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kottke.org posts about Covid-19

The New Normal

posted by Jason Kottke   Jul 09, 2020

This Is Fine

For Vox, David Roberts writes about how “shifting baselines” affect our thinking and how easily overwhelmingly large issues like climate change or a pandemic can become normalized.

Maybe climate chaos, a rising chorus of alarm signals from around the world, will simply become our new normal. Hell, maybe income inequality, political dysfunction, and successive waves of a deadly virus will become our new normal. Maybe we’ll just get used to [waves hands] all this.

Humans often don’t remember what we’ve lost or demand that it be restored. Rather, we adjust to what we’ve got.

The concept of shifting baselines was introduced in a 1995 paper by Daniel Pauly. Roberts explains:

So what are shifting baselines? Consider a species of fish that is fished to extinction in a region over, say, 100 years. A given generation of fishers becomes conscious of the fish at a particular level of abundance. When those fishers retire, the level is lower. To the generation that enters after them, that diminished level is the new normal, the new baseline. They rarely know the baseline used by the previous generation; it holds little emotional salience relative to their personal experience.

And so it goes, each new generation shifting the baseline downward. By the end, the fishers are operating in a radically degraded ecosystem, but it does not seem that way to them, because their baselines were set at an already low level.

Over time, the fish goes extinct — an enormous, tragic loss — but no fisher experiences the full transition from abundance to desolation. No generation experiences the totality of the loss. It is doled out in portions, over time, no portion quite large enough to spur preventative action. By the time the fish go extinct, the fishers barely notice, because they no longer valued the fish anyway.

And it’s not just groups of people that do this over generations:

It turns out that, over the course of their lives, individuals do just what generations do — periodically reset and readjust to new baselines.

“There is a tremendous amount of research showing that we tend to adapt to circumstances if they are constant over time, even if they are gradually worsening,” says George Loewenstein, a professor of economics and psychology at Carnegie Mellon. He cites the London Blitz (during World War II, when bombs were falling on London for months on end) and the intifada (the Palestinian terror campaign in Israel), during which people slowly adjusted to unthinkable circumstances.

“Fear tends to diminish over time when a risk remains constant,” he says, “You can only respond for so long. After a while, it recedes to the background, seemingly no matter how bad it is.”

Ok, I’ll let you just read the rest of it, but it’s not difficult to see how shifting baselines apply to all sorts of challenges facing the world today. I mean the lines “You can only respond for so long. After a while, it recedes to the background, seemingly no matter how bad it is.” seem like they were written specifically about the pandemic.

Acceptable Risk

posted by Jason Kottke   Jul 09, 2020

Acceptable Risk

Some Americans obviously aren’t troubling themselves with this but many of us are constantly running risk calculations in our heads for every little thing we do and don’t do during the course of the week during the pandemic.

Is it ok to visit the grocery store more than once this week? Can my kid have a playdate with her friend? Has her friend’s family been careful about seeing other people and how do I even ask them about it without sounding judgmental? Should I order that thing online or go to the store for it? Is it safe to take a roadtrip to a neighboring state? (Where the hell are we supposed to stop to use the bathroom?) Can I get a haircut? Do I need to order that thing online or do I just want it? Should schools reopen in the fall? And if they do, should I send my kids? Is eating at a restaurant safe for the staff? Can a friend come over for dinner? Can my son safely play in a baseball league? Will there be too many people not wearing masks in the store that I need to visit to get this one thing? Should I keep going to my favorite coffee shop when the barista just can’t seem to keep his mask up over his nose?

It goes on and on and on and IT’S EXHAUSTING. Comic from XKCD.

A Time Lapse World Map of Every Covid-19 Death

posted by Jason Kottke   Jul 08, 2020

From January to the end of June, over 500,000 people died of confirmed cases of Covid-19. In order to demonstrate the magnitude of the pandemic, James Beckwith made a time lapse map of each Covid-19 death.

Each country is represented by a tone and an expanding blip on the map when a death from Covid-19 is recorded. Each day is 4 seconds long, and at the top of the screen is the date and a counter showing the total numbers of deaths. Every country that has had a fatality is included.

As was the case with the pandemic, the video starts slow but soon enough the individual sounds and blips build to a crescendo, a cacophony of death. The only way this could be made more ominous & upsetting is by including the first song off of Cliff Martinez’s Contagion soundtrack as a backing track. As Beckwith notes in the description: “It is likely a sequel will need to be made.” (via open culture)

Anthony Fauci: USA on Track for 100,000 Covid-19 Cases Per Day

posted by Jason Kottke   Jun 30, 2020

US Covid Stupid Graph

The director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, told a Senate committee today that the US could be heading towards 100,000 new reported cases of Covid-19 per day. 100,000 cases per day. Yesterday the US recorded about 40,000 new cases.

“It is going to be very disturbing, I will guarantee you that,” he said.

“What was thought to be unimaginable turns out to be the reality we’re facing right now,” Fauci said, adding that “outbreaks happen, and you have to deal with them in a very aggressive, proactive way.”

Fewer than 20 countries have recorded more than 100,000 cases in total. Canada, for instance, has confirmed about 106,000 Covid-19 cases since the outbreak began.

Public health and infectious diseases experts, who have been gravely concerned about the way the U.S. response has unfolded, concurred with Fauci’s assessment.

Bars and restaurants are reopening around the country without any serious effort to test/trace/isolate/support. In the absence of strident guidance from the federal government, people are worrying less about social distancing and wearing masks to protect others. As this guy says, it’s just a matter of math:

“It’s unfortunately just a simple consequence of math plus a lack of action,” said Marm Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz. “On the one hand it comes across as ‘Oh my God, 100,000 cases per day!’ But then if you actually look at the current case counts and trends, how would you not get that?”

Absolutely nothing has changed about the virus, so its spread is determined by pretty simple exponential growth.

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.

We’ve known for months (and epidemiologists and infectious disease experts have known for their entire careers) what works and yet the federal government and many state governments have not listened and, in some cases, have actively suppressed use of such measures. So the pandemic will continue to escalate in the United States until proper measures are put in place by governments and people follow them. The virus will not change, the mathematics will not change, so we must.

Graph at the top of the post via Rishi Desai.

The Pandemic and the American Mountain of Dead

posted by Jason Kottke   Jun 30, 2020

For his piece The 3 Weeks That Changed Everything in The Atlantic, James Fallows talked to many scientists, health experts, and government officials about the US government’s response to the pandemic. In the article, he compares the pandemic response to how the government manages air safety and imagines what it would look like if we investigated the pandemic catastrophe like the National Transportation Safety Board investigates plane crashes.

Consider a thought experiment: What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude? I’ll jump to the answer before laying out the background: This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

And he continues:

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf. As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that — when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell — will be a central part of the history of our times.

But he rightly pins much of the blame for the state we’re in on the Trump administration almost completely ignoring the plans put into place for a viral outbreak like this that were developed by past administrations, both Republican and Democratic alike.

