So many things going on in the world! I’m working on a lengthy piece on our institutional cognitive biases (for lack of better term) as revealed by our pandemic stress test, and another one for Insight explaining what I think is going on with variants (and why, I think, we’re kind of missing the big picture). Other than that, what’s on your mind? Open thread!
One theme I notice a lot in your writing about covid is some variant of “it didn’t have to be this way.” Yet that same theme never finds it way into your writing about democratic retreat and white supremacy, and I feel like there is sometimes a disconnect between how the latter causes the incompetence and malevolence that led to such bad outcomes in the former. I.e. no one ever says about racism “it didn’t have to be this way,” so maybe when it comes to covid, it really did have to be this way because we never fully addressed our cultural/societal demons. Could you touch on this at some point in your writing?
Still schools. Our 10 year old is going back in late March, and in the presentation last night they spent an awful lot of time talking about deep cleaning and using sanitizers. Air circulation and ventilation only came in at the end. It’s like they are STILL worried about the wrong items months after we know it was aerosol based.
We're lucky that our school has recognized that ventilation is important in their communications. To be clear, we're not back to in-person school yet, but I'm encouraged that they will be taking the correct precautions.
You've covered but bears repeating: the media drumbeat around virus variants drowning out coverage of the astounding success rates of vaccines; and often failing to include data about which variants vaccines may be effective against. Are people throwing up their hands — "I'm just gonna get it”—in part b/c of this? Have anecdotal evidence from Americans in their 30s and early 40s says so ("I have a strong immune system. May not even work against anyway..." throw up their hands) Is it naive to want coverage of variants only when it can include studies showing effectiveness of approved vaccines against each? What would your messaging be to mainstream media and to state health orgs/Biden Admin about how to communicate most effectively about variants?
I've been thinking a lot over the past year about the ways cooperation evolves, because we've been witnessing emergent etiquette and social stigmatization in real time, around things like masking. I have been modeling the world as a giant iterated prisoners dilemma, and the rate of defection is so much higher than I would have expected. It has really changed the parameters that I use to model my fellow humans, and not in a good way.
“Rate of defection” is a good way to put it. My mind is very much on polarization right now, and how strict adherence to ideology (like framing mask mandates as government overreach and a matter of freedom) causes harm to others.
I have a pet theory, totally unsupported by any actual research on my part, that humans are evolved for viewing things through the lens of cooperation/defection, and in the absence of strong evolutionary pressure (like in a country with lots of wealth and resources) we redirect that cognitive bias towards slotting people into in-groups and out-groups along weird axes, like professional sports teams, or political parties, or mustard-vs-ketchup-on-hotdogs (the answer to which, by the way, is mustard, and anyone who disagrees with me should be burned at the stake.)
I also have a shorter reply to your part about how having wealth and resources leads to division: In many cultures in idyllic settings (temperate beaches, available food and water) one finds very brutal religions.
My pet theory, born I am sure in my growing-up setting, probably would be better informed if I would get around to reading Sebastian Junger's Tribes.
This is long, and I'll state the conclusion first: In this country it has become all about race, with a subtext of upset over free riders. This has been inflamed by politicians who use "let's you and him fight." Over the past few years I have been thinking over the connection between what has been done, particularly in the South, and the example of the partition of Africa, in which the European powers divided Africa by putting opposing peoples together in the same country, and knowing what they were about when they did so.
I grew up in the deep South of the U.S. My family was interesting. My schools were segregated all the way through college. Racism was just how things were. Negroes were accepted in their place and all was calm. Truman had integrated the armed forces and there was a bit of a kerfuffle about that, but no big deal.
It was a pretty quiet time. the Depression and the War (WWII) were over. Segregation was established and little considered within the white population.
My mother was interesting. She had been imprinted by her racist mother. Grandmother's motivation seems to me to have been maintaining class superiority in a poor country environment in northeast Texas. Mother believed deeply by the time I came along that racism was wrong, a belief apparently founded in her experience teaching school in El Paso. She loved the people there. But she also believed that her visceral reactions to Negroes would never fade. My parents traveled together to participate in a form of theater. Mother ensured that our live-in sitter for these absences was a Negro woman, a schoolteacher. My father mumbled a bit about why was this necessary, but there was not much use going up against my mother, or her mother before her.
Louisiana ensured that integration would be done in the hardest way possible, by integrating the senior year of High School first and working down, year-by-year. Mother was a reading specialist, and by the time the integration reached elementary grades she was flooded with students who could not read. Of course by then the school funding was being cut year by year in Louisiana. She had to retire over stress of being unable to do a good job.
My father was a computer pioneer and whiz at the oil refinery. One day they hired a Negro man in his very white collar unit and my father was sure it was tokenism and grumbled about that. Over time he said the guy was good at his job. Over more time he (quietly) saw to it that as the industry-leading mainframes were retired from the refinery they went to the local Historically Black University and were set up and maintained there. He spent a lot of time at the university working with faculty, staff, and students.
I spent my career at the University of Houston, which was the perfect place for me. It was called the most diverse major research university in the country. It is just a few blocks from where George Floyd grew up. Houston is just about as good as the country does at integration. Yet, my nephew from Venezuela can't understand why we in this country care what color people are. He says it doesn't matter in Venezuela.
In the eighties I thought we had turned a corner. We had not. Growing up, I thought that as my grandmother's generation died out their views would go with them. They did not. I know from my nephew that race does not have to be what it is here. I also see from Venezuela that if it is not race, division can be sown in another field. I see many politicians over the years sowing these fields.
I'm still thinking about this, and that is where I am now.
I like both but dislike hot dogs so I’m not sure where that leaves us ;)
I agree about being evolved to categorize and group, which leads to “in” and “out” groups. I guess my wondering is about how, knowing that bias exists, we can acknowledge it and still manage to live together in shared spaces on a shared planet. Leaving out fantasies about Mars and Seasteads and whatever, which still can’t escape the quandary of how humans live together.
I am pretty pessimistic about changing fundamental human nature. I think in general our best bet is to develop technologies that render the problems more tractable, such that they no longer become contentious (which is my approach to climate change). It's popular to crap on techno-types for being utopians, but I think people who believe we can just all sing kumbaya and agree to bike more are the utopians.
First ketchup and now bikes?! J/k I don’t like biking very much, though I am a pedestrianisation advocate.
I don’t think we can change the fundamentals of human nature, either, but I do think (and research backs this up) that there is far more cooperation in our nature than we’re usually led to believe. I’m somewhat techno-skeptic but only to the point that I’d like to see far more consideration of negative consequences that we might not notice at first dazzle. Tech, I hope, can help us reacquaint ourselves with the better parts of our nature that were always there anyway but I’d like it to serve us rather than us serving it. Honestly, you make a good point about utopians, but I think I’d caveat with utopian thinking is maybe the result of trying to ignore the slow, boring day-to-day work of making change and building social good, and both pro-tech and anti-tech people are prone to it.
All during the election I was trying to point out that (mostly in Facebook, also in NYT comments) polarization is itself more dangerous than extremist thinking. It seems obvious to me in so many ways, but many otherwise tolerant and open people seem to be absolutely unwilling to give up their emotions about and endless chastising of "the other side."
I guess it partly depends on what the situation is. Where I live (Montana), it feels very much that polarization and extremism are feeding off of each other. For example, just today a committee in the legislature shut down an attempt to confront the threat of white supremacist groups by scoffing at the idea that they're either a threat or that they're active in the state (this is Montana! This is not new, people!). At the same time, they're considering a bill to categorize Antifa as a domestic terrorist group. I guess without polarization the extremism wouldn't be enabled quite so much, but in this situation it's almost a moot point wondering which is worse. Every place is going to have its different struggles, though!
For me, what has been revealed by the pandemic is how global warming crisis, economic inequality, and toxic nationalism trends all are part of a stew of crisis that's going to require a global movement. Keep doing all your great work, I remember you from my UT-Austin graduate study days, and I'm constantly forwarding your posts and Op Eds to my social media feeds! - Kyle
Writing this as I'm in training at work (via Zoom) and also keeping an eye on my younger child's schoolwork. He's obviously missing the in-person attention and social interactions with his friends, but I've relished glimpses of his interactions with his teachers (which I previously didn't have access to) and other benefits (him being able to sleep in, having more time around vs schlepping to and fro). I wonder at the factors that explain difference between the open-the-schools-now push (majority of white parents) vs those who prefer to wait. I also wonder at how that transition back to school and work will be.
Our schools have been open since September, with remote options. A part of your question could also include learning differences between remote vs. in-school learners within the same district. We opted to just homeschool (my kids loathed remote) and the “getting as much sleep as they need” thing has been huge, though the loneliness also is.
Yes, learning differences is a factor (a huge pivot for my child's Montessori-based school!), but also trust in the school (district), personal ranking of considerations (safety, loss of academic/sports progress), etc? Also in a way, sadly many current options offered by schools combine only the worst parts of the new reality, e.g., a few hours in-school (requiring drop off and pick up), in-person proctoring of remote learning.
So true. Most of my kids’ friends who are doing remote have to have a dedicated adult present to help them through it. It’s so unsustainable and/or unattainable for so many.
This newsletter post on schools just came into my inbox this morning. It’s more general, along the lines of “how do we help people see this is a systemic problem” but a very good read, and definitely worth clicking over to read Part II if the first part speaks to you: https://thewhitepages.substack.com/p/teachers-parents-and-cans-full-of
Thanks for sharing the newsletter. Our family is definitely familiar with the discussions here because my spouse is a teacher (and we also live in Oakland). And every time I hear the phrase "the powerful teacher's union" I roll my eyes. Sure, they're so powerful that teachers' starting salary is $70k and they earn overtime pay and generous retirement.
I guess it's even more relevant then! Kudos to your spouse. It really drives me nuts how willing people are to blame teachers for everything. Our state is so happy to constantly shave away at public school budgets, and then people start attacking the teachers or the school board for not doing enough.
That gets to the meta issue, I guess, which is how to help people perceive the problems causing the problems they're upset about, and then take action on the actual problems rather than the perceived problems.
It's going on two months now and the state capitol where I live (New Mexico) is still cut off, surrounded by fencing and cops with flashing lights, despite Santa Fe being about as much a hotbed of right-wing extremism as Somerville or Berkeley. The NM legislators recently got in trouble with the fire marshal because they had effectively sealed themselves in, with no emergency exists. I'm curious whether people are seeing a similar ongoing freakout in their own states.
Although those people will say it's in the *same* direction. They just think that the best defense is a good offense, rather than getting rid of guns in public spaces.
Hi Zeynep! Thanks for doing these. I was wondering if you could recommend sources or articles to read to learn about whether the covid vaccine limits transmission? I got my Pfizer vaccine yesterday (I work in medical device manufacturing) and am trying to figure out whether I should see friends or family or continue to isolate?
The human toll of Covid-19 worries me. I'm not looking at the 500K deaths or the number of people who demonstrably have the disease, or all the families who have lost members to it. It's the more the lasting effects on people who are victims only of pandemic societal change -- and not only folks connected to medicine in some way. Sure, the doctors I know socially are burned out, even a radiologist, who has been working with people coming off intubation. The NYTimes today had two opinion pieces about burned out nurses. I expect that kind of reaction. Yet the PTSD seems to stretch way beyond front line people to the millions who have been in some form of quarantine for close to a year. I have seen nothing (and I'd love to know if I'm just plain wrong) about plans to deal with the mass of PTSD cases that are likely to arise as the pandemic fades. The social effects will not disappear when the disease parts of the pandemic is declared officially resolved.
Prior to the pandemic I worked on an initiative to equip nursing home staff to provide trauma-informed care - there was interest driven by an Obama-era regulatory change requiring the adoption of a trauma-informed approach for older people (and inevitably for staff as well). The need for this kind of work in that industry is now unimaginable - and your point about the massive experience of trauma (primary and secondary) at the population level - and the resulting PTSD - is right on point. The human brain responds to the experience of trauma with an 'amygdala hijack,' with that portion of the brain taking the prefrontal cortex temporarily offline and flooding the body with adrenaline and cortisol to prepare a fight, flight, freeze or play dead response. Unfortunately, social media algorithms now promote content that triggers this same response because anger and terror are VERY engaging and tend to keep people on the site (and thus giving up data).The pandemic is traumatizing the public, and so is time spent on the major social media platforms - a downward spiral, I'm afraid.
Your comment on the experience of trauma applies to so many of our current issues. I too find myself being enraged by things that are important, but would be better considered with less cortisol.
I communicated some of my feelings to the mainstream media I consume that increasingly editorializes and uses inflammatory adjectives in news stories and headlines. Everything is built for clicks.
Such great observations. I pulled back from mainstream media significantly after the 2016 elections and really limit my exposure, trying instead to read and listen to journalism and analysis that is not driven by the clickbait business model. I subscribe to four substack e-newsletters, including this one, and I'm a member of Tortoise, which is a UK based slow journalism organization that publishes articles to read, podcasts to listen to and produces almost daily 'thinkins' - a journalist invites several guest who address a topic, with very thoughtful questions, and then members who share ideas in the chat are brought in to contribute, not to ask questions but to share ideas. It is beautifully moderated and the quality of the conversations is extraordinarly. It's eighty pounds per year, but well worth it - I wish we had the same model in the US, but their topics are relevant to us and I support the model. I'm trying to spend to support work that isn't built on commodifying our attention.
