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kottke.org posts about COVID-19

The Pandemic Is a Marathon Without a Finish Line. How Can We Win?

posted by Jason Kottke   Nov 25, 2020

With the positive news about the Covid-19 vaccine trials, I assume many of you have started to think about the potential end of the pandemic — what we’ll do, where we’ll go, who we’ll see, and reckon with what’s changed and what’s been lost. I know I have. Alex Hutchinson has written an intriguing piece on what sports science might be able to tell us about the psychology of a situation like the pandemic, where the finish line is poorly defined, ever-changing, or even non-existent.

As it happens, there’s a whole subfield of sports science, at the intersection of physiology and psychology, that explores this terrain. It’s called teleoanticipation, a term coined in 1996 by German physiologist Hans-Volkhart Ulmer to describe how our knowledge of an eventual endpoint (or telos) influences the entirety of an experience. Using endurance sports as their medium, researchers in this subfield have probed what happens when you hide the finish line, surreptitiously move it or take it away entirely. For those of us tempted by promising vaccine updates to start fantasizing about an end to the pandemic, these researchers have some advice: don’t.

Instead, the key seems to be remaining in the moment instead of focusing on the goal.

It turns out that, if you ask yourself “Can I keep going?” rather than “Can I make it to the finish?” you’re far more likely to answer in the affirmative.

This squares with mindfulness practices from Buddhism and Stoicism but also reminds me of a motivational trick I first heard a few years ago: that you can do anything for 10 seconds — and then you just begin a new 10 seconds. Turns out that was popularized by Unbreakable Kimmy Schmidt. Good advice can come from anywhere.

Imagining a Covid-19 Pandemic Memorial

posted by Jason Kottke   Nov 25, 2020

Covid Memorial

Even though we’re still in the midst of it, The Atlantic commissioned three designers/artists to design hypothetical Covid-19 memorials. Ian Bogost writes:

So this might seem like a strange time to imagine memorializing the pandemic in a formal way. A premature time. Maya Lin’s Vietnam Veterans Memorial was conceived in 1981, six years after the United States had withdrawn from the conflict. Michael Arad and Peter Walker’s 9/11 memorial broke ground at the site of the World Trade Center in 2006, almost five years after the attacks.

But there are downsides to waiting. A traumatic event is an author of its own memorial; as a famous anecdote attests, when a Nazi soldier asked Pablo Picasso if he had made Guernica, the famous painting the artist created during the month following the Luftwaffe’s bombing of its Basque namesake in 1937, Picasso replied, “No, you did.” The feelings, facts, and ideas available during a calamity dissipate as it ebbs. The temptation arises to contain tragedy in a tidy box, closing the book on its history.

Each of the three ideas is intriguing in its own way. I liked how Ronald Rael and Virginia San Fratello (who made those border wall teeter-totters last year) explained their thought process (which Rael elaborated on here).

Quarantine has limited our ability to use smell and touch for communion, so she and Rael became interested in finding a way to replicate the experience. That’s where pennies come in: Copper is an antiviral — a quality with obvious symbolism in the moment — and one that evolves over time, developing a patina as it interacts with water and air. So the pair latched on to it as a material.

Rael San Fratello’s first idea was a pragmatic one: a traditional memorial made of copper molded into a bulbous, organic wall. The copper material would invite the touch lost to quarantine. Outdoors, it could develop a green or purple patina. “If touched constantly,” San Fratello said, “the patina might never occur, and the memorial will remain shiny.”

See also the design for a pandemic memorial already in the planning stages in Uruguay.

A Framework for the Equitable Allocation of a COVID-19 Vaccine

posted by Jason Kottke   Nov 24, 2020

Now that the preliminary results of various Covid-19 vaccine trials are coming out (and looking promising), attention is turning to the eventual distribution of the vaccines. The logistics of getting the doses out to hospitals, clinics, and doctor’s offices is one concern but so is the question of who should get vaccinated first. Supplies of the vaccines will be limited at first, so we’ll need to decide as a society what distribution method is most fair and is of the most benefit to the greatest number of people.

To this end, and in response to a request by the CDC and NIH, the National Academies of Sciences, Engineering, and Medicine formed a committee to produce a report called Framework for Equitable Allocation of COVID-19 Vaccine. The 252-page report is available to the public for free to read online or download.

In addition several recommendations — including that the vaccine be distributed to everyone free of charge — a central feature of the report is a four-phase system of vaccine distribution, summarized in this graphic:

Four-phase framework for the equitable allocation of a COVID-19 vaccine

I’d like to stress that this graphic does not show all groups of people included in each phase — please consult the text of the report for that before you go sharing that graphic on social media without context. For example, here’s the full description for “high-risk health workers” in Phase 1a:

This group includes frontline health care workers (who are in hospitals, nursing homes, or providing home care) who either (1) work in situations where the risk of SARS-CoV-2 transmission is higher, or (2) are at an elevated risk of transmitting the infection to patients at higher risk of mortality and severe morbidity. These individuals — who are themselves unable to avoid exposure to the virus — play a critical role in ensuring that the health system can care for COVID-19 patients.

These groups include not only clinicians (e.g., nurses, physicians, respiratory technicians, dentists and hygienists) but also other workers in health care settings who meet the Phase 1a risk criteria (e.g., nursing assistants, environmental services staff, assisted living facility staff, long-term care facility staff, group home staff, and home caregivers). The health care settings employing these workers who are at increased risk of exposure to the virus may also include ambulatory and urgent care clinics; dialysis centers; blood, organ, and tissue donation facilities; and other non-hospital health care facilities. Finally, there are community and family settings where care for infected patients occurs. Not all the workers in these settings are paid for their labor, but, while they are caring for infected people, they all need to be protected from the virus.

