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kottke.org posts about medicine

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

posted by Jason Kottke   Oct 15, 2020

A spin studio (aka an indoor gym with stationary bikes) in Hamilton, Ontario is dealing with an outbreak of Covid-19 stemming from one asymptomatic patron that has resulted in 69 positive cases so far, even though the studio “followed the rules”. From the CNN report:

SPINCO, in Hamilton, Ontario, just reopened in July and had all of the right protocols in place, including screening of staff and attendees, tracking all those in attendance at each class, masking before and after classes, laundering towels and cleaning the rooms within 30 minutes of a complete class, said Dr. Elizabeth Richardson, Hamilton’s medical officer of health, in a statement.

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

Although Hamilton requires masks to be worn in most public settings, the law includes an exemption for anyone “actively engaged in an athletic or fitness activity.” In keeping with that policy, the studio, SPINCO, allowed riders to remove their masks once clipped into their bikes, and told them to cover up again before dismounting.

The problem here is that while the studio may have followed the rules, they were not the right rules. This outbreak appears to be another clear-cut instance of Covid-19 spread by aerosols. A group of people indoors, without masks, breathing heavily, over long periods of time in what I’m guessing is not a properly ventilated room — this is exactly the sort of thing that has been shown over and over again to be problematic.1The science is there, but governments and public health agencies have not caught up with this yet. If you take the transmission by aerosols into account, the rules for gyms (and bars and restaurants) being open is that they should probably not be open at all — or if they are, they should be well-ventilated and the wearing of masks should be mandatory at all times.2 (via @DrEricDing)

  1. To return once again to aerosol expert Jose-Luis Jimenez’s excellent smoke analogy, attending a spin class with an asymptomatic patron who is breathing heavily is like being in a room with someone who is furiously chain-smoking for an hour. Unless that room is extremely well-ventilated, everyone is going to be breathing in so much smoke.

  2. And to compensate these businesses for their public service in remaining closed, they should be financially supported by the government. We cannot let these businesses, especially small businesses, and their owners go under, for people to lose their savings or go bankrupt, etc. as they help keep the rest of us safe. If we want to have bars and restaurants and gyms and movie theaters and concert venues on the other side of this pandemic, they have to be compensated for their sacrifice on our behalf.

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

posted by Jason Kottke   Oct 13, 2020

We’re all so goddamned tired of this fucking pandemic and so people are looking at the development and distribution of a vaccine as the thing that’s going to get us out of this (and quick). But realistically, that’s not what’s going to happen. Carl Zimmer wrote about some of the challenges with Covid-19 vaccines.

The first vaccines may provide only moderate protection, low enough to make it prudent to keep wearing a mask. By next spring or summer, there may be several of these so-so vaccines, without a clear sense of how to choose from among them. Because of this array of options, makers of a superior vaccine in early stages of development may struggle to finish clinical testing. And some vaccines may be abruptly withdrawn from the market because they turn out not to be safe.

“It has not yet dawned on hardly anybody the amount of complexity and chaos and confusion that will happen in a few short months,” said Dr. Gregory Poland, the director of the Vaccine Research Group at the Mayo Clinic.

See also Dr. Fauci’s belief that our best case scenario for returning to something close to normal life in the US is late 2021.

On Twitter, Zimmer also commented on something that I hadn’t really thought about: that all of these vaccines in development in the US are only for adults:

I wrote last month that no trials for kids had started. Update: still no US trials for kids. The goal of having shots ready for them by fall 2021 may be slipping further away.

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

Only if researchers discovered no serious side effects would they start testing them in children, often beginning with teenagers, then working their way down to younger ages. Vaccine developers are keenly aware that children are not simply miniature adults. Their biology is different in ways that may affect the way vaccines work. Because their airways are smaller, for example, they can be vulnerable to low levels of inflammation that might be harmless to an adult.

These trials allow vaccine developers to adjust the dose to achieve the best immune protection with the lowest risk of side effects. The doses that adults and children need are sometimes different — children get smaller doses of hepatitis B vaccines, for example, but bigger doses for pertussis.

You probably hate reading these kinds of articles; I know I do. But facing up to the reality of our situation, particularly here in the US where our political leadership has utterly failed in protecting us from this virus, is much better than burying our heads in the sand — that’s just not mentally healthy.

A Scientific Portrait of the SARS-CoV-2 Virus

posted by Jason Kottke   Oct 12, 2020

A model of the SARS-CoV-2 virus

This is a great piece from Carl Zimmer about how much scientists have learned about SARS-CoV-2 through imaging, including how the virus works and prospects for treatment and a vaccine.

Thanks to the work of scientists like Dr. Li, the new coronavirus, known as SARS-CoV-2, is no longer a cipher. They have come to know it in intimate, atomic detail. They’ve discovered how it uses some of its proteins to slip into cells and how its intimately twisted genes commandeer our biochemistry. They’ve observed how some viral proteins throw wrenches into our cellular factories, while others build nurseries for making new viruses. And some researchers are using supercomputers to create complete, virtual viruses that they hope to use to understand how the real viruses have spread with such devastating ease.

I’ve been watching the lectures for MIT’s online Covid-19 class and the thing that has struck me most is just how much scientists have learned about the SARS-CoV-2 virus in such a short amount of time. To be clear, there are many things that they still do not understand about it (and viruses in general), but scientists know this thing upside down and backwards. The depth and breadth of their knowledge is so impressive and I wish more people were aware of it.

