And they kept acting.
For example, when they heard of a case across the border (ie, not in Mongolia) South Gobi declared an emergency and put everyone in masks. The center also shut down coal exports — a huge economic hit, which they took proactively.
As you can see, at every turn they’re reacting like other countries only did when it was too late. This looked like an over-reaction, but in fact, Mongolia was always on time.
I have to tell you true: I got really upset reading this. Like crying and furious. The United States could have done this. Italy could have done this. Brazil could have done this. Sweden could have done this. England could have done this. Spain could have done this. Mongolia listened to the experts, acted quickly, and kept their people safe. Much of the rest of the world, especially the western world — the so-called first-world countries — failed to act quickly enough and hundreds of thousands of people have needlessly died and countless others have been left with chronic health issues, grief, and economic chaos.
If you look at the list of cases at the bottom of this article (translated by Google), you can see that every reported case is from people coming into the country who were tested and quarantined.↩
That’s the front page of the NY Times today, listing the names of hundreds of the nearly 100,000 Americans who have died from Covid-19 (the full listing is of ~1000 names and continues inside the paper).
Here’s a more readable PDF version and an online version that scrolls and scrolls and scrolls. They compiled the list by going through obituaries from local newspapers from around the countries.
Putting 100,000 dots or stick figures on a page “doesn’t really tell you very much about who these people were, the lives that they lived, what it means for us as a country,” Ms. Landon said. So, she came up with the idea of compiling obituaries and death notices of Covid-19 victims from newspapers large and small across the country, and culling vivid passages from them.
Alain Delaquérière, a researcher, combed through various sources online for obituaries and death notices with Covid-19 written as the cause of death. He compiled a list of nearly a thousand names from hundreds of newspapers. A team of editors from across the newsroom, in addition to three graduate student journalists, read them and gleaned phrases that depicted the uniqueness of each life lost:
“Alan Lund, 81, Washington, conductor with ‘the most amazing ear’ … “
“Theresa Elloie, 63, New Orleans, renowned for her business making detailed pins and corsages … “
“Florencio Almazo Morán, 65, New York City, one-man army … “
“Coby Adolph, 44, Chicago, entrepreneur and adventurer … “
Every one of these names was a person with a whole life behind them and so much more to come. Each has a family and friends who are mourning them. Here are a few more of their names and short stories:
Romi Cohn, 91, New York City, saved 56 Jewish families from the Gestapo.
Jermaine Ferro, 77, Lee County, Fla., wife with little time to enjoy a new marriage.
Julian Anguiano-Maya, 51, Chicago, life of the party.
Alan Merrill, 69, New York City, songwriter of “I Love Rock ‘n’ Roll.”
Lakisha Willis White, 45, Orlando, Fla., was helping to raise some of her dozen grandchildren.
In the past five months, more Americans have died from Covid-19 than in the decade-plus of the Vietnam War and the death toll is a third of the number of Americans who died in World War II. When this is over (whatever that means), the one thing we cannot do is forget all of these people. And we owe to them to make this mean something.
As summer ramps up in North America, people are looking to get out to enjoy the weather while also trying to keep safe from Covid-19 infection. Here in Vermont, I am very much looking forward to swim hole season and have been wondering if swimming is a safe activity during the pandemic. The Atlantic’s Olga Khazan wrote about the difficulty of opening pools back up this summer:
The coronavirus can’t remain infectious in pool water, multiple experts assured me, but people who come to pools do not stay in the water the entire time. They get out, sit under the sun, and, if they’re like my neighbors, form a circle and drink a few illicit White Claws. Social-distancing guidelines are quickly forgotten.
“If someone is swimming laps, that would be pretty safe as long as they’re not spitting water everywhere,” says Angela Rasmussen, a virologist at Columbia University. “But a Las Vegas-type pool party, that would be less safe, because people are just hanging out and breathing on each other.”
“There is no data that somebody got infected this way [with coronavirus],” said professor Karin B. Michels, chair of UCLA’s Department of Epidemiology, in a recent interview.
“I can’t say it’s absolutely 100% zero risk, but I can tell you that it would never cross my mind to get COVID-19 from a swimming pool or the ocean,” said Paula Cannon, a professor of molecular microbiology and immunology at USC’s Keck School of Medicine. “It’s just extraordinarily unlikely that this would happen.”
As long as you keep your distance of course:
Rather than worry about coronavirus in water, UCLA’s Michels and USC’s Cannon said, swimmers should stay well separated and take care before and after entering the pool, lake, river or sea.
“I would be more concerned about touching the same lockers or surfaces in the changing room or on the benches outside the pool. Those are higher risk than the water itself,” Michels said. “The other thing is you have to maintain distance. … More distance is always better.”
After 2+ months of lockdown in most areas, a small minority of Americans want our country to go back to “normal” despite evidence and expert advice to the contrary. They want to get haircuts, not wear masks in public, go to crowded beaches, and generally go about their lives. These folks couch their desires in terms of freedom & liberty: the government has no right to infringe on the individual freedoms of its citizens.
In response to these vehement appeals to individual freedom, public-health leaders in London, Liverpool, Manchester and elsewhere developed a powerful counterargument. They too framed their argument in terms of freedom — freedom from disease. To protect citizens’ right to be free from disease, in their view, governments and officials needed the authority to isolate those who were sick, vaccinate people, and take other steps to reduce the risk of infectious disease.
