On hydroxychloroquine, expertise, and the power of persuasion.

On hydroxychloroquine, expertise, and the power of persuasion.

Recently, a friend who works in the ER wrote to ask me about hydroxychloroquine.

Yes, I know. I was shocked, too. But my friend was sincere. Although most reputable news outlets have publicized that hydroxychloroquine doesn’t work against Covid-19, my friend read an article from Harvey Risch in Newsweek that seemed really compelling.

Risch has impeccable credentials – he’s an M.D. Ph.D. and a professor of epidemiology at Yale’s School of Public Health. And a lot of what he wrote for his July 23rd article is quite sensible:

Why has hydroxychloroquine been disregarded?

First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed.

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Medical data isn’t perfect, and confirmation bias is very real. So there’s a chance that medical doctors really could hoodwink themselves into discounting a helpful medication, the same way that so many medical doctors get suckered into overprescribing drugs after pharmaceutical companies bribe them with gifts. Yup, medical doctors are human, too.

I know that I’m so dismayed by our current president that I’m inclined to distrust hydroxychloroquine just because he says the drug is great.

So it was a shock for me to read Risch’s article. He wrote that there was data showing that hydroxychloroquine, when used in a combination therapy early during a high-risk person’s Covid-19 infection, could dramatically reduce the risk of serious complications. If more people took hydroxychloroquine, he wrote, fewer would die.

Risch acknowledges that hydroxychloroquine is dangerous – it might kill 1 out of each 10,000 people who take it – but Covid-19 is obviously dangerous, too – it kills 3 out of each 1,000 people who contract it:

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.

But for now, reality demands a clear, scientific eye of the evidence and where it points. For the sake of high-risk patients, for the same of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionately affected, we must start treating immediately.

Those are strong words. And, really, the Newsweek article felt persuasive to me. And so I looked up Risch’s research in the American Journal of Epidemiology, hoping to see the actual data in support of his claims.

I’m lucky, that way. I’m a scientist, so I don’t have to trust the words of a supposed expert. I’m an expert. I get to look at the data.

The data are much less compelling than Risch’s words.

Risch discusses the results of an uncontrolled study by Vladimir Zelenko, a medical doctor in Monroe, New York: “For example, among Connecticut cases 60 years of age or older, at present the mortality is 20%. Thus it would be ballpark to estimate that some 20% of the 1466 treated high-risk patients in the Zelenko cohort would have died without outpatient hydroxychloroquine plus antibiotic.

This is an egregiously inaccurate statement. The high death rate cited – 20 – is for older patients who test positive for Covid-19 and have such severe symptoms that they need to be hospitalized.

As described in the short statement released by Zelenko, he treated 405 people who visited his office complaining of mild cough, fever, headache, sore throat, or diarrhea. His patients were not given a Covid-19 test. Presumably, many were never infected with Covid-19.

It is not a surprise to see that a 60-year-old patient who takes hydroxychloroquine after developing a sore throat from seasonal allergies is less likely to die than a 60-year-old patient who is diagnosed with Covid-19 in the hospital.

Of Zelenko’s 405 patients, at least two 2 died. This is lower than the expected 1% mortality rate of high-risk patients who contract Covid-19. But this set of 405 patients included low-risk patients experiencing shortness of breath and high-risk patients experiencing mild headache, many of whom never had Covid-19.

Zelenko’s report is two pages long and written in extremely lucid prose. Risch either totally misread it, which is galling, or intentionally mis-described it, which is worse.

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So, why was Zelenko giving people hydroxychloroquine in the first place?

Well, I’d heard that an in vitro study – which means “inside a test tube or petri dish, not a person” – showed that hydroxychloroquine reduced Covid-19 viral replication. But I hadn’t read the original paper. So I looked it up.

It should have taken me less than a minute to find this paper. Unfortunately, people have been pretty sloppy with their references. I get it. Covid-19 is scary, and it’s urgent, so people are publishing faster than usual.

I assumed that I could pull up almost any paper on hydroxychloroquine and Covid-19 and quickly find the citation for the original study. Indeed, most purport to be citing it. But in this, the citation that ought to have pointed to that study instead sent me to a paper on the differentiation of lung stem cells, and in this, the relevant citation incorrectly points to a paper on the drug lopinavir.

Ugh. I mean, these bungled citations aren’t that big a deal for me, personally – just means I had to give up on piggybacking and instead search Pubmed. But it undermines trust when you can’t get the little things right.

Anyway, the earliest reference that I found was from Liu et al., their study “Hydroxychloroquine, a less toxic derivative of chloroquine, is effective at inhibiting SARS-CoV-2 infection in vitro.” And, yes, I’ll admit – I thought about putting in the wrong link just to mess with you. But, if I did that, would you still trust me about the rest of this?

Liu et al. used Vero cells – a cell line derived from a kidney cancer in African green monkeys – and for Figure 1, they measured both how much hydroxychloroquine it takes to kill cells (about 200 micromolar is a cytotoxic dose) and how much hydroxychloroquine it takes to inhibit viral infection (about a 10 micromolar dose).

Okay. To me, that’s already sounding a little spooky. The bigger the difference between an effective dose and a lethal dose, the safer you are.

That’s why a bunch of hippies died after The Teachings of Don Juan was published. That book touted jimsomweed as a psychedelic. Indeed, the plant contains a high concentration of scopolamine, which can give people nightmarish visions of flying. It’s a powerful hallucinogen. But the effective dose is quite close to the lethal dose – when curious kids try to get high off it, they’re flirting with death.

Everyone’s body is a little different from everyone else’s. Maybe a dose that’s safe for you would kill me. The odds of disaster are worse when the effective dose and lethal dose are similar.

So, Liu et al. saw cytotoxicity kick in at around 100 micromolar hydroxychloroquine, getting pretty high by 200 micromolar. And for their visual assay of viral infection, they bathed their Vero cells in 50 micromolar hydroxychloroquine.

To block viral entry, they were coming pretty close to just killing these cells with the drug.

And the problem is even worse inside a human body. You take a drug and it gets into your bloodstream. It’ll reach some concentration there. This is the concentration that matters most for toxicity.

But the drug will only be effective against Covid-19 when it reaches your lungs. When Marzolini et al. used mass spectrometry to measure how much of hydroxychloroquine was actually getting from a patient’s blood to their lungs, they found that it wasn’t at a high enough concentration to reproduce any effects seen in vitro.

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Indeed, a randomized clinical study showed that hydroxychloroquine fails as a post-exposure prophylaxis. The drug was given to people who were worried about exposure because they’d spent time with someone who tested positive for Covid-19. The drug didn’t help – these people contracted the infection at the same rate as people who were given a placebo.

A randomized clinical study also showed that hydroxychloroquine fails as a cure. People who visited a hospital and tested positive for Covid-19 but had mild symptoms were given the drug. Their disease was just as likely to progress as people who received a placebo.

Hydroxychloroquine doesn’t work, and it’s toxic.

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I was left wondering: why would Risch write these things? Why would he write that article for Newsweek? He’s clearly intelligent, and, from the tone of his writing, I feel confident that he wants to help people.

He might even believe wholeheartedly in the conclusion he’s presenting.

That’s generally true among scientists. Confirmation bias is insidious.

That paper from the team at Harvard? They did some modeling and argued that, if Covid-19 is seasonal, we will save most lives by periodically shutting down. But their model left out the waning immunity that would cause Covid-19 to be seasonal! Whoops. That’s why they reached the wrong conclusion.

Or the recent New York Times editorial from Iwasaki and Medzhitov, both professors of immunobiology at Yale, reassuring readers that they won’t get Covid-19 twice. Well, that’s not correct.

Some antigens confer immunity that lasts about as long as our lives. Most don’t. Influenza immunity lasts months, not years. The paper that Iwasaki and Medzhitov cited in their article, a study in which people were intentionally infected with a less dangerous coronavirus, found that immunity to that virus lasted months, not years.

Covid-19 immunity will not last forever. The relevant question isn’t whether you can be infected again, it’s how soon you can be re-infected. With the data we have so far, it’s reasonable to expect that the answer will be measured in months, not years.

There’s some good news – the second time you contract Covid-19, it’ll probably be less severe than the first. In addition to antibodies, your immune system has “T cell memory” to help you fight off subsequent infections. But, as is also described in the paper cited by Iwasaki and Medzhitov, even people who felt fine were shedding virus again the second time they were infected.

