Changing the psychology of masks

Until this past month, I haven’t really thought much about surgical masks either way.  Obviously, the general idea is that we are to protect us from what we breathe in, but, since I never really thought much about it it was really easy to make the switch (as we clearly should in the case of Covid) to think about the mask as protecting others from what I breathe out and, honestly, more importantly (because I’m only one person) protecting me from what everybody else is breathing out.  

A month ago when it was hard to even get a cloth mask I went to the store, kept my distance, and took an intellectual interest in mask-wearing percentages.  Now I take it damn seriously.  While wearing my own mask, of course, I try and keep extra far from anyone not wearing a mask and see them as a threat to my health. This got me thinking, that it really shouldn’t be too hard to convert more people to this way of thinking as easily as it came to me, once I was educated on the topic.  Again, a few clear PSA’s and elite cues could do a lot here.  Part of me wonders… forget social solidarity, just scare people?  Like, if most people where mildly afraid to be around other people without masks indoors, that would be a lot of positive and potent social pressure for people to wear masks.  People would see a sign at a grocery store “masks required” and not think, “damn, they are taking away my liberty” but, rather, “oh, good, I don’t have to worry about anybody breathing Covid onto me.” 

Can we do this?  Is this psychological shift possible at the scale we need.  ¯\_(ツ)_/¯.  But surely worth trying.

The impediment?  Pathetic men like Donald Trump and Mike Pence.  Loved this post on mask wearing and toxic masculinity:

Why the reluctance to model safe behavior? My research with Jennifer Berdahl and others suggest one critical reason, which is that appearing to play it safe contradicts a core principle of masculinity: show no weakness. In short, wearing a mask emasculates.

The refusal to wear a mask undermines the message that the rest of us should take safety precautions. But that’s the least of the problem. Leaders who are more concerned with preserving a macho public image put our lives at risk as they prove their manhood by showing resistance to experts’ opinions, hypersensitivity to criticism and constant feuding with anyone who seems to disagree with them.

In our research, the show-no-weakness principle manifests by acting like you always know the answer. Admitting uncertainty or that you rely on anyone else’s opinion seems “weak.” Trump’s resistance to experts’ advice stems from a constant need to demonstrate that “I alone can fix it.”…

The coronavirus has laid bare just how strongly some male leaders value projecting a tough, macho image, even at the risk of contracting or spreading coronavirus. President Trump, a germaphobe known to hate shaking hands even in the best of times, ostentatiously continued to press the flesh well into March. Why? It’s the same reason that Trump, in 2017, courted danger from a different corona, making a show of staring at the sun during an eclipse. Defying experts’ warnings about personal danger signals “I’m a tough guy, bring it on.”

Yikes.  Clearly so true.  And tough to counter.  But, just maybe, if enough of us adopt the posture of “alright, tough guy but I don’t need you breathing your potential Covid on me!” we can get past this.  

Bring on Don Draper for the mask campaign.  And, actually, speaking of which, I did just see this.  I Imagine Draper would’ve come up with something more elegant, but, definitely gets the point across:


Testing. 1…2…3… Testing.

In a Facebook posting last week, NC State Senator Jeff Jackson– who was doing great on-line briefings for a while and seems to have given them up for an unknown reason– noted that the key factor limiting testing in NC was actually the PPE for the health care workers administering the test.  And when you administer a nasopharyngeal swab– sticking something all the way through the nose to the throat, basically, you damn well need PPE as you are getting a ton of exposure.

You know what creates way less exposure?  Letting somebody run a swab around the inside of their own nose.  And it is apparently just as effective.  (My sense is this is not the case with most respiratory viruses, but, fortunately, it seems to be for Covid).  Bill Gates mentioned this on the latest Ezra Klein podcast.  And here’s a Stat News piece:

The FDA on Thursday took other steps that could help speed up diagnostic testing. It now says that a sample can be collected simply by circling the swab in the nose, instead of sticking a longer swab much deeper into the throat through a nostril. That process is deeply uncomfortable and causes patients to sneeze, meaning that health care providers need to be wearing full protective gear.

The agency also said the swab can be done by a patient, instead of by a health care professional. And instead of being stored in viral transport media, a special solution that is in short supply, the FDA also now said that it is OK to use saline solution, which is much more readily available, if necessary…

Yuan-Po Tu, a physician at the UnitedHealth Group-owned Everett Clinic in Everett, Wash., worked with the Gates Foundation to run studies on how various testing swab techniques compared. Quantigen, a diagnostics firm, was also involved in the study, the results of which were announced simultaneously with the changes in FDA policy.

Tu said the research has shifted how he practices at his clinic, where he now tests patients in their cars, having them swab their own noses.

“This can be done very quickly in our drive-through,” Tu said. “We can collect one person every three minutes. When we do it in a car, we’re using the car as the containment vehicle. It’s not only faster, it’s nicer and more user-friendly and it’s much safer for everybody involved.”

The material used in the swab can affect testing. The tests work by growing large amounts of the virus using a reaction called the polymerase chain reaction, or PCR. Q-tips, for instance, don’t work, in part due to the fact that the cotton on the tip contains its own DNA; cotton, after all, is a plant. The swabs that are currently used are nylon or foam. But the FDA’s expansion of permitted materials to some made of polyester could help reduce shortages.

So, why isn’t this the standard for testing everywhere like yesterday?  Seriously!  Meanwhile, it looks like a swab just inside the mouth may also work great:

As testing for the novel coronavirus continues to scale up, a new study finds that saliva samples are a “preferable” indicator for infection than the deep nasal swabs now widely used.