One of the most important reformers was George Buchanan, the chief medical officer for England from 1879 to 1892. He argued that cities and towns had the authority to take necessary steps to ensure the communal “sanitary welfare.” He and other reformers based their arguments on an idea developed by the 19th-century English philosopher John Stuart Mill, who is, ironically, remembered largely as a staunch defender of individual liberty. Mill articulated what he called the “harm principle,” which asserts that while individual liberty is sacrosanct, it should be limited when it will harm others: “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty and action of any of their number, is self-protection,” Mill wrote in On Liberty in 1859. Public-health reformers argued that the harm principle gave them the authority to pursue their aims.
An essay published in The Lancet in 1883 sums up this view nicely: “We cannot see that there is any undue violation of personal liberty in the sanitary authority acting for the whole community, requiring to be informed of the existence of diseases dangerous to others. A man’s liberty is not to involve risk to others,” the author wrote. “A man with smallpox has the natural liberty to travel in a cab or an omnibus; but society has a right that overrides his natural liberty, and says he shall not.”
In these times of COVID-19, there are the usual suspects: shortenings like “sanny” (hand sanitizer) and “iso” (isolation), abbreviations like BCV (before corona virus) and WFH (working from home), also compounds “corona moaner” (the whingers) and “zoombombing” (the intrusion into a video conference).
Plenty of nouns have been “verbed” too — the toilet paper/pasta/tinned tomatoes have been “magpied”. Even rhyming slang has made a bit of a comeback with Miley Cyrus lending her name to the virus (already end-clipped to “the Miley”). Some combine more than one process — “the isodesk” (or is that “the isobar”) is where many of us are currently spending our days.
“I’ve got the Miley”…I’ve always been a fan of rhyming slang. Linguist Tony Thorne, who specializes in slang & jargon, has compiled a list of new language introduced to (and by) the general public because of the pandemic.
Quarantimes - a hashtag or label for the prevailing circumstances under lockdown due to the coronavirus pandemic
Rona, Lady Rona, roni, rone - the coronavirus personified/familiarised
Boomer remover - the coronavirus viewed as a phenomenon resulting in the decimation of the baby boomer demographic
Covidiot - a person behaving irresponsibly in conditions of containment
Recent polling compiled by Randall Munroe indicates that Americans agree on what to do about the Covid-19 pandemic to a greater extent than they “feel positively about kittens” or even “enjoy apple pie”.
There are a lot of different lenses you can use to look at how the United States and its government have confronted the Covid-19 pandemic. Race is a particularly useful one. As a reminder, here’s America’s current operating racial contract (from an Atlantic piece by Adam Serwer):
The implied terms of the racial contract are visible everywhere for those willing to see them. A 12-year-old with a toy gun is a dangerous threat who must be met with lethal force; armed militias drawing beads on federal agents are heroes of liberty. Struggling white farmers in Iowa taking billions in federal assistance are hardworking Americans down on their luck; struggling single parents in cities using food stamps are welfare queens. Black Americans struggling in the cocaine epidemic are a “bio-underclass” created by a pathological culture; white Americans struggling with opioid addiction are a national tragedy. Poor European immigrants who flocked to an America with virtually no immigration restrictions came “the right way”; poor Central American immigrants evading a baroque and unforgiving system are gang members and terrorists.
Serwer goes on to argue that the recently shifting American response to the pandemic, primarily in conservative circles, is due to an increasing awareness of which groups are bearing the brunt of the crisis: black and Latino Americans.
That more and more Americans were dying was less important than who was dying.
The disease is now “infecting people who cannot afford to miss work or telecommute-grocery store employees, delivery drivers and construction workers,” The Washington Post reported. Air travel has largely shut down, and many of the new clusters are in nursing homes, jails and prisons, and factories tied to essential industries. Containing the outbreak was no longer a question of social responsibility, but of personal responsibility. From the White House podium, Surgeon General Jerome Adams told “communities of color” that “we need you to step up and help stop the spread.”
This is a response that America is quite comfortable with because it fits with our racial contract, under which Jim Crow never actually ended. The US isn’t the only place this is happening btw. Early on, Singapore was praised for its response to the pandemic, but their reliance on and mistreatment of an underclass of migrant workers caused a secondary surge in cases.
Singapore is a small city-state with a population of just under 6 million inhabitants. On a per capita basis, it’s the second-richest country in Asia.
But its economy relies heavily on young men from Bangladesh, India and other countries who work jobs in construction and manufacturing. Singapore has no minimum wage for foreign or domestic employees. The foreign workers’ salaries can be as low as US$250 per month, but a typical salary is $500 to $600 a month.
It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That’s what’s going to happen with a lockdown.
As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I’ve said before, if you don’t solve the biology, the economy won’t recover.
But since things are opening up anyway (whether epidemiologists like it or not), Bromage goes through a number of scenarios you might potentially find yourself in over the next few months and what the associated risks might be. His guiding principle is that infection is caused by exposure to the virus over time — increase the time or the exposure and your risk goes up. For example, public bathrooms might give you a ton of exposure to the virus over a relatively short period of time:
Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
But being in the same room with another person simply breathing may not carry a large risk if you limit the time.
A single breath releases 50-5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.
But that time would drop sharply if the person is speaking:
Speaking increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.
Again, this is all indoors. Being in enclosed spaces with other humans, particularly if they are poorly ventilated, is going to hold higher risks for the foreseeable future.
The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. (Ref)
Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections). (ref)
The Michael Pollan version of advice for socializing during the pandemic might be: Spend time with people, not too much, mostly masked and outdoors.
As someone who suspects I may have had a mild case of Covid-19 a couple of months ago, I’ve been thinking about getting tested for antibodies. But as this video from ProPublica shows, even really accurate tests may not actually tell you all that much.
