Tuesday, March 31, 2020
Food Fight
By now, the sight of ravaged grocery store shelves across the United States has become grimly familiar—and those right-wing memes about food shopping in Venezuela are suddenly as scarce as hen’s teeth—as the country struggles to contain the rapidly spreading coronavirus pandemic. Grocery stores have become ground zero in the battle over social distancing and the site of endless disheartening displays of misguided resource hoarding. Worse, millions of underpaid and overworked grocery store workers are now on the receiving end of the public’s panic over the pandemic—as well as their germs.
Not only does the nature of their work put all grocery store employees—from cashiers to floor workers to those in the warehouse—at high risk of exposure to the virus, they’re also forced to deal with customers’ increasingly nasty attitudes, as supplies run out and shelves sit empty. This added emotional labor is, of course, unpaid, and many hourly workers are braving such conditions without the protection of a union or a living wage, to say nothing of paid sick leave or hazard pay. Through it all, there’s continued pressure coming from above for them to stay smiling as the world around them crumbles. These essential workers are being treated as disposable. As one told me yesterday, “It’s hard to feel like an essential worker when you don’t have health care.”
Even people who work at supposedly more progressive chains like Trader Joe’s and Whole Foods (at least until its Amazon takeover) are anxious, tired, and afraid, and they certainly aren’t being paid enough to deal with these extraordinary circumstances—especially when the hand sanitizer runs out, and emotions at the cash register run high.
“None of us ever expected to be emergency workers; the idea of an ‘essential worker’ is a totally new concept that no grocery store bag boy considers when they drop off an application,” a current Whole Foods worker who prefers to stay anonymous told me. “There’s all of this rhetoric around how we’re just as important as the doctors, and yes, that’s true, but we’re getting paid way less, and medical workers have a little bit more of an idea of the risks that they are setting themselves up for. . . . We’re not used to this shit.” (...)
The lack of safety and support in the workplace is even more of a problem now that the ongoing coronavirus pandemic has thrust Trader Joe’s workers and their fellow grocery store workers onto the front lines of a public health crisis. As a current TJ’s worker based in a Manhattan store put it, “Trader Joes does not give a fuck about human beings; at the end of the day, this is just progressive-themed corporate retail without a soul.”
Trader Joe’s isn’t the only crunchy liberal favorite that has been coming under fire from its frightened and frustrated workforce. Whole Foods—another grocery chain with a notorious allergy to unions—has also failed its workers during this fraught time. The company has taken only incremental measures to protect them, like promising workers up to two weeks of sick leave contingent on a positive COVID-19 test at a time when the vast majority of civilians cannot access them, and offering a $2 hourly wage increase through April. Meanwhile, the chain’s parent company is literally owned by the richest man in the world. (...)
Back in January, Whole Foods cut health care benefits for 1,900 of its part-time workers, a decision that now appears especially cruel. As the Chicago worker told me, “Any kind of argument about money saving or profitability just seems totally absurd when we’re owned by Jeff Bezos. There’s no rationalization for not giving your workers health insurance during a pandemic.”
A group called Whole Worker has since launched a public campaign to hold Whole Foods accountable. They have organized a sickout today in order to bring attention to their demands, which include guaranteed paid sick leave for workers who self-quarantine, hazard pay, proper sanitation procedures, and reinstating the health care benefits that were lost in January. Since Whole Foods has temporarily relaxed its attendance policy, those who participate in the sickout can do so without fear of reprisal, which is a huge advantage when dealing with a company so adamantly opposed to collective organizing.
Matthew Hunt, a former Whole Foods worker who says he was fired in 2017 for trying to start a union, spent several years with the United Food and Commercial Workers International Union (UFCW) before reconnecting with some of his former colleagues and starting Whole Worker. Hunt, who lives in Queens, theorizes that the company is actively trying to cover up the number of employees who have already been exposed. “They’re just protecting their profits. That’s what they do, so I wouldn’t expect anything less from the employing class, especially Jeff fucking Bezos,” he says. “They want people to either quit or to show up to work. They really don’t give a shit about employees.”
Not only does the nature of their work put all grocery store employees—from cashiers to floor workers to those in the warehouse—at high risk of exposure to the virus, they’re also forced to deal with customers’ increasingly nasty attitudes, as supplies run out and shelves sit empty. This added emotional labor is, of course, unpaid, and many hourly workers are braving such conditions without the protection of a union or a living wage, to say nothing of paid sick leave or hazard pay. Through it all, there’s continued pressure coming from above for them to stay smiling as the world around them crumbles. These essential workers are being treated as disposable. As one told me yesterday, “It’s hard to feel like an essential worker when you don’t have health care.”Even people who work at supposedly more progressive chains like Trader Joe’s and Whole Foods (at least until its Amazon takeover) are anxious, tired, and afraid, and they certainly aren’t being paid enough to deal with these extraordinary circumstances—especially when the hand sanitizer runs out, and emotions at the cash register run high.
“None of us ever expected to be emergency workers; the idea of an ‘essential worker’ is a totally new concept that no grocery store bag boy considers when they drop off an application,” a current Whole Foods worker who prefers to stay anonymous told me. “There’s all of this rhetoric around how we’re just as important as the doctors, and yes, that’s true, but we’re getting paid way less, and medical workers have a little bit more of an idea of the risks that they are setting themselves up for. . . . We’re not used to this shit.” (...)
The lack of safety and support in the workplace is even more of a problem now that the ongoing coronavirus pandemic has thrust Trader Joe’s workers and their fellow grocery store workers onto the front lines of a public health crisis. As a current TJ’s worker based in a Manhattan store put it, “Trader Joes does not give a fuck about human beings; at the end of the day, this is just progressive-themed corporate retail without a soul.”
Trader Joe’s isn’t the only crunchy liberal favorite that has been coming under fire from its frightened and frustrated workforce. Whole Foods—another grocery chain with a notorious allergy to unions—has also failed its workers during this fraught time. The company has taken only incremental measures to protect them, like promising workers up to two weeks of sick leave contingent on a positive COVID-19 test at a time when the vast majority of civilians cannot access them, and offering a $2 hourly wage increase through April. Meanwhile, the chain’s parent company is literally owned by the richest man in the world. (...)
Back in January, Whole Foods cut health care benefits for 1,900 of its part-time workers, a decision that now appears especially cruel. As the Chicago worker told me, “Any kind of argument about money saving or profitability just seems totally absurd when we’re owned by Jeff Bezos. There’s no rationalization for not giving your workers health insurance during a pandemic.”
A group called Whole Worker has since launched a public campaign to hold Whole Foods accountable. They have organized a sickout today in order to bring attention to their demands, which include guaranteed paid sick leave for workers who self-quarantine, hazard pay, proper sanitation procedures, and reinstating the health care benefits that were lost in January. Since Whole Foods has temporarily relaxed its attendance policy, those who participate in the sickout can do so without fear of reprisal, which is a huge advantage when dealing with a company so adamantly opposed to collective organizing.
Matthew Hunt, a former Whole Foods worker who says he was fired in 2017 for trying to start a union, spent several years with the United Food and Commercial Workers International Union (UFCW) before reconnecting with some of his former colleagues and starting Whole Worker. Hunt, who lives in Queens, theorizes that the company is actively trying to cover up the number of employees who have already been exposed. “They’re just protecting their profits. That’s what they do, so I wouldn’t expect anything less from the employing class, especially Jeff fucking Bezos,” he says. “They want people to either quit or to show up to work. They really don’t give a shit about employees.”
by Kim Kelly, The Baffler | Read more:
Image: Wikimedia Commons
[ed. See also: We Keep You Alive (The Baffler); “Amazon Is a Breeding Ground”; Nationalize Amazon (Jacobin); and We Need Amazon During the Coronavirus. That’s a Problem. (NY Times).]
Monday, March 30, 2020
Bosses Panic-Buy Spy Software to Keep Tabs on Remote Workers
The email came from the boss.
We’re watching you, it told Axos Financial Inc. employees working from home. We’re capturing your keystrokes. We’re logging the websites you visit. Every 10 minutes or so, we’re taking a screen shot.
So get to work — or face the consequences.
“We have seen individuals taking unfair advantage of flexible work arrangements” by essentially taking vacations, Gregory Garrabrants, the online bank’s chief executive officer, wrote in the March 16 message reviewed by Bloomberg News. If daily tasks aren’t completed, workers “will be subject to disciplinary action, up to and including termination.”
Straight-up Big Brother, perhaps, but it’s perfectly legal for businesses to keep an unblinking eye on employees as long as they disclose they’re doing it. Of course, digital surveillance has been used for years on office desktops, yet it seems a violation of privacy to a lot of workers when they’re required to have software on their computers that tracks their every move in their own homes.
Workers at various companies have complained of excesses, but many of them are new to telecommuting, with its temptations of a midday nap or the demands of children out of school. Employers justify going full Orwell by saying that monitoring curbs security breaches, which can be expensive, and helps keep the wheels of commerce turning.
With so many people working remotely because of the coronavirus, surveillance software is flying off the virtual shelves.
by Polly Mosendz and Anders Melin, Bloomberg | Read more:
Image: Nick Little
[ed. See also: Bigger Brother: The Age of Surveillance Capitalism (NYRB).]
We’re watching you, it told Axos Financial Inc. employees working from home. We’re capturing your keystrokes. We’re logging the websites you visit. Every 10 minutes or so, we’re taking a screen shot.
So get to work — or face the consequences.
