Thursday, August 6, 2020
How Not to Lose the Lockdown Generation
Picture this: You live in rural Arkansas and tragedy strikes. A family member has fallen ill with that contagious respiratory illness that has already killed so many — but you don’t have enough space in your small home to quarantine them in a room of their own. Your relative’s case doesn’t appear to be life-threatening, but you are terrified that their persistent cough will spread the illness to more vulnerable family members. You call the local public health authority to see if there is room in local hospitals, and they explain that they are all stretched too thin with emergency cases. There are private facilities, but you can’t afford those.
Not to worry, you are told: A crew will be by shortly to set up a sturdy, well-ventilated, portable, tiny house in your yard. Once installed, your family member will be free to convalesce in comfort. You can deliver home-cooked meals to their door and communicate through open windows — and a trained nurse will be by for regular examinations. And no, there will be no charge for the house.
This is not a dispatch from some future functional United States, one with a government capable of caring for its people in the midst of spiraling economic carnage and a public health emergency. It’s a dispatch from this country’s past, a time eight decades ago when it similarly found itself in the two-fisted grip of an even deeper economic crisis (the Great Depression), and a surging contagious respiratory illness (tuberculosis).
Yet the contrast between how U.S. state and federal government met those challenges in the 1930s, and how they are failing so murderously to meet them now, could not be starker. Those tiny houses are just one example, but they are a revelatory one for the sheer number of problems those humble structures attempted to solve at once.
Known as “isolation huts,” the little clapboard houses were distributed to poor families in several states. Small enough to fit on the back of a trailer, they had just enough space for a bed, chair, dresser, and stove, and were outfitted with large screened-in windows and shutters to maximize the flow of fresh air and sunshine — considered essential for TB recovery.
As physical structures, the TB huts were an elegant answer to the public health challenges posed by crowded homes on the one hand and expensive private sanatoriums on the other. If houses were unable to accommodate safe patient quarantines, then the state, with Washington’s help, would just bring an addition to those houses for the duration of the illness.
It’s worth letting that sink in, given the learned helplessness that pervades the U.S. today. For months, the White House hasn’t been able to figure out how to roll out free Covid-19 tests at anything like the scale required, let alone contact tracing, never mind quarantine support for poor families. Yet in the 1930s, during a much more desperate economic time for the country, state and federal agencies cooperated to deliver not just free tests but free houses.
And that is only the beginning of what makes it worth dwelling on the TB huts . The cabins themselves were built by very young men in their late teens and early 20s who were out of work and had signed up for the National Youth Administration. “The State Board of Health furnishes the materials for these cottages and NYA supplies the labor,” explained Betty and Ernest Lindley, authors of a 1938 history of the program. “The total average cost of one hut is $146.28,” or about $2,700 in today’s dollars.
The TB cabins were just one of thousands upon thousands of projects taken on by the 4.5 million young people who joined the NYA: a vast program started in 1935 that paired young people in economic need, who could not find jobs in the private sector, with publicly minded work that needed doing. They gained marketable skills, while earning money that allowed many to stay, or return to, high school or college. Other NYA projects including building some of the country’s most iconic urban parks, repairing thousands of dilapidated schools and outfitting them with playgrounds; and stocking classrooms with desks, lab tables, and maps the young workers had made and painted themselves. NYA workers built huge outdoor pools and artificial lakes, trained to be teaching and nursing aides, and even built entire youth centers and small schools from scratch, often while living together in “resident centers.”
The NYA served as a kind of urban complement to FDR’s better-known youth program, the Civilian Conservation Corps, launched two years earlier. The CCC employed some 3 million young men from poor families to work in forests and farms: planting more than 2 billion trees, shoring up rivers from erosion, and building the infrastructure for hundreds of state parks. They lived together in a network of camps, sent money home to their families, and put on weight at a time when malnutrition was epidemic. Both the NYA and the CCC served a dual purpose: directly helping the young people involved, who found themselves in desperate straights, and meeting the country’s most pressing needs, whether for reforested lands or more hands in hospitals. (...)
According to a survey conducted by National Center for Health Statistics and the Census Bureau last month, 53 percent of people aged 18-29 reported symptoms of anxiety and/or depression. Fifty-three percent. That’s more than 13 percentage points higher than the rest of the population, which itself was off the charts compared with this time last year.
And that still may be a dramatic undercount. Mental Health America, part of the National Health Council, released a report in June based on surveys of nearly 5 million Americans. It found that “younger populations including teens and young adults (25<) are being hit particularly hard” by the pandemic, with 90 percent “experiencing symptoms of depression.”
Some of that suffering is finding expression in another invisible crisis of the Covid era: a dramatic increase in drug overdoses, with some parts of the country reporting increases over last year of 50 percent. It should all be a reminder that when we talk about being in the midst of a cataclysm on par with the Great Depression, it isn’t only GDP and employment rates that are depressed. Huge numbers of people are depressed as well, particularly young people.
This is, of course, a global crisis. U.N. Secretary-General António Guterres recently warned that the world faces “a generational catastrophe that could waste untold human potential, undermine decades of progress, and exacerbate entrenched inequalities.” In a video message, he said, “We are at a defining moment for the world’s children and young people. The decisions that governments and partners take now will have lasting impact on hundreds of millions of young people, and on the development prospects of countries for decades to come.”
As in the 1930s, this generation is already being referred to as a “lost generation” — but compared to the Great Depression, almost nothing is being done to find them, certainly not at the governmental level in the U.S. There are no ambitious and creative programs being designed to offer steady income beyond expanded summer job programs, and nothing designed to arm them with useful skills for the Covid and climate change era. All Washington has offered is a temporary break on student loan repayments, set to expire this fall.
Young people are discussed, of course. But it is almost exclusively to shame them for Covid partying. Or to debate (usually in their absence) the question of whether or not they will be permitted to learn in-person in classrooms, or whether they will have to stay home, glued to screens. Yet what the Depression era teaches us is that these are not the only possible futures we should be considering for people in their late teens and 20s, especially as we come to grips with the reality that Covid-19 is going to be reshaping our world for a long time to come. Young people can do more than go to school or stay home; they can also contribute enormously to the healing of their communities.
Not to worry, you are told: A crew will be by shortly to set up a sturdy, well-ventilated, portable, tiny house in your yard. Once installed, your family member will be free to convalesce in comfort. You can deliver home-cooked meals to their door and communicate through open windows — and a trained nurse will be by for regular examinations. And no, there will be no charge for the house.
This is not a dispatch from some future functional United States, one with a government capable of caring for its people in the midst of spiraling economic carnage and a public health emergency. It’s a dispatch from this country’s past, a time eight decades ago when it similarly found itself in the two-fisted grip of an even deeper economic crisis (the Great Depression), and a surging contagious respiratory illness (tuberculosis).
Yet the contrast between how U.S. state and federal government met those challenges in the 1930s, and how they are failing so murderously to meet them now, could not be starker. Those tiny houses are just one example, but they are a revelatory one for the sheer number of problems those humble structures attempted to solve at once.
Known as “isolation huts,” the little clapboard houses were distributed to poor families in several states. Small enough to fit on the back of a trailer, they had just enough space for a bed, chair, dresser, and stove, and were outfitted with large screened-in windows and shutters to maximize the flow of fresh air and sunshine — considered essential for TB recovery.As physical structures, the TB huts were an elegant answer to the public health challenges posed by crowded homes on the one hand and expensive private sanatoriums on the other. If houses were unable to accommodate safe patient quarantines, then the state, with Washington’s help, would just bring an addition to those houses for the duration of the illness.
It’s worth letting that sink in, given the learned helplessness that pervades the U.S. today. For months, the White House hasn’t been able to figure out how to roll out free Covid-19 tests at anything like the scale required, let alone contact tracing, never mind quarantine support for poor families. Yet in the 1930s, during a much more desperate economic time for the country, state and federal agencies cooperated to deliver not just free tests but free houses.
And that is only the beginning of what makes it worth dwelling on the TB huts . The cabins themselves were built by very young men in their late teens and early 20s who were out of work and had signed up for the National Youth Administration. “The State Board of Health furnishes the materials for these cottages and NYA supplies the labor,” explained Betty and Ernest Lindley, authors of a 1938 history of the program. “The total average cost of one hut is $146.28,” or about $2,700 in today’s dollars.
The TB cabins were just one of thousands upon thousands of projects taken on by the 4.5 million young people who joined the NYA: a vast program started in 1935 that paired young people in economic need, who could not find jobs in the private sector, with publicly minded work that needed doing. They gained marketable skills, while earning money that allowed many to stay, or return to, high school or college. Other NYA projects including building some of the country’s most iconic urban parks, repairing thousands of dilapidated schools and outfitting them with playgrounds; and stocking classrooms with desks, lab tables, and maps the young workers had made and painted themselves. NYA workers built huge outdoor pools and artificial lakes, trained to be teaching and nursing aides, and even built entire youth centers and small schools from scratch, often while living together in “resident centers.”
The NYA served as a kind of urban complement to FDR’s better-known youth program, the Civilian Conservation Corps, launched two years earlier. The CCC employed some 3 million young men from poor families to work in forests and farms: planting more than 2 billion trees, shoring up rivers from erosion, and building the infrastructure for hundreds of state parks. They lived together in a network of camps, sent money home to their families, and put on weight at a time when malnutrition was epidemic. Both the NYA and the CCC served a dual purpose: directly helping the young people involved, who found themselves in desperate straights, and meeting the country’s most pressing needs, whether for reforested lands or more hands in hospitals. (...)