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

posted by Jason Kottke   Oct 08, 2020

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

With a very effective vaccine ready in Nov/Dec, distributed widely, and if lots of people take it (i.e. the best case scenario), the earliest we could return to “normal life” in the world is the end of 2021.

At the New Yorker Festival earlier in the week, Michael Specter asked him about a return to normalcy and Fauci elaborated a bit more on this timeline (starts ~10:22 in the video).

When are we gonna get back to something that closely resembles, or is in fact, normal as we knew it?

We’re already making doses, tens and hundreds of millions of doses to be ready, first at least, in graded numbers at the end of the year in November/December. By the time we get to April, we likely will have doses to be able to vaccinate anybody who needs to be vaccinated. But logistically by the time you get everybody vaccinated, it likely will not be until the third or even the beginning of the fourth quarter of 2021.

So let’s say we get a 70% effective vaccine, which I hope we will get, but only 60% of the people get vaccinated. There are going to be a lot of vulnerable people out there, which means that the vaccine will greatly help us to pull back a bit on the restrictions that we have now to maintain good public health, but it’s not going to eliminate things like mask wearing and avoiding crowds and things like that.

So I think we can approach normality, but I don’t think we’re going to be back to normal until the end of 2021. We may do better than that; I hope so but I don’t think so.

Leaving aside what “normal” might mean and who it actually applies to,1 there’s some good news and bad news in there. The good news is, they’re already producing doses of the vaccine to be ready if and when the phase 3 trials are successful. Ramping up production before the trials conclude isn’t usually done because it’s a waste of money if the trials fail, but these vaccines are so critical to saving lives that they’re spending that money to save time. That’s great news.

The bad news is that we’re not even halfway through the pandemic in the best case scenario. We’re going to be wearing masks in public for at least another year (and probably longer than that). Large gatherings of people (especially indoors) will continue to be problematic — you know: movie theaters, concerts, clubs, bars, restaurants, schools, and churches — and folks staying within small pods of trusted folks will likely be the safest course of action.

A change in national leadership in both the executive branch and Senate could change the outlook for the better. We could get some normalcy back even without a vaccine through measures like a national mask mandate/distribution, a real national testing & tracing effort, taking aerosol transmission seriously, and easing the economic pressure to “open back up” prematurely. We’re never going to do as well as Vietnam or Taiwan, but I’d settle for Greece or Norway.

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

Topol: When do you think we’ll see pre-COVID life restored?

Rivers: I wish I knew. I’m thinking toward the end of 2021. It’s really hard to say with any certainty. We should all be mentally prepared to have quite a bit ahead of us.

  1. It’s America. If we know anything by now about this country, it’s that access to healthcare and economic opportunity is going to apply unevenly to the people who live here. For instance, it’s likely that Black & brown communities, which have been disproportionately affected by the pandemic, may face difficulty in getting access to vaccines compared to wealthier, predominantly white communities.

The Science Is In: Wear. A. Mask!

posted by Jason Kottke   Oct 07, 2020

Back in June, in a post called Jesus Christ, Just Wear a Face Mask!, I presented a bunch of evidence and arguments for wearing face masks to prevent the spread of Covid-19. Even then it was pretty clear that masks were working. In piece published by Nature yesterday, Lynne Peeples summarizes what the data and science currently says about the effectiveness of wearing face masks. Here is her one-sentence summary:

To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease.

And importantly, even ardently pro-mask scientists agree that masks should be worn in conjunction with taking other precautions: limiting large gatherings, maintaining distance, limiting the time you spend indoors with others, etc.

Totally Under Control

posted by Jason Kottke   Oct 02, 2020

In secrecy over the past several months, filmmaker Alex Gibney has been making a documentary film about the US government’s response to the Covid-19 pandemic called Totally Under Control. He and co-directors Ophelia Harutyunyan and Suzanne Hillinger interviewed “countless scientists, medical professionals, and government officials on the inside” to produce the film.

Academy Award-winning filmmaker Alex Gibney, directing with Ophelia Harutyunyan and Suzanne Hillinger, interrogates this question and its devastating implications in Totally Under Control. With damning testimony from public health officials and hard investigative reporting, Gibney exposes a system-wide collapse caused by a profound dereliction of Presidential leadership.

Gibney previously directed Enron: The Smartest Guys in the Room, Going Clear, and Zero Days (all excellent documentaries). The film comes out in theaters on October 13 and on Hulu on October 20.

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

posted by Jason Kottke   Oct 02, 2020

A group of scientists who believe that WHO and the CDC are being too slow in acknowledging the role of aerosol transmission in spreading Covid-19 have written up a Google Doc of advice for the public: FAQs on Protecting Yourself from COVID-19 Aerosol Transmission.

The goal of these FAQs is to provide information to the general public in an efficient manner about how to prevent aerosol transmission of COVID-19, with the hope that this will allow more informed decision making by individuals or organizations. All of this information has been posted in Twitter and other forums, but can be difficult to find. Having multiple experts working together, and having the ability to update this information also improves its quality. These FAQs represent our best understanding at this time, and should always be similar or more stringent than information provided by CDC, WHO, and most regional & local health authorities. If your authority has a more stringent guideline than discussed here, follow that more stringent guideline.

