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kottke.org posts about COVID-19

Caremongering

posted by Jason Kottke   Mar 17, 2020

Canada caremongering

In Canada, “caremongering” groups are being organized to connect helpers with those in need during the COVID-19 pandemic.

The first “caremongering” group was set up by Mita Hans with the help of Valentina Harper and others. Valentina explained the meaning behind the name.

“Scaremongering is a big problem,” she tells the BBC. “We wanted to switch that around and get people to connect on a positive level, to connect with each other.

“It’s spread the opposite of panic in people, brought out community and camaraderie, and allowed us to tackle the needs of those who are at-risk all the time — now more than ever.”

During times of crisis, Mister Rogers urged children to “look for the helpers”. As adults, we need to step up and be those helpers, even though many of us are self-quarantined at home. (via jodi)

Free stock photo of hockey player on phone courtesy of Canada’s Internet Registration Authority.

We May Be In This for the Long Haul…

posted by Jason Kottke   Mar 17, 2020

Note: I feel the need to add a disclaimer to this post. This was a really hard thing to read for me and it might be for you too. It is a single paper from a scientific team dedicated to the study of infectious diseases — it has not been peer reviewed, the available data is changing every day (for things like death rates, transmission rates, and potential immunity), and there might be differing opinions & assumptions by other infectious disease experts that would result in a different analysis. Even so, this seems like a possibility to take seriously and I hope I’m being responsible in sharing it.

This is an excellent but extremely sobering read: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, a 20-page paper by the Imperial College COVID-19 Response Team (and a few other organizations, including the WHO Collaborating Centre for Infectious Disease Modelling).

The paper is technical in nature but mostly written in plain English so it’s pretty readable, but here is an article that summarizes the paper. It discusses the two main strategies for dealing with this epidemic (mitigation & suppression), the strengths and weaknesses of each one, and how they both may be necessary in some measure to best address the crisis. For instance, here’s a graph showing the effects of three different suppression scenarios for the US compared to critical care bed capacity:

Suppression Graph US

Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread — reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package — or something equivalently effective at reducing transmission — will need to be maintained until a vaccine becomes available (potentially 18 months or more) — given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing — triggered by trends in disease surveillance — may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

If you missed the scale on the graph (it extends until March 2021) and the bit in there about closures, quarantine, and self-distancing measures needing to remain in place for months and months, the authors repeat that assertion throughout the paper. From the discussion section of the paper:

Overall, our results suggest that population-wide social distancing applied to the population as a whole would have the largest impact; and in combination with other interventions — notably home isolation of cases and school and university closure — has the potential to suppress transmission below the threshold of R=1 required to rapidly reduce case incidence. A minimum policy for effective suppression is therefore population-wide social distancing combined with home isolation of cases and school and university closure.

To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population — which could be 18 months or more. Adaptive hospital surveillance-based triggers for switching on and off population-wide social distancing and school closure offer greater robustness to uncertainty than fixed duration interventions and can be adapted for regional use (e.g. at the state level in the US). Given local epidemics are not perfectly synchronised, local policies are also more efficient and can achieve comparable levels of suppression to national policies while being in force for a slightly smaller proportion of the time. However, we estimate that for a national GB policy, social distancing would need to be in force for at least 2/3 of the time (for R0=2.4, see Table 4) until a vaccine was available.

I absolutely do not want to seem alarmist here, but if this analysis is anywhere close to being in the ballpark, it seems at least feasible that this whole thing is going to last far longer than the few weeks that people are thinking about. The concluding sentence:

However, we emphasise that is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear.

The paper is available in several languages here.

Update: Here is a short review of the Imperial College paper by Chen Shen, Nassim Nicholas Taleb, and Yaneer Bar-Yam. The important bit:

However, they make structural mistakes in analyzing outbreak response. They ignore standard Contact Tracing [2] allowing isolation of infected prior to symptoms. They also ignore door-to-door monitoring to identify cases with symptoms [3]. Their conclusions that there will be resurgent outbreaks are wrong. After a few weeks of lockdown almost all infectious people are identified and their contacts are isolated prior to symptoms and cannot infect others [4]. The outbreak can be stopped completely with no resurgence as in China, where new cases were down to one yesterday, after excluding imported international travelers that are quarantined.