According to a survey conducted by National Center for Health Statistics and the Census Bureau last month, 53 percent of people aged 18-29 reported symptoms of anxiety and/or depression. Fifty-three percent. That’s more than 13 percentage points higher than the rest of the population, which itself was off the charts compared with this time last year.
And that still may be a dramatic undercount. Mental Health America, part of the National Health Council, released a report in June based on surveys of nearly 5 million Americans. It found that “younger populations including teens and young adults (25<) are being hit particularly hard” by the pandemic, with 90 percent “experiencing symptoms of depression.”
Some of that suffering is finding expression in another invisible crisis of the Covid era: a dramatic increase in drug overdoses, with some parts of the country reporting increases over last year of 50 percent. It should all be a reminder that when we talk about being in the midst of a cataclysm on par with the Great Depression, it isn’t only GDP and employment rates that are depressed. Huge numbers of people are depressed as well, particularly young people.
This is, of course, a global crisis. U.N. Secretary-General António Guterres recently warned that the world faces “a generational catastrophe that could waste untold human potential, undermine decades of progress, and exacerbate entrenched inequalities.” In a video message, he said, “We are at a defining moment for the world’s children and young people. The decisions that governments and partners take now will have lasting impact on hundreds of millions of young people, and on the development prospects of countries for decades to come.”
As in the 1930s, this generation is already being referred to as a “lost generation” — but compared to the Great Depression, almost nothing is being done to find them, certainly not at the governmental level in the U.S. There are no ambitious and creative programs being designed to offer steady income beyond expanded summer job programs, and nothing designed to arm them with useful skills for the Covid and climate change era. All Washington has offered is a temporary break on student loan repayments, set to expire this fall.
Young people are discussed, of course. But it is almost exclusively to shame them for Covid partying. Or to debate (usually in their absence) the question of whether or not they will be permitted to learn in-person in classrooms, or whether they will have to stay home, glued to screens. Yet what the Depression era teaches us is that these are not the only possible futures we should be considering for people in their late teens and 20s, especially as we come to grips with the reality that Covid-19 is going to be reshaping our world for a long time to come. Young people can do more than go to school or stay home; they can also contribute enormously to the healing of their communities.
by Naomi Klein, The Intercept | Read more:
Image: Robert Nickelsberg/Getty Images
'Kitchen Sink Time': Speed Vs. Accuracy
Unfortunately, the latest data now shows that testing is falling across much of the U.S. According to Johns Hopkins University, the average number of COVID-19 tests conducted per 1,000 people declined in the past week in 30 states — more than half the country. Nationally, the average number of daily tests dropped by 8.75 percent during the same period, from 822,470 on July 29 to 750,517 on Aug. 4. (...)
The good news is that there might be a simple solution: new tests that prioritize speed over sensitivity.
Storms aside, the main reason U.S. testing is going down instead of up is because the type of testing we’re doing — PCR (polymerase chain reaction) — seems to have reached its limit. PCR tests are the gold standard for diagnosing COVID-19, and rightly so: They correctly identify more than 98 percent of positive cases.
But they’re also slow, and getting slower. As the virus spreads, more and more potentially exposed Americans are demanding tests, forcing overwhelmed U.S. labs to compete with other countries for the supplies required to process so many samples. Often, labs run out. As a result, crippling backlogs have been delaying test results for so long they’ve essentially become worthless. (...)
Americans seem to be getting the message. “Long wait times and long turnaround times means people are just giving up,” Dr. Ashish Jha, director of the Harvard Global Health Institute, tweeted Tuesday.
The collapse of U.S. testing has, in short, exposed its fatal flaw. Costly and cumbersome PCR tests are fine when an outbreak is relatively modest; in that situation, you can afford to invest in a slower, labor-intensive test that won’t miss any positive cases because you want to stop the virus from spreading before it’s too late.
But when it’s already too late — when more than 4.8 million infections have been reported and nearly 160,000 people have died — the PCR infrastructure can’t keep up.
That’s why experts such as Dr. Michael Mina, an assistant professor of epidemiology at both Harvard Medical School and the Harvard T.H. Chan School of Public Health, are suggesting we scrap it and start over.
“We need to change the whole script of what it means to test people,” Mina recently explained.
Imagine a $1, at-home, paper-based test that’s as easy to distribute and use as a pregnancy test. Imagine waking up in the morning, adding saliva or mucus to a tube of chemicals, waiting 15 minutes, dipping a paper strip in the tube and reading your results — instantly.
Now imagine every single person in America doing this every couple of days.
So-called rapid antigen tests aren’t science fiction. In fact, they already exist. Two such tests, made by BD and Quidel, have received emergency authorization from the Food and Drug Administration, though both still require instruments to run. (The governors of six states announced this week a joint bid to purchase a total of 3.5 million of these antigen tests.) Another $1 antigen test has been put to use in Senegal. And U.S. companies such as E25Bio and Sherlock Biosciences have developed at-home tests as cheap and easy as the one described above.
These are not the same thing as the antibody tests you might have heard of, which detect virus-fighting substances in the blood of people who were infected previously (and may therefore have immunity). Rapid antigen tests are meant to detect ongoing, active infections.
So why isn’t the U.S. government mass-producing antigen tests and distributing them freely to everyone? The major hurdle, so far, has been what news stories tend to describe as “accuracy.” But “sensitivity” is a better way to think about it.
Storms aside, the main reason U.S. testing is going down instead of up is because the type of testing we’re doing — PCR (polymerase chain reaction) — seems to have reached its limit. PCR tests are the gold standard for diagnosing COVID-19, and rightly so: They correctly identify more than 98 percent of positive cases.
But they’re also slow, and getting slower. As the virus spreads, more and more potentially exposed Americans are demanding tests, forcing overwhelmed U.S. labs to compete with other countries for the supplies required to process so many samples. Often, labs run out. As a result, crippling backlogs have been delaying test results for so long they’ve essentially become worthless. (...)Americans seem to be getting the message. “Long wait times and long turnaround times means people are just giving up,” Dr. Ashish Jha, director of the Harvard Global Health Institute, tweeted Tuesday.
The collapse of U.S. testing has, in short, exposed its fatal flaw. Costly and cumbersome PCR tests are fine when an outbreak is relatively modest; in that situation, you can afford to invest in a slower, labor-intensive test that won’t miss any positive cases because you want to stop the virus from spreading before it’s too late.
But when it’s already too late — when more than 4.8 million infections have been reported and nearly 160,000 people have died — the PCR infrastructure can’t keep up.
That’s why experts such as Dr. Michael Mina, an assistant professor of epidemiology at both Harvard Medical School and the Harvard T.H. Chan School of Public Health, are suggesting we scrap it and start over.
“We need to change the whole script of what it means to test people,” Mina recently explained.
Imagine a $1, at-home, paper-based test that’s as easy to distribute and use as a pregnancy test. Imagine waking up in the morning, adding saliva or mucus to a tube of chemicals, waiting 15 minutes, dipping a paper strip in the tube and reading your results — instantly.
Now imagine every single person in America doing this every couple of days.
So-called rapid antigen tests aren’t science fiction. In fact, they already exist. Two such tests, made by BD and Quidel, have received emergency authorization from the Food and Drug Administration, though both still require instruments to run. (The governors of six states announced this week a joint bid to purchase a total of 3.5 million of these antigen tests.) Another $1 antigen test has been put to use in Senegal. And U.S. companies such as E25Bio and Sherlock Biosciences have developed at-home tests as cheap and easy as the one described above.
These are not the same thing as the antibody tests you might have heard of, which detect virus-fighting substances in the blood of people who were infected previously (and may therefore have immunity). Rapid antigen tests are meant to detect ongoing, active infections.
So why isn’t the U.S. government mass-producing antigen tests and distributing them freely to everyone? The major hurdle, so far, has been what news stories tend to describe as “accuracy.” But “sensitivity” is a better way to think about it.
by Andrew Romano, Yahoo News | Read more:
Image: uncredited
[ed. See also: Fast, Less-Accurate Coronavirus Tests May Be Good Enough (NYT).]
Tuesday, August 4, 2020
Coronavirus Vaccine Will Not Change World Right Away
In the public imagination, the arrival of a coronavirus vaccine looms large: It’s the neat Hollywood ending to the grim and agonizing uncertainty of everyday life in a pandemic.
But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal and could lead to resistance to simple strategies that can tamp down transmission and save lives in the short term.
Two coronavirus vaccines entered the final stages of human testing last week, a scientific speed record that prompted top government health officials to utter words such as “historic” and “astounding.” Pharmaceutical executives predicted to Congress in July that vaccines might be available as soon as October, or before the end of the year.
As the plotline advances, so do expectations: If people can just muddle through a few more months, the vaccine will land, the pandemic will end and everyone can throw their masks away. But best-case scenarios have not materialized throughout the pandemic, and experts – who believe wholeheartedly in the power of vaccines – foresee a long path ahead.
“It seems, to me, unlikely that a vaccine is an off-switch or a reset button where we will go back to pre-pandemic times,” said Yonatan Grad, an assistant professor of infectious diseases and immunology at the Harvard University T.H. Chan School of Public Health.
Or, as Columbia University virologist Angela Rasmussen puts it, “It’s not like we’re going to land in Oz.”
