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kottke.org posts about Covid-19

The Omicron Variant

posted by Jason Kottke   Nov 29, 2021

Last week, a worrisome variant of SARS-CoV-2 burst into the public consciousness: the Omicron variant. The concern among scientists and the public at large is substantial, but it is unfortunately going to take a few weeks to figure out whether those concerns are warranted. For a measured take on what we know now and what we can expect, read these two posts by epidemiologist Dr. Katelyn Jetelina (as well as this one on vaccines).

B.1.1.529 has 32 mutations on the spike protein alone. This is an insane amount of change. As a comparison, Delta had 9 changes on the spike protein. We know that B.1.1.529 is not a “Delta plus” variant. The figure below shows a really long line, with no previous Delta ancestors. So this likely means it mutated over time in one, likely immunocompromised, individual.

Of these, some mutations have properties to escape antibody protection (i.e. outsmart our vaccines and vaccine-induced immunity). There are several mutations association with increased transmissibility. There is a mutation associated with increased infectivity.

That sounds bad but again, we presently do not have enough information to know for sure about any of this. As Jetelina concludes in one of the posts:

We still have more questions than answers. But we will get them soon. Do not take Omicron lightly, but don’t abandon hope either. Our immune systems are incredible.

None of this changes what you can to do right now: Ventilate spaces. Use masks. Test if you have symptoms. Isolate if positive. Get vaccinated. Get boosted.

This Science piece by Kai Kupferschmidt also provides a great overview about where we’re at with Omicron, without the sensationalism.

Whether or not Omicron turns out to be another pandemic gamechanger, the lesson we should take from it (but probably won’t) is that grave danger is lurking in that virus and we need to get *everyone* *everywhere* vaccinated, we need free and ubiquitous rapid testing *everywhere*, we need to focus on indoor ventilation, we need to continue to use measures like distancing and mask-wearing, and we need to keep doing all of the other things in the Swiss cheese model of pandemic defense. Anything else is just continuing our idiotic streak with this virus of fucking around and then finding out. (via jodi ettenberg & eric topol)

Entering the Acceptance Phase of the Pandemic

posted by Jason Kottke   Oct 12, 2021

In the United States and in many other countries around the world, we’re slowly shifting away from the Covid-19 pandemic to SARS-CoV-2 being endemic (like the flu), Dr. Lucy McBride argues that we need to recalibrate our risk calculations and expectations of what’s safe & dangerous. From A COVID Serenity Prayer in The Atlantic:

For the past 18 months, my patients have craved straightforward answers: a simple “Yes-it’s perfectly safe” or “Go for it. Have fun!” or even a “No, you absolutely cannot” to quiet the endless loops of risk calculations. But medicine is not about certainty. It never has been.

The two things that patients want-reassurance that they won’t get COVID-19 and permission to engage in life-I cannot deliver, and I never will be able to. SARS-CoV-2 is here to stay. The virus will be woven into our everyday existence much like RSV, influenza, and other common coronaviruses are. The question isn’t whether we’ll be exposed to the novel coronavirus; it’s when.

And although many of us will inevitably get COVID-19, for the majority of vaccinated people, it won’t be so bad. The vaccines weren’t designed to wholly prevent COVID-19; they transformed it into a manageable illness like the flu.

That means that, from a decision-making perspective, we’re starting to reach the acceptance phase of the pandemic: a time when we must recalibrate our individual risk gauges, which have been completely thrown out of whack. The approach I’m embracing with patients boils down to a secular version of the serenity prayer. We need “the serenity to accept the things [we] cannot change, courage to change the things [we] can, and the wisdom to know the difference.”

Time Lapse Map of Covid-19’s Spread Across the US, 2/2020 to 9/2021

posted by Jason Kottke   Oct 05, 2021

Using data from Johns Hopkins, this time lapse video shows the spread of Covid-19 across the US from Feb 2020 to Sept 2021. This looks so much like small fires exploding into raging infernos and then dying down before flaring up all over again. Indeed, forest fire metaphors seem to be particularly useful in describing pandemics like this.

Think of COVID-19 as a fire burning in a forest. All of us are trees. The R0 is the wind speed. The higher it is, the faster the fire tears through the forest. But just like a forest fire, COVID-19 needs fuel to keep going. We’re the fuel.

In other forest fire metaphorical scenarios, people are ‘kindling’, ‘sparks being thrown off’ (when infecting others) and ‘fuel’ (when becoming infected). In these cases, fire metaphors convey the dangers posed by people being in close proximity to one another, but without directly attributing blame: people are described as inanimate entities (trees, kindling, fuel) that are consumed by the fire they contribute to spread.

See also A Time Lapse World Map of Every Covid-19 Death (from July 2020).

“Profoundly Unequal” US is Unprepared for the Next Pandemic

posted by Jason Kottke   Sep 29, 2021

Ed Yong: We’re Already Barreling Toward the Next Pandemic. The US is throwing too little money at high-tech, ultimately private sector solutions but much of the problem comes down to our underfunded public health system and “profoundly unequal society”.

“To be ready for the next pandemic, we need to make sure that there’s an even footing in our societal structures,” Seema Mohapatra, a health-law expert at Indiana University, told me. That vision of preparedness is closer to what 19th-century thinkers lobbied for, and what the 20th century swept aside. It means shifting the spotlight away from pathogens themselves and onto the living and working conditions that allow pathogens to flourish. It means measuring preparedness not just in terms of syringes, sequencers, and supply chains but also in terms of paid sick leave, safe public housing, eviction moratoriums, decarceration, food assistance, and universal health care. It means accompanying mandates for social distancing and the like with financial assistance for those who might lose work, or free accommodation where exposed people can quarantine from their family. It means rebuilding the health policies that Reagan began shredding in the 1980s and that later administrations further frayed. It means restoring trust in government and community through public services. “It’s very hard to achieve effective containment when the people you’re working with don’t think you care about them,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me.