Situations associated with higher risk of transmission include caring for COVID-19 patients, cleaning areas where COVID-19 patients are admitted, treated, and housed, and performing procedures with higher risk of aerosolization such as endotracheal intubation, bronchoscopy, suctioning, turning the patient to the prone position, disconnecting the patient from the ventilator, invasive dental procedures and exams, invasive specimen collection, and cardiopulmonary resuscitation. In addition, there are other frontline health care workers who, if they have uncontrolled exposure to the patients or the public in the course of their work, should be in this initial phase. This group includes those individuals distributing or administering the vaccine — especially in areas of higher community transmission — such as pharmacists, plasma and blood donation workers, public health nurses, and other public health and emergency preparedness workers. The committee also includes morticians, funeral home workers, and other death care professionals involved in handling bodies as part of this high-risk group.

The report declines to list specific industries which would be covered in Phase 2’s “critical workers in high-risk settings” but generally says:

The industries in which these critical workers are employed are essential to keeping society and the economy functioning. Since the beginning of the pandemic, millions of people have been going to work and risking exposure to the virus to ensure that markets have food; drug stores have pharmaceutical products; public safety and order are maintained; mail and packages are delivered; and buses, trains, and planes are operating.

Note also the text at the bottom of the graphic: they recommend that within each phase, priority be given to geographic areas where folks are more socially vulnerable in situations like these (e.g. as represented in the CDC’s Social Vulnerability Index).

In developing this phased approach, the committee focused on those who are at the most risk of exposure, severe illness or death, and passing along the virus to others as well as critical workers:

Risk of acquiring infection: Individuals have higher priority to the extent that they have a greater probability of being in settings where SARS-CoV-2 is circulating and of being exposed to a sufficient dose of the virus.

Risk of severe morbidity and mortality: Individuals have higher priority to the extent that they have a greater probability of severe disease or death if they acquire infection.

Risk of negative societal impact: Individuals have higher priority to the extent that societal function and other individuals’ lives and livelihood depend on them directly and would be imperiled if they fell ill.

Risk of transmitting infection to others: Individuals have higher priority to the extent that there is a higher probability of their transmitting the infection to others.

You should read (or at least skim) the full report for more information about the plan and the rationale behind it.

On a personal parting note, as someone who is squarely in the 5-15% of Americans covered in Phase 4 — more specifically: as a 40-something straight white man who non-essentially works from home, isn’t low-income, doesn’t socialize widely even under normal circumstances, and should probably be the very last person on this whole Earth scheduled to be vaccinated under an equitable framework — I am content to wait my turn should the US adopt this framework or something like it.1 Distributing vaccines to those who need them most is absolutely the right thing to do, both ethically and from the standpoint of getting society “back to normal” as quickly as possible and with as little additional death and suffering as possible.

  1. Being that equity often isn’t America’s thing, especially during the pandemic, I could see this going either way. And even if this framework is adopted, those who can afford it will undoubtably be able to procure themselves a dose right alongside those medical workers in Phase 1a.

Tracking Pre-Pandemic “Lasts” and Post-Lockdown “Firsts”

posted by Jason Kottke   Nov 24, 2020

Giorgia Lupi's hand-drawn 2020 timeline

For the print version of the NY Times from this past Sunday, information designer Giorgia Lupi created a hand-drawn visualization that “tracks the last time [she] did something before the pandemic hit, and the first time she did something new with social distancing”.

Our lives have been transformed during the Covid-19 pandemic as the activities we used to do every day have been put on hold and new, socially distanced routines have taken their place. Pentagram partner Giorgia Lupi documents these changes in her own life in a data visualization commissioned by The New York Times for the cover of its “At Home” section, which runs as part of the newspaper’s Sunday edition. The hand-drawn visualization is a personal timeline that tracks the “last” time Giorgia did something before the pandemic hit, and the “first” time she did something new as she started to emerge from lockdown.

Not hand-drawn, but I remember pretty clearly what my lasts were:

I don’t remember my firsts as well, although one that sticks out is eating french fries (take-out) in July. On a normal day, french fries are delicious but when you haven’t had them in months, they are otherworldly.

Oxford-AstraZeneca’s Covid-19 Vaccine Up to 90% Effective

posted by Jason Kottke   Nov 23, 2020

Preliminary results from the trials of the Covid-19 vaccine jointly developed by the University of Oxford and AstraZeneca indicate that the vaccine’s overall efficacy is 70% but that a regimen that calls for a lower first dose is 90% effective.

The preliminary results on the AstraZeneca vaccine were based on a total of 131 Covid-19 cases in a study involving 11,363 participants. The findings were perplexing. Two full doses of the vaccine appeared to be only 62% effective at preventing disease, while a half dose, followed by a full dose, was about 90% effective. That latter analysis was conducted on a small subset of the study participants, only 2,741.

Hopefully more study will be done on that dosage question. From the AP:

“The report that an initial half-dose is better than a full dose seems counterintuitive for those of us thinking of vaccines as normal drugs: With drugs, we expect that higher doses have bigger effects, and more side-effects,” he said. “But the immune system does not work like that.”