If I understand this correctly, Shen et al. are saying that some tactics not taken into account by the Imperial College analysis could be hyper-effective in containing the spread of COVID-19. The big if, particularly in countries like the US and Britain that are acting like failing states is if those measures can be implemented on the scale required. (thx, ryan)

Update: The lead author of the Imperial College paper, Neil Ferguson, has likely contracted COVID-19. From his Twitter acct:

Sigh. Developed a slight dry but persistent cough yesterday and self isolated even though I felt fine. Then developed high fever at 4am today.

Ferguson says he’s still at his desk, working away.

Update: The pair of articles I linked to in this post are excellent and you should read them after reading the Imperial College paper.

Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.

Moral Choices in an Overwhelming Emergency

posted by Jason Kottke   Mar 17, 2020

This is from a few days ago, but because the United States is a couple of weeks behind Italy in addressing the COVID-19 pandemic, what was happening there then might still be in our future if we don’t take (seemingly unreasonable but actually entirely reasonable) precautions. From Yascha Mounk’s The Extraordinary Decisions Facing Italian Doctors:

The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”

Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, would be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”

In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.” This is in part because early studies of the virus seem to suggest that patients with serious preexisting health conditions are significantly more likely to die. But it is also because patients in a worse state of overall health could require a greater share of scarce resources to survive: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”

Mounk continues:

My academic training is in political and moral philosophy. I have spent countless hours in fancy seminar rooms discussing abstract moral dilemmas like the so-called trolley problem. If a train is barreling toward five innocent people who are tied to the tracks, and I could divert it by pulling the lever, but at the cost of killing an innocent bystander, should I do it?

Part of the point of all those discussions was, supposedly, to help professionals make difficult moral choices in real-world circumstances. If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?

Despite those years of theory, I must admit that I have no moral judgment to make about the extraordinary document published by those brave Italian doctors. I have not the first clue whether they are recommending the right or the wrong thing.

I have been rewatching The Good Place with my kids (they love it), and all of the moral philosophy stuff underpinning the show has taken on a greater meaning over the last week or two.

The Power of the Individual in an Exponential Crisis

posted by Jason Kottke   Mar 16, 2020

Over the past week or so, echoing public health officials & epidemiologists, I’ve been trying to illustrate the often counterintuitive concept of exponential growth that you see in an epidemic and how flattening the curve can help keep people healthy and alive. But I think people have a hard time grasping what that means, personally, to them. Like, what’s one person in the face of a pandemic?

Well, epidemiologist Britta Jewell had a similar thought and came up with this brilliantly simple graph, one of the best I’ve seen in illustrating the power of exponential growth and how we as individuals can affect change:

One Person Exponential

Jewell explains a bit more about what we’re looking at:

The graph illustrates the results of a thought experiment. It assumes constant 30 percent growth throughout the next month in an epidemic like the one in the U.S. right now, and compares the results of stopping one infection today — by actions such as shifting to online classes, canceling of large events and imposing travel restrictions — versus taking the same action one week from today.

The difference is stark. If you act today, you will have averted four times as many infections in the next month: roughly 2,400 averted infections, versus just 600 if you wait one week. That’s the power of averting just one infection, and obviously we would like to avert more than one.

So that’s 1800 infections averted from the actions of just one person. Assuming a somewhat conservative death rate of 1% for COVID-19, that’s 18 deaths averted. Think about that before you head out to the bar tonight or convene your book group as usual. Your actions have a lot of power in this moment; take care in how you wield it.

The Paradox of Preparation

posted by Jason Kottke   Mar 16, 2020

Coronavirus, social distancing, exponential growth, flatten the curve, pandemic, immunocompromised — those are just some of the concepts related to COVID-19 we have had to come up to speed on over the last few weeks. We should add the “paradox of preparation” to that list.

The paradox of preparation refers to how preventative measures can intuitively seem like a waste of time both before and after the fact. Most of us don’t stop brushing our teeth because the dentist didn’t find any cavities at our most recent checkup, but with larger events that have effects more difficult to gauge (like COVID-19, climate change, and Y2K), it can be hard to spur people to action. From Chris Hayes:

A doctor I spoke to today called this the “paradox of preparation” and it’s the key dynamic in all this. The only way to get ahead of the curve is to take actions that *at the time* seem like overreactions, eg: Japan closing all schools for a month with very few confirmed cases.