“We have seen individuals taking unfair advantage of flexible work arrangements” by essentially taking vacations, Gregory Garrabrants, the online bank’s chief executive officer, wrote in the March 16 message reviewed by Bloomberg News. If daily tasks aren’t completed, workers “will be subject to disciplinary action, up to and including termination.”Straight-up Big Brother, perhaps, but it’s perfectly legal for businesses to keep an unblinking eye on employees as long as they disclose they’re doing it. Of course, digital surveillance has been used for years on office desktops, yet it seems a violation of privacy to a lot of workers when they’re required to have software on their computers that tracks their every move in their own homes.
Workers at various companies have complained of excesses, but many of them are new to telecommuting, with its temptations of a midday nap or the demands of children out of school. Employers justify going full Orwell by saying that monitoring curbs security breaches, which can be expensive, and helps keep the wheels of commerce turning.
With so many people working remotely because of the coronavirus, surveillance software is flying off the virtual shelves.
by Polly Mosendz and Anders Melin, Bloomberg | Read more:
Image: Nick Little
[ed. See also: Bigger Brother: The Age of Surveillance Capitalism (NYRB).]
The Frontier Couple Who Chose Death Over Life Apart
Eric Bealer arrived in Sitka for the last time in a boat weighed down with his art.
It was late March 2018. Bealer, an Alaskan artist who specialized in intricately detailed wood engravings, had just traveled for two days from his homestead on Lisianski Inlet, through the rough winter waters off the western edges of Chichagof and Baranof Islands, to the relative shelter of Sitka Sound. His skiff, built by hand using materials harvested and salvaged from Alaska’s coast, was jam-packed with his work: old prints, new prints, even the ink-stained, delicately carved wooden blocks used to make the prints themselves. There was so much art filling the little boat that, during his overnight layover en route to Sitka, Bealer had no room to lie down. He slept onshore, on the ground.
Eugene Solovyov met him on the dock in Sitka’s Crescent Harbor. Solovyov, owner of the Sitka Rose Gallery, had known Bealer for more than two decades, ever since the artist walked in one day in the mid-1990s, looking to place his work. Solovyov was immediately impressed with Bealer’s depictions of Alaska’s landscapes, the state’s flora and fauna. It wasn’t just the technical proficiency, the fine detail. Bealer’s images, wild and moody, made you feel something. And they were the kind of art almost anyone could afford: prints sold for $25, or $40, or $45. Bealer went on to become the gallery’s most popular artist with both visitors and locals.
In their twenty-plus years of acquaintance, the pair had became much more than gallery owner and artist, vendor and producer. They were close friends. Every couple of years, Bealer would travel to Sitka by plane or boat for a gallery show. He stayed in Solovyov’s apartment, and they’d catch up over a few beers. Sometimes, Bealer’s wife, Pam, came along, too, although her visits were less frequent after she was diagnosed with multiple sclerosis, an autoimmune disease that attacks the nerves in the brain and spinal cord, with effects ranging from manageable problems like pain and numbness to serious physical disabilities. As the years passed and Pam’s symptoms worsened, she and Solovyov kept in touch by e-mail, trading photos and stories.
Solovyov later told me that, when he saw the little boat crammed with art that March day, he should have known. For years, the couple had talked with close friends about their intention to die together when Pam’s time came. She did not wish to see her disease through; Eric did not plan to live without his wife. But it was one thing to talk about this in the abstract. It was another for Solovyov to stand in the harbor and realize that his friend had prepared his last exhibition. “He brought everything with him,” he said.
The show went well. Bealer’s work sold briskly, as it always does, and when he motored out of the harbor and headed home, his boat was a great deal lighter.
Throughout that summer, the Bealers traveled back and forth between their main homestead, a few miles outside the small village of Pelican, and their more remote cabin nearby, on the west coast of Yakobi Island. They planted their vegetable garden and cared for their chickens. They worked on their art. In early September, they headed to the cabin again.
Isolated as the cabin was, they had a neighbor there, and his place had Wi-Fi, which they were able to use even when he was away. So they were generally in touch with people by e-mail. When that communication stopped, in mid-September, their friends took notice. They put the word out to folks in Pelican: If anyone was heading for Yakobi Island, could they look in on the Bealers?
On October 5, a pair of Pelican-area residents, a married couple, made the trip to the island. Leaving his wife in their boat, the husband hiked up a trail to the Bealers’ cabin. The screen door to the covered porch was open. He went in and found a plastic bin filled with packages and letters, and a note taped to the glass window of the main door, which was locked. On one side the note read: “Hello, if you are looking for the Bealers… Please read this. If you found this, please mail the attached packages. It will go to the people who will know what to do next and take care of things. Please accept the cash as a gift to pay you for your trouble, and postage for these packages and envelopes.”
On the back side it said, “To the world and all concerned: This is to officially notify you that Eric and Pam Bealer, by their own choice and free will, have committed suicide. We are dead, gone, and free from this physical world. Free. We have gone to some effort to hide our bodies, as we do not want them found. Please do not waste time and money looking. It would serve no purpose. We are gone, leave us to our peace.”
Below their declaration was a passage attributed to Richard Bach, which said: “Why, instead of suffering and fighting it, don’t people reach a time when they decide, ‘Done! We’ve finished everything we came to do. There are no mountains we haven’t pretty well climbed, nothing unlearned we wanted to learn, we’ve lived a nice life.’ And then they just sit themselves down under a tree or a star, lift themselves out of their bodies, and never come back?”
Underneath the poem was one more note from the Bealers: “Why indeed?” (...)
My thoughts about the right to die began to form in the mid-1990s, shaped by two high-profile Canadian cases. The first was the death of Sue Rodriguez, a woman with ALS who had fought all the way to the Canadian Supreme Court for the right to receive medical assistance in dying on her own timetable. The court turned her down five to four, but Rodriguez found a still-anonymous doctor who was willing to break the law to help her. She died February 12, 1994, from an overdose of morphine.
Around the same time as the Rodriguez case, a farmer in Saskatchewan named Robert Latimer put his 12-year-old daughter, Tracy, in his truck and filled the cab with exhaust, killing her. Tracy had a severe case of cerebral palsy—she couldn’t speak or walk, among other limitations—and over a chorus of outrage from disability-rights advocates, Latimer defended his choice by saying that he was sparing her further agony. He was found guilty of second-degree murder.
I was in junior high when these stories played out. I didn’t have any strong feelings about Rodriguez’s case, just a vague, unexamined sense that she was right. Tracy Latimer, unable to speak for herself, was much more complicated. But I latched on to something I’d heard on the radio: that she suffered as many as a half-dozen seizures a day.
At the time, I was newly diagnosed with epilepsy, and the three full-body seizures I’d experienced before medication brought them under control were the worst experiences of my young life. I remember sitting at a table at school with a few friends, talking about the Latimer case, and while I didn’t pretend to know what Tracy thought or felt, I knew one thing for sure. “If you told me I’d have six seizures a day, every day, for the rest of my life,” I said, “I would beg you to kill me.”
So I grew up broadly sympathetic to the idea of choosing one’s own time and place. But on three occasions I also felt the particular, sickening sadness of learning that a classmate has died by suicide. I’ve read about suicide clusters and suicide contagion. I know that it can be a corrosive act, leaving grief and anger in its wake. Our choices can have ripple effects far beyond our own lives. (...)
Assisted suicide is not yet legal in Alaska, and Pam Bealer wouldn’t have qualified for it anyway—most legal frameworks require the patient’s death to be imminent. Eric’s choice goes beyond what most right-to-die advocates envision. I wasn’t sure how to feel about what they’d done.
It was late March 2018. Bealer, an Alaskan artist who specialized in intricately detailed wood engravings, had just traveled for two days from his homestead on Lisianski Inlet, through the rough winter waters off the western edges of Chichagof and Baranof Islands, to the relative shelter of Sitka Sound. His skiff, built by hand using materials harvested and salvaged from Alaska’s coast, was jam-packed with his work: old prints, new prints, even the ink-stained, delicately carved wooden blocks used to make the prints themselves. There was so much art filling the little boat that, during his overnight layover en route to Sitka, Bealer had no room to lie down. He slept onshore, on the ground.
Eugene Solovyov met him on the dock in Sitka’s Crescent Harbor. Solovyov, owner of the Sitka Rose Gallery, had known Bealer for more than two decades, ever since the artist walked in one day in the mid-1990s, looking to place his work. Solovyov was immediately impressed with Bealer’s depictions of Alaska’s landscapes, the state’s flora and fauna. It wasn’t just the technical proficiency, the fine detail. Bealer’s images, wild and moody, made you feel something. And they were the kind of art almost anyone could afford: prints sold for $25, or $40, or $45. Bealer went on to become the gallery’s most popular artist with both visitors and locals.
In their twenty-plus years of acquaintance, the pair had became much more than gallery owner and artist, vendor and producer. They were close friends. Every couple of years, Bealer would travel to Sitka by plane or boat for a gallery show. He stayed in Solovyov’s apartment, and they’d catch up over a few beers. Sometimes, Bealer’s wife, Pam, came along, too, although her visits were less frequent after she was diagnosed with multiple sclerosis, an autoimmune disease that attacks the nerves in the brain and spinal cord, with effects ranging from manageable problems like pain and numbness to serious physical disabilities. As the years passed and Pam’s symptoms worsened, she and Solovyov kept in touch by e-mail, trading photos and stories. Solovyov later told me that, when he saw the little boat crammed with art that March day, he should have known. For years, the couple had talked with close friends about their intention to die together when Pam’s time came. She did not wish to see her disease through; Eric did not plan to live without his wife. But it was one thing to talk about this in the abstract. It was another for Solovyov to stand in the harbor and realize that his friend had prepared his last exhibition. “He brought everything with him,” he said.