The study led by the Yale School of Public Health — and conducted at Yale New Haven Hospital with 44 inpatients and 98 health care workers — found that saliva samples taken from just inside the mouth provided greater detection sensitivity and consistency throughout the course of an infection than the broadly recommended nasopharyngeal (NP) approach. The study also concluded that there was less variability in results with the self-sample collection of saliva.

Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing,” said first author Anne Wyllie, an associate research scientist at the Yale School of Public Health and a member of its Public Health Modeling Unit. She was joined by 49 other researchers at Yale on the study.

I get that nasopharyngeal swabs have been the “gold standard.”  But, now we clearly have way easier methods that put way less stress on the system (in terms of PPE requirements and health care worker skill– I’m not threading something thorough my own nose!)  Those long swabs need to be gone yesterday (or, honestly, just cut down to nasal swab size).  

Relatedly, everybody writes about the great job that Germany and South Korea have done with rapidly creating and deploying tests.  But shouldn’t they have figured these things out.  The most comprehensive articles on the matter (admittedly after limited google searching) make no mention at all of the swabs.  

And, lastly, if biotech companies can successfully create an antigen test for Covid, that would be a real game-changer:

The gold standard for covid-19 testing is the polymerase chain reaction (PCR) test. In a PCR test, genetic material collected in a nasal swab is copied millions or billions of times over so that markers for covid-19 infection can be identified (the virus’s RNA is too tiny to identify on its own, but making more copies makes it easier to find). PCR testing isn’t perfect, but it’s seen as the most accurate form of testing available for viruses. Unfortunately, it takes time, energy, and trained personnel to run these tests. That makes PCR testing too hard to scale up to the numbers we really need. 

“There will never be the ability on a [PCR] test to do 300 million tests a day or to test everybody before they go to work or to school,” Deborah Birx, head of the White House Coronavirus Task Force, said on April 17. “But there might be with the antigen test.”

What’s an antigen test? While PCR tests look for evidence of viral genetic material, and antibody testing detects human antibodies against the virus, antigen tests look for fragments of viral surface proteins as a marker for infection. (An antigen is the part of a pathogen that elicits an immune response.) These proteins, usually from the coronavirus’s surface spikes, are big enough to study on their own, without spending time and energy making new copies.

Identifying their presence could mean a diagnosis of infection in just a matter of minutes, without expensive equipment, training, or power. In theory, a reliable antigen test could be pretty easy to scale up and could then be used in the home or at point-of-care locations. It could be the test we need to get America back on its feet again…

“We think the first threshold for returning to normal life is to make sure you’re not infectious and the people around you are not infectious,” says Steve Tang, CEO of OraSure, which makes millions of HIV antigen tests a year and is now working on a covid-19 test. “We have to get ourselves out of these testing bottlenecks that are hurting us right now. Antigen testing could be a powerful new tool in that goal.”

Gehrke is a cofounder of a Cambridge-based biotech company called E25Bio, which is developing a covid-19 antigen test. Like most others being developed for the coronavirus, the test works by taking a nasal swab from a patient and introducing that sample into a solution that is then exposed to one end of a series of paper strips. The strips contain artificial antibodies specially designed to bind to coronavirus antigens. As the solution moves up the strip, any antigens that are present will bind to it and give a visual readout. The whole thing takes less than 30 minutes, and it doesn’t require special equipment or training. 

Sounds terrific, but here’s some cold water:

Not everyone is so gung-ho on the technology’s potential. “I would say antigen testing for covid-19 would be a total game-changer, except for one aspect: it won’t work,” says Alan Wells, the medical director of clinical laboratories at the University of Pittsburgh Medical Center. 

Why not? An antigen test for a bacterial disease like strep works well. But respiratory viruses like coronavirus are a whole other game. The home of a respiratory illness is in the respiratory system, so ideally you want to use a nasal swab to collect samples deep in the nasal cavity. But the presence of the virus in this area varies from person to person. For example, the antigen test for influenza has a decent sensitivity of about 70 to 80% when run properly on a good nasal swab—but only for children, because the quantity of the virus in children is typically much higher than in adults. When you use the same influenza antigen tests on adults, the sensitivity drops to less than 50%. And this is something observed across the board for respiratory viruses. In a PCR test, the viral genetic material is amplified so that it’s easier to identify signs of covid-19. There’s no amplification of viral proteins in an antigen test. Either the test detects them in the sample or it doesn’t.

Companies like E25Bio and OraSure have made successful tests for other diseases, but not for respiratory viruses, and Wells is very skeptical they’ve solved the biological and technological issues that hold these tests back. “I would love to be wrong,” he says. “But if I’m betting, the covid-19 virus is not going to be any different from the other viruses. It’s not a new biology or a new chemistry.” Antigen testing groups that are claiming sensitivities above 90% are basing that on laboratory samples. They are still waiting for validation tests on actual patient samples, which may be much less accurate.

But, just maybe?  I’d like to think these companies wouldn’t be investing in this if they didn’t at least think there was a chance they could make the science work.  Here’s hoping they do.

But, for now, can’t we at least re-think the whole nasopharyngeal swab thing?! 

Only in America

Please, please, please let this British vaccine actually be effective.  Signs are definitely encouraging so far.  But damn if this highlighted paragraph didn’t pull me up short:

Other scientists involved in the project are working with a half dozen drug manufacturing companies across Europe and Asia to prepare to churn out billions of doses as quickly as possible if the vaccine is approved. None have been granted exclusive marketing rights, and one is the giant Serum Institute of India, the world’s largest supplier of vaccines.