The Psychology of Pandemics

posted by Jason Kottke   Sep 20, 2021

I don’t know if this is comforting or what, but psychologist Steven Taylor published a book two months before the start of the Covid-19 pandemic called The Psychology of Pandemics that predicted many of the behaviors we’ve been seeing over the past 18+ months, including masking backlash, the acceptance of conspiracy theories, vaccine resistance, and wholesale denial that the pandemic is even happening.

Taylor would know because he predicted it. He wrote a remarkable little book back in 2019 called “The Psychology of Pandemics.” Its premise is that pandemics are “not simply events in which some harmful microbe ‘goes viral,’” but rather are mass psychological phenomena about the behaviors, attitudes and emotions of people.

The book came out pre-COVID and yet predicts every trend and trope we’ve been living for 19 months now: the hoarding of supplies like toilet paper at the start; the rapid spread of “unfounded rumors and fake news”; the backlash against masks and vaccines; the rise and acceptance of conspiracy theories; and the division of society into people who “dutifully conform to the advice of health authorities” — sometimes compulsively so — and those who “engage in seemingly self-defeating behaviors such as refusing to get vaccinated.”

He has no crystal ball, he says, it’s just that all of this has happened before. A lot of people believed the Spanish flu pandemic of 1918 was spread by the Germans through Bayer aspirin. It’s all based on basic psychology as to how people react to health emergencies.

The denialists and refuseniks today are engaging in what the psychology field calls “psychological reactance.” It’s “a motivational response to rules, regulations, or attempts at persuasion that are perceived as threatening one’s autonomy and freedom of choice,” the book describes. Think what happens when someone says “Eat your broccoli.”

Following onto that is what psychologists term “motivated reasoning.” That’s when people stick with their story even if the facts obviously are contrary to it, as a form of “comforting delusion,” Taylor says. The book covers “unrealistic optimism bias,” in which people in pandemics are prone to convincing themselves that it can’t or won’t happen to them.

The book almost wasn’t even released at all — Taylor’s publisher told him the book was “interesting, but no one’s going to want to read it”.

Even with Delta Variant, the Amazing Vaccines Are Saving Lives

posted by Jason Kottke   Aug 25, 2021

It may seem like sometimes that with the pandemic, we’re back to square one. With the much more contagious Delta variant in play and an increasing number of breakthrough infections, the efficacy of these vaccines that we thought were amazing maybe aren’t? (Or maybe we just need to readjust our expectations?) But in terms of what these vaccines were specifically developed for — reducing & preventing severe disease and death — they are still very much doing their job. Just take a look at this graph from a White House Covid-19 press briefing yesterday:

a graph of Covid-19-associated hospitalizations among unvaccinated and fully vaccinated in the US

Even with Delta endemic in the country, the vaccines are providing extraordinary protection against infections severe enough to land folks in the hospital. In a recent CDC study of infections and hospitalizations in Los Angeles County, they report that on July 25, the hospitalization rate of unvaccinated people was 29.2 times that of fully vaccinated persons. 29 times the protection is astounding for a medical intervention. These vaccines work, we’re lucky to have them, and we need to get as many people worldwide as we can vaccinated as quickly as we can. Period.

Dying in the Name of Vaccine Freedom

posted by Jason Kottke   Aug 23, 2021

You might want to take a deep breath or do a couple of laps around the house before watching this video about a community in the Ozarks with a very low Covid-19 vaccination rate. Here’s a sample. An ICU patient wearing an oxygen mask on why he didn’t get vaccinated:

I’m more of a libertarian and I don’t like being told what I have to do. I’m still not completely 100% sold on the inoculation.

Video narrator:

It was eerie to hear Christopher insist on his individual freedoms even as he struggled to breathe.

Can you hear me screaming all the way from my desk to wherever you are? I don’t like being told what I have to do?! Fucking hell. And this:

There’s no better place to see the impact of this political rhetoric than in the hospital. Only about 50 percent of the staff are vaccinated. None of the unvaccinated staffers were willing to talk.

Absolutely maddening. I want off this ride.

The Parents Are Not Alright

posted by Jason Kottke   Aug 23, 2021

Dan Sinker writes for The Atlantic about how navigating Covid risks, politically motivated bullshit, and America’s failing infrastructure has broken parents during the pandemic: Parents Are Not Okay.

Instead it was a year in limbo: school on stuttering Zoom, school in person and then back home again for quarantine, school all the time and none of the time. No part of it was good, for kids or parents, but most parts of it were safe, and somehow, impossibly, we made it through a full year. It was hell, but we did it. We did it.

Time collapsed and it was summer again, and, briefly, things looked better. We began to dream of normalcy, of trips and jobs and school. But 2021’s hot vax summer only truly delivered on the hot part, as vaccination rates slowed and the Delta variant cut through some states with the brutal efficiency of the wildfires that decimated others. It happened in a flash: It was good, then it was bad, then we were right back in the same nightmare we’d been living in for 18 months.

And suddenly now it’s back to school while cases are rising, back to school while masks are a battleground, back to school while everyone under 12 is still unvaccinated. Parents are living a repeat of the worst year of their lives-except this time, no matter what, kids are going back.

Almost every parent I know is struggling with exactly this: trying to keep their kids (and family and friends) safe from Covid-19 while balancing the social & emotional wellbeing of everyone concerned and not getting a lot of help from their governments or communities. Remote school is no longer an option, few infrastructure upgrades have been made to improve ventilation in schools, no vaccine mandates for teachers or staff, parents fighting administrators about vaccine & mask mandates, and everyone is trying to do complex risk calculations about sending their can’t-yet-be-vaccinated kids into buildings with other kids whose parents, you suspect, are not vaccinated and aren’t taking any precautions in states where Delta is endemic. All while trying to work and remain sane somehow? And most of the parents I know have resources — they have steady income & savings, live in safe communities, and have friends & family to fall back on when times get tough. Those who don’t? I truly do not know how they are doing any of this without incurring significant, long-term trauma for parents and kids. We, inasmuch as we’re still a “we” in America, are failing them all.