The show went well. Bealer’s work sold briskly, as it always does, and when he motored out of the harbor and headed home, his boat was a great deal lighter.
Throughout that summer, the Bealers traveled back and forth between their main homestead, a few miles outside the small village of Pelican, and their more remote cabin nearby, on the west coast of Yakobi Island. They planted their vegetable garden and cared for their chickens. They worked on their art. In early September, they headed to the cabin again.
Isolated as the cabin was, they had a neighbor there, and his place had Wi-Fi, which they were able to use even when he was away. So they were generally in touch with people by e-mail. When that communication stopped, in mid-September, their friends took notice. They put the word out to folks in Pelican: If anyone was heading for Yakobi Island, could they look in on the Bealers?
On October 5, a pair of Pelican-area residents, a married couple, made the trip to the island. Leaving his wife in their boat, the husband hiked up a trail to the Bealers’ cabin. The screen door to the covered porch was open. He went in and found a plastic bin filled with packages and letters, and a note taped to the glass window of the main door, which was locked. On one side the note read: “Hello, if you are looking for the Bealers… Please read this. If you found this, please mail the attached packages. It will go to the people who will know what to do next and take care of things. Please accept the cash as a gift to pay you for your trouble, and postage for these packages and envelopes.”
On the back side it said, “To the world and all concerned: This is to officially notify you that Eric and Pam Bealer, by their own choice and free will, have committed suicide. We are dead, gone, and free from this physical world. Free. We have gone to some effort to hide our bodies, as we do not want them found. Please do not waste time and money looking. It would serve no purpose. We are gone, leave us to our peace.”
Below their declaration was a passage attributed to Richard Bach, which said: “Why, instead of suffering and fighting it, don’t people reach a time when they decide, ‘Done! We’ve finished everything we came to do. There are no mountains we haven’t pretty well climbed, nothing unlearned we wanted to learn, we’ve lived a nice life.’ And then they just sit themselves down under a tree or a star, lift themselves out of their bodies, and never come back?”
Underneath the poem was one more note from the Bealers: “Why indeed?” (...)
My thoughts about the right to die began to form in the mid-1990s, shaped by two high-profile Canadian cases. The first was the death of Sue Rodriguez, a woman with ALS who had fought all the way to the Canadian Supreme Court for the right to receive medical assistance in dying on her own timetable. The court turned her down five to four, but Rodriguez found a still-anonymous doctor who was willing to break the law to help her. She died February 12, 1994, from an overdose of morphine.
Around the same time as the Rodriguez case, a farmer in Saskatchewan named Robert Latimer put his 12-year-old daughter, Tracy, in his truck and filled the cab with exhaust, killing her. Tracy had a severe case of cerebral palsy—she couldn’t speak or walk, among other limitations—and over a chorus of outrage from disability-rights advocates, Latimer defended his choice by saying that he was sparing her further agony. He was found guilty of second-degree murder.
I was in junior high when these stories played out. I didn’t have any strong feelings about Rodriguez’s case, just a vague, unexamined sense that she was right. Tracy Latimer, unable to speak for herself, was much more complicated. But I latched on to something I’d heard on the radio: that she suffered as many as a half-dozen seizures a day.
At the time, I was newly diagnosed with epilepsy, and the three full-body seizures I’d experienced before medication brought them under control were the worst experiences of my young life. I remember sitting at a table at school with a few friends, talking about the Latimer case, and while I didn’t pretend to know what Tracy thought or felt, I knew one thing for sure. “If you told me I’d have six seizures a day, every day, for the rest of my life,” I said, “I would beg you to kill me.”
So I grew up broadly sympathetic to the idea of choosing one’s own time and place. But on three occasions I also felt the particular, sickening sadness of learning that a classmate has died by suicide. I’ve read about suicide clusters and suicide contagion. I know that it can be a corrosive act, leaving grief and anger in its wake. Our choices can have ripple effects far beyond our own lives. (...)
Assisted suicide is not yet legal in Alaska, and Pam Bealer wouldn’t have qualified for it anyway—most legal frameworks require the patient’s death to be imminent. Eric’s choice goes beyond what most right-to-die advocates envision. I wasn’t sure how to feel about what they’d done.
by Eva Holland, Outside | Read more:
Image: uncredited
[ed. I predict someday we'll look back on our current end-of-life policies with something like horror. Speaking only for myself, the way I'll die scares me a hell of a lot more than the when.]
[ed. I predict someday we'll look back on our current end-of-life policies with something like horror. Speaking only for myself, the way I'll die scares me a hell of a lot more than the when.]
Where We Are Today: 3/30/2020
Sunday, March 29, 2020
Bob Dylan
[ed. Trump Extends Social Distancing Guidelines Through End of April. Something finally got to him (which is scary in itself). See also: Coronavirus Slowdown in Seattle Suggests Restrictions Are Working (NY Times).]
"Citing figures from his advisers that showed that as many as 200,000 people could die from the virus even if the country took aggressive action to slow its spread, Mr. Trump said the restrictions must continue, even if it meant more sacrifice in the days ahead.
“During this period, it’s very important that everyone strongly follow the guidelines. Have to follow the guidelines,” Mr. Trump told reporters, with members of the government’s coronavirus task force nearby. “Therefore, we will be extending our guidelines to April 30 to slow the spread.”
Getting Through, Making Memories and Being the Grown-Ups
I’m not here to tell you what the “good thing” is about the coronavirus situation, because there is no good thing about a pandemic, not ever. That doesn’t mean there won’t be acts of heroism, because there will be, and heartwarming stories, because we’ll have those too, and even — if we’re lucky — moments of scientific brilliance. But we still have to get through the bad stuff. And getting through the bad stuff with your kids may be your act of heroism, your heartwarming story, and even your moment of scientific brilliance.
What I’m here to tell you, you already know, but even so, it’s always a hard thing to hear, at any age: we — the grown-ups — have to be the grown-ups here. And for those with young children, especially those at home now for the foreseeable future with those young children, with schools and day care centers closed, with “social distancing” the order of the day, I want to talk about getting through, making memories and being the grown-ups.
First a disclaimer: I’m a pediatrician and a mother of three, but I’m not particularly good at spending long periods of time with young children — or elementary-school-age children. I like children, and I think they’re interesting, and I’d certainly rather have them as my patients than adults, but I have always understood that I do not have what it takes to be even a decent day care teacher, or kindergarten teacher, or grade school teacher.
My kids had plenty of decent teachers, and not a few brilliant teachers, with all the energy and creativity and endless patience that I don’t have, and I worshiped them with the grateful fervor of the parent who knew that she paled by comparison. And certainly we should all acknowledge how much skill goes into doing these jobs well — and as we yearn for the world to start up again, maybe we’ll spare some energy to do that.
But here’s the thing — in addition to everything else that you are doing, if you are unexpectedly home with your kids right now, in addition to trying to work from home, and tracking all the worrisome news, and hoarding toilet paper (just kidding), not to mention looking up recipes for making your own hand sanitizer — in addition to all that, you are also making memories, and helping your kids lay them down.
This is going to be an event that defines their childhoods. It’s going to be a touchstone for the little kids whose schools have closed just as it is for the college students sent home when they expected to be spring breaking and senior springing. Decades from now, at their college reunions, this will be one of the things those students remember, what they hark back to, what they have in common.
It will be like the memories of where you were and what you understood on 9/11, or (for people my age) where you were and what you understood when John F. Kennedy was assassinated — but it will be more than that, because it will not just be about where you were and what you did at one defining point in time, but instead a memory of a long, strange interlude, when the world was interrupted. And heaven knows, there are many things about that future memory that are out of our control. So let me acknowledge the many levels of uncertainty, anxiety and catastrophic thinking that are gripping us all.
What I’m here to tell you, you already know, but even so, it’s always a hard thing to hear, at any age: we — the grown-ups — have to be the grown-ups here. And for those with young children, especially those at home now for the foreseeable future with those young children, with schools and day care centers closed, with “social distancing” the order of the day, I want to talk about getting through, making memories and being the grown-ups.
First a disclaimer: I’m a pediatrician and a mother of three, but I’m not particularly good at spending long periods of time with young children — or elementary-school-age children. I like children, and I think they’re interesting, and I’d certainly rather have them as my patients than adults, but I have always understood that I do not have what it takes to be even a decent day care teacher, or kindergarten teacher, or grade school teacher.My kids had plenty of decent teachers, and not a few brilliant teachers, with all the energy and creativity and endless patience that I don’t have, and I worshiped them with the grateful fervor of the parent who knew that she paled by comparison. And certainly we should all acknowledge how much skill goes into doing these jobs well — and as we yearn for the world to start up again, maybe we’ll spare some energy to do that.
But here’s the thing — in addition to everything else that you are doing, if you are unexpectedly home with your kids right now, in addition to trying to work from home, and tracking all the worrisome news, and hoarding toilet paper (just kidding), not to mention looking up recipes for making your own hand sanitizer — in addition to all that, you are also making memories, and helping your kids lay them down.
This is going to be an event that defines their childhoods. It’s going to be a touchstone for the little kids whose schools have closed just as it is for the college students sent home when they expected to be spring breaking and senior springing. Decades from now, at their college reunions, this will be one of the things those students remember, what they hark back to, what they have in common.
It will be like the memories of where you were and what you understood on 9/11, or (for people my age) where you were and what you understood when John F. Kennedy was assassinated — but it will be more than that, because it will not just be about where you were and what you did at one defining point in time, but instead a memory of a long, strange interlude, when the world was interrupted. And heaven knows, there are many things about that future memory that are out of our control. So let me acknowledge the many levels of uncertainty, anxiety and catastrophic thinking that are gripping us all.
by Perri Klass, MD, NY Times | Read more:
Image: Getty
Saturday, March 28, 2020
The Korean Clusters and Patient 31
The Korean Clusters and Patient 31 (Reuters)
Image: Korea Centers for Disease Control & Prevention (KCDP)
[ed. See also: The Missing Six Weeks (The Guardian).]