The group was organized by chemist Jose-Luis Jimenez, who has been studying aerosols for 20 years. You may remember Jimenez from his excellent piece in Time magazine, where he used the analogy of smoke to explain aerosol transmission. Here’s a snippet from the FAQ, highlighting something I’ve been concerned about lately: people wearing face shields instead of masks and employees in stores not wearing masks behind plexiglass shields:

7.13. Are face shields and masks interchangeable?
No, face shields do not offer much protection against aerosols (also see this video), while masks do. Face shields are good for blocking ballistic droplets released by the wearer or that might fly into the wearer’s face when close to others. Face shields are considered a supplement to masks for partial eye protection (but less useful than closed glasses, as discussed above), but not a substitute for them.

7.14. Are plexiglass barriers helpful?
Plexiglass barriers are generally useful to avoid direct droplet infection and direct aerosol transmission whenever people are in close proximity and distance cannot be kept. Therefore, it is recommended to use them as a direct transmission suppression tool at such places, such as a supermarket checkout.

However, as aerosols follow the air movements indoors, the protective effects of the plexiglas barriers against aerosols will be limited. Plexiglas barriers alone are not a sufficient approach to protect against aerosol transmission. Their installation alone cannot protect against indoor aerosol transmission and should not be regarded as safe and sufficient protection.

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

We update the document all the time. We’re effectively having to be a little WHO or CDC. We’re saying the things that they should be saying. This is frustrating, but it’s the situation we find ourselves in. These organizations have been flat-out refusing to consider if aerosol transmission is important, which leaves people unprotected. So we feel it’s our duty to communicate directly with the public.

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

“This Overlooked Variable Is the Key to the Pandemic”

posted by Jason Kottke   Oct 02, 2020

Zeynep Tufekci says that we are paying too much attention to the R value of SARS-CoV-2 (basically the measure of its contagiousness) and not nearly enough attention to the k value (“whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once”).

There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious. Overdispersion and super-spreading of this virus is found in research across the globe. A growing number of studies estimate that a majority of infected people may not infect a single other person. A recent paper found that in Hong Kong, which had extensive testing and contact tracing, about 19 percent of cases were responsible for 80 percent of transmission, while 69 percent of cases did not infect another person. This finding is not rare: Multiple studies from the beginning have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of transmission, and that many people barely transmit it.

We’ve known, or at least suspected, this about SARS-CoV-2 for awhile now — I linked to two articles about superspreading back in May and June — but Tufekci says we have not adjusted our thinking about what that means for prevention. We should be avoiding superspreading environments/events (“Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration, Unmasked, Talking/singing/Yelling”), doing backwards contact tracing, and rapid testing.

In an overdispersed regime, identifying transmission events (someone infected someone else) is more important than identifying infected individuals. Consider an infected person and their 20 forward contacts-people they met since they got infected. Let’s say we test 10 of them with a cheap, rapid test and get our results back in an hour or two. This isn’t a great way to determine exactly who is sick out of that 10, because our test will miss some positives, but that’s fine for our purposes. If everyone is negative, we can act as if nobody is infected, because the test is pretty good at finding negatives. However, the moment we find a few transmissions, we know we may have a super-spreader event, and we can tell all 20 people to assume they are positive and to self-isolate-if there is one or two transmissions, it’s likely there’s more exactly because of the clustering behavior. Depending on age and other factors, we can test those people individually using PCR tests, which can pinpoint who is infected, or ask them all to wait it out.

Part of the problem is that dispersion and its effects aren’t all that intuitive.

Overdispersion makes it harder for us to absorb lessons from the world because it interferes with how we ordinarily think about cause and effect. For example, it means that events that result in spreading and non-spreading of the virus are asymmetric in their ability to inform us. Take the highly publicized case in Springfield, Missouri, in which two infected hairstylists, both of whom wore masks, continued to work with clients while symptomatic. It turns out that no apparent infections were found among the 139 exposed clients (67 were directly tested; the rest did not report getting sick). While there is a lot of evidence that masks are crucial in dampening transmission, that event alone wouldn’t tell us if masks work. In contrast, studying transmission, the rarer event, can be quite informative. Had those two hairstylists transmitted the virus to large numbers of people despite everyone wearing masks, it would be important evidence that, perhaps, masks aren’t useful in preventing super-spreading.

The piece is an important read and interesting throughout: just read the whole thing.

Horrifying Reports of Forced Hysterectomies at ICE Detention Camps

posted by Jason Kottke   Sep 15, 2020

A coalition of organizations led by Project South (which was founded as the Institute to Eliminate Poverty & Genocide — more on that last word in a minute) has filed a complaint based on a whistleblower about an ICE concentration camp in Georgia where, the complaint alleges, detained immigrants are not being properly treated for Covid-19, important medications are being withheld, conditions are appalling, and women are being given unnecessary hysterectomies. From a piece about the complaint:

Multiple women came forward to tell Project South about what they perceived to be the inordinate rate at which women in ICDC were subjected to hysterectomies — a surgical operation in which all or part of the uterus is removed. Additionally, many of the immigrant women who underwent the procedure were reportedly “confused” when asked to explain why they had the surgery, with one detainee likening their treatment to prisoners in concentration camps.