That was in response to Dr. James Hamblin:

The thing is if shutdowns and social distancing work perfectly and are extremely effective it will seem in retrospect like they were totally unnecessary overreactions.

Epidemiologist Mari Armstrong-Hough made a similar point earlier on Twitter:

You won’t ever know if what you did personally helped. That’s the nature of public health. When the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction.

Preparation, prevention, regulations, and safeguards prevent catastrophes all the time, but we seldom think or hear about it because “world continues to function” is not interesting news. We have to rely on statistical analysis and the expert opinions of planners and officials in order to evaluate both crucial next steps and the effectiveness of preparatory measures after the fact, and that can be challenging for us to pay attention to. So we tend to forget that preparation & prevention is necessary and discount it the next time around.

The good news is that while unchecked epidemics grow exponentially, another thing that can also spreads exponentially is behavioral norms. The basic expert advice on how we can slow the spread of COVID-19 in our communities is pretty unambiguous — wash your hands, don’t touch your face, maintain social distance, self-quarantine, etc. — and so is the huge potential impact of those precautions on the number of people who will get infected and die. To help overcome the paradox of preparation, let’s continue to spread the word about what the experts are urging us to do. Because if we don’t, there might be a lot fewer of us around in a month or two.

Update: In the same vein, Vaughn Tan writes:

This means that any effective actions taken against coronavirus in the few days before the epidemic curve shoots upward in any country will always look unreasonable and disproportionate.

By the time those actions look reasonable and appropriate, they will be too late.

And Now Is the Time to Overreact Ian Bogost in the Atlantic:

The idea that an extreme reaction, such as closing schools and canceling events, might prove to be an overreaction that would look silly or wasteful later outweighs any other concern. It can also feel imprudent; just staying home isn’t so easy for workers who depend on weekly paychecks, and closing is a hard decision for local companies running on thin margins. But experts are saying that Americans can’t really over-prepare right now. Overreaction is good!

It’s hard to square that directive with the associations we’ve built up around overreactions. Ultimately, overreaction is a matter of knowledge-an epistemological problem. Unlike viruses or even zombies, the concept lives inside your skull rather than out in the world. The sooner we can understand how that knowledge works, and retool our action in relation to its limits, the better we’ll be able to handle the unfolding crisis.

Michael Specter writing about America’s weakened public-health system for the New Yorker:

Few people have trouble understanding the purpose of public education or public housing: they are tangible programs that, at least in theory, are designed to improve our lives. Public-health accomplishments, however, are measured in an entirely different way: success is defined by what is prevented, not by what is produced. This creates an odd psychological dynamic.

When public-health programs are successful, they are invisible, and what is invisible is almost always taken for granted. Nobody cheers when they remain untouched by a disease that they hardly knew existed. That makes it easy for shortsighted politicians to deny long-term realities. And that is what they almost always do.

Excellent Presentation on the Latest COVID-19 Research, Hygiene Tips, and Treatment Options

posted by Jason Kottke   Mar 16, 2020

From Stanford professor of neurobiology and bioengineering Michael Lin, this is an excellent 31-page PDF presentation (Slideshare) on what we know about COVID-19 so far and how to deal with it, with extensive references to the latest research (as of 3/15). I’m going to include a few of the most interesting and important slides right here, but do read the whole thing — it is very informative.

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

And here are a few other quotes I pulled out:

Compare to Spanish flu of 1917-1918: Cumulative infection rate 27%, IFR 2%. Spanish flu might have higher IFR than COVID-19, but medical care was much worse then (no ventilators, no drugs). In reality COVID-19 is likely the more severe disease. In any case, Spanish flu was devastating.

Large meetings that bring people from around the country are obviously a big risk. Large numbers of people who might breath the same air and touch the same things (e.g. at Biogen meeting, attendants used the same serving utensils at a buffet, and 70 got infected)

If you are young, the worry is more about transmitting virus to older people than about yourself.

Death rates will lag infection rates by 3-4 weeks (2 weeks from diagnosis but that’s 1 week from infection time on average with current testing practices)

Read Lin’s entire presentation here.