What’s the Proper Metaphor for the Covid Vaccine?

posted by Jason Kottke   Aug 13, 2021

For The Atlantic, Katherine Wu writes about the difficulty of communicating how vaccines work and how they protect individuals and communities from disease: Vaccines Are Like Sunscreen… No, Wait, Airbags… No, Wait…

Unfortunately, communal benefit is harder to define, harder to quantify, and harder to describe than individual protection, because “it’s not the way Americans are used to thinking about things,” Neil Lewis, a behavioral scientist and communications expert at Cornell, told me. That’s in part because communal risk isn’t characteristic of the health perils people in wealthy countries are accustomed to facing: heart disease, stroke, diabetes, cancer. Maybe that’s part of why we gravitate toward individual-focused comparisons. Slipping into a pandemic-compatible, population-based frame of mind is a big shift. In the age of COVID-19, “there’s been a lot of focus on the individual,” Lewis told me. That’s pretty at odds “with how infection works.”

As someone who has struggled with analogizing the virus & vaccines, I was nodding my head a lot while reading this. Something I’ve noticed in recent years that Wu didn’t get into is that readers desire precision in metaphors and analogies, even though metaphor is — by definition! — not supposed to be taken literally. People seem much more interested in taking analogies apart, identifying what doesn’t work, and discarding them rather than — more generously and constructively IMO — using them as the author intended to better understand the subject matter. The perfect metaphor doesn’t exist because then it wouldn’t be a metaphor.

Getting into the Delta Variant Mindset

posted by Jason Kottke   Aug 12, 2021

I’m just going to go ahead and say it right up front here: if you had certain expectations in May/June about how the pandemic was going to end in the US (or was even thinking it was over), you need to throw much of that mindset in the trash and start again because the Delta variant of SARS-CoV-2 has changed the game. I know this sucks to hear,1 but Delta is sufficiently different that we need to reset and stop assuming we can solely rely on the vaccines to stop Covid-19 from spreading. Ed Yong’s typically excellent piece on how delta has changed the pandemic’s endgame is helping me wrap my head around this.

But something is different now — the virus. “The models in late spring were pretty consistent that we were going to have a ‘normal’ summer,” Samuel Scarpino of the Rockefeller Foundation, who studies infectious-disease dynamics, told me. “Obviously, that’s not where we are.” In part, he says, people underestimated how transmissible Delta is, or what that would mean. The original SARS-CoV-2 virus had a basic reproduction number, or R0, of 2 to 3, meaning that each infected person spreads it to two or three people. Those are average figures: In practice, the virus spread in uneven bursts, with relatively few people infecting large clusters in super-spreading events. But the CDC estimates that Delta’s R0 lies between 5 and 9, which “is shockingly high,” Eleanor Murray, an epidemiologist at Boston University, told me. At that level, “its reliance on super-spreading events basically goes away,” Scarpino said.

In simple terms, many people who caught the original virus didn’t pass it to anyone, but most people who catch Delta create clusters of infection. That partly explains why cases have risen so explosively. It also means that the virus will almost certainly be a permanent part of our lives, even as vaccines blunt its ability to cause death and severe disease.

And a reminder, as we “argue over small measures” here in the US, that most of the world is in a much worse place:

Pandemics end. But this one is not yet over, and especially not globally. Just 16 percent of the world’s population is fully vaccinated. Many countries, where barely 1 percent of people have received a single dose, are “in for a tough year of either lockdowns or catastrophic epidemics,” Adam Kucharski, the infectious-disease modeler, told me. The U.S. and the U.K. are further along the path to endemicity, “but they’re not there yet, and that last slog is often the toughest,” he added. “I have limited sympathy for people who are arguing over small measures in rich countries when we have uncontrolled epidemics in large parts of the world.”

Where I think Yong’s piece stumbles a little is in its emphasis of the current vaccines’ protection against infection from Delta. As David Wallace-Wells explains in his piece Don’t Panic, But Breakthrough Cases May Be a Bigger Problem Than You’ve Been Told, vaccines still offer excellent protection against severe infection, hospitalization, and death, but there is evidence that breakthrough infections are more common than many public health officials are saying. The problem lies with the use of statistics from before vaccines and Delta were prevalent:

Almost all of these calculations about the share of breakthrough cases have been made using year-to-date 2021 data, which include several months before mass vaccination (when by definition vanishingly few breakthrough cases could have occurred) during which time the vast majority of the year’s total cases and deaths took place (during the winter surge). This is a corollary to the reassuring principle you might’ve heard, over the last few weeks, that as vaccination levels grow we would expect the percentage of vaccinated cases will, too — the implication being that we shouldn’t worry too much over panicked headlines about the relative share of vaccinated cases in a state or ICU but instead focus on the absolute number of those cases in making a judgment about vaccine protection across a population. This is true. But it also means that when vaccination levels were very low, there were inevitably very few breakthrough cases, too. That means that to calculate a prevalence ratio for cases or deaths using the full year’s data requires you to effectively divide a numerator of four months of data by a denominator of seven months of data. And because those first few brutal months of the year were exceptional ones that do not reflect anything like the present state of vaccination or the disease, they throw off the ratios even further. Two-thirds of 2021 cases and 80 percent of deaths came before April 1, when only 15 percent of the country was fully vaccinated, which means calculating year-to-date ratios means possibly underestimating the prevalence of breakthrough cases by a factor of three and breakthrough deaths by a factor of five. And if the ratios are calculated using data sets that end before the Delta surge, as many have been, that adds an additional distortion, since both breakthrough cases and severe illness among the vaccinated appear to be significantly more common with this variant than with previous ones.