During the second infection, the research subjects were shedding viral particles for a shorter period of time. But, especially with Covid-19 – a virus that can be transmitted simply by talking – a person who sheds virus for a short time while feeling fine is probably more likely to transmit the disease than somebody who sheds virus for a whole week while feeling like garbage.

The person who feels like garbage will stay home. The person who feels fine won’t.

Still, though, I was left wondering – what underlying beliefs would sway Risch enough that he’d make these blunders?

Eventually, I decided to lump his motivation in with mine. Maybe that’s fair, maybe it’s not. Really, I have no idea what he was thinking, so this is just my best guess.

But I imagine that many of these people – Risch, Iwasaki, Medzhitov, John Ioannidis, David Katz, all of whom are very smart, and all of whom mean well – understand that the strategies we’re using against Covid-19 are both ineffectual and are causing harm.

No shutdown will eliminate Covid-19 – the best we can do is to delay it. And we can delay it only as long as we maintain the shutdown. Maybe that seems fine if you’re an older, wealthy person brimming with optimism about vaccine development, like Anthony Fauci who thinks we’ll have a working vaccine early next year, but it’s unconscionable if you think a working vaccine might be five or more years away.

I don’t think we should try to pause children’s development for five years.

Still, there’s no mathematical or logical way to prove what we should do. School closures definitely slow the spread of Covid-19. How do you balance the good of delaying an elderly person’s infection by three months (which is equivalent to a drug that extends a patient’s life by three months) with the harms we’re causing?

I know what I’d do, but other people have different priorities than me. And that’s okay!

I’d like to think, though, that I’m not trying to hoodwink anybody about the science in order to deceptively get them to do the thing I think is right.

Like, yes, I think schools should be open. I think we owe it to children. Right now, children are suffering, but this is our fault, the fault of grown-ups.

We have known for over a decade that we ought to make coronavirus vaccines – we didn’t devote enough resources to it, and now we don’t have one. We’ve known for decades that eating animals – both those sold in meat markets like in Wuhan and the ones raised in “concentrated animal feeding operations” throughout the U.S. – will create more zoogenic diseases, and we kept doing it. We know that a guaranteed basic income would’ve given people the resources they needed to self-isolate during an epidemic – we don’t have one. We know that guaranteed access to health care would keep our death rate down.

Climate change will make pandemics more frequent, in addition to making our world unliveable for future generations. And we haven’t taken action to stop it.

None of these failings are children’s fault. We, older people, have failed. We fucked up. And now we’re asking children to make sacrifices to dampen the impact of our mistake (although, again, it won’t work – it’ll just delay the eventual repercussions).

I think today’s children deserve a fair shot at a good life, and I think that school is an essential part of that.

But don’t let anybody try to convince you that it’s safe to re-open schools because hydroxychloroquine will stop Covid-19.

On fire and ash.

On fire and ash.

The phoenix falls into fire, burns, and dies. Then rises again, reborn.

The phoenix triumphs over adversity. Life gets hard, excruciatingly hard. Everything falls to shit. But the phoenix rises again.

Or so we hope.

Sometimes, the fire burns too hot. And then the phoenix dies and stays dead. Sometimes ash isn’t a phoenix egg.

Sometimes ash is only ash.

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Here’s a poem by my friend Satish:

COULD I BE

Satish Brown

a peacock, so vibrant

& bright, but vulnerable

for lack of flight, a

turkey that flutters

searching for height.

A dove that flies so

high, so pure & clean.

I’m none of these.

Just searching for a

balance – in between.

Maybe a phoenix, mystical,

reborn from fire &

ashes.

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Satish wrote this poem while he was living inside the dormitory on the ground floor of the Monroe County Jail. This is an awful little space. It’s about the size of my living room. Twelve men lived there. They slept on bunk beds. The fluorescent lights were turned off only from midnight until four a.m. The single window, a tiny rectangle of wire-reinforced glass inside the steel door, faced the subterranean booking desk – no glimpse of the outdoors. There were two steel tables bolted to the floor, and each table had six steel stools curving out from beneath it, like a pair of silver-skinned twice-amputated octopuses where the men could sit to eat their meals.

The jail dorm shared a wall with soft booking – “the drunk tank.” Much of the time, someone with mental health issues would be in there, hollering. If someone in the tank decides to stand there rhythmically kicking the steel door, the noise resounds through your skull like the repeated cocking of a shotgun inside your brain. All thoughts disappear but hate. At least, that was my experience, and I never spent more than two hours at a time inside that space.

Satish was there for months.

But he stayed chipper. It was always a pleasure to go in there with a stack of poems and have the chance to talk with him. On his good days, his enthusiasm was infectious, leaning in close to ask questions or banter about religion, his huge eyes gleaming like polished fishbowls.

The saddest poem he wrote was about cheating on his girlfriend with an old man – “old man” is slang for heroin.

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The other men in the dorm loved having him around. In such a small space, where people are going through the worst time of their lives and yet are expected to endure the constant presence of a roomful of other men who’re also going through the worst time of their lives, emotions fray easily. Twice when I came in there, my buddy Max had ugly blue bruises covering his face.

“We had a little disagreement,” Max would tell me. And he’d mention the name of somebody who’d been in the dorm the week before, but had since been moved to a different block.

But nobody had trouble with Satish.

Nobody except the judge.

Max told me, “Judge ______ gave him this deal, Satish was on this drug court thing, and she was going to pretend to care. She said, ‘write me a letter, write me a letter and convince me why I should go easy on you.’ But if she’s going to go easy, why would she need that letter? So Satish wrote this letter, he basically wrote to her, ‘Fuck you, just do what you’re going to do.’ “

The thing is, we all thought he would walk. The case, as far as I knew it, was pretty weak. He had come home, he’d lost his keys, and he was high. He thought he could sleep it off, go look for his keys in the morning, and so he tried to get in through the window.

Except he picked the wrong window. He was climbing in the neighbors’, and they freaked and called the police. The cops came. By then they figured out who he was, everybody was confused, but mistakes happen. Mistakes happen more when people are on drugs, but, regardless, mistakes happen.

The neighbors didn’t want to press charges. They weren’t going to cooperate with a case.

In the United States, prosecutors have a lot of leeway, though. Doesn’t matter what the police report says, doesn’t matter what the witnesses say, the prosecutor gets to decide what charges to file. They get to pile charges on as leverage for plea bargaining. They don’t have to justify which people get dog piled and which people walk free.

The prosecutor’s decisions are yet another place in our criminal justice system where racial injustice creeps in. Perhaps it’s worth mentioning that, in the eyes of the state, Satish was Black.

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So, a phoenix. Maybe they’d send him away. But he could overcome adversity.

Well.

We thought he would walk. We expected that he’d go to court, then get sent home for time served.

Instead, they gave him seven years.

He was shipped off to the “Reception & Diagnostics Center.” This is where they do psychological evaluations, figure out which prison you’ll be sent to. While at reception & diagnostics, nobody can get a hold of you.

He’d been there two days when his girlfriend – mother of his two children, pregnant with their third – overdosed and died. She’d been clean a while. But after something like that – you think he’s coming out, instead they give him seven years – it’s easy to relapse.

Heroin killed her. But the courts killed her too.

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He took it hard.

We volleyed letters for a while – he’d send me folded bundles, six or seven sheets that he’d written over the course of a week, and he stamped the envelopes low to dodge the postmark – but he always said that it was hard to find time to write. He was doing as many programs as he could, trying to get level-headed, trying to get out. Most programs will give you a time cut.

They’d given him seven years, but he was out after another two. Lots of guys have tried to explain the math of criminal justice time to me; I have never understood.

Max said, “He was in a pretty good place, at first. I mean, he had a handle on it, what’d happened with Chelsea, everything that happened. But when he started using …”

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He was trying to rise. Twenty-nine, and rebuilding his life.

But sometimes the fire burns too hot. Sometimes it burns and burns and the ash stops being an egg. Sometimes ash is only ash.

Rest in peace, Satish.

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.

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Header image from Badeeh Abla on flickr.

On empathy and the color red.

On empathy and the color red.

I can’t fly.

I try to feed my children every night, but I never vomit blood into their mouths.

When I try to hang upside down – like from monkey bars at a playground – I have to clench my muscles, and pretty soon I get dizzy. I couldn’t spend a whole day like that.

And, yes, sometimes I shout. Too often during the pandemic, I’ve shouted at my kids. But when I shout, I’m trying to make them stop hitting each other – I’m not trying to figure out where they are.

