According to an unpublicized report by the Chinese government, the first documented case of Covid-19 was a 55-year-old person living in Hubei province on November 17, 2019. That makes today the first anniversary of the start of the Covid-19 pandemic. From that person (and possibly earlier or concurrent cases), the disease slowly and silently spread until it was determined to be due to a novel coronavirus.
They found that following the Nov. 17 case, about one to five new cases were reported every day and by Dec. 15, the total infections reached 27. Daily cases seem to have increased after that, with the case count reaching 60 by Dec. 20, the SCMP reported.
On Dec. 27, Dr. Zhang Jixian, head of the respiratory department at Hubei Provincial Hospital, reported to health officials in China that a novel coronavirus was causing the disease; by that day, it had infected more than 180 individuals. (Doctors may not have been aware of all of those cases at the time, but only identified those cases after going back over the records, the Morning Post reported.)
No one had any idea how much the world was going to change that day. What an awful, humbling, terrifying, ghoulish year.
Zeynep Tufekci says that a devastating third pandemic surge is upon us and that It’s Time to Hunker Down. She leads with the good news (vaccines, treatments, knowledge, testing capacity & quickness) but notes that with winter coming and a high baseline of cases from a summer not spent in preparation, now is the time to really knuckle down so that we can get to the finish line.
Whatever the causes, public-health experts knew a fall and winter wave was a high likelihood, and urged us to get ready.
But we did not.
The best way to prepare would have been to enter this phase with as few cases as possible. In exponential processes like epidemics, the baseline matters a great deal. Once the numbers are this large, it’s very easy for them to get much larger, very quickly — and they will. When we start with half a million confirmed cases a week, as we had in mid-October, it’s like a runaway train. Only a few weeks later, we are already at about 1 million cases a week, with no sign of slowing down.
Americans are reporting higher numbers of contacts compared with the spring, probably because of quarantine fatigue and confusing guidance. It’s hard to keep up a restricted life. But what we’re facing now isn’t forever.
It’s time to buckle up and lock ourselves down again, and to do so with fresh vigilance. Remember: We are barely nine or 10 months into this pandemic, and we have not experienced a full-blown fall or winter season. Everything that we may have done somewhat cautiously — and gotten away with — in summer may carry a higher risk now, because the conditions are different and the case baseline is much higher.
On Friday, November 13, 170,792 new cases of Covid-19 were reported in the United States. About 3000 of those people will die from their disease on Dec 6 — one day of Covid deaths equal to the number of people who died on 9/11. It’s already baked in, it’s already happened. Here’s how we know.
The case fatality rate (or ratio) for a disease is the number of confirmed deaths divided by the number of confirmed cases. For Covid-19 in the United States, the overall case fatality rate (CFR) is 2.3%. That is, since the beginning of the pandemic, 2.3% of those who have tested positive for Covid-19 in the US have died. In India, it’s 1.5%, Germany is at 1.6%, Iran 5.5%, and in Mexico it’s a terrifying 9.8%.
1. Reported deaths from Covid-19 lag behind reported cases by 22 days. Some deaths are reported sooner and some later, but in general it’s a 22-day lag.1
2. The overall CFR in the US is 2.3% but if you use the 22-day lag to calculate what Bedford calls “a lag-adjusted case fatality rate”, it’s a pretty steady average of 1.8% since August. Here’s a graph:
As you can see, in the early days of the pandemic, 4-6% of the cases ended in death and now that’s down to ~1.8%. That’s good news! The less good news is that the current case rate is high and rising quickly. Because of the lag in reported deaths, the rise in cases might not seem that alarming to some, even though those deaths will eventually happen. What Bedford’s analysis provides is a quick way to estimate the number of deaths that will occur in the future based on the number of cases today: just multiply the number of a day’s cases by 1.8% and you get an estimated number of people who will die 22 days later.2
For instance, as I said above, 170,792 cases were reported on Nov 13 — 1.8% is 3074 deaths to be reported on December 6. Cases have been over 100,000 per day for 11 days now: here are the estimated deaths from that time period:
Date
Cases
Est. deaths (on date)
2020-11-15
145,670
2622 (2020-12-08)
2020-11-14
163,473
2943 (2020-12-07)
2020-11-13
170,792
3074 (2020-12-06)
2020-11-12
150,526
2709 (2020-12-05)
2020-11-11
144,499
2601 (2020-12-04)
2020-11-10
130,989
2358 (2020-12-03)
2020-11-09
118,708
2137 (2020-12-02)
2020-11-08
110,838
1995 (2020-12-01)
2020-11-07
129,191
2325 (2020-11-30)
2020-11-06
125,252
2255 (2020-11-29)
2020-11-05
116,153
2091 (2020-11-28)
2020-11-04
103,067
1855 (2020-11-27)
Totals
1,609,158
28,965
Starting the day after Thanksgiving, a day traditionally called Black Friday, the 1.6 million positive cases reported in the past 12 days will result in 2-3000 deaths per day from then into the first week of December. Statistically speaking, these deaths have already occurred — as Bedford says, they are “baked in”. Assuming the lagged CFR stays at ~1.8% (it could increase due to an overtaxed medical system) and if the number of cases keeps rising, the daily death toll would get even worse. As daily case totals are reported, you can just do the math yourself:
number of cases × 0.018
200,000 cases in a day would be ~3600 deaths. 300,000 daily cases, a number that would have been inconceivable to imagine in May but is now within the realm of possibility, would result in 5400 deaths in a single day. Vaccines are coming, there is hope on the horizon. But make no mistake: this is an absolute unmitigated catastrophe for the United States.