Expert Advice and Harsh Truths About Social Distancing

posted by Jason Kottke   Mar 14, 2020

Social distancing has been recommended by epidemiologists and public health officials as a way to slow the spread of COVID-19, flatten the curve, and save lives. Avoiding rock concerts and sporting events is easy, but what about going to the grocery store or visiting with a friend? The Atlantic’s Kaitlyn Tiffany talked to a number of public health experts about The Dos and Don’ts of ‘Social Distancing’.

Q: Should I be avoiding bars and restaurants?

Cannuscio: People should avoid gathering in public places. People should be at home as much as possible. The measures that have worked to get transmission under control or at least to bend the curve, in China and South Korea, have been extreme measures to increase social distancing.

Q: Should I stop visiting elderly relatives?

Cannuscio: I think if we are fortunate enough to live near our elders and we get into the mode of seriously isolating our own families, then one person should be designated to go and visit. If we’re not in a situation where we can truly limit our own social contact, then we will be putting that elder at risk by going to visit.

In my estimation, the answers that Carolyn Cannuscio, of Penn’s Center for Public Health Initiatives, gives are the ones to follow. Dr. Asaf Bitton’s advice is even stricter:

2. No kid playdates, parties, sleepovers, or families/friends visiting each other’s houses and apartments.

This sounds extreme because it is. We are trying to create distance between family units and between individuals. It may be particularly uncomfortable for families with small children, kids with differential abilities or challenges, and for kids who simply love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take four to five days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky — I definitely do not recommend that people do so outside of their family.

They both rightly talk about how the early actions we take will end up having a big impact in limiting the damage. (Check out this video about epidemics & exponential growth if you haven’t already.) Singapore, Hong Kong, Taiwan, and other places were able to nip the epidemic in the bud in part because of aggressive social distancing practices.

Italy Sings Together During Coronavirus Lockdown

posted by Jason Kottke   Mar 14, 2020

People under quarantine lockdown in Italy due to the country’s COVID-19 outbreak have been singing and playing music out their windows and on their balconies to keep their spirits up while social distancing.

Here’s a Twitter thread with more videos from Salerno, Turin, Naples, Siena, Florence, etc.

No matter how much fear and panic and anxiety and negativity are on display during a crisis, it also brings out the best in people. Humans are social animals and we can’t help sharing with our neighbors, comforting one another, and coming together even when we’re physically apart.

How to Wash Your Hands Properly

posted by Jason Kottke   Mar 13, 2020

Most humans have been washing their hands since childhood, but I bet very few of us have been doing it correctly. Because of the effectiveness of hand-washing with soap in preventing the spread of COVID-19, the CDC and the WHO (and health professionals everywhere) both make it their top recommendation and provide guidance on how to do it properly: CDC hand-washing instructions, WHO hand-washing instructions.

Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

Here’s a video from the WHO on proper hand-washing technique (and a similar one from Johns Hopkins that has subtitles):

And a graphic from the WHO:

Wash Hands Instructions

And if you’re getting sick of singing Happy Birthday while washing your hands, a site called Wash Your Lyrics can help you make a hand-washing infographic with your favorite song’s lyrics.

Why Is the US So Behind in COVID-19 Testing?

posted by Jason Kottke   Mar 13, 2020

According to an ongoing investigation at The Atlantic, the US has tested only about 14,000 people for COVID-19 so far (a stat CDC data seems to confirm). 14,000 out of 330 million people. Olga Khazan writes about the four main reasons why the US is so behind in testing for the virus.

Interviews with laboratory directors and public-health experts reveal a Fyre-Festival-like cascade of problems that have led to a dearth of tests at a time when America desperately needs them. The issues began with onerous requirements for the labs that make the tests, continued because of arcane hurdles that prevented researchers from getting the right supplies, and extended to a White House that seemed to lack cohesion in the pandemic’s early days. Getting out lots of tests for a new disease is a major logistical and scientific challenge, but it can be pulled off with the help of highly efficient, effective government leadership. In this case, such leadership didn’t appear to exist.

Here’s another take on the problem from a few days ago in the NY Times.

The US has bungled the situation so badly that a pair of Chinese foundations announced this morning that they were donating 500,000 testing kits and 1 million masks to the US. Last month in my Asian travelogue, I wrote that my main observation after spending three weeks in Asia was: “America is a rich country that feels like a poor country”. That we have to rely on foreign aid in situations like this is a good example of what I was referring to.