It’s pretty clear that I’m not a bat.

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Photograph by Anne Brooke, USFWS

Because I haven’t had these experiences, philosopher Thomas Nagel would argue that I can’t know how it feels to be a bat.

In so far as I can imagine [flitting through the dark, catching moths in my mouth], it tells me only what it would be like for me to behave as a bat behaves.

But that is not the question. I want to know what it is like for a bat to be a bat.

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Perhaps I can’t know what it feels like for a bat to be a bat. And yet, I can empathize with a bat. I can imagine how it might feel to be trapped in a small room while a gamboling, wiry-limbed orc-thing tried to swat me with a broom.

It would be terrifying!

And that act of imagination – of empathy – is enough for me to want to protect bats’ habitats. To make space for them in our world. Sure, you could argue that bats are helpful for us – they’re pollinators, they eat pesky bugs – but empathy lets us care about the well-being of bats for their own sake.

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Literature exercises our minds: when we read, invent, and share stories, we build our capacity for empathy, becoming more generally aware of the world outside our own skulls.

Writing can be a radical act of love. Especially when we write from a perspective that differs from our own. The poet Ai said that “Whoever wants to speak in my poems is allowed to speak, regardless of sex, race, creed, or color.” Her poems often unfurl from the perspective of violent men, and yet she treats her protagonists with respect and kindness. Ai gives them more than they deserve: “I don’t know if I embrace them, but I love them.

Ai

That capacity for love, for empathy, will let us save the world. Although many of us haven’t personally experienced a lifetime of racist microaggressions or conflict with systemic oppression, we all need to understand how rotten it would feel. We need to understand that the pervasive stress seeps into a person’s bones, causing all manner of health problems. We need understand the urgency of building a world where all children feel safe.

And if we don’t understand – yet – maybe we need to read more.

Experiments suggest that reading any engaging literary fiction boosts our ability to empathize with others. Practice makes better: get outside your head for a while, it’ll be easier to do it again next time.

Of course, we’ll still need to make an effort to learn what others are going through. Thomas Nagel was able to ruminate so extensively about what it would feel like to live as a bat because we’ve learned about echolocation, about their feeding habits, about their family lives. If we want to be effective anti-racists, we need to learn about Black experiences in addition to developing our empathy more generally.

Luckily, there’s great literature with protagonists facing these struggles – maybe you could try How We Fight for Our Lives, Americanah, or The Sellout.

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As a bookish White person, it’s easy for me to empathize with the experiences of other bookish White people. In Search of Lost Time doesn’t tax my brain. Nor does White Noise. The characters in these books are a lot like me.

The cognitive distance between me and the protagonists of Americanah is bigger. Which is sad in and of itself – as high schoolers, these characters were playful, bookish, and trusting, no different from my friends or me. But then they were forced to endure hard times that I was sufficiently privileged to avoid. And so when I read about their lives, perched as I was atop my mountain of privilege, it was painful to watch Ifemelu and Obinze develop their self-protective emotional carapaces, armoring themselves against the injustice that ceaselessly buffets them.

Another reader might nod and think, I’ve been there. I had to exercise my imagination.

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In Being a Beast, Charles Foster describes his attempts to understand the lives of other animals. He spent time mimicking their behaviors – crawling naked across the dirt, eating worms, sleeping in an earthen burrow. He wanted a badger’s-eye view of the world.

Foster concluded that his project was a failure – other animals’ lives are just so different from ours.

And yet, as a direct consequence of his attempt at understanding, Foster changed his life. He began treating other animals with more kindness and respect. To me, this makes his project a success.

White people might never understand exactly how it feels to be Black in America. I’m sure I don’t. But we can all change the way we live. We can, for instance, resolve to spend more money on Black communities, and spend it on more services than just policing.

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Empathy is working when it forces us to act. After all, what we do matters more than what we purport to think.

It’s interesting to speculate what it would feel like to share another’s thoughts – in Robert Jackson Bennett’s Shorefall, the protagonists find a way to temporarily join minds. This overwhelming rush of empathy and love transforms them: “Every human being should feel obliged to try this once.

In the real world, we might never know exactly how the world feels to someone else. But Nagel wants to prove, with words, that he has understood another’s experience.

One might try, for example, to develop concepts that could be used to explain to a person blind from birth what it was like to see. One would reach a blank wall eventually, but it should be possible to devise a method of expressing in objective terms much more than we can at present, and with much greater precision.

The loose intermodal analogies – for example, “Red is like the sound of a trumpet” – which crop up in discussions of this subject are of little use. That should be clear to anyone who has both heard a trumpet and seen red.

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We associate red with many of our strongest emotions: anger, violence, love.

And we could tell many different “just so” stories to explain why we have these associations.

Like:

Red is an angry color because people’s faces flush red when they’re mad. Red blood flows when we’re hurt, or when we hurt another.

Or:

Red represents love because a red glow spreads over our partners’ necks and chests and earlobes as we kiss and caress and fumble together.

Or:

Red is mysterious because a red hue fills the sky at dawn and dusk, the liminal hours when we are closest to the spirit world.

These are all emergent associations – they’re unrelated to the original evolutionary incentive that let us see red. Each contributes to how we see red now, but none explains the underlying why.

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We humans are blue-green-red trichromatic – we can distinguish thousands of colors, but our brains do this by comparing the relative intensities of just three.

And we use the phrase “color blind” to describe the people and other animals who can’t distinguish red from green. But all humans are color blind – there are colors we can’t see. To us, a warm body looks identical to a cold wax replica. But their colors are different, as any bullfrog could tell you.

Photograph by Tim Mosenfelder, Getty Images

Our eyes lack the receptors – cone cells with a particular fold of opsin – that could distinguish infrared light from other wavelengths. We mistakenly assume these two singers have the same color skin.

When we look at flowers, we often fail to see the beautiful patterns that decorate their petals. These decorations are obvious to any bee, but we’re oblivious. Again, we’re missing the type of cone cells that would let us see. To fully appreciate flowers, we’d need receptors that distinguish ultraviolet light from blue.

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Most humans can see the color red because we’re descended from fruit eaters. To our bellies, a red berry is very different from a green berry. And so, over many generations, our ancestors who could see the difference were able to gather more nutritious berries than their neighbors. Because they had genes that let them see red, they were better able to survive, have children, and keep their children fed.

The genes for seeing red spread.

Now, several hundred thousand years later, this wavelength of light blares at us like a trumpet. Even though the our ancestors learned to cook food with fire, and switched from fruit gathering to hunting, and then built big grocery stores where the bright flashes of color are just advertisements for a new type of high-fructose-corn-syrup-flavored cereal, red still blares at us.

Once upon a time, we really needed to see ripe fruit. The color red became striking to us, wherever we saw it. And so we invented new associations – rage, or love – even though these are totally unrelated to the evolutionary pressures that gave us our red vision.

Similarly, empathy wasn’t “supposed” to let us build a better world. Evolution doesn’t care about fairness.

And yet. Even though I might never know exactly how it feels when you see the color red, I can still care how you’re treated. Maybe that’s enough.

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Header image: a greater short-nosed fruit bat, photograph by Anton 17.

On money, nursing home care, and Covid-19.

In April, I wrote several essays and articles about our collective response to Covid-19.

I was worried – and am still worried, honestly – that we weren’t making the best choices.

It’s hard not to feel cynical about the reasons why we’ve failed. For instance, our president seems more concerned about minimizing the visibility of disaster than addressing the disaster itself. We didn’t respond until this virus had spread for months, and even now our response has become politicized.

Also, the best plans now would include a stratified response based on risk factor. Much more than seasonal influenza, the risk of serious complications from Covid-19 increases with age. Because we didn’t act until the virus was widespread, eighty-year-olds should be receiving very different recommendations from forty- and fifty-year-olds.

Our national response is being led by an eighty-year-old physician, though, and he might be biased against imposing exceptional burdens on members of his own generation (even when their lives are at stake) and may be less sensitive to the harms that his recommendations have caused younger people.

I’m aware that this sounds prejudiced against older folks. That’s not my intent.

I care about saving lives.

Indeed, throughout April, I was arguing that our limited Covid-19 PCR testing capacity shouldn’t be used at hospitals. These tests were providing useful epidemiological data, but in most cases the results weren’t relevant for treatment. The best therapies for Covid-19 are supportive care – anti-inflammatories, inhalers, rest – delivered as early as possible, before a patient has begun to struggle for breath and further damage their lungs. Medical doctors provided this same care whether a Covid-19 test came back positive or negative.