Donors are currently spending tens of millions of dollars to start the manufacturing process at facilities in Britain and the Netherlands even before the vaccine is proven to work, said Sandy Douglas, 37, a doctor at Oxford overseeing vaccine production.

“There is no alternative,” he said.

But the team has not yet reached an agreement with a North American manufacturer, in part because the major pharmaceutical companies there typically demand exclusive worldwide rights before investing in a potential medicine.

“I personally don’t believe that in a time of pandemic there should be exclusive licenses,” Professor Hill said. “So we are asking a lot of them. Nobody is going to make a lot of money off this.”

Can we do this?

So, in exciting news for my Sunday, I had far and away my most popular tweet ever (to be clear, that’s really not saying much).  I’ve been following Helen Branswell an excellent science/health reporter for Stat News and she tweeted about the lack of masks on people in Boston.  My reply:

I know this would be hard, but I was met by hard skepticism from PS colleagues:

It’s not “impossible” said I, just hard.  Met by:

So, is it impossible?  Am I just a hopeless Pollyanna on Covid (though, I do think my friend Kyle definitely tends Cassandra)?

Can we not convince a sufficient number of Republican politicians that it is their political interest to get us all wearing masks when we are out in public? The worse this is for everybody, the worse Republicans, tethered to Trump will do.  Can’t political self preservation break the cycle?  Or maybe, some blue areas can go hard on this and show how effective it can be (e.g., the Czechia vs. Austria example Tufekci wrote about) and convince everybody it’s worth doing?  Could a couple of Republican governors with foresight (e.g., Dewine, Hogan) take a strong lead on this and get bipartisan buy-in in their states?

I’m not actually too worried about ordinary Republicans.  If we get the right elite messaging, they will wear a mask.  That’s how this stuff works (obviously, it does not help at all that doofus-in-chief doesn’t believe in them).

I’m not trying to suggest we can just rely very widespread mask usage to save us (though evidence is it can sure help).  But it can be a key feature of a public health approach that, hopefully, can get us to some semblance of normalcy before a vaccine.  Because while this level of shutdown might be okay for the short term, no modern society/economy is built for it at the length we will be waiting for a vaccine.  And given the utter failure so far of national leadership to gear up the tests, tests, tests we so clearly need, maybe masks, masks, masks might be the next best thing.

Quick hits (part II)

1) So, obviously President Trump is too stupid too understand that which kills pathogens outside the human body often cannot be used to kill pathogens inside the human body.  That said, his idiocy did lead me to read up on “Far UVC light‘ which may have some very cool potential:

The president’s invocation of pseudoscience — which he claimed on Friday had been a joke intended “sarcastically” to provoke reporters — overshadowed the news from the briefing about evidence, first reported last week by Yahoo News, that ultraviolet light does destroy the coronavirus. Researchers have shown it can be used to disinfect surfaces and kill viruses in ambient air in ways that could be used to reduce transmission in public spaces.

“Continuous very low dose-rate far-UVC light in indoor public locations is a promising, safe and inexpensive tool to reduce the spread of airborne-mediated microbial diseases,” wrote a team of researchers in a 2018 paper published in Scientific Reports.

Transmission of the coronavirus is thought to be more common through particles spread through the air than by contact with hard surfaces, but scientists are still working to understand how the virus spreads.

Yet if commercially available UV products were to mitigate some of the risk of contracting the coronavirus, that might help ease the transition out of a total lockdown. “This approach may help limit seasonal influenza epidemics, transmission of tuberculosis, as well as major pandemics,” the scientific researchers wrote in 2018.

The key is advances in UV lighting technology, specifically the advent of “far-UVC” lamps, which operate at a wavelength of 222 nanometers, a frequency that doesn’t penetrate skin or the outer layer of the human eye. Previously, disinfecting ultraviolet could not be used in public spaces because the wavelengths used, of 254 nanometers and up, can cause skin cancer and damage the eyes.

Like most cool things, probably not going to be our Covid magic bullet, but definitely some real potential here.

2) Good stuff in the Bulwark, “We Cannot “Reopen” America: No matter when government stay-at-home orders are revoked, the American economy will not reopen. Because the source of the economic shock is not government orders. It’s the pandemic.”

The fallacy is the notion that lifting stay-at-home orders will result in people going back to their normal routines. This is false. The state-issued stay-at-home orders did not determine most people’s desires to stay home—they merely ratified behaviors that the vast majority of people and institutions were already adopting in response to COVID-19.

The fantasy is that we can go back to what the world looked like 12 weeks ago. This is not possible now and will not be possible until we possess a vaccine for the novel coronavirus.

Understand that I am not saying that stay-at-home orders should be indefinite. What I am saying is that whenever the stay-at-home orders are rolled back—whether it is tomorrow or a month from now—it will not result in anything like a “reopening” of the country.  And the sooner people grasp how completely and fundamentally the world has changed, the faster we’ll be able to adapt to this new reality.

Let’s take a close look at just a couple of examples.

Las Vegas will not “reopen” because the city as we knew it in February 2020 is gone.

Las Vegas is the 28th-largest metropolitan area in America, home to 2.2 million people. Its main business is gambling-related tourism. The city welcomes roughly 42 million visitors a year who pour $58 billion dollars into the local economy and support 370,000 jobs. Almost 40 percent of the area’s workers are employed in the hospitality industry.