CoronaLinks 3/27/20: We're Number One
The United States now has more coronavirus cases than any other country, including China, marking a new stage in the epidemic. As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice.
Hammer and dance
Most of the smart people I’ve been reading have converged on something like the ideas expressed in The Hammer And The Dance – see this Less Wrong post for more.
[ed. For summaries of these links, see the following posts.]
Summary: Asian countries have managed to control the pandemic through mass testing, contact tracing, and travel bans, without economic shutdown. The West lost the chance for a clean win when it bungled its first month of response, but it can still recover its footing. We need a medium-term national shutdown to arrest the spread of the virus until authorities can get their act together – manufacture lots of tests and face masks, create a testing infrastructure, come up with policies for how to respond when people test positive, distribute the face masks to everyone, etc. With a lot of work, we can manage that in a month or so. After that, we can relax the national shutdown, start over with a clean slate, and pursue the Asian-style containment strategy we should have been doing since the beginning.
This is the only plan I’ve heard from anybody that doesn’t result in either hundreds of thousands of deaths, or the economy crashing so hard we’re all reduced to eating weeds and rocks.
I relayed some criticism of a previous Medium post, Flattening The Curve Is A Deadly Delusion, last links post. In retrospect, I was wrong, it was right (except for the minor math errors it admitted to), and it was trying to say something similar to this. There is no practical way to “flatten the curve” except by making it so flat that the virus is all-but-gone, like it is in South Korea right now. I think this was also the conclusion of the Imperial College London report that everyone has been talking about. (...)
Japan and other mysteries
Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. Japan is super-dense and full of old people, so at this point the living should envy the dead.
But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.
The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.
Some people have gestured at the Japanese being an unusually clean and law-abiding people. Maybe the government has just sort of subtly communicated “don’t do anything that will mess up our Olympics chances” and everyone has been really good at not touching their face. Maybe widespread use of face masks is much much more important than anyone has previously believed. I don’t know.
One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.
Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.
Takeout
So far every US state and local self-isolation order has included exceptions for getting takeout or delivery food. I’m sure restaurants appreciate the business and consumers appreciate getting to keep that particular aspect of a normal lifestyle. But is it actually safe?
All the big organizations say yes. From Forbes:
I am really craving something other than the three or four things I can cook myself, and I have a lot of mutually-quarantined housemates to convince, so if any of you have any clearer estimate of the risk situation, please share.
Ventilator numbers
Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?). The head of a small ventilator company says they usually “sell 50 in a good month”.
Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis – remember, that’s twice what the whole UK has right now. The American Hospital Association says 960,000 Americans may require ventilators during the pandemic – hopefully not all at once.
Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” – which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.
If you’re confused about the difference between ventilators, oxygen concentrators, etc, or you have clever questions like “can we repurpose CPAP machines as ventilators?”, you might like Sarah Constantin’s Oxygen Supplementation 101.
The British reversal
A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.
They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.
But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.
Hammer and dance
Most of the smart people I’ve been reading have converged on something like the ideas expressed in The Hammer And The Dance – see this Less Wrong post for more.
[ed. For summaries of these links, see the following posts.]
Summary: Asian countries have managed to control the pandemic through mass testing, contact tracing, and travel bans, without economic shutdown. The West lost the chance for a clean win when it bungled its first month of response, but it can still recover its footing. We need a medium-term national shutdown to arrest the spread of the virus until authorities can get their act together – manufacture lots of tests and face masks, create a testing infrastructure, come up with policies for how to respond when people test positive, distribute the face masks to everyone, etc. With a lot of work, we can manage that in a month or so. After that, we can relax the national shutdown, start over with a clean slate, and pursue the Asian-style containment strategy we should have been doing since the beginning.
This is the only plan I’ve heard from anybody that doesn’t result in either hundreds of thousands of deaths, or the economy crashing so hard we’re all reduced to eating weeds and rocks.
I relayed some criticism of a previous Medium post, Flattening The Curve Is A Deadly Delusion, last links post. In retrospect, I was wrong, it was right (except for the minor math errors it admitted to), and it was trying to say something similar to this. There is no practical way to “flatten the curve” except by making it so flat that the virus is all-but-gone, like it is in South Korea right now. I think this was also the conclusion of the Imperial College London report that everyone has been talking about. (...)
Japan and other mysteries
Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. Japan is super-dense and full of old people, so at this point the living should envy the dead.
But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.
The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.
Some people have gestured at the Japanese being an unusually clean and law-abiding people. Maybe the government has just sort of subtly communicated “don’t do anything that will mess up our Olympics chances” and everyone has been really good at not touching their face. Maybe widespread use of face masks is much much more important than anyone has previously believed. I don’t know.
One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.
Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.
Takeout
So far every US state and local self-isolation order has included exceptions for getting takeout or delivery food. I’m sure restaurants appreciate the business and consumers appreciate getting to keep that particular aspect of a normal lifestyle. But is it actually safe?
All the big organizations say yes. From Forbes:
“Takeout food seems to pose a very minimal risk of passing on coronavirus. Here, virology experts explain why….”There is no evidence that SARS-CoV-2 can be transmitted by eating food. I imagine that if this is possible, the risk is extremely low,” said Angela L. Rasmussen, PhD, a virologist in the faculty of the Center for Infection and Immunity at the Columbia Mailman School of Public Health, adding that she is not aware of any human coronaviruses that can be transmitted through food.And the San Francisco Chronicle:
With dining in restaurants off the table, many Americans are wondering if take-out and delivery food options are still viable in the age of coronavirus. Luckily for people tired of their own home cooking, the answer is, by and large, yes.
According to the CDC, transmission of COVID-19 primarily happens person-to-person, so your largest risk is not in the food but in human interaction. Keep your distance as much as possible when picking up food, or request that delivery workers leave the food on your doorstep. As with other in-person interactions, remember to avoid touching your face and be sure to wash your hands thoroughly as soon as you can.
“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads,” the CDC says.On the other hand, all of my friends who are actually worried about getting the condition are avoiding delivery food like, well, the plague. Their argument is that we know the virus can survive on surfaces for a while, so all you need is one food worker to cough on your food after it’s been cooked (or on food that doesn’t get cooked at all), and you’re screwed. Restauarants are supposed to follow sanitary precautions, but people familiar with the industry say these precautions are not so strong to 100% (or even an especially high percent) ensure you get un-coughed-on food. The CDC telling food workers they don’t need face masks does not exactly inspire confidence here.
I am really craving something other than the three or four things I can cook myself, and I have a lot of mutually-quarantined housemates to convince, so if any of you have any clearer estimate of the risk situation, please share.
Ventilator numbers
Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?). The head of a small ventilator company says they usually “sell 50 in a good month”.
Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis – remember, that’s twice what the whole UK has right now. The American Hospital Association says 960,000 Americans may require ventilators during the pandemic – hopefully not all at once.
Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” – which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.
If you’re confused about the difference between ventilators, oxygen concentrators, etc, or you have clever questions like “can we repurpose CPAP machines as ventilators?”, you might like Sarah Constantin’s Oxygen Supplementation 101.
The British reversal
A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.
They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.
But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.
by Scott Alexander, Slate Star Codex | Read more:
Covid-19 Points of Leverage, Travel Bans and Eradication
#Don'tFlattenTheCurve
The optimal strategy to defeat the disease is currently the subject of much debate. Several strategies have emerged, and a popular meme right now is #flattenthecurve. The idea of flattening the curve is that if we increase the duration of the pandemic, the number of people infected at any one time will be lower and our ability to treat people properly will be increased. People put a lot of time into creating convincing memes and diagrams showing how this works:
Unfortunately people didn't put much effort into getting the numbers right. Every single one of these diagrams is a steaming pile of nonsense because the line for "Healthcare System Capacity" is about 20-50 times too high, which was first pointed out by Joshua Bach. That tiny red line right next to the x-axis is our health system capacity:
(taken from The Imperial College COVID-19 Response Team's latest report ).
The UK government's "herd immunity" strategy was another possible way forward, but the government reversed course on this when they realized it would involve at least a few hundred thousand deaths.
Contain and Eradicate
In my opinion, the correct strategy to beat covid-19 whilst minimizing losses from this point forward is a contain-and-eradicate strategy. The New England Complex Systems Institute's writeup on this, written by Nassim Nicholas Taleb of Black Swan fame outlines the strategy:
- Close borders and limit internal travel, lockdown and hygiene to drive R0 below 1
- Ban large events to cut off the long tail of the R0 distribution
- Use aggressive testing and contact tracing to clean up any remaining holdouts, and eradicate the virus on a region-by-region and country-by-country level.
- "Green" regions can return to mostly normal life, albeit without large events and travel. That means that people can go back to work and we can reverse the economic damage.
Contain-and-eradicate probably results in both less loss of life and less economic damage than any other strategy, and we can see this as a consequence of taking an exponential process and fighting it in the low orders of magnitude rather than the high ones. Flatten-The-Curve is bad because a flat curve that lasts for a long time is still, in log-terms, almost at the maximum power of the virus and therefore it can do huge amounts of damage. Herd-Immunity and Deliberate-Infection are bad for the same reason. The only other sensible plan I have seen is the idea of rushing a vaccine as quickly as possible, but that is beyond my expertise.