(Or, they should have. Many patients were simply sent home and told to come back if they felt short of breath. Because they didn’t receive treatment early enough, some of these patients then died.)

Instead, our limited testing capacity should have been used at nursing homes. We should have been testing everyone before they went through the doors of a nursing home, because people in nursing homes are the most vulnerable to this virus.

I realize that it’s an imposition to make people get tested before going in, either for care or to work – even with real-time reverse-transcription PCR, you have to wait about two hours to see the results. But the inconvenience seems worthwhile, because it would save lives.

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From March 25 until May 10 – at the same time that I was arguing that our limited Covid-19 tests be used at nursing homes instead of hospitals – the state of New York had a policy stating that nursing homes were prohibited from testing people for Covid-19.

I really dislike the phrase “asymptomatic transmission” – it’s both confusing and inaccurate, because viral shedding is itself a symptom – but we knew early on that Covid-19 could be spread by people who felt fine. That’s why we should have been using PCR tests before letting people into nursing homes.

But in New York, nursing homes were “prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.

This policy caused huge numbers of deaths.

Not only do nursing homes have the highest concentration of vulnerable people, they also have far fewer resources than hospitals with which to keep people safe. Nursing home budgets are smaller. Hallways are narrower. Air circulation is worse. The workers lack protective gear and training in sterile procedure. Nursing home workers are horrendously underpaid.

The low wages of nursing home workers aren’t just unethical, they’re dangerous. A recent study found that higher pay for nursing home workers led to significantly better health outcomes for residents.

This study’s result as described in the New York Times – “if every county increased its minimum wage by 10 percent, there could be 15,000 fewer deaths in nursing homes each year” – is obviously false. But even though the math doesn’t work out, raising the minimum wage is the right thing to do.

If we raised the minimum wage, we probably would have a few years in which fewer people died in nursing homes. But then we’d see just as many deaths.

Humans can’t live forever. With our current quality of care, maybe nursing home residents die at an average age of 85. If we raise the minimum wage, we’ll get better care, and then nursing home residents might die at an average age of 87. After two years, we’d reach a new equilibrium and the death rate would be unchanged from before.

But the raw number here – how many people die each year – isn’t our biggest concern. We want people to be happy, and an increase in the minimum wage would improve lives: both nursing home residents and workers. Which I’m sure that study’s lead author, economist Kristina Ruffini, also believes. The only problem is that things like “happiness” or “quality of life” are hard to quantify.

Especially when you’re dealing with an opposition party that argues that collective action can never improve the world, you have to focus on quantifiable data. Happiness is squishy. A death is unassailable.

Indeed, that’s partly why we’ve gotten our response to Covid-19 wrong. Some things are harder to measure than others. It’s easy to track the number of deaths caused by Covid-19. (Or at least, it should be – our president is still understating the numbers.)

It’s much harder to track the lives lost to fear, to domestic violence, and to despair (no link for this one – suddenly Fox News cares about “deaths of despair,” only because they dislike the shutdown even more than they dislike poor people).  It’s hard to put a number on the value of 60 million young people’s education.

But we can’t discount the parts of our lives that are hard to measure – often, they’re the most important.

On hubris and climate change.

On hubris and climate change.

Recently, a local science teacher sent me an essay written by a climate change skeptic.

Well, okay. I figured that I could skim the essay, look over the data, and briefly explain what the author’s errors were. After all, it’s really important to help teachers understand this topic, because they’re training our next generation of citizens.

And I thought to myself, how hard can this be? After all, I’m a scientist. I felt unconcerned that I’ve never read research papers about climate science before, and that it’s been years since I’ve worked through the sort of differential equations you need for even basic fluid mechanics calculations, and that I’ve never run any simulations on oceanic heat transfer or glacier melting.

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Since then, I’ve read a fair bit about climate science. I’ll be honest: I didn’t go through the math. All I did was read the papers and look over the processed data.

This is lazy, I know. I’m sorry. But my kids are at home. At the moment, this is the best I’ve got.

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Prominent climate change skeptic Richard Lindzen, an emeritus professor of meteorology, recently delivered a lecture to the Global Warming Policy Foundation. I wholeheartedly agreed with Lindzen when he stressed that the science behind climate change is really, really complicated.

Former senator and Secretary of State John F. Kerry is typical when he stated, with reference to greenhouse warming, ‘I know sometimes I can remember from when I was in high school and college, some aspects of chemistry or physics can be tough. But this is not tough. This is simple. Kids at the earliest age can understand this.’

As you have seen, the greenhouse effect is not all that simple. Only remarkably brilliant kids would understand it. Given Kerry’s subsequent description of climate and its underlying physics, it was clear that he was not up to the task.

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Climate science is tricky. In a moment, I’ll try to explain why it’s so tricky.

When people make predictions about what’s going to happen if the average global temperature rises by half a degree – or one degree, or two – their predictions are probably incorrect.

My assumption that I could skim through somebody’s essay and breezily explain away the errors was incredibly arrogant. I was a fool, I tell you! A fool!

But my arrogance pales in comparison to the hubris of climate change skeptics. Once I started learning about climate science, I realized how maddeningly difficult it is.

Lindzen, who should know better, has instead made brash claims:

So there you have it. An implausible conjecture backed by false evidence and repeated incessantly has become politically correct ‘knowledge,’ and is used to promote the overturn of industrial civilization. What we will be leaving our grandchildren is not a planet damaged by industrial progress, but a record of unfathomable silliness as well as a landscape degraded by rusting wind farms and decaying solar panel arrays.

There is at least one positive aspect to the present situation. None of the proposed policies will have much impact on greenhouse gases. Thus we will continue to benefit from the one thing that can be clearly attributed to elevated carbon dioxide: namely, its effective role as a plant fertilizer, and reducer of the drought vulnerability of plants.

Meanwhile, the IPCC is claiming that we need to prevent another 0.5ºC of warming, although the 1ºC that has occurred so far has been accompanied by the greatest increase in human welfare in history.

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So. What aspects of climate science can we understand, and what’s too hard?

Let’s start with the easy stuff. Our planet gets energy from the sun. The sun is a giant ball of thermonuclear fire, spewing electromagnetic radiation. When these photons reach Earth, they’re relatively high energy – with wavelengths mostly in the visible spectrum – and they’re all traveling in the same direction.

What we do – “we” here referring to all the inhabitants of our planet, including the rocks and plants and other animals and us – is absorb a small number of well-organized, high-energy photons, and then release a larger number of ill-organized, low-energy photons. This is favorable according to the Second Law of Thermodynamics. We’re making chaos.

And here’s the greenhouse effect: if the high-energy photons from the sun can pass through our atmosphere, but then the low-energy photons that we release get absorbed, we (as a planet) will retain more of the sun’s energy. Our planet heats up.

Easy!

And, in defense of former senator John Kerry, this is something that a kid can understand. My children are four and six, and this summer we’re going to build a solar oven out of a pane of glass and a cardboard box. (After all, we need stuff to do while all the camps are closed.)

If we fill our air with more carbon dioxide, which lets the sun’s high-energy photons in but then won’t let our low-energy photons out, the planet should heat up, right? What’s the hard part?

Well, the problem – the reason why climate science is too difficult for humans to predict, even with the most powerful computers at our command – is that there are many feedback loops involved.

Some of these are “negative feedback loops” – although atmospheric carbon dioxide causes us to absorb more energy from the sun, various mechanisms can buffer us from a rise in temperature. For example, warm air can hold more water vapor, leading to more cloud formation, which will reflect more sunlight back into space. If the sun’s high-energy photons can’t reach us, the warming stops.

And some are “positive feedback loops” – as we absorb extra energy from the sun, which causes the planet to heat up a little, various mechanisms can cause us to absorb even more energy in the future, and then the planet will heat up a lot. This may be what happened on Venus. The planet Venus may have been habitable, a long long time ago, but then runaway climate change led to the formation of a thick layer of smog, and now it’s broiling, with sulfuric acid drizzling from the sky.

On Earth, an example of a positive feedback loop would be the melting of polar ice caps. As polar ice melts, it reflects less light, so our planet absorbs more of the sun’s energy. Heat made the ice melt in the first place, but then, once the ice has melted, we heat up even more.

And it turns out that there are a huge number of different positive and negative feedback loops. After all, our planet is really big!