The declaration that a vaccine has been shown safe and effective will be a beginning, not the end. Deploying the vaccine to people in the United States and around the world will test and strain distribution networks, the supply chain, public trust and global cooperation. It will take months or, more likely, years to reach enough people to make the world safe.
For those who do get a vaccine as soon as shots become available, protection won’t be immediate – it takes weeks for the immune system to call up full platoons of disease-fighting antibodies. And many vaccine technologies will require a second shot weeks after the first to raise immune defenses.
Immunity could be short-lived or partial, requiring repeated boosters that strain the vaccine supply or require people to keep social distancing and wearing masks even after they’ve received their shots. And if a vaccine works less well for some groups of people, if swaths of the population are reluctant to get a vaccine or if there isn’t enough to go around, some people will still get sick even after scientists declare victory on a vaccine – which could help foster a false impression that it does not work.
A proven vaccine will profoundly change the relationship the world has with the novel coronavirus and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth – especially with the earliest vaccines – probably will be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.
The drive to develop vaccines is frequently characterized as a race, with one country or company in the lead. The race metaphor suggests that what matters is who reaches the finish line first. But first across the line is not necessarily the best – and it almost certainly isn’t the end of the race, which could go on for years.
“The realistic scenario is probably going to be more like what we saw with HIV/AIDS,” said Michael Kinch, an expert in drug development and research at Washington University in St. Louis. “With HIV, we had a first generation of, looking back now, fairly mediocre drugs. I am afraid – and people don’t like to hear this, but I’m kind of constantly preaching it – we have to prepare ourselves for the idea we do not have a very good vaccine. My guess is the first generation of vaccines may be mediocre.” (...)
All approved vaccines must be shown to be safe and effective, but that does not mean they perform the same. The measles vaccine is one of the best – 98% effective at preventing disease. But the flu vaccine clocks in most years at 40% to 60% effective. And some vaccines work less well in groups of people – older people, for example, have less robust immune responses and need a special high-dose flu vaccine, or one with an extra ingredient called an adjuvant.
U.S. regulators will require a coronavirus vaccine to be 50% effective, and if a shot just barely clears that bar, public education will be required to help communicate how many people need to receive it to establish herd immunity – a threshold at which enough of the population is immune to stop the spread, when the virus is truly tamed.
“If you get a vaccine that just meets the guidelines, the chances are you’re not going to be able to achieve herd immunity,” said Walter Orenstein, associate director of the Emory Vaccine Center. “You tamp down transmission, substantially. It decreases your risk of getting exposed, but it doesn’t eliminate it. But a 50% effective vaccine is a lot better than 0% effective vaccine. I would take it.”
But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal and could lead to resistance to simple strategies that can tamp down transmission and save lives in the short term.
Two coronavirus vaccines entered the final stages of human testing last week, a scientific speed record that prompted top government health officials to utter words such as “historic” and “astounding.” Pharmaceutical executives predicted to Congress in July that vaccines might be available as soon as October, or before the end of the year.
As the plotline advances, so do expectations: If people can just muddle through a few more months, the vaccine will land, the pandemic will end and everyone can throw their masks away. But best-case scenarios have not materialized throughout the pandemic, and experts – who believe wholeheartedly in the power of vaccines – foresee a long path ahead.“It seems, to me, unlikely that a vaccine is an off-switch or a reset button where we will go back to pre-pandemic times,” said Yonatan Grad, an assistant professor of infectious diseases and immunology at the Harvard University T.H. Chan School of Public Health.
Or, as Columbia University virologist Angela Rasmussen puts it, “It’s not like we’re going to land in Oz.”
The declaration that a vaccine has been shown safe and effective will be a beginning, not the end. Deploying the vaccine to people in the United States and around the world will test and strain distribution networks, the supply chain, public trust and global cooperation. It will take months or, more likely, years to reach enough people to make the world safe.
For those who do get a vaccine as soon as shots become available, protection won’t be immediate – it takes weeks for the immune system to call up full platoons of disease-fighting antibodies. And many vaccine technologies will require a second shot weeks after the first to raise immune defenses.
Immunity could be short-lived or partial, requiring repeated boosters that strain the vaccine supply or require people to keep social distancing and wearing masks even after they’ve received their shots. And if a vaccine works less well for some groups of people, if swaths of the population are reluctant to get a vaccine or if there isn’t enough to go around, some people will still get sick even after scientists declare victory on a vaccine – which could help foster a false impression that it does not work.
A proven vaccine will profoundly change the relationship the world has with the novel coronavirus and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth – especially with the earliest vaccines – probably will be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.
The drive to develop vaccines is frequently characterized as a race, with one country or company in the lead. The race metaphor suggests that what matters is who reaches the finish line first. But first across the line is not necessarily the best – and it almost certainly isn’t the end of the race, which could go on for years.
“The realistic scenario is probably going to be more like what we saw with HIV/AIDS,” said Michael Kinch, an expert in drug development and research at Washington University in St. Louis. “With HIV, we had a first generation of, looking back now, fairly mediocre drugs. I am afraid – and people don’t like to hear this, but I’m kind of constantly preaching it – we have to prepare ourselves for the idea we do not have a very good vaccine. My guess is the first generation of vaccines may be mediocre.” (...)
All approved vaccines must be shown to be safe and effective, but that does not mean they perform the same. The measles vaccine is one of the best – 98% effective at preventing disease. But the flu vaccine clocks in most years at 40% to 60% effective. And some vaccines work less well in groups of people – older people, for example, have less robust immune responses and need a special high-dose flu vaccine, or one with an extra ingredient called an adjuvant.
U.S. regulators will require a coronavirus vaccine to be 50% effective, and if a shot just barely clears that bar, public education will be required to help communicate how many people need to receive it to establish herd immunity – a threshold at which enough of the population is immune to stop the spread, when the virus is truly tamed.
“If you get a vaccine that just meets the guidelines, the chances are you’re not going to be able to achieve herd immunity,” said Walter Orenstein, associate director of the Emory Vaccine Center. “You tamp down transmission, substantially. It decreases your risk of getting exposed, but it doesn’t eliminate it. But a 50% effective vaccine is a lot better than 0% effective vaccine. I would take it.”
by Carolyn Y. Johnson, Seattle Times (via Washington Post) | Read more:
Image: REUTERS/Dado Ruvic/Illustration
Permanent Funding for Land and Water Conservation Fund
A landmark bill committing $900 million a year for land conservation and a one-time $9.5 billion boost to help catch up over the next five years on maintenance needs at national parks was signed into law by President Donald Trump Monday.
The Great American Outdoors Act, S. 3422, will increase by two or three times the historic average amount of money spent by Congress for the Land and Water Conservation Fund. The program, used to fund acquisitions from willing sellers for federal, state and local open space and outdoor recreation, is paid for from royalties earned on oil and natural gas leases on public lands.
Washington state will receive hundreds of millions of dollars over the next decade under the program, for everything from repairs at National Parks and tribal schools to acquiring open space for outdoor recreation.
The program has deep roots in Washington: the Land and Water Conservation Fund was created by Sen. Henry M. “Scoop” Jackson, of Washington, in 1965. Sen. Maria Cantwell, D-Wash., worked with lawmakers in both chambers and both sides of the aisle to broker the combination of legislation in the works that added up to the Great American Outdoors Act.
In addition to funding about half the national park maintenance backlog, the legislation’s signal breakthrough is establishing permanent funding for the conservation fund at $900 million a year, ending chronic underfunding for the program.
by Lynda V. Mapes, Seattle Times | Read more:
Image: Bettina Hansen / The Seattle Times
The Great American Outdoors Act, S. 3422, will increase by two or three times the historic average amount of money spent by Congress for the Land and Water Conservation Fund. The program, used to fund acquisitions from willing sellers for federal, state and local open space and outdoor recreation, is paid for from royalties earned on oil and natural gas leases on public lands.
Washington state will receive hundreds of millions of dollars over the next decade under the program, for everything from repairs at National Parks and tribal schools to acquiring open space for outdoor recreation.The program has deep roots in Washington: the Land and Water Conservation Fund was created by Sen. Henry M. “Scoop” Jackson, of Washington, in 1965. Sen. Maria Cantwell, D-Wash., worked with lawmakers in both chambers and both sides of the aisle to broker the combination of legislation in the works that added up to the Great American Outdoors Act.
In addition to funding about half the national park maintenance backlog, the legislation’s signal breakthrough is establishing permanent funding for the conservation fund at $900 million a year, ending chronic underfunding for the program.
Image: Bettina Hansen / The Seattle Times
[ed. WTF? This is awesome. I'm sure Trump gives a f*ck about the LWCF, or even knows what it is. But someone (probably soon to be fired) slipped this legislation through. Or maybe it's just desperation, a last ditch effort to buy votes with sportsmen/women ahead of the election. No matter. This is great news. See also: Land and Water Conservation Fund fully funded after decades of uncertainty; and, The history of the Land and Water Conservation Fund, a critical tool supporting parks and outdoor recreation (Wilderness Society)]
Using Telemedicine to Treat Opioid Addiction
Covid-19 has made life much harder for people with opioid addiction. But the response to the virus has also revealed a way forward that could radically expand effective treatment and reduce overdose deaths.
Until now, getting effective treatment depended on where you lived. Forty percent of American counties — much of Appalachia, for example — have no providers licensed to prescribe buprenorphine, the most successful treatment so far.