In cases of disease outbreak, U.S. leadership and coordination of the international response was as well established and taken for granted as the role of air traffic controllers in directing flights through their sectors. Typically this would mean working with and through the World Health Organization — which, of course, Donald Trump has made a point of not doing. In the previous two decades of international public-health experience, starting with SARS and on through the rest of the acronym-heavy list, a standard procedure had emerged, and it had proved effective again and again. The U.S, with its combination of scientific and military-logistics might, would coordinate and support efforts by other countries. Subsequent stages would depend on the nature of the disease, but the fact that the U.S. would take the primary role was expected. When the new coronavirus threat suddenly materialized, American engagement was the signal all other participants were waiting for. But this time it did not come. It was as if air traffic controllers walked away from their stations and said, “The rest of you just work it out for yourselves.”

From the U.S. point of view, news of a virulent disease outbreak anywhere in the world is unwelcome. But in normal circumstances, its location in China would have been a plus. Whatever the ups and downs of political relations over the past two decades, Chinese and American scientists and public-health officials have worked together frequently, and positively, on health crises ranging from SARS during George W. Bush’s administration to the H1N1 and Ebola outbreaks during Barack Obama’s. As Peter Beinart extensively detailed in an Atlantic article, the U.S. helped build China’s public-health infrastructure, and China has cooperated in detecting and containing diseases within its borders and far afield. One U.S. official recalled the Predict program: “Getting Chinese agreement to American monitors throughout their territory — that was something.” But then the Trump administration zeroed out that program.

Americans, and indeed everyone in the world, should be absolutely furious about this, especially since the situation is actively getting worse after months (months!) of inactivity by the federal government.

Mass Covid-19 Death in Brazil

posted by Jason Kottke   Jun 26, 2020

My God, this aerial photo of dozens of recent graves in the Nossa Senhora Aparecida cemetery in Manaus, Brazil:

Brazil Covid-19 graves

The photo is one of several from In Focus’s look at the Thousands of Burials Across Latin America. Brazil has 1.2 million confirmed Covid-19 cases, second most in the world (but only half the total of the US) and 55,000 confirmed deaths, though the number is likely much higher when you take excess mortality rates into account. Way back in April, when the reported death toll in Brazil was only (only!) ~3300, NPR reported on the mass graves and modified funeral procedures that were necessary due to Covid-19 and the Brazilian government’s disastrous response to it.

Yet the coronavirus has introduced a new kind of horror. The Nossa Senhora Aparecida cemetery has begun using backhoes to dig mass graves.

This has become “the only option” because it is “humanly impossible” to dig the required number of graves, says Viana, who runs a funeral company and is president of the Syndicate of Funeral Businesses in Amazonas.

According to Viana, the city’s daily average of deaths has risen from 30 to more than 100. The mayor’s office confirmed to NPR that there have been 340 burials just in the past three days. In most cases, the cause of death was listed as unknown, said a city hall spokeswoman.

City authorities are in little doubt that COVID-19 victims account for most of the spike. This means the virus is taking a far deadlier toll on Manaus than the official count of 172 virus-related deaths suggests. The reported death toll throughout Brazil is 3,313.

Video footage has appeared online showing the collapse of Manaus’ burial services and public hospitals. In one, corpses lie on beds in a hospital alongside live patients undergoing treatment. Another shows a line of vans waiting to deliver bodies for burial at the Nossa Senhora Aparecida cemetery.

The many layers of trauma from the pandemic are going to resonate for decades in places like Brazil and the US. Decades.

Covid-19 Superspreading Events and “Speech Superemitters”

posted by Jason Kottke   Jun 25, 2020

From Christie Aschwanden’s Scientific American article about How ‘Superspreading’ Events Drive Most COVID-19 Spread comes this speculation by a group of scientists that the way in which some people talk or breathe might spread many more potential coronavirus-carrying droplets than other people.

The scientists also have found intriguing evidence that a small subset of people may behave as “speech superemitters” — individuals who consistently broadcast an order of magnitude more respiratory particles than their peers. “It is very difficult to identify who is going to be a superemitter ahead of time,” he says. “One of the superemitters was a very petite young woman. And I was a bigger, bulkier guy and was not a superemitter.”

I don’t know why I find this so interesting, but I do. Add “speech superemitter” to the list of new Covid-19 vocabulary.

How the Pandemic Will Reshape Architecture

posted by Jason Kottke   Jun 23, 2020

For the New Yorker, Kyle Chayka looks at how the pandemic will change how we see our homes, workplaces, and public spaces — and the architectural shifts resulting from our new perspectives.

Unlike the airy, pristine emptiness of modernism, the space needed for quarantine is primarily defensive, with taped lines and plexiglass walls segmenting the outside world into zones of socially distanced safety. Wide-open spaces are best avoided. Barriers are our friends. Stores and offices will have to be reformatted in order to reopen, our spatial routines fundamentally changed. And, at home, we might find ourselves longing for a few more walls and dark corners.

The reimagining of our living spaces, where everyone is now eating, sleeping, working, and homeschooling, reminded me of this recent tweet:

I think we need to stop calling it ‘working from home’ and start calling it ‘living at work’

I’m also intrigued by the “6 Feet Office” concept:

The result was “the 6 Feet Office.” Carpet tiles demarcate six-foot black circles around every desk in the open floor plan. Extra chairs, positioned outside of the circles, facilitate conversation among colleagues. Conference-room chairs have been thinned out, and closed spaces must be exited clockwise, in unison, so that co-workers don’t bump into each other. “Hotdesking,” or the sharing of one desk by multiple workers, is made possible with disposable paper desk pads, on which a worker sets her laptop or keyboard and mouse when she arrives.

Cushman & Wakefield is slowly testing the 6 Feet Office design at its Amsterdam office, which used to hold two hundred and seventy-five people but now only has seventy-five at a time. As the lockdown lifts, Lokerse expects to start with twenty-five per cent of employees back at the office, but as more workers come back they’ll have staggered start times to avoid overcrowding on public transportation, and thirty-per-cent fewer desks over all. Bruce Mosler, the chairman of global brokerage at Cushman & Wakefield, noted that office spaces were already feeling too crowded before the pandemic and had started to limit crowding, a trend that is now accelerating. “We got carried away in the over-all densification process, in the effort to be as efficient as possible,” he said. “We went a bit too far. This is going to change that.”

See also Tape As Pandemic Architectural Element.

The Pandemic’s Epidemic of Loneliness

posted by Jason Kottke   Jun 22, 2020

In The Price of Isolation for Rolling Stone, Alex Morris writes about how trends toward increasing social isolation in America left us ill-prepared to face weeks and months of time by ourselves during the pandemic. Studies have shown that humans in isolation are less healthy and less able to fight off disease than when other humans are around. This part in particular really really resonated with me:

Sometimes, though, the body can be tricked. When Cole and his colleagues started looking for ways to combat the physical effects of loneliness, they didn’t find that positive emotions made a difference at all. But one thing did: “It was something called eudaimonic well-being, which is a sense of purpose and meaning, a sense of a commitment to some kind of self-transcendent goal greater than your own immediate self-gratification. People who have a lot of connection to some life purpose? Their biology looked great.” Even when researchers compared lonely people with purpose to social butterflies without it, purpose came out on top. In other words, it’s possible when we’re doing things to better our society, the body assumes there’s a society there to better. We’re technically alone, but it doesn’t feel that way.