For instance, the essay I was sent included graphs of ice core data suggesting that, in the ancient past, changes in average global temperatures may have preceded changes in the concentration of atmospheric carbon dioxide.

Frank Brown Cloud holding demo ice core.
Holding a demo ice core like my spouse uses in her classroom. The real ones drilled from glaciers are several miles long! I haven’t spent enough time at the gym to lift those.

But this is just another feedback loop. In the past, there was no mechanism for carbon dioxide to pour into our atmosphere before temperatures rose – dinosaurs didn’t invent internal combustion engines. This is the first time on Earth when carbon dioxide levels could rise before temperatures, and we don’t know yet what the effect will be.

Extra carbon dioxide will probably cause an increase in temperature, but a planet’s climate is really complicated. We have huge quantities of poorly mixed water (otherwise known as oceans). Our topography is jagged, interspersed with valleys and mountains. There are huge forests (only some of which are on fire). The air is turbulent.

We might find that temperatures are buffered more than we thought. The ocean might act like a giant heat sink.

Or then again, the ocean might warm up, accelerate polar ice loss by lapping at the undersides of glaciers, and magnify the changes.

The mathematics underlying fluid mechanics and heat transfer within an enormous, inhomogeneous system are so complex that it’s almost impossible to say. Nobody knows how much detail you’d need to put into a simulation to get accurate results – all we know for sure is that we can’t simulate the world with as much detail as actually exists. All our models are approximations. Some of them contradict each other.

With my admittedly limited understanding, I don’t think anybody knows enough to assert with confidence whether our climate will exhibit either buffered or switch-like behavior. Maybe we can muck about without hurting much. Or we might bring about our own doom with a tiny mistake.

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Our planet’s climate is so complex that you could make a similar argument – we really don’t know whether we’re going to be buffered from future changes, or whether we’re at the precipice of doom – no matter what evidence we obtain.

Maybe sea levels start rising – well, perhaps that will somehow reduce the further heating of our planet. Maybe we get more horrible tropical storms – well, perhaps they’re linked to a greater density of sunlight-reflecting clouds.

Maybe things seem to be changing fast for a little while, but then we enter another stable state.

Or, insidiously, maybe it will seem like we’re in a well-buffered system – pumping large amounts of carbon dioxide and methane into the atmosphere without seeing much harm – until, suddenly, we tip over the edge. We often see that sort of behavior from positive feedback loops. Nothing seems to happen, for a while, then everything changes at once. That’s how cooperative binding of oxygen to hemoglobin works in your body.

Another problem is that climate change will probably happen on a very different rhythm from our lives. Weather happens on timescales that we can understand. A decade of droughts. Two years of tropical storms. A few hard winters, or hot summers. But climate happens over hundreds or thousands of years. Most of the time, it changes more slowly than we’d notice.

A two degree shift in average global temperatures, spread out over a few decades? That’s bad, but it’s boring. Which was the main focus of Jonathan Safran Foer’s We Are the Weather.

History not only makes a good story in retrospect; good stories become history. With regard to the fate of our planet – which is also the fate of our species – that is a profound problem. As the marine biologist and filmmaker Randy Olson put it, “Climate is quite possibly the most boring subject the science world has ever had to present to the public.”

Climate science doesn’t fit our culture. Especially not now, when the pressures of surveillance capitalism have forced even the New York Times to run like an advertising company. They earn more from news that gets clicks. Stories need to be sensational. Yes, they run stories about climate change. For these, the polar bears need to be dying, now, and there needs to be an evil villain like Exon lurking in the shadows.

Nobody wants to click on a story explaining that we, collectively, have made and are making a whole lot of small shabby decisions that will cause grizzly bears and polar bears to re-mix and de-speciate.

I got bored even typing that sentence.

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Life is incredibly robust.

Our planet has swung through many extremes of temperature. At times, it’s been much hotter than it is now. At times, it was much colder. And life has marched on.

The human species is much less robust than life itself, though. Our kind has flourished for only a brief twinkling of time, during which our climate has been quite stable and mild. A small change could drive us to extinction. An even smaller change could cause our nations to collapse.

Disrupt our food supply – which could happen with just a few years of bad weather, let alone climate change – and there will be war.

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So. I tried to learn about climate change, focusing on the work of skeptics. And in the end, I partly agreed with the skeptics:

I agree that climate science is too complicated for anyone to understand.

I appreciate that people are trying. I had fun learning about ice cores, atmospheric modeling, energy absorption, and the like. Well, sometimes I was having fun. I also gave myself several headaches along the way. But also, my kids were being wild. They’ve been home from school for three months now! I was probably on the precipice of headaches before I even began.

Here’s where I disagree with the skeptics, though: given that climate science is too complicated for us to understand – and given that we know that small changes in average temperature can make the world a much worse place to live – why would be blithely continue to perturb our climate in an unprecedented way?

Maybe things will be fine. Yay buffers! Or maybe we’ll reduce the carrying capacity of the planet Earth from a few billion humans to a few million, dooming most of our kind.

I know, I know – eventually our universe will dwindle into heat death, so our species is terminal anyway. We will go extinct. It’s guaranteed.

I still think it would be neat if our great-great-grandchilden were out there among the stars. At least for a little while.

Or even, if they stay here on Earth, it’s nice to imagine them living on a comfortable planet with lots of beautiful trees, and interesting animals to see.

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Also, I’m biased.

After all, what are the things that you’re supposed to do if you want to reduce your carbon emissions?

Eat fewer animal products. Live in a smaller home. Drive less. Fly less. Buy less stuff.

Those are all things that I’d recommend to most Americans, for ethical and philosophical reasons, even if we weren’t concerned about climate change. So for me, personally, I don’t need to see much proof that we’ll ruin our climate unless we do these things. I think we should be doing them anyway.

Instead, I think the burden of proof should fall to the people hawking Big Macs. I’d want them to show that a world full of CAFO-raised cows won’t cause climate change, won’t propagate antibiotic resistant bacteria, won’t condemn billions of conscious beings to a torturous existence.

The world is complex. We’re going to err.

I’d rather err on the side of kindness.

On bias.

On bias.

At the beginning of our poetry class, back when the county jail was still admitting volunteers, two men read some poems they’d written together. 

The first was a love poem – the gist was that any relationship that could survive a partner’s incarceration could probably survive anything. 

The second was a poem about living in a trailer park:

If you’re looking for drugs – not just grass –

Depends where you look, you’ll pro’lly find glass

Pitbulls in the back

Nine times outta ten you’re already in a trap

As it happens, I already knew that one of the authors had a pack of five chihuahuas that road around town in his backpack.  After they finished reading, I mentioned the dogs.

The other guy answered: “Well, yeah, he has those chihuahuas, but I’ve got two pitpulls.”

After we finished talking about their poems, they had a question for me:

“Hey, so you’re a scientist, right?  Cause I heard there’s like this planet where diamonds rain from the sky.  Do you know anything about that?”

I said it sounded ridiculous.  I was imagining walking through a field and suddenly getting hit on the head by a diamond.  Like a really hard hailstone.

Whenever hail falls, my children dart outside to eat ice.  But a fallen diamond would break your teeth.  Doesn’t melt in your mouth or your hand!

During class, we spent a while talking about how diamonds form.  Under extremely high pressure, the hydrogen atoms in an organic molecule can be displaced by carbon-carbon bonds.  There are a few different shapes that work for a molecule made entirely of carbon.  You can have all the atoms in a flat sheet, which we call graphite.  The atoms can form spheres, which we can buckeyballs.  A length of graphite can wrap between the two round caps of a buckeyball.  Or you can have the atoms in a tetrahedral lattice – a diamond.

If you squeeze carbon atoms under really high pressure, you can turn any of the other shapes into diamonds.  Diamonds are the most stable form.  You can make diamonds just by compressing natural gas.

“This pencil, the part it writes with is graphite,” I said.  “If you were strong enough, you could squeeze it until it was a diamond.  But I don’t think they’d fall like rain.”

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I was wrong.  I was biased about what planets should look like – I live on a small, rocky ball with a thin atmosphere, very different from the gas giants that broil like miniature stars – and biased, unfortunately, against the people who wind up in jail.  I study chemistry, I big expert!

Obviously, there are many occasions when the other people in class know things that I do not.  About poetry, chemistry, and physics.

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Since 1981, computer models have shown that the extreme heat and pressure deep inside Neptune was likely to create diamonds.  If I’d ever taken an astronomy course – or had borrowed library books about our solar system when I was growing up, instead of reading the same book about Godzilla movies over and over – I could have known this, too.