The seemingly lower efficacy comes with some perhaps significant benefits: this vaccine is cheaper to produce and doesn’t require any special refrigeration.

The vaccine can be transported under “normal refrigerated conditions” of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit), AstraZeneca said. By comparison, Pfizer plans to distribute its vaccine using specially designed “thermal shippers” that use dry ice to maintain temperatures of minus-70 degrees Celsius (minus-94 degrees Fahrenheit).

The Pfizer and Moderna vaccines were pretty similar in many respects and this one seems quite different. These results were just released a few hours ago, so it will be interesting to follow the debate and expert commentary on this. Stay tuned…

Update: This is amazing: the seemingly more effective 1/2 dose + full dose regimen was a mistake.

Around the time when Astra was initiating its partnership with Oxford at the end of April, university researchers were administering doses to trial participants in Britain.

They soon noticed expected side effects such as fatigue, headaches or arm aches were milder than expected, he said.

“So we went back and checked … and we found out that they had underpredicted the dose of the vaccine by half,” said Pangalos.

A far smaller number of participants was given the initial half-dose, so more research will need to be done to determine if this mistake will be added to the long list of scientific discoveries made because of errors. There’s a good piece in Nature that talks about what we know and don’t know about the vaccine results so far along with some informed speculation.

But, if the differences are bona fide, researchers are eager to understand why. “I don’t think it’s an anomaly,” says Katie Ewer, an immunologist at Oxford’s Jenner Institute who is working on the vaccine. “I’m keen to get into the lab and start thinking about how we address that question.” She has two leading theories for why a lower first dose might have led to better protection against COVID. It’s possible that lower doses of vaccine do a better job at stimulating the subset of immune cells called T cells that support the production of antibodies, she says.

Another potential explanation is the immune system’s response against the chimpanzee virus. The vaccine triggers an immune response not only to the SARS-CoV-2 spike protein, but also to components of the viral vector. It’s possible that the full first dose blunted this reaction, says Ewer. She plans to look at antibody responses against the chimpanzee virus to help address this question.

Update: A short thread by Dr. Natalie Dean, which leads with “AstraZeneca/Oxford get a poor grade for transparency and rigor when it comes to the vaccine trial results they have reported”.

The Moral Calculus of COVID-19

posted by Tim Carmody   Nov 20, 2020

deep-space.jpg

You may have heard that MSNBC host Rachel Maddow has been quarantining at home following close contact with a person who had tested positive for COVID-19. You may have also heard that last night, Maddow returned to her show (still filming from home) to reveal that this person was her partner of 20+ years, artist/photographer Susan Mikula. Mikula is recovering, but at at least one point, the couple genuinely feared for her life. Maddow herself is still testing negative; with Mikula in much less danger and Maddow nearing the end of quarantine, they felt it was time to open the curtain on their experience.

If you haven’t seen it already, I’d like you to watch the video of Maddow describing her experience of living with a loved one who is suffering from COVID-19, whom you have to care for but cannot touch without grave risk to yourself, and then to others. (It is about Mikula’s own experience, but it’s really much more about Maddow’s experience, for good reason.)

Here’s a quick excerpt, if you want a textual preview (via Vulture):

“Just believe me: Whatever you have calculated into your life as acceptable risk, as inevitable risk, something that you’re willing to go through in terms of this virus because statistically, hey probably, it will be fine for you and your loved ones, I’m just here to tell you to recalibrate that,” [Maddow] warned. “Frankly, the country needs you to recalibrate that because broadly speaking, there’s no room for you in the hospital right now.”

She cites hospitals being overwhelmed with a “50 percent” increase in patients “in two weeks.” While it may be easy to risk your own life, the virus doesn’t let you make the choice. “What you need to know is whoever’s the most important person in your life, whoever you most love and most care for and most cherish in the world, that’s the person who you may lose and who you may spend weeks up all night freaking out about and calling doctors all over the place and over and over again all night long, trying to figure out how to keep that person breathing and out of the hospital,” she said. “Whatever you’re doing, however you’ve calibrated risk in your life, don’t get this thing.”

Another moment worth noting in the video is shortly after she begins. Maddow is interrupted by a recurring beeping noise in a room off-camera. She has to attend to it herself, in the middle of a live television show, because there’s no one else at home who can do it. She takes off her microphone and earpiece, then has to put it back on. After already revealing at the beginning of the show that she’s not wearing makeup—she doesn’t know how to apply it herself, and no one can help her—it’s a nice peek behind the scenes.

I don’t know if everyone always understands how much work it takes it is to perform for live television: how many accessories you need, how much support is required. People don’t see what you have to look like, sound like, or act like; they don’t see the almost cyborg contraption you have to become in order to make a successful television appearance. Being good at television is a specific skill. It’s as different from writing, reporting, or public speaking as football, baseball, and basketball are from playing polo. It doesn’t matter if you have your words on a teleprompter (although that does help): you still have to deliver them, in time, no backsies, and look and sound good while you’re doing it.

The disruption of the show also happens in the middle of a charming metaphor Maddow uses to describe her relationship:

The way that I think about it is not that she is the sun and I’m a planet that orbits her—that would give too much credit to the other planets. I think of it more as a pitiful thing: that she is the planet and I am a satellite, and I’m up there sort of beep-beep-beeping at her and blinking my lights and just trying to make her happy.