Which has profound implications in the moment in which we currently find ourselves, a moment when the physical isolation and disconnection the virus has inflicted is now layered over the clear divisions and systemic inequities that have always plagued our country. In the midst of our solitude, we’ve been confronted with the terrible knowledge that people of color are dying of the virus at the highest rates and that 40 percent of families making less than $40,000 a year have lost their livelihoods. We’ve been confronted with the killings of Ahmaud Arbery, Breonna Taylor, and George Floyd. We’ve been confronted with the lie that the virus is a great equalizer. We’ve witnessed the many ways it isn’t.

See also We’re All Lonely Together and An Epidemic of Middle-aged Male Loneliness.

A Visual Guide to the SARS-CoV-2 Coronavirus

posted by Jason Kottke   Jun 17, 2020

Inside SARS-CoV-2

For its July 2020 issue, Scientific American has published A Visual Guide to the SARS-CoV-2 Coronavirus detailing what scientists have learned about this tiny menace that’s brought our world to a halt.

In the graphics that follow, Scientific American presents detailed explanations, current as of mid-May, into how SARS-CoV-2 sneaks inside human cells, makes copies of itself and bursts out to infiltrate many more cells, widening infection. We show how the immune system would normally attempt to neutralize virus particles and how CoV-2 can block that effort. We explain some of the virus’s surprising abilities, such as its capacity to proofread new virus copies as they are being made to prevent mutations that could destroy them. And we show how drugs and vaccines might still be able to overcome the intruders.

Vietnam, Population 95 Million, Has Recorded 0 Deaths from Covid-19

posted by Jason Kottke   Jun 16, 2020

Several countries have been celebrated for their success in curtailing the Covid-19 pandemic — Iceland, New Zealand, Mongolia, Hong Kong, Taiwan — but Vietnam, a nation of 95 million people that borders China, has recorded only 334 total infections and 0 deaths. 0 deaths. They are currently on a 61-day streak without a single community transmission. (For reference, the US has recorded 2.1 million cases and more than 115,000 deaths with just 3.4 times the population of Vietnam.)

How have they done it? They acted early and aggressively.

Experts say experience dealing with prior pandemics, early implementation of aggressive social distancing policies, strong action from political leaders and the muscle of a one-party authoritarian state have helped Vietnam.

“They had political commitment early on at the highest level,” says John MacArthur, the U.S. Centers for Disease Control and Prevention’s country representative in neighboring Thailand. “And that political commitment went from central level all the way down to the hamlet level.”

With experience gained from dealing with the 2003 SARS and 2009 H1N1 pandemics, Vietnam’s government started organizing its response in January — as soon as reports began trickling in from Wuhan, China, where the virus is believed to have originated. The country quickly came up with a variety of tactics, including widespread quarantining and aggressive contact tracing. It has also won praise from the World Health Organization and the CDC for its transparency in dealing with the crisis.

From the BBC:

Vietnam enacted measures other countries would take months to move on, bringing in travel restrictions, closely monitoring and eventually closing the border with China and increasing health checks at borders and other vulnerable places.

Schools were closed for the Lunar New Year holiday at the end of January and remained closed until mid-May. A vast and labour intensive contact tracing operation got under way.

“This is a country that has dealt with a lot of outbreaks in the past,” says Prof Thwaites, from Sars in 2003 to avian influenza in 2010 and large outbreaks of measles and dengue.

“The government and population are very, very used to dealing with infectious diseases and are respectful of them, probably far more so than wealthier countries. They know how to respond to these things.”

By mid-March, Vietnam was sending everyone who entered the country - and anyone within the country who’d had contact with a confirmed case — to quarantine centres for 14 days.

Costs were mostly covered by the government, though accommodation was not necessarily luxurious. One woman who flew home from Australia — considering Vietnam a safer place to be - told BBC News Vietnamese that on their first night they had “only one mat, no pillows, no blankets” and one fan for the hot room.

Forced bussing to quarantine centers in the US, could you even imagine? Better that hundreds of thousands of people die, I guess.

The Vietnamese health system also implemented aggressive contact tracing:

Authorities rigorously traced down the contacts of confirmed coronavirus patients and placed them in a mandatory two-week quarantine.

“We have a very strong system: 63 provincial CDCs (centers for disease control), more than 700 district-level CDCs, and more than 11,000 commune health centers. All of them attribute to contact tracing,” said doctor Pham with the National Institute of Hygiene and Epidemiology.

A confirmed coronavirus patient has to give health authorities an exhaustive list of all the people he or she has met in the past 14 days. Announcements are placed in newspapers and aired on television to inform the public of where and when a coronavirus patient has been, calling on people to go to health authorities for testing if they have also been there at the same time, Pham said.

More from Axios and The Guardian.

If NYC Were 100 People…

posted by Jason Kottke   Jun 15, 2020

Using census data (which she acknowledges can be imperfect in capturing the full range of people’s identities), data scientist/artist Mona Chalabi created a drawing of 100 people who are representative of NYC’s population for a NY Times opinion piece on inequality and coronavirus.

100 New Yorkers

Chalabi writes on Instagram:

When you think about who is most affected by Covid-19, you need to consider inequalities in housing, in access to healthcare, in wealth. And so much of that ends up consistently affecting people of color. You could think of it as overlapping circles in a Venn diagram. Or, you could look at these 100 people.

She’s selling prints of this on her website (pink background, black background), with all profits going towards a Covid-19 rent relief fund for families organized by The Conscious Kid.

See also If Only 100 People Lived on Earth…

Jesus Christ, Just Wear a Face Mask!

posted by Jason Kottke   Jun 11, 2020

The conclusion from a recent paper in the Proceedings of the Royal Society A:

We conclude that facemask use by the public, when used in combination with physical distancing or periods of lock-down, may provide an acceptable way of managing the COVID-19 pandemic and re-opening economic activity. These results are relevant to the developed as well as the developing world, where large numbers of people are resource poor, but fabrication of home-made, effective facemasks is possible. A key message from our analyses to aid the widespread adoption of facemasks would be: ‘my mask protects you, your mask protects me’.

From a Reuters report on the paper:

The research, led by scientists at the Britain’s Cambridge and Greenwich Universities, suggests lockdowns alone will not stop the resurgence of the new SARS-CoV-2 coronavirus, but that even homemade masks can dramatically reduce transmission rates if enough people wear them in public.

“Our analyses support the immediate and universal adoption of face masks by the public,” said Richard Stutt, who co-led the study at Cambridge.

A pair of recent papers used the geographic differences in mask usage in Germany to gauge the effectiveness of masks in preventing the spread of Covid-19. Face Masks Considerably Reduce COVID-19 Cases in Germany:

We use the synthetic control method to analyze the effect of face masks on the spread of Covid-19 in Germany. Our identification approach exploits regional variation in the point in time when face masks became compulsory. Depending on the region we analyse, we find that face masks reduced the cumulative number of registered Covid-19 cases between 2.3% and 13% over a period of 10 days after they became compulsory. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 40%.

And Compulsory face mask policies do not affect community mobility in Germany suggests that people don’t go out more or “feel invincible” when they’re wearing masks:

We use anonymised GPS data from Google’s Location History feature to measure daily mobility in public spaces (groceries and pharmacies, transport hubs and workplaces). We find no evidence that compulsory face mask policies affect community mobility in public spaces in Germany. The evidence provided in this paper makes a crucial contribution to ongoing debates about how to best manage the COVID-19 pandemic.