The sky on Neptune is very different from the sky on Earth.  Our air hugs us with a pressure of about fifteen pounds per square inch.  Deep inside the clouds of Neptune, though, the air would squeeze you six million times tighter.  Needless to say, you’d be crushed.  Parts of you might compress into diamond. 

Temperature is a measure of how fast molecules are moving.  Hot air bumps into you more often than cold air, and each collision is a little harder.

Deep in the clouds of Neptune, the gravity is so strong that air molecules accelerate dangerously fast between every collision.  This means the air is really, really hot – thousands of degrees.  Any parts of you that weren’t being compressed into diamond would melt, or wisp away into the broiling clouds.

The high temperature means there’s plenty of energy available for chemical reactions, so molecules can adopt their most stable configurations even if there is a high “activation barrier.” 

An activation barrier is like a wall that separates a thing from what it wants.  Maybe you’d like to eat breakfast but dread the thought of leaving your warm bed – that’s an activation barrier, too.  We could make the activation barrier lower by yanking your blankets off, which makes your current circumstance worse.  Or we could increase your odds of overcoming the activation barrier by pumping you full of caffeine.  With more jittery energy, maybe you’d get up on your own. 

The second strategy – caffeine! – is roughly what happens when you raise the temperature of a chemical reaction.  Carbon is very stable once it becomes a diamond, but it’s difficult for methane to slough off the warm security of all those bonds to hydrogen atoms.

After methane on Neptune is compressed to form a diamond, the diamond will fall.  A diamond is more dense than the air around it.  But the diamond won’t hit the ground like hail, because there’s no ground beneath the hot dense sky of Neptune.  Instead the rocky core seems to be covered by a superheated ocean – well above its boiling point, but still not evaporating because the liquid is kept in place by dense clouds.  Roughly the same way an Instant Pot uses high pressure to cook food in superheated water.

When the diamonds splash into this ocean, they melt.

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In class that day, I hadn’t yet researched Neptune’s atmosphere. I was mostly scribbling crude schematics of crystal structures. I explained how to read a phase diagram.  We talked about diamond mining and the technology used to create synthetics.

I claimed, incorrectly, that diamonds weren’t likely to fall from the sky.

One of the guys shook his head.

“I mean, yeah, that sounds all smart and all, but I swear I heard this thing about diamond rain.  Can you look it up before next week?”

The guys in jail can pay to use iPads – at a rate of five or ten cents per minute – but they have very limited access to the Internet.  There’s one un-blocked application with some scientific lectures, but that’s very different from being allowed to learn what you want.

So I agreed.  It sounded ridiculous to me, but I jotted “SKY DIAMONDS?” and promised to do some research.

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The next week, I was ready to deliver my big mea culpa.  But when I got there, we were missing one of the guys who’d been invested in our discussion.  I asked about him.

“Yeah, he’s not coming back,” said the guy sitting next to me.  “Somebody said he was a cho-mo.”

“Oh,” I said, grimacing.  “He went to seg?”

“Yeah,” said the guy, nodding. We left unsaid that this man probably got the shit kicked out of him first.  If somebody convincingly claims that you’re locked up on a child molestation case, bad things happen.  In prison, you might get murdered by a gang looking to bolster their reputation – because child molesters have such a toxic reputation, there are less likely to be reprisals.  And even a county jail can be a violent place.

After the first fight, the guy who got beaten up will usually choose to go to seg.  Segregation, or solitary confinement, is known to cause permanent brain damage – people suffer from depression, anxiety, and hallucinations.  But staying in a cell block with thirty people who want to kick the shit out of you is likely to lead to brain damage, too.

Solitary confinement might be the less bad of two terrible options.

Despite his bias, the guy I was talking to offered a little sympathy.

“It’s rough,” he said.  “But them’s the politics of the place.”

On grammar in Latin and English.

On grammar in Latin and English.

I spent most of my time during high school doodling in notebooks – during an entire year of biology, the only thing I learned was that the word for several fish of a single type is “fish,” but the word for several fish of different species is “fishes.” 

For dissections – earthworms, giant crickets, pig hearts, and frogs – we were partnered with whomever sat at the table with us.  My partner always brought the newspaper and ostentatiously checked stock prices during class.  The kid in front of me spent a few weeks reading A Confederacy of Dunces. 

My eyesight wasn’t good enough to read over her shoulder.

At least the distinction between fish and fishes turned out to be correct.  My statistics teacher was a baseball coach – he didn’t know calculus, so the only explanation he gave for the workings of a Gaussian distribution was that the numbers were printed on a chart. 

The baseball team had a winning record, though. 

Even in English class, my brain was filled with junk.  We were taught not to split infinitives or end sentences with prepositions.  These are sensible rules in Latin.  An infinitive – like “to read” – is a single word in Latin, so it would be quite strange to put another word in the middle.  Latin also has strict rules about word order — a sentence would be garbled if the preposition was in the wrong place.

But we weren’t learning Latin!  We were learning English, and – lo and behold! – the grammar rules of English are different.  In English, word order is flexible.  A lot of nuance comes from the arrangement of our sentences.  English doesn’t have as many tenses as other languages – there’s no subjunctive – so we English speakers need to scrape out nuance where we can.

In my high school English class, we were also taught not to use “their” as a singular possessive.  Even now, I rarely do – I don’t write “Each student brought their book,” I instead sacrifice the meaning of my sentences and write things like “Students brought their books.”

I was hoodwinked!  Instead of using the word “their” as a singular pronoun – which it is, in English – I trusted my teachers when they claimed that this word was exclusively plural.

Hogwash!  The equivalent claim would be to say that it’s incorrect to write:

You are reading this essay.

After all, “you” is a plural pronoun.  And “are” is the plural conjugation of the verb “to be,” which I used only to match the expected conjugation of the pronoun “you.”  The correct thing to write is:

Thou is reading this essay.

See?  There’s only one person reading, so I need a singular pronoun, “thou,” and a singular conjugation, “is.”

From What’s Your Pronoun? by Dennis Baron, I learned that the pronoun “they” has been used as a singular since the 1300s.

In a sense, singular you is even more of a newcomer on the pronoun scene.  The plural you was applied as a singular pronoun to address royalty as early as the thirteenth century and was used in other situations demanding deference and formality – call the monarch thy majesty instead of your majesty and it could mean off with your head.

But you doesn’t appear as a singular in all contexts until the 1600s, when it slowly, slowly starts pushing out thou, thee, thy, and thine, second-person singulars that English speakers had been using since the days of Beowulf.  The th- singulars persist even now in some English dialects, and nineteenth-century grammar books regularly demanded singular thou and thee, along with thy and thine, even though these pronouns were no longer considered standard English.

It consoled me somewhat to read that students have long been taught outdated, inaccurate information.  It’s not just my brain that was filled with rubbish.

When a cabal of misogynistic grammarians worked to replace singular they with he in English textbooks, people tried to protest. 

In 1885, in an article titled “The New Pronoun,” the Atlanta Constitution printed:

There is nothing awkward or ungrammatical in [singular they] so far as the construction of English is concerned.  It is ungrammatical when measured by the Latin method – but what has Latin grammar to do with the English tongue?

If you wanted, you could even make a scientific argument for the validity of singular they – in quantum mechanics, the state of each single particle is described by a superposition of states.  Immediately after a measurement, wavefunctions can “collapse” to be composed primarily of a unique form – after a photon passes through a polarizer, it’s fluctuation will be parallel to the polarizer’s axis.  But even this “up and down” state can be expressed as an equal superposition of two perpendicular polarizations tilted forty-five degrees.  Indeed, the latter expression is the only useful way to describe this photon if it’s about to pass through a second polarizer tilted forty-five degrees from the first.

We are not monolithic.  Each and all of us can be described as an amalgam of many different traits.

But we don’t need any scientific justification for the use of singular they in English.  This grammatical usage is deeply enshrined in our language, and the singular pronoun “they” can best convey the plenitude of many individual humans’ identity & experience.

It’s still difficult for me to use the word “they” as a singular pronoun in formal sentences – my crummy education was pernicious.  The proscriptions are deeply ingrained in my brain.  But I’d like to think that I’m not totally calcified in my ways.  And I’m quite grateful that Denis Baron prepared such an erudite history of English pronoun usage.  What’s Your Pronoun​? is a lovely little book.