And people who don’t have the option to quarantine, too, especially people in customer service who are exposed and don’t want to be, having to manage anti-masking anger, etc.
Given that you have expertise about both the sociology of pandemics and digital sociology, I would welcome your thoughts at the intersection of advancing public health (via communications and modeling / shaping social norms) and the digital/social media environment that normalizes antisocial behavior and spreads disinformation far, far faster than factual information. I'm concerned that progressives and many public intellectuals are fighting with tools that are no match for the digital medium and those with the skills, funding and disregard of ethics to use the medium to drive polarization and paranoia. I don't see how human communicators trying to frame effective messages can win against bots and trolls that drive trending topics and warp the whole ecosystem.
I’ve read several unsettling articles about disdain for public health agencies. It’s as if they are being held to a standard of 100% accuracy rather, neglecting that their role is to provide guidance given the best guesses at the moment. Their failure to live up to unrealistic expectations is reflected in dismissal as incompetent.
I do take relief that this disdain extends beyond public health. During former work consulting for the National Interagency Fire Center I heard many complaints about impatient members of Congress who needed to know with precision what was going on in a wildfire when it was impossible to know. The people in the Center were labeled as either know-nothings or liars.
It just seems to go with the territory of working on tough and complex problems and dealing with those who want immediate gratification.
I agree that most people have little grasp of complex problems across many fields, and when people don't know much about a topic they tend to search for something they do know about and reason with that (filling a cognitive hole) - usually the mental model they're using is not applicable and produces unproductive reasoning and conclusions. That said, fields that work at the population level are particularly subject to the use of unproductive cultural models that explain social problems by blaming marginalized communities and/or reasoning from fatalism (nothing we can do - too big to fix - not my problem).
This reminds me of something I saw yesterday about how well-meaning wealthy liberal-types try to launch things like local newspapers but expect business plans and profitability, whereas similar wealthy right-wing types are happy to pour money into rags like the Epoch Times, making it free and knowing it’ll never make money but also knowing they’ll reap rewards in other ways.
What had me thinking a lot these days (weeks, months) is the connection between the covid response in our western societies / states and the continued undermining by a certain branch of politics of our public service system and the health system in particular. A health system has at least two aspects, the private aspect (I am ill, I need a doctor), and the public aspect (how healthy is society as a whole). These aspects are intertwined with a reallly dangerous approach of economics. Running hospitals as businesses is a fundamentally flawed approach. Having no health crisis coordination ready to kick in between states (US or EU, not much difference) is dangerous neglect. Obviously in the US the first year of covid has been a complete political dissaster, but I think the problem goes much deeper. All politicians in the last 20 years that had hospitals closed, had refused pay raises for nurses, or pushed clinic executives to squeeze out the last bit, are personnally resposible for the mess we are in.
I've been thinking about the ways in which extreme cultural individualism in the U.S. has reduced thinking about health to the private you describe (I'm ill, I need a doctor). Part of my work involves helping public officials (in health and human services) frame communications in ways that help people see systemic and structural causes and solutions. COVID-19 has foregrounded for me how much of Americans' reasoning about health is purely private / individual. The concept of population-level health outcomes is virtually out of reach and hard to think for so many Americans. This affects behavior and it also affects reactions to policy and practice choices - including opposing choices that have evidence and benefit most people - and ultimately all of us.
Both of you are talking about something so vital here. I live in a very conservative county with anti-masking county commissioners who appointed a prominent anti-vaxxer to the county health board a little over a year ago. The county health department itself does an excellent job of working on public health, including Covid, yet has been hamstrung by the board and commissioners. It’s almost exactly that public-private worldview disconnect: to the health department, it’s about what will promote public health at the county level; for the commissioners, it’s about individual choice and freedom. It’s an unequal disconnect—there’s not equivalent blinkers on both sides, just on the anti-public health side.
Sorry to hear about that split between the professional health sphere and the political part. Here in France compentence and incompentence seems about equally split, but unfortunately for both the reflex is never to try to explain but to go "law and order", more and more stupid rules, that are not based in science, but where they suppose is the least resistence.
The point about resistance is also a big one. How can we manage big crises when it’s not a matter of what works or what’s best practice but of what people will put up with?
But the other side of it is that people will put up with more if they believe the issue is serious and their action will do some good - and everyone else is going to do it too. That is where leadership - including by example - and messaging can make a real difference.
That is true. I have had lots of conversations where I have said "look at what they are doing in Australia / Germany / Taiwan / wherever", and the answer is simply "You couldn't do that here."
Americans tend to say that about any big desirable change that would make our lives better. What is really interesting is watching up and coming leaders who are asking us to imagine that we can actually do big things and build a possible better future.
Karen I am an immigrant of 20 years to the US, and I feel the same way. It seems really hard for Americans even to think of prioritizing individual action for the common good. Maybe it could have been achieved with consistent messaging. New Zealanders are individualists, but they responded when their PM asked her "Team of 5 million" to "go hard and go early". She used rugby coach language to speak to a nation of rugby fanatics. In the US, it was left to states to lead the detailed action, but even governors who tried to deliver a strong consistent message were never going to get their message supported by everyone in the state when the message from the White House was inconsistent and sometimes contradictory.
It felt last summer like we could have managed that kind of solidarity messaging at some point if we'd had different leadership. What I don't understand is why we're not getting it at the national level now, not really, not to the extent we need. You are absolutely right--no matter how good a governor was (ours at the time was very good), without national leadership there was only so much they could do, even just to persuade people to do the right thing.
I live in Ohio. Our Governor De Wine and his health director tried to do all the right things. He is a Republican and he struggled with the Republican legislature, who consistently tried to block him. And of course so many Republican voters listened first to the President. The Governor got death threats. The health director (who is Jewish) got accused BY THE WIFE OF A LEGISLATOR of being a Nazi, and had to have guards put on her house. She eventually resigned. Very sad.
Oh I remember that! I did a webinar with an Ohio doctor last May or something who was very impressed with De Wine's handling.
That is horrible. And there was so much of it. Our first county health director left due to death threats. I wish, really wish, I knew where this kind of insanity came from and how to defuse it.
This "out of reach" is even more difficult for them when going beyon a national level. For many people even in goverment (here in Europe same as the US) it is inconceivable that helping other nations get vacines, for example, is helping their own populations.
Are you aware of any work on the sociology of media specifically? Things like what groups tend to work in media, how that has changed over time, as well as the role of media in the social life of consumers of it?
I love your Substack as the community is so supportive and open to ideas. I only use Twitter for news but when I was not able to fly back to my home in Canada Tuesday because the phone line to book 3 day mandatory hotel stay didn’t work, I took to Twitter about the phone line not working.I was shamed and repeatedly attacked and called “bitch” because “I was entitled” and shouldn’t be traveling. I had gone to see my 88 yr old mom in Florida after 14 months and her 2nd vaccine. Two days now and finally got through and on my way home. Had to take a 2nd covid test as the last one was outside 72 hour window. When I land I have to go straight to a government booked hotel. You have to take an uber there and then once in your room a self administered spit test and call Purolator to pick it up. After results are back in 2-3 days I can go home. Once again I have to take an uber home. Where’s the science? I live in my own home with my husband and I will quarantine in our basement apartment. Meanwhile I have spent 2k in hotels and ubers “quarantining” when it would be safer at home and I could donate the 2k to covax or any good cause. Sorry for rant but would love your thoughts
I think at least part of the issue is that although *you* would have quarantined, there's a good fraction of people in your situation who would have *said* they were quarantining and yet not done so.
Last summer, I went on a road trip to visit family in New Mexico, and while we were visiting them we went to an outdoor restaurant one day. After we left, I learned that New Mexico at that time officially required out-of-state visitors to quarantine for two weeks, and we had violated that. I happen to think that an outdoor dinner at a restaurant was very low risk, and in any case, my partner and I had been living a much lower risk lifestyle out of state than the family we were visiting in New Mexico. But even if one agrees that *I* wasn't in fact posing a risk in this case, it's natural to think that a good fraction of people, when told to quarantine *would* in fact pose a risk if they're not supervised.
As for the Ubers, those are likely higher risk than most of the behaviors you've been engaged in (you sound like you're generally quite careful!) but again, for a very large number of people (and for the ones that matter) the Uber is lower risk than sending them home unsupervised and asking them to promise to stay home.
Agree. The rule breakers ruin it for us all. But they also say that hotel rooms are in the top 3 places to get covid. I feel much more at risk with this hotel quarantine protocol. The frigid temperatures make it harder to get ventilation in an uber and these hotels were all built during the energy crisis in the 1970s which means likely substandard HVAC. And if travelers are likely to have covid what about the exposure to uber drivers?
You've talked about focusing on individuals versus institutions, and the need to address institutional failures versus swap out people. I'm specifically thinking of the GoT article, and the comment about how swapping out Mark Zuckerberg for $EXECUTIVE probably wouldn't change much. But how do you balance this with holding individuals accountable? What does institutional change (in general) look like, if not making personnel changes? How does accountability fit in?
For example, in August / September when many universities were reopening and the Big 10 couldn't decide if it was playing football or not, there were a large number of institutional failures (the NCAA, higher education costs, entertainment for college students), but also specific University presidents were making specific mistakes (e.g. Michigan president Mark Schlissel reopened dorms despite lack of access to testing and no accountability for safety protocols). How should we think about individuals vs institutions when talking about fixing problems and accountability?
I live in Sydney, Australia. And one thing I have noticed over the course of this pandemic is how far we're willing to bend the rules for otherwise competent political leaders.
Specifically in my state of NSW our premier Gladys Berejiklian is widely considered to have done a great job at managing the pandemic (aside from the Ruby Princess cruise ship incident early on in which infectious passengers were let out into the community with no quarantine). We have experienced several weeks of lock down and varying degrees of restrictions (caps on patrons at venues, weddings, public transport, mandatory masks etc.) but we have never experienced the tragedies that have happened in so many other places with overrun hospitals and mass unemployment (unemployment is an issue here too obviously but not to the same extent as most of the U.S. and Europe).
It seems that because of this success in managing the pandemic, public opinion by and large seems to give our premier a free pass on issues which in any other period would have posed serious concerns for her leadership. Without going too far into detail, she has knowingly failed to report the blatantly corrupt behaviour of her former partner (who was also a lower house representative) to either the police or ICAC (independent commission against corruption) and has openly admitted to pork-barrelling during election campaigns. She even went as far as to say she wears the criticism with pride.
Ten years ago we had a premier resign because he forgot to declare a $3000 bottle of wine as a gift from a private donor. Now our premier admits to pork-barrelling and failing to report her ex-lover abusing his power for personal financial gain and no one seems to care.
Is it inevitable that during a pandemic, we lower our expectations of our politicians? Is it possible to raise the bar again once (if) the pandemic is over?
That's really interesting - in the US, the governor of NY was highly praised for his handling of the pandemic and now is under fire for one aspect (underreporting nursing home deaths - and this is egregious) and it's not moved on to other allegations about him (sexual harassment, intimidation). I personally have very mixed feelings about him, and all of the negatives reported merit attention, but I must admit I suspect a right wing campaign to destroy him - well financed, probably using bots to spread these stories. It's a dilemma - I believe the stories should be reported, of course, but I also think the question of where the stories are coming from and why now are also important.
On the subject of cognitive biases and cognitive errors, we fund COVID research, and it’s frustrating that everybody feels so burned by the hydroxychloroquine experience that nobody wants to be associated with new treatments. Nobody wants to be the one who thinks of a treatment as promising if it doesn’t turn out well. Perhaps it’s the anchoring effect— if the treatments we are working on were proposed BEFORE hydroxychloroquine, they would be considered game-changing!
The other cognitive bias, I think, is that old, known drugs are treated like new, unknown drugs— like they’re going to be the next thalidomide or something. But one of the drugs we’re studying, fluvoxamine, is a relative of Prozac, for heaven’s sake. 13% of the country is already taking antidepressants (and I think upwards of a quarter of the white population over 60)— we know their side effect profile very well. Policymakers want even larger studies before recommending fluvoxamine for people who test positive— they want to “do no harm.” But it’s not like by NOT treating, we are really doing no harm— in the studies to date, 8-12% of the non-fluvoxamine group ended up hospitalized, versus ZERO hospitalization in the treatment groups. That’d be quite a trick for what is basically a relative of Prozac to cause 8-12% hospitalization, matching the harm of the no treatment and placebo groups— that’d be quite something to see!
Luckily some pretty wealthy Silicon Valley funders are supporting the ever-larger studies (as a small funder, we-- Parsemus Foundation-- move quickly to get studies off the ground, but other larger funders are coming in to run with them)— but are we going to go into the next surge and NOT use the $10 drug that could keep people out of the hospital and solve the hospitalization crisis? Are we really THAT risk-averse? And blind to the risk of non-action?
I've been wondering about the vaccine production efforts and logistics. I understand that manufacturing these vaccines requires highly specialized machinery and cannot be expanded on the short term. However, in the probably required longer term, expanding production capacity around the world with new factories should be possible, and governments could and should try to support those efforts financially. Or am I not seeing the whole picture, and that is already happening? I was expecting more news in mainstream media about production expansion.