For patients getting tested, the main concern is how to interpret the outcome: If I test negative with an RT-PCR genetic test, what are the chances I actually have the virus? Or if I test positive with an antibody test, does it actually mean I have the antibodies?
It turns out that the answers to these questions don’t just hinge on the accuracy of the test. “Mathematically, the way that works out, that actually depends on how many people in your area have Covid,” Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, said.
The rarer the disease in the population, the less you’ll learn by testing.
Let’s say we have a hypothetical Covid-19 test for antibodies that is both 99 percent sensitive — meaning almost all people with antibodies will test positive — and 99 percent specific, meaning almost all people who were never infected will yield a negative result.
If you test a group of 100 uninfected people, odds are one of them will still test positive even though they don’t have the virus. Conversely, if you test 100 people who were infected, it’s likely one of them will still test negative.
Now let’s presume the virus has a prevalence rate of 1 percent, so one person in 100 carries antibodies to it. If you test 100 random people and get a positive result, what is the chance that this person was truly infected?
Deborah Birx, the White House Covid-19 response coordinator, explained the answer at a press conference on April 20: “So if you have 1 percent of your population infected and you have a test that’s only 99 percent specific, that means that when you find a positive, 50 percent of the time will be a real positive and 50 percent of the time it won’t be.”
So even if I test positive for antibodies and I assume that confers immunity, given that the number of confirmed infections in Vermont is so low (~900 statewide), it doesn’t seem like I would be justified in changing my behavior at all. I would still have to act as though I’ve never had the virus, both for my own health and the health of those around me. Maybe if I had two or three corroborating tests could I be more certain…
From Nature’s David Cyranoski, a piece that takes a look at what the latest research says about SARS-CoV-2, where it came from, and how it is able to infect the human body. I’m going to highlight a few things from the article I thought were particularly interesting. As Cyranoski has done throughout, I’d like to stress that because this virus is so new to us and the situation is moving so quickly, many of these results are based on preliminary research, have been published in pre-print papers, and haven’t been peer-reviewed.
The first is about the detective work being done to trace where SARS-CoV-2 came from and how long it’s been in existence (possibly decades).
But studies released over the past few months, which have yet to be peer-reviewed, suggest that SARS-CoV-2 — or a very similar ancestor — has been hiding in some animal for decades. According to a paper posted online in March, the coronavirus lineage leading to SARS-CoV-2 split more than 140 years ago from the closely related one seen today in pangolins. Then, sometime in the past 40-70 years, the ancestors of SARS-CoV-2 separated from the bat version, which subsequently lost the effective receptor binding domain that was present in its ancestors (and remains in SARS-CoV-2). A study published on 21 April came up with very similar findings using a different dating method.
The section on how the virus acts in the body is particularly interesting because it attempts to explain the unusual and varying behaviors SARS-CoV-2 exhibits and causes in different parts of the human body. For example, SARS-CoV-2, unusually, can initially infect two places in the body: the throat and lungs.
Having these two infection points means that SARS-CoV-2 can mix the transmissibility of the common cold coronaviruses with the lethality of MERS-CoV and SARS-CoV. “It is an unfortunate and dangerous combination of this coronavirus strain,” he says.
The virus’s ability to infect and actively reproduce in the upper respiratory tract was something of a surprise, given that its close genetic relative, SARS-CoV, lacks that ability. Last month, Wendtner published results of experiments in which his team was able to culture virus from the throats of nine people with COVID-19, showing that the virus is actively reproducing and infectious there. That explains a crucial difference between the close relatives. SARS-CoV-2 can shed viral particles from the throat into saliva even before symptoms start, and these can then pass easily from person to person. SARS-CoV was much less effective at making that jump, passing only when symptoms were full-blown, making it easier to contain.
These differences have led to some confusion about the lethality of SARS-CoV-2. Some experts and media reports describe it as less deadly than SARS-CoV because it kills about 1% of the people it infects, whereas SARS-CoV killed at roughly ten times that rate. But Perlman says that’s the wrong way to look at it. SARS-CoV-2 is much better at infecting people, but many of the infections don’t progress to the lungs. “Once it gets down in the lungs, it’s probably just as deadly,” he says.
And this is a somewhat hopeful speculation on one of the many possible ways the Covid-19 pandemic could go:
“By far the most likely scenario is that the virus will continue to spread and infect most of the world population in a relatively short period of time,” says Stöhr, meaning one to two years. “Afterwards, the virus will continue to spread in the human population, likely forever.” Like the four generally mild human coronaviruses, SARS-CoV-2 would then circulate constantly and cause mainly mild upper respiratory tract infections, says Stöhr. For that reason, he adds, vaccines won’t be necessary.
Some previous studies support this argument. One showed that when people were inoculated with the common-cold coronavirus 229E, their antibody levels peaked two weeks later and were only slightly raised after a year. That did not prevent infections a year later, but subsequent infections led to few, if any, symptoms and a shorter period of viral shedding.
The OC43 coronavirus offers a model for where this pandemic might go. That virus also gives humans common colds, but genetic research from the University of Leuven in Belgium suggests that OC43 might have been a killer in the past.
But then, from a few paragraphs down:
People like to think that “the other coronaviruses were terrible and became mild”, says Perlman. “That’s an optimistic way to think about what’s going on now, but we don’t have evidence.”
For now, it’s just another thing we don’t know about this virus we learned about only 5 months ago. It’s a long road ahead, but I’m thankful that so many scientists are bent on making sense of it all.
The plan is to have no plan, to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible — by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by “flooding the zone with shit,” Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call “search costs” for reliable intelligence.