Up until this past January, 70,000 people got off an airplane in Las Vegas every single day, mostly to take in the city’s charms.

On these flights, passenger seats are roughly 17 inches wide with 31 inches of pitch. So in order to get to Las Vegas—where the principal pleasure is spending disposable income on hotel rooms, while eating expensive meals, and playing casino games—something like 150 people would share 8,000 cubic feet of cabin space and recycled air for anywhere from one to four hours.

So tell me: When the state of Nevada lifts the stay-at-home order that it issued on March 12 and the casinos that drive the state’s economy reopen their doors, do you think that Las Vegas is going to come roaring back?

Because I do not.

What is much more likely is that the former steady flow of visitors to Las Vegas will resume as a trickle.

3) This is really cool.  And definitely tells us we should work so much harder for relying upon less-polluting forms of energy (which we can so do).  “As people stay home, Earth turns wilder and cleaner. These before-and-after images show the change.”

4) Vox, “Why you’re unlikely to get the coronavirus from runners or cyclists.”  Though I would change the headline to very unlikely.  And we should behave and make policy accordingly.

5) One of the most interesting things about Covid is the amount of asymptomatic and presymptomatic spread.  What I just learned though, is that completely aysmptomatic spread happens with other diseases, too.  More Vox:

How many people catch the coronavirus and never get sick at all?

We know that people who get Covid-19 start feeling sick anywhere from two to 14 days after they first catch the virus. But there also seems to be a subset of people who test positive for it but never develop any symptoms.

This isn’t that unusual. Other viruses often have many people carrying them who don’t get sick. For example, a study in the UK found that about 77 percent of people who had had the current flu strain never got sick (some studies have pointed to lower rates, which also shows how little we know even about common illnesses).

For the norovirus, a common stomach bug, about a third of people who get it don’t become ill — but can still transmit it to others.

And that number is even higher for other viruses, like polio, which only causes illness in some 5 to 10 percent of infections — but the asymptomatic carriers can still spread it to others, who might get the full-blown disease.

For SARS-CoV-2, the World Health Organization cited the statistic that about 75 percent of people who seem asymptomatic when they test positive for the virus eventually go on to develop symptoms of Covid-19. And a series of recent reports have backed that up.

6) And in non-Covid science, this is so cool.  And definitely click through to the moving image that I cannot embed here. “This Might Be the Longest Creature Ever Seen in the Ocean: Scientists spotted a swirling siphonophore off Western Australia that was 150 feet long.”

Nerida Wilson couldn’t take her eyes off the computer screen. Some 2,000 feet beneath the research boat she was aboard, a creature drifted past in the shape of a vast, galactic swirl. By her team’s estimates, it was 150 feet long.

“It looked like an incredible U.F.O.,” said Dr. Wilson, a senior research scientist at the Western Australian Museum.

She and her colleagues documented this organism with the help of SuBastian, a remotely piloted deep-sea robot, during a March expedition on the Falkor, a research vessel operated by the Schmidt Ocean Institute. Their mission was to understand what lives in the deep waters off Australia’s western edge. And the coiling stringy mass they had just found was a siphonophore, the first spotted off Western Australia and potentially the longest organism in the sea.

The longest previously known marine creature is the lion’s mane jellyfish — its tentacles can be up to 120 feet long. By comparison, blue whales, while the most massive creatures ever to have lived, are nearly 100 feet long.

7) Interesting NYT article on Covid and comorbidities.  Is the health of adult Americans really this shockingly poor.  Am I truly in the 88% of health simply in lacking one of these ongoing health issues?

“Only 12 percent of Americans are without high blood pressure, high cholesterol, diabetes or pre-diabetes,” he said in an interview last week. “The statistics are horrifying, but unlike Covid they happened gradually enough that people just shrugged their shoulders. However, beyond age, these are the biggest risk factors for illness and death from Covid-19.”

The characteristics of what doctors call the metabolic syndrome — excess fat around the middle, hypertension, high blood sugar, high triglycerides and a poor cholesterol profile — suppress the immune system and increase the risk of infections, pneumonia and cancers. They’re all associated with low-grade, body-wide inflammation, Dr. Mozaffarian explained, “and Covid kills by causing an overwhelming inflammatory response that disables the body’s ability to fight off pathogens.”

8) And the NYT with a write-up of the fascinating restaurant airflow study and Covid.

A diagram of the arrangement of a restaurant’s tables and air conditioning airflow at site of an outbreak of coronavirus in Guangzhou, China. Red circles indicate the seating of future case-patients; the yellow-filled red circle indicates the index case, or first-documented, patient.

9) Really good New Yorker interview with Jeffrey Sachs on all this.  Plenty of good stuff, but I really liked this little bit on Trump.

Is there some leader Trump reminds you of whom you’ve worked with?

Trump is the worst political leader I have experienced in all of my professional life, which is forty years of working with governments at a high level. I’ve never seen anything like the narcissism of this man, and here we are, a country so rich in expertise, in resources, in capacities, and yet we’re watching a complete failure of a political response—with a massive loss of life—in real time. It’s quite shocking, because Trump not only does not know how to approach this issue but he blocks those who do.

10) And this was really interesting and non-Covid “How the Dumb Design of a WWII Plane Led to the Macintosh: At first, pilots took the blame for crashes. The true cause, however, lay with the design. That lesson led us into our user-friendly age—but there’s peril to come.”