Vaccines are still the best way to protect yourself and your community from Covid-19. The vaccines are still really good, better than we could have hoped for. But they’re not magic and with the rise of Delta (and potentially worse variants on the horizon if the virus is allowed to continue to spread unchecked and mutate), we need to keep doing the other things (masking, distancing, ventilation, etc.) in order to keep the virus in check and avoid lockdowns, school closings, outbreaks, and mass death. We’ve got the tools; we just need to summon the will and be in the right mindset.

  1. In a tweet introducing his piece, Yong says “Many folks are upset & confused by the last month” and that’s right where I am with this. Maybe you are too. I’m expecting to get angry email about this post, calling it alarmist. But Covid is different now and thinking our same March 2021 thoughts about it isn’t going to help ourselves, our families, or our communities. The sooner we can regroup, the better.

One Woman’s Mission to Get Vaccines to Her Rural Alabama Town

posted by Jason Kottke   Aug 12, 2021

The Panola Project is a short film by Rachael DeCruz and Jeremy Levine that follows the efforts of local convenience store owner Dorothy Oliver to get the people in her small Alabama community vaccinated against Covid-19. A trusted member of her community, Oliver teams up with county commissioner Drucilla Russ-Jackson to call & go door-to-door, talking with people one-on-one, cajoling and telling personal stories of loss to get folks signed up for a mobile vaccination clinic.

In the film, Oliver and Russ-Jackson arrange for a hospital to set up a pop-up site in Panola, but the site will only be established if they get at least forty people to sign up to take the vaccine. We follow Oliver as she goes door to door, talking people into signing up, lightly cajoling them about their fears and concerns. When I asked her how she does it, her answer was disarmingly simple: “I just be nice to them,” she said. “I don’t go at them saying, ‘You gotta do that.’” DeCruz, too, was struck by the way Oliver and Jackson talked to people who were on the fence about the vaccine, an issue more often discussed with stridency of various types. “There’s this very warm and kind of loving and caring way that Dorothy and Ms. Jackson approached those conversations, even when people aren’t in agreement. And it wasn’t done in a way that’s, like, ‘I know better than you.’ “

Oliver’s charm with the skeptics is remarkable, but so is her determination to bring the vaccine to her underserved town. Most of the women and men Oliver talked to leaped at the opportunity to sign up for the vaccine. On vaccine day, they rolled down their car windows to thank her. “We appreciate y’all giving it to us, because a lot of people don’t really know where to go to take these vaccines,” one woman tells her. Vaccine hesitancy in Black communities has been harped on in the media, but those conversations can gloss over questions of availability. Levine told me that they were struck by how many people had put off vaccination for logistical rather than ideological reasons. In Panola, he says, they regularly heard people say, “I want the shot. How do I get this? I don’t have a car; how am I going to get forty miles to the closest hospital and back?”

The result? In a state with one of the lowest vaccination rates in the country, 94% of adults in Panola have been vaccinated, due in part to Oliver’s and Russ-Jackson’s efforts.

How Taiwan Held Off Covid-19 (Until It Didn’t)

posted by Jason Kottke   Jul 29, 2021

This video from Vox takes a look at how Taiwan avoided a Covid-19 outbreak for more than a year (and kept total deaths to just 7 in 2020 in a country of 23.6 million) while residents were mostly able to go about their normal lives. The video features photojournalist Ed Ou, who underwent a mandatory 14-day quarantine when he traveled to Taiwan last year. Ou had this to say after spending time in Taiwan, doing normal things without lockdowns or restrictions:

This was an alternate universe of what America, and the rest of the world, had seen all year. The Taiwanese people had been able to just live their lives, as if nothing had happened. Like, to me, that’s freedom.

After more than a year of almost no cases, Taiwan experienced its first Covid-19 outbreak in May (after relaxing their quarantine rules and, presumably, the rise of the delta variant) but has since gotten it under control. Other countries that had been successful in controlling the virus until recently — like Vietnam, Thailand, and Mongolia — are also seeing outbreaks now. When the rest of the world is teeming with the virus, it becomes more likely over time that even the most organized and protected systems are going to be vulnerable.

Visualization of Conservative America’s Vaccine Refusal

posted by Jason Kottke   Jul 28, 2021

Charles Gaba has been graphing the Covid-19 vaccination rates of the 50 states (and DC) against the percentage of people who voted for Donald Trump in 2020 and there is unsurprisingly a clear correlation between the two:

Covid-19 vaccination rates for the 50 states graphed against the percentage of Trump voters

As one commenter noted, all of the solidly “blue” states are above the vaxxed national average and all the solidly “red” states are below it. The picture is a little more muddy when you look at the rates at the county level:

Covid-19 vaccination rates for US counties graphed against the percentage of Trump voters

The “conservatives are unvaxxed” trend is still there, but a lack of access and education around the vaccines in counties with large Black and Latino populations also plays a large role in whether people are vaccinated or not.

Save Your Mask for the Next Disaster

posted by Jason Kottke   Jul 22, 2021

In what will be an increasingly common occurrence in the years to come, smoke from fires in the western United States and Canada covered a large part of the US over the past few days. The smoke drifted thousands of miles to the eastern seaboard and turned the skies hazy, the Sun orange, and the air dangerous for some people to breathe. But there’s good news: your Covid mask works for air pollution too!

Dr. Commane said people should avoid going outdoors in high-pollution conditions, and especially avoid strenuous exercise. She also suggested that wearing filtered masks can provide protection for those who can’t avoid the outdoors.

“A lot of the masks people have been wearing for Covid are designed to capture PM2.5,” she said, referring to N95-style masks. “That’s the right size to be very useful for air quality.”

It’s always nice when your apocalyptic dystopias match up so nicely.