And these are just from the last few days. Why WHY WHY!!!! are we still talking about this? There’s no credible evidence that wearing a mask is harmful, so at worse it’s harmless. If there’s like a 1-in-10 chance that masks are somewhat helpful — and the growing amount of research suggests that both 1-in-10 and “somewhat helpful” are both understatements — isn’t it worth the tiny bit of effort to wear one and help keep our neighbors safe from potential fucking death? Just in case?

I mean, look at where we are as a country right now. Most of the US is reopening while the number of infections continue to rise. Testing is still not where it needs to be in many areas. Tracing and isolation are mostly not happening. According to epidemiologists, those are the minimum things you need to do to properly contain a pandemic like this. Maybe if you’re Iceland you can pooh pooh the efficacy of masks because you test/trace/isolated to near-perfection, but if you’re going to half-ass it like the US has chosen to do, then wearing masks under semi-lockdown conditions is all we have left! Can we do the bare minimum that is asked of us?

Update: And some anecdotal evidence from Missouri: two hairstylists saw 140 clients while symptomatic last month and it resulted in zero infections. Both the hairstylists and their clients wore masks and took other precautions (staggered appointments, chairs spaced apart).

Update: I deleted a reference to this paper that many epidemiologists et al. have flagged as problematic (see here, here, and here for instance). (via @harrislapiroff)

The Masks Masquerade by Nassim Nicholas Taleb is worth a read.

“Libertarians” (in brackets) are resisting mask wearing on grounds that it constrains their freedom. Yet the entire concept of liberty lies in the Non-Aggression Principle, the equivalent of the Silver Rule: do not harm others; they in turn should not harm you. Even more insulting is the demand by pseudolibertarians that Costco should banned from forcing customers to wear mask — but libertarianism allows you to set the rules on your own property. Costco should be able to force visitors to wear pink shirts and purple glasses if they wished.

Note that by infecting another person you are not infecting just another person. You are infecting many many more and causing systemic risk.

Wear a mask. For the Sake of Others.

And finally, obviously, if wearing a mask is not advisable for you — for a genuine medical reason or if it makes you look dangerous to a racist policing system for instance — then you shouldn’t wear one! But the vast majority of us should be able to manage it.

Update: A study in Health Affairs analyzing the infection rates in US states with face mask mandates versus those without finds that a mandate was associated with a decline in the Covid-19 growth rate (italics mine).

Mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage points in 1-5, 6-10, 11-15, 16-20, and 21+ days after signing, respectively. Estimates suggest as many as 230,000-450,000 COVID-19 cases possibly averted By May 22, 2020 by these mandates. The findings suggest that requiring face mask use in public might help in mitigating COVID-19 spread.

In a comparison among countries, those where people wore masks early fared much better than those where people didn’t. This is a pretty stark difference:

Mask vs. non-mask mortality

And this study noted that Google search volume of people searching for masks in various countries correlated with the infection rate — in general, the earlier the search volume increased in a given country, the fewer infections recorded in that country.

Update: A list of 70 scientific studies, dating all the way back to 2003, that support the wearing of face masks to prevent disease spread.

Bill Nye recently did a quick mask demonstration featuring a candle to show how effective homemade cloth masks are at blocking exhaled breath. He calls wearing a mask in public to protect other people “literally a matter of life and death”.

Stewart Reynolds shares some reasons to not wear a face mask, including selfish syndrome and chronic dickishness.

And this is a sad and all-too-typical American story in four parts. April: I’m not buying a mask; June: crowded pool party; July: complaining about being sick followed by an obituary. We need to fix this, now. People should not be dying like this — this is a 100% preventable death.

On the Public Health Experts’ Support of Antiracism Protests

posted by Jason Kottke   Jun 11, 2020

In The Atlantic, epidemiologists Julia Marcus and Gregg Gonsalves explain why public health officials are not being hypocritical in their support of the antiracism protests around the country.

At its core, the argument being leveled against public-health experts is that the reason for the protests shouldn’t matter. The coronavirus doesn’t care whether it’s attending an anti-lockdown protest or an anti-racism one. But these two kinds of protests are not equivalent from a public-health perspective. Some critics might argue that the anti-lockdown protests promoted economic activity, which can help stave off the health implications of poverty. (On this count, public-health experts were ahead of the curve: Many — including one of us — were advocating for a massive infusion of assistance to individual Americans as early as March.) But these protests were organized by pro-gun groups that believe the National Rifle Association is too compromising on gun safety. Egged on by the president to “save your great 2nd Amendment,” anti-lockdown protesters stormed government buildings with assault rifles and signs reading COVID-19 IS A LIE. The anti-lockdown demonstrations were explicitly at odds with public health, and experts had a duty to oppose them. The current protests, in contrast, are a grassroots uprising against systemic racism, a pervasive and long-standing public-health crisis that leads to more than 80,000 excess deaths among black Americans every year.

If “conservative commentators” cared at all about keeping people safe from Covid-19 infection, they would have denounced the I-Need-A-Haircut protests as reckless and they didn’t. Instead, they engage in these bad faith arguments that are just designed to stir up outrage.

Gonsalves wrote a thread on Twitter a few days ago that’s relevant here as well.

The risk to all of us was inflamed by an absolute decision at the highest levels that this epidemic was not worth an all-out, coordinated, comprehensive national mobilization. It took weeks for the President to even agree that the epidemic wouldn’t go away on its own.

The US, the richest nation in the world, then couldn’t get it together to scale-up the number of tests we needed to understand what was going on in our communities with SARS-COV-2, and in the end said it was up to the states to figure it all out.

And then this is the last word as far as I’m concerned:

We’ve all been put at far more jeopardy during this pandemic by our political leaders than by the people on the streets over the past week or so.

How Iceland Beat Covid-19 (So Far)

posted by Jason Kottke   Jun 10, 2020

One of the countries with the best response to Covid-19 has been Iceland. The country didn’t lockdown nor do many people wear masks, but they have virtually eliminated the virus through a vigorous program of test, trace, and isolate that was coordinated by public-health authorities. Iceland’s numbers were high in the beginning (the virus was carried into the country from people returning from vacation) but they acted quickly and aggressively — Elizabeth Kolbert has the story for the New Yorker.

Möller pulled up a series of graphs and charts on her laptop. These showed that, per capita, Iceland had had more COVID-19 cases than any other Scandinavian country, and more than even Italy or Britain. There was an outbreak in a nursing home in the town of Bolungarvík, in northwestern Iceland, and one in the Westman Islands, an archipelago off the southern coast, which seemed to have started at a handball game. (In Europe, handball is a team sport that’s sort of a cross between basketball and soccer.)

“The numbers in the beginning were terrible,” Möller said. She attributed the country’s success in bringing the caseload down in part to having got an early start. The “trio,” along with officials from Iceland’s university hospital, had begun meeting back in January. “We saw what was going on in China,” she recalled. “We saw the pictures of people lying dead in emergency departments, even on the street. So it was obvious that something terrible was happening. And, of course, we didn’t know if it would spread to other countries. But we didn’t dare take the chance. So we started preparing.” For example, it was discovered that the country didn’t have enough protective gear for its health-care workers, so hospital officials immediately set about buying more.