The reason why all those pilots were crashing when their B-17s were easing into a landing was that the flaps and landing gear controls looked exactly the same. The pilots were simply reaching for the landing gear, thinking they were ready to land. And instead, they were pulling the wing flaps, slowing their descent, and driving their planes into the ground with the landing gear still tucked in. Chapanis came up with an ingenious solution: He created a system of distinctively shaped knobs and levers that made it easy to distinguish all the controls of the plane merely by feel, so that there’s no chance of confusion even if you’re flying in the dark.

By law, that ingenious bit of design—known as shape coding—still governs landing gear and wing flaps in every airplane today. And the underlying idea is all around you: It’s why the buttons on your videogame controller are differently shaped, with subtle texture differences so you can tell which is which. It’s why the dials and knobs in your car are all slightly different, depending on what they do. And it’s the reason your virtual buttons on your smartphone adhere to a pattern language.

But Chapanis and Fitts were proposing something deeper than a solution for airplane crashes. Faced with the prospect of soldiers losing their lives to poorly designed machinery, they invented a new paradigm for viewing human behavior. That paradigm lies behind the user-friendly world that we live in every day. They realized that it was absurd to train people to operate a machine and assume they would act perfectly under perfect conditions.

Instead, designing better machines meant figuring how people acted without thinking, in the fog of everyday life, which might never be perfect. You couldn’t assume humans to be perfectly rational sponges for training. You had to take them as they were: distracted, confused, irrational under duress. Only by imagining them at their most limited could you design machines that wouldn’t fail them.

This new paradigm took root slowly at first. But by 1984—four decades after Chapanis and Fitts conducted their first studies—Apple was touting a computer for the rest of us in one of its first print ads for the Macintosh: “On a particularly bright day in Cupertino, California, some particularly bright engineers had a particularly bright idea: Since computers are so smart, wouldn’t it make sense to teach computers about people, instead of teaching people about computers? So it was that those very engineers worked long days and nights and a few legal holidays, teaching silicon chips all about people. How they make mistakes and change their minds. How they refer to file folders and save old phone numbers. How they labor for their livelihoods, and doodle in their spare time.” (Emphasis mine.) And that easy-to-digest language molded the smartphones and seamless technology we live with today.

11) Dahlia Lithwick on the “hero” trap:

But in this country parched for heroes, there is a long tradition of using the language of “heroism” to disserve the heroes and, indeed, to affirmatively harm them. After virtually every mass school shooting, the children who were killed for having attended school that day are celebrated as brave little warriors; the teachers and staff who hurl themselves in the path of flying bullets to protect those children are also held up as saviors and saints. More often than not, this search for superhuman lifesavers in a crisis short-circuits the ordinary processes of accountability and reform. It’s considered inappropriate to talk about political and systemic failures immediately in the wake of a tragedy because doing so might dishonor the heroes and victims. And under that cloak of national reverence and well-intentioned hero worship, political and systemic failures are never corrected in ways that might prevent other ordinary Americans from ever having to commit such acts of “heroism” in the future.

12) So I recently befriend an extended family member of my wife on Facebook that she warned be about, but I was curious.  He recently shared this, “Malia And ‘Undocumented’ Boyfriend Arrested In Dog Fighting Ring Bust.”  But, I noticed the accompanying image had a “satire” logo on it and it is actually categorized under “Malia Obama fan fiction.”  So, no, I don’t think this deplorable thought this was actually true.  But I shared with a friend and said, “what does it say about a perrson that they would think this worth sharing on social media.”  Succinct response, “that they are racist.”  Yep, I think that’s it.

13) Harry Enten on Trump’s slipping standing in battleground states.

14) On that theme, this from Patrick Egan:


Quick hits

1) Terrific twitter thread from Jay Rosen on how and why the media is struggling so mightily in the age of Trump.

2) So, it’s become pretty clear that this Covid-19 virus is just crazy and unprecedented in all sorts of ways.  The latest is that it can, apparently, lead to strokes in seemingly otherwise healthy people in their 30’s and 40’s.  That’s scientifically interesting and horrible for those that it happens to, but given what we know about the rates of fatality and serious illness in those under 50, this is probably not the most important thing to read about Covid today, as many suggested on twitter.  We need to take this disease very seriously.  We don’t need to scare people that they are going to get a stroke if they don’t stay home.

3) Loved this on the “swiss cheese” approach to our second chance (i.e., we have flattened the curve in most places) on Covid.  Yes, test, test, test, but, also, masks, masks, masks.  And this sensible conclusion:

As we are seeing in Asia, relaxation of social interventions can lead to a resurgence of virus transmission. This will be a risk until we have substantial immunity in the population from a vaccine and/or previous exposure. We need to define triggers to reinstate social interventions early and in a coordinated manner, such as laboratory-based surveillance in the community or our inability to link new cases to known cases. Those triggers and actions should be understood and exercised by all communities.

After this wave of the Covid-19 pandemic, we will have a “new normal” way of living and working that will provide a layer of protection compared to our pre-pandemic life. Early on, we can expect fewer public gatherings, less travel, more social distancing in the workplace, and more virtual interactions. These will certainly reduce the risk of rebound. And if we’ve successfully deployed the first two solutions — masks and testing — we can avoid the most extreme measures that we are experiencing now.

These interventions are the layers of Swiss cheese that can let us reopen our cities while preventing a resurgence of infections. They’ll enable us to flatten a second wave of the pandemic if it comes in the fall — or sooner — but most importantly they will buy us much-needed time until we have a vaccine.