The optimal strategy to defeat the disease is currently the subject of much debate. Several strategies have emerged, and a popular meme right now is #flattenthecurve. The idea of flattening the curve is that if we increase the duration of the pandemic, the number of people infected at any one time will be lower and our ability to treat people properly will be increased. People put a lot of time into creating convincing memes and diagrams showing how this works:
Unfortunately people didn't put much effort into getting the numbers right. Every single one of these diagrams is a steaming pile of nonsense because the line for "Healthcare System Capacity" is about 20-50 times too high, which was first pointed out by Joshua Bach. That tiny red line right next to the x-axis is our health system capacity:
(taken from The Imperial College COVID-19 Response Team's latest report ).
The UK government's "herd immunity" strategy was another possible way forward, but the government reversed course on this when they realized it would involve at least a few hundred thousand deaths.
Contain and Eradicate
In my opinion, the correct strategy to beat covid-19 whilst minimizing losses from this point forward is a contain-and-eradicate strategy. The New England Complex Systems Institute's writeup on this, written by Nassim Nicholas Taleb of Black Swan fame outlines the strategy:
Since lockdowns result in exponentially decreasing numbers of cases, a comparatively short amount of time can be sufficient to achieve pathogen extinction, after which relaxing restrictions can be done without resurgence. ...
Finally, the use of geographic boundaries and travel restrictions allows for effective and comparatively low cost imposition and relaxation of interventions. Such a multi-scale approach accelerates response efforts, reduces social impacts, allows for relaxing restrictions in areas earlier that are less affected, enables uninfected areas to assist in response in the ares that are infected, and is a much more practical and effective way to stop otherwise devastating outbreaks. ...
A few other issues are of importance: They ignore the possibility of superspreader events in gatherings by not including the fat tail distribution of contagion in their model. This leads them to deny the importance of banning them, which has been shown to be incorrect, including in South Korea. Cutting the fat tail of the infection distribution is critical to reducing R0.Basically:
- Close borders and limit internal travel, lockdown and hygiene to drive R0 below 1
- Ban large events to cut off the long tail of the R0 distribution
- Use aggressive testing and contact tracing to clean up any remaining holdouts, and eradicate the virus on a region-by-region and country-by-country level.
- "Green" regions can return to mostly normal life, albeit without large events and travel. That means that people can go back to work and we can reverse the economic damage.
Contain-and-eradicate probably results in both less loss of life and less economic damage than any other strategy, and we can see this as a consequence of taking an exponential process and fighting it in the low orders of magnitude rather than the high ones. Flatten-The-Curve is bad because a flat curve that lasts for a long time is still, in log-terms, almost at the maximum power of the virus and therefore it can do huge amounts of damage. Herd-Immunity and Deliberate-Infection are bad for the same reason. The only other sensible plan I have seen is the idea of rushing a vaccine as quickly as possible, but that is beyond my expertise.
by Roko, Less Wrong | Read more:
Images: CDC/The Economist; The Imperial College COVID-19 Response Team report
Coronavirus: The Hammer and the Dance
This article follows Coronavirus: Why You Must Act Now, with over 40 million views and 30 translations. If you agree with this article, consider signing the corresponding White House petition. Over 30 translations available at the bottom. Running list of endorsements here. Over 10 million views so far.
Summary of the article: Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
Within a week, countries around the world have gone from: “This coronavirus thing is not a big deal” to declaring the state of emergency. Yet many countries are still not doing much. Why?
Every country is asking the same question: How should we respond? The answer is not obvious to them.
Some countries, like France, Spain or Philippines, have since ordered heavy lockdowns. Others, like the US, UK, or Switzerland, have dragged their feet, hesitantly venturing into social distancing measures.
Here’s what we’re going to cover today, again with lots of charts, data and models with plenty of sources:
What’s the current situation?
What options do we have?
What’s the one thing that matters now: Time
What does a good coronavirus strategy look like?
How should we think about the economic and social impacts?
When you’re done reading the article, this is what you’ll take away:
Our healthcare system is already collapsing.
Countries have two options: either they fight it hard now, or they will suffer a massive epidemic.
If they choose the epidemic, hundreds of thousands will die. In some countries, millions.
And that might not even eliminate further waves of infections.
If we fight hard now, we will curb the deaths.
We will relieve our healthcare system.
We will prepare better.
We will learn.
The world has never learned as fast about anything, ever.
And we need it, because we know so little about this virus.
All of this will achieve something critical: Buy Us Time.
If we choose to fight hard, the fight will be sudden, then gradual.
We will be locked in for weeks, not months.
Then, we will get more and more freedoms back.
It might not be back to normal immediately.
But it will be close, and eventually back to normal.
And we can do all that while considering the rest of the economy too.
Ok, let’s do this.
1. What’s the situation?
by Tomas Pueyo, Medium | Read more:
Summary of the article: Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
Within a week, countries around the world have gone from: “This coronavirus thing is not a big deal” to declaring the state of emergency. Yet many countries are still not doing much. Why?
Every country is asking the same question: How should we respond? The answer is not obvious to them.
Some countries, like France, Spain or Philippines, have since ordered heavy lockdowns. Others, like the US, UK, or Switzerland, have dragged their feet, hesitantly venturing into social distancing measures.
Here’s what we’re going to cover today, again with lots of charts, data and models with plenty of sources:
What’s the current situation?
What options do we have?
What’s the one thing that matters now: Time
What does a good coronavirus strategy look like?
How should we think about the economic and social impacts?
When you’re done reading the article, this is what you’ll take away:
Our healthcare system is already collapsing.
Countries have two options: either they fight it hard now, or they will suffer a massive epidemic.
If they choose the epidemic, hundreds of thousands will die. In some countries, millions.
And that might not even eliminate further waves of infections.
If we fight hard now, we will curb the deaths.
We will relieve our healthcare system.
We will prepare better.
We will learn.
The world has never learned as fast about anything, ever.
And we need it, because we know so little about this virus.
All of this will achieve something critical: Buy Us Time.
If we choose to fight hard, the fight will be sudden, then gradual.
We will be locked in for weeks, not months.
Then, we will get more and more freedoms back.
It might not be back to normal immediately.
But it will be close, and eventually back to normal.
And we can do all that while considering the rest of the economy too.
Ok, let’s do this.
1. What’s the situation?
by Tomas Pueyo, Medium | Read more:
Life Will Eventually Go Back to Being Normal-Bad Again
In a matter of weeks, the coronavirus outbreak has fundamentally changed American life. Businesses and schools have closed indefinitely, and hundreds of thousands of people have lost their jobs. As the economy continues to crash, everyday life feels more precarious than it ever has before. To help, government officials across the country are proposing a slew of benefits, such as a moratorium on evictions and mortgage payments, student loan deferments, releasing prisoners from crowded jails, moving unhoused citizens into hotels and unused apartment buildings, and sending a check to every American citizen for as long as this pandemic lasts.
These unprecedented actions have bipartisan support, as both sides of the aisle understand them to be necessary to address this national emergency. And while I know how scared Americans are feeling, I want to make one thing clear: we will weather this storm. Once the quarantine is lifted and a COVID-19 vaccine is developed, it will once again be business as usual. All the benefits you’ve come to rely on will go away, we will cut the social safety net we hastily assembled, and life will return to normal. As terrifying as things are now, we will persevere and return to the normal terror we’re used to.
We are not underestimating the devastating effects of COVID-19. We are taking this virus seriously, and help is on the way. We are in the process of implementing many left-wing policies — universal income, debt relief, free healthcare, reducing the prison population — that were unfathomable just a month ago. But I want to stress to all Americans that these policies are only temporary. While we might make coronavirus testing, and possibly even treatment, free of charge, rest assured, once this blows over, you will continue to go into debt for any other health issue. Nothing can stop the American way of life, not even a pandemic. We will not let this virus prevent our insurance companies from gouging us for basic services the way our Founding Fathers intended. (...)
Some of you might be wondering, why can’t we take this opportunity to address our country’s issues, create a strong welfare state, and change society for the better? I hear your concerns, but it’s a slippery slope. Once we start being decent, there’s no going back. If Americans aren’t one missed payment away from losing their home, people are going to be kind to one another on a scale we’ve never seen before. Neighbors will help neighbors. Young people will look after older people. Quality of life could skyrocket to levels we haven’t seen since before the invention of capitalism. It’s complete and utter altruism, and it will tear us apart. The sooner we go back to fucking each other over, the better.
[ed. See also: How We're Keeping Up the Fight (Elizabeth Warren); The Novel Coronavirus has a Well-Known Left-Wing Bias (Juan Cole); and The World Is Changing — So Can We (David Byrne).]
These unprecedented actions have bipartisan support, as both sides of the aisle understand them to be necessary to address this national emergency. And while I know how scared Americans are feeling, I want to make one thing clear: we will weather this storm. Once the quarantine is lifted and a COVID-19 vaccine is developed, it will once again be business as usual. All the benefits you’ve come to rely on will go away, we will cut the social safety net we hastily assembled, and life will return to normal. As terrifying as things are now, we will persevere and return to the normal terror we’re used to.We are not underestimating the devastating effects of COVID-19. We are taking this virus seriously, and help is on the way. We are in the process of implementing many left-wing policies — universal income, debt relief, free healthcare, reducing the prison population — that were unfathomable just a month ago. But I want to stress to all Americans that these policies are only temporary. While we might make coronavirus testing, and possibly even treatment, free of charge, rest assured, once this blows over, you will continue to go into debt for any other health issue. Nothing can stop the American way of life, not even a pandemic. We will not let this virus prevent our insurance companies from gouging us for basic services the way our Founding Fathers intended. (...)