Living with Delta

posted by Jason Kottke   Jul 21, 2021

This piece by Susan Matthews is really helpful for those of us who are vaccinated and trying to figure out what their risks are regarding the much more transmissible delta variant of SARS-CoV-2. Covid-19 is endemic now — how do we live with that? What reasonable actions should we take to keep ourselves, our communities, and our loved ones safe?

All of this is making people — yes, probably mostly vaccinated people — rethink the basic questions they thought their vaccine had answered for them: Can I go to restaurants and bars unmasked? Can I go back to the office? Can I see my grandma? Can I go on vacation? Can I unmask at my people-facing job? Can I have a wedding, or a party? The answer to those questions is not quite as easy as “yes, if you’re vaccinated.” It depends partly on how many in your group are vaccinated, but the actual answer is basically the same as it’s been all pandemic: It depends on your risk tolerance, it depends on what is happening with case counts locally (though, as more people travel, this might become a less reliable tool), and it depends on any unique risk factors in your group. Kass’ perspective felt novel to me: She said she suspects that in the end, a lot of people are going to end up boosting their immunity by suffering through a mild case of COVID. So no one should feel that bad about getting sick after they’re vaxxed. What matters is getting the order right: “If everyone who gets vaccinated still gets COVID but doesn’t die, that’s a success,” she said. The issue is that it doesn’t feel like a success for vaccinated people. Plus, “if you get infected after you’re vaxxed, it’s all you talk about,” she said. And right now, that’s understandably freaking out a lot of vaccinated people who thought they were in the clear.

Long Covid isn’t mentioned anywhere in here though — surely that has to be part of the conversation here (although anecdotally it doesn’t seem like too much of a worry).

“It’s Too Late”

posted by Jason Kottke   Jul 21, 2021

Dr. Brytney Cobia treats Covid-19 patients at the Grandview Medical Center in Birmingham, Alabama, a state that ranks last in the US in fully vaccinated adults. In a recent Facebook post, Cobia shares that people are willing to get vaccinated after having to watch an unvaccinated member of their family die from Covid.

I’ve made a LOT of progress encouraging people to get vaccinated lately!!! Do you want to know how? I’m admitting young healthy people to the hospital with very serious COVID infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.

Heartbreaking.

The US Isn’t Ready for Another Pandemic

posted by Jason Kottke   Jul 02, 2021

Olga Khazan writing for The Atlantic:

After an inept coronavirus response, will the United States do better when the next pandemic strikes? Experts generally agree that America learned from the past year, and that the next public-health crisis won’t be quite as bewildering. But America’s pandemic preparedness still has major gaps, some of which are too big for any one administration to fix. In recent weeks, I’ve called back many of the experts I interviewed over the past 18 months about masks, testing, contact tracing, quarantine, and more. I asked them, “Are we ready for another one?” The short answer is “Not quite.” The long answer is that being truly “ready” will be harder than anyone realizes.

The Trump administration mishandled the American response to Covid-19 so completely that it’s tempting to pin most of the pandemic carnage on him. But the more I read about the pandemic (Michael Lewis’s The Premonition is a recent example), the more I have come to believe that the majority of the American pandemic deaths were baked in, no matter who was President. Trump was definitely a worst-case scenario, but even a more competent person in the White House in Jan 2020 (like Clinton or Sanders or Romney) would not have done so much better. Poor public health infrastructure, politicized government agencies, no mandatory paid leave, an overpriced healthcare system that only works for some, uncoordinated national response (+ federalism), years of defunding government programs, a reactive (rather than proactive) CDC, unhealthy populace, poverty, systemic racism in medicine, entitled individualism, high rate of uninsured people, growing anti-science sentiment — the pandemic was destined to race through the United States like a brush fire no matter what.

Even the European Union, whose member nations do not share many of America’s aforementioned challenges (but have other issues), did only marginally better than the US in preventing Covid deaths. The UK did worse:

a chart showing the cumulative covid deaths per million of the US, UK, EU, and world

Where Did SARS-CoV-2 Come From?

posted by Jason Kottke   Jun 28, 2021

Over the past several months, I’ve read several pieces about the possible origins of SARS-CoV-2 and have been frustrated with the certainty with which folks who should know better have embraced the “lab leak hypothesis”. So, I was happy to see Zeynep Tufekci’s characteristically even-handed and comprehensive overview of the evidence about the virus’s origins in the NY Times.

While the Chinese government’s obstruction may keep us from knowing for sure whether the virus, SARS-CoV-2, came from the wild directly or through a lab in Wuhan or if genetic experimentation was involved, what we know already is troubling.

Years of research on the dangers of coronaviruses, and the broader history of lab accidents and errors around the world, provided scientists with plenty of reasons to proceed with caution as they investigated this class of pathogens. But troubling safety practices persisted.

Worse, researchers’ success at uncovering new threats did not always translate into preparedness.

Even if the coronavirus jumped from animal to human without the involvement of research activities, the groundwork for a potential disaster had been laid for years, and learning its lessons is essential to preventing others.

Is it possible that SARS-CoV-2 came from a lab? Yes. Is it probable? We can’t know that right now. It’s a tantalizing puzzle involving a possible cover-up, but irresponsibly assigning certainty to the situation does no one but attention-seeking pundits any good.