“Recently, a detained immigrant told Project South that she talked to five different women detained at ICDC between October and December 2019 who had a hysterectomy done,” the complaint stated. “When she talked to them about the surgery, the women ‘reacted confused when explaining why they had one done.’ The woman told Project South that it was as though the women were ‘trying to tell themselves it’s going to be OK.’”

“When I met all these women who had had surgeries, I thought this was like an experimental concentration camp. It was like they’re experimenting with our bodies,” the detainee said.

According to Wooten, ICDC consistently used a particular gynecologist — outside the facility — who almost always opted to remove all or part of the uterus of his female detainee patients.

“Everybody he sees has a hysterectomy — just about everybody,” Wooten said, adding that, “everybody’s uterus cannot be that bad.”

According to the UN’s Genocide Convention of 1948, “imposing measures intended to prevent births” within “a national, ethnical, racial or religious group” is genocide. Congresswoman Alexandria Ocasio-Cortez commented:

The fact of the matter is the United States has engaged in a program of mass human rights violations targeting immigrants.

I’ll remind you, as I have with increasing frequency lately about the activities of our country’s increasingly authoritarian government, that forced sterilization in detention camps is literally what the literal Nazis did (inspired by, you guessed it, America’s treatment of “undesirable” populations).

You can read the complaint here and check out this thread from Brooke Binkowski for more context and examples of detainee mistreatment at the hands of the increasingly extra-legal ICE.

The Trailer for Denis Villeneuve’s Dune

posted by Jason Kottke   Sep 09, 2020

I’ve never read or seen any of the Dunes (Herbert’s book, David Lynch’s movie, or even Jodorowsky’s Dune) but I have very fond memories of the video game Dune II and will watch anything that Denis Villeneuve makes, so I’m definitely going to check this out when it’s released…let’s see….on December 18, 2020 in theaters? WTF?

Ok, so just watch the trailer if that’s what you’re here for, but I remain baffled that movie theaters are a) currently open (Tenet was showing in 2810 US theaters last weekend) and b) slated to still be open in December in a country trapped in a pandemic death spiral. Easy testing w/ quick results and contact tracing, the twin keys to controlling the virus, are still a mess. A safe & tested vaccine that’s distributed widely by the end of the year? I wouldn’t hold my breath. And you’re going to put a bunch of people who are laughing and gasping together in a room for two-plus hours with a virus that’s airborne1 and assume they’re going to stay properly masked up (except for when they are eating popcorn and nachos!) and properly distant from each other? (Have you met Americans?!) Even if you assume that movie theater screening rooms are huge & well-ventilated (some definitely are not) and capacity is restricted, I repeat: What The Fuck? And in terms of societal trade-offs, reopening places where people gather indoors for entertainment is more important than ensuring our kids can safely go to school? *extreme hair-tearing-out noise*

Update: Aaaaand the Dune release has been delayed until Oct 2021. Between the Trump debacle2 and the CDC acknowledging that the virus may spread through aerosols, I feel like people are coming around to the idea that indoor gatherings, entertainment, and dining are going to be problematic for several more months.

  1. Along with the lack of testing and tracing, the evidence that the virus can be transmitted through aerosols is the important bit here. Most people and organizations are still acting as though it’s not airborne because the measures would be different if they were taking that into account. See this expert’s advice about movie-going for example — there’s not a single mention of aerosols in the entire piece, so it’s tough for me to take it seriously.

  2. Just to clarify, I mean the outbreak of Covid-19 in the White House and not any other previous or future debacles.

Smoke on the Wind: the Aerosol Spread of Covid-19

posted by Jason Kottke   Aug 26, 2020

Chemist Jose-Luis Jimenez writing for Time magazine: COVID-19 Is Transmitted Through Aerosols. We Have Enough Evidence, Now It Is Time to Act. In it, he argues that while much of the early attention has been on fomites (surface contamination) and droplets as pathways for spreading Covid-19, tranmission by aerosols may be more significant. His analogy of smoke makes it quite easy to understand:

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.

Thinking of smoke can help guide our actions:

The visual analogy of smoke can help guide our risk assessment and risk reduction strategies. One just has to imagine that others they encounter are all smoking, and the goal is to breathe as little smoke as possible. But COVID-19 is not very contagious under most situations, unlike, for example, measles: the CDC says that 15 minutes of close proximity to a COVID-19 infected person often leads to contagion, which provides an estimate of how much “exhaled smoke” one may need to inhale for infection. Inhaling a little whiff of “smoke” here and there is OK, but a lot of “smoke” for a sustained period of time and without a mask is risky. (To be clear, actual smoke does not increase the probability of infection.)

In thinking about aerosolized Covid, Jimenez recommends avoiding crowds & indoor spaces and cutting down on proximity & duration, among other things.

We should continue doing what has already been recommended: wash hands, keep six feet apart, and so on. But that is not enough. A new, consistent and logical set of recommendations must emerge to reduce aerosol transmission. I propose the following: Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration, Unmasked, Talking/singing/Yelling (“A CIViC DUTY”). These are the important factors in mathematical models of aerosol transmission, and can also be simply understood as factors that impact how much “smoke” we would inhale.

But what about masks? N95s can block most aerosols but cloth masks have “huge” holes in them relative to aerosol particles, right? They still work in lowering risk (but not eliminating it!) because your “smoke” doesn’t travel as far when you’re wearing a mask and it filters incoming smoke (if your mask fits correctly and you’re keeping your distance).