Some of you might be wondering, why can’t we take this opportunity to address our country’s issues, create a strong welfare state, and change society for the better? I hear your concerns, but it’s a slippery slope. Once we start being decent, there’s no going back. If Americans aren’t one missed payment away from losing their home, people are going to be kind to one another on a scale we’ve never seen before. Neighbors will help neighbors. Young people will look after older people. Quality of life could skyrocket to levels we haven’t seen since before the invention of capitalism. It’s complete and utter altruism, and it will tear us apart. The sooner we go back to fucking each other over, the better.
by Matthew Brian Cohen, McSweeny's | Read more:
Image: Andrew Harnik/AP via ABC[ed. See also: How We're Keeping Up the Fight (Elizabeth Warren); The Novel Coronavirus has a Well-Known Left-Wing Bias (Juan Cole); and The World Is Changing — So Can We (David Byrne).]
Give Us This Day Our Daily Bread: Coronavirus and Food Security
As Bloomberg reports in Countries Starting to Hoard Food, Threatening Global Trade:
I lived in the United Kingdom for three years prior to my stint in Geneva, and for one one year after. At that time, UK food prices were much lower than Swiss ones. Now, as those who monitored Brexit discussions no doubt already know, the UK is dependent on imports for roughly half of its food, 53 per cent, to be exact.
As Tim Lang writes in The Conversation, Coronavirus: rationing based on health, equity and decency now needed – food system expert:
Image:UN’s Food & Agriculture Organization Global Perspectives Studies/Bloomberg
It’s not just grocery shoppers who are hoarding pantry staples. Some governments are moving to secure domestic food supplies during the conoravirus pandemic.
Kazakhstan, one of the world’s biggest shippers of wheat flour, banned exports of that product along with others, including carrots, sugar and potatoes. Vietnam temporarily suspended new rice export contracts. Serbia has stopped the flow of its sunflower oil and other goods, while Russia is leaving the door open to shipment bans and said it’s assessing the situation weekly.
To be perfectly clear, there have been just a handful of moves and no sure signs that much more is on the horizon. Still, what’s been happening has raised a question: Is this the start of a wave of food nationalism that will further disrupt supply chains and trade flows?Yesterday, the United Nations warned that coronavirus measures could lead to food shortages, as The Guardian reports in Coronavirus measures could cause global food shortage, UN warns:
Protectionist measures by national governments during the coronavirus crisis could provoke food shortages around the world, the UN’s food body has warned.
Harvests have been good and the outlook for staple crops is promising, but a shortage of field workers brought on by the virus crisis and a move towards protectionism – tariffs and export bans – mean problems could quickly appear in the coming weeks, Maximo Torero, chief economist of the UN Food and Agriculture Organisation, told the Guardian.
“The worst that can happen is that governments restrict the flow of food,” he said. “All measures against free trade will be counterproductive. Now is not the time for restrictions or putting in place trade barriers. Now is the time to protect the flow of food around the world.”At present, the UN’s warning is ominous, but not dire. Yet the food shortage threat will only increase, as the coronavirus crisis continues, and the northern hemisphere moves into the heart of its growing season. Encore for The Guardian:
While the supply of food is functioning well in most countries at present, problems could start to be seen within weeks and intensify over the following two months as key fruit and vegetables come into season. These types of produce often have short ripening times and are highly perishable, and need skilled pickers to work quickly at the right time.
“We need to be careful not to break the food value chain and the logistics or we will be looking at problems with fresh vegetables and fruits soon,” said Torero. “Fruit and vegetables are also very labour intensive, if the labour force is threatened because people can’t move then you have a problem.”
As governments impose lockdowns in countries across the world, recruiting seasonal workers will become impossible unless measures are taken to ensure vital workers can still move around, while preventing the virus from spreading.
“Coronavirus is affecting the labour force and the logistical problems are becoming very important,” said Torero. “We need to have policies in place so the labour force can keep doing their job. Protect people too, but we need the labour force. Major countries have yet to implement these sorts of policies to ensure that food can keep moving.”
Countries such as the UK, with a sinking currency and high level of imports, are also likely to see food price rises unless the government takes action or retailers absorb some of the costs, he said.
The most important role governments can play is to keep the food supply chain operating, intervene to ensure there are enough workers, and keep the global food markets from panicking, according to Torero.
“If traders start to become nervous, conditions will get difficult,” he said. “It just needs one big trader to make a decision [to disrupt the supply of staple crops] and that will affect everywhere. Governments must properly regulate, that is their biggest function in this situation. It’s very important to keep alive the food value chain: intervene to protect the value chain [including the supply of workers] but not to distort the market.”The United Kingdom
I lived in the United Kingdom for three years prior to my stint in Geneva, and for one one year after. At that time, UK food prices were much lower than Swiss ones. Now, as those who monitored Brexit discussions no doubt already know, the UK is dependent on imports for roughly half of its food, 53 per cent, to be exact.
As Tim Lang writes in The Conversation, Coronavirus: rationing based on health, equity and decency now needed – food system expert:
Food security is no laughing matter at the best of times, but I gasped when I first read the Department for Environment, Food and Rural Affairs’ (Defra) annual food civil contingencies infrastructure report in 2018. It is barely a page long (in public at least) and assures us everything is OK and that the food system is resilient and able to withstand shocks. As the coronvirus racks the nation and panic buying continues, this complacency is about to be tested.
Few analysts of the UK food system are anything other than sober about its fragility. There is little storage. All operates on a just-in-time basis in which food travels down the supply chain – literally, just in time for when the next link or process needs it. Food businesses have been realigned to cut delays and storage. Consumers have come to expect constant flows of food, without hiccups or gaps. New industries have emerged, notably logistics and satellites which track this all from farm to shop. We are trucker-dependent now.
Only 53% of food consumed in the UK is produced in the country. Others feed the Brits. Some scientists calculate that UK external dependency is even greater, with hidden use of external land to provide animal feed.
While this distortedly efficient food revolution has been rolled out, the UK food trade gap – the difference between exports and imports by value – has widened. In 2018, food worth £46.8 billion was imported, with exports worth only £22.5 billion, leaving a food trade gap of £24.3 billion. Much of the imports are vital for health, the £10bn imports of fruit and veg in particular. UK fruit and veg growing has sunk. The UK’s main “oral” export these days is whisky. Even meat – supposedly Britain’s forte – is in the red. If borders close or supply chains snap, what then?Lang believes that the UK may soon be facing a food crisis, and calls for the government ito think about imposing a system of rationing, rather than allowing a free for all to ensue.
A crunch point for UK food policy and planning is surely approaching. The coronavirus crisis is already spawning worrying actions. Whereas under Brexit no-deal threats, stoicism ruled and “preppers” – people stocking up – were generally few. Today shelves are being stripped and queues form for supermarkets to open. It’s why colleagues and I have called on the UK prime minister to set up a rational system of rationing – based on health, equity and decency – to see the country through this crisis.The alternative is for food retailers to engage in de facto rationing, according to whatever principles they care to apply, rather than those that would prevail in a transparent public rationing system. Lang again:
Meanwhile, it is the food retailers who are beginning to ration supply. This is unacceptable in a democracy. If to happen, it ought to be in the open – and guided by health and sustainability. Surely the “public good” lies in feeding all well, according to need not income. Those values are what got the UK through the second world war, as our Churchill-inspired prime minister ought to know.by Jerri-Lynn Scofield, Naked Capitalism | Read more:
Image:UN’s Food & Agriculture Organization Global Perspectives Studies/Bloomberg
Friday, March 27, 2020
Gilead Sciences Backs Off Monopoly Claim For Promising Coronavirus Drug
[ed. Previously: Coronavirus Treatment Developed by Gilead Sciences Granted "Rare Disease" Status, Potentially Limiting Affordability (The Intercept/Duck Soup).]
Gilead Sciences on Wednesday announced that it has submitted a request to the Food and Drug Administration to rescind the exclusive marketing rights it had secured for remdesivir, an antiviral drug that shows promise in treating Covid-19, the disease caused by the new coronavirus. As The Intercept reported on Monday, the FDA had awarded Gilead seven years of exclusive marketing rights to the drug through the Orphan Drug Act, even though the statute was designed to induce pharmaceutical companies to make treatments for rare diseases that affect fewer than 200,000 people in the United States.
Although the new coronavirus will almost certainly infect that many people, Gilead had exploited a loophole that grants orphan drug status if a company files for it before the official number of cases hits 200,000. As of Wednesday afternoon, there were more than 438,000 confirmed cases worldwide, with more than 59,000 in the United States.
After a public outcry, Gilead issued a press release stating:
The law, known as Section 1498, gives the government the right to override a patent at any time as long as the company receives “reasonable compensation.” Essentially functioning as a kind of eminent domain for patented products, the provision breaks the monopoly and permits low-cost competition. And if drugs such as Gilead’s antiviral remdesivir and other potential treatments and vaccines for the coronavirus are priced out of reach, it could give the government critical leverage to negotiate lower prices. Through the Defense Production Act, the government could even start producing lifesaving treatments itself.
“The government should use every tool that it has to make sure that any coronavirus treatment or vaccine is affordable, including taking away monopolies through 1498,” said Zain Rizvi, a drug-pricing expert at Public Citizen. (...)
The federal government regularly used Section 1498 in the 1960s and 1970s to purchase generic drugs when the patented versions were far more expensive. But pharmaceutical companies railed against the provision and while it has been used for other inventions it has rarely been used for drugs since. In 2001, during the anthrax scare, just the threat of using 1498 proved effective when the government was trying to secure access to the antibiotic ciprofloxacin, which could be used to treat people who were exposed to anthrax. After then-Secretary of Health and Human Services Tommy Thompson raised the possibility of using the provision, Bayer cut the price of ciprofloxacin in half.