Tibshirani’s first finding was that the lag time between states was quite variable-and that the median lag time was 16 days, a lot shorter than the mean. Looking state by state, Tibshirani concluded, it seemed difficult to land on an exact number of days as the “right” lag “with any amount of confidence,” he told us. Because cases are rising quickly, a shorter lag time would mean a larger denominator of cases for recent days — and a lower current case-fatality rate, something like 1.4 percent. This could mean fewer overall people are dying.
But this approach does not change the most important prediction. The country will still cross the threshold of 2,000 deaths a day, and even more quickly than Bedford originally predicted. Cases were significantly higher 16 days ago than 22 days ago, so a shorter lag time means that those higher case numbers show up in the deaths data sooner. Even with a lower case-fatality rate, deaths climb quickly. Estimating this way, the country would hit an average of 2,000 deaths a day on November 30.
The other major finding in Tibshirani’s analysis is that the individual assumptions and parameters in a Bedford-style model don’t matter too much. You can swap in different CFRs and lag-time parameters, and the outputs are more consistent than you might expect. They are all bad news. And, looking retrospectively, Tibshirani found that a reasonable, Bedford-style lagged-CFR model would have generated more accurate national-death-count predictions than the CDC’s ensemble model since July.
Courtesy of Ed Yong, the lag between cases and hospitalizations is about 11 days. So the full ICUs and packed ERs were hearing about now are going to get so much worse in the next two weeks. And just think about the potential situation a month from now if cases keep rising at the rate they are now for two more weeks…↩
Just to stress again: this is only an estimate. The real reported deaths from a single day’s reported cases will be spread out over several days or weeks. And case reporting is much lower on Sundays and Mondays than on other days (fewer reports on weekends). Bedford accounted for this in his analysis by using 7-day averages.↩
The drugmaker Moderna announced on Monday that its coronavirus vaccine was 94.5 percent effective, based on an early look at the results from its large, continuing study.
Researchers said the results were better than they had dared to imagine. But the vaccine will not be widely available for months, probably not until spring.
Despite the delivery timeline, this is such good news.
The companies’ products open the door to an entirely new way of creating vaccines — and creating them fast. Both use a synthetic version of coronavirus genetic material, called messenger RNA or mRNA, to program a person’s cells to churn out many copies of a fragment of the virus. That fragment sets off alarms in the immune system and stimulates it to attack, should the real virus try to invade. Although a number of vaccines using this technology are in development for other infections and cancers, none have yet been approved or marketed.
“The fact that two different vaccines made by two different companies with two different kinds of structures, in a new messenger RNA concept, both worked so effectively confirms the concept once and for all that this is a viable strategy not only for Covid but for future infectious disease threats,” said Dr. Barry R. Bloom, a professor of public health at Harvard.
Natalie E. Dean, a biostatistician at the University of Florida, said an important finding was that the vaccine appeared to prevent severe disease. Pfizer did not release information about disease severity when reporting its results.
Researchers say the positive results from Pfizer and Moderna bode well for other vaccines, because all of the candidates being tested aim at the same target - the so-called spike protein on the coronavirus that it uses to invade human cells.
It’s only a few more months — please please do what you can to stay safe and keep others safe (especially medical workers) until these vaccines can be rolled out.
In a press release (and not a paper in a peer-reviewed journal) based on a preliminary outside review of data from its phase 3 trial, Pfizer says its Covid-19 vaccine was more than 90% effective in preventing the disease.
