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.
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.
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.
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.
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.
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.
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.
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
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?
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.
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.
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.
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...
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.
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?
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.
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.
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.
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.
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.
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.
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.
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
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?
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.
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.
Wondering what a good or useful description of a / the / our public sphere looks like these days?
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.
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.
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...
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.
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.
TWITTER: SOCIAL NET + or -????
🙏🏼RIBOFLAVIN.COM
InVitro:B2 kills virus
ExVivo:B2 kills virus
InVivo:B2 necessary for cell growth,health,energy, T-cell
Does it kill the virus InVivo?
Hurt to try?
Hurt not to try? NO UP LIMIT
If + or symptom 100mg ev2hr upto 8Xday #covid19 LETS TALK
COVID is a SOCIAL XRAY. It shows the bones of a society. Amazing how different we are on this level.
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.