But the pandemic has made it possible to see a licensed provider from home, and that could make buprenorphine treatment available anywhere.
Michelle (she asked me to not use her family name) is 57, lives near Wilkes-Barre, Pa., and works from home as a customer service representative. Her computer allows her to live a good life — after eight years on heroin that followed many years on other drugs.
Over the internet, she sees a psychiatric nurse practitioner, Roseanna Melle, who offers light counseling and prescribes the widely used drug Suboxone — a combination of buprenorphine and the overdose reversal drug naloxone. It blocks her cravings and prevents withdrawal symptoms, but doesn’t get her high. She feels … normal.
Before starting telemedicine in April, Michelle got Suboxone at a local addiction medicine clinic. “It was a revolving door — sometimes standing room only,” she said. “Who wouldn’t want to just do your appointment in the comfort and privacy of your own home?”
Robert, 30, another of Ms. Melle’s patients, from nearby Scranton, said: “Home treatment lessens the shame for me. I don’t have to worry what doctors around here think. My Suboxone — it’s just a medication. I don’t think about it. I just take it and go about my day.”
Ms. Melle is one of two — soon to be four — providers at a new telemedicine company in Pennsylvania called Ophelia. It’s one of several companies started in the last few years that prescribe Suboxone: Bicycle Health, Bright Heart Health, Workit Health, PursueCare, Boulder Care. Each is slightly different and they operate in different states.
The science is unequivocal: The only effective treatment for opioid use disorder is what is called “medication-assisted treatment.” Medication makes patients far more successful in treatment and less likely to overdose.
But at least 80 percent of people who could benefit from it don’t receive it. Some are deterred by the stigma still attached to taking Suboxone. But likely more important is the shortage of local providers. In 2016, the Obama administration increased the number of providers and allowed them to treat more patients. It’s still far from enough.
So people buy Suboxone from their drug dealer. “I bought it on the black market — a lot of people do,” Michelle said. “They sometimes try it because they can’t get their drug of choice. Or they’re thinking about getting clean, and they don’t have insurance and don’t want to go through the red tape.”
Ophelia’s medical director, Arthur Robin Williams, an addiction psychiatrist and assistant professor at Columbia University said, “It is easier for people to get the dangerous drugs than to get the treatment for addiction.”
Some clinics have been using telemedicine for the last few years, but patients still faced many barriers to treatment. The first visit had to be in person — which meant that access to treatment still depended on where you lived. Doctors were paid a pittance for telehealth appointments, so few doctors offered them. A patient could get only a week’s supply of buprenorphine at a time.
Advocates for treatment have campaigned to remove these barriers — unsuccessfully until Covid-19.
The pandemic has led to regulatory changes: Treatment can now be entirely virtual, including the first appointment. Medicare now pays providers the same for a video appointment as a conventional one — many insurers and Medicaid programs have followed. Patients can get a month’s prescription for buprenorphine instead of just a week’s.
These changes are temporary, but everyone I talked to wanted them made permanent.
“This has just catapulted through this crisis,” said Allegra Schorr, a Manhattan doctor and the president of Compa, a New York State coalition of medication-assisted treatment providers and advocates. “Now everybody’s doing it,” she said. “Within this environment, it certainly seems to be working.”
Prevention Point Philadelphia is among the largest harm reduction centers in the country. It offers syringe exchange, medical care, social services — and now, food. The majority of its patients are without homes, and most suffer from multiple mental and physical illnesses.
Prevention Point has offered medication-assisted treatment for 12 years and now treats 268 patients — many out of a mobile van. “We try to wipe out any barriers,” said Silvana Mazzella, associate executive director.
In mid-March, Prevention Point started prescribing Suboxone through telemedicine. But many of its patients can’t do the “tele” part. They don’t have phones or have no-data phones and can’t afford the airtime for an appointment. Prevention Point has given patients some donated phones with data and minutes of usage included, and is seeking more.
Ms. Mazzella said telemedicine has helped the patients who can use it. “It’s a reduction of the hassle, wait times, anxiety and fear of withdrawal in a waiting room,” she said. But the switch has also changed the foundations of treatment,” she added. “We have moved to more of a harm reduction model. We have taken away drug screens and things that feel punitive, things patients must do to prove they’re a good patient. We’ve removed the stigma and the power dynamic that typically exists in a clinic. We are putting the same level of trust in patients as you would with diabetes or hypertension.”
She said telemedicine patients have proven more likely to fill their prescriptions than patients who had appeared in person in the past.
by Tina Rosenberg, NY Times | Read more:
Image: Sabina Louise Pierce for The New York Times
Until now, getting effective treatment depended on where you lived. Forty percent of American counties — much of Appalachia, for example — have no providers licensed to prescribe buprenorphine, the most successful treatment so far.
But the pandemic has made it possible to see a licensed provider from home, and that could make buprenorphine treatment available anywhere.
Michelle (she asked me to not use her family name) is 57, lives near Wilkes-Barre, Pa., and works from home as a customer service representative. Her computer allows her to live a good life — after eight years on heroin that followed many years on other drugs.Over the internet, she sees a psychiatric nurse practitioner, Roseanna Melle, who offers light counseling and prescribes the widely used drug Suboxone — a combination of buprenorphine and the overdose reversal drug naloxone. It blocks her cravings and prevents withdrawal symptoms, but doesn’t get her high. She feels … normal.
Before starting telemedicine in April, Michelle got Suboxone at a local addiction medicine clinic. “It was a revolving door — sometimes standing room only,” she said. “Who wouldn’t want to just do your appointment in the comfort and privacy of your own home?”
Robert, 30, another of Ms. Melle’s patients, from nearby Scranton, said: “Home treatment lessens the shame for me. I don’t have to worry what doctors around here think. My Suboxone — it’s just a medication. I don’t think about it. I just take it and go about my day.”
Ms. Melle is one of two — soon to be four — providers at a new telemedicine company in Pennsylvania called Ophelia. It’s one of several companies started in the last few years that prescribe Suboxone: Bicycle Health, Bright Heart Health, Workit Health, PursueCare, Boulder Care. Each is slightly different and they operate in different states.
The science is unequivocal: The only effective treatment for opioid use disorder is what is called “medication-assisted treatment.” Medication makes patients far more successful in treatment and less likely to overdose.
But at least 80 percent of people who could benefit from it don’t receive it. Some are deterred by the stigma still attached to taking Suboxone. But likely more important is the shortage of local providers. In 2016, the Obama administration increased the number of providers and allowed them to treat more patients. It’s still far from enough.
So people buy Suboxone from their drug dealer. “I bought it on the black market — a lot of people do,” Michelle said. “They sometimes try it because they can’t get their drug of choice. Or they’re thinking about getting clean, and they don’t have insurance and don’t want to go through the red tape.”
Ophelia’s medical director, Arthur Robin Williams, an addiction psychiatrist and assistant professor at Columbia University said, “It is easier for people to get the dangerous drugs than to get the treatment for addiction.”
Some clinics have been using telemedicine for the last few years, but patients still faced many barriers to treatment. The first visit had to be in person — which meant that access to treatment still depended on where you lived. Doctors were paid a pittance for telehealth appointments, so few doctors offered them. A patient could get only a week’s supply of buprenorphine at a time.
Advocates for treatment have campaigned to remove these barriers — unsuccessfully until Covid-19.
The pandemic has led to regulatory changes: Treatment can now be entirely virtual, including the first appointment. Medicare now pays providers the same for a video appointment as a conventional one — many insurers and Medicaid programs have followed. Patients can get a month’s prescription for buprenorphine instead of just a week’s.
These changes are temporary, but everyone I talked to wanted them made permanent.
“This has just catapulted through this crisis,” said Allegra Schorr, a Manhattan doctor and the president of Compa, a New York State coalition of medication-assisted treatment providers and advocates. “Now everybody’s doing it,” she said. “Within this environment, it certainly seems to be working.”
Prevention Point Philadelphia is among the largest harm reduction centers in the country. It offers syringe exchange, medical care, social services — and now, food. The majority of its patients are without homes, and most suffer from multiple mental and physical illnesses.
Prevention Point has offered medication-assisted treatment for 12 years and now treats 268 patients — many out of a mobile van. “We try to wipe out any barriers,” said Silvana Mazzella, associate executive director.
In mid-March, Prevention Point started prescribing Suboxone through telemedicine. But many of its patients can’t do the “tele” part. They don’t have phones or have no-data phones and can’t afford the airtime for an appointment. Prevention Point has given patients some donated phones with data and minutes of usage included, and is seeking more.
Ms. Mazzella said telemedicine has helped the patients who can use it. “It’s a reduction of the hassle, wait times, anxiety and fear of withdrawal in a waiting room,” she said. But the switch has also changed the foundations of treatment,” she added. “We have moved to more of a harm reduction model. We have taken away drug screens and things that feel punitive, things patients must do to prove they’re a good patient. We’ve removed the stigma and the power dynamic that typically exists in a clinic. We are putting the same level of trust in patients as you would with diabetes or hypertension.”