Another thing that has been bothering me is the distribution of vaccines around the world. The richer countries (I live in the EU) apparently will get their entire populations vaccinated before looking around. And if demand for vaccines doesn't drastically reduce, because of boosters for variants, will this tendency persist? Besides, won't it be more likely that there will be new variants if many of the poorer countries don't have any vaccines at all?
I just started working on a group volunteer project to help get people in my local community connected to vaccines. Basically seeking out elders, people without tech access, people with limited mobility, non-English speakers, etc. and making sure they have what they need to register and get to vaccinations. (I assume hesitancy will be an issue, but right now the big issues are extremely limited supply and local governments doing very little to improve equity.) I'd love to see more examples of where governments are doing distribution right and/or where outside groups are improving information and access. Those of us trying to fix this from the outside are overwhelmed! I hope that supply improvements help, but relying on them still leaves some people waiting longer than they should.
In Buffalo, they are trying to accomplish this through a vax clinic they have opened that is only available to approved recipients in four zip codes. Limited time of 2 weeks, by the way, then it will be open to eligible regardless of address.
Minor issues as always, Zeynep. You have enough on your plate as it is, but I would love for you at some point to go over our selective blindness as to viral pandemics, and extend it to other regression-to-the-tail risks, such as antibiotic resistance. What are the cultural political processes that prevent us from taking into account and addressing these type of risks, bound to become dominant and structure our life?
I understand that institutions may appropriately focus on actions and messaging to reduce covid spread and protect the institution at the same time. But am feeling frustrated at the lack of recognition of the discrepancy between competing interests of the individual vs an institution. For example, if I must have a medical procedure or screening appointment, I’m told by dr that I’m not to be concerned about the institution’s failure to ventilate or filter air, nor their failure to insist their staff wear close-fitting high quality masks, because they say they’re following guidelines that they consider reasonable and they haven’t had a known case of staff-to-patient covid transmission.
To me it says that most infections are caused by about 1 successful virion (maybe out of 1000 or whatever in inoculum) acting independently of all the others. Which means that a simple linear model of infections vs. aerosol exposure is an excellent approximation. That in turn means to forget about the various silly schemes (musical chairs,...) and focus on something easier to calculate, total exposure. That sounds very compatible with your emphasis on HEPA, etc.
People say you have to breath in pretty many particles (maybe ~1000) to get sick. If those viruses somehow worked together to overcome your immune system, then it would be pretty safe to only breath in ~100. You'd just have to do things to avoid intense exposure. But if they work independently, each one just has a chance (say 1/1000) of getting you sick. You're at just as much risk from going into lightly contaminated rooms 10 times as from going into heavily contaminated rooms once. This means that the strategy for reducing infections is simply to reduce total exposure regardless of how it's distributed in space and time.
The new preprint argues that almost all cases come from just 1 to 3 successful virions, which supports that latter picture.
I have long shared your belief in the relatively lower risk associated with outside activities. Studies of both the Sturgis rally and BLM protests indicate nearly all infections occurred by indoor exposures, so why the resistance to opening beaches, parks, and playgrounds?
I live in Florida, and am no fan of Ron DeSantis. I disagree with about ninety percent of his actions and directives, but he did two things right. He focused on long-term care residents first, and he did not totally close down all the outside activities. He's a political opportunist, with his nose up Trump's butt for sure, but he has done a few things right.
Just to offer a slightly different perspective, I do understand the data about outdoor activity, but as an almost-60 year old married to a 76 year old, we have found that trying to walk or run outdoors ends up with too many close calls with runners who are unmasked, breathing heavily, and come within inches of us to pass us. From a 'swiss cheese' perspective or risk mitigation, we have our masks (one layer) and outdoors (a second) - but without social distancing and the other person - breathing heavily - being masked it feels riskier than the recommendations acknowledge. In other words if people were all masked and maintaining at least 6 ft of distance we'd be fine, but they are not, and that means we are deprived of the privilege of outdoor exercise, which is really unfortunate. The chances that we could be exposed to COVID-19 by the young man who ran by us last week, unmasked, came within inches of us and then coughed is just too high. All the mitigation measures need to be considered together. This is like people believe that 6 feet is a magic number - of course that's absurd - it's a good cognitive shortcut or rule of thumb, but of course it is not absolute. It is hard to get people to really understand recommendations and not just cherry pick the parts that justify them doing what they want to do.
It boils down to respect. I walk in the mornings on a six-foot wide sidewalk around a lake. Most folks move into single file when approaching me, but too many are engaged in conversation and will not move to the side. Sometimes I feel like playing a game of "chicken" with them, staying in the center until the very last minute. What's sad is that very few get it. Even though we are vaccinated, we still wear our masks and avoid close contact in grocery stores. Indoor dining is still a no-no.
I am researching the message that will arose Golfs Governing Bodies and move them to meaningful action to support the access to the game for the underserved Title 1 communities as well as the disabled, and veteran communities. Jack “Age of Betrayal” Beatty’s wonderful theme Referring to “network effects”....’the Golconda of connectivity, things joined multiplying the value of things apart”, is the spark! I am willing to put in the work and need assurance on the mission , awareness, and path.
(1) The confusion between public health and medical practice. Physicans are duty bound to advocate for their patients and since patients have quite diverse health and living situations their advice is all over the map. When in front of the camera they communicate to the most vulnerable. Public health, collective action for collective benefit, has been poorly communicated. This issue arises in considerations of the use of rapid screening tests (inaccurate! and yet case finding is of huge benefit to us all!), vaccines (not 100%, but maybe R<1 would be nice?). How do we teach people to interpret the message by knowing the messenger?
(2) Innate immunity and the benefits of reduced infectious load. This topic is super important to managing the relaxation of COVID restrictions.
My wife requires 4 liters/min. of oxygen 24/7 for her COPD. If I bring home covid and she becomes infected, she probably won’t make it. When we hear statements like “this mask will work for most”, we know we are not in that group of “most”. We are in the ‘must be successfully vigilant at all times’ group. In broad terms, in how many days of your life have you had an actual chance of dying? I know that over time, the 98% filtration rate of some N95 masks also come with a 8-10% leakage rate, meaning you are not getting 98% filtration. We use P100 masks (0.25% leakage); with a surgical mask over it if we need to filter exhalation.
For many, ‘source control’ is the opposite of PPE. Source control assumes an infected person and works to reduce transmission in the community; identify the infected, contact tracing, quarantine, if we are overrun, lockdown, repeat; PPE is for individual protection; masks, gowns, gloves, goggles. I see $50 billion of the pending covid bill allocated to covid testing. Is there $50 billion for PPE for everyone? I did hear about the releasing of $25 million for essential/medical worker’s PPE. It sounded like a drop hitting the bottom of an empty bucket. We need much more.
If I wear PPE successfully, I will never need to be ‘identified’, because I won’t become infected. Does that make PPE the best version of source control? Just about everyone involved in our efforts to defeat covid is for ‘masking’, and I applaud the efforts to find/make higher filtration masking for the public. I haven’t seen anyone promote the government’s arranging, manufacturing, and distributing appropriate high filtration masks for the general population. This is key. It will cost quite a bit less per person than the average cost of a cell phone. One obvious point of distribution would be when people are vaccinated. They will have 15 minutes to obtain masks for themselves and their family members during the observation period.
The most practical way to prevail against the virus is under the rubric of “We never want to do this again”. Why, because our response will not only be antigen specific but also directed toward maintaining clean, virus-free air to breathe during the pandemic. Masks do the latter, as does ventilation and air filtration. Our aerosol specialists have been stepping into the void and promoting specific actions to clean the air of virus in enclosed spaces. Aerosol specialists need more authority in current and future planning and execution. Source control becomes the third element with fine control.
The important discussions regarding the opening of schools are also a surrogate for opening many other aspects of enclosed-space society, e.g. office space, large elevators to the 50th floor, mass transit, theaters..
Misc.
What are the plans to product all the polypropylene we will need for the` many thousands of portable air filtration units we need?
Uses of N95/ with exhalation port:
fully vaccinated -give equivalent of 3M Aura 9211+. Distribute when vaccinated (and give appropriate masks for the entire family)
relatively home bound seniors/high risk +/- multi-generational dwellings, many people won’t tolerate a non-ported N95 mask 24 hours a day
for family members in dwellings with a + covid family member (who should wear a non-ported N95 as much as possible
Good article. A few thoughts on vaccines and why they have not been greeted by dancing in the streets.....
- A lot of the population doesn’t believe the virus is serious, and some have behaved as though nothing is going on. Why would these people rejoice about a vaccine?
- Whoever delivers a message in America is likely to be disbelieved by 40% of the people. Trump told us we’d have mass vaccination by the end of 2020. I instinctively didn’t believe him. It turns out he was exaggerating, but not terribly. The roll-out has been far quicker than expected. But who wants to give the Trump administration credit for supporting the development of the vaccines?
- Poor messaging by Biden. He reacted to Trump’s pretense that the virus is nothing serious by saying relentlessly how awful things are going to be. This is not what people want to hear. We’ve had a long, hard year. Tell us that if we stick with this a bit longer, success is on the horizon. When you’ve been losing a game, and the game starts to turn in your favour, you don’t take your foot off the gas and let your opponent back in the game. But you also shouldn’t dwell on the negative. (The only messaging I've seen that got this right was a commercial for the Ford Motor Company. How strange is that?)
- Media desire to look for the negative. We are vaccinating 1.4 million per day. That is fantastic. We are far ahead of most countries in the world. But if you read certain sections of the media, the sole focus is on the “inequity” of who gets vaccinated before whom. Distribution has been far from perfect. But with an infectious disease, each person vaccinated helps the whole community.
- Complacency. Most of the population has little memory of times when infectious disease imperiled whole societies. We just expect these things to be fixed.
I'm interested in the point about risk compensation. Because of my interests in urban transportation, I've thought about this mostly in the context of driving. And there, it does seem like risk compensation is a major effect. I've heard that roundabouts are a lot safer than four-way stops partly *because* they feel more complex and risky, so people pay more attention. Similarly that wide lanes and absence of street trees, which are often proposed to make streets safer for drivers, end up making them *much* more dangerous for pedestrians (because drivers feel safe going faster, while speed is a much bigger risk factor for pedestrians than narrow lanes, and trees save pedestrians).
If I were to try to explain why risk compensation might be more significant in these cases than in many other cases, I would guess that it's because one set of risks is very visible to the people involved, while the other set of risks is very invisible. Mitigating visible risks might then encourage people to take a lot more invisible risks.
In the cases where harm reduction strategies are much more important, it seems to me that all the risks might be equally visible, so that people are unlikely to overcompensate. But this is just a guess as to what might be going on, if I'm in fact right that risk compensation is much more important for some risks than for others.
Long COVID. Not just the human toll (much of which is yet to come), but as another special case of institutional and cultural inertia when it comes to integrating newly emerging evidence and realities into older paradigms, and marginalizing of voices and experiences that don't fit the main narrative. Even with all the great pieces by Ed Yong and others, and growing acknowledgment by experts, and a robust network of support groups and advocates, it remains the elephant in the room. No one knows exactly what to do about it, and few really want to talk about it (except as an afterthought). It potentially affects so many people, but continues to be left out of cost-benefit analyses and policy discussions because it's so hard to quantify and so unpredictable - it's still just cases, deaths and hospitalizations. The people I know who are skeptical about the seriousness of COVID or value of precautions think exclusively in terms of death/ICU and preexisting conditions; Long COVID isn't even on their radar. Yet like masks, aerosols, ventilation and all those other blind spots, this should not be novel or surprising given what we know about post-viral conditions. So again, this huge disconnect between what is known, and what is actually internalized. It's another massive failure of communication.
But with Long COVID most of that belated recognition was driven by the efforts and insights of patients themselves, which I think is really interesting and significant. This article "How and why patients made Long COVID" summarizes those developments and implications:
He has me convinced that based on how vaccines are being distributed, expecting to NOT have a B117 surge in the U.S. in the next 5-12 weeks is at this point magical thinking. The optimism was nice (if disorienting) while it lasted...
However, it could still happen AND still be not that big a change in the curve. The virus is inexorably running through available hosts, transmission is harder
All of this talk about the K-shaped recovery related to Covid has me thinking a lot about how quality of life and employment seems to be trending upwards for white collar workers and trending downward people in blue collar jobs.
Anecdotally, it seems that for parents who are white collar workers the new flexibility in remote work has allowed for a more equitable share of parenting responsibilities. I wonder if this effect is seen in blue collar families or if it is reversed (things are getting less equitable) due to financial hardships and less flexible working conditions brought about by covid.
In a similar vein, we might be seeing similar K-shaped effects due to school closures and remote learning. it seems that the children of parents who are financially able to have reliable internet, a flexible professional job, and the ability to afford other technology are going to do better than those who don't have those things.
The businesses doing well during the pandemic, such as Instacart, Amazon, UberEats etc. seem to also be adding to this trend. While wealthy people are saving time and energy (and lessening their potential exposure to covid) getting their packages, groceries, and meals delivered, these things come at the cost of businesses that offer questionable value and benefits to the people they employ.