Second, masks are essential, even when we are able to maintain social distance. We should also pay attention to fitting masks snugly, as they are not just a parapet against ballistic droplets, but also a means to prevent “smoke” from leaking in through gaps. We should not remove masks to talk, nor allow someone who is not wearing a mask to talk to us, because we exhale aerosols 10 times as much when talking compared to breathing. Everyone should be careful to not stand behind someone with a poorly fitting mask, as the curvature of an ill-fitting mask can cause aerosols to travel behind the person wearing it.

Great article, full of common sense advice backed up by science.

Meet the Long-Haulers, Whose Covid-19 Symptoms Last For Months

posted by Jason Kottke   Aug 20, 2020

In the Atlantic, Ed Yong checks back in with the long-haulers, people who are still experiencing Covid-19 symptoms months after their initial infection. (Read his previous article from early June.)

Lauren Nichols has been sick with COVID-19 since March 10, shortly before Tom Hanks announced his diagnosis and the NBA temporarily canceled its season. She has lived through one month of hand tremors, three of fever, and four of night sweats. When we spoke on day 150, she was on her fifth month of gastrointestinal problems and severe morning nausea. She still has extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog. Even writing an email can be hard, she told me, “because the words I think I’m writing are not the words coming out.” She wakes up gasping for air twice a month. It still hurts to inhale.

As Yong says in a thread about the article: “The pandemic is going to create a large wave of chronically disabled people.” Once again for the people in the back: this is not just the flu. The flu does not incapacitate otherwise healthy people like this. I know at least two long-haulers personally and am astounded on a daily basis by how casually some Americans continue to regard Covid-19.

More than 90 percent of long-haulers whom Putrino has worked with also have “post-exertional malaise,” in which even mild bouts of physical or mental exertion can trigger a severe physiological crash. “We’re talking about walking up a flight of stairs and being out of commission for two days,” Putrino said. This is the defining symptom of myalgic encephalomyelitis, or chronic fatigue syndrome. For decades, people with ME/CFS have endured the same gendered gaslighting that long-haulers are now experiencing. They’re painfully familiar with both medical neglect and a perplexing portfolio of symptoms.

You can read Seabiscuit author Laura Hillenbrand’s excellent article on her chronic fatigue syndrome diagnosis and how difficult it is for people with chronic conditions like this to get the right diagnosis and to get family and friends to believe what’s going on.

Also, Yong should win all the awards this year for his pandemic coverage. It has been simply outstanding.

Study Suggests That Some Masks Are Much Better than Others

posted by Jason Kottke   Aug 12, 2020

Masks comparison chart

A new study on masks that measures the number of droplets emerging from the mouth during speech shows that properly fitted N95, surgical, and polypropylene masks are best, layered cotton masks are good, bandanas are not great, and neck gaiters may be worse than wearing no mask. Here’s a Washington Post article about the study.

I have some issues with this study — most masks were tested by only one speaker and mask materials were not identified precisely1 — but when combined with other studies about masks, it is clear that surgical masks or masks that are made with similar materials (polypropylene non-woven fabric) are what you want to shoot for, you want multiple layers for more protection (no single-layer microfiber gaiters), homemade cotton masks are pretty good (but would be better with a layer of polypropylene non-woven fabric), proper fit matters, and for god’s sake, stop wearing a bandana as a mask. Yes, bandanas are convenient, but you’re probably trading safety for that convenience, especially if you factor in the amount of time you’ll be wearing a mask over the next several months. A proper mask is going to protect you and your neighbors much more over the long haul — it’s just common sense at this point.

Re: the tested neck gaiter being worse than wearing no mask: the hypothesis is that the gaiter’s material splits large droplets into smaller ones, hence the higher count.

We noticed that speaking through some masks (particularly the neck fleece) seemed to disperse the largest droplets into a multitude of smaller droplets (see Supplementary Fig. S5), which explains the apparent increase in droplet count relative to no mask in that case. Considering that smaller particles are airborne longer than large droplets (larger droplets sink faster), the use of such a mask might be counterproductive.

Here’s what I’m taking away from this and other mask studies: wear the highest quality mask you can locate (multi-layered, incorporating surgical mask materials) that fits properly and, secondarily, is comfortable & convenient. For me, that’s a two-layer cotton mask (like these Vida masks) with an inserted layer of polypropylene non-woven fabric. An N95 would be much better in terms of efficacy, but it’s overkill in most situations (particularly here in VT, where rates continue to be low) and is difficult to fit properly and quickly. (via @EricTopol)

Update: Slate’s Susan Matthews goes into more detail about the problems with this study and the conclusions that others are drawing from it.

The purpose of the research was to establish that the testing method worked in principle-not to come up with meaningful or accurate verdicts about particular masks.

But she also concludes (correctly, in my mind):

Should you think twice about wearing just a gaiter inside, in close proximity to other people? Yeah, a fitted mask is probably better. But you didn’t need this study to tell you that.

(via @BrianDau)

Update: But interesting to note that in this test, scarves, bandanas, and microfiber neck gaiters came in last.