For the First Time Since Early 2020…

posted by Jason Kottke   Jun 10, 2021

For many of us in the US and other parts of the world, with Covid-19 on the decline because of vaccinations, the last month or two has seen people getting back into the world for the first time since the pandemic began in early 2020. XKCD’s Randall Munroe plotted out some of these experiences on a scale from “normal” to “alarming”:

a list of things people haven't done since early 2020

America’s Individualism and Our Poor Pandemic Response

posted by Jason Kottke   Jun 09, 2021

Ed Yong writing in The Atlantic, Individualism Is Still Sabotaging the Pandemic Response:

From its founding, the United States has cultivated a national mythos around the capacity of individuals to pull themselves up by their bootstraps, ostensibly by their own merits. This particular strain of individualism, which valorizes independence and prizes personal freedom, transcends administrations. It has also repeatedly hamstrung America’s pandemic response. It explains why the U.S. focused so intensely on preserving its hospital capacity instead of on measures that would have saved people from even needing a hospital. It explains why so many Americans refused to act for the collective good, whether by masking up or isolating themselves. And it explains why the CDC, despite being the nation’s top public-health agency, issued guidelines that focused on the freedoms that vaccinated people might enjoy. The move signaled to people with the newfound privilege of immunity that they were liberated from the pandemic’s collective problem. It also hinted to those who were still vulnerable that their challenges are now theirs alone and, worse still, that their lingering risk was somehow their fault. (“If you’re not vaccinated, that, again, is taking your responsibility for your own health into your own hands,” Walensky said.)

The pandemic demonstrated, in plain and easily understandable numbers of Covid deaths, that America is a place where the swift leave the stragglers to the wolves. I hope against hope that’ll change for the better in the future.

We Know What You Did During Lockdown

posted by Jason Kottke   May 25, 2021

After watching this short film on how much data private companies are able to gather about you (data that we willingly give them in some cases), you might be forgiven for thinking that, never mind some far flung future, we are living in a full-on dystopia right now. The set design, the acting, the positioning of the tables, the see-through table tops, the laptop vs. notebook…this was really well done. When the interrogator got up from his desk, I viscerally felt the invasion of privacy.

The Continuing Trauma of the Pandemic

posted by Jason Kottke   May 21, 2021

Because of the remarkable Covid-19 vaccines, the pandemic is easing in America. In many parts of the country, things are returning to some semblance of normal, whatever that means. But many will continue to struggle and come to terms with what happened for awhile longer. Ed Yong, What Happens When Americans Can Finally Exhale:

But there is another crucial difference between May 2020 and May 2021: People have now lived through 14 months of pandemic life. Millions have endured a year of grief, anxiety, isolation, and rolling trauma. Some will recover uneventfully, but for others, the quiet moments after adrenaline fades and normalcy resumes may be unexpectedly punishing. When they finally get a chance to exhale, their breaths may emerge as sighs. “People put their heads down and do what they have to do, but suddenly, when there’s an opening, all these feelings come up,” Laura van Dernoot Lipsky, the founder and director of the Trauma Stewardship Institute, told me. Lipsky has spent decades helping people navigate the consequences of natural disasters, mass shootings, and other crises. “As hard as the initial trauma is,” she said, “it’s the aftermath that destroys people.”

And it wasn’t just the pandemic:

Not everyone will feel this way. Perhaps most Americans won’t. In past work, Silver, the UC Irvine psychologist, found that even communities that go through extreme traumas, such as years of daily rocket fire, can show low levels of PTSD. Three factors seem to protect them: confidence in authorities, a sense of belonging, and community solidarity. In the U.S., the pandemic eroded all three. It reduced trust in institutions, separated people from their loved ones, and widened political divisions. It was something of a self-reinforcing disaster, exacerbating the conditions that make recovery harder.

Also, let’s not forget: “Globally, the pandemic is set to kill more people in 2021 than in 2020.”

“Maybe We Need Masks Indoors Just a Bit Longer”

posted by Jason Kottke   May 14, 2021

Since yesterday’s announcement, I’d been feeling uneasy about the CDC’s decision to update its guidance to state that fully vaccinated people don’t need to wear masks in most situations indoors or out. Zeynep Tufekci’s piece in the Times nails why.

It’s difficult for officials to issue rules as conditions evolve and uncertainty continues. So I hesitate to question the agency’s approach. But it’s not clear whether it was responding to scientific evidence or public clamor to lift state and local mandates, which the C.D.C. said could remain in place.

It might have been better to have kept up indoor mask mandates to help suppress the virus for maybe as little as a few more weeks.

The C.D.C. could have set metrics to measure such progress, saying that guidelines would be maintained until the number of cases or the number vaccinations reached a certain level, determined by epidemiologists.

The vaccine is on its way to controlling Covid-19 in the US — but we’re not there yet. We’re not the UK or Israel…they’re further along in their vaccination campaigns and their daily cases and deaths are way down, warranting behavioral changes. In the US, over 600 people/day are still dying of Covid-19 and our case positivity rate is still above 3%. Too many people, including almost all children, are still vulnerable and as Tufekci says, the CDC could have waited a few more weeks to more quickly drive down the virus levels.

Update: The CDC’s move has been sharply condemned by National Nurses United, the nation’s largest union of registered nurses:

“The union noted that more than 35,000 new cases of coronavirus were being reported each day and that more than 600 people were dying each day. “Now is not the time to relax protective measures, and we are outraged that the C.D.C. has done just that while we are still in the midst of the deadliest pandemic in a century,” Ms. Castillo said.”

And Ken Schultz notes that the needle the CDC is trying to thread here might not work out the way that they’d hoped.

Imagine the social preference ordering is:

1. Unvaccinated wear masks, vaccinated don’t.
2. Everyone wears masks.
3. No one wears masks.

Selfish, short-sighted behavior and the inability to monitor vaccination status mean that, in trying to get #1, you can end up at #3.

So I trust the CDC’s position that #1 is socially desirable from a scientific perspective. But by undermining mask mandates, they have made it more likely that we end up in #3, which science says is still risky. Living with #2 for now respects both science and social science.