Washing Your Hands Is Important Because Soap “Absolutely Annihilates” Coronavirus

posted by Jason Kottke   Mar 13, 2020

The number one recommendation on the list of protective measures for COVID-19 from both WHO and the CDC is to regularly wash your hands. The CDC in particular recommends hand-washing over using hand sanitizer.

Wash Hands

Vox recently talked with chemistry professor Palli Thordarson about why washing with soap is so effective when dealing with coronaviruses.

The soap takes care of the virus much like it takes care of the oil in the water. “It’s almost like a crowbar; it starts to pull all the things apart,” Thordarson says.

One side of the soap molecule (the one that’s attracted to fat and repelled by water) buries its way into the virus’s fat and protein shell. Fortunately, the chemical bonds holding the virus together aren’t very strong, so this intrusion is enough to break the virus’s coat. “You pull the virus apart, you make it soluble in water, and it disintegrates,” he says.

Then the harmless shards of virus get flushed down the drain. (And even if it the soap doesn’t destroy every virus, you’ll still rid them from your hands with soap and water, as well as any grease they may be clinging to.)

And why do you need to wash for 20 seconds? Because that gives soap time to do its work.

First off, your skin is wrinkly, and it takes time for soap to penetrate into all the tiny folds and demolish the viruses that lurk within. Then the soap needs a few moments to do its chemical work. “You do need a bit of time for all the soap to interact back and forth with the virus particle,” he says. Twenty seconds should do the trick just fine.

See also Why Soap Works from the NY Times, which explains why soap & water is better than hand sanitizer in these cases:

On the whole, hand sanitizers are not as reliable as soap. Sanitizers with at least 60 percent ethanol do act similarly, defeating bacteria and viruses by destabilizing their lipid membranes. But they cannot easily remove microorganisms from the skin. There are also viruses that do not depend on lipid membranes to infect cells, as well as bacteria that protect their delicate membranes with sturdy shields of protein and sugar. Examples include bacteria that can cause meningitis, pneumonia, diarrhea and skin infections, as well as the hepatitis A virus, poliovirus, rhinoviruses and adenoviruses (frequent causes of the common cold).

Update: Thordarson also wrote an article for The Guardian on how effective soap is at killing coronavirus.

Recipe for Making Your Own Hand Sanitizer

posted by Jason Kottke   Mar 12, 2020

Many stores have long since sold out of hand sanitizer in the US and washing your hands is a better move anyway, but if you’d like to have some sanitizer on hand for when you can’t get to a sink, the World Health Organization has you covered. The WHO recipe is for making 10-liter batchs, so Popular Science helpfully scaled it down to a more reasonable size:

1 cup 99% isopropyl alcohol
1 tablespoon 3% hydrogen peroxide
1 teaspoon 98% glycerin/glycerol
1/4 cup, 1 tablespoon, and 1 teaspoon sterile distilled or boiled cold water

To the alcohol, add the hydrogen peroxide & glycerin and stir or shake if you’re mixing in a container with a lid. Then add the water.

For COVID-19 prevention, the CDC recommends a hand sanitizer that contains at least 60% alcohol; this recipe will end up being about 75% alcohol. The Popular Science piece also includes another recipe for a hand sanitizing gel that’s much closer to store-bought gels that involves mixing isopropyl alcohol, aloe vera gel, and tea tree oil. They also note that vodka does not contain enough alcohol to meet the CDC’s recommendation, especially when mixed with the other ingredients.

Surreal Video of a Soccer Match Played In an Empty Stadium

posted by Jason Kottke   Mar 12, 2020

Yesterday I watched a bit of the Champions League match between PSG and Borussia Dortmund, played at the Parc des Princes stadium in Paris, which has a seating capacity of almost 48,000 under normal circumstances. But for yesterday’s game, the game was played in a completely empty stadium in order to help prevent the spread of COVID-19. Without the chants, jeers, and cheers of the crowd, you can clearly hear the actual sounds of the game like the players talking to each other and the ball being kicked.

Here’s another video from a Borussia Monchengladbach & FC Koln match played under similar circumstances. This shot from just before kickoff really underscores just how huge and empty these stadiums are.

Surreal Soccer No Fans

I’m not sure how much the empty stadium hampered the potential spread of the virus though — PSG fans gathered in huge numbers outside Parc des Princes to cheer on their team during the match and celebrate the win afterwards.