Stated another way, the plan is to default on public problem solving, and then prevent the public from understanding the consequences of that default. To succeed this will require one of the biggest propaganda and freedom of information fights in U.S. history, the execution of which will, I think, consume the president’s re-election campaign.
While his actions often have complex effects, Trump has never been a complicated person. This “plan” fits with what we know about Trump’s personality & behavior, plays to his strengths by relying on reactions & tactics and not strategy, is consistent with Occam’s razor, allows his administration to continue pursuing his aggressive agenda (restricting immigration, strengthening big business, weakening public institutions, enriching himself, consolidating power, getting re-elected), and whips his base into a frenzy. As Dave Eggers put it in a satirical opinion piece for the NY Times:
Having no plan is the plan! Haven’t you been listening? Plans are for commies and the Danish. Here we do it fast and loose and dumb and wrong, and occasionally we have a man who manufactures pillows come to the White House to show the president encouraging texts. It all works! Eighteen months, 800,000 deaths, no plan, states bidding against states for medicine and equipment, you’re on your own, plans are lame.
There’s no galaxy brain here, only a twitchy muscle attached to a frayed nerve.
This too-short profile of Pulitzer Prize-winning journalist Laurie Garrett, who has been writing about epidemics since the 90s, is closer to my personal feelings as to how the pandemic plays out in the US than almost anything else I’ve read.
But she can’t envision that vaccine anytime in the next year, while Covid-19 will remain a crisis much longer than that.
“I’ve been telling everybody that my event horizon is about 36 months, and that’s my best-case scenario,” she said.
“I’m quite certain that this is going to go in waves,” she added. “It won’t be a tsunami that comes across America all at once and then retreats all at once. It will be micro-waves that shoot up in Des Moines and then in New Orleans and then in Houston and so on, and it’s going to affect how people think about all kinds of things.”
They’ll re-evaluate the importance of travel. They’ll reassess their use of mass transit. They’ll revisit the need for face-to-face business meetings. They’ll reappraise having their kids go to college out of state.
Much of the federal government’s response has been to help big business, and the wealthy are going to have opportunities to not only ride out the storm more easily but to take advantage:
If America enters the next wave of coronavirus infections “with the wealthy having gotten somehow wealthier off this pandemic by hedging, by shorting, by doing all the nasty things that they do, and we come out of our rabbit holes and realize, ‘Oh, my God, it’s not just that everyone I love is unemployed or underemployed and can’t make their maintenance or their mortgage payments or their rent payments, but now all of a sudden those jerks that were flying around in private helicopters are now flying on private personal jets and they own an island that they go to and they don’t care whether or not our streets are safe,’ then I think we could have massive political disruption.”
I could quote something from just about every paragraph, but for now I’ll just do one more excerpt and you can go and read the rest.
Garrett recounted her time at Harvard. “The medical school is all marble, with these grand columns,” she said. “The school of public health is this funky building, the ugliest possible architecture, with the ceilings falling in.”
“That’s America?” I asked.
“That’s America,” she said.
See also Dave Eggers’ pandemic Q&A, which shares a certain pessimistic honesty with Garrett’s thoughts.
Creative technologist Nicky Case and epidemiologist Marcel Salathé have teamed up to produce a concise but thorough playable explainer about important epidemiological concepts, how we could/should respond to the Covid-19 pandemic, and different scenarios about what the next few years could look like.
If you’ve been keeping up with the various models and experts’ plans (test/trace/isolate, etc.), there’s not a lot new here until close to end, but it is pretty comprehensive and the playable simulations are really useful. The whole thing takes about 30 minutes to get through, but at the end, you will have an excellent simplified understanding of what this virus could do to us and what we can do to mitigate its effects.
Isolating symptomatic cases would reduce R by up to 40%, and quarantining their pre/a-symptomatic contacts would reduce R by up to 50%:
Thus, even without 100% contact quarantining, we can get R < 1 without a lockdown! Much better for our mental & financial health. (As for the cost to folks who have to self-isolate/quarantine, governments should support them — pay for the tests, job protection, subsidized paid leave, etc. Still way cheaper than intermittent lockdown.)
The problem with this explainer, as excellent as it is, is the problem with all of these plans: many government officials on both the state & federal level don’t seem interested in listening to the experts. It is also unclear — if the unmasked crowds gathering in American cities during this past weekend’s warm weather are any indication — that Americans will be willing to take the steps necessary to keep each other safe. I’m not sure what it’s going to take to address those situations, but I don’t think playable graphs are going to help that much.
As Ed Yong notes in his helpful overview of the pandemic, this is such a huge and quickly moving event that it’s difficult to know what’s happening. Lately, I’ve been seeking information on Covid-19’s presenting symptoms after seeing a bunch of anecdotal data from various sources.
In the early days of the epidemic (January, February, and into March), people were told by the CDC and other public health officials to watch out for three specific symptoms: fever, a dry cough, and shortness of breath. In many areas, testing was restricted to people who exhibited only those symptoms. Slowly, as more data is gathered, the profile of the presenting symptoms has started to shift. From a New York magazine piece by David Wallace-Wells on Monday:
While the CDC does list fever as the top symptom of COVID-19, so confidently that for weeks patients were turned away from testing sites if they didn’t have an elevated temperature, according to the Journal of the American Medical Association, as many as 70 percent of patients sick enough to be admitted to New York State’s largest hospital system did not have a fever.