Compare this to Farhad Manjoo’s essay in The New York Times today, “I Traced My COVID-19 Bubble and It’s Enormous.” Manjoo starts with a classic dilemma: they know it’s unsafe in general to travel for Thanksgiving, but they wonder if it might be safer for their family, given the size of their social circle and the precautions they’ve taken. They’d like to find out more, to replace their general intuitions, which pull them in both directions, with something more concrete. This is a time-honored journalistic premise (a rhetorical trope, really) for answering a question many people might have.

In researching their close contacts, and their own exposure to other people, Manjoo quickly has cold water thrown on the notion that their bubble is in any way contained to the degree they’d imagined it to be. (This part of the story is well-illustrated: I’ll give you the text excerpts, but it’s worth clicking through and scrolling through yourself.)

I thought my bubble was pretty small, but it turned out to be far larger than I’d guessed.

My only close contacts each week are my wife and kids.

My kids, on the other hand, are in a learning pod with seven other children and my daughter attends a weekly gymnastics class.

I emailed the parents of my kids’ friends and classmates, as well as their teachers, and asked how large each family’s bubble was.

Already, my network was up to almost 40 people.

Turns out a few of the families in our learning pod have children in day care or preschool.

And one’s classmate’s mother is a doctor who comes into contact with about 10 patients each week.

Once I had counted everyone, I realized that visiting my parents for Thanksgiving would be like asking them to sit down to dinner with more than 100 people.

They aren’t actually done counting yet: from themself, they’ve only gone to three degrees of separation. But presumably, the point in the headline is made. The author’s bubble is enormous, and presumably the reader’s is, too.

Then a curious thing happens. Manjoo decides that what they’ve learned doesn’t matter. They thinks their family and their contacts are special after all. “All of my indirect contacts are taking the virus seriously—none of them spun conspiracy theories about the pandemic, or suggested it was no big deal or told me to bug off and mind my own business.” (This is a very low threshold for “taking the virus seriously.”) And they would really like to take their wife and children to see their parents. An epidemiologist gives them some cover, saying their desire to see their parents is understandable, and it’s all a matter of assessing and evaluating risk.

So, they change their mind again. They make a few concessions (drive, not fly; an outdoor meal rather than an indoor one; staying off-site rather than sleeping over). And they’re going to travel five hours each way with their wife and children and their 100+ direct and indirect contacts to celebrate Thanksgiving with their parents.

This is contrarianism on a scale not usually seen in a newspaper article. (They’re usually too short to take this many turns.) It is one thing to counter received wisdom by posing a counterfactual. It is another to spend hours of reporting, gathering facts, calling in experts, putting everything on the record, and then deciding that none of that matters.

On Twitter, I called it “the full Gladwell”; only Malcolm Gladwell at The New Yorker can consistently pull this hairpin twist off and stick the landing, even if he frequently violates good sense and plain facts to do it.

It’s important, though, that this is not just a rhetorical trick. These are the real lives of real people, both in the story itself, and radiating out to its readers and their contacts in a global newspaper, the United States’ paper of record. And the reasoning and evidence that are considered but discarded gives the illusion that this is a choice motivated not by setting reason aside, but considering all options and maximizing one’s expected utility.

Not to “both sides” this, but I’m gonna “both sides” this: in some sense, both Maddow and Manjoo are putting their thumb on the scales, in opposite directions. For Maddow, the experience of almost losing the love of her life makes it so that she would take no willing risk that might endanger her or anyone else. (She acknowledges that a certain amount of unavoidable, unwilling risk remains.)

Manjoo is different. They acknowledge that they have no such experience. They are less concerned with the possible loss of their parents’ lives than the loss of their presence in his life and in their childrens’ lives. They see the willing assumption of risk as an open moral question, and something that can be calculated and appropriately mitigated.

Maddow has constructed a universe where she is a tiny satellite orbiting a much larger planet, whose continued health and existence is the central focus of her concern. Manjoo has drawn a map with themself at its center, where anyone beyond the reach of their telephone falls off the edges.

Maddow is also explicitly pleading with her viewers to learn what they can from her experience, and adjust their behavior accordingly. Manjoo is performing their calculus only for themself; they implicitly present themself as a representative example (while also claiming they and their circle are extraordinarily conscientious and effective), but each reader can draw their own conclusions and make their own decision.

At this point the balancing dominoes tip over. Maddow’s position, her argument, and her example are clearly more moral and more persuasive than Manjoo’s. Manjoo’s essay is worth reading, but the conclusion is untenable. It doesn’t do the work needed to arrive there or persuade anyone else to do the same. And at a time when many people are spinning conspiracies about the pandemic, or claiming that it’s no big deal, and in turn influencing others—when we haven’t even yet considered the virus’s impact on the uncounted number of people, from medical staff and many other essential workers to prisoners and the impoverished, who do not simply get to choose how to spend their holiday—it’s irresponsible.

The larger moral tragedy is that because our leaders have failed, and too often actually worked to damage the infrastructure, expertise, and goodwill accumulated over generations, we have no consistent, authoritative guidance on what we should and should not do. We do not know who to trust. We have no money, no help, and no plan but to wait. We have no sense of what rules our friends and neighbors, colleagues and workers, are following when they’re not in our sight; we don’t even know what practices they would even admit to embracing. We have no money; we have no help. We are left on our own, adrift in deep space, scribbling maps and adding sums on the back of a napkin. We are all in this together, yet we are completely alone.