I’d kind of like to go back to some of your earlier work related to Twitter and Tear Gas and how lasting social movements are built and change can be created. Because social media has caused so much harm, it’s hard to untangle those harms from the supportive or beneficial role that it can play in helping to build movements effecting social good. And maybe part of that — is protest losing its efficacy? If so, why?
COVID variants: Much epidemiology but minimal mechanistic explanation. Looking at this topic as a pharmacologist, I suspect that variant spike proteins bind to the human ACE2 receptors more tightly. Therefore, fewer viral particles are required to produce COVID symptoms. Asymptotic infections become symptomatic, and mild symptoms become more serious. Put another way, the viral load required to cause disease has been lowered.
The actual spread of variant virus is not changed. Virus - aerosol interactions and properties are not altered.
Understanding this biology should help public health responses and messaging. Wearing tight-fitting face masks becomes even more important. Mutations to a more “potent” virus was probably inevitable.
I wrote to you once previously; I had a serious reaction to my first dose of the Novavax trial vaccine and declined to take the second injection. I am continuing in the trial to provide data (blood samples) for “one-shot” subjects.
Now that there is mounting evidence in favor of dose stretching strategies. Why are authorities not taking them into account. Also why they dont even explain why they made such decision.
When the pandemic us behind us, i wonder if we are going to really learn any lessons. Looking forward to your piece.
On another note, i wonder what is very important research that better be done during the pandemic to help us advance understanding of epidemiology.
My high school senior wants a job as a beach attendant to fill her last few months before college, attending to tourists, where we live in Florida. Job starts mid-march. She'd be masked, and it's outside (obviously). Variants have me a tad nervous, but I guess I'm wondering how to best transition kids out of the house and into the pandemic world on their own.
Our neighbor's daughter, a year ahead of yours in school, has had a job for the past 2 summers (one pre-covid) as a swimming pool lifeguard. It is a community pool. She did not get covid (or she got an asymptomatic case).
She did not have to go inside on site. I would think the risk would be greater where the attendant showers or changes inside.
Of course some beach crowds are rowdy and some people may be inclined to get too close for too long. You probably know your beach and what is likely to happen.
Thank you for that. We will likely let her go ahead and try it out. If the Super Bowl outside gatherings didn't cause a spike here, I guess a bunch of people on the beach won't either. It scares me because Florida is wide open, indoor concerts with 500 maskless attendees, open restaurants, bars, you name it, and no mask mandate. This is just our reality and I've got to let my kid learn how to maneuver in it. I tried to prepare my kids for all the other hazards of growing up, but "How to enter adulthood in a pandemic" wasn't in any parenting books. Thankfully, I do have all the faith in the world that she will be exceedingly responsible, it's just her nature. And hopefully she can get the vaccine by summer.
I think you needn’t worry about the job. Outdoors, with a mask, not usually too close to people and getting lots of sunshine and Vitamin D. BUT don’t go to the beach in a car with four friends and no masks with the windows closed!
I'd say if you're masked, outdoors, that reduces the risk a pretty considerable amount. In the end though the decision to accept the risk / how much risk to accept is up to your kid!
She's still a minor, so I've got a little bit longer try to help her make the *most* sensible decisions. And thankfully, we've got a good enough relationship to where she listens to the information we share with her. This is less about the specific job, and more a general pondering on the generation that's hitting lifetime benchmarks and developing during this pandemic and all its phases.
How do you think she's been affected by having her senior year of highschool be virtual / the pandemic in general? Definitely a fascinating thing to ponder how loing we'll be feeling the reverberations of the impacts of the pandemic.
In Florida schools have been open since August, so I know how she's been affected, deeply. When 90% of her friends went back and we kept her home to keep crowding down...in a state that has had essentially no governmental guidance and let it be a free for all - and had cases rip through schools and teachers have died and neighbors have died and people are essentially crumbling all around, but Florida still has hotels open so those who are fine can come for some sun?
I know I'm new here, but this has been fun for my first pandemic post.
I personally would be fine with masked, outdoors activities for any sensible teen. It's a double protective effect: sunny outdoors are much safer; masks make it safer. The threats in such settings usually are the breaks/lunch/food. I'd encourage her to learn about transmission mechanisms: chatting indoors during lunch break isn't okay just because it's a break! Once she knows how it works, she can keep herself safer.
1) Future pandemics caused by lab leaks or bioterror could wipe out civilization.
2) The best insurance policy against this scenario is to have everyone acquire and familiarize themselves with the use reusable elastomeric respirators with P100 filters (or equivalent/better PPE) and have government set up a worldwide, permanent, testing regime in order to detect the spread of new, potentially dangerous viruses (especially those with long incubation periods) in humans.
Well, the best scientists on COVID are being ignored. The doctors that got the most important treatment, corticosteroids, approved in the US (thanks to UK researchers) can't overcome the bias to get the next great idea in practice. (Dr. Pierre Kory and Paul Marik). According to 20 peer reviewed placebo controlled studies from independent researchers all around the world, we can save a good fraction of the 60,000 people dying of COVID-19, with one drug alone. The FDA is incapable of moving forward. Procedures mandated by Congress don't give them a budget to study drugs-- they rely on for-profit corporations to advocate for them. But what for-profit company can spend millions of dollars advocating for a non-profit generic drug so their competitors make money? The Bill & Melinda Gates foundation is stepping up... but it will take months and we already have much more statistical rigor than an expensive "Phase 3" trial the FDA uses as gatekeeper.
We have a drug so safe, it has resulted in 18 deaths, over 30 years, with a population of 300,000,000 people taking it regularly... that's safer than Bologna! Safer than Chicken Soup! If it might work, try it! Death rates for COVID are lower in countries where it is in common use or administered as a prophylactic, such as Peru or India, or sub-saharan Africa.
I think this has flown a bit under the rader outside the UK, but any thoughts on the recent decision to NOT prioritize certain professions? There had been plans to potentially prioritize people working in e.g. education, police, military. The policy now is to simply go by age with the main argument being that introducing an extra layer of complexity (the NHS which leads vaccination does not have that job info) will potentially slow down the overall process. I would have been a beneficiary as I work in academia but I think overall this policy makes sense, in that the current vaccination rate has been relatively fast in the UK so why risk introducing an additional layer of bureaucracy. Thoughts?
Through 2020 I had this growing feeling, or more like I was experiencing an "intuition" coming into being that there is an inherent paradox where "personal freedom" taken to its logical conclusion actually results in the loss of freedom. If our institutions (eg. CDC) and leaders (eg. Trump) had been quicker to act the coronavirus may have been containable to some degree here in the US. Maybe not to the extent that it was containable in South Korea or Taiwan (or other smaller, more homogenous nations), but it would have been more containable. But, since they chose to prioritize "personal liberty" over all else now we have more than 500k dead, or kids haven't been to a normal school or been able to hang out with friends in almost a year and I feel a whole hell of alot less free than I did at the beginning of 2020. Is there any kind of overlap between this seeming paradox and institutional cognitive bias? How do you get the firebrand libertarian carnival barkers to see that individuals can't actually exist without community? Why is it so hard for some people to understand that we are actually part of an interconnected whole?
I want to pick up something Baby Djojonegero (hope I got that right--I couldn't cut and paste it) said on the 25th: "Thanks for sharing the newsletter. Our family is definitely familiar with the discussions here because my spouse is a teacher (and we also live in Oakland). And every time I hear the phrase "the powerful teacher's union" I roll my eyes. Sure, they're so powerful that teachers' starting salary is $70k and they earn overtime pay and generous retirement. "
Regarding unions, which President Biden has made a topic right now, can anyone contribute some starter reading on whether it is possible to adapt them to do something I think is needed (or shoot down my thought)?
Is there a way within a conceivable union structure to have a workable process to remove the bad eggs? The people who just can't learn how to teach well, the police who just can't quit doing what society says they shouldn't, etc?
5 stat presentations choices that have led to bad public messaging
Early focus on mortality rate locked the public health community into insisting that it was particularly lethal--as much as 2% mortality. When evidence pointed to it being, primarily, super-transmissable, those numbers, by mathematical law, had to correspondingly fall. But to admit so would be to seem to agree with Trump (damn him), and so...The result was felt in the summer surge, when people learned for themselves that most cases were asymptomatic. No worries!
"Test" positivity numbers became the gold standard for spread. The number was treated in the press with belief, and even today the NYC still reports cases numbering 28 million. Which some dummy reporter turns around into a "we will never reach herd immunity" article. But we all know that number ignores every person that wasn't tested! Worse, states, cities, unions and politicians learned that they could game the testing to get the numbers they wanted. Worse, the utter lack of any meaningful testing at all in the spring led to--a still existing curve-- of this low number of cases leading to a tremendously high number of deaths. Gosh those northeasterners are weak, and such bad doctors! In the end, a mostly deceptive, counter productive, somewhat deceptive, subject to manipulation piece-of-crap stat that continues to mask the true spread. Instead, we could have focused on...
Total daily hospitalizations were never tracked. Tracking hospitlization levels was of vital importance because it let hospitals show their communities and states what remaining capacity they had. Sho 'nuff. But daily totals don't take into account the new arrivals, in a clearly identifiable way. For that, you need the new daily hospitalizations total. Unlike tests, hospitalizations can't be gamed, massaged, or easily misrepresented. If one assumes a steady rate of infections per hospitalization (which I do, Occam's razor), charting the rolling changes in daily new hospitalizations will give the public a true number, that you could then reverse-engineer into PROBABLE community infection numbers.
Hospitalizations and deaths are related, SAY SO PLAINLY. Just an armchair epidemiologist here, but based on what some real epi from Columbia U said (est >110M infections), I would put it at about 125 cases to produce a hospitalization (as for LTC facilities, your results may vary...much worse rate). Now add to that guesstimate, this little nugget: Deaths just hit 500,000, and total hospitalizations are somewhere north of 900,000. Let's dumb that down for the public and call that a one-death-for every-2-hospitalizations. I think it would have mattered if Tony F. had stepped to the mic and said "If you go into a hospital with this, you have a 50-50 chance of dying: Heads, you leave by the front door. Tails, you leave out the back."
Still have never corrected the stats to reflect what went wrong last spring. Lets take MIS-C cases as a teaching point here: (see chart, https://www.cdc.gov/mis-c/cases/index.html). When these cases first arose in the spring, what was the reaction? KIDS GET IT TOO, PANIC! (If it was your kid, awful, not funny). But when the summer surge in the south came, cases of MIS-C didn't explode, they rose far short of the NE peak. Numbers didn't significantly rise again until the holiday surges, where they met the same daily level as the summer, but with longer tails. Occam's razor again, but you probably have a fairly accurate picture of the instant horror that the virus inflicted on the Northeast. Looking at it from here, the NYC area could not have produced those deaths, hospitalizations or MIS-C cases that close together, unless something like 10 million people got it over a 2 week period.
What is on my mind? Modiism. A threat that no one seems to be paying close attention to. Since 2014 is encouragement of demagoguery, use of social media to manipulate opinions, weakening of institutions that act as check and balances and cyber trolling and abuse of anyone who criticises the government. (Ask Meena Harris, Rihanna or any journalists, especially women, who get caught in the Indian right-wing’s crosshair)
While China’s crackdown on dissent is covered in great detail, India is getting away with far more as it carries the “democratic” tag.
But more than just the political part, as a social media student, take a close look at its manipulation to control the narrative and create a comprehensive alternate reality despite crisis on almost every front. An effective textbook for any leader to gain complete control of a democracy. Trumpism was a pale version of Modiism.
Thanks for all the great writing Zeynep! I'm curious if you have any updated thoughts on the dispersion theory of Covid spread. Your September article was such a fascinating read - I share it and refer back to it often, and am surprised the theory hasn't gained more traction in the public discourse.
Hi Zeynep,
One theme I notice a lot in your writing about covid is some variant of “it didn’t have to be this way.” Yet that same theme never finds it way into your writing about democratic retreat and white supremacy, and I feel like there is sometimes a disconnect between how the latter causes the incompetence and malevolence that led to such bad outcomes in the former. I.e. no one ever says about racism “it didn’t have to be this way,” so maybe when it comes to covid, it really did have to be this way because we never fully addressed our cultural/societal demons. Could you touch on this at some point in your writing?
Those are very thought-provoking points!
Thanks!
Still schools. Our 10 year old is going back in late March, and in the presentation last night they spent an awful lot of time talking about deep cleaning and using sanitizers. Air circulation and ventilation only came in at the end. It’s like they are STILL worried about the wrong items months after we know it was aerosol based.
We're lucky that our school has recognized that ventilation is important in their communications. To be clear, we're not back to in-person school yet, but I'm encouraged that they will be taking the correct precautions.
You've covered but bears repeating: the media drumbeat around virus variants drowning out coverage of the astounding success rates of vaccines; and often failing to include data about which variants vaccines may be effective against. Are people throwing up their hands — "I'm just gonna get it”—in part b/c of this? Have anecdotal evidence from Americans in their 30s and early 40s says so ("I have a strong immune system. May not even work against anyway..." throw up their hands) Is it naive to want coverage of variants only when it can include studies showing effectiveness of approved vaccines against each? What would your messaging be to mainstream media and to state health orgs/Biden Admin about how to communicate most effectively about variants?