Over the past few months, Boston’s Brigham and Women’s Hospital has been compiling and revising, in real time, treatment guidelines for COVID-19 which have become a trusted clearinghouse of best-practices information for doctors throughout the country. According to those guidelines, as few as 44 percent of coronavirus patients presented with a fever (though, in their meta-analysis, the uncertainty is quite high, with a range of 44 to 94 percent). Cough is more common, according to Brigham and Women’s, with between 68 percent and 83 percent of patients presenting with some cough — though that means as many as three in ten sick enough to be hospitalized won’t be coughing. As for shortness of breath, the Brigham and Women’s estimate runs as low as 11 percent. The high end is only 40 percent, which would still mean that more patients hospitalized for COVID-19 do not have shortness of breath than do. At the low end of that range, shortness of breath would be roughly as common among COVID-19 patients as confusion (9 percent), headache (8 to 14 percent), and nausea and diarrhea (3 to 17 percent).
Recently, as noted by the Washington Post, the CDC has changed their list of Covid-19 symptoms to watch out for. They now list two main symptoms (cough & shortness of breath) and several additional symptoms (fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell). They also note that “this list is not all inclusive”. Compare that with their list from mid-February.
In addition, there’s evidence that children might have different symptoms (including stomach issues or diarrhea), doctors are reporting seeing “COVID toes” on some patients, and you might want to look at earlier data from thesethreestudies about symptoms observed in Wuhan and greater China.
The reason I’m interested in this shift in presenting symptoms is that on the last day or two of my trip to Asia, I got sick — and I’ve been wondering if it was Covid-19.
Here’s the timeline: starting on Jan 21, I was in Saigon, Vietnam for two weeks, then in Singapore for 4 days, and then Doha, Qatar for 48 hours. The day I landed in Doha, Feb 9, I started to feel a little off, and definitely felt sick the next day. I had a sore throat, headache, and congestion (stuffy nose) for the first few days. There was also some fatigue/tiredness but I was jetlagged too so… All the symptoms were mild and it felt like a normal cold to me. Here’s how I wrote about it in my travelogue:
I got sick on the last day of the trip, which turned into a full-blown cold when I got home. I dutifully wore my mask on the plane and in telling friends & family about how I was feeling, I felt obliged to text “***NOT*** coronavirus, completely different symptoms!!”
I flew back to the US on Feb 11 (I wore a mask the entire time in the Doha airport, on the plane, and even in the Boston airport, which no one else was doing). I lost my sense of taste and smell for about 2 days, which was a little unnerving but has happened to me with past colds. At no point did I have even the tiniest bit of fever or shortness of breath. The illness did drag on though — I felt run-down for a few weeks and a very slight cough that developed about a week and a half after I got sick lingered for weeks.
According to guidance from the WHO, CDC, and public health officials at the time, none of my initial symptoms were a match for Covid-19. I thought about getting a test or going to the doctor, but in the US in mid-February, and especially in Vermont, there were no tests available for someone with a mild cold and no fever. But looking at the CDC’s current list of symptoms — which include headache, sore throat, and new loss of taste or smell — and considering that I’d been in Vietnam and Singapore when cases were reported in both places, it seems plausible to me that my illness could have been a mild case of Covid-19. Hopefully it wasn’t, but I’ll be getting an antibody test once they are (hopefully) more widely available, even though the results won’t be super reliable.
While not as common as other symptoms, loss of smell was the most highly correlated with testing positive, as shown with odds ratios below, after adjusting for age and gender. Those with loss of smell were more likely to test positive for COVID-19 than those with a high fever.
Seeing this makes me think more than ever that I had it. I had three of the top five symptoms, plus an eventual cough (the most common symptom) and a loss of smell & taste (the most highly correlated symptom). The timing of the onset of my symptoms (my first day in Qatar) indicates that I probably got infected on my last day in Vietnam, in transit from Vietnam to Singapore (1 2-hr plane ride, 2 airports, 1 taxi, 1 train ride), or on my first day in Singapore. But I went to so many busy places during that time that it’s impossible to know where I might have gotten infected (or who I then went on to unwittingly infect).
Update: A few weeks ago, I noticed some horizontal lines on several of my toenails, a phenomenon I’d never seen before. When I finally googled it, I discovered they’re called Beau’s lines and they can show up when the body has been stressed by illness or disease. Hmm. From the Wikipedia page:
Some other reasons for these lines include trauma, coronary occlusion, hypocalcaemia, and skin disease. They may be a sign of systemic disease, or may also be caused by an illness of the body, as well as drugs used in chemotherapy, or malnutrition. Beau’s lines can also be seen one to two months after the onset of fever in children with Kawasaki disease.
Conditions associated with Beau’s lines include uncontrolled diabetes and peripheral vascular disease, as well as illnesses associated with a high fever, such as scarlet fever, measles, mumps and pneumonia.
From the estimated growth of my nails, it seems as though whatever disruption that caused the Beau’s lines happened 5-6 months ago, which lines up with my early February illness that I believe was Covid-19. Covid-19 can definitely affect the vascular systems of infected persons. Kawasaki disease is a vascular disease and a similar syndrome in children resulting from SARS-CoV-2 exposure is currently under investigation. And here’s a paper from December 1971 that tracked the development of Beau’s lines in several people who were ill during the 1968 flu pandemic (an H3N2 strain of the influenza A virus) — coronaviruses and influenza viruses are different but this is still an indicator that viruses can result in Beau’s lines. “Covid toe” has been observed in many Covid-19 patients. Harvard dermatologist and epidemiologist Dr. Esther Freeman reports that people may be experiencing hair loss due to Covid-19.