I hope that my kids’ brains will be less muddled than my own.  When we read stories aloud, we typically correct unnecessarily gendered language.  Girls and boys become kids.  An actress is an actor, too.  Our Curious George lives in a world of fire fighters and police officers.

I was reading Rob Harrell’s gorgeous Monster on the Hill to our kids when our three-year-old interrupted me.  At first, I couldn’t understand what she was saying.  I asked her to repeat herself.

“You should say spouse.”

from Rob Harrell’s Monster on the Hill

She was right, of course.  I’d unthinkingly read the text as written.  So I felt embarrassed … for a moment.  Then I remembered to feel proud.

On noticing.

On noticing.

Midway through dinner, I thought I heard a strange sound.  A faint bleating, maybe, that seemed to be coming from our backyard.  Many musicians studying at the Jacobs School live in the apartment complex behind our house – we can often hear them practicing – but this didn’t sound like a conventional instrument.

I stood up, walked over to the window, and opened it, looking around our yard.  It’s currently grackle mating season – watching a male grackle inflate his plumage to double his size is pretty incredible – and they make a variety of noises.  So I suspected an ardent bird.  I lingered there a moment, looking and listening, trying to determine where the sound had come from.

Those few seconds were too long.

I heard it again, and, with the window open, recognized the distress cry of a young rabbit.

I pulled off my socks, ran outside.  Sprinted around our house to the small fenced enclosure where we have our air conditioning unit.

A large rabbit fled from the HVAC enclosure when it saw me.  It bolted across the yard and slipped through the back fence.

Yes.  Our yard has a lot of fences.  We have dogs.  The back fence keeps them inside the yard.  The fence around the HVAC unit keeps our dogs from crashing into the various wires and tubing and ripping them from the wall (which our younger dog did last year, necessitating expensive repairs).

The distress call had stopped, but now I knew where to look.  And there, sprawled on the mulch, was a juvenile rabbit, about as big as my hand.  His fur had been ripped from his face, leaving his nose raw and bleeding; he was also bleeding from gaping wounds down his back, and his hind legs were broken.  (I’m assuming gender here because I think that’s what triggered the attack – probably a territorial adult male felt that this juvenile was impinging on his territory.)

The mutilated juvenile sat watching me for a moment, then tried to hop away.  He couldn’t.  His legs kicked back slowly and he toppled.

Prostrate on his side, the wounds looked even worse.  He was breathing heavily, watching me.

My children, still inside the house, called through the window to ask what was happening.  I shook my head.

“There’s a baby rabbit, and he’s very, very hurt.  He’s going to die.”

The kids wanted to come see.  I didn’t really want them to – they are only four and six years old – but we all have to learn about death.  Our elder child visited her grandfather in hospice while he was dying after a stroke, and she understands that her grandmother died after somebody hurt her.  Our younger child is at an age where many of the stories she tells involve death, but I’m not sure she understands the permanence yet.

And the thing I really didn’t want to talk about – but would have to, for them to understand – is the brutality of territorial violence.  I hadn’t known that it was so horrific in rabbits.  This baby bunny had been murdered by an irate elder.

And the violence that we humans use to claim and protect territory is one of the worst aspects of our species.  We are a brilliantly inventive species.  Many – perhaps most – of our inventions sprang from the desire to make better weapons.

The world was here before us, but we pound sticks into the ground and say “This part of the world is mine.”

We’re far too fond of building walls. 

And fences.

I sighed.

The kids joined me outside.  My spouse came out; as soon as she saw the poor rabbit, she cried.  I tried, as gently and non-pedantically as I was able, to explain what had happened.

My younger child clasped her hands in front of her chin.  “I’m sad the baby bunny is going to die.”

The rabbit’s breathing was clearly labored.  I wonder how well he understood that this was the end.

“Yeah,” I said.  “I’m sad, too.”

The sun was setting, and the air was starting to grow chilly.  My spouse went back inside and cut up one of my old socks (I typically wear socks until they disintegrate, and my spouse thinks that any sock missing both the heel and toes is fair game to destroy, so we always have spare fabric on hand) to make a small blanket.

The dying rabbit probably felt scared – I’d asked the kids to keep a respectful distance, but we humans are quite large.  Still, I tried to make myself as small as possible as I reached out to cover the rabbit’s torso with the blanket.  I left my hand there, gently resting over his chest, for warmth.  I could feel his panting breaths rise and fall beneath my palm.

I quietly offered my apologies and said a prayer.  The rabbit watched me.  I tried to smile with no teeth.  I stayed crouching, immobile, until the rabbit’s breathing stopped five minutes later.

Then I went inside and finished eating dinner.

At times, being vegan is a comfort.  All of us, in living, impose harms upon the world – that’s the unfortunate nature of existence.  To grow food crops, we till the soil.  Spray pesticides.  And kill all those plants.

Our lives matter, too.  If we don’t take care of ourselves, and strive to enjoy our time alive – if we don’t place value on our own lives – then how could we value others?

Still, my family tries to minimize the harm we wreck by being here.  We live well, but try to be cognizant of the costs.

I was glad that the meal I returned to was made from only plants.

After I finished eating, I went and sat on our front porch with my children.  We spread a blanket over our laps.  We watched birds flit between the trees.  A chipmunk dashed across the lawn.  Two squirrels chased each other through a neighbors yard.

Our elder child clutched me tightly.  I hugged her back.  We sat silently.  I didn’t know what to say.

Then it was time for the kids to go to bed.

It was my spouse’s turn to read the bedtime stories that night, and our dogs wanted to go outside, so I took them to the back yard. 

I don’t think our dogs would hurt a rabbit – when my father-in-law died, the dwarf rabbit he’d purchased as a love token for his twenty-year-old ladyfriend came to live with us (they’d broken up a few days before his stroke, which is why she didn’t want to adopt the rabbit), and when our dogs dug up a rabbit’s nest two years ago, they gently carried a newborn bunny around the yard (we returned it to the nest and it survived until it was old enough to hop away).

I didn’t want for the dogs to carry the dead rabbit around our yard, though.  Or hide it somewhere for the kids to find.

So I walked over to the HVAC unit, ready to explain to the dogs not to bother it.  But the rabbit was gone.  The sock blanket was still there, but no corpse.

We don’t live in a particularly rural area – we’re in Bloomington, about half a mile south of the Indiana University campus.  Our backyard is shared with a sixty-unit apartment complex.  And yet.  Even here, the natural world is bustling enough that a dead thing can disappear within twenty minutes.  I’ve seen hawks, vultures, crows, raccoons, possums, skunks.  Many deer, and a groundhog, although they wouldn’t eat a rabbit.  One semi-feral cat.  I’ve seen foxes down the street from us, in fields a half mile away, but never in our yard.

And, it’s strange.  The dead rabbit lay in our yard for less than twenty minutes.  If we had been listening to music over dinner – which we often do – I wouldn’t have heard his cries through the glass windowpane.

Scientists often pride ourselves on our powers of observations.  But noticing, this time, only made me sad.  If I hadn’t heard that faint sound, I never would have realized that anything untoward had happened in our yard.  And I could have remained blissfully ignorant of the ruthless violence that rabbits apparently inflict upon young children.

The natural world is not a peaceful place.

Still.  I would rather know.  Understanding the pervasive violence that surrounds us helps me to remember how important it is – since we have a choice – to choose to do better.

On worms.

On worms.

My spouse is a high school teacher, and because her students are no longer attending class, they have more time to make TikTok videos.

I’m not quite sure what a TikTok video is.  I think it’s something like a Vine video, but longer.  Or perhaps something like a YouTube video, but shorter.  Or perhaps something like a Music Video, but not introduced by Kurt Loder.

Last year I was volunteering with a local sixth grader once a week, working mostly on music theory and game design, and every so often he’d eye me as though I were a Homo erectus freshly emerged from a block of glacial ice.  My gaffes weren’t even that egregious!  I just don’t know about TikTok!

So it goes.

While working on a TikTok video, one of my spouse’s students messaged her to ask, “Would you still teach me if I was a worm?”

My spouse wrote back, “I don’t know. One of my kids had ringworm last year and it was awful!”

Ask a silly question, you get a silly answer.

And that’s where it should end, right?  But the student persisted – after all, my spouse’s answer was insufficient basis for a good TikTok video.

“No, I mean like a regular earthworm.”

So, here’s the deal.  If you ask a silly question – once – you get a silly answer.  But the second time?

That’s when we unleash the trolls.

And by “trolls,” I mean me.

Image by Thomas Brown on Flickr.