Excellent question, the last sentence.
I've been thinking a lot over the past year about the ways cooperation evolves, because we've been witnessing emergent etiquette and social stigmatization in real time, around things like masking. I have been modeling the world as a giant iterated prisoners dilemma, and the rate of defection is so much higher than I would have expected. It has really changed the parameters that I use to model my fellow humans, and not in a good way.
“Rate of defection” is a good way to put it. My mind is very much on polarization right now, and how strict adherence to ideology (like framing mask mandates as government overreach and a matter of freedom) causes harm to others.
I have a pet theory, totally unsupported by any actual research on my part, that humans are evolved for viewing things through the lens of cooperation/defection, and in the absence of strong evolutionary pressure (like in a country with lots of wealth and resources) we redirect that cognitive bias towards slotting people into in-groups and out-groups along weird axes, like professional sports teams, or political parties, or mustard-vs-ketchup-on-hotdogs (the answer to which, by the way, is mustard, and anyone who disagrees with me should be burned at the stake.)
I also have a shorter reply to your part about how having wealth and resources leads to division: In many cultures in idyllic settings (temperate beaches, available food and water) one finds very brutal religions.
My pet theory, born I am sure in my growing-up setting, probably would be better informed if I would get around to reading Sebastian Junger's Tribes.
This is long, and I'll state the conclusion first: In this country it has become all about race, with a subtext of upset over free riders. This has been inflamed by politicians who use "let's you and him fight." Over the past few years I have been thinking over the connection between what has been done, particularly in the South, and the example of the partition of Africa, in which the European powers divided Africa by putting opposing peoples together in the same country, and knowing what they were about when they did so.
I grew up in the deep South of the U.S. My family was interesting. My schools were segregated all the way through college. Racism was just how things were. Negroes were accepted in their place and all was calm. Truman had integrated the armed forces and there was a bit of a kerfuffle about that, but no big deal.
It was a pretty quiet time. the Depression and the War (WWII) were over. Segregation was established and little considered within the white population.
My mother was interesting. She had been imprinted by her racist mother. Grandmother's motivation seems to me to have been maintaining class superiority in a poor country environment in northeast Texas. Mother believed deeply by the time I came along that racism was wrong, a belief apparently founded in her experience teaching school in El Paso. She loved the people there. But she also believed that her visceral reactions to Negroes would never fade. My parents traveled together to participate in a form of theater. Mother ensured that our live-in sitter for these absences was a Negro woman, a schoolteacher. My father mumbled a bit about why was this necessary, but there was not much use going up against my mother, or her mother before her.
Louisiana ensured that integration would be done in the hardest way possible, by integrating the senior year of High School first and working down, year-by-year. Mother was a reading specialist, and by the time the integration reached elementary grades she was flooded with students who could not read. Of course by then the school funding was being cut year by year in Louisiana. She had to retire over stress of being unable to do a good job.
My father was a computer pioneer and whiz at the oil refinery. One day they hired a Negro man in his very white collar unit and my father was sure it was tokenism and grumbled about that. Over time he said the guy was good at his job. Over more time he (quietly) saw to it that as the industry-leading mainframes were retired from the refinery they went to the local Historically Black University and were set up and maintained there. He spent a lot of time at the university working with faculty, staff, and students.
I spent my career at the University of Houston, which was the perfect place for me. It was called the most diverse major research university in the country. It is just a few blocks from where George Floyd grew up. Houston is just about as good as the country does at integration. Yet, my nephew from Venezuela can't understand why we in this country care what color people are. He says it doesn't matter in Venezuela.
In the eighties I thought we had turned a corner. We had not. Growing up, I thought that as my grandmother's generation died out their views would go with them. They did not. I know from my nephew that race does not have to be what it is here. I also see from Venezuela that if it is not race, division can be sown in another field. I see many politicians over the years sowing these fields.
I'm still thinking about this, and that is where I am now.
I like both but dislike hot dogs so I’m not sure where that leaves us ;)
I agree about being evolved to categorize and group, which leads to “in” and “out” groups. I guess my wondering is about how, knowing that bias exists, we can acknowledge it and still manage to live together in shared spaces on a shared planet. Leaving out fantasies about Mars and Seasteads and whatever, which still can’t escape the quandary of how humans live together.
I am pretty pessimistic about changing fundamental human nature. I think in general our best bet is to develop technologies that render the problems more tractable, such that they no longer become contentious (which is my approach to climate change). It's popular to crap on techno-types for being utopians, but I think people who believe we can just all sing kumbaya and agree to bike more are the utopians.
First ketchup and now bikes?! J/k I don’t like biking very much, though I am a pedestrianisation advocate.
I don’t think we can change the fundamentals of human nature, either, but I do think (and research backs this up) that there is far more cooperation in our nature than we’re usually led to believe. I’m somewhat techno-skeptic but only to the point that I’d like to see far more consideration of negative consequences that we might not notice at first dazzle. Tech, I hope, can help us reacquaint ourselves with the better parts of our nature that were always there anyway but I’d like it to serve us rather than us serving it. Honestly, you make a good point about utopians, but I think I’d caveat with utopian thinking is maybe the result of trying to ignore the slow, boring day-to-day work of making change and building social good, and both pro-tech and anti-tech people are prone to it.
All during the election I was trying to point out that (mostly in Facebook, also in NYT comments) polarization is itself more dangerous than extremist thinking. It seems obvious to me in so many ways, but many otherwise tolerant and open people seem to be absolutely unwilling to give up their emotions about and endless chastising of "the other side."
I guess it partly depends on what the situation is. Where I live (Montana), it feels very much that polarization and extremism are feeding off of each other. For example, just today a committee in the legislature shut down an attempt to confront the threat of white supremacist groups by scoffing at the idea that they're either a threat or that they're active in the state (this is Montana! This is not new, people!). At the same time, they're considering a bill to categorize Antifa as a domestic terrorist group. I guess without polarization the extremism wouldn't be enabled quite so much, but in this situation it's almost a moot point wondering which is worse. Every place is going to have its different struggles, though!
The uncertainty about any specific defection leading to a bad consequence probably makes defection more likely.
Adding: I think the norm breaking modeled by our glorious dear leader over the last four years probably had a significant effect on it.
For me, what has been revealed by the pandemic is how global warming crisis, economic inequality, and toxic nationalism trends all are part of a stew of crisis that's going to require a global movement. Keep doing all your great work, I remember you from my UT-Austin graduate study days, and I'm constantly forwarding your posts and Op Eds to my social media feeds! - Kyle
Writing this as I'm in training at work (via Zoom) and also keeping an eye on my younger child's schoolwork. He's obviously missing the in-person attention and social interactions with his friends, but I've relished glimpses of his interactions with his teachers (which I previously didn't have access to) and other benefits (him being able to sleep in, having more time around vs schlepping to and fro). I wonder at the factors that explain difference between the open-the-schools-now push (majority of white parents) vs those who prefer to wait. I also wonder at how that transition back to school and work will be.
Our schools have been open since September, with remote options. A part of your question could also include learning differences between remote vs. in-school learners within the same district. We opted to just homeschool (my kids loathed remote) and the “getting as much sleep as they need” thing has been huge, though the loneliness also is.
Yes, learning differences is a factor (a huge pivot for my child's Montessori-based school!), but also trust in the school (district), personal ranking of considerations (safety, loss of academic/sports progress), etc? Also in a way, sadly many current options offered by schools combine only the worst parts of the new reality, e.g., a few hours in-school (requiring drop off and pick up), in-person proctoring of remote learning.
So true. Most of my kids’ friends who are doing remote have to have a dedicated adult present to help them through it. It’s so unsustainable and/or unattainable for so many.
This newsletter post on schools just came into my inbox this morning. It’s more general, along the lines of “how do we help people see this is a systemic problem” but a very good read, and definitely worth clicking over to read Part II if the first part speaks to you: https://thewhitepages.substack.com/p/teachers-parents-and-cans-full-of
Thanks for sharing the newsletter. Our family is definitely familiar with the discussions here because my spouse is a teacher (and we also live in Oakland). And every time I hear the phrase "the powerful teacher's union" I roll my eyes. Sure, they're so powerful that teachers' starting salary is $70k and they earn overtime pay and generous retirement.
I guess it's even more relevant then! Kudos to your spouse. It really drives me nuts how willing people are to blame teachers for everything. Our state is so happy to constantly shave away at public school budgets, and then people start attacking the teachers or the school board for not doing enough.
That gets to the meta issue, I guess, which is how to help people perceive the problems causing the problems they're upset about, and then take action on the actual problems rather than the perceived problems.
It's going on two months now and the state capitol where I live (New Mexico) is still cut off, surrounded by fencing and cops with flashing lights, despite Santa Fe being about as much a hotbed of right-wing extremism as Somerville or Berkeley. The NM legislators recently got in trouble with the fire marshal because they had effectively sealed themselves in, with no emergency exists. I'm curious whether people are seeing a similar ongoing freakout in their own states.
Our state just legalized concealed gun carry on campuses and in the state capitol building so it’s kind of a freakout in the other direction.
Although those people will say it's in the *same* direction. They just think that the best defense is a good offense, rather than getting rid of guns in public spaces.
Well, yes, that’s the general and very exhausting argument :/
Hi Zeynep! Thanks for doing these. I was wondering if you could recommend sources or articles to read to learn about whether the covid vaccine limits transmission? I got my Pfizer vaccine yesterday (I work in medical device manufacturing) and am trying to figure out whether I should see friends or family or continue to isolate?
I thought this was a good article, though it's probably useful to find a few others that disagree with it, and see whether the points of disagreement seem to count in favor of this one or those others: https://www.vox.com/future-perfect/22291959/covid-vaccines-transmission-protect-spread-virus-moderna-pfizer
The human toll of Covid-19 worries me. I'm not looking at the 500K deaths or the number of people who demonstrably have the disease, or all the families who have lost members to it. It's the more the lasting effects on people who are victims only of pandemic societal change -- and not only folks connected to medicine in some way. Sure, the doctors I know socially are burned out, even a radiologist, who has been working with people coming off intubation. The NYTimes today had two opinion pieces about burned out nurses. I expect that kind of reaction. Yet the PTSD seems to stretch way beyond front line people to the millions who have been in some form of quarantine for close to a year. I have seen nothing (and I'd love to know if I'm just plain wrong) about plans to deal with the mass of PTSD cases that are likely to arise as the pandemic fades. The social effects will not disappear when the disease parts of the pandemic is declared officially resolved.
Prior to the pandemic I worked on an initiative to equip nursing home staff to provide trauma-informed care - there was interest driven by an Obama-era regulatory change requiring the adoption of a trauma-informed approach for older people (and inevitably for staff as well). The need for this kind of work in that industry is now unimaginable - and your point about the massive experience of trauma (primary and secondary) at the population level - and the resulting PTSD - is right on point. The human brain responds to the experience of trauma with an 'amygdala hijack,' with that portion of the brain taking the prefrontal cortex temporarily offline and flooding the body with adrenaline and cortisol to prepare a fight, flight, freeze or play dead response. Unfortunately, social media algorithms now promote content that triggers this same response because anger and terror are VERY engaging and tend to keep people on the site (and thus giving up data).The pandemic is traumatizing the public, and so is time spent on the major social media platforms - a downward spiral, I'm afraid.
Your comment on the experience of trauma applies to so many of our current issues. I too find myself being enraged by things that are important, but would be better considered with less cortisol.
I communicated some of my feelings to the mainstream media I consume that increasingly editorializes and uses inflammatory adjectives in news stories and headlines. Everything is built for clicks.
Such great observations. I pulled back from mainstream media significantly after the 2016 elections and really limit my exposure, trying instead to read and listen to journalism and analysis that is not driven by the clickbait business model. I subscribe to four substack e-newsletters, including this one, and I'm a member of Tortoise, which is a UK based slow journalism organization that publishes articles to read, podcasts to listen to and produces almost daily 'thinkins' - a journalist invites several guest who address a topic, with very thoughtful questions, and then members who share ideas in the chat are brought in to contribute, not to ask questions but to share ideas. It is beautifully moderated and the quality of the conversations is extraordinarly. It's eighty pounds per year, but well worth it - I wish we had the same model in the US, but their topics are relevant to us and I support the model. I'm trying to spend to support work that isn't built on commodifying our attention.
And people who don’t have the option to quarantine, too, especially people in customer service who are exposed and don’t want to be, having to manage anti-masking anger, etc.
Very true. All the people we’ve relied on to make life under the pandemic somewhat normal.
Given that you have expertise about both the sociology of pandemics and digital sociology, I would welcome your thoughts at the intersection of advancing public health (via communications and modeling / shaping social norms) and the digital/social media environment that normalizes antisocial behavior and spreads disinformation far, far faster than factual information. I'm concerned that progressives and many public intellectuals are fighting with tools that are no match for the digital medium and those with the skills, funding and disregard of ethics to use the medium to drive polarization and paranoia. I don't see how human communicators trying to frame effective messages can win against bots and trolls that drive trending topics and warp the whole ecosystem.