I couldn’t find any scientific literature about the possible correlation of Covid-19 and Beau’s lines, but I did find some suggestive anecdotal information. I found several people on Twitter who noticed lines in their nails (both fingers and toes) and who also have confirmed or suspected cases of Covid-19. And if you go to Google’s search bar and type “Beau’s lines c”, 3 of the 10 autocomplete suggestions are related to Covid-19, which indicates that people are searching for it (but not enough to register on Google Trends).
But I am definitely intrigued. Are dermatologists and podiatrists seeing Beau’s lines on patients who have previously tested positive for Covid-19? Have people who have tested positive noticed them? Email me at [email protected] if you have any info about this; I’d love to get to the bottom of this.
You charted how your homes, neighborhoods, cities and countries have transformed under social distancing and stay-at-home orders around the planet, from daily work routines and the routes of your “sanity walks,” to the people you miss and the places you fled.
While most used markers, pens, and computer-based drawing tools to sketch maps by hand, some used watercolors, clay, and photography. Some were humorous, others heart-wrenching - between them all, a full spectrum of quarantine-era emotion emerged.
For the cover of this week’s New Yorker, Chris Ware drew several vignettes of NYC arranged in his trademark grid as a companion to this incredible piece about a single day of the Covid-19 crisis in the city. About the cover, Ware wrote:
Teeming with unpredictable people and unimaginable places and unforeseeable moments, life there is measured not in hours but in densely packed minutes that can fill up a day with a year’s worth of life. Lately, however, closed up in our homes against a worldwide terror, time everywhere has seemed to slur, to become almost Groundhog Day-ish, forced into a sort of present-perfect tense — or, as my fellow New Yorker contributor Masha Gessen more precisely put it, ‘loopy, dotted, and sometimes perpendicular to itself.’ But disaster can also have a recalibrating quality. It reminds us that the real things of life (breakfast, grass, spouse) can, in normal times, become clotted over by anxieties and nonsense. We’re at low tide, but, as my wife, a biology teacher, said to me this morning, “For a while, we get to just step back and look.” And really, when you do, it is pretty marvellous.
In early March, Dr. Caroline Schulman was responsible for calling patients at her hospital to tell them they had tested positive for Covid-19. She shared some of her experiences in a piece for Stat.
Erik lives with his entire family in a one-room rental house with eight other occupants. He didn’t understand the precautions for preventing the spread of Covid-19 and had regularly been socializing in the apartment. He kept asking how to file for unemployment and how to isolate the household when the house itself could barely hold those living in it.
Jeff lives alone. He has a chronic blood condition and is struggling to get by. A few hours before we talked, he had resumed his job as a ride share driver because he needed to make ends meet.
Angela is 40 years old and has one of the preexisting conditions that put people at high risk for serious complications of Covid-19. When we spoke, she told me that she was feeling better, but that her home life was difficult. Her children had returned home after Mayor Muriel Bowser issued a stay-at-home order for the District of Columbia. She asked her kids to take precautions, but they continued to leave the house often. One son brought home his girlfriend, who had a cough, and displaced Angela from her room. She was unable to make an appointment with her primary doctor and couldn’t afford her medical supplies because of insurance issues. When I spoke with her, she sounded well and had no classic symptoms, but something didn’t sound right. I arranged a televisit that afternoon to have her evaluated more closely. By the time she got the call two hours later, she was so short of breath she could barely speak. When an ambulance arrived to take her to the hospital, her oxygen levels were dangerously low.
Reading through these stories, I just kept thinking about the measures that are going to be necessary if we’re going to safely restart public life in America — hygiene, mask wearing, some social distancing, and eventually a vaccine — and how our collective safety is going to depend on individuals doing the right thing. And most people will. But it’s clear that, especially without coherent national leadership & economic support, some people will be unable to take the necessary precautions for economic reasons and others won’t because they don’t understand why these measures are necessary, don’t trust science, or a dozen other reasons.
From director Robert Bingaman, a video interpretation of a timely passage from John Donne’s Devotions upon Emergent Occasions, which was written by Donne in 1623 while recovering from a serious illness. The passage is from Meditation XVII and is paired in the video with images of businesses and public places emptied out by the pandemic.
No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.
In the self-submitted videos, people dance, play music, take us on a tour of their refrigerator, and introduce us to their pets. Edited together, these intimate moments create a synchronicity of humanity — a feeling of togetherness that’s difficult to conjure when you’re sequestered at home.
Hackman, the film’s composer, wrote sheet music that he distributed to musicians across the world. When he received their recordings, Hackman combined the performances to create an original score.
“Roadmap to Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society,” lays out how a massive scale-up of testing, paired with contact tracing and supported isolation, can rebuild trust in our personal safety and re-mobilize the U.S. economy.
Among the report’s top recommendations is the need to deliver at least 5 million tests per day by early June to help ensure a safe social opening. This number will need to increase to 20 million tests per day by mid-summer to fully re-mobilize the economy.
What we need to do is much bigger than most people realize. We need to massively scale-up testing, contact tracing, isolation, and quarantine-together with providing the resources to make these possible for all individuals.
Broad and rapid access to testing is vital for disease monitoring, rapid public health response, and disease control.
We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further. By the time we know if we need to do that, we should be in a better position to know how to do it. In any situation, achieving these numbers depends on testing innovation.
Between now and August, we should phase in economic mobilization in sync with growth in our capacity to provide sustainable testing programs for mobilized sectors of the workforce.
The great value of this approach is that it will prevent cycles of opening up and shutting down. It allows us to steadily reopen the parts of the economy that have been shut down, protect our frontline workers, and contain the virus to levels where it can be effectively managed and treated until we can find a vaccine.