  1. What is a “gaiter type neck fleece” made out of exactly? If you look at the photo, it doesn’t look like fleece so much as microfiber polyester, which is what my kids wear for skiing. This article says the neck gaiter was “made of polyester mixed with a little spandex”, which is definitely not fleece. My guess is they tested a one-layer microfiber gaiter and that higher quality gaiters would perform better (but still not as well as a surgical mask).

Defund the Police? We’ve Already Done It Successfully in America.

posted by Jason Kottke   Aug 05, 2020

The American system of law enforcement is so deeply embedded into our national psyche that if you find the idea of defunding or abolishing the police challenging, I don’t blame you. But imagine calling an ambulance because a loved one was having trouble breathing or was suffering a stroke and, instead of the expected trained paramedics, a man with a gun showed up. Not great, right? As Jamie Ford explains in this thread, that was not unusual in America until recently.

Until the 70s, ambulance services were generally run by local police and fire departments. There was no law requiring medical training beyond basic first-aid and in many cases the assignment of ambulance duty was used as a form of punishment.

As you can imagine, throwing people with medical emergencies into the back of a paddy wagon produced less than spectacular health outcomes. Now imagine how much worse it became when disgruntled white police officers were demoted to ambulance duty in black neighborhoods.

From Kevin Hazzard’s The First Responders:

Emergency care was mostly a transportation industry, focused on getting patients to hospitals, and it was dominated by two groups: funeral homes and police departments. Call the local authorities for help and you’d likely get morticians in a hearse or cops in a paddy wagon. If you received any treatment en route to the hospital — and most likely you did not — it wouldn’t be very good. At best, one of the people helping may have taken a first-aid course. At worst, you’d ride alone in the back, hoping, if you were conscious, that you’d survive.

Pittsburgh’s Freedom House Ambulance Service changed all that, ushering in a new era of much improved medical care for communities around the US.

Together the two men hashed out a plan: Hallen would raise the money, Safar would contribute his medical expertise, and together they would design advanced ambulances and teach paramedics to provide care on the scene of an accident or emergency. It would be a pioneering medical effort, and Hallen, who was white, suggested another first. The Falk Fund was committed to mitigating racism, and Hallen wanted to staff the service with young black men from the Hill. He hoped that empowering individuals long deemed unemployable would be a source of pride in the black community, a symbol of equality, and a signal that bigoted notions about the black people of Pittsburgh standing in their own way were nonsense.

To help with recruitment, Hallen and Safar partnered with an organization called Freedom House Enterprises, a nonprofit dedicated to establishing and supporting black-run businesses in the city. Freedom House handled staffing for the fledgling ambulance service and recruited the first class of paramedics, including Vietnam veterans and men with criminal records.

So this is a great instance in which armed and untrained police officers have been relieved of a particular responsibility and replaced with specially trained personnel, resulting in a greatly improved outcome for members of the community. If you want other examples, just think about how odd, unhelpful, and dangerous it would be for our communities if the police showed up — armed with a loaded weapon — to collect your garbage, to put out fires, to inspect restaurants, to fix potholes, or to deliver the mail. No, we have sanitation workers, firefighters, public health inspectors, municipal maintenance workers, and postal workers to do these jobs — and they’re all trained in the ins and outs of their particular disciplines.

With these examples in mind, instead of armed personnel handling a wide variety of situations for which they are often not trained, it becomes easier to imagine traffic patrols conducting transportation safety stops, social workers responding to domestic disputes, special crisis centers assisting rape victims, mental health counselors helping people behaving erratically in public, housing guides finding homeless folks a place to stay, student safety coaches helping struggling students navigate school, unarmed personnel responding to property crime, and drug addiction counselors helping drug users stay safe. These are all areas where American communities have applied policing by default, like a flimsy bandaid. It’s ineffective, expensive, and dangerous, and communities should think seriously about supporting and funding alternatives that will be more effective, cheaper, safer, and produce better outcomes for everyone.

Update: See also (hear also?) 99% Invisible’s episode on the Freedom House Ambulance Service.

Nurse to Teachers: Suck It Up!

posted by Jason Kottke   Aug 04, 2020

Kristen McConnell writing for The Atlantic: I’m a Nurse in New York. Teachers Should Do Their Jobs, Just Like I Did.

So I can understand that teachers are nervous about returning to school. But they should take a cue from their fellow essential workers and do their job. Even people who think there’s a fundamental difference between a nurse and a teacher in a pandemic must realize that there isn’t one between a grocery-store worker and a teacher, in terms of obligation. People who work at grocery stores in no way signed up to expose themselves to disease, but we expected them to go to work, and they did. If they had not, society would have collapsed. What do teachers think will happen if working parents cannot send their children to school? Life as we know it simply will not go on.

Oh yes, that is a totally awesome thing our brave grocery store workers did for us out of a sense of obligation and not because their choice was between risking their health and losing their job in a country with a terrible social safety net. But let’s leave that to one side for a second.

I think many more people would support (and indeed rapturously welcome) kids going back to school if a) there were many fewer cases of Covid-19 in the US, b) if the federal and state governments were doing more testing, tracing, and isolation & support of those who test positive, c) if there was more support for parents, and especially low-income folks, with other options around education and childcare (more on that below), and d) if the mask issue wasn’t so contentious in some parts of the country. Oh and don’t forget that even before any of this happened, teachers regularly used their own money and held online fundraisers to buy necessary school supplies for their classrooms.