4) Speaking of test, test, test, I love the idea of using random sampling to get a sense of population-level dynamics with much smaller samples, just like we do in public opinion polling.  Especially since we are struggling so much to get enough tests.  E.g., random samples in major metro areas.

Given our current capacity, random testing is the quickest, most feasible and most effective means of assessing the U.S. population. Ideally, we could test every American today, or over the next month, but even tens of millions of test kits would not accomplish this. We could triple the current number of tests under existing protocols, but we would remain in the dark about future hospital needs and when and how to relax restrictions on economic activity.

Random testing uses but a sliver of that capacity to deliver immense value. And it can be done now, using incremental new capacity or at hospitals and universities that have capacity that remains idle because it is not yet authorized. It is the only way to get a true picture of prevalence, hospitalization and fatality rates and more.

The recent Nobel in economic science went to Abhijit Banerjee, Esther Duflo and Michael Kremer, researchers using random control trials, the mainstay of scientific medicine. Their work dramatizes how misleading it can be, for example, to measure disease prevalence by reference to those who seek treatment at rural health clinics, omitting the multitudes who have no access.

Local random tests should be undertaken immediately. University researchers, working with local governments or operating independently, could conduct simple randomization, testing perhaps 5,000 or 10,000 individuals. We would quickly learn whether total cases were five times or 50 times current estimates in those areas.

5) Relatedly, nasopharyngeal tests sound really unpleasant (a swab inserted through your nose all the way down to your throat).  Very excited to hear that saliva-based testing may be coming soon  There’s huge advantages to this in that it doesn’t require heavily-PPE-protected health care workers and may even be more accurate.

6) Also, very much relatedly, if we are going to massively scale up testing, we need to massively scale up the production of the chemical reagents required.  Let’s get on that!!

7) And on health care more broadly, this is terrific, “America Can Afford a World-Class Health System. Why Don’t We Have One?”

The American health care industry is not good at promoting health, but it excels at taking money from all of us for its benefit. It is an engine of inequality.

Now is a difficult time to talk about the costs of health care. Doctors and nurses are risking their lives to fight the virus. We need more doctors and nurses. We need more beds, more ventilators and more protective equipment, and we need vaccines and drugs. High prices are not the best nor the only way to get drugs or vaccines that will win the war against the virus, but they can help…

Yet we cannot go on as we have been. America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic

The first step to reform is to change the way we think about the health care system. Many Americans think their health insurance is a gift from their employers — a “benefit” bestowed on lucky workers by benevolent corporations. It would be more accurate to think of employer-provided health insurance as a tax.

One way or another, everyone pays for health care. It accounts for about 18 percent of G.D.P. — nearly $11,000 per person. Individuals directly pay about a quarter, the federal and state governments pay nearly half, and most of the rest is paid by employers…

American doctors control access to their profession through a system that limits medical school admissions and the entry of doctors trained abroad — an imbalance that was clear even before the pandemic. That keeps their numbers down and their salaries up. As of 2012, doctors were the largest single occupation in the top 1 percent. The business model under which most doctors practice isn’t working; without the revenue from high-paid elective care, some hospitals are now resorting to furloughs and layoffs of doctors and nurses.

Hospitals, many of them classified as nonprofits, have consolidated, with monopolies over health care in many cities, and they have used that monopoly power to raise prices. Many Americans, even those with insurance, face bills that they cannot pay, or are hit with “surprise” medical bills charged by providers working at in-network hospitals who have opted not to accept insurance. Ambulance services and emergency departments that don’t accept insurance have become favorites of private equity investors because of their high profits. Medical device manufacturers have also consolidated, in some cases using a “catch and kill” strategy to swallow up nimbler start-ups and keep the prices of their products high…

At the very least, America must stop financing health care through employer-based insurance, which encourages some people to work but it eliminates jobs for less-skilled workers. Employer-based health care is a particular nightmare in this pandemic. In recent weeks, millions have lost their paychecks and their insurance, and will have to face the virus without either.

We are believers in free-market capitalism, but health care is not something it can deliver in a socially tolerable way.

8) Loved using Lee Drutman’s Breaking the Two-Party Doom Loop in my Political Parties class this semester.  Excellent and thorough review here.

9) EJ Dionne:

“We need to push the pause button here,” McConnell said in a Tuesday interview with the Wall Street Journal. “We have racked up $2.7 trillion in national debt without much consideration of the impact of that on the future of this country.”

Deficits, it seems, start mattering only when it comes time to help hungry people, or renters pressed to the wall, or those who have lost their health insurance. Do Trump and McConnell really want to say that governors should take responsibility for dealing with the coronavirus crisis, but sorry, the federal government won’t be there to help their states out of the mess this is creating? That’s where McConnell seemed to be headed in his interview with Hewitt when he suggested state and local governments might be able to “use the bankruptcy route.”

Democrats might consider calling McConnell’s bluff by proposing provisional tax increases on the well-off in the next package, including a rollback of the corporate tax giveaway, that would not kick in until the economy recovered. Sure, Republicans would reject them, but in doing so they’d underscore how fake their deficit concerns are.

10) This is great from Bill Gates “Here are the innovations we need to reopen the economy.”  I really wish we had a competent president to just appoint Gates Covid Czar and give him the authority to make the necessary things happen.  Maybe just a wee bit more qualified and competent than Jared.