We can have bottom-up innovation and participation and top-down direction and protection at the same time; that is what our federal system is designed for.
This policy roadmap lays out how massive testing plus contact tracing plus social isolation with strong social supports, or TTSI, can rebuild trust in our personal safety and the safety of those we love. This will in turn support a renewal of mobility and mobilization of the economy. This paper is designed to educate the American public about what is emerging as a consensus national strategy.
Unfortunately for this plan and for all of us, I have a feeling that the first true step in any rational plan to reopen the United States without unnecessary death and/or massive economic disruption that lasts for years is the removal of Donald Trump from office (and possibly also the end of the Republican-controlled Senate). Barring that, the ineffectual circus continues. (via @riondotnu)
As part of the One World: Together at Home fundraiser organized by the WHO, Global Citizen, and Lady Gaga that raised $127.9 million for Covid-19 relief efforts, the members of the Rolling Stones, each in their own home, got together via video to perform You Can’t Always Get What You Want. It’s a lovely messy & spare performance and the choice of song is timely — plenty of people around the world are definitely not getting what they want right now, but hopefully we will eventually end up getting what we need.
Thousands of scientific research papers on Covid-19 and SARS-CoV-2 are being published each week and with them comes a clearer picture of the virus and the disease it causes. There’s still a lot we don’t know, but this piece from Science magazine is the best synthesis of the emerging science that I have read. It details a virus that “acts like no microbe humanity has ever seen” and affects not only the lungs but also the kidneys, heart, brain, and the intestines.
As the number of confirmed cases of COVID-19 surges past 2.2 million globally and deaths surpass 150,000, clinicians and pathologists are struggling to understand the damage wrought by the coronavirus as it tears through the body. They are realizing that although the lungs are ground zero, its reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain.
“[The disease] can attack almost anything in the body with devastating consequences,” says cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is leading multiple efforts to gather clinical data on COVID-19. “Its ferocity is breathtaking and humbling.”
Understanding the rampage could help the doctors on the front lines treat the fraction of infected people who become desperately and sometimes mysteriously ill. Does a dangerous, newly observed tendency to blood clotting transform some mild cases into life-threatening emergencies? Is an overzealous immune response behind the worst cases, suggesting treatment with immune-suppressing drugs could help? What explains the startlingly low blood oxygen that some physicians are reporting in patients who nonetheless are not gasping for breath? “Taking a systems approach may be beneficial as we start thinking about therapies,” says Nilam Mangalmurti, a pulmonary intensivist at the Hospital of the University of Pennsylvania (HUP).
I’ve been hearing that although Covid-19’s attack begins in the lungs, it is as much a vascular disease as it is a respiratory disease — and there is some evidence emerging to support this view:
If COVID-19 targets blood vessels, that could also help explain why patients with pre-existing damage to those vessels, for example from diabetes and high blood pressure, face higher risk of serious disease. Recent Centers for Disease Control and Prevention (CDC) data on hospitalized patients in 14 U.S. states found that about one-third had chronic lung disease-but nearly as many had diabetes, and fully half had pre-existing high blood pressure.
Mangalmurti says she has been “shocked by the fact that we don’t have a huge number of asthmatics” or patients with other respiratory diseases in HUP’s ICU. “It’s very striking to us that risk factors seem to be vascular: diabetes, obesity, age, hypertension.”
What struck me most about this piece is the sheer energy of the vast network of minds bent towards understanding this thing with the hope of beating it as soon as possible. This is the scientific method at work right here, in all its urgent & messy glory.
A few weeks ago, the Washington Post interviewed Scott Z. Burns, who wrote the screenplay for Contagion, Steven Soderbergh’s film about a bat-borne illness that starts a global pandemic. What’s most striking about the interview is how outlandish Burns finds certain aspects of the Covid-19 pandemic, so ridiculous in fact that people would find them implausible if this were a fictional story.
I would have never imagined that the movie needed a “bad guy” beyond the virus itself. It seems pretty basic that the plot should be humans united against the virus. If you were writing it now, you would have to take into account the blunders of a dishonest president and the political party that supports him. But any good studio executive would have probably told us that such a character was unbelievable and made the script more of a dark comedy than a thriller.
Unsurprising that this movie doesn’t work — the screenplay was a dog’s breakfast.
So much heavy handed foreshadowing. The apocalyptic footage from Wuhan, the super villain American president, the whistleblower dying, the Russia/China border closed while people still claimed it was just a flu, the warnings unheeded. Insulting to the audience’s intelligence.
And then — that most annoying of horror/disaster movie tropes — the hapless idiots walking into disaster after disaster, all of which the audience can see coming from a mile away.
The over the top details of world leaders and their wives falling ill, the far fetched idea that industrialized countries wouldn’t have proper protective gear for front line workers and ventilators. Pleeeeaaase. This movie needed a script doctor.
It’s interesting that there are certain boundaries in fiction related to the audience’s suspension of disbelief that are are routinely ignored by reality. I’m also reminded of how Margaret Atwood approached The Handmaid’s Tale and The Testaments, using only elements that have historical precedent:
The television series has respected one of the axioms of the novel: no event is allowed into it that does not have a precedent in human history.
And yet some critics consider the events from the novels and TV show to be too much, over-the-top.