She said telemedicine patients have proven more likely to fill their prescriptions than patients who had appeared in person in the past.
by Tina Rosenberg, NY Times | Read more:
Image: Sabina Louise Pierce for The New York Times
Monday, August 3, 2020
Ghosting The News
Earlier this month, the McClatchy Company, publisher of 30 daily newspapers, including the Miami Herald, The Kansas City Star and the Charlotte Observer, was sold in a bankruptcy auction to the Chatham Management Group, a New Jersey hedge fund. Hedge fund ownership of other papers has led to sharp budget cuts and reduced local coverage. Due to competition from the Internet and other pressures, more than 2,000 American newspapers have gone out of business since 2004. Financial stresses from the coronavirus pandemic have only made things worse.
Our guest, veteran journalist Margaret Sullivan, believes the decline of local news coverage is a crisis every bit as serious as the spread of disinformation on the Internet. In a new book, Sullivan argues that when local news fails, citizens lack critical information to make good decisions, and democracy is weakened. (...)
DAVIES: The decline of traditional media organizations, especially daily newspapers, is not a new story. Why did you want to sound the alarm about it now?
SULLIVAN: Well, it's - it is an alarming situation but one that, most members of the public don't seem to be very tuned into. In fact there's research that's been done that shows that, you know, some 70% of Americans think that local news organizations are doing pretty well financially. That's not the case, especially when it comes to newspapers. And after spending most of my career at a regional newspaper in Buffalo, I know how important that is to the community and to - sort of as an underpinning of our democracy.
And I thought it would be important to show people the connection between the decline of local news and what's happening in our society at large. And it's - it means less political engagement, less voting across party lines, the possibility of more corruption at the local government level and, I think, the weakening of community ties in which we all kind of relate to each other based on a shared, you know, group of facts that we may want to do different things with - interpret in different ways. But we all can sort of agree on what's happening. So I see it as a real crisis. And I wanted to let people know what the price of it is before it's entirely too late.
DAVIES: One medium-sized newspaper that you write about is the Youngstown, Ohio, Vindicator. Just tell us briefly its story and what it meant to the community and what happened.
SULLIVAN: So last summer, there was a surprise announcement that The Vindicator in Youngstown, Ohio, which is a substantial city, was going to close its doors the next month. The announcement was in July. They would - their last day of publication would be in August. And it was a shocker to the community. The paper had been around for over 150 years, mostly family-owned during that time and still family-owned. And people just couldn't believe it.
So I actually went off to Youngstown and spent quite a bit of time chatting with people and trying to - spending time in the newsroom there and trying to understand what had happened and what the cost of it would be. It's a very disturbing story because it would leave a pretty decent-sized city without its own newspaper anymore and one that had been a real part of the community. Everybody called it The Vindy. Everybody had, you know, had a story about delivering it. Or your mom's obit had been in it. Or they covered my sports event - whatever it was. This was going to go away.
I attended a community meeting, and people were in tears about it. But a - one of the editors who I spoke with later said, well, that was very poignant, but I wonder if we had had a show of hands about who among the crying audience had actually been seven-day-a-week subscribers - I wonder what that would have been. And his theory was that not very many. Circulation had gone way, way down.
DAVIES: So what was the impact when The Vindicator went under in Youngstown?
SULLIVAN: Well, since The Vindicator closed, of course, there's a loss to the community. And there's no doubt about that. And people are feeling it. But there have been some things that have kind of come in to help to fill the gap a little bit. There is a new digital-only organization that McClatchy and Google are involved in called Mahoning Matters, with - the Mahoning Valley is the larger area around Youngstown. I think they have four reporters and a couple editors. So that's, you know, maybe six people. That's a far cry from the 44-member Vindicator newsroom but still a good thing.
A neighboring news chain has started to put out an addition in Youngstown that, again, isn't really a fully Youngstown paper, but it does something. They do still - and they took on The Vindicator name. So there is still something called the Youngstown Vindicator. It just isn't what it once was. And ProPublica, the great, you know, and much-esteemed digital-only investigative journalism organization, has put a reporter in Youngstown at one of the TV stations to you know help do some of this enterprise or investigative coverage. So, you know, I think it's a great, little laboratory. There was a big loss. And people feel it, and the community feels it. And yet there are some bright spots, too.
DAVIES: You cite an example of the impact of the decline of many small newspapers in the case of a congressman from western New York, Chris Collins, who was indicted for fraud as he was running for reelection. And this gave his opponent, seemingly, a huge advantage, a guy named Nate McMurray. What did McMurray find when he sought to raise this as a campaign issue?
SULLIVAN: Well, McMurray, who was a Democrat running in a very red district - in fact, it's New York state's most Republican district and one that spreads across eight counties - found that when he went out to some of the more rural parts of the district, where there was less local news coverage and where newspapers had gone under, that - you know, he told me that when he would start to talk to people about Chris Collins's indictment on insider trading charges, that some of them said, what are you talking about? We - you know, they did not know about it. And when he tried to inform them about it, they would, you know, sort of shout back that this was fake news.
And, in fact, Chris Collins was fundraising from the reports of his indictment that The Buffalo News, my old paper, had been writing about a lot. So in the parts of the district that had more local news and were more sort of immersed in local news coverage, a lot of people crossed the aisle to vote for the challenger, people who normally would, we can say, I think, confidently would have voted Republican. But in the parts of the district that had far less local news, one of which is termed a news desert, that didn't happen nearly as much. And McMurray said that, you know, he was really surprised. But he could understand it because he thought that people were getting a lot of their information from less dependable sources - social media, talk radio and just what he called rumors.
So there - you know, it's impossible to say exactly what would have happened if there'd been a great local newspaper in those parts of the district. But the sort of anecdotal evidence suggests that it really did have an effect.
DAVIES: Right. So McMurray, the challenger, lost the primary. The congressman ultimately resigned, right?
SULLIVAN: That's right. McMurray lost by just a whisker, one half of 1%, which was far, far less than what would normally have happened. And, you know, he would say that if there'd been great local news coverage in the further out parts of the district, including this news desert area, he believes he would have won. And then, ultimately, Chris Collins - the case went to trial. And he was sentenced to a jail term.
DAVIES: You know, another point you make is that the loss of local news coverage isn't just about watchdog reporting and investigations into local government officials, as important as that is. There was also a way in which they knitted communities together. So what's the impact when the paper closes?
SULLIVAN: Well, I mean, this is something that I feel so strongly about because part of - a big chunk of my time at the Buffalo News was as the features editor. So the people who I was dealing with every day and supervising and whose work I was lucky enough to edit were, for example, the book critic, the movie critic, the pop music critic, people who wrote feature stories about local people. And, you know, this was in a daily section called Life and Arts.
And when that section and when those jobs go away, which they have in Buffalo, I think that we lose something. We lose that connection. That has nothing to do with corrupt local officials. It has to do with how we relate to each other as members of a community. Our arts and our culture and, you know, sort of our society as a community, I think, becomes less knitted together and weakened.
SULLIVAN: Well, it's - it is an alarming situation but one that, most members of the public don't seem to be very tuned into. In fact there's research that's been done that shows that, you know, some 70% of Americans think that local news organizations are doing pretty well financially. That's not the case, especially when it comes to newspapers. And after spending most of my career at a regional newspaper in Buffalo, I know how important that is to the community and to - sort of as an underpinning of our democracy.
And I thought it would be important to show people the connection between the decline of local news and what's happening in our society at large. And it's - it means less political engagement, less voting across party lines, the possibility of more corruption at the local government level and, I think, the weakening of community ties in which we all kind of relate to each other based on a shared, you know, group of facts that we may want to do different things with - interpret in different ways. But we all can sort of agree on what's happening. So I see it as a real crisis. And I wanted to let people know what the price of it is before it's entirely too late.DAVIES: One medium-sized newspaper that you write about is the Youngstown, Ohio, Vindicator. Just tell us briefly its story and what it meant to the community and what happened.
SULLIVAN: So last summer, there was a surprise announcement that The Vindicator in Youngstown, Ohio, which is a substantial city, was going to close its doors the next month. The announcement was in July. They would - their last day of publication would be in August. And it was a shocker to the community. The paper had been around for over 150 years, mostly family-owned during that time and still family-owned. And people just couldn't believe it.
So I actually went off to Youngstown and spent quite a bit of time chatting with people and trying to - spending time in the newsroom there and trying to understand what had happened and what the cost of it would be. It's a very disturbing story because it would leave a pretty decent-sized city without its own newspaper anymore and one that had been a real part of the community. Everybody called it The Vindy. Everybody had, you know, had a story about delivering it. Or your mom's obit had been in it. Or they covered my sports event - whatever it was. This was going to go away.
I attended a community meeting, and people were in tears about it. But a - one of the editors who I spoke with later said, well, that was very poignant, but I wonder if we had had a show of hands about who among the crying audience had actually been seven-day-a-week subscribers - I wonder what that would have been. And his theory was that not very many. Circulation had gone way, way down.
DAVIES: So what was the impact when The Vindicator went under in Youngstown?
SULLIVAN: Well, since The Vindicator closed, of course, there's a loss to the community. And there's no doubt about that. And people are feeling it. But there have been some things that have kind of come in to help to fill the gap a little bit. There is a new digital-only organization that McClatchy and Google are involved in called Mahoning Matters, with - the Mahoning Valley is the larger area around Youngstown. I think they have four reporters and a couple editors. So that's, you know, maybe six people. That's a far cry from the 44-member Vindicator newsroom but still a good thing.