The NBA was considering playing their games in front of empty stadiums, but then Utah Jazz player Rudy Gobert tested positive for COVID-19 (after touching all the microphones as a way to mock coronavirus fears — life comes at you fast!) and now the NBA has suspended its season for at least a month. MLB and the NHL have done likewise.

Why Do New Diseases Like COVID-19 Appear First in China?

posted by Jason Kottke   Mar 12, 2020

This video from Vox is a few days old but is still a good look at why diseases like SARS and COVID-19 originate in China. It involved the designation of wild animals as “natural resources” by the Chinese government, which caused a large increase in wildlife farming, with many more and different kinds of animals being put into contact with humans and each other on a regular basis. Add illegally trafficked animals into the mix, and you’ve got the right conditions for diseases to jump from the animals to humans. Then potentially infected animals and their meat, accompanied by potentially infected humans who raised those animals and butchered that meat, are then brought to the wet markets for sale to the public.

It’s important to note, as Christopher St. Cavish says in the LA Times, “most wet markets are not wildlife markets, and confusing the two is dangerous”:

“Wet” markets are what China calls its fresh food markets, the kind you see all over the developing world and in many parts of Europe, where small stalls sell fresh vegetables and butchers sell meat, primarily pork. They are the daily market for tens of millions of Chinese who prefer to talk to the people who sell them produce, meat, seafood and tofu, and in small cities, are often the only outlet for small-scale farmers who can’t meet the supplier requirements for supermarkets.

I couldn’t find any up-to-date information on which animal is suspected of passing the coronavirus responsible for COVID-19 along to humans, but bats are a prime suspect with a possible pangolin intermediary. (via open culture)

Media Paywalls Dropped for COVID-19 Crisis Coverage

posted by Jason Kottke   Mar 11, 2020

In recent years, many media outlets have joined publications like the WSJ and NY Times in erecting paywalls around their online offerings, giving visitors access to a few articles a month before asking them to pay for unlimited access. Due to the continuing worldwide COVID-19/coronavirus crisis and in order to make information about the pandemic more accessible to the public, several publications have dropped their paywalls for at least some of their coronavirus coverage (thanks to everyone who responded to my tweet about this).

Among them are The Atlantic, WSJ, Talking Points Memo, Globe and Mail, Seattle Times, Miami Herald (and other McClatchy-owned properties), Toronto Star, Stat, Dallas Morning News, Medium, NY Times, Washington Post, Baltimore Sun, Chicago Tribune, Christian Science Monitor and several medical/science journals. Notably, The Guardian relies on online subscription revenue but doesn’t put anything behind a paywall, including their coronavirus coverage.

In addition, a group of archivists have created an online directory of scientific papers related to coronaviruses, available for free download.

“These articles were always written to be shared with as many people as possible,” Reddit user “shrine,” an organizer of the archive, said in a call. “From every angle that you look at it, [paywalled research] is an immoral situation, and it’s an ongoing tragedy.”

Kudos to those media organizations for doing the right thing — this information can save people’s lives. Let’s hope others (*cough* Washington Post) will soon follow suit. And if you find the coverage helpful, subscribe to these outlets!

BTW, like The Guardian, kottke.org is supported by readers just like you who contribute to make sure that every single thing on the site is accessible to everyone. If you’re a regular reader, please consider supporting this experiment in openness.

Update: Added the NY Times to the list above. I am also hearing that many European papers are not dropping their paywalls in the face of the crisis.

Update: Added several media outlets to the list, including Washington Post and Chicago Tribune. At this point, it seems to be standard practice now (at least in the US & Canada) so this will be the final update. (thx, @maschweisguth)

WHO Declares COVID-19 Outbreak Is Officially a Pandemic

posted by Jason Kottke   Mar 11, 2020

In a media briefing that’s still ongoing as I’m writing this, Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization, has officially characterized the COVID-19 outbreak as a pandemic. A pandemic is defined as:

An influenza pandemic is a global epidemic caused by a new influenza virus to which there is little or no pre-existing immunity in the human population. Influenza pandemics are impossible to predict; and they may be mild, or cause severe disease or death. Severe disease may occur in certain risk groups, which may correspond to those at risk of severe disease due to seasonal influenza.

Here’s a transcript of Dr. Tedros’s opening remarks from the briefing.