I’ve read several unsettling articles about disdain for public health agencies. It’s as if they are being held to a standard of 100% accuracy rather, neglecting that their role is to provide guidance given the best guesses at the moment. Their failure to live up to unrealistic expectations is reflected in dismissal as incompetent.
I do take relief that this disdain extends beyond public health. During former work consulting for the National Interagency Fire Center I heard many complaints about impatient members of Congress who needed to know with precision what was going on in a wildfire when it was impossible to know. The people in the Center were labeled as either know-nothings or liars.
It just seems to go with the territory of working on tough and complex problems and dealing with those who want immediate gratification.
I agree that most people have little grasp of complex problems across many fields, and when people don't know much about a topic they tend to search for something they do know about and reason with that (filling a cognitive hole) - usually the mental model they're using is not applicable and produces unproductive reasoning and conclusions. That said, fields that work at the population level are particularly subject to the use of unproductive cultural models that explain social problems by blaming marginalized communities and/or reasoning from fatalism (nothing we can do - too big to fix - not my problem).
I have to agree. I’ve experienced it personally far too many times.
This reminds me of something I saw yesterday about how well-meaning wealthy liberal-types try to launch things like local newspapers but expect business plans and profitability, whereas similar wealthy right-wing types are happy to pour money into rags like the Epoch Times, making it free and knowing it’ll never make money but also knowing they’ll reap rewards in other ways.
What had me thinking a lot these days (weeks, months) is the connection between the covid response in our western societies / states and the continued undermining by a certain branch of politics of our public service system and the health system in particular. A health system has at least two aspects, the private aspect (I am ill, I need a doctor), and the public aspect (how healthy is society as a whole). These aspects are intertwined with a reallly dangerous approach of economics. Running hospitals as businesses is a fundamentally flawed approach. Having no health crisis coordination ready to kick in between states (US or EU, not much difference) is dangerous neglect. Obviously in the US the first year of covid has been a complete political dissaster, but I think the problem goes much deeper. All politicians in the last 20 years that had hospitals closed, had refused pay raises for nurses, or pushed clinic executives to squeeze out the last bit, are personnally resposible for the mess we are in.
I've been thinking about the ways in which extreme cultural individualism in the U.S. has reduced thinking about health to the private you describe (I'm ill, I need a doctor). Part of my work involves helping public officials (in health and human services) frame communications in ways that help people see systemic and structural causes and solutions. COVID-19 has foregrounded for me how much of Americans' reasoning about health is purely private / individual. The concept of population-level health outcomes is virtually out of reach and hard to think for so many Americans. This affects behavior and it also affects reactions to policy and practice choices - including opposing choices that have evidence and benefit most people - and ultimately all of us.
Both of you are talking about something so vital here. I live in a very conservative county with anti-masking county commissioners who appointed a prominent anti-vaxxer to the county health board a little over a year ago. The county health department itself does an excellent job of working on public health, including Covid, yet has been hamstrung by the board and commissioners. It’s almost exactly that public-private worldview disconnect: to the health department, it’s about what will promote public health at the county level; for the commissioners, it’s about individual choice and freedom. It’s an unequal disconnect—there’s not equivalent blinkers on both sides, just on the anti-public health side.
Sorry to hear about that split between the professional health sphere and the political part. Here in France compentence and incompentence seems about equally split, but unfortunately for both the reflex is never to try to explain but to go "law and order", more and more stupid rules, that are not based in science, but where they suppose is the least resistence.
The point about resistance is also a big one. How can we manage big crises when it’s not a matter of what works or what’s best practice but of what people will put up with?
But the other side of it is that people will put up with more if they believe the issue is serious and their action will do some good - and everyone else is going to do it too. That is where leadership - including by example - and messaging can make a real difference.
I absolutely agree. Probably the biggest thing that came home to me over the last year was how important good leadership is.
That is true. I have had lots of conversations where I have said "look at what they are doing in Australia / Germany / Taiwan / wherever", and the answer is simply "You couldn't do that here."
Americans tend to say that about any big desirable change that would make our lives better. What is really interesting is watching up and coming leaders who are asking us to imagine that we can actually do big things and build a possible better future.
Karen I am an immigrant of 20 years to the US, and I feel the same way. It seems really hard for Americans even to think of prioritizing individual action for the common good. Maybe it could have been achieved with consistent messaging. New Zealanders are individualists, but they responded when their PM asked her "Team of 5 million" to "go hard and go early". She used rugby coach language to speak to a nation of rugby fanatics. In the US, it was left to states to lead the detailed action, but even governors who tried to deliver a strong consistent message were never going to get their message supported by everyone in the state when the message from the White House was inconsistent and sometimes contradictory.
It felt last summer like we could have managed that kind of solidarity messaging at some point if we'd had different leadership. What I don't understand is why we're not getting it at the national level now, not really, not to the extent we need. You are absolutely right--no matter how good a governor was (ours at the time was very good), without national leadership there was only so much they could do, even just to persuade people to do the right thing.
I live in Ohio. Our Governor De Wine and his health director tried to do all the right things. He is a Republican and he struggled with the Republican legislature, who consistently tried to block him. And of course so many Republican voters listened first to the President. The Governor got death threats. The health director (who is Jewish) got accused BY THE WIFE OF A LEGISLATOR of being a Nazi, and had to have guards put on her house. She eventually resigned. Very sad.
Oh I remember that! I did a webinar with an Ohio doctor last May or something who was very impressed with De Wine's handling.
That is horrible. And there was so much of it. Our first county health director left due to death threats. I wish, really wish, I knew where this kind of insanity came from and how to defuse it.
This "out of reach" is even more difficult for them when going beyon a national level. For many people even in goverment (here in Europe same as the US) it is inconceivable that helping other nations get vacines, for example, is helping their own populations.
It seems so obvious and yet clearly isn’t to most.
Are you aware of any work on the sociology of media specifically? Things like what groups tend to work in media, how that has changed over time, as well as the role of media in the social life of consumers of it?
I love your Substack as the community is so supportive and open to ideas. I only use Twitter for news but when I was not able to fly back to my home in Canada Tuesday because the phone line to book 3 day mandatory hotel stay didn’t work, I took to Twitter about the phone line not working.I was shamed and repeatedly attacked and called “bitch” because “I was entitled” and shouldn’t be traveling. I had gone to see my 88 yr old mom in Florida after 14 months and her 2nd vaccine. Two days now and finally got through and on my way home. Had to take a 2nd covid test as the last one was outside 72 hour window. When I land I have to go straight to a government booked hotel. You have to take an uber there and then once in your room a self administered spit test and call Purolator to pick it up. After results are back in 2-3 days I can go home. Once again I have to take an uber home. Where’s the science? I live in my own home with my husband and I will quarantine in our basement apartment. Meanwhile I have spent 2k in hotels and ubers “quarantining” when it would be safer at home and I could donate the 2k to covax or any good cause. Sorry for rant but would love your thoughts
I think at least part of the issue is that although *you* would have quarantined, there's a good fraction of people in your situation who would have *said* they were quarantining and yet not done so.
Last summer, I went on a road trip to visit family in New Mexico, and while we were visiting them we went to an outdoor restaurant one day. After we left, I learned that New Mexico at that time officially required out-of-state visitors to quarantine for two weeks, and we had violated that. I happen to think that an outdoor dinner at a restaurant was very low risk, and in any case, my partner and I had been living a much lower risk lifestyle out of state than the family we were visiting in New Mexico. But even if one agrees that *I* wasn't in fact posing a risk in this case, it's natural to think that a good fraction of people, when told to quarantine *would* in fact pose a risk if they're not supervised.
As for the Ubers, those are likely higher risk than most of the behaviors you've been engaged in (you sound like you're generally quite careful!) but again, for a very large number of people (and for the ones that matter) the Uber is lower risk than sending them home unsupervised and asking them to promise to stay home.
Agree. The rule breakers ruin it for us all. But they also say that hotel rooms are in the top 3 places to get covid. I feel much more at risk with this hotel quarantine protocol. The frigid temperatures make it harder to get ventilation in an uber and these hotels were all built during the energy crisis in the 1970s which means likely substandard HVAC. And if travelers are likely to have covid what about the exposure to uber drivers?
You've talked about focusing on individuals versus institutions, and the need to address institutional failures versus swap out people. I'm specifically thinking of the GoT article, and the comment about how swapping out Mark Zuckerberg for $EXECUTIVE probably wouldn't change much. But how do you balance this with holding individuals accountable? What does institutional change (in general) look like, if not making personnel changes? How does accountability fit in?
For example, in August / September when many universities were reopening and the Big 10 couldn't decide if it was playing football or not, there were a large number of institutional failures (the NCAA, higher education costs, entertainment for college students), but also specific University presidents were making specific mistakes (e.g. Michigan president Mark Schlissel reopened dorms despite lack of access to testing and no accountability for safety protocols). How should we think about individuals vs institutions when talking about fixing problems and accountability?
I live in Sydney, Australia. And one thing I have noticed over the course of this pandemic is how far we're willing to bend the rules for otherwise competent political leaders.
Specifically in my state of NSW our premier Gladys Berejiklian is widely considered to have done a great job at managing the pandemic (aside from the Ruby Princess cruise ship incident early on in which infectious passengers were let out into the community with no quarantine). We have experienced several weeks of lock down and varying degrees of restrictions (caps on patrons at venues, weddings, public transport, mandatory masks etc.) but we have never experienced the tragedies that have happened in so many other places with overrun hospitals and mass unemployment (unemployment is an issue here too obviously but not to the same extent as most of the U.S. and Europe).
It seems that because of this success in managing the pandemic, public opinion by and large seems to give our premier a free pass on issues which in any other period would have posed serious concerns for her leadership. Without going too far into detail, she has knowingly failed to report the blatantly corrupt behaviour of her former partner (who was also a lower house representative) to either the police or ICAC (independent commission against corruption) and has openly admitted to pork-barrelling during election campaigns. She even went as far as to say she wears the criticism with pride.
Ten years ago we had a premier resign because he forgot to declare a $3000 bottle of wine as a gift from a private donor. Now our premier admits to pork-barrelling and failing to report her ex-lover abusing his power for personal financial gain and no one seems to care.
Is it inevitable that during a pandemic, we lower our expectations of our politicians? Is it possible to raise the bar again once (if) the pandemic is over?
That's really interesting - in the US, the governor of NY was highly praised for his handling of the pandemic and now is under fire for one aspect (underreporting nursing home deaths - and this is egregious) and it's not moved on to other allegations about him (sexual harassment, intimidation). I personally have very mixed feelings about him, and all of the negatives reported merit attention, but I must admit I suspect a right wing campaign to destroy him - well financed, probably using bots to spread these stories. It's a dilemma - I believe the stories should be reported, of course, but I also think the question of where the stories are coming from and why now are also important.
On the subject of cognitive biases and cognitive errors, we fund COVID research, and it’s frustrating that everybody feels so burned by the hydroxychloroquine experience that nobody wants to be associated with new treatments. Nobody wants to be the one who thinks of a treatment as promising if it doesn’t turn out well. Perhaps it’s the anchoring effect— if the treatments we are working on were proposed BEFORE hydroxychloroquine, they would be considered game-changing!
The other cognitive bias, I think, is that old, known drugs are treated like new, unknown drugs— like they’re going to be the next thalidomide or something. But one of the drugs we’re studying, fluvoxamine, is a relative of Prozac, for heaven’s sake. 13% of the country is already taking antidepressants (and I think upwards of a quarter of the white population over 60)— we know their side effect profile very well. Policymakers want even larger studies before recommending fluvoxamine for people who test positive— they want to “do no harm.” But it’s not like by NOT treating, we are really doing no harm— in the studies to date, 8-12% of the non-fluvoxamine group ended up hospitalized, versus ZERO hospitalization in the treatment groups. That’d be quite a trick for what is basically a relative of Prozac to cause 8-12% hospitalization, matching the harm of the no treatment and placebo groups— that’d be quite something to see!
Luckily some pretty wealthy Silicon Valley funders are supporting the ever-larger studies (as a small funder, we-- Parsemus Foundation-- move quickly to get studies off the ground, but other larger funders are coming in to run with them)— but are we going to go into the next surge and NOT use the $10 drug that could keep people out of the hospital and solve the hospitalization crisis? Are we really THAT risk-averse? And blind to the risk of non-action?
I've been wondering about the vaccine production efforts and logistics. I understand that manufacturing these vaccines requires highly specialized machinery and cannot be expanded on the short term. However, in the probably required longer term, expanding production capacity around the world with new factories should be possible, and governments could and should try to support those efforts financially. Or am I not seeing the whole picture, and that is already happening? I was expecting more news in mainstream media about production expansion.
Another thing that has been bothering me is the distribution of vaccines around the world. The richer countries (I live in the EU) apparently will get their entire populations vaccinated before looking around. And if demand for vaccines doesn't drastically reduce, because of boosters for variants, will this tendency persist? Besides, won't it be more likely that there will be new variants if many of the poorer countries don't have any vaccines at all?