Blaming teachers for not wanting to go back to work because their country and communities can’t or won’t do the hard work of making it safe is ridiculous. It’s not fair to ask them to do their part when others with greater responsibility to act are not. Someone has been watching too many war movies where soldiers dying due to the negligence, incompetence, or bad intentions of their superiors is played off as patriotic service & bravery instead of murder.

And this…this is just flat out false:

(And parents who want their children to stay home have that option, whether through homeschooling or continued remote learning.)

Rich people with reliable internet access and extra computers lying around have that option, and it’s a terrible option if those parents work (especially if they’re single parents). A huge chunk of America does not.1 If, by some miracle, the federal government started paying people to stay home from work to help their kids with school, gave everyone a laptop stipend (as well as enough money so that kids have access to meals that they might usually get through school programs), and ensured internet access to those who don’t have it, that statement would be closer to the truth. As long as we’re waving magic wands, I would like a chocolate pony and a peanut butter unicorn.

I would have been far more sympathetic to McConnell’s case had she made a convincing argument that school is so essential to children that it’s worth the risk to them, their teachers, and their families, that schools and governments are doing the right things to ensure the safety of their students and staff, and that Covid-19 is coming under control in the United States. But she did not.

Update: Sarah Jones rebuts McConnell’s argument for New York magazine: Teachers Aren’t Sacrificial Lambs. No Essential Worker Is.

The idea that remote work and home education don’t qualify as doing one’s part for society is so pernicious that it nearly distracts from McConnell’s core argument, which is both simple and widespread: If work is essential, it must also be sacrificial. That argument is worth examining, not least because it’s likely to reappear as parents cope with another semester at home. McConnell has taken a view expressed most commonly in the pandemic policies of certain large corporations and extended it to teachers. The same thread is visible both in Amazon’s failure to get enough masks to workers and to ensure social-distancing in warehouses and in the insistence that teachers should head back into classrooms, whatever the risk.

I also had a bunch of mail in my inbox this morning, both from teachers and healthcare professionals, poking holes in this poorly argued piece. The Atlantic’s coverage of the pandemic has been outstanding, but this article was just not very good — a rare misfire. (via @zidaya)

  1. In the spring here in Vermont, where cell service and internet can be spotty, there was a steady stream of people asking on local message boards if anyone had extra computers to donate to their kids and where they could find free wifi that was accessible from the parking lot so their kids could sit in the car and do their schoolwork.

Only Six Weeks to Eliminate Coronavirus in the US? Sure.

posted by Jason Kottke   Jul 27, 2020

From We Can Eliminate Covid-19 if We Want To by Andy Slavitt:

We can virtually eliminate the virus any time we decide to. We can be back to a reasonably normal existence: schools, travel, job growth, safer nursing homes and other settings. And we could do it in a matter of weeks. If we want to.

Take New Zealand. With its fancy curve and life back to normal. Why can’t we? Not fair, you say. It’s an island nation. Okay. What about Germany? Not an island nation, large, growing diversity. Don’t like that comparison? What about countries that have been in big trouble? There’s Italy, France, and Spain. Those countries had it reasonably bad the same time we did. In fact, pick virtually any country you want.

But don’t tell me the United States can’t take action if we want to. And we can’t face the families of 150,000 people who didn’t have to die and tell them this had to happen. And I think it’s why our national political leaders won’t go near these families and the grieving process.

The good news — and it is good news — is we are always four to six weeks from being able to do what countries around the world have done.

I know this article is supposed to be hopeful and optimistic, but people have known what to do about Covid-19 since at least March. Instead the United States has not done it and indeed has done mostly the opposite. The “we” that are supposed to decide to lead this effort won’t because they don’t want to put in the work (it’s easier to blame the virus, Democrats, and China), they don’t want to just give money to people to stay home (a huge no-no for Republicans), and they don’t care that much about who is dying (urbanites, low-income, the elderly, Black & brown people).

As long as Republicans control the Senate and White House, the current scattershot approach of each state/county/city/person deciding what is best (or most in their self-interest) is what we’re stuck with. Treatments will improve, vaccines will be developed, many people will do the right thing and mostly stay home for many more months (sacrificing their mental health to do so), and Covid-19 will eventually come under control, but hundreds of thousands more people will die, many more will recover but carry chronic illnesses for years, vital years of the survivors’ lives will have been lost, and we will collectively grieve these losses for generations.

A Covid-19 Vaccine Is “Only the Beginning of the End”

posted by Jason Kottke   Jul 24, 2020

The Atlantic’s Sarah Zhang has A Vaccine Reality Check for us.

Biologically, a vaccine against the COVID-19 virus is unlikely to offer complete protection. Logistically, manufacturers will have to make hundreds of millions of doses while relying, perhaps, on technology never before used in vaccines and competing for basic supplies such as glass vials. Then the federal government will have to allocate doses, perhaps through a patchwork of state and local health departments with no existing infrastructure for vaccinating adults at scale. The Centers for Disease Control and Prevention, which has led vaccine distribution efforts in the past, has been strikingly absent in discussions so far — a worrying sign that the leadership failures that have characterized the American pandemic could also hamper this process. To complicate it all, 20 percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult.