For Some, the Effects of Covid-19 Last for Months

posted by Jason Kottke   Jun 04, 2020

The Atlantic’s Ed Yong interviewed several people who, like thousands of others around the world, have been experiencing symptoms of Covid-19 for months now, indicating that the disease is chronic for some. Thousands Who Got COVID-19 in March Are Still Sick:

I interviewed nine of them for this story, all of whom share commonalities. Most have never been admitted to an ICU or gone on a ventilator, so their cases technically count as “mild.” But their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy. “It is mild relative to dying in a hospital, but this virus has ruined my life,” LeClerc said. “Even reading a book is challenging and exhausting. What small joys other people are experiencing in lockdown-yoga, bread baking-are beyond the realms of possibility for me.”

One of those who has been sick for months is Paul Garner, a professor of infectious diseases:

It “has been like nothing else on Earth,” said Paul Garner, who has previously endured dengue fever and malaria, and is currently on day 77 of COVID-19. Garner, an infectious-diseases professor at the Liverpool School of Tropical Medicine, leads a renowned organization that reviews scientific evidence on preventing and treating infections. He tested negative on day 63. He had waited to get a COVID-19 test partly to preserve them for health-care workers, and partly because, at one point, he thought he was going to die. “I knew I had the disease; it couldn’t have been anything else,” he told me. I asked him why he thought his symptoms had persisted. “I honestly don’t know,” he said. “I don’t understand what’s happening in my body.”

Garner wrote about his experience for BMJ.

The illness went on and on. The symptoms changed, it was like an advent calendar, every day there was a surprise, something new. A muggy head; acutely painful calf; upset stomach; tinnitus; pins and needles; aching all over; breathlessness; dizziness; arthritis in my hands; weird sensation in the skin with synthetic materials. Gentle exercise or walking made me worse — I would feel absolutely dreadful the next day. I started talking to others. I found a marathon runner who had tried 8 km in her second week, which caused her to collapse with rigors and sleep for 24 hours. I spoke to others experiencing weird symptoms, which were often discounted by those around them as anxiety, making them doubt themselves.

We still have no idea what the long-term effects of this disease are going to be. But it is definitely not the flu. And I remain unwilling to risk myself or my family getting it.

Welcome to American Capitalism

posted by Jason Kottke   May 28, 2020

From an April 17th Facebook post by Paul Field, a succinct summary of how the pandemic exposes American deficiencies. It’s tough to not just quote the whole thing, so here’s the beginning:

Everyone is entitled to their own opinion, but you need to know how silly you look if you post some variation of, “Welcome to Socialism…”

You are not seeing Socialism. What you are seeing is one of the wealthiest, geographically advantaged, productive capitalist societies in the world flounder and fail at its most basic test. Taking care of its people.

This crisis is not about the virus.

This crisis is about the massive failure of our, “Booming economy,” to survive even modest challenges. It is about the market dissonance of shortages in stores, even as farmers/producers destroy unused crops and products. This crisis is about huge corporations needing an emergency bailout within days of the longest Bull Market in our history ending and despite the ability to borrow with zero percent interest rates.

The pandemic has revealed that American democracy and our economic system is extremely fragile. Ok, unless you’re wealthy, in which case you’re going to be fine, all part of the plan, etc.

The Country with the Best Covid-19 Response? Mongolia.

posted by Jason Kottke   May 26, 2020

Mongolia Covid-19 response

Several countries have had solid responses to the Covid-19 pandemic: Taiwan, South Korea, New Zealand, and Hong Kong. But Indi Samarajiva thinks we should be paying much more attention to Mongolia, a country of 3.17 million people where no one has died and no locally transmitted cases have been reported.1 Let’s have that again: 3.17 million people, 0 local cases, 0 deaths. How did they do it? They saw what was happening in Wuhan, coordinated with the WHO, and acted swiftly & decisively in January.

Imagine that you could go back in time to January 23rd with the horse race results and, I dunno, the new iPhone. People believe you. China has just shut down Hubei Province, the largest cordon sanitaire in human history. What would you scream to your leaders? What would you tell them to do?

You’d tell them that this was serious and that it’s coming for sure. You’d tell them to restrict the borders now, to socially distance now, and to get medical supplies ready, also now. You’d tell them to react right now, in January itself. That’s 20/20 hindsight.

That’s exactly what Mongolia did, and they don’t have a time machine. They just saw what was happening in Hubei, they coordinated with China and the WHO, and they got their shit together fast. That’s their secret, not the elevation. They just weren’t dumb.

When you go to World In Data’s Coronavirus Data Explorer and click on “Mongolia” to add their data to the graph, nothing happens because they have zero reported cases and zero deaths. They looked at the paradox of preparation — the idea that “when the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction” — and said “sign us up for the overreacting!”

Throughout February, Mongolia was furiously getting ready - procuring face masks, test kits, and PPE; examining hospitals, food markets, and cleaning up the city. Still no reported cases. Still no let-up in readiness. No one was like “it’s not real!” or “burn the 5G towers!”

The country also suspended their New Year celebrations, which are a big deal in Asia. They deployed hundreds of people and restricted intercity travel to make sure, though the public seemed to broadly support the move.

Again — and I’ll keep saying this until March — there were still NO CASES. If you want to know how Mongolia ended up with no local cases, it’s because they reacted when there were no local cases. And they kept acting.

For example, when they heard of a case across the border (ie, not in Mongolia) South Gobi declared an emergency and put everyone in masks. The center also shut down coal exports — a huge economic hit, which they took proactively.

As you can see, at every turn they’re reacting like other countries only did when it was too late. This looked like an over-reaction, but in fact, Mongolia was always on time.

I have to tell you true: I got really upset reading this. Like crying and furious. The United States could have done this. Italy could have done this. Brazil could have done this. Sweden could have done this. England could have done this. Spain could have done this. Mongolia listened to the experts, acted quickly, and kept their people safe. Much of the rest of the world, especially the western world — the so-called first-world countries — failed to act quickly enough and hundreds of thousands of people have needlessly died and countless others have been left with chronic health issues, grief, and economic chaos.

  1. If you look at the list of cases at the bottom of this article (translated by Google), you can see that every reported case is from people coming into the country who were tested and quarantined.

US Covid-19 Death Toll Nears 100,000

posted by Jason Kottke   May 24, 2020

NY Times Covid-19 Front Page

That’s the front page of the NY Times today, listing the names of hundreds of the nearly 100,000 Americans who have died from Covid-19 (the full listing is of ~1000 names and continues inside the paper).

NY Times Covid-19 Obituaries Detail

Here’s a more readable PDF version and an online version that scrolls and scrolls and scrolls. They compiled the list by going through obituaries from local newspapers from around the countries.

Putting 100,000 dots or stick figures on a page “doesn’t really tell you very much about who these people were, the lives that they lived, what it means for us as a country,” Ms. Landon said. So, she came up with the idea of compiling obituaries and death notices of Covid-19 victims from newspapers large and small across the country, and culling vivid passages from them.

Alain Delaquérière, a researcher, combed through various sources online for obituaries and death notices with Covid-19 written as the cause of death. He compiled a list of nearly a thousand names from hundreds of newspapers. A team of editors from across the newsroom, in addition to three graduate student journalists, read them and gleaned phrases that depicted the uniqueness of each life lost:

“Alan Lund, 81, Washington, conductor with ‘the most amazing ear’ … “

“Theresa Elloie, 63, New Orleans, renowned for her business making detailed pins and corsages … “

“Florencio Almazo Morán, 65, New York City, one-man army … “

“Coby Adolph, 44, Chicago, entrepreneur and adventurer … “

Every one of these names was a person with a whole life behind them and so much more to come. Each has a family and friends who are mourning them. Here are a few more of their names and short stories:

Romi Cohn, 91, New York City, saved 56 Jewish families from the Gestapo.