While there has been plenty of fiction written about pandemics, I think the biggest difference between those scenarios and our reality is how poorly our government has handled it. If your goal is to dramatize the threat posed by an unknown virus, there’s no advantage in depicting the officials responding as incompetent, because that minimizes the threat; it leads the reader to conclude that the virus wouldn’t be dangerous if competent people were on the job. A pandemic story like that would be similar to what’s known as an “idiot plot,” a plot that would be resolved very quickly if your protagonist weren’t an idiot. What we’re living through is only partly a disaster novel; it’s also — and perhaps mostly — a grotesque political satire.
I am currently blazing through Exhalation (Kindle), Chiang’s collection of science & technology fables. (via @jasondh)
A disease that killed tens of millions of people, more than the number who died in World War I, might not seem like a promising subject for a song, but the legendary Texas bluesman Blind Willie Johnson didn’t see it that way. In Dallas in 1928, Johnson recorded “Jesus Is Coming Soon,” an intense chronicle of the ravaging influenza pandemic of 1918-1919. In a growl that conveyed the horror of the illness, as well as its scarifying ubiquity, Johnson declared that the “great disease was mighty and the people were sick everywhere / It was an epidemic, it floated through the air.”
Other lines seem as if they could have been written yesterday: “Well, the nobles said to the people, ‘You better close your public schools / Until the events of death has ended, you better close your churches, too.’”
At Elmhurst, the improvisation began as soon as the first surge of coronavirus patients started arriving in the middle of March. In order to more efficiently sift through the crowds and find the most severe cases, the staff set up a divider at the entrance. Medical workers armed with thermometers and oxygen monitors steered people with milder symptoms to a separate treatment tent. Those who were seriously ill went into critical care. Thirteen patients at the hospital died over a 24-hour stretch during the fourth week in March. A refrigerated trailer was parked behind the building to store dead bodies.
In a short behind-the-scenes video about his photos and the piece, Montgomery says “I think if the general public could stand where I was for at least 10 to 30 seconds, I think everyone would be staying home.”
Family members weren’t allowed into the hospital because they, too, could get infected or spread the virus to others if they themselves were sick. But Duca asked for permission from his supervisor to let the man’s wife and daughter in, just for a few minutes. “I saw his face when he looked at his wife coming inside this room,” Duca recalls. “He smiled at her. It was a fraction of a second. He had this wonderful smile.” He continues: “Then I saw that he was looking at me. He realized that there was something wrong if only his relatives were coming inside.” The man knew in that instant that he was going to die, Duca says. As the man’s breathing worsened, morphine was started. He died 12 hours later.
Read the whole thing; it’s upsetting, terrifying, and deeply humanizing. I wish Americans watched less TV news and read more — if everyone in the US read these articles, I believe the entire tone of this crisis would change and become more urgent.
Julio Vincent Gambuto writes that the Covid-19 pandemic has given Americans an unprecedented chance to “see ourselves and our country in the plainest of views” and that we should prepare for a coalition of powerful forces that will try to convince us that this whole thing never happened.
Until then, get ready, my friends. What is about to be unleashed on American society will be the greatest campaign ever created to get you to feel normal again. It will come from brands, it will come from government, it will even come from each other, and it will come from the left and from the right. We will do anything, spend anything, believe anything, just so we can take away how horribly uncomfortable all of this feels. And on top of that, just to turn the screw that much more, will be the one effort that’s even greater: the all-out blitz to make you believe you never saw what you saw. The air wasn’t really cleaner; those images were fake. The hospitals weren’t really a war zone; those stories were hyperbole. The numbers were not that high; the press is lying. You didn’t see people in masks standing in the rain risking their lives to vote. Not in America. You didn’t see the leader of the free world push an unproven miracle drug like a late-night infomercial salesman. That was a crisis update. You didn’t see homeless people dead on the street. You didn’t see inequality. You didn’t see indifference. You didn’t see utter failure of leadership and systems.
In Singapore, tape is being used as a sort of architectural element to denote closure of public spaces and promote & enforce proper social distancing practices. The @tape_measures account on Instagram is documenting instances of this practice around the city.
From Juliette Kayyem at The Atlantic: After Social Distancing, a Strange Purgatory Awaits. I’ve been thinking about this stuff a lot over the past few weeks and nodded vigorously along to this whole piece.
Over the past week, I’ve been informally contacting friends and colleagues in a variety of fields — sports, travel, architecture, entertainment, arts, the clergy, and more — to ask them how their world might look after social distancing. The answer: It looks weird.
We will get used to seeing temperature-screening stations at public venues. If America’s testing capacity improves and results come back quickly, don’t be surprised to see nose swabs at airports. Airlines may contemplate whether flights can be reserved for different groups of passengers — either high- or low-risk. Mass-transit systems will set new rules; don’t be surprised if they mandate masks too.
It’s like our timeline has split and an alternate reality awaits us on the other side of the quarantine. All sorts of activities that were considered normal and we did without thinking will now require deliberation.
On dating apps, people will specify (with varying degrees of accuracy) whether they’ve had COVID-19. Casual making out will come to seem reckless. A handshake? Have those test results ready. A friendly hug? I don’t even know your last name.
Our attitudes and outlooks may change in disappointing ways. We will be home a lot more. We’ll also use shaming, against friends and others whom we judge to be taking needless risks, to cultivate better voluntary behavior.
The simplistic idea of “opening up” fails to acknowledge that individual Americans’ risk-and-reward calculus may have shifted dramatically in the past few weeks. Yes, I’d like to go meet some girlfriends for drinks. But I am also a mother with responsibilities to three kids, so is a Moscow mule worth it? The answer will depend on so many factors between my home and sitting at the bar, and none of them will be weighed casually.
I’m wondering — how many people are aware that this is going to be our reality for the next few years? There is no “normal” we’re going back to, only weird uncharted waters.
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