11) This is really good in Pro Publica, “To Understand the Medical Supply Shortage, It Helps to Know How the U.S. Lost the Lithium Ion Battery to China”

But the effort to establish a lithium battery manufacturing base in the U.S. largely failed, even after the Obama administration made it a keystone of its 2009 stimulus program, aiming to produce 40% of the world’s lithium ion batteries for advanced vehicles by 2015.

Today, that number stands at about 10%, largely because of Tesla’s battery plant in Nevada. Most of the batteries used in a plethora of U.S. products are shipped in from China or other foreign suppliers. Despite its economic nationalist rhetoric, the Trump administration has done little to revive battery-making, proposing deep cuts to alternative energy research and favoring fossil fuels at every turn. (A spokeswoman for the Department of Energy declined to comment on the record.)

12) Good discussion in Inside Higher Ed, “How lenient, or not, should professors be with students right now?”  My take?  Lenient on deadlines, but, damn if I’m going to be lenient on quality.  B work does not suddenly become A work because life sucks.

13) Great stuff from Brian Beutler on how the media is getting played again, just like with the Tea party:

The most uncanny echo of the late aughts is the orchestration by well-heeled right-wing donors of small anti-government, anti-lockdown protests, populated in large part by a hodgepodge of militants, conspiracy theorists, and neo-Confederates in state capitals across the country. The Tea Party movement began the same way, before it exploded into a mass uprising and a Republican revival—fueled by a priceless deluge of free media—just two years after the GOP left the country in shambles. But what makes this parallel truly alarming has less to do with the anti-lockdown protests per se than with the breathless way the national press, and in some cases the very same reporters, have chosen to cover it. They have treated these gatherings once again as the tip of the spear of a vast conservative insurrection, as if oblivious to polls showing overwhelming majorities of Americans, including Republicans, support their states’ social-distancing guidelines. The Tea Party was fringe, too, before this kind of treatment. The snowball effect is real, and it can happen again

Other parallels here are imperfect. It’s unsurprising that moneyed pro-Trump forces hope to get the band back together before the 2020 election, to buoy Trump through a tough election. But the actual Tea Party didn’t really blossom into a movement until after Republicans had been swept out of power, making its anti-government activism a more natural fit for the times than it would be today, with Trump in the White House. They have compensated for this awkwardness by organizing their protests in blue-state capitals, as if the jackboot of big government resides in Sacramento, Lansing, Harrisburg, and other small cities, rather than in Washington, DC. The Tea Party likewise presented itself not as the reactionary, xenophobic movement it was, but as an organic rebellion against soaring levels of federal debt. Many Tea Party protesters even rendered the word “TEA” in all caps as an acronym for “Taxed Enough Already.” The anti-lockdown protesters would make further mockery of themselves by protesting federal debt as it mushrooms under Trump’s watch, particularly if they did so at the doorstep of state governments.

14) Trump keeps on lying (take the hint, journalists) that voting by mail leads to voter fraud.  It doesn’t.  Great summary of the copious evidence.

15) My kids’ school in actual form (hard to consider the on-line replacement as school) was just canceled for the year.  I get it, but it makes me sad.  It sucks.  But, damn do I feel bad for HS and College seniors.  So, so bad.  But, also, it sucks for all kids who, you know, need to learn.  Yglesias, “Prolonged school closures could be very costly for America’s students”

16) Bright Line watch on the faltering state of US Democracy.  In chart form:


17) Good stuff from Frum: “Trump’s Two Horrifying Plans for Dealing With the Coronavirus:
If he can’t confine the suffering to his opponents, he is prepared to incite a culture war to distract his supporters.”

From his entry into presidential politics, Trump has divided Americans into first class, second class, and third class. He has continued that politics of division into this pandemic. On Saturday, Trump retweeted an ugly insinuation that state governments were favoring Muslim Ramadan observance over Easter worship.

The division is more than rhetorical. It shapes who gets economic assistance, who gets aid, and now, whose deaths are acceptable in order to put the country back to work.

Life never can be risk-free. The reopening of the economy cannot wait for the discovery and distribution of a coronavirus vaccine. The job of our political leadership is to win acceptance of risk by undertaking that the accompanying benefits be shared. Trump’s noisy attacks on the cities and states that have suffered most—and his politics-first response—send the message that he’s acting in his self-interest, not the public interest.

Both Trump’s Plan A and Plan B intend to turn American against American, in an ugly spirit of rancor and resentment. In pandemic as in prosperity, the Trump way is to punish opponents, reward friends; accuse victims, protect culprits; demand credit, refuse accountability; protect preferred classes and groups of Americans—and sacrifice the rest.

18) Really, really good stuff from James Hamblin, “Why Some People Get Sicker Than Others
COVID-19 is proving to be a disease of the immune system. This could, in theory, be controlled.”

While America’s deepest health disparities absolutely would require generations  to undo, the country still could address many gaps right now. Variation in immune responses between people is due to much more than age or chronic disease. The immune system is a function of the communities that brought us up and the environments with which we interact every day. Its foundation is laid by genetics and early-life exposure to the world around us—from the food we eat to the air we breathe. Its response varies on the basis of income, housing, jobs, and access to health care.

The people who get the most severely sick from COVID-19 will sometimes be unpredictable, but in many cases, they will not. They will be the same people who get sick from most every other cause. Cytokines like IL-6 can be elevated by a single night of bad sleep. Over the course of a lifetime, the effects of daily and hourly stressors accumulate. Ultimately, people who are unable to take time off of work when sick—or who don’t have a comfortable and quiet home, or who lack access to good food and clean air—are likely to bear the burden of severe disease.