Jermaine Ferro, 77, Lee County, Fla., wife with little time to enjoy a new marriage.

Julian Anguiano-Maya, 51, Chicago, life of the party.

Alan Merrill, 69, New York City, songwriter of “I Love Rock ‘n’ Roll.”

Lakisha Willis White, 45, Orlando, Fla., was helping to raise some of her dozen grandchildren.

In the past five months, more Americans have died from Covid-19 than in the decade-plus of the Vietnam War and the death toll is a third of the number of Americans who died in World War II. When this is over (whatever that means), the one thing we cannot do is forget all of these people. And we owe to them to make this mean something.

Just When You Thought It Was Safe to Go Back Into the Water…

posted by Jason Kottke   May 21, 2020

As summer ramps up in North America, people are looking to get out to enjoy the weather while also trying to keep safe from Covid-19 infection. Here in Vermont, I am very much looking forward to swim hole season and have been wondering if swimming is a safe activity during the pandemic. The Atlantic’s Olga Khazan wrote about the difficulty of opening pools back up this summer:

The coronavirus can’t remain infectious in pool water, multiple experts assured me, but people who come to pools do not stay in the water the entire time. They get out, sit under the sun, and, if they’re like my neighbors, form a circle and drink a few illicit White Claws. Social-distancing guidelines are quickly forgotten.

“If someone is swimming laps, that would be pretty safe as long as they’re not spitting water everywhere,” says Angela Rasmussen, a virologist at Columbia University. “But a Las Vegas-type pool party, that would be less safe, because people are just hanging out and breathing on each other.”

This story by Christopher Reynolds in the LA Times focuses more on transmission via water (pool water, salt water, river/lake water).

“There is no data that somebody got infected this way [with coronavirus],” said professor Karin B. Michels, chair of UCLA’s Department of Epidemiology, in a recent interview.

“I can’t say it’s absolutely 100% zero risk, but I can tell you that it would never cross my mind to get COVID-19 from a swimming pool or the ocean,” said Paula Cannon, a professor of molecular microbiology and immunology at USC’s Keck School of Medicine. “It’s just extraordinarily unlikely that this would happen.”

As long as you keep your distance of course:

Rather than worry about coronavirus in water, UCLA’s Michels and USC’s Cannon said, swimmers should stay well separated and take care before and after entering the pool, lake, river or sea.

“I would be more concerned about touching the same lockers or surfaces in the changing room or on the benches outside the pool. Those are higher risk than the water itself,” Michels said. “The other thing is you have to maintain distance. … More distance is always better.”

Sorta related but not really: ten meters is definitely more distance.

How to Think About Freedom and Liberty During a Pandemic

posted by Jason Kottke   May 19, 2020

After 2+ months of lockdown in most areas, a small minority of Americans want our country to go back to “normal” despite evidence and expert advice to the contrary. They want to get haircuts, not wear masks in public, go to crowded beaches, and generally go about their lives. These folks couch their desires in terms of freedom & liberty: the government has no right to infringe on the individual freedoms of its citizens.

But governments routinely do just that for all kinds of good reasons — e.g. you can’t murder someone just because you feel like it — and as Johns Hopkins’ public health historian Graham Mooney points out, there’s a precedent for a different way of thinking about freedom in the context of public health.

In response to these vehement appeals to individual freedom, public-health leaders in London, Liverpool, Manchester and elsewhere developed a powerful counterargument. They too framed their argument in terms of freedom — freedom from disease. To protect citizens’ right to be free from disease, in their view, governments and officials needed the authority to isolate those who were sick, vaccinate people, and take other steps to reduce the risk of infectious disease.

One of the most important reformers was George Buchanan, the chief medical officer for England from 1879 to 1892. He argued that cities and towns had the authority to take necessary steps to ensure the communal “sanitary welfare.” He and other reformers based their arguments on an idea developed by the 19th-century English philosopher John Stuart Mill, who is, ironically, remembered largely as a staunch defender of individual liberty. Mill articulated what he called the “harm principle,” which asserts that while individual liberty is sacrosanct, it should be limited when it will harm others: “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty and action of any of their number, is self-protection,” Mill wrote in On Liberty in 1859. Public-health reformers argued that the harm principle gave them the authority to pursue their aims.

An essay published in The Lancet in 1883 sums up this view nicely: “We cannot see that there is any undue violation of personal liberty in the sanitary authority acting for the whole community, requiring to be informed of the existence of diseases dangerous to others. A man’s liberty is not to involve risk to others,” the author wrote. “A man with smallpox has the natural liberty to travel in a cab or an omnibus; but society has a right that overrides his natural liberty, and says he shall not.”

Covid-19 Slang and How Language Evolves Quickly in Stressful Times

posted by Jason Kottke   May 13, 2020

Couchella

Kate Burridge and Howard Manns recently wrote a piece about how the Covid-19 pandemic is changing the English language. It’s written from an Australian perspective, so some of the slang might be a bit hard to follow for Americans et al.

In these times of COVID-19, there are the usual suspects: shortenings like “sanny” (hand sanitizer) and “iso” (isolation), abbreviations like BCV (before corona virus) and WFH (working from home), also compounds “corona moaner” (the whingers) and “zoombombing” (the intrusion into a video conference).

Plenty of nouns have been “verbed” too — the toilet paper/pasta/tinned tomatoes have been “magpied”. Even rhyming slang has made a bit of a comeback with Miley Cyrus lending her name to the virus (already end-clipped to “the Miley”). Some combine more than one process — “the isodesk” (or is that “the isobar”) is where many of us are currently spending our days.

“I’ve got the Miley”…I’ve always been a fan of rhyming slang. Linguist Tony Thorne, who specializes in slang & jargon, has compiled a list of new language introduced to (and by) the general public because of the pandemic.

Quarantimes - a hashtag or label for the prevailing circumstances under lockdown due to the coronavirus pandemic

Rona, Lady Rona, roni, rone - the coronavirus personified/familiarised

Boomer remover - the coronavirus viewed as a phenomenon resulting in the decimation of the baby boomer demographic

Covidiot - a person behaving irresponsibly in conditions of containment

Doomscrolling/doomsurfing - obsessively accessing upsetting news online

Infits - outfits worn in conditions of confinement

Zoom mullet - a hairstyle developed in lockdown which is ‘camera-ready’ (presentable to a webcam) at front and sides and dishevelled at the rear

Covid waltz - manoeuvring to avoid close contact with passers-by while distance restrictions are in place

Apropos Couchella illustration by the awesome Gemma Correll. (via lera boroditsky)

Polling Indicates Americans Overwhelmingly Agree on Covid-19 Countermeasures

posted by Jason Kottke   May 12, 2020

Recent polling compiled by Randall Munroe indicates that Americans agree on what to do about the Covid-19 pandemic to a greater extent than they “feel positively about kittens” or even “enjoy apple pie”.

XKCD Coronavirus Polling

Here’s a list of his sources.