In 2017, a group of academics at Yale Law School made the case for the government’s use of Section 1498 to procure a lifesaving treatment for hepatitis C called Sofosbuvir, also manufactured by Gilead, which is too expensive for many people who need it. Sofosbuvir costs $48,000 for a 24-week course, or about $1,000 a pill. Because of the exorbitant price, insurers have refused to cover it for all of the roughly 5 million people infected with hepatitis C, instead making the drug available to only the sickest patients.
Gilead Sciences on Wednesday announced that it has submitted a request to the Food and Drug Administration to rescind the exclusive marketing rights it had secured for remdesivir, an antiviral drug that shows promise in treating Covid-19, the disease caused by the new coronavirus. As The Intercept reported on Monday, the FDA had awarded Gilead seven years of exclusive marketing rights to the drug through the Orphan Drug Act, even though the statute was designed to induce pharmaceutical companies to make treatments for rare diseases that affect fewer than 200,000 people in the United States.Although the new coronavirus will almost certainly infect that many people, Gilead had exploited a loophole that grants orphan drug status if a company files for it before the official number of cases hits 200,000. As of Wednesday afternoon, there were more than 438,000 confirmed cases worldwide, with more than 59,000 in the United States.
After a public outcry, Gilead issued a press release stating:
Gilead has submitted a request to the U.S. Food and Drug Administration to rescind the orphan drug designation it was granted for the investigational antiviral remdesivir for the treatment of Covid-19 and is waiving all benefits that accompany the designation. Gilead is confident that it can maintain an expedited timeline in seeking regulatory review of remdesivir, without the orphan drug designation. Recent engagement with regulatory agencies has demonstrated that submissions and review relating to remdesivir for the treatment of Covid-19 are being expedited.Still, public health experts remain concerned about the potential for Gilead and other pharmaceutical companies to engage in price gouging during the global pandemic. And while pharmaceutical companies are testing dozens of drugs as potential vaccines and treatments for the new coronavirus, some legal scholars have pointed to an obscure statute to help ensure that companies won’t price critical drugs out of reach.
The law, known as Section 1498, gives the government the right to override a patent at any time as long as the company receives “reasonable compensation.” Essentially functioning as a kind of eminent domain for patented products, the provision breaks the monopoly and permits low-cost competition. And if drugs such as Gilead’s antiviral remdesivir and other potential treatments and vaccines for the coronavirus are priced out of reach, it could give the government critical leverage to negotiate lower prices. Through the Defense Production Act, the government could even start producing lifesaving treatments itself.
“The government should use every tool that it has to make sure that any coronavirus treatment or vaccine is affordable, including taking away monopolies through 1498,” said Zain Rizvi, a drug-pricing expert at Public Citizen. (...)
The federal government regularly used Section 1498 in the 1960s and 1970s to purchase generic drugs when the patented versions were far more expensive. But pharmaceutical companies railed against the provision and while it has been used for other inventions it has rarely been used for drugs since. In 2001, during the anthrax scare, just the threat of using 1498 proved effective when the government was trying to secure access to the antibiotic ciprofloxacin, which could be used to treat people who were exposed to anthrax. After then-Secretary of Health and Human Services Tommy Thompson raised the possibility of using the provision, Bayer cut the price of ciprofloxacin in half.
In 2017, a group of academics at Yale Law School made the case for the government’s use of Section 1498 to procure a lifesaving treatment for hepatitis C called Sofosbuvir, also manufactured by Gilead, which is too expensive for many people who need it. Sofosbuvir costs $48,000 for a 24-week course, or about $1,000 a pill. Because of the exorbitant price, insurers have refused to cover it for all of the roughly 5 million people infected with hepatitis C, instead making the drug available to only the sickest patients.
by Sharon Lerner, The Intercept | Read more:
Image: David Paul Morris/Bloomberg/Getty
[ed. Amazing what some bad PR and public pressure can accomplish during a crisis. And what obscure information comes to light. Like Section 1498. That's some pretty heavy leverage. Also, just in (Friday 3/27): after endless dithering the President has finally been convinced to use the Defense Production Act to speed up production of ventilators. Why so long? Perhaps because of this. Or this. Or, maybe it's just because he likes haggling.]
Cellphone ‘Heat Map’ Shows Distribution of Florida Spring Breakers After Party
A heat map highlighting cellphone location data within the U.S. is providing a frightening insight into the movements of humans amid the ongoing coronavirus pandemic.
The data, collected by location technology company X-Mode, was recently plugged into the geospatial data visualization platform known as Tectonix as part of an effort to track the coronavirus across the globe.
In just one example of the project’s findings, cellphones on a beach in Fort Lauderdale, Florida, during spring break were selected and tracked. When the festivities ended, the cellphones were seen sprawling out across the Eastern half of the country, potentially bringing cases of the highly contagious virus with them.
X-Mode states that the data used is “anonymized,” meaning a cellphone’s location is not linked to its user’s identity. Tectonix took that raw data and honed in specifically on devices moving between 3 and 10 miles per hour in an attempt to pinpoint cellphone owners believed to be walking or traveling with bikes or scooters.
Aside from Florida, the project has also released its analysis of New York City, which is currently the epicenter of the pandemic in the U.S. Just like Florida, the data on New York, specifically Manhattan, shows widespread movement throughout the month of March.
by Mikael Thalen, Daily Dot | Read more:
Image: Tectonix
[ed. Click on the link for the video. Just to be clear, this is an example of geo-tracking (which may be useful for assessing travel restrictions) not the actual spread of the virus (just partygoers dispersing from unsafe conditions). Also, if you're concerned about anonymity and privacy issues turn off your smartphone location setting.]
Thursday, March 26, 2020
How to Make Your Own Hand Sanitizer
Properly scrubbing your hands is one of the best ways to stop the spread of germs and viruses, and to ensure you don’t get sick yourself. But if you don't have access to soap and clean water, or if you're out and about and nowhere near a sink, you should carry hand sanitizer to protect your health.
As you're no doubt aware, bottles of hand sanitizer (Purell, Wet Ones, and the like) sell out quickly during public health crises. But don't worry—making your own hand sanitizer is remarkably easy. You just have to be careful you don't mess it up. Make sure that the tools you use for mixing are properly sanitized; otherwise you could contaminate the whole thing. Also, the World Health Organization recommends letting your concoction sit for a minimum of 72 hours after you're done. That way the sanitizer has time to kill any bacteria that might have been introduced during the mixing process.
(Note: To reiterate, nothing beats washing your hands. Hand sanitizer—even the real, professionally made stuff—should always be a last resort.)
We actually have two recipes for you, and links to find the ingredients. The first is one you can make with stuff you likely already have in your cabinets and under the sink, so it's effective in emergency situations. The second recipe is more complex, but easy to make if you have the opportunity to do some shopping and planning ahead of time. Another note: a lot of these items are quickly going out of stock because of high demand. There's a higher chance of finding them at your local drug store, but your first priority is to stay indoors.
Potency Matters
You’re going to need some alcohol. According to the Centers for Disease Control and Prevention, your sanitizer mix must be at least 60 percent alcohol to be effective. But it's better to get way above that—aim for a minimum of 75 percent. A bottle of 99 percent isopropyl alcohol is the best thing to use. Your regular vodka and whiskey are too wimpy and won’t cut it.
The Quick (Gel) Recipe
Isopropyl alcohol (also here)
Aloe vera gel (also here)
Tea tree oil (also here)
Mix 3 parts isopropyl alcohol to 1 part aloe vera gel. Add a few drops of tea tree oil to give it a pleasant scent and to align your chakras.
Image: Jena Ardell/Getty
As you're no doubt aware, bottles of hand sanitizer (Purell, Wet Ones, and the like) sell out quickly during public health crises. But don't worry—making your own hand sanitizer is remarkably easy. You just have to be careful you don't mess it up. Make sure that the tools you use for mixing are properly sanitized; otherwise you could contaminate the whole thing. Also, the World Health Organization recommends letting your concoction sit for a minimum of 72 hours after you're done. That way the sanitizer has time to kill any bacteria that might have been introduced during the mixing process.(Note: To reiterate, nothing beats washing your hands. Hand sanitizer—even the real, professionally made stuff—should always be a last resort.)
We actually have two recipes for you, and links to find the ingredients. The first is one you can make with stuff you likely already have in your cabinets and under the sink, so it's effective in emergency situations. The second recipe is more complex, but easy to make if you have the opportunity to do some shopping and planning ahead of time. Another note: a lot of these items are quickly going out of stock because of high demand. There's a higher chance of finding them at your local drug store, but your first priority is to stay indoors.
Potency Matters
You’re going to need some alcohol. According to the Centers for Disease Control and Prevention, your sanitizer mix must be at least 60 percent alcohol to be effective. But it's better to get way above that—aim for a minimum of 75 percent. A bottle of 99 percent isopropyl alcohol is the best thing to use. Your regular vodka and whiskey are too wimpy and won’t cut it.
The Quick (Gel) Recipe
Isopropyl alcohol (also here)
Aloe vera gel (also here)
Tea tree oil (also here)
Mix 3 parts isopropyl alcohol to 1 part aloe vera gel. Add a few drops of tea tree oil to give it a pleasant scent and to align your chakras.
The aloe mixture gets the job done, but aloe also leaves your skin annoyingly sticky. So, here's a recipe that's less sticky and more potent, based on the mix recommended by the WHO.