11 Reasons to Keep Wearing a Mask After You’re Vaccinated and the Pandemic is “Over”

posted by Jason Kottke   May 12, 2021

two people wearing face masks

  1. You 100% do not want to get Covid-19.
  2. You are immunocompromised. Millions of people have immune conditions that make contracting Covid-19 much more dangerous for them.
  3. You’re traumatized from “the mental and emotional toll of the last year”.
  4. Because you need to be around people you suspect may not be vaccinated or taking Covid-19 seriously (e.g. as part of your job).
  5. You’re not feeling well and want to make sure to protect others around you.
  6. Because you want to signal to others that you are being safe and thinking of the health and wellness of those around you.
  7. You live in a household with unvaccinated people (kids, for example) and want to make sure to protect them.
  8. Because your personal risk tolerance is lower than other people’s.
  9. You need some time to feel comfortable enough taking your mask off around others after more than a year of that very behavior being dangerous.
  10. Because you want to.
  11. But mostly because it is NONE OF ANYONE’S GODDAMN CONCERN if you choose to keep wearing a mask. Fuck off! Mind your own business!

Michael Lewis’s New Book About the Pandemic (and Who Should Have Been in Charge)

posted by Jason Kottke   May 03, 2021

book cover for The Premonition by Michael Lewis

When large, seemingly sudden systemic failures occur, Michael Lewis is one of those writers who’s just waiting to pounce on it and tell us all about it. So it’s not a surprise to see that his new book comes out tomorrow: The Premonition: A Pandemic Story (ebook). From a Time interview with Lewis:

The Premonition makes sense of the COVID-19 pandemic through three people, each of whom knows a great deal about how to stop it-and none of whom is ever approached by the U.S. government: A “redneck epidemiologist” named Carter Mercher who had written the closest thing the government had to a pandemic strategy; Joe DeRisi, a McArthur Fellow who once built a chip containing all the world’s viruses; and Dr. Chastity Dean, an obscure local health official in California.

And from a mainly positive review by the NY Times’ Jennifer Szalai:

True to form, Lewis makes few grand claims for what he finds, preferring instead to let the curated details speak for themselves. “I like to think that my job is mainly to find the story in the material,” he writes in the prologue. “I think this particular story is about the curious talents of a society, and how those talents are wasted if not led. It’s also about how gaps open between a society’s reputation and its performance.”

The main question running through “The Premonition” is how, when it came to the initial Covid response, a very rich country that was ranked first globally in pandemic readiness in 2019 managed to incentivize almost all the wrong things.

Of course, this is the reality that all of us have been living for the past year, so the failures of the system don’t come as much of a surprise. Still, Lewis finds ways not just to showcase the brokenness of the system writ large but to zoom in on the sand in the gears.

But Szalai also notes the drawback of most of Lewis’s books:

This method of hewing so tightly to his characters’ perspectives gives Lewis’s narrative its undeniable propulsion, but it also comes at a cost. He doesn’t supply any endnotes, or even a sense of how many people he talked to. His main characters are presented to us as they would undoubtedly like to appear: charmingly obsessive, unwaveringly principled and unfailingly right.

You can listen to a brief interview with Lewis on NPR’s Morning Edition.

Labor Shortage or Terrible Jobs?

posted by Jason Kottke   Apr 26, 2021

Anne Helen Peterson noticed a bunch of reports about fast food & retail businesses around the US having trouble finding employees, which difficulty the business owners are blaming on lazy American workers whose unemployment benefits have been extended/expanded during the pandemic. But what if, she writes, those benefits are actually providing a safety net to American workers so that they do not need to take terrible jobs for low wages at terrible companies under terrible management? The ‘Capitalism is Broken’ Economy:

Stick with me here, but what if people weren’t lazy — and instead, for the first time in a long time, were able to say no to exploitative working conditions and poverty-level wages? And what if business owners are scandalized, dismayed, frustrated, or bewildered by this scenario because their pre-pandemic business models were predicated on a steady stream of non-unionized labor with no other options? It’s not the labor force that’s breaking. It’s the economic model.

Unemployment benefits have offered a steady paycheck while you figure out your options. Put differently: a version of the safety net that’s been missing from most American employment, and, by extension, the ability to say no. No, I don’t have to work for a restaurant that only gives me my hours three days ahead of time, thus making it nearly impossible to find reliable childcare. No, I don’t have to work clopen shifts. No, I don’t have to expect a job without sick leave or paid time off. No, I don’t have to deal with asshole customers or managers who degrade me without consequence. No, I don’t have to work in a job with significant, accumulating health risks.

Her question near the end of the piece is worth considering: “If a business can’t pay a living wage, should it be a business?”

Proposed Post-Pandemic New Yorker Covers

posted by Jason Kottke   Apr 26, 2021

Tomer Hanuka asked his third-year illustration students at SVA to “come up with a post-pandemic New Yorker magazine cover” and posted some of their wonderful & thoughtful work to Twitter. Here are a few that caught my eye:

New Yorker Post Pandemic

New Yorker Post Pandemic

New Yorker Post Pandemic

New Yorker Post Pandemic

The second cover down, by Katrina Catacutan, is probably my favorite (the body language of the woman answering the door is just perfect) but the last image by Amy Young hit me like a ton of bricks. The New Yorker should run all of these covers for an issue of the magazine in a few weeks — collect them all!

Case Closed: SARS-CoV-2 Spreads Primarily by Aerosols

posted by Jason Kottke   Apr 16, 2021

In a letter published in The Lancet, a group of scholars argue, with an extensive review of the available evidence, that the primary mode of transmission from human to human of the virus responsible for Covid-19 is via aerosols, not through larger particles called droplets or through fomites (transfer from surfaces). Here are three of their ten reasons why:

Third, asymptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally and is a key way SARS-CoV-2 has spread around the world, supportive of a predominantly airborne mode of transmission. Direct measurements show that speaking produces thousands of aerosol particles and few large droplets, which supports the airborne route.

Fourth, transmission of SARS-CoV-2 is higher indoors than outdoors and is substantially reduced by indoor ventilation. Both observations support a predominantly airborne route of transmission.