If I were working with a student interested in the educational capabilities of earthworms, I’d first mention Charles Darwin’s experiments on earthworm intelligence.  Worms dig little burrows in the dirt, and they often plug the entrances of these with leaves. 

So Darwin gave the worms novel building materials – not space-age polymer fabrics or anything, just different types of leaves – and let the worms choose which to use to plug up their burrows.  In his estimation, the worms made sensible choices.  You can read a lovely description of this experiment in Eileen Crist’s “The Inner Life of Earthworms.”

Then I might slide into a discussion of equality among worms, perhaps citing the recent children’s picture book, Worm Loves Worm.  I imagine that, like the other characters of that story, our worm’s schoolmates would benefit by having more diversity in class.

And then, because my thoughts tend to careen suddenly to darkness, I might mention my unfinished horror novel, “Our Heroic Annelid Makes a Daring Escape.” 

You see, moles often capture worms and save them for later.  The doomed worms are stored inside the mole’s burrow. 

The mole doesn’t kill the worms – then they’d rot.  But worms can’t just be left inside a mud-lined burrow – then they’d dig their way out. 

So moles mutilate their captives.  An injured worm is unable to dig free, and, because worms rely largely on their sematosensory system to construct a mental image of the world, the worm is partially blinded.

But worms can regenerate.  So the tension of the story becomes, will the worm heal before the mole returns to eat it?

So spooky!

By Kenneth Catania, Vanderbilt University, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8923296

All told, I would be willing to teach an earthworm.  It seems that worms have the cognitive capacity to learn at least a little.  But it would be heartbreaking to have one of my students captured by a mole.

On moral outrage.

On moral outrage.

My family had spring break travel plans for before the shutdown.

We canceled them.

At the time, we feared for our safety. My spouse said to me, “You caught the flu twice this year, even after you were vaccinated, and the second time was the sickest I’ve ever seen you. I’m really worried about what will happen if you catch this new thing, too.”

She wanted me to cancel my poetry classes in the local jail. My father, an infectious diseases doctor and professor of immunology, recommended that I still go in to teach. “If somebody’s in there coughing up a lung, you should recommend he skip class next week,” my father told me.

But I was spooked. I felt glad when the jail put out a press release saying they’d no longer allow volunteers to come in – I didn’t want to choose between helping the incarcerated men and protecting my family.

My spouse is a high school science teacher. She felt glad that her biology classroom has over a dozen sinks. During the final week of school, she asked all her students to wash their hands for 20 seconds as soon as they walked into the room.

My spouse and I are both scientists, but it wasn’t until a week into the shutdown that I began to read research papers about Covid-19. Until then, we had gotten all our information from the newspaper. And the news was terrifying. Huge numbers of people were dying in Italy. Our imbecilic president claimed that Covid-19 was no big deal, making me speculate that this disease was even more dangerous than I’d thought.

Later, I finally went through the data from Italy and from the Diamond Princess cruise ship. These data – alongside the assumption that viral exposure should be roughly similar across age groups, if not higher for school children and young people who are out and about in the world – showed my family that our personal risk was probably quite low.

Still, we stayed inside. We were worried about harming others.

When I saw photographs of beaches packed with revelers, I felt furious. Did those selfish young people not realize that their choices could cause more people to die?

So it was shocking for me to learn that those selfish young people were actually doing the thing that would save most lives.

#

We now know that Covid-19 can be transmitted by people who feel no symptoms, and that it was widespread in this country by March.

If we, as a people, had acted earlier, we could have prevented all these deaths. In January, it would have been enough to impose a brief quarantine after all international travel. In February, it would have been enough to use our current strategy of business closures, PCR testing, and contact tracing. In March, we were too late. The best we could do then – the best we can do now – was to slow the spread of infections.

Unfortunately, slowing the spread of infections will cause more people to die.

There’s an obvious short-term benefit to slowing the spread of infections – if too many people became critically ill at the same time, our hospitals would be overwhelmed, and we’d be unable to offer treatment to everyone who wanted it. We’d run out of ventilators.

This problem is exacerbated by the fact that we, as a people, are terrible about talking about death. There’s no consensus about what constitutes a good life – what more would have to happen for you to feel ready to die?

Personally, I don’t want to die. As my mind stopped, I’d feel regret that I wouldn’t get to see my children become self-sufficient adults. But I’d like to think that I could feel proud that I’ve done so much to set them on the right path. Since my twenties, I’ve put forth a constant effort to live ethically, and I’d like to imagine that my work – my writing, teaching, and research – has improved other people’s lives.

I’ve also gotten to see and do a lot of wonderful things. I’ve been privileged to visit four countries. I visited St. Louis’s City Museum when one of my kids was old enough to gleefully play. I have a bundle of some two dozen love letters that several wonderful people sent me.

I’ve had a good life. I’d like for it to continue, but I’ve already had a good life.

Many medical doctors, who have seen how awful it can be for patients when everything is done to try to save a life, have “do not resuscitate” orders. My spouse and I keep our living wills in an accessible space in our home. But a majority of laypeople want dramatic, painful measures to be taken in the attempt to save their lives.

People are making this choice even during the pandemic, when the choice to experience an excruciating death puts medical professionals at risk and reduces the quality of care available for everyone else.

Still. Even without our reluctance to discuss death, there would be a short-term benefit to slowing the spread of infections. The American healthcare system is terrible, and was already strained to the breaking point. We weren’t – and aren’t – ready to handle a huge influx of sick patients.

But the short-term benefit of slowing the spread of Covid-19 comes at a major cost.

The shutdown itself hurts people. The deaths caused by increased joblessness, food insecurity, educational disruption, domestic violence, and loneliness (“loneliness and social isolation can be as damaging to health as smoking 15 cigarettes a day”) are more difficult to measure than the deaths caused by Covid-19. We won’t have a PCR test to diagnose which people were killed by the shutdown.

Those deaths won’t all come at once. But those deaths are no less real, and no less tragic, than the immediate horror of a person drowning from viral-induced fluid buildup in their lungs.

And, perhaps more damning, if the shutdown ends before there’s a vaccine, the shutdown will cause more people to die of Covid-19.

Without a vaccine, slowing the spread of Covid-19 has a short-term benefit of reducing the rate of hospital admissions, at the long-term cost of increasing the total number of Covid-19 cases.

#

All immunity fades – sometimes after decades, sometimes after months. Doesn’t matter whether you have immunity from recovery or from vaccination – eventually, your immunity will disappear. And, for a new disease, we have no way of predicting when. Nobody knows why some antigens, like the tetanus vaccine, trigger such long-lasting immunity, while other antigens, such as the flu vaccine or the influenza virus itself, trigger such brief protection.

We don’t know how long immunity to Covid-19 will last. For some coronaviruses, immunity fades within a year. For others, like SARS, immunity lasts longer.

The World Health Organization has warned, repeatedly, that immunity to Covid-19 might be brief. But the WHO seems unaware of the implications of this warning.

The shorter the duration of a person’s immunity, the more dangerous the shutdown. If our shutdown causes the Covid-19 epidemic to last longer than the duration of individual immunity, there will be more total infections – and thus more deaths – before we reach herd immunity.

This is, after all, exactly how a one-time “novel zoogenic disease” like influenza became a permanent parasite on our species, killing tens of thousands of people in the United States each year. Long ago, transmission was slowed to the point that the virus could circulate indefinitely. Influenza has been with us ever since.

That’s the glaring flaw in the recent Harvard Science paper recommending social distancing until 2022 – in their key figure, they do not incorporate a loss of immunity. Depending on the interplay between the rate of spread and the duration of immunity, their recommendation can cause this epidemic to never end.

And, if the shutdown ends before we have a vaccine, the lost immunity represents an increased death toll to Covid-19. Even neglecting all the other harms, we’ll have killed more people than if we’d done nothing.

This sounds terrifying. And it is. But the small glimmer of good news is that people’s second infections will probably be less severe. If you survive Covid-19 the first time you contract it, you have a good chance of surviving subsequent infections. But prolonging the epidemic will still cause more deaths, because herd immunity works by disrupting transmission. Even though an individual is less likely to die during a second infection, that person can still spread the virus. Indeed, people are more likely to spread the virus during subsequent infections, because they’re more likely to feel healthy while shedding infectious particles.

#

This calculation would be very different if people could be vaccinated.

Obviously, vaccination would be the best way to end this epidemic. In order to reach herd immunity by a sufficient number of people recovering, there would have to be a huge percentage of