The Better (Spray) Recipe
by Boone Ashworth, Wired | Read more:
Face Masks: Much More Than You Wanted to Know
There’s been recent controversy about the use of face masks for protection against coronavirus. Mainstream sources, including the CDC and most of the media say masks are likely useless and not recommended. They’ve recently been challenged, for example by Professor Zeynep Tufekci in the New York Times and by Jim and Elizabeth on Less Wrong. There was also some debate in the comment section here last week, so I promised I’d look into it in more depth.
As far as I can tell, both sides agree on some points.
They agree that N95 respirators, when properly used by trained professionals, help prevent the wearer from getting infected.
They agree that surgical masks help prevent sick people from infecting others. Since many sick people don’t know they are sick, in an ideal world with unlimited mask supplies everyone would wear surgical masks just to prevent themselves from spreading disease.
They also agree that there’s currently a shortage of both surgical masks and respirators, so for altruistic reasons people should avoid hoarding them and give healthcare workers first dibs.
But they disagree on whether surgical masks alone help prevent the wearer from becoming infected, which will be the focus of the rest of this piece.
1. What are the theoretical reasons why surgical masks might or might not work?
Epidemiologists used to sort disease transmission into three categories: contact, droplet, and airborne. Contact means you only get a disease by touching a victim. This could be literally touching them, or a euphemism for very explicit contact like kissing or sex. Droplet means you get a disease when a victim expels disease-laden particles into your face, usually through coughing, sneezing, or talking. Airborne means you get a disease because it floats in the air and you breathe it in. Transmission via “fomites”, objects like doorknobs and tables that a victim has touched and left their germs on, is a bonus transmission route that can accompany any of these other methods.
More recently, scientists have realized that droplet and airborne transmission exist along more of a spectrum. Droplets can stay in the air for more or less time, and spread through more or less volume of space before settling on the ground. The term for this new droplet-airborne spectrum idea is “aerosol transmission”. Diseases with aerosol transmission may be spread primarily through droplets, but can get inhaled along with the air too. This concept is controversial, with different authorities having different opinions over which viruses can be aerosolized. It looks like most people now believe aerosol transmission is real and applicable to conditions like influenza, SARS, and coronavirus.
Surgical masks are loose pieces of fabric placed in front of the mouth and nose. They offer very good protection against outgoing droplets (eg if you sneeze, you won’t infect other people), and offer some protection against incoming droplets (eg if someone else sneezes, it doesn’t go straight into your nose). They’re not airtight, so they offer no protection against airborne disease or the airborne component of aerosol diseases.
Respirators are tight pieces of fabric that form a seal around your mouth and nose. They have various “ratings”; N95 is the most common, and I’ll be using “N95 respirator” and “respirator” interchangably through most of this post even though that’s not quite correct. When used correctly, they theoretically offer protection against incoming and outgoing droplet and airborne diseases; since aerosol diseases are a combination of these, they offer generalized protection against those too. Hospitals hate the new “aerosol transmission” idea, because it means they probably have to switch from easy/cheap/comfortable surgical masks to hard/expensive/uncomfortable respirators for a lot more diseases.
Theory alone tells us surgical masks should not provide complete protection. Coronavirus has aerosol transmission, so it is partly airborne. Since surgical masks cannot prevent inhalation of airborne particles, they shouldn’t offer 100% safety against coronavirus. But theory doesn’t tell us whether they might not offer 99% safety against coronavirus, and that would still be pretty good.
2. Are people who wear surgical masks less likely to get infected during epidemics?
It’s unethical to randomize people to wear vs. not-wear masks during a pandemic, so nobody has done this. Instead we have case-control studies. After the pandemic is over, scientists look at the health care workers who did vs. didn’t get infected, and see whether the infected people were less likely to wear masks. If so, that suggests maybe the masks helped.
This is an especially bad study design, for two reasons. First, it usually suffers recall bias – if someone wore a mask inconsistently, then they’re more likely to summarize this as “didn’t wear masks” if they got infected, and more likely to summarize it as “did wear masks” if they stayed safe. Second, probably some nurses are responsible and do everything right, and other nurses are irresponsible and do everything wrong, and that means that if anything at all helps (eg washing your hands), then it will look like masks working, since the nurses who washed their hands are more likely to have worn masks. Still, these studies are the best we can do.
3M makes about two dozen versions of the N95, for different industrial and medical purposes. Generally they’re constructed from nonwoven materials—infinitesimal plastic strands blown together to form a random thicket that, under a microscope, “is going to look like pickup sticks,” says Nikki McCullough, 3M’s global leader for occupational health and safety. “If you’re a submicron particle, it’s quite the journey through there.” The filters can block invaders as small as 0.3 microns, or about 1/100th the thickness of a human hair. The virus is smaller than that, at about 0.125 microns, but it often travels within larger particles when an infected person coughs or sneezes.
As far as I can tell, both sides agree on some points.
They agree that N95 respirators, when properly used by trained professionals, help prevent the wearer from getting infected.
They agree that surgical masks help prevent sick people from infecting others. Since many sick people don’t know they are sick, in an ideal world with unlimited mask supplies everyone would wear surgical masks just to prevent themselves from spreading disease.They also agree that there’s currently a shortage of both surgical masks and respirators, so for altruistic reasons people should avoid hoarding them and give healthcare workers first dibs.
But they disagree on whether surgical masks alone help prevent the wearer from becoming infected, which will be the focus of the rest of this piece.
1. What are the theoretical reasons why surgical masks might or might not work?
Epidemiologists used to sort disease transmission into three categories: contact, droplet, and airborne. Contact means you only get a disease by touching a victim. This could be literally touching them, or a euphemism for very explicit contact like kissing or sex. Droplet means you get a disease when a victim expels disease-laden particles into your face, usually through coughing, sneezing, or talking. Airborne means you get a disease because it floats in the air and you breathe it in. Transmission via “fomites”, objects like doorknobs and tables that a victim has touched and left their germs on, is a bonus transmission route that can accompany any of these other methods.
More recently, scientists have realized that droplet and airborne transmission exist along more of a spectrum. Droplets can stay in the air for more or less time, and spread through more or less volume of space before settling on the ground. The term for this new droplet-airborne spectrum idea is “aerosol transmission”. Diseases with aerosol transmission may be spread primarily through droplets, but can get inhaled along with the air too. This concept is controversial, with different authorities having different opinions over which viruses can be aerosolized. It looks like most people now believe aerosol transmission is real and applicable to conditions like influenza, SARS, and coronavirus.
Surgical masks are loose pieces of fabric placed in front of the mouth and nose. They offer very good protection against outgoing droplets (eg if you sneeze, you won’t infect other people), and offer some protection against incoming droplets (eg if someone else sneezes, it doesn’t go straight into your nose). They’re not airtight, so they offer no protection against airborne disease or the airborne component of aerosol diseases.
Respirators are tight pieces of fabric that form a seal around your mouth and nose. They have various “ratings”; N95 is the most common, and I’ll be using “N95 respirator” and “respirator” interchangably through most of this post even though that’s not quite correct. When used correctly, they theoretically offer protection against incoming and outgoing droplet and airborne diseases; since aerosol diseases are a combination of these, they offer generalized protection against those too. Hospitals hate the new “aerosol transmission” idea, because it means they probably have to switch from easy/cheap/comfortable surgical masks to hard/expensive/uncomfortable respirators for a lot more diseases.
Theory alone tells us surgical masks should not provide complete protection. Coronavirus has aerosol transmission, so it is partly airborne. Since surgical masks cannot prevent inhalation of airborne particles, they shouldn’t offer 100% safety against coronavirus. But theory doesn’t tell us whether they might not offer 99% safety against coronavirus, and that would still be pretty good.
2. Are people who wear surgical masks less likely to get infected during epidemics?
It’s unethical to randomize people to wear vs. not-wear masks during a pandemic, so nobody has done this. Instead we have case-control studies. After the pandemic is over, scientists look at the health care workers who did vs. didn’t get infected, and see whether the infected people were less likely to wear masks. If so, that suggests maybe the masks helped.
This is an especially bad study design, for two reasons. First, it usually suffers recall bias – if someone wore a mask inconsistently, then they’re more likely to summarize this as “didn’t wear masks” if they got infected, and more likely to summarize it as “did wear masks” if they stayed safe. Second, probably some nurses are responsible and do everything right, and other nurses are irresponsible and do everything wrong, and that means that if anything at all helps (eg washing your hands), then it will look like masks working, since the nurses who washed their hands are more likely to have worn masks. Still, these studies are the best we can do.
by Scott Alexander, Slate Star Codex | Read more:
Image: Jamie Chung, Bloomberg
[ed. See also: How 3M Plans to Make More Than a Billion Masks By End of Year (Bloomberg). Excerpt:
[ed. See also: How 3M Plans to Make More Than a Billion Masks By End of Year (Bloomberg). Excerpt:
The N95 respirator is so named because, worn properly, it blocks at least 95% of airborne particles from entering a wearer’s mouth and nose, while still allowing respiration through the microscopically porous shell. This design protects a person from medical and other hazards; flimsier, looser-fitting surgical masks are intended to prevent the wearer from infecting others with expelled mucus, blood, or spit.
3M makes about two dozen versions of the N95, for different industrial and medical purposes. Generally they’re constructed from nonwoven materials—infinitesimal plastic strands blown together to form a random thicket that, under a microscope, “is going to look like pickup sticks,” says Nikki McCullough, 3M’s global leader for occupational health and safety. “If you’re a submicron particle, it’s quite the journey through there.” The filters can block invaders as small as 0.3 microns, or about 1/100th the thickness of a human hair. The virus is smaller than that, at about 0.125 microns, but it often travels within larger particles when an infected person coughs or sneezes.
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