“The Coronavirus Was an Emergency Until Trump Found Out Who Was Dying”

posted by Jason Kottke   May 11, 2020

There are a lot of different lenses you can use to look at how the United States and its government have confronted the Covid-19 pandemic. Race is a particularly useful one. As a reminder, here’s America’s current operating racial contract (from an Atlantic piece by Adam Serwer):

The implied terms of the racial contract are visible everywhere for those willing to see them. A 12-year-old with a toy gun is a dangerous threat who must be met with lethal force; armed militias drawing beads on federal agents are heroes of liberty. Struggling white farmers in Iowa taking billions in federal assistance are hardworking Americans down on their luck; struggling single parents in cities using food stamps are welfare queens. Black Americans struggling in the cocaine epidemic are a “bio-underclass” created by a pathological culture; white Americans struggling with opioid addiction are a national tragedy. Poor European immigrants who flocked to an America with virtually no immigration restrictions came “the right way”; poor Central American immigrants evading a baroque and unforgiving system are gang members and terrorists.

Serwer goes on to argue that the recently shifting American response to the pandemic, primarily in conservative circles, is due to an increasing awareness of which groups are bearing the brunt of the crisis: black and Latino Americans.

That more and more Americans were dying was less important than who was dying.

The disease is now “infecting people who cannot afford to miss work or telecommute-grocery store employees, delivery drivers and construction workers,” The Washington Post reported. Air travel has largely shut down, and many of the new clusters are in nursing homes, jails and prisons, and factories tied to essential industries. Containing the outbreak was no longer a question of social responsibility, but of personal responsibility. From the White House podium, Surgeon General Jerome Adams told “communities of color” that “we need you to step up and help stop the spread.”

This is a response that America is quite comfortable with because it fits with our racial contract, under which Jim Crow never actually ended. The US isn’t the only place this is happening btw. Early on, Singapore was praised for its response to the pandemic, but their reliance on and mistreatment of an underclass of migrant workers caused a secondary surge in cases.

Singapore is a small city-state with a population of just under 6 million inhabitants. On a per capita basis, it’s the second-richest country in Asia.

But its economy relies heavily on young men from Bangladesh, India and other countries who work jobs in construction and manufacturing. Singapore has no minimum wage for foreign or domestic employees. The foreign workers’ salaries can be as low as US$250 per month, but a typical salary is $500 to $600 a month.

A Practical Guide to Covid-19 Risks and How to Avoid Them

posted by Jason Kottke   May 11, 2020

As some places in the United States and other countries are opening back up (some very prematurely), immunologist and biologist Dr. Erin Bromage has written a practical guide to the known Covid-19 risks and how to avoid them that’s based on recent scientific research. He begins:

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That’s what’s going to happen with a lockdown.

As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I’ve said before, if you don’t solve the biology, the economy won’t recover.

But since things are opening up anyway (whether epidemiologists like it or not), Bromage goes through a number of scenarios you might potentially find yourself in over the next few months and what the associated risks might be. His guiding principle is that infection is caused by exposure to the virus over time — increase the time or the exposure and your risk goes up. For example, public bathrooms might give you a ton of exposure to the virus over a relatively short period of time:

Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.

But being in the same room with another person simply breathing may not carry a large risk if you limit the time.

A single breath releases 50-5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.

But that time would drop sharply if the person is speaking:

Speaking increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.

Again, this is all indoors. Being in enclosed spaces with other humans, particularly if they are poorly ventilated, is going to hold higher risks for the foreseeable future.

The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. (Ref)

Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections). (ref)

The Michael Pollan version of advice for socializing during the pandemic might be: Spend time with people, not too much, mostly masked and outdoors.

On the Accuracy of Covid-19 Testing

posted by Jason Kottke   May 07, 2020

As someone who suspects I may have had a mild case of Covid-19 a couple of months ago, I’ve been thinking about getting tested for antibodies. But as this video from ProPublica shows, even really accurate tests may not actually tell you all that much.

And the thing is, the “do I have Covid-19 right now” tests are plagued by the same issue.

For patients getting tested, the main concern is how to interpret the outcome: If I test negative with an RT-PCR genetic test, what are the chances I actually have the virus? Or if I test positive with an antibody test, does it actually mean I have the antibodies?

It turns out that the answers to these questions don’t just hinge on the accuracy of the test. “Mathematically, the way that works out, that actually depends on how many people in your area have Covid,” Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, said.

The rarer the disease in the population, the less you’ll learn by testing.

Let’s say we have a hypothetical Covid-19 test for antibodies that is both 99 percent sensitive — meaning almost all people with antibodies will test positive — and 99 percent specific, meaning almost all people who were never infected will yield a negative result.

If you test a group of 100 uninfected people, odds are one of them will still test positive even though they don’t have the virus. Conversely, if you test 100 people who were infected, it’s likely one of them will still test negative.

Now let’s presume the virus has a prevalence rate of 1 percent, so one person in 100 carries antibodies to it. If you test 100 random people and get a positive result, what is the chance that this person was truly infected?

Deborah Birx, the White House Covid-19 response coordinator, explained the answer at a press conference on April 20: “So if you have 1 percent of your population infected and you have a test that’s only 99 percent specific, that means that when you find a positive, 50 percent of the time will be a real positive and 50 percent of the time it won’t be.”

So even if I test positive for antibodies and I assume that confers immunity, given that the number of confirmed infections in Vermont is so low (~900 statewide), it doesn’t seem like I would be justified in changing my behavior at all. I would still have to act as though I’ve never had the virus, both for my own health and the health of those around me. Maybe if I had two or three corroborating tests could I be more certain…

SARS-CoV-2, An Emerging Portrait

posted by Jason Kottke   May 06, 2020

From Nature’s David Cyranoski, a piece that takes a look at what the latest research says about SARS-CoV-2, where it came from, and how it is able to infect the human body. I’m going to highlight a few things from the article I thought were particularly interesting. As Cyranoski has done throughout, I’d like to stress that because this virus is so new to us and the situation is moving so quickly, many of these results are based on preliminary research, have been published in pre-print papers, and haven’t been peer-reviewed.

The first is about the detective work being done to trace where SARS-CoV-2 came from and how long it’s been in existence (possibly decades).

SARS-CoV-2 genetic origin

But studies released over the past few months, which have yet to be peer-reviewed, suggest that SARS-CoV-2 — or a very similar ancestor — has been hiding in some animal for decades. According to a paper posted online in March, the coronavirus lineage leading to SARS-CoV-2 split more than 140 years ago from the closely related one seen today in pangolins. Then, sometime in the past 40-70 years, the ancestors of SARS-CoV-2 separated from the bat version, which subsequently lost the effective receptor binding domain that was present in its ancestors (and remains in SARS-CoV-2). A study published on 21 April came up with very similar findings using a different dating method.

The section on how the virus acts in the body is particularly interesting because it attempts to explain the unusual and varying behaviors SARS-CoV-2 exhibits and causes in different parts of the human body. For example, SARS-CoV-2, unusually, can initially infect two places in the body: the throat and lungs.

Having these two infection points means that SARS-CoV-2 can mix the transmissibility of the common cold coronaviruses with the lethality of MERS-CoV and SARS-CoV. “It is an unfortunate and dangerous combination of this coronavirus strain,” he says.