Update: An earlier version of this post used incorrect pronouns for Farhad Manjoo. Manjoo uses they/them pronouns. I regret the error, which, compunded, led to many errors. —TC

Second Update: Actually, Farhad uses both they/them and he/him pronouns. I am relieved I didn’t inadvertently offend the subject of my post with the first version, and since this one is still correct, I am not changing it back.

A Secret to Vermont’s Pandemic Success

posted by Jason Kottke   Nov 19, 2020

For Vox, Julia Belluz takes a look at the approach that’s made Vermont more successful than most other US states in combatting Covid-19. The big thing? State officials recognized that those most at risk needed more support.

There’s a fatal flaw embedded in the basic Covid-19 test, trace, and isolate trifecta used around the world: It doesn’t account for the fact that the coronavirus is not an equal-opportunity pathogen. The people who are most likely to be tested, and to have the easiest time quarantining or isolating, are also the least likely to get sick and die from the virus.

From the United Kingdom to Sweden to Canada, we have evidence that the virus preys on people employed in “essential service” jobs (bus drivers, nurses, factory workers), which don’t allow for telecommuting or paid sick leave; people in low-income neighborhoods; and people in “congregate housing” like shelters, prisons, and retirement homes.

People of color tend to be overrepresented in these groups — but there’s no biological reason they’re more likely to get sick and die from the virus. Simply put: They tend to work jobs that bring them outside the home and into close contact with other people, live in crowded environments ideal for coronavirus contagion, or both.

The state then directed efforts, resources, and money to nursing homes, the unhoused, prisons, and essential workers to make it easier for those folks to stay safe.

I also thought this bit was really interesting:

There’s a simple adage in public health: “Never do a test without offering something in exchange,” said Johns Hopkins’s Stefan Baral. So when a patient gets tested for HIV, for example, they’re offered treatment, support, or contact tracing. “We’re not just doing the testing to get information but also providing a clear service,” Baral added, and potentially preventing that person from spreading the virus any further. “This is basic public health.”

With Covid-19, the US has failed at basic public health. Across the country, people have been asked to get tested without anything offered in exchange.

“If we are asking people to stay home and not work, we have to make sure society is supporting them,” Baral said. “An equitable program would support people to do the right thing.”

“Never do a test without offering something in exchange.” To the extent that federal and state governments have been asking to people to stay home, get tested, and wear a mask, many of those same governments have been unwilling or unable to provide people with much in return for doing so. And so, here we are months into this, paying for that inaction with 250,000 lives.

Update: How NYC does “never do a test without offering something in exchange”:

You can access a free hotel room to safely isolate from your family, which include meals, Rx delivery, free wi-fi, medical staff on site, and transportation to and from hotel and medical appointments.

(via @agoX)

Pandemic Safety Rules

posted by Jason Kottke   Nov 18, 2020

As I write this, it’s snowing outside here in Vermont and Covid-19 has finally gained a foothold in our little state. At the governor’s press conference yesterday, he and his pandemic response team announced that contact tracing done by the state showed that the rise in cases started as an outbreak in some hockey leagues. That initial outbreak wasn’t contained and subsequent non-essential, indoor, mask-less, multi-household gatherings and Halloween parties resulted in the very sharp rise we started to see here in the first week of November.

Scott explained that 71% of outbreaks reported from Oct. 1 to Nov. 13 were linked to “social events, parties and people hanging out at home or bars and clubs.” He added Vermont has not seen the virus spread widely at schools, restaurants or other businesses.

Dr. Mark Levine, the state health commissioner, said those parties came in a variety of sizes of parties — Halloween gatherings large and small, dinner parties, baby showers, “people in the high single numbers at a deer camp.”

In states with many infections, particularly in the Midwest, contact tracing is all but impossible, so it’s instructive to pay attention to Vermont’s example here: we’re doing the tracing and the tracers say the infections are coming from people gathering indoors across multiple households. Which is exactly what public health and medical experts have been urging people not to do for months now.

And that brings us to Thanksgiving. For The Atlantic, Rachel Gutman asked her colleagues who have been writing extensively about the pandemic for some of their top safety rules and guidelines and their number one was, say it with me:

My colleagues’ guidance boils down to this winter’s golden rule for interacting with anyone outside your immediate household: Don’t spend time indoors with other people.

Here it is again in a fun font, just to make sure you got it: 𝓓𝓸𝓷’𝓽 𝓼𝓹𝓮𝓷𝓭 𝓽𝓲𝓶𝓮 𝓲𝓷𝓭𝓸𝓸𝓻𝓼 𝔀𝓲𝓽𝓱 𝓸𝓽𝓱𝓮𝓻 𝓹𝓮𝓸𝓹𝓵𝓮.

Look, for some people spending time indoors with others is essential — jobs, education, etc. — but those who don’t have to, shouldn’t. And this goes for everywhere in the US because no states (aside from maybe Hawaii) are doing well right now — cases are either high, rising sharply, or both. Please please don’t gather in indoor, multi-household groups for Thanksgiving if you haven’t quarantined beforehand. In the US right now, about 1-in-55 people who get Covid-19 die from it. With rates already high around the country, if many people do Thanksgiving as usual, an already horrific and deadly situation could become much much worse.

Today Marks a Year of Covid-19

posted by Jason Kottke   Nov 17, 2020

According to an unpublicized report by the Chinese government, the first documented case of Covid-19 was a 55-year-old person living in Hubei province on November 17, 2019. That makes today the first anniversary of the start of the Covid-19 pandemic. From that person (and possibly earlier or concurrent cases), the disease slowly and silently spread until it was determined to be due to a novel coronavirus.