I am the least anti-vaxxer person in the world, but I have to say that getting a vaccine for Covid-19 that was rushed through trials in time for the election (October surprise!) and signed off by a Trump administration that has completely politicized science does not sound like something I want to go near. Which, for me personally, is a really really depressing thing to even think.

Update: I got a lot of flack for suggesting that I’d be skeptical of a Trump-approved vaccine rushed to market in time for the election (a very specific set of circumstances). But his buddy Putin is attempting something similar in Russia (skipping phase 3 trials), so if you don’t think Trump can try to bully the FDA and CDC into signing off on a vaccine that hasn’t been fully tested — perhaps made by a company whose CEO has donated millions to a Trump SuperPAC? — in order to salvage his reelection chances, I suggest that you haven’t paying proper attention over the past 4 years.

Update: A poll suggests that many Americans across the political spectrum are worried about a politicized FDA being forced to approve a Covid-19 vaccine before it’s adequately tested.

Seventy-eight percent of Americans worry the Covid-19 vaccine approval process is being driven more by politics than science, according to a new survey from STAT and the Harris Poll, a reflection of concern that the Trump administration may give the green light to a vaccine prematurely.

The response was largely bipartisan, with 72% of Republicans and 82% of Democrats expressing such worries, according to the poll, which was conducted last week and surveyed 2,067 American adults.

The sentiment underscores rising speculation that President Trump may pressure the Food and Drug Administration to approve or authorize emergency use of at least one Covid-19 vaccine prior to the Nov. 3 election, but before testing has been fully completed.

“The Morning You Die, I Don’t Want to Be There”

posted by Jason Kottke   Jul 20, 2020

From Dr. Anna DeForest, a devastating article — a prose poem almost — in The New England Journal of Medicine: The New Stability.

This is the day you start to turn. What we suck up from your lungs turns frothy pink and then the frank red of blood. We don’t know if your heart is finally failing or if the virus has destroyed so much tissue that this is necrosis, hemorrhaged in your lungs. There are tests, but no one willing to run them — you are too sick, and you have never cleared the virus. No one would ever want to be what you are now: a hazard, a threat, a frightening object on the edge of death. We try not to touch you. We construct our plans for saving you around staying as far away from you as possible.

I tell your husband about the blood. It’s true that nothing else has changed: your struggling lungs, with help, still take in air, your heart, with help, still brags along. “But she is stable,” he asks, barely a question. Why do I lie? “Yes,” I say, “for now.”

DeForest wrote this in early May as Covid-19 cases peaked at her hospital in New Haven. The country and its leaders ignored this and now cases are spiking in many hospitals all around the country now. Just some sniffles, though, nothing to bother anyone about.

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’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.

The 1850s Map that Made Modern Epidemiology

posted by Jason Kottke   Jun 18, 2020

In 1854, Dr. John Snow produced a map of a London cholera outbreak which showed deaths from the disease concentrated around a water pump on Broad Street. The prevailing view at the time was that cholera spread through dirty air, but Snow hypothesized that it was actually spread through water and constructed this early medical data visualization to help prove it.

John Snow Cholera Map

Through a mix of personal interviews, clever detective work, and data analysis that included tables and a famous map, Snow managed to stop the outbreak and convince local public health officials, eventually, that cholera could be transmitted through water, not a miasma. Since his breakthrough study, the map has become an iconic piece of epidemiological history, as an illustration of keen detective work, analysis, and visual representation with a map that, even today, tells a story.

Aside from the cluster of deaths around the pump (which could be argued were the result of a miasma cloud and not contaminated water), stories of nearby people who didn’t get sick (brewers who drank the beer they produced rather than well water, people in buildings with their own wells) and far away people who died because they had drunk water from the well were also essential in proving his theory:

I was informed by this lady’s son that she had not been in the neighbourhood of Broad Street for many months. A cart went from broad Street to West End every day and it was the custom to take out a large bottle of the water from the pump in Broad Street, as she preferred it. The water was taken on Thursday 31st August., and she drank of it in the evening, and also on Friday. She was seized with cholera on the evening of the latter day, and died on Saturday

You can read more about John Snow and how his map changed science and medicine in Steven Johnson’s excellent Ghost Map.

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.

Which Country Has the World’s Best Health Care?

posted by Jason Kottke   Jun 16, 2020

In a his book out today, Which Country Has the World’s Best Health Care?, oncologist & bioethicist Ezekiel Emanuel compares the outcomes of several countries’ health care systems.

The US spends more than any other nation, nearly $4 trillion, on healthcare. Yet, for all that expense, the US is not ranked #1 — not even close.

In Which Country Has the World’s Best Healthcare? Ezekiel Emanuel profiles 11 of the world’s healthcare systems in pursuit of the best or at least where excellence can be found. Using a unique comparative structure, the book allows healthcare professionals, patients, and policymakers alike to know which systems perform well, and why, and which face endemic problems. From Taiwan to Germany, Australia to Switzerland, the most inventive healthcare providers tackle a global set of challenges — in pursuit of the best healthcare in the world.

In his ranking of 11 countries profiled, China and the United States are, respectively, dead last and second-to-last in providing health care for their citizens. In the case of the United States at least, that failure is on display with our response to the Covid-19 pandemic.

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.

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.

Update: The most recent version of an ongoing review of scientific studies about face mask efficacy was recently published online. From the abstract:

We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.

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.

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.

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.