A neighboring news chain has started to put out an addition in Youngstown that, again, isn't really a fully Youngstown paper, but it does something. They do still - and they took on The Vindicator name. So there is still something called the Youngstown Vindicator. It just isn't what it once was. And ProPublica, the great, you know, and much-esteemed digital-only investigative journalism organization, has put a reporter in Youngstown at one of the TV stations to you know help do some of this enterprise or investigative coverage. So, you know, I think it's a great, little laboratory. There was a big loss. And people feel it, and the community feels it. And yet there are some bright spots, too.
DAVIES: You cite an example of the impact of the decline of many small newspapers in the case of a congressman from western New York, Chris Collins, who was indicted for fraud as he was running for reelection. And this gave his opponent, seemingly, a huge advantage, a guy named Nate McMurray. What did McMurray find when he sought to raise this as a campaign issue?
SULLIVAN: Well, McMurray, who was a Democrat running in a very red district - in fact, it's New York state's most Republican district and one that spreads across eight counties - found that when he went out to some of the more rural parts of the district, where there was less local news coverage and where newspapers had gone under, that - you know, he told me that when he would start to talk to people about Chris Collins's indictment on insider trading charges, that some of them said, what are you talking about? We - you know, they did not know about it. And when he tried to inform them about it, they would, you know, sort of shout back that this was fake news.
And, in fact, Chris Collins was fundraising from the reports of his indictment that The Buffalo News, my old paper, had been writing about a lot. So in the parts of the district that had more local news and were more sort of immersed in local news coverage, a lot of people crossed the aisle to vote for the challenger, people who normally would, we can say, I think, confidently would have voted Republican. But in the parts of the district that had far less local news, one of which is termed a news desert, that didn't happen nearly as much. And McMurray said that, you know, he was really surprised. But he could understand it because he thought that people were getting a lot of their information from less dependable sources - social media, talk radio and just what he called rumors.
So there - you know, it's impossible to say exactly what would have happened if there'd been a great local newspaper in those parts of the district. But the sort of anecdotal evidence suggests that it really did have an effect.
DAVIES: Right. So McMurray, the challenger, lost the primary. The congressman ultimately resigned, right?
SULLIVAN: That's right. McMurray lost by just a whisker, one half of 1%, which was far, far less than what would normally have happened. And, you know, he would say that if there'd been great local news coverage in the further out parts of the district, including this news desert area, he believes he would have won. And then, ultimately, Chris Collins - the case went to trial. And he was sentenced to a jail term.
DAVIES: You know, another point you make is that the loss of local news coverage isn't just about watchdog reporting and investigations into local government officials, as important as that is. There was also a way in which they knitted communities together. So what's the impact when the paper closes?
SULLIVAN: Well, I mean, this is something that I feel so strongly about because part of - a big chunk of my time at the Buffalo News was as the features editor. So the people who I was dealing with every day and supervising and whose work I was lucky enough to edit were, for example, the book critic, the movie critic, the pop music critic, people who wrote feature stories about local people. And, you know, this was in a daily section called Life and Arts.
And when that section and when those jobs go away, which they have in Buffalo, I think that we lose something. We lose that connection. That has nothing to do with corrupt local officials. It has to do with how we relate to each other as members of a community. Our arts and our culture and, you know, sort of our society as a community, I think, becomes less knitted together and weakened.
by Dave Davies, NPR | Read more:
Image: Mark Lennihan / Associated Press
Sunday, August 2, 2020
‘This Push to Open Schools Is Guaranteed to Fail’
In March, we were all living in 15-day increments. Working from home and distance learning, for those who had the terrible luxury of such things, would be a weeks-long affair, surreal but temporary. Fifteen days to flatten the curve. Fifteen days to slow the spread.
Scientists warned us even then that a return to normalcy would take longer, but the telescoped timeline had obvious appeal. You can put up with almost anything for just 15 days.
Acting on the chance to get it right was essential, but we now know it was not temporary. We’ve seen the failures—in testing, in containment, in federal and state leadership—compound in catastrophic ways. And as our pandemic summer has stretched on, many of us have let go, one by one, of experiences from the world we used to inhabit. We bid goodbye to sleepaway camp, to live music, to distant travel, to boisterous weddings, and to spontaneity in general. Today, a new realization is dawning, and as the debate over schools reopening rages, we must acknowledge it plainly: We aren’t going back to how it was. And we shouldn’t.
“This push to open schools is guaranteed to fail,” says Peter Hotez, a pediatrician and molecular virologist, and the dean for the National School of Tropical Medicine at Baylor College of Medicine. I’ve been corresponding with Hotez, and with several epidemiologists, over the course of the pandemic, and have noticed a starkness in their views in recent weeks. “The social-distancing expectations and mask requirements for the lower grades are unrealistic,” Hotez told me. “In communities with high transmission, it’s inevitable that COVID-19 will enter the schools. Within two weeks of opening schools in communities with high virus transmission, teachers will become ill. All it will take is for a single teacher to become hospitalized with COVID and everything will shut down.”
Hotez has good reason to be pessimistic. There were 68,605 new cases in the United States yesterday, according to data from the Centers for Disease Control and Prevention. The seven-day average has stayed above 60,000 new cases per day since July 13. Reaching 100,000 cases per day, once seen as an apocalyptic, worst-case-scenario warning from Anthony Fauci, is no longer difficult to imagine. Indeed, my conversations with epidemiologists in recent days were all strikingly dark. They agreed: Schools should not risk reopening, probably not even for the youngest children, in the coming weeks. “We can’t pretend like everything’s fine,” said Gary Simon, the director of the infectious diseases division at George Washington University. “If I had a school-age kid, I wouldn’t want to send him to school.”
The evidence is all around us. There is the summer camp in Georgia where hundreds of kids and counselors—nearly half the camp—got infected after only a few days together. Then there’s the school in Indiana where, just hours after reopening last week, a student tested positive for the coronavirus. (“We knew it was a when, not if,” the superintendent told The New York Times, but officials were “very shocked it was on Day 1.”)
There’s also the JAMA Pediatrics study that suggests that babies and young children can carry extremely high viral loads of SARS-CoV-2. The study’s authors found at least as much viral material in the throats and airways of young children as in infected adults, and sometimes 100 times as much as in adults. We’ve long known that kids older than age 10 can efficiently transmit the virus, but this new research suggests that younger kids pose a risk of transmission to the people around them, just as older children do. The more we learn, the more likely it seems that children are highly effective vectors for transmission. Springtime school closures took place before the virus seized the nation. A return to the classroom now—even with thoughtful precautions—would create excellent conditions to test just how quickly COVID-19 can saturate a community. School was deemed unsafe for children, teachers, and staffers back in March. The pandemic is worse in the United States now than it was then, with multiple epicenters burning across the country. So why would schools reopen now?
“The problem is the White House and the task force could never organize themselves to lead a federal response and bring virus transmission down to containment levels,” said Hotez, who has argued for the necessity of a federal containment plan that, if executed effectively, might allow the nation to reopen comprehensively as soon as October. “Instead they took a lazy and careless route, claiming schools are important, as we all know, and the teachers and principals need to figure it out. What they did was deliberately set up the teachers, staff, and parents to fail. It’s one of the most careless, incompetent, and heartless actions I’ve ever seen promoted by the executive branch of the federal government.”
There is another cause for concern, this one about what the virus might do to children themselves. Although the rate of morbidity in young children is relatively low, young children are also among the least-tested cohort in America. Fauci has stressed repeatedly in recent weeks that we know relatively little about children and the virus. For example, we still don’t know how frequently children get infected, or what percentage of children are symptomatic, or how underlying conditions may exacerbate or even alleviate the severity of the infection. The results of one six-month National Institutes of Health study, which enrolled thousands of families from 11 U.S. cities, are expected in December.
But “we don’t need additional information to make decisions,” Hotez insisted. Right now, he said, there are at least 40 states in which schools simply should not open. “Remember, schools are not hermetically sealed ... We need to reach containment first. It’s that simple.”
One of the strangest things about living through a pandemic is the lag in understanding of how bad things are, an awful mirror of the lag in deaths that come like clockwork after a surge in coronavirus cases. All along, this disaster has been simultaneously wholly shared and wholly individualized, a weird dissonance in a collective tragedy that each person, each family, has to navigate with intricate specificity to their circumstances. The despair that has seemed to crest in recent days represents another kind of lag—a lag of realization—and the inevitable end of hopefulness about what life might be like in September.
by Adrienne LaFrance, The Atlantic | Read more:
Image: Olivia Authur/Magnum
[ed. I wonder if we might see a wave of early retirements, too. See also: Why Can’t We Just Have Class Outside? (Atlantic)]
Scientists warned us even then that a return to normalcy would take longer, but the telescoped timeline had obvious appeal. You can put up with almost anything for just 15 days.
Acting on the chance to get it right was essential, but we now know it was not temporary. We’ve seen the failures—in testing, in containment, in federal and state leadership—compound in catastrophic ways. And as our pandemic summer has stretched on, many of us have let go, one by one, of experiences from the world we used to inhabit. We bid goodbye to sleepaway camp, to live music, to distant travel, to boisterous weddings, and to spontaneity in general. Today, a new realization is dawning, and as the debate over schools reopening rages, we must acknowledge it plainly: We aren’t going back to how it was. And we shouldn’t.