The virus’s ability to infect and actively reproduce in the upper respiratory tract was something of a surprise, given that its close genetic relative, SARS-CoV, lacks that ability. Last month, Wendtner published results of experiments in which his team was able to culture virus from the throats of nine people with COVID-19, showing that the virus is actively reproducing and infectious there. That explains a crucial difference between the close relatives. SARS-CoV-2 can shed viral particles from the throat into saliva even before symptoms start, and these can then pass easily from person to person. SARS-CoV was much less effective at making that jump, passing only when symptoms were full-blown, making it easier to contain.

These differences have led to some confusion about the lethality of SARS-CoV-2. Some experts and media reports describe it as less deadly than SARS-CoV because it kills about 1% of the people it infects, whereas SARS-CoV killed at roughly ten times that rate. But Perlman says that’s the wrong way to look at it. SARS-CoV-2 is much better at infecting people, but many of the infections don’t progress to the lungs. “Once it gets down in the lungs, it’s probably just as deadly,” he says.

And this is a somewhat hopeful speculation on one of the many possible ways the Covid-19 pandemic could go:

“By far the most likely scenario is that the virus will continue to spread and infect most of the world population in a relatively short period of time,” says Stöhr, meaning one to two years. “Afterwards, the virus will continue to spread in the human population, likely forever.” Like the four generally mild human coronaviruses, SARS-CoV-2 would then circulate constantly and cause mainly mild upper respiratory tract infections, says Stöhr. For that reason, he adds, vaccines won’t be necessary.

Some previous studies support this argument. One showed that when people were inoculated with the common-cold coronavirus 229E, their antibody levels peaked two weeks later and were only slightly raised after a year. That did not prevent infections a year later, but subsequent infections led to few, if any, symptoms and a shorter period of viral shedding.

The OC43 coronavirus offers a model for where this pandemic might go. That virus also gives humans common colds, but genetic research from the University of Leuven in Belgium suggests that OC43 might have been a killer in the past.

But then, from a few paragraphs down:

People like to think that “the other coronaviruses were terrible and became mild”, says Perlman. “That’s an optimistic way to think about what’s going on now, but we don’t have evidence.”

For now, it’s just another thing we don’t know about this virus we learned about only 5 months ago. It’s a long road ahead, but I’m thankful that so many scientists are bent on making sense of it all.

The Plan Is to Have No Plan

posted by Jason Kottke   May 05, 2020

This short description by Jay Rosen accurately describes the Trump administration’s plan for dealing with the Covid-19 pandemic.

The plan is to have no plan, to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible — by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by “flooding the zone with shit,” Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call “search costs” for reliable intelligence.

Stated another way, the plan is to default on public problem solving, and then prevent the public from understanding the consequences of that default. To succeed this will require one of the biggest propaganda and freedom of information fights in U.S. history, the execution of which will, I think, consume the president’s re-election campaign.

While his actions often have complex effects, Trump has never been a complicated person. This “plan” fits with what we know about Trump’s personality & behavior, plays to his strengths by relying on reactions & tactics and not strategy, is consistent with Occam’s razor, allows his administration to continue pursuing his aggressive agenda (restricting immigration, strengthening big business, weakening public institutions, enriching himself, consolidating power, getting re-elected), and whips his base into a frenzy. As Dave Eggers put it in a satirical opinion piece for the NY Times:

Having no plan is the plan! Haven’t you been listening? Plans are for commies and the Danish. Here we do it fast and loose and dumb and wrong, and occasionally we have a man who manufactures pillows come to the White House to show the president encouraging texts. It all works! Eighteen months, 800,000 deaths, no plan, states bidding against states for medicine and equipment, you’re on your own, plans are lame.

There’s no galaxy brain here, only a twitchy muscle attached to a frayed nerve.

Some Pandemic Real-Talk from Epidemic Expert Laurie Garrett

posted by Jason Kottke   May 04, 2020

This too-short profile of Pulitzer Prize-winning journalist Laurie Garrett, who has been writing about epidemics since the 90s, is closer to my personal feelings as to how the pandemic plays out in the US than almost anything else I’ve read.

But she can’t envision that vaccine anytime in the next year, while Covid-19 will remain a crisis much longer than that.

“I’ve been telling everybody that my event horizon is about 36 months, and that’s my best-case scenario,” she said.

“I’m quite certain that this is going to go in waves,” she added. “It won’t be a tsunami that comes across America all at once and then retreats all at once. It will be micro-waves that shoot up in Des Moines and then in New Orleans and then in Houston and so on, and it’s going to affect how people think about all kinds of things.”

They’ll re-evaluate the importance of travel. They’ll reassess their use of mass transit. They’ll revisit the need for face-to-face business meetings. They’ll reappraise having their kids go to college out of state.

Much of the federal government’s response has been to help big business, and the wealthy are going to have opportunities to not only ride out the storm more easily but to take advantage:

If America enters the next wave of coronavirus infections “with the wealthy having gotten somehow wealthier off this pandemic by hedging, by shorting, by doing all the nasty things that they do, and we come out of our rabbit holes and realize, ‘Oh, my God, it’s not just that everyone I love is unemployed or underemployed and can’t make their maintenance or their mortgage payments or their rent payments, but now all of a sudden those jerks that were flying around in private helicopters are now flying on private personal jets and they own an island that they go to and they don’t care whether or not our streets are safe,’ then I think we could have massive political disruption.”

I could quote something from just about every paragraph, but for now I’ll just do one more excerpt and you can go and read the rest.

Garrett recounted her time at Harvard. “The medical school is all marble, with these grand columns,” she said. “The school of public health is this funky building, the ugliest possible architecture, with the ceilings falling in.”

“That’s America?” I asked.

“That’s America,” she said.

See also Dave Eggers’ pandemic Q&A, which shares a certain pessimistic honesty with Garrett’s thoughts.

What Happens Next? Our Possible Covid-19 Futures…

posted by Jason Kottke   May 04, 2020

Creative technologist Nicky Case and epidemiologist Marcel Salathé have teamed up to produce a concise but thorough playable explainer about important epidemiological concepts, how we could/should respond to the Covid-19 pandemic, and different scenarios about what the next few years could look like.

A gameplan to get R below 1 for coronavirus

If you’ve been keeping up with the various models and experts’ plans (test/trace/isolate, etc.), there’s not a lot new here until close to end, but it is pretty comprehensive and the playable simulations are really useful. The whole thing takes about 30 minutes to get through, but at the end, you will have an excellent simplified understanding of what this virus could do to us and what we can do to mitigate its effects.

Isolating symptomatic cases would reduce R by up to 40%, and quarantining their pre/a-symptomatic contacts would reduce R by up to 50%:

Thus, even without 100% contact quarantining, we can get R < 1 without a lockdown! Much better for our mental & financial health. (As for the cost to folks who have to self-isolate/quarantine, governments should support them — pay for the tests, job protection, subsidized paid leave, etc. Still way cheaper than intermittent lockdown.)

The problem with this explainer, as excellent as it is, is the problem with all of these plans: many government officials on both the state & federal level don’t seem interested in listening to the experts. It is also unclear — if the unmasked crowds gathering in American cities during this past weekend’s warm weather are any indication — that Americans will be willing to take the steps necessary to keep each other safe. I’m not sure what it’s going to take to address those situations, but I don’t think playable graphs are going to help that much.