I just started working on a group volunteer project to help get people in my local community connected to vaccines. Basically seeking out elders, people without tech access, people with limited mobility, non-English speakers, etc. and making sure they have what they need to register and get to vaccinations. (I assume hesitancy will be an issue, but right now the big issues are extremely limited supply and local governments doing very little to improve equity.) I'd love to see more examples of where governments are doing distribution right and/or where outside groups are improving information and access. Those of us trying to fix this from the outside are overwhelmed! I hope that supply improvements help, but relying on them still leaves some people waiting longer than they should.
In Buffalo, they are trying to accomplish this through a vax clinic they have opened that is only available to approved recipients in four zip codes. Limited time of 2 weeks, by the way, then it will be open to eligible regardless of address.
Minor issues as always, Zeynep. You have enough on your plate as it is, but I would love for you at some point to go over our selective blindness as to viral pandemics, and extend it to other regression-to-the-tail risks, such as antibiotic resistance. What are the cultural political processes that prevent us from taking into account and addressing these type of risks, bound to become dominant and structure our life?
I understand that institutions may appropriately focus on actions and messaging to reduce covid spread and protect the institution at the same time. But am feeling frustrated at the lack of recognition of the discrepancy between competing interests of the individual vs an institution. For example, if I must have a medical procedure or screening appointment, I’m told by dr that I’m not to be concerned about the institution’s failure to ventilate or filter air, nor their failure to insist their staff wear close-fitting high quality masks, because they say they’re following guidelines that they consider reasonable and they haven’t had a known case of staff-to-patient covid transmission.
I wonder if you think this new analysis on the transmission bottleneck https://www.biorxiv.org/content/10.1101/2021.02.22.432096v1
is correct and if so what are the implications.
To me it says that most infections are caused by about 1 successful virion (maybe out of 1000 or whatever in inoculum) acting independently of all the others. Which means that a simple linear model of infections vs. aerosol exposure is an excellent approximation. That in turn means to forget about the various silly schemes (musical chairs,...) and focus on something easier to calculate, total exposure. That sounds very compatible with your emphasis on HEPA, etc.
Can you explain to a layperson?
People say you have to breath in pretty many particles (maybe ~1000) to get sick. If those viruses somehow worked together to overcome your immune system, then it would be pretty safe to only breath in ~100. You'd just have to do things to avoid intense exposure. But if they work independently, each one just has a chance (say 1/1000) of getting you sick. You're at just as much risk from going into lightly contaminated rooms 10 times as from going into heavily contaminated rooms once. This means that the strategy for reducing infections is simply to reduce total exposure regardless of how it's distributed in space and time.
The new preprint argues that almost all cases come from just 1 to 3 successful virions, which supports that latter picture.
Thank you. People could be shown the odds of infection/hospitalization/death in the context of lottery odds: a lottery you don't want to "win"
Winning powerball? terrible stats. Winning SARS CoV-2 at a crowded restaurant? Not bad!
Wondering what a good or useful description of a / the / our public sphere looks like these days?
Technically it's more of an oblate public spheroid
I have long shared your belief in the relatively lower risk associated with outside activities. Studies of both the Sturgis rally and BLM protests indicate nearly all infections occurred by indoor exposures, so why the resistance to opening beaches, parks, and playgrounds?
I live in Florida, and am no fan of Ron DeSantis. I disagree with about ninety percent of his actions and directives, but he did two things right. He focused on long-term care residents first, and he did not totally close down all the outside activities. He's a political opportunist, with his nose up Trump's butt for sure, but he has done a few things right.
Just to offer a slightly different perspective, I do understand the data about outdoor activity, but as an almost-60 year old married to a 76 year old, we have found that trying to walk or run outdoors ends up with too many close calls with runners who are unmasked, breathing heavily, and come within inches of us to pass us. From a 'swiss cheese' perspective or risk mitigation, we have our masks (one layer) and outdoors (a second) - but without social distancing and the other person - breathing heavily - being masked it feels riskier than the recommendations acknowledge. In other words if people were all masked and maintaining at least 6 ft of distance we'd be fine, but they are not, and that means we are deprived of the privilege of outdoor exercise, which is really unfortunate. The chances that we could be exposed to COVID-19 by the young man who ran by us last week, unmasked, came within inches of us and then coughed is just too high. All the mitigation measures need to be considered together. This is like people believe that 6 feet is a magic number - of course that's absurd - it's a good cognitive shortcut or rule of thumb, but of course it is not absolute. It is hard to get people to really understand recommendations and not just cherry pick the parts that justify them doing what they want to do.
It boils down to respect. I walk in the mornings on a six-foot wide sidewalk around a lake. Most folks move into single file when approaching me, but too many are engaged in conversation and will not move to the side. Sometimes I feel like playing a game of "chicken" with them, staying in the center until the very last minute. What's sad is that very few get it. Even though we are vaccinated, we still wear our masks and avoid close contact in grocery stores. Indoor dining is still a no-no.
I am researching the message that will arose Golfs Governing Bodies and move them to meaningful action to support the access to the game for the underserved Title 1 communities as well as the disabled, and veteran communities. Jack “Age of Betrayal” Beatty’s wonderful theme Referring to “network effects”....’the Golconda of connectivity, things joined multiplying the value of things apart”, is the spark! I am willing to put in the work and need assurance on the mission , awareness, and path.
Zeynep,
Hooray!
2 pitfall that I'd like to see expounded on:
(1) The confusion between public health and medical practice. Physicans are duty bound to advocate for their patients and since patients have quite diverse health and living situations their advice is all over the map. When in front of the camera they communicate to the most vulnerable. Public health, collective action for collective benefit, has been poorly communicated. This issue arises in considerations of the use of rapid screening tests (inaccurate! and yet case finding is of huge benefit to us all!), vaccines (not 100%, but maybe R<1 would be nice?). How do we teach people to interpret the message by knowing the messenger?
(2) Innate immunity and the benefits of reduced infectious load. This topic is super important to managing the relaxation of COVID restrictions.
Covid Dialectics
My wife requires 4 liters/min. of oxygen 24/7 for her COPD. If I bring home covid and she becomes infected, she probably won’t make it. When we hear statements like “this mask will work for most”, we know we are not in that group of “most”. We are in the ‘must be successfully vigilant at all times’ group. In broad terms, in how many days of your life have you had an actual chance of dying? I know that over time, the 98% filtration rate of some N95 masks also come with a 8-10% leakage rate, meaning you are not getting 98% filtration. We use P100 masks (0.25% leakage); with a surgical mask over it if we need to filter exhalation.
For many, ‘source control’ is the opposite of PPE. Source control assumes an infected person and works to reduce transmission in the community; identify the infected, contact tracing, quarantine, if we are overrun, lockdown, repeat; PPE is for individual protection; masks, gowns, gloves, goggles. I see $50 billion of the pending covid bill allocated to covid testing. Is there $50 billion for PPE for everyone? I did hear about the releasing of $25 million for essential/medical worker’s PPE. It sounded like a drop hitting the bottom of an empty bucket. We need much more.
If I wear PPE successfully, I will never need to be ‘identified’, because I won’t become infected. Does that make PPE the best version of source control? Just about everyone involved in our efforts to defeat covid is for ‘masking’, and I applaud the efforts to find/make higher filtration masking for the public. I haven’t seen anyone promote the government’s arranging, manufacturing, and distributing appropriate high filtration masks for the general population. This is key. It will cost quite a bit less per person than the average cost of a cell phone. One obvious point of distribution would be when people are vaccinated. They will have 15 minutes to obtain masks for themselves and their family members during the observation period.
The most practical way to prevail against the virus is under the rubric of “We never want to do this again”. Why, because our response will not only be antigen specific but also directed toward maintaining clean, virus-free air to breathe during the pandemic. Masks do the latter, as does ventilation and air filtration. Our aerosol specialists have been stepping into the void and promoting specific actions to clean the air of virus in enclosed spaces. Aerosol specialists need more authority in current and future planning and execution. Source control becomes the third element with fine control.
The important discussions regarding the opening of schools are also a surrogate for opening many other aspects of enclosed-space society, e.g. office space, large elevators to the 50th floor, mass transit, theaters..
Misc.
What are the plans to product all the polypropylene we will need for the` many thousands of portable air filtration units we need?
Uses of N95/ with exhalation port:
fully vaccinated -give equivalent of 3M Aura 9211+. Distribute when vaccinated (and give appropriate masks for the entire family)
relatively home bound seniors/high risk +/- multi-generational dwellings, many people won’t tolerate a non-ported N95 mask 24 hours a day
for family members in dwellings with a + covid family member (who should wear a non-ported N95 as much as possible
Timely article.
Thanks,
Glenn Fink, MD
Good article. A few thoughts on vaccines and why they have not been greeted by dancing in the streets.....
- A lot of the population doesn’t believe the virus is serious, and some have behaved as though nothing is going on. Why would these people rejoice about a vaccine?
- Whoever delivers a message in America is likely to be disbelieved by 40% of the people. Trump told us we’d have mass vaccination by the end of 2020. I instinctively didn’t believe him. It turns out he was exaggerating, but not terribly. The roll-out has been far quicker than expected. But who wants to give the Trump administration credit for supporting the development of the vaccines?
- Poor messaging by Biden. He reacted to Trump’s pretense that the virus is nothing serious by saying relentlessly how awful things are going to be. This is not what people want to hear. We’ve had a long, hard year. Tell us that if we stick with this a bit longer, success is on the horizon. When you’ve been losing a game, and the game starts to turn in your favour, you don’t take your foot off the gas and let your opponent back in the game. But you also shouldn’t dwell on the negative. (The only messaging I've seen that got this right was a commercial for the Ford Motor Company. How strange is that?)
- Media desire to look for the negative. We are vaccinating 1.4 million per day. That is fantastic. We are far ahead of most countries in the world. But if you read certain sections of the media, the sole focus is on the “inequity” of who gets vaccinated before whom. Distribution has been far from perfect. But with an infectious disease, each person vaccinated helps the whole community.
- Complacency. Most of the population has little memory of times when infectious disease imperiled whole societies. We just expect these things to be fixed.
This is attached to the wrong article!
I'm interested in the point about risk compensation. Because of my interests in urban transportation, I've thought about this mostly in the context of driving. And there, it does seem like risk compensation is a major effect. I've heard that roundabouts are a lot safer than four-way stops partly *because* they feel more complex and risky, so people pay more attention. Similarly that wide lanes and absence of street trees, which are often proposed to make streets safer for drivers, end up making them *much* more dangerous for pedestrians (because drivers feel safe going faster, while speed is a much bigger risk factor for pedestrians than narrow lanes, and trees save pedestrians).
If I were to try to explain why risk compensation might be more significant in these cases than in many other cases, I would guess that it's because one set of risks is very visible to the people involved, while the other set of risks is very invisible. Mitigating visible risks might then encourage people to take a lot more invisible risks.
In the cases where harm reduction strategies are much more important, it seems to me that all the risks might be equally visible, so that people are unlikely to overcompensate. But this is just a guess as to what might be going on, if I'm in fact right that risk compensation is much more important for some risks than for others.
Long COVID. Not just the human toll (much of which is yet to come), but as another special case of institutional and cultural inertia when it comes to integrating newly emerging evidence and realities into older paradigms, and marginalizing of voices and experiences that don't fit the main narrative. Even with all the great pieces by Ed Yong and others, and growing acknowledgment by experts, and a robust network of support groups and advocates, it remains the elephant in the room. No one knows exactly what to do about it, and few really want to talk about it (except as an afterthought). It potentially affects so many people, but continues to be left out of cost-benefit analyses and policy discussions because it's so hard to quantify and so unpredictable - it's still just cases, deaths and hospitalizations. The people I know who are skeptical about the seriousness of COVID or value of precautions think exclusively in terms of death/ICU and preexisting conditions; Long COVID isn't even on their radar. Yet like masks, aerosols, ventilation and all those other blind spots, this should not be novel or surprising given what we know about post-viral conditions. So again, this huge disconnect between what is known, and what is actually internalized. It's another massive failure of communication.
But with Long COVID most of that belated recognition was driven by the efforts and insights of patients themselves, which I think is really interesting and significant. This article "How and why patients made Long COVID" summarizes those developments and implications:
https://www.sciencedirect.com/science/article/pii/S0277953620306456
The other thing on my mind: This interview with epidemiologist Michael Osterholm at the University of Minnesota:
https://www.youtube.com/watch?v=IR5sdtbb9As
He has me convinced that based on how vaccines are being distributed, expecting to NOT have a B117 surge in the U.S. in the next 5-12 weeks is at this point magical thinking. The optimism was nice (if disorienting) while it lasted...
However, it could still happen AND still be not that big a change in the curve. The virus is inexorably running through available hosts, transmission is harder
All of this talk about the K-shaped recovery related to Covid has me thinking a lot about how quality of life and employment seems to be trending upwards for white collar workers and trending downward people in blue collar jobs.
Anecdotally, it seems that for parents who are white collar workers the new flexibility in remote work has allowed for a more equitable share of parenting responsibilities. I wonder if this effect is seen in blue collar families or if it is reversed (things are getting less equitable) due to financial hardships and less flexible working conditions brought about by covid.
In a similar vein, we might be seeing similar K-shaped effects due to school closures and remote learning. it seems that the children of parents who are financially able to have reliable internet, a flexible professional job, and the ability to afford other technology are going to do better than those who don't have those things.