“This push to open schools is guaranteed to fail,” says Peter Hotez, a pediatrician and molecular virologist, and the dean for the National School of Tropical Medicine at Baylor College of Medicine. I’ve been corresponding with Hotez, and with several epidemiologists, over the course of the pandemic, and have noticed a starkness in their views in recent weeks. “The social-distancing expectations and mask requirements for the lower grades are unrealistic,” Hotez told me. “In communities with high transmission, it’s inevitable that COVID-19 will enter the schools. Within two weeks of opening schools in communities with high virus transmission, teachers will become ill. All it will take is for a single teacher to become hospitalized with COVID and everything will shut down.”Hotez has good reason to be pessimistic. There were 68,605 new cases in the United States yesterday, according to data from the Centers for Disease Control and Prevention. The seven-day average has stayed above 60,000 new cases per day since July 13. Reaching 100,000 cases per day, once seen as an apocalyptic, worst-case-scenario warning from Anthony Fauci, is no longer difficult to imagine. Indeed, my conversations with epidemiologists in recent days were all strikingly dark. They agreed: Schools should not risk reopening, probably not even for the youngest children, in the coming weeks. “We can’t pretend like everything’s fine,” said Gary Simon, the director of the infectious diseases division at George Washington University. “If I had a school-age kid, I wouldn’t want to send him to school.”
The evidence is all around us. There is the summer camp in Georgia where hundreds of kids and counselors—nearly half the camp—got infected after only a few days together. Then there’s the school in Indiana where, just hours after reopening last week, a student tested positive for the coronavirus. (“We knew it was a when, not if,” the superintendent told The New York Times, but officials were “very shocked it was on Day 1.”)
There’s also the JAMA Pediatrics study that suggests that babies and young children can carry extremely high viral loads of SARS-CoV-2. The study’s authors found at least as much viral material in the throats and airways of young children as in infected adults, and sometimes 100 times as much as in adults. We’ve long known that kids older than age 10 can efficiently transmit the virus, but this new research suggests that younger kids pose a risk of transmission to the people around them, just as older children do. The more we learn, the more likely it seems that children are highly effective vectors for transmission. Springtime school closures took place before the virus seized the nation. A return to the classroom now—even with thoughtful precautions—would create excellent conditions to test just how quickly COVID-19 can saturate a community. School was deemed unsafe for children, teachers, and staffers back in March. The pandemic is worse in the United States now than it was then, with multiple epicenters burning across the country. So why would schools reopen now?
“The problem is the White House and the task force could never organize themselves to lead a federal response and bring virus transmission down to containment levels,” said Hotez, who has argued for the necessity of a federal containment plan that, if executed effectively, might allow the nation to reopen comprehensively as soon as October. “Instead they took a lazy and careless route, claiming schools are important, as we all know, and the teachers and principals need to figure it out. What they did was deliberately set up the teachers, staff, and parents to fail. It’s one of the most careless, incompetent, and heartless actions I’ve ever seen promoted by the executive branch of the federal government.”
There is another cause for concern, this one about what the virus might do to children themselves. Although the rate of morbidity in young children is relatively low, young children are also among the least-tested cohort in America. Fauci has stressed repeatedly in recent weeks that we know relatively little about children and the virus. For example, we still don’t know how frequently children get infected, or what percentage of children are symptomatic, or how underlying conditions may exacerbate or even alleviate the severity of the infection. The results of one six-month National Institutes of Health study, which enrolled thousands of families from 11 U.S. cities, are expected in December.
But “we don’t need additional information to make decisions,” Hotez insisted. Right now, he said, there are at least 40 states in which schools simply should not open. “Remember, schools are not hermetically sealed ... We need to reach containment first. It’s that simple.”
One of the strangest things about living through a pandemic is the lag in understanding of how bad things are, an awful mirror of the lag in deaths that come like clockwork after a surge in coronavirus cases. All along, this disaster has been simultaneously wholly shared and wholly individualized, a weird dissonance in a collective tragedy that each person, each family, has to navigate with intricate specificity to their circumstances. The despair that has seemed to crest in recent days represents another kind of lag—a lag of realization—and the inevitable end of hopefulness about what life might be like in September.
by Adrienne LaFrance, The Atlantic | Read more:
Image: Olivia Authur/Magnum
[ed. I wonder if we might see a wave of early retirements, too. See also: Why Can’t We Just Have Class Outside? (Atlantic)]
Saturday, August 1, 2020
Here's What's Going to Happen
We thought the pandemic would be over by now but it's not. So, we're back to making predictions and dreaming about the future. (...)
Indoor dining will fully shut down again. We expected some sort of indoor dining rollback, but we didn’t expect last week’s announcement that indoor dining will soon be limited to members of the same household, sitting at the same table. 🤔 What about eating out with a partner who lives in another apartment? Or with a child who lives with another family member? Won’t people just lie? This Tinder-Dates-on-the-Patio-Only Rule will apparently be enforced by “restaurants—say, a host or hostess—ask[ing] customers if they are in the same household,” says the governor’s deputy communications director. “Verification is not required.” Oookay. This isn’t going to work. Expect a full rollback of indoor dining if we can’t get coronavirus to calm down. And then expect a wave of closures. What a mess. —C.B. (...)
Bring on the tuition riots. The whole college thing has been a racket for many years. Students are forced to pay way too much for even a standard college degree. And student debt in the US has become obscene. And now colleges want students to continue paying all of this money and carrying all of this debt for classes online? This is an explosive situation. When millions of college students return to their online classes this fall, expect, on day one, sparks to fly from a fuse that is not very long. —C.M.
Teens will spend their gap year(s) pursuing TikTok careers. Maybe there’s only one sustainable career path as the unemployment rate nears 20 percent in major U.S. cities, AKA double what it was in the 2008 Great Recession: Tik Tok.
The Chinese video-sharing app is highly addicting, is potentially spyware, and is hot and getting hotter. The company (which is expected to add 10,000 U.S. jobs) just announced a $200 million fund for stateside creators to spur more original content. COVID-19 is far from over. We should be gearing up for the second wave (or the end of the first wave?) but instead we decided to spit into the face of God and open up bars and restaurants. As we inevitably close down again, many teens' go-to first jobs—waiting tables, schlepping coffee, working at Cinerama—will go up in flames. Maybe those Tik Tok dances they've been learning throughout high school were a Plan B. While companies fail and the service industry goes kaput, live-streaming sites like Twitch and content hubs like Tik Tok will become the most dependable paychecks. —N.G. (...)
We'll pay for Twitter. Eventually. It’s inevitable. After destroying blogs, Twitter will end up behind its own paywall. Digital advertising is not working for Twitter. (It’s not working for anyone—except Google and Facebook.) Twitter’s user growth is soaring, but its revenue is plummeting. Its stock bounced when it was discovered that the company was hiring for a subscription platform under the code name “Gryphon,” and last week CEO Jack Dorsey announced that the company is looking at multiple subscription models. Will people pay for it? Will it make the product better? Will the platform’s cult of contrarians complain that this is censorship? We’ll see—I bet within the next year. —C.B. (...)
Virtual fans will become the norm at major events. Last week, FOX announced that they will digitally insert virtual fans into empty stadiums during their Major League Baseball broadcasts to make the games "look natural." The National Basketball Association is using Microsoft Teams' Together Mode to invite fans to the game by using AI to segment their face and shoulders, virtually putting them together on 17-foot tall LED screens that wrap around the court. The fans can react in real-time and players can see and hear those reactions.
Sports lovers are, admittedly, not in love with the technology as it's still a lil bit freaky to see virtual bodies where real ones should be. But as we push further into a socially distant society with a "need" for big in-person events like political conventions, concerts, game shows, award ceremonies, and other sporting events, I believe virtual crowds will become the norm. Especially as they open up a new advertising revenue stream for channels and organizations that desperately need it.
And not to be all Black Mirror, but this development immediately reminded me of their "Fifteen Million Merits" episode, where singing competition contestants sang in front of a crowd of virtual avatars. Maybe we're not too far from that future after all. —J.K.
Baseball is gonna be canceled. I’m sorry! But the games started five days ago and we’ve already got COVID outbreaks! Why did anyone think a 60-game season across 30 stadiums during a blooming pandemic was going to work! The hubris! —C.B.
With a looming wave of evictions and economic crisis, I suspect we’ll see a lot more petty crimes of desperation—stealing a loaf of bread to feed a family, breaking into a construction site to sleep out of the rain. The uniquely American lack of a safety net, such as those enjoyed by more developed nations, is going to be bad enough for everyone involved; and I think the rich are going to react not with compassion but with insular self-interest. They’ll retreat into ever more fortified enclaves, terrified of the surge in crime, and gated communities will start to have the same military-grade gear as suburban police departments. Within a year, I suspect the wealthy will have their own militias patrolling their McMansions. That alarming couple who brandished guns at protestors are just a taste of what’s to come — how long do you think it’ll be before those militias start eyeing each other with suspicion, or pondering a pre-emptive attack on perceived threats? —M.B.
This crisis is going to last years, not months. What if the timeline on this disease is less like SARS and more like HIV? The coronavirus is not as deadly as HIV, but it is transmitted more easily, and scientists say they are finding "eerie parallels with HIV," including depletion of T cells. Chinese researchers said in May that the coronavirus "emulates the HIV strategy to remove marker molecules on the surface of an infected cell that are used to identify invaders, in a manner to evade attack from the human immune system," leading them to the speculation that this disease "may be around for some time." —C.F.