The company said that the analysis found that the vaccine was more than 90 percent effective in preventing the disease among trial volunteers who had no evidence of prior coronavirus infection. If the results hold up, that level of protection would put it on par with highly effective childhood vaccines for diseases such as measles. No serious safety concerns have been observed, the company said.
I really hope this analysis holds up when more data from the study is released:
The data released by Pfizer Monday was delivered in a news release, not a peer-reviewed medical journal. It is not conclusive evidence that the vaccine is safe and effective, and the initial finding of more than 90 percent efficacy could change as the trial goes on.
The world, and the United States, could really really use some good news like this about the pandemic.
Pfizer’s first analysis was planned for 32 events, which they pushed back after discussions with FDA. But by the time they analyzed the data, 94 had accrued. This shows how quickly trials can generate results when placed in hotspots (and how much transmission is ongoing!).
These vaccines are tested until a certain number of infections happen. So you have this interesting paradoxical situation where if a potential vaccine is more successful at curbing infection, the longer it takes for the study to conclude. You get a better vaccine but wait longer for it. Countering that are the rising transmission counts in the US — more community transmission will get you to the target number of infections more quickly.
Update: From virologist Dr. Florian Krammer, a thread about what Pfizer and other companies will be looking for in terms of the efficacy of vaccines in a number of different situations. Overall, he is optimistic about these preliminary results. And here’s a FAQ about the vaccine from the NY Times.
Another open question is whether children will get protection from the vaccine. The trial run by Pfizer and BioNTech initially was open to people 18 or older, but in September they began including teenagers as young as 16. Last month, they launched a new trial on children as young as 12 and plan to work their way to younger ages.
The NY Times has a fantastic visualization on how face masks help keep us safe from catching Covid-19 by taking readers on a journey through a mask to see how they block aerosols and droplets.
A lot of the pushback around the efficacy of masks from non-scientists focuses on the size of the droplets and aerosols (super tiny) compared to the gaps between the fibers in the masks (relatively large). Intuitively, it seems like masks don’t stand a chance of stopping anything. But as this visualization shows, multiple layers of fibers do the job quite well. Masks don’t work like sieves, which will let every particle smaller than the holes through the mesh. Instead, imagine shooting a BB gun into a thick stand of trees — no one tree stands a good chance of getting hit by the BB but the forest will stop it eventually.
N95, KN95, and masks made from polypropylene have an extra weapon against particles: the fibers carry an electrostatic charge that attracts particles to trap them. Picture our BB flying through a forest of magnetic trees — it’s got a much better chance of being captured that way.
The visualization also touches on the importance of making sure your mask fits properly. The best masks fit tightly around the edges and include a space around your nose and nostrils. Masks with unfiltered valves should not be used — you’re just breathing virus out into the air. It’s been 8-9 months now that we’ve been dealing with the pandemic and there will be many more months of wearing masks. If your mask is fits poorly around your nose, your straps aren’t tight enough, you need to fuss with it after putting it on, have a mask with a valve, or (god forbid) are still just wearing a bandana, please please do yourself and others a favor and upgrade your mask. High-quality, well-made masks are much easier to find now than 6-8 months ago.1 If you can’t afford a proper mask, email me and I’ll buy you one. Masks are one of the most successful low-tech interventions we can do to prevent the spread of Covid-19, and the better our masks, the more effective they will be.
I am hesitant in recommending particular masks because I am not a doctor or scientist, but you might want to look at Airpop’s masks. I also recently bought some Vida KN95s (but have not worn one yet). My daily mask is this Allett mask that combines a cotton layer with a non-woven polypropylene layer (I wouldn’t wear this on a plane for 4 hours but for 10 minutes in the grocery store in Vermont where community transmission levels are low, it’s fine). It’s more comfortable than a straight KN95 and fits my face perfectly — no “bunching up” gap between the ear loops or around the nose. Disposable surgical masks are very easy to find — they are better than wearing a bandana, valved mask, or even a thin cotton mask.↩
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.
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)
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.↩
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.↩
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.
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.
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.
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.
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.
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.↩
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.
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.
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.
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.
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 inresearchacross 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: Multiplestudies 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.
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.
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).
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.
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.↩
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.
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.
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)
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.
Update: But interesting to note that in this test, scarves, bandanas, and microfiber neck gaiters came in last.
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).↩
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.
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.
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.
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)
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.↩
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.
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.
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.
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?”
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.
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.
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.
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.
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.
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.
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.)
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.
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.
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.
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