They found that following the Nov. 17 case, about one to five new cases were reported every day and by Dec. 15, the total infections reached 27. Daily cases seem to have increased after that, with the case count reaching 60 by Dec. 20, the SCMP reported.

On Dec. 27, Dr. Zhang Jixian, head of the respiratory department at Hubei Provincial Hospital, reported to health officials in China that a novel coronavirus was causing the disease; by that day, it had infected more than 180 individuals. (Doctors may not have been aware of all of those cases at the time, but only identified those cases after going back over the records, the Morning Post reported.)

No one had any idea how much the world was going to change that day. What an awful, humbling, terrifying, ghoulish year.

The Swiss Cheese Covid-19 Defense

posted by Jason Kottke   Nov 16, 2020

The Swiss cheese respiratory virus pandemic defense

The Swiss cheese model of accident causation is a framework for thinking about how to layer security measures to minimize risk and prevent failure. The idea is that when several layers of interventions, despite their weaknesses, are properly stacked up between a hazard and a potentially bad outcome, they are able to cumulatively prevent that outcome because there’s no single point of failure. During the pandemic, health care workers and public health officials have been using the Swiss cheese model to visualize how various measures can work together to help keep people safe.

Virologist Dr. Ian Mackay has visualized the Swiss cheese Covid-19 defense in a wonderful way (pictured above). Each layer of cheese represents a personal or shared intervention — like mask wearing, limiting your time indoors w/ crowds, proper ventilation, quarantine, vaccines — and the holes are imperfections. Applied together, these imperfect measures work like a filter and can vastly improve chances of success.1 He even added a “misinformation mouse” chewing through one of the cheese slices to represent how deceptive information can weaken these defenses.

Mackay has released this graphic under a Creative Commons license (free to share and adapt w/ attribution) and is available in English, German, French, Spanish, Korean, and several other languages. (via @EricTopol)

  1. It’s interesting that the Swiss cheese model is physically how masks work to stop aerosols and droplets — like layered filters and not sieves.

“It’s Time to Hunker Down”

posted by Jason Kottke   Nov 16, 2020

Zeynep Tufekci says that a devastating third pandemic surge is upon us and that It’s Time to Hunker Down. She leads with the good news (vaccines, treatments, knowledge, testing capacity & quickness) but notes that with winter coming and a high baseline of cases from a summer not spent in preparation, now is the time to really knuckle down so that we can get to the finish line.

Whatever the causes, public-health experts knew a fall and winter wave was a high likelihood, and urged us to get ready.

But we did not.

The best way to prepare would have been to enter this phase with as few cases as possible. In exponential processes like epidemics, the baseline matters a great deal. Once the numbers are this large, it’s very easy for them to get much larger, very quickly — and they will. When we start with half a million confirmed cases a week, as we had in mid-October, it’s like a runaway train. Only a few weeks later, we are already at about 1 million cases a week, with no sign of slowing down.

Americans are reporting higher numbers of contacts compared with the spring, probably because of quarantine fatigue and confusing guidance. It’s hard to keep up a restricted life. But what we’re facing now isn’t forever.

It’s time to buckle up and lock ourselves down again, and to do so with fresh vigilance. Remember: We are barely nine or 10 months into this pandemic, and we have not experienced a full-blown fall or winter season. Everything that we may have done somewhat cautiously — and gotten away with — in summer may carry a higher risk now, because the conditions are different and the case baseline is much higher.

The Covid-19 Crystal Ball: Estimating Future Deaths from Today’s Reported Cases

posted by Jason Kottke   Nov 16, 2020

On Friday, November 13, 170,792 new cases of Covid-19 were reported in the United States. About 3000 of those people will die from their disease on Dec 6 — one day of Covid deaths equal to the number of people who died on 9/11. It’s already baked in, it’s already happened. Here’s how we know.

The case fatality rate (or ratio) for a disease is the number of confirmed deaths divided by the number of confirmed cases. For Covid-19 in the United States, the overall case fatality rate (CFR) is 2.3%. That is, since the beginning of the pandemic, 2.3% of those who have tested positive for Covid-19 in the US have died. In India, it’s 1.5%, Germany is at 1.6%, Iran 5.5%, and in Mexico it’s a terrifying 9.8%.

A recent analysis by infectious disease researcher Trevor Bedford tells us two things related to the CFR.

1. Reported deaths from Covid-19 lag behind reported cases by 22 days. Some deaths are reported sooner and some later, but in general it’s a 22-day lag.1

2. The overall CFR in the US is 2.3% but if you use the 22-day lag to calculate what Bedford calls “a lag-adjusted case fatality rate”, it’s a pretty steady average of 1.8% since August. Here’s a graph:

Lagged CFR

As you can see, in the early days of the pandemic, 4-6% of the cases ended in death and now that’s down to ~1.8%. That’s good news! The less good news is that the current case rate is high and rising quickly. Because of the lag in reported deaths, the rise in cases might not seem that alarming to some, even though those deaths will eventually happen. What Bedford’s analysis provides is a quick way to estimate the number of deaths that will occur in the future based on the number of cases today: just multiply the number of a day’s cases by 1.8% and you get an estimated number of people who will die 22 days later.2

For instance, as I said above, 170,792 cases were reported on Nov 13 — 1.8% is 3074 deaths to be reported on December 6. Cases have been over 100,000 per day for 11 days now: here are the estimated deaths from that time period:



Date Cases Est. deaths (on date)
2020-11-15145,6702622  (2020-12-08)
2020-11-14163,4732943  (2020-12-07)
2020-11-13170,7923074  (2020-12-06)
2020-11-12150,5262709  (2020-12-05)
2020-11-11144,4992601  (2020-12-04)
2020-11-10130,9892358  (2020-12-03)
2020-11-09118,7082137  (2020-12-02)
2020-11-08110,8381995  (2020-12-01)
2020-11-07129,1912325  (2020-11-30)
2020-11-06125,2522255  (2020-11-29)
2020-11-05116,1532091  (2020-11-28)
2020-11-04103,0671855  (2020-11-27)
Totals1,609,15828,965

Starting the day after Thanksgiving, a day traditionally called Black Friday, the 1.6 million positive cases reported in the past 12 days will result in 2-3000 deaths per day from then into the first week of December. Statistically speaking, these deaths have already occurred — as Bedford says, they are “baked in”. Assuming the lagged CFR stays at ~1.8% (it could increase due to an overtaxed medical system) and if the number of cases keeps rising, the daily death toll would get even worse. As daily case totals are reported, you can just do the math yourself:

number of cases × 0.018

200,000 cases in a day would be ~3600 deaths. 300,000 daily cases, a number that would have been inconceivable to imagine in May but is now within the realm of possibility, would result in 5400 deaths in a single day. Vaccines are coming, there is hope on the horizon. But make no mistake: this is an absolute unmitigated catastrophe for the United States.

Update: Over at The Atlantic, Alexis Madrigal and Whet Moser took a closer look at Bedford’s model, aided by Ryan Tibshirani’s analysis.

Tibshirani’s first finding was that the lag time between states was quite variable-and that the median lag time was 16 days, a lot shorter than the mean. Looking state by state, Tibshirani concluded, it seemed difficult to land on an exact number of days as the “right” lag “with any amount of confidence,” he told us. Because cases are rising quickly, a shorter lag time would mean a larger denominator of cases for recent days — and a lower current case-fatality rate, something like 1.4 percent. This could mean fewer overall people are dying.

But this approach does not change the most important prediction. The country will still cross the threshold of 2,000 deaths a day, and even more quickly than Bedford originally predicted. Cases were significantly higher 16 days ago than 22 days ago, so a shorter lag time means that those higher case numbers show up in the deaths data sooner. Even with a lower case-fatality rate, deaths climb quickly. Estimating this way, the country would hit an average of 2,000 deaths a day on November 30.

The other major finding in Tibshirani’s analysis is that the individual assumptions and parameters in a Bedford-style model don’t matter too much. You can swap in different CFRs and lag-time parameters, and the outputs are more consistent than you might expect. They are all bad news. And, looking retrospectively, Tibshirani found that a reasonable, Bedford-style lagged-CFR model would have generated more accurate national-death-count predictions than the CDC’s ensemble model since July.

  1. Courtesy of Ed Yong, the lag between cases and hospitalizations is about 11 days. So the full ICUs and packed ERs were hearing about now are going to get so much worse in the next two weeks. And just think about the potential situation a month from now if cases keep rising at the rate they are now for two more weeks…

  2. Just to stress again: this is only an estimate. The real reported deaths from a single day’s reported cases will be spread out over several days or weeks. And case reporting is much lower on Sundays and Mondays than on other days (fewer reports on weekends). Bedford accounted for this in his analysis by using 7-day averages.

Preliminary Results: Moderna Covid-19 Vaccine Is 94.5% Effective

posted by Jason Kottke   Nov 16, 2020

Last Monday the world got some good news: an early review of the data showed that Pfizer’s Covid-19 vaccine was “more than 90% effective” in preventing the disease. The results pointed to other vaccines also being highly effective against the virus and this morning comes this news: Early Data Show Moderna’s Coronavirus Vaccine Is 94.5% Effective.

The drugmaker Moderna announced on Monday that its coronavirus vaccine was 94.5 percent effective, based on an early look at the results from its large, continuing study.

Researchers said the results were better than they had dared to imagine. But the vaccine will not be widely available for months, probably not until spring.

Despite the delivery timeline, this is such good news.

The companies’ products open the door to an entirely new way of creating vaccines — and creating them fast. Both use a synthetic version of coronavirus genetic material, called messenger RNA or mRNA, to program a person’s cells to churn out many copies of a fragment of the virus. That fragment sets off alarms in the immune system and stimulates it to attack, should the real virus try to invade. Although a number of vaccines using this technology are in development for other infections and cancers, none have yet been approved or marketed.

“The fact that two different vaccines made by two different companies with two different kinds of structures, in a new messenger RNA concept, both worked so effectively confirms the concept once and for all that this is a viable strategy not only for Covid but for future infectious disease threats,” said Dr. Barry R. Bloom, a professor of public health at Harvard.

Natalie E. Dean, a biostatistician at the University of Florida, said an important finding was that the vaccine appeared to prevent severe disease. Pfizer did not release information about disease severity when reporting its results.

Researchers say the positive results from Pfizer and Moderna bode well for other vaccines, because all of the candidates being tested aim at the same target - the so-called spike protein on the coronavirus that it uses to invade human cells.

It’s only a few more months — please please do what you can to stay safe and keep others safe (especially medical workers) until these vaccines can be rolled out.