Americans will give up. Since the first recorded COVID-19 death in the US (February 6, 2020), nearly 150,000 Americans have been killed by the virus. Today, we can expect 1,000 Americans to exit the world by way of the pandemic. And if Trump is re-elected, we will be forced to live with crowded hospitals, traumatized health professionals, and the daily destruction of thousands upon thousands of Americans for the next four years. This is what the presidential election of 2020 has come down to: necro-America or no necro-America. And 40 percent of voters still support Trump. Who are these people? Are they even people? 40 percent means 60,000,000 Americans are fine with living in a country that, by the spring of 2021, will likely be dumping surplus bodies into massive graves.
As we near Election Day, and the possibility of a necro-America increases, the strain will be too much for a good number of heads. In this depressing condition, many Americans will be too exhausted to fight for their lives. They will not correct a car that has unexpectedly veered toward a ditch or a tree, or just give up while drowning, or not care if a lump appears on their stomach. These people are not exactly suicidal; they would happily live (and fight to live) in a world where the forces of death, of necro-economics, are not in so much power.
That said, here is a passage I love from Marcel Proust's Remembrance of Things Past. —C.M.
The flying sushi boat scene in The Fifth Element will give some idea of converted ice cream van of the future. —C.M.
by Staff, The Stranger | Read more:
Indoor dining will fully shut down again. We expected some sort of indoor dining rollback, but we didn’t expect last week’s announcement that indoor dining will soon be limited to members of the same household, sitting at the same table. 🤔 What about eating out with a partner who lives in another apartment? Or with a child who lives with another family member? Won’t people just lie? This Tinder-Dates-on-the-Patio-Only Rule will apparently be enforced by “restaurants—say, a host or hostess—ask[ing] customers if they are in the same household,” says the governor’s deputy communications director. “Verification is not required.” Oookay. This isn’t going to work. Expect a full rollback of indoor dining if we can’t get coronavirus to calm down. And then expect a wave of closures. What a mess. —C.B. (...)Bring on the tuition riots. The whole college thing has been a racket for many years. Students are forced to pay way too much for even a standard college degree. And student debt in the US has become obscene. And now colleges want students to continue paying all of this money and carrying all of this debt for classes online? This is an explosive situation. When millions of college students return to their online classes this fall, expect, on day one, sparks to fly from a fuse that is not very long. —C.M.
Teens will spend their gap year(s) pursuing TikTok careers. Maybe there’s only one sustainable career path as the unemployment rate nears 20 percent in major U.S. cities, AKA double what it was in the 2008 Great Recession: Tik Tok.
The Chinese video-sharing app is highly addicting, is potentially spyware, and is hot and getting hotter. The company (which is expected to add 10,000 U.S. jobs) just announced a $200 million fund for stateside creators to spur more original content. COVID-19 is far from over. We should be gearing up for the second wave (or the end of the first wave?) but instead we decided to spit into the face of God and open up bars and restaurants. As we inevitably close down again, many teens' go-to first jobs—waiting tables, schlepping coffee, working at Cinerama—will go up in flames. Maybe those Tik Tok dances they've been learning throughout high school were a Plan B. While companies fail and the service industry goes kaput, live-streaming sites like Twitch and content hubs like Tik Tok will become the most dependable paychecks. —N.G. (...)
We'll pay for Twitter. Eventually. It’s inevitable. After destroying blogs, Twitter will end up behind its own paywall. Digital advertising is not working for Twitter. (It’s not working for anyone—except Google and Facebook.) Twitter’s user growth is soaring, but its revenue is plummeting. Its stock bounced when it was discovered that the company was hiring for a subscription platform under the code name “Gryphon,” and last week CEO Jack Dorsey announced that the company is looking at multiple subscription models. Will people pay for it? Will it make the product better? Will the platform’s cult of contrarians complain that this is censorship? We’ll see—I bet within the next year. —C.B. (...)
Virtual fans will become the norm at major events. Last week, FOX announced that they will digitally insert virtual fans into empty stadiums during their Major League Baseball broadcasts to make the games "look natural." The National Basketball Association is using Microsoft Teams' Together Mode to invite fans to the game by using AI to segment their face and shoulders, virtually putting them together on 17-foot tall LED screens that wrap around the court. The fans can react in real-time and players can see and hear those reactions.
Sports lovers are, admittedly, not in love with the technology as it's still a lil bit freaky to see virtual bodies where real ones should be. But as we push further into a socially distant society with a "need" for big in-person events like political conventions, concerts, game shows, award ceremonies, and other sporting events, I believe virtual crowds will become the norm. Especially as they open up a new advertising revenue stream for channels and organizations that desperately need it.
And not to be all Black Mirror, but this development immediately reminded me of their "Fifteen Million Merits" episode, where singing competition contestants sang in front of a crowd of virtual avatars. Maybe we're not too far from that future after all. —J.K.
Baseball is gonna be canceled. I’m sorry! But the games started five days ago and we’ve already got COVID outbreaks! Why did anyone think a 60-game season across 30 stadiums during a blooming pandemic was going to work! The hubris! —C.B.
With a looming wave of evictions and economic crisis, I suspect we’ll see a lot more petty crimes of desperation—stealing a loaf of bread to feed a family, breaking into a construction site to sleep out of the rain. The uniquely American lack of a safety net, such as those enjoyed by more developed nations, is going to be bad enough for everyone involved; and I think the rich are going to react not with compassion but with insular self-interest. They’ll retreat into ever more fortified enclaves, terrified of the surge in crime, and gated communities will start to have the same military-grade gear as suburban police departments. Within a year, I suspect the wealthy will have their own militias patrolling their McMansions. That alarming couple who brandished guns at protestors are just a taste of what’s to come — how long do you think it’ll be before those militias start eyeing each other with suspicion, or pondering a pre-emptive attack on perceived threats? —M.B.
This crisis is going to last years, not months. What if the timeline on this disease is less like SARS and more like HIV? The coronavirus is not as deadly as HIV, but it is transmitted more easily, and scientists say they are finding "eerie parallels with HIV," including depletion of T cells. Chinese researchers said in May that the coronavirus "emulates the HIV strategy to remove marker molecules on the surface of an infected cell that are used to identify invaders, in a manner to evade attack from the human immune system," leading them to the speculation that this disease "may be around for some time." —C.F.
Americans will give up. Since the first recorded COVID-19 death in the US (February 6, 2020), nearly 150,000 Americans have been killed by the virus. Today, we can expect 1,000 Americans to exit the world by way of the pandemic. And if Trump is re-elected, we will be forced to live with crowded hospitals, traumatized health professionals, and the daily destruction of thousands upon thousands of Americans for the next four years. This is what the presidential election of 2020 has come down to: necro-America or no necro-America. And 40 percent of voters still support Trump. Who are these people? Are they even people? 40 percent means 60,000,000 Americans are fine with living in a country that, by the spring of 2021, will likely be dumping surplus bodies into massive graves.
As we near Election Day, and the possibility of a necro-America increases, the strain will be too much for a good number of heads. In this depressing condition, many Americans will be too exhausted to fight for their lives. They will not correct a car that has unexpectedly veered toward a ditch or a tree, or just give up while drowning, or not care if a lump appears on their stomach. These people are not exactly suicidal; they would happily live (and fight to live) in a world where the forces of death, of necro-economics, are not in so much power.
That said, here is a passage I love from Marcel Proust's Remembrance of Things Past. —C.M.
[The] next day, [Charlus had to] begin afresh his attempt to find out what Odette had been doing, must use all his influence to contrive to see her. This compulsion to an activity without respite, without variety, without result, was so cruel a scourge that one day, noticing a swelling over his stomach, he felt an actual joy in the idea that he had, perhaps, a tumour which would prove fatal, that he need not concern himself with anything further, that it was his malady which was going to govern his life, to make a plaything of him, until the not-distant end. If indeed, at this period, it often happened that, though without admitting it even to himself, he longed for death, it was in order to escape not so much from the keenness of his sufferings as from the monotony of his struggle. (...)The only way a second lockdown will not happen is if Trump is re-elected. And if history is kind to us, we can expect not only a second lockdown but one that will be more thorough and better managed than the first. Such a regime will require the imposition of strict controls on every home. In the second lockdown, movement in and out of the house will be rationed (one person is permitted exit and entry per day). Here is where ice cream trucks might be handy. The owners of these vans could transform them into necessary businesses that carry coffee, cigarettes, carbonated water, booze, eggs, and pickles. Picture this: The van makes its way down your street at around 8 in the morning. You order what you need by an app; the van operator drops your goods at your doorstep.
The flying sushi boat scene in The Fifth Element will give some idea of converted ice cream van of the future. —C.M.
by Staff, The Stranger | Read more:
Image: Sasha Suzi/Getty
Living Tree Bridges In A Land Of Clouds
PHOTOS: Living Tree Bridges In A Land Of Clouds (NPR)
Images: Prasenjeet Yadav
"When I think back to my own arduous trek across this hillscape, I begin to comprehend how much the geography of this place is characterized by isolation and disconnectedness. Even today, most of these villages do not have road access. A trip to the closest town might require climbing down into valleys and crossing flooding rivers to reach another village.
But crossing these rivers isn't possible without a bridge.
It's hardly surprising, then, that it was the need for connectedness that provided the first guiding impulse for these ancient experiments in bioengineering. Tree bridges are structures that are literally rooted in the terrain and that thrive under the relentless pressures of the wettest land in the world."
~ Prasenjeet Yadav
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