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.

Progress on fighting COVID-19 can be made everywhere when the right steps are taken:

If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.

Even those countries with community transmission or large clusters can turn the tide on this virus.

Several countries have demonstrated that this virus can be suppressed and controlled.

The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same — it’s whether they will.

But WHO also acknowledges how disruptive the pandemic can be:

We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.

We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.

And in closing he deflects attention from the word “pandemic”:

Let me give you some other words that matter much more, and that are much more actionable.

Prevention.

Preparedness.

Public health.

Political leadership.

And most of all, people.

We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.

Decrease in Economic Activity Due to COVID-19 Reduced Air Pollution and Saved Lives

posted by Jason Kottke   Mar 11, 2020

COVID-19 Pollution

Stanford professor Marshall Burke, who does research on the social and economic impacts of environmental change, wrote a post about how the decrease in economic activity in China due to COVID-19 quarantine and other countermeasures resulted in a significant drop in air pollution, which Burke estimates will save more lives than deaths caused by COVID-19.

Putting these numbers together [see table below for details] yields some very large reductions in premature mortality. Using the He et al 2016 estimates of the impact of changes in PM on mortality, I calculate that having 2 months of 10ug/m3 reductions in PM2.5 likely has saved the lives of 4,000 kids under 5 and 73,000 adults over 70 in China. Using even more conservative estimates of 10% reduction in mortality per 10ug change, I estimate 1400 under-5 lives saved and 51700 over-70 lives saved. Even under these more conservative assumptions, the lives saved due to the pollution reductions are roughly 20x the number of lives that have been directly lost to the virus.

And his conclusion is not that viral pandemics are a net positive for the world (you will see people naively arguing this, siding a little too closely with a snapping Thanos for my comfort) but that situations like this remind us, as Burke summarized on Twitter: “the way our economies operate absent pandemics has massive hidden health costs”:

But it seems overall incorrect and foolhardy to conclude that pandemics are good for health — and again I emphasize that the effects calculated above are just the health benefits of the air pollution changes, and do not account for the many other short- or long-term negative consequences of social and economic disruption on health or other outcomes. But the calculation is perhaps a useful reminder of the often-hidden health consequences of the status quo, i.e. the substantial costs that our current way of doing things exacts on our health and livelihoods.

Graphic above via NASA.

How to Stop the Spread of COVID-19: Cancel Everything

posted by Jason Kottke   Mar 11, 2020

Yascha Mounk writing for The Atlantic:

These three facts imply a simple conclusion. The coronavirus could spread with frightening rapidity, overburdening our health-care system and claiming lives, until we adopt serious forms of social distancing.

This suggests that anyone in a position of power or authority, instead of downplaying the dangers of the coronavirus, should ask people to stay away from public places, cancel big gatherings, and restrict most forms of nonessential travel.

Given that most forms of social distancing will be useless if sick people cannot get treated-or afford to stay away from work when they are sick-the federal government should also take some additional steps to improve public health. It should take on the costs of medical treatment for the coronavirus, grant paid sick leave to stricken workers, promise not to deport undocumented immigrants who seek medical help, and invest in a rapid expansion of ICU facilities.

This is very close to my own personal thinking right now, particularly after watching this excellent video about exponential growth and epidemics.

Exponential Growth and Epidemics

posted by Jason Kottke   Mar 10, 2020

From 3blue1brown’s Grant Sanderson, this is an excellent quick explanation of exponential growth and how we should think about it in relation to epidemics like COVID-19. Depending on how rusty your high school math is, you might need to rewind a couple of times to fully grasp the explanation, but you should persevere and watch the whole thing.

The most important bit is at the end, right around the 7:45 mark, when he talks about how limiting person-to-person exposure and decreasing the probability of exposures becoming infections can have a huge effect on the total number of people infected because the growth is exponential. If large numbers of people start doing things like limiting travel, cancelling large gatherings, social distancing, and washing their hands frequently, the total number of infections could fall by several orders of magnitude, making the exponential work for us, not against us. Small efforts have huge results. If, as in the video, you’re talking about 100 million infected in two months (at the current transmission rate) vs. 400,000 (at the lowered rate) and if the death rate of COVID-19 is between 1-3%, you’re looking at 1-3 million dead vs. 4-12,000 dead.