Fifth, nosocomial infections have been documented in health-care organisations, where there have been strict contact-and-droplet precautions and use of personal protective equipment (PPE) designed to protect against droplet but not aerosol exposure.

The letter concludes with a plea by the authors for public health officials to finally embrace this reality: “The public health community should act accordingly and without further delay.”

I can’t believe we’re actually still arguing about this. One of the authors, Jose-Luis Jimenez, wrote this seminal Time magazine piece that provided the smoke analogy that is the mental model I’ve been using to think about potential risks during the pandemic.

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.

Another of the authors, Zeynep Tufekci, has been arguing the case for aerosols (and masks & overdispersion) since early in the pandemic, and she succinctly explained in a Twitter thread how predominantly aerosol transmission fits with the mitigation methods that have really worked around the world:

Airborne transmission unites three things crucial to recognize for effective COVID-19 mitigation: transmission without symptoms (thus aerosols), clusters driving the epidemic (also aerosols) and masks/ventilation indoors being key (hey, also aerosols). This framework is coherent.

Her whole thread is worth a read — like this bit about how other respiratory pathogens are likely spread by aerosols and not droplets (as commonly believed):

Fascinatingly, you search the scientific record high and low, but there really is little to no direct evidence for gravity-sprayed droplets being predominant mode of transmission for respiratory illnesses outside of coughing/sneezing. It’s many… assumptions. Like a tradition.

If any good comes out of the pandemic at all, a better and more useful scientific understanding of how respiratory pathogens are transmitted would be a good start.

Update: One of the authors, Trisha Greenhalgh, responds succinctly to criticisms of the paper in this Twitter thread.

Criticism 1: “The paper is just opinion, and several authors aren’t even doctors.”

Response: No. It’s well-researched scholarly argument, produced by an interdisciplinary team of 6 professors including 3 docs, 2 aerosol scientists and 1 social scientist.

‘The Last Time a Vaccine Saved America’

posted by Jason Kottke   Apr 15, 2021

In 1955, epidemiologist Thomas Francis Jr. announced the results of a field trial of the polio vaccine that Jonas Salk had developed. America erupted in joy.

Now a phalanx of bulky television cameras focussed on Francis as he prepared to report on the efficacy of the vaccine. He had good news to share: to cheers from the audience, he explained that the Salk vaccine was sixty to seventy per cent effective against the most prevalent strain of poliovirus, and ninety per cent effective against the other, less common strains. All this had been shown through what was, at that time, the largest vaccine trial ever conducted.

All afternoon and evening, church bells rang out across America. People flooded into the streets, kissing and embracing; parents hugged their kids with joy and relief. Salk became an instant national hero, turning down the offer of a ticker-tape parade in New York City; President Dwight D. Eisenhower invited him to the White House and, later, asked Congress to award him a Congressional Gold Medal. That night, from the kitchen of a colleague’s house, Salk — whose name was being touted in newspapers, magazines, radio reports, and television news broadcasts around the world — gave his first network-TV interview to Edward R. Murrow, whose show “See It Now” had exposed the tactics of Senator Joseph McCarthy a year earlier. Blushing in admiration, Murrow asked the doctor, “Who owns the patent on this vaccine?” “The people,” Salk said, nobly. “There is no patent. Could you patent the sun?”

In the days that followed, schoolchildren were instructed by their teachers to write thank-you notes to Salk. Universities lined up to offer him honorary degrees. Millions of American doctors, nurses, and parents got down to the serious business of vaccinating their children against polio, using a shot they’d been anticipating for seventeen years.

But the polio vaccine rollout had its challenges, including a manufacturing negligence & oversight failure that resulted in tens of thousands of polio cases in otherwise healthy children.

In May, the polio vaccination drive was temporarily suspended. Leonard Scheele, the U.S. Surgeon General, inspected the facilities of all six vaccine companies and fired the government officials he considered to be culpable; the director of the N.I.H. and the Secretary of Health voluntarily resigned. New safety procedures were developed, including an improved means of filtering the viral mix just before the formaldehyde was added. Better tests were developed to detect live virus, and stricter record-keeping was instituted. The incident could have created a vaccine-hesitancy crisis. But, incredibly, the American public readily accepted the medical establishment’s explanation for the failure, and its pledges to right the situation. The nation’s trust in medical progress and in Dr. Salk was so resolute that, when it was announced that a new, safe polio vaccine was available, parents pushed their children back to the head of the line. It’s hard to imagine such an outcome today.

‘Private Choices Have Public Consequences’

posted by Jason Kottke   Apr 13, 2021

This is a very good and bracing essay from David Roth for Defector about a certain type of knee-jerk libertarian response to the pandemic in the US.

In place of any actually ennobling liberty or more fundamental freedom, contemporary American life mostly offers choices. But since most of these are not really choices at all in any meaningful way, it might be more accurate to say that we’re offered selection. The choice between paying for health insurance and running up six figures of non-dischargeable debt because you got sick, for instance, is honestly less a choice than a hostage situation. But because the second outcome is still extremely possible even if you choose to pay for health insurance, it’s more correct to say that the choice is already made, and that the decision is more about choosing from an array of variously insufficient and predatory options the one whose name or price or risk you like most. Sometimes there isn’t even that, and the choice is a binary one between something and nothing. None of this is really what anyone would choose, but these ugly individuated choices are what we get.

And then:

The broader complacent and unreasoned acceptance that props up our otherwise untenable status quo is shot through all these facile “it’s a private matter and a personal choice” formulations; if you have accepted that mostly useless choices between dreary outcomes are all you could ever get as a citizen in the wealthiest and most powerful country on earth, then you have also accepted that these choices are actually very important, and that making them is the thing makes you free. None of these personal choices actually make anything better for the person making them. In the case of the vaccine, those choices have devastating downstream impacts for all the people who glance off the choice-maker as they carve their personal hero’s journeys through the world. None of this matters as much as the idea that the choice is theirs to make.