The businesses doing well during the pandemic, such as Instacart, Amazon, UberEats etc. seem to also be adding to this trend. While wealthy people are saving time and energy (and lessening their potential exposure to covid) getting their packages, groceries, and meals delivered, these things come at the cost of businesses that offer questionable value and benefits to the people they employ.
I’d kind of like to go back to some of your earlier work related to Twitter and Tear Gas and how lasting social movements are built and change can be created. Because social media has caused so much harm, it’s hard to untangle those harms from the supportive or beneficial role that it can play in helping to build movements effecting social good. And maybe part of that — is protest losing its efficacy? If so, why?
COVID variants: Much epidemiology but minimal mechanistic explanation. Looking at this topic as a pharmacologist, I suspect that variant spike proteins bind to the human ACE2 receptors more tightly. Therefore, fewer viral particles are required to produce COVID symptoms. Asymptotic infections become symptomatic, and mild symptoms become more serious. Put another way, the viral load required to cause disease has been lowered.
The actual spread of variant virus is not changed. Virus - aerosol interactions and properties are not altered.
Understanding this biology should help public health responses and messaging. Wearing tight-fitting face masks becomes even more important. Mutations to a more “potent” virus was probably inevitable.
I wrote to you once previously; I had a serious reaction to my first dose of the Novavax trial vaccine and declined to take the second injection. I am continuing in the trial to provide data (blood samples) for “one-shot” subjects.
Now that there is mounting evidence in favor of dose stretching strategies. Why are authorities not taking them into account. Also why they dont even explain why they made such decision.
When the pandemic us behind us, i wonder if we are going to really learn any lessons. Looking forward to your piece.
On another note, i wonder what is very important research that better be done during the pandemic to help us advance understanding of epidemiology.
My high school senior wants a job as a beach attendant to fill her last few months before college, attending to tourists, where we live in Florida. Job starts mid-march. She'd be masked, and it's outside (obviously). Variants have me a tad nervous, but I guess I'm wondering how to best transition kids out of the house and into the pandemic world on their own.
Our neighbor's daughter, a year ahead of yours in school, has had a job for the past 2 summers (one pre-covid) as a swimming pool lifeguard. It is a community pool. She did not get covid (or she got an asymptomatic case).
She did not have to go inside on site. I would think the risk would be greater where the attendant showers or changes inside.
Of course some beach crowds are rowdy and some people may be inclined to get too close for too long. You probably know your beach and what is likely to happen.
Thank you for that. We will likely let her go ahead and try it out. If the Super Bowl outside gatherings didn't cause a spike here, I guess a bunch of people on the beach won't either. It scares me because Florida is wide open, indoor concerts with 500 maskless attendees, open restaurants, bars, you name it, and no mask mandate. This is just our reality and I've got to let my kid learn how to maneuver in it. I tried to prepare my kids for all the other hazards of growing up, but "How to enter adulthood in a pandemic" wasn't in any parenting books. Thankfully, I do have all the faith in the world that she will be exceedingly responsible, it's just her nature. And hopefully she can get the vaccine by summer.
Thank you again for the kind response.
I think you needn’t worry about the job. Outdoors, with a mask, not usually too close to people and getting lots of sunshine and Vitamin D. BUT don’t go to the beach in a car with four friends and no masks with the windows closed!
I'd say if you're masked, outdoors, that reduces the risk a pretty considerable amount. In the end though the decision to accept the risk / how much risk to accept is up to your kid!
She's still a minor, so I've got a little bit longer try to help her make the *most* sensible decisions. And thankfully, we've got a good enough relationship to where she listens to the information we share with her. This is less about the specific job, and more a general pondering on the generation that's hitting lifetime benchmarks and developing during this pandemic and all its phases.
How do you think she's been affected by having her senior year of highschool be virtual / the pandemic in general? Definitely a fascinating thing to ponder how loing we'll be feeling the reverberations of the impacts of the pandemic.
In Florida schools have been open since August, so I know how she's been affected, deeply. When 90% of her friends went back and we kept her home to keep crowding down...in a state that has had essentially no governmental guidance and let it be a free for all - and had cases rip through schools and teachers have died and neighbors have died and people are essentially crumbling all around, but Florida still has hotels open so those who are fine can come for some sun?
I know I'm new here, but this has been fun for my first pandemic post.
I personally would be fine with masked, outdoors activities for any sensible teen. It's a double protective effect: sunny outdoors are much safer; masks make it safer. The threats in such settings usually are the breaks/lunch/food. I'd encourage her to learn about transmission mechanisms: chatting indoors during lunch break isn't okay just because it's a break! Once she knows how it works, she can keep herself safer.
Thank you 🙏 (that last part is what I needed to hear today)
1) Future pandemics caused by lab leaks or bioterror could wipe out civilization.
2) The best insurance policy against this scenario is to have everyone acquire and familiarize themselves with the use reusable elastomeric respirators with P100 filters (or equivalent/better PPE) and have government set up a worldwide, permanent, testing regime in order to detect the spread of new, potentially dangerous viruses (especially those with long incubation periods) in humans.
https://www.usatoday.com/in-depth/opinion/2021/03/22/why-covid-lab-leak-theory-wuhan-shouldnt-dismissed-column/4765985001/
https://thebulletin.org/2015/05/small-groups-dangerous-technology-can-they-be-controlled/
https://www.newscientist.com/article/dn311-killer-mousepox-virus-raises-bioterror-fears/
https://www.ncbi.nlm.nih.gov/books/NBK540078/
Well, the best scientists on COVID are being ignored. The doctors that got the most important treatment, corticosteroids, approved in the US (thanks to UK researchers) can't overcome the bias to get the next great idea in practice. (Dr. Pierre Kory and Paul Marik). According to 20 peer reviewed placebo controlled studies from independent researchers all around the world, we can save a good fraction of the 60,000 people dying of COVID-19, with one drug alone. The FDA is incapable of moving forward. Procedures mandated by Congress don't give them a budget to study drugs-- they rely on for-profit corporations to advocate for them. But what for-profit company can spend millions of dollars advocating for a non-profit generic drug so their competitors make money? The Bill & Melinda Gates foundation is stepping up... but it will take months and we already have much more statistical rigor than an expensive "Phase 3" trial the FDA uses as gatekeeper.
We have a drug so safe, it has resulted in 18 deaths, over 30 years, with a population of 300,000,000 people taking it regularly... that's safer than Bologna! Safer than Chicken Soup! If it might work, try it! Death rates for COVID are lower in countries where it is in common use or administered as a prophylactic, such as Peru or India, or sub-saharan Africa.
See https://covid19criticalcare.com/about/the-flccc-physicians/
or http://treatEarly.org
I think this has flown a bit under the rader outside the UK, but any thoughts on the recent decision to NOT prioritize certain professions? There had been plans to potentially prioritize people working in e.g. education, police, military. The policy now is to simply go by age with the main argument being that introducing an extra layer of complexity (the NHS which leads vaccination does not have that job info) will potentially slow down the overall process. I would have been a beneficiary as I work in academia but I think overall this policy makes sense, in that the current vaccination rate has been relatively fast in the UK so why risk introducing an additional layer of bureaucracy. Thoughts?
Through 2020 I had this growing feeling, or more like I was experiencing an "intuition" coming into being that there is an inherent paradox where "personal freedom" taken to its logical conclusion actually results in the loss of freedom. If our institutions (eg. CDC) and leaders (eg. Trump) had been quicker to act the coronavirus may have been containable to some degree here in the US. Maybe not to the extent that it was containable in South Korea or Taiwan (or other smaller, more homogenous nations), but it would have been more containable. But, since they chose to prioritize "personal liberty" over all else now we have more than 500k dead, or kids haven't been to a normal school or been able to hang out with friends in almost a year and I feel a whole hell of alot less free than I did at the beginning of 2020. Is there any kind of overlap between this seeming paradox and institutional cognitive bias? How do you get the firebrand libertarian carnival barkers to see that individuals can't actually exist without community? Why is it so hard for some people to understand that we are actually part of an interconnected whole?
I want to pick up something Baby Djojonegero (hope I got that right--I couldn't cut and paste it) said on the 25th: "Thanks for sharing the newsletter. Our family is definitely familiar with the discussions here because my spouse is a teacher (and we also live in Oakland). And every time I hear the phrase "the powerful teacher's union" I roll my eyes. Sure, they're so powerful that teachers' starting salary is $70k and they earn overtime pay and generous retirement. "
Regarding unions, which President Biden has made a topic right now, can anyone contribute some starter reading on whether it is possible to adapt them to do something I think is needed (or shoot down my thought)?
Is there a way within a conceivable union structure to have a workable process to remove the bad eggs? The people who just can't learn how to teach well, the police who just can't quit doing what society says they shouldn't, etc?
I would appreciate your thoughts.
5 stat presentations choices that have led to bad public messaging
Early focus on mortality rate locked the public health community into insisting that it was particularly lethal--as much as 2% mortality. When evidence pointed to it being, primarily, super-transmissable, those numbers, by mathematical law, had to correspondingly fall. But to admit so would be to seem to agree with Trump (damn him), and so...The result was felt in the summer surge, when people learned for themselves that most cases were asymptomatic. No worries!
"Test" positivity numbers became the gold standard for spread. The number was treated in the press with belief, and even today the NYC still reports cases numbering 28 million. Which some dummy reporter turns around into a "we will never reach herd immunity" article. But we all know that number ignores every person that wasn't tested! Worse, states, cities, unions and politicians learned that they could game the testing to get the numbers they wanted. Worse, the utter lack of any meaningful testing at all in the spring led to--a still existing curve-- of this low number of cases leading to a tremendously high number of deaths. Gosh those northeasterners are weak, and such bad doctors! In the end, a mostly deceptive, counter productive, somewhat deceptive, subject to manipulation piece-of-crap stat that continues to mask the true spread. Instead, we could have focused on...
Total daily hospitalizations were never tracked. Tracking hospitlization levels was of vital importance because it let hospitals show their communities and states what remaining capacity they had. Sho 'nuff. But daily totals don't take into account the new arrivals, in a clearly identifiable way. For that, you need the new daily hospitalizations total. Unlike tests, hospitalizations can't be gamed, massaged, or easily misrepresented. If one assumes a steady rate of infections per hospitalization (which I do, Occam's razor), charting the rolling changes in daily new hospitalizations will give the public a true number, that you could then reverse-engineer into PROBABLE community infection numbers.
Hospitalizations and deaths are related, SAY SO PLAINLY. Just an armchair epidemiologist here, but based on what some real epi from Columbia U said (est >110M infections), I would put it at about 125 cases to produce a hospitalization (as for LTC facilities, your results may vary...much worse rate). Now add to that guesstimate, this little nugget: Deaths just hit 500,000, and total hospitalizations are somewhere north of 900,000. Let's dumb that down for the public and call that a one-death-for every-2-hospitalizations. I think it would have mattered if Tony F. had stepped to the mic and said "If you go into a hospital with this, you have a 50-50 chance of dying: Heads, you leave by the front door. Tails, you leave out the back."
Still have never corrected the stats to reflect what went wrong last spring. Lets take MIS-C cases as a teaching point here: (see chart, https://www.cdc.gov/mis-c/cases/index.html). When these cases first arose in the spring, what was the reaction? KIDS GET IT TOO, PANIC! (If it was your kid, awful, not funny). But when the summer surge in the south came, cases of MIS-C didn't explode, they rose far short of the NE peak. Numbers didn't significantly rise again until the holiday surges, where they met the same daily level as the summer, but with longer tails. Occam's razor again, but you probably have a fairly accurate picture of the instant horror that the virus inflicted on the Northeast. Looking at it from here, the NYC area could not have produced those deaths, hospitalizations or MIS-C cases that close together, unless something like 10 million people got it over a 2 week period.
What is on my mind? Modiism. A threat that no one seems to be paying close attention to. Since 2014 is encouragement of demagoguery, use of social media to manipulate opinions, weakening of institutions that act as check and balances and cyber trolling and abuse of anyone who criticises the government. (Ask Meena Harris, Rihanna or any journalists, especially women, who get caught in the Indian right-wing’s crosshair)
While China’s crackdown on dissent is covered in great detail, India is getting away with far more as it carries the “democratic” tag.
But more than just the political part, as a social media student, take a close look at its manipulation to control the narrative and create a comprehensive alternate reality despite crisis on almost every front. An effective textbook for any leader to gain complete control of a democracy. Trumpism was a pale version of Modiism.
Very much agree, some of us have been paying attention. Democracy is not "your little pony"
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COVID is a SOCIAL XRAY. It shows the bones of a society. Amazing how different we are on this level.
What're some examples of the differences you've seen because of covid?
Here’s a happy story.
https://www.washingtonpost.com/lifestyle/style/covid-vaccine-joy-hope/2021/02/24/62b10432-7184-11eb-85fa-e0ccb3660358_story.html
Thanks for all the great writing Zeynep! I'm curious if you have any updated thoughts on the dispersion theory of Covid spread. Your September article was such a fascinating read - I share it and refer back to it often, and am surprised the theory hasn't gained more traction in the public discourse.