So let’s start flattening that exponential curve. South Korea and China both seem to have done it, so there’s no reason the rest of the world can’t through aggressive action. (thx, david)

Update: Vox has a nice explainer on what epidemiologists refer to as “flattening the curve”.

Yet the speed at which the outbreak plays out matters hugely for its consequences. What epidemiologists fear most is the health care system becoming overwhelmed by a sudden explosion of illness that requires more people to be hospitalized than it can handle. In that scenario, more people will die because there won’t be enough hospital beds or ventilators to keep them alive.

A disastrous inundation of hospitals can likely be averted with protective measures we’re now seeing more of — closing schools, canceling mass gatherings, working from home, self-quarantine, avoiding crowds - to keep the virus from spreading fast.

Epidemiologists call this strategy of preventing a huge spike in cases “flattening the curve”.

Here’s the relevant graphic explanation from Our World in Data’s COVID-19 package:

Flatten The Curve

COVID-19 Empties Out Public Spaces

posted by Jason Kottke   Mar 10, 2020

For the Atlantic, Alan Taylor compiled a bunch of photos of normally bustling places that are a lot emptier due to the COVID-19 crisis. This is the Grand Mosque in Mecca:

Covid 19 Empty Spaces

A Europa league football match played in an empty stadium (play in Italy’s Serie A league has been suspended until at least April 3):

Covid 19 Empty Spaces

And here’s Sunday mass at a church in Milan:

Covid 19 Empty Spaces

You can see the whole photo gallery here.

See also Ghost City Photos of a Usually Bustling Shanghai During Coronavirus Outbreak.

Update: Several more photo collections of the outside world’s increasingly empty spaces:

For Nieman Lab, Cherine Fahd and Sara Oscar wrote about the uncanny melancholy of empty photographs in the time of coronavirus.

These artists demonstrate a longstanding fascination with photographing architecture devoid of human subjects.

This fascination may be due to what architectural historian Anthony Vidler described as “the architectural uncanny.” Abandoned and deserted spaces, he said, make our familiar spaces become unfamiliar. For Vidler, this estrangement from space hinges on visual representation, such as in photography. These photographs of empty public spaces capture a departure from our everyday and instead visualize this uncanniness: an alternative reality emptied of our presence.

COVID-19: Not Just A Bad Flu

posted by Jason Kottke   Mar 10, 2020

A few days ago, Dr. Daniele Macchini, a physician in Bergamo, Italy, made a long post on Facebook (also reprinted here) about how the outbreak of COVID-19 (coronavirus) is overwhelming the hospitals there and pleads with the rest of the world to take the virus seriously. The original post is in Italian and Google Translate does pretty well with it. Dr. Silva Stringhini translated the important bits of Dr. Macchini’s post in this Twitter thread and is somewhat easier to read:

After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.

“I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.

“I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly ‘emptied’, elective activities were interrupted, intensive care were freed up to create as many beds as possible.

“All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.

“I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least.

“The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.

“The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.

Dr. Macchini urges: “Let’s stop saying it’s a bad flu.” But this is the part that stopped me in my tracks and got me to write this post:

So have patience, too, that you cannot go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate.

His overall message is that we shouldn’t panic, but that we should take COVID-19 seriously. The goal here is to keep the most vulnerable of us as safe as possible and work to slow the spread of the virus so it doesn’t overwhelm our healthcare system. So let’s do that — the elderly and those most at risk are counting on us.

Ghost City Photos of a Usually Bustling Shanghai During Coronavirus Outbreak

posted by Jason Kottke   Feb 12, 2020

One Person City

One Person City

One Person City

For her series One Person City, photographer nicoco has been taking photos of Shanghai that emphasize how deserted the city was due to the COVID-19 outbreak that has killed more than 1000 people in China. In an interview with Hyperallergic, the photographer said:

My objective for this series was to capture the feeling of apocalyptic emptiness. Some of the photos may look as if they were captured at strange early morning hours, but as a collection, it seeks to reinforce there were no people, anywhere.

These are Shanghai’s busiest locations that can compare to Times Square in New York City, Big Ben in London, the Bean in Chicago, or the Washington Monument in DC. They are very popular on an average day, and very, very popular during holidays as domestic tourists and residents spend time with their families and check out festive displays, shop, or just meander around.

You can find the photos on her Instagram.