Much is yet unknown about specific cytokines and their roles in disease. But the likelihood of disease in general is not so mysterious. Often, it’s a matter of what societies choose to tolerate. America has empty hotels while people sleep in parking lots. We are destroying food while people go hungry. We are allowing individuals to endure the physiological stresses of financial catastrophe while bailing out corporations. With the coronavirus, we do not have vulnerable populations so much as we have vulnerabilities as a population. Our immune system is not strong.

19) Top-notch satire from Alexandra Petri, “Powerless to help, Donald Trump worries about incompetent pandemic leadership”

Why was nobody doing anything? That was the question President Trump kept asking himself, over and over, as he gazed at the United States’ response to the covid-19 pandemic.

“The states have to step up their TESTING!” he tweeted. Why was no one helping them? The United States was supposed to be some kind of a great nation, not a floundering compilation of states, each acting at cross purposes. Why were they bidding against one another for medical essentials? They were one country! Did no one realize that? Why were they being left to solve this alone? Could nobody help them coordinate? He looked on, helpless, as the rate of testing ticked up all too slowly.

It was heartbreaking to see. He sat in front of the television, barely watching baseball (“I’m tired of watching baseball games that are 14 years old,” as he told reporters at a briefing. “But I haven’t actually had too much time to watch. I would say maybe I watch one batter then I get back to work.”), wondering why someone was not working harder to fix the numerous problems the nation, as a whole, faced with the pandemic. Shouldn’t someone be developing a plan? It seemed as though the guidance the states had received about whether to do that had been very mixed!

“Get out there and get the job done,” he tweeted to the governor of New York. If only he were in a position to offer more than verbal encouragement! He was happy to tell governors around the country whether they were doing good jobs or bad jobs, but it frustrated him to see them running low on supplies. Still, seeing New York behave as though it belonged to some larger entity that might be able to obtain more supplies at better prices gave him hope. Perhaps New York had a Costco membership?


Win 2020 with marijuana!

Love this from Michael Tesler in the Monkey Cage.  A strong, empirical case that Joe Biden should definitely emphasize marijuana legalization as a winning issue:

Marijuana has even become a winning political issue, with a remarkable rise in public support for legalization over the past two decades. Two-thirds of Americans back legal recreational use, up from one-third 20 years ago.

But the political benefits of running on legalization extend beyond that. Legalization is popular in swing states and among swing voters. It’s also one of the only policies that is important to voters across the political spectrum. Together, those facts make marijuana an especially potent campaign issue…

More importantly, the map shows that marijuana legalization is also popular in the handful of battleground states that will determine who wins the 2020 presidential election. Swing-state support for legal cannabis ranges from a low 65 percent in Minnesota to a high of 67 percent in New Hampshire… [emphases mine]

Undecided and third-party voters support legal cannabis

Marijuana isn’t just popular in swing states. It’s also popular with swing voters. We can look at how small, but potentially pivotal, groups feel about legalization in the UCLA/Nationscape data, an enormous academic survey that has interviewed more than 200,000 registered voters since the summer of 2019.

Source: UCLA/Nationscape, registered voters.  
Graph: Michael Tesler.
Source: UCLA/Nationscape, registered voters. Graph: Michael Tesler.

The graph above shows public opinion about marijuana legalization among undecided 2020 voters, third-party voters from 2016 and pure independents who don’t lean toward one of the two major parties.

As you can see, independent and undecided voters support marijuana legalization by more than a 2-to-1 margin. Americans who voted for Gary Johnson and Jill Stein in 2016 — third-party candidates who both made marijuana legalization central to their presidential bids — even more strongly support legalizing cannabis.

Marijuana legalization is important to voters

It’s one thing to say that voters support legalizing marijuana. It’s quite another to say they would actually vote for a presidential candidate based on this policy…

Marijuana legalization appears to be one of these strongly held, gut-level issues, too. Political science research from the 1970s found that Americans as a whole held stronger views about marijuana than just about any other public policy…

much newer study also shows that marijuana legalization is one of the more important issues to voters…

Of course, legalizing marijuana was not as important to voters as the most polarizing issues of the day, such as impeachment and the border wall. But it was a more important priority to voters than any of the fiscal issues that dominate so much political debate, such as taxes and health care, especially among pure independents who do not lean toward either party…

Implications for 2020

To be sure, the popularity of marijuana legalization and its importance to many voters would only matter in a close 2020 election. Most voters are already locked into their choices, given how polarized party supporters are and how strongly Americans feel about President Trump.

But the data still suggest that Joe Biden is missing a big political opportunity to run on legalization in a presidential campaign in which Democrats face an uphill battle in the electoral college. Although Biden’s position on marijuana policy is more lenient than Trump’s, he remains opposed to full legalization in the United States.

Biden has repeatedly defended his position on legal cannabis by saying that the policy’s impact still needs to be studied. The political impact, however, is unambiguous: Marijuana legalization is a winning campaign issue.

Wow.  Compelling case.  Only question is is Biden savvy enough to capitalize on this.  Given that Ezra Klein has (aptly) pegged his ideology as finding the center of the Democratic party and planting himself there, I am hopeful that he will be.  Furthermore, as an old white dude with a history of opposition, he’s a good messenger on the issue who cannot be written off as just some crazy drug-loving liberal.  Let’s make it happen, Joe.

And, while I’m at it, a 4/20 conversation with my daughter.  

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