Fantastical Face Masks

posted by Jason Kottke   Nov 13, 2020

Creative face masks

Creative face masks

Creative face masks

Denver’s Vicki Myhren Gallery is hosting a virtual exhibition called MASK that showcases participating artists’ takes on the now-ubiquitous Covid-19 face masks.

Through this project, we hope to call attention to the significance and signification of masking as an issue of public health and a demonstration of civic responsibility. Equally, MASK calls attention to this newly important medium’s function as an outward mode of self-expression and opportunity for creativity.

(via colossal)

Biden’s Plans for Halting the Unchecked Spread of Covid-19 in the US

posted by Jason Kottke   Nov 09, 2020

This morning, the transition team for President-elect Joe Biden announced the members of his Covid-19 task force.

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.

From Biden’s transition website, here’s the Biden-Harris administration’s seven-point plan to beat COVID-19 (which is the first item in the site’s “Priorities” menu). The seven points are:

  1. Ensure all Americans have access to regular, reliable, and free testing.
  2. Fix personal protective equipment (PPE) problems for good.
  3. 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.
  4. Plan for the effective, equitable distribution of treatments and vaccines - because development isn’t enough if they aren’t effectively distributed.
  5. Protect older Americans and others at high risk.
  6. Rebuild and expand defenses to predict, prevent, and mitigate pandemic threats, including those coming from China.
  7. 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.

Initial Data Shows Covid-19 Vaccine Is More than 90% Effective

posted by Jason Kottke   Nov 09, 2020

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.

Update: Here’s Pfizer’s press release. And a thread from Dr. Natalie Dean on how she is interpreting this news (“Celebrate, but let the process play out over time as intended.”)

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.

Update: A very simplified explanation of Pfizer’s RNA-based vaccine.

How Masks Protect Us from Covid-19

posted by Jason Kottke   Nov 02, 2020

How an N95 mask filters aerosols and droplets

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.

  1. 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.

An Archive of Pandemic and Anti-Racist Street Art

posted by Jason Kottke   Oct 30, 2020

Pandemic & anti-racist street art

Pandemic & anti-racist street art

Pandemic & anti-racist street art

Pandemic & anti-racist street art

The Urban Art Mapping Research Project has been collecting photos of street art created over the past several months related to the Covid-19 pandemic and the anti-racist protests.

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.

(via open culture)

Visualizing How Covid-19 Spreads Indoors

posted by Jason Kottke   Oct 29, 2020

Visualization of how Covid-19 spreads in a bar via aerosols

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.

“Liberty Doesn’t Mean Freedom to Infect Other People”

posted by Jason Kottke   Oct 26, 2020

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.

Charming Local Covid-19 Social Distancing Signs

posted by Jason Kottke   Oct 19, 2020

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:

Local social distance signs: keep one cow apart

Journalist Rebecca Boyle recently asked her followers to share their local Covid-19 signage and they responded with some great examples.

Local social distance signs: 1 newborn Orca whale apart

Local social distance signs: a small moose apart

Local social distance signs: I was born to walk alone

This homage to the Ministry of Silly Walks might be my favorite:

Local social distance signs: Ministry of silly walks

You can scroll through the whole thread for many more.

We Need to Reckon with the Aerosol Spread of Covid-19

posted by Jason Kottke   Oct 15, 2020

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.

As the Washington Post reports, patrons were allowed to take their masks off while exercising:

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)

  1. 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.

  2. 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.

Vaccines May Help End the Pandemic. But Realistically, It’s Not Even Halftime Yet.

posted by Jason Kottke   Oct 13, 2020

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.

From Zimmer’s article on the development of a kids’ vaccine:

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.

A Scientific Portrait of the SARS-CoV-2 Virus

posted by Jason Kottke   Oct 12, 2020

A model of the SARS-CoV-2 virus

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.

Winter Is Coming. Is It Safe to Socialize Indoors?

posted by Jason Kottke   Oct 12, 2020

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.

Dr. Fauci: Earliest We’ll Be “Back to Normal” Is the End of 2021

posted by Jason Kottke   Oct 08, 2020

A few weeks ago during the Q&A session after his lecture for MIT’s online biology class about the pandemic, Dr. Anthony Fauci shared his expert opinion on when things might return to “normal” in the US. Here was my paraphrased tweet about it:

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.

Update: In an interview posted yesterday, Johns Hopkins epidemiologist Dr. Caitlin Rivers gives her best guess at a return to normalcy:

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.

  1. 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.

The Science Is In: Wear. A. Mask!

posted by Jason Kottke   Oct 07, 2020

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.

Representing Covid-19 Deaths, 20,000 Empty Chairs Face the White House

posted by Jason Kottke   Oct 06, 2020

An array of 20,000 chairs set up in front of the White House

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.

  1. 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.”

Totally Under Control

posted by Jason Kottke   Oct 02, 2020

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.

How to Protect Yourself from the Aerosol Spread of Covid-19

posted by Jason Kottke   Oct 02, 2020

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.

MIT Technology Review’s Charlotte Jee interviewed Jimenez about the FAQ document.

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.

Right now, in my opinion as someone who has done a ton of reading about Covid-19, the most best accessible information on how individuals and societies can protect themselves and others during the pandemic (and why) is available in Jimenez’s Time article, Aaron Carroll’s NY Times piece about how to think about risk management, Zeynep Tufekci’s piece in the Atlantic about dispersion and superspreading, and now this Google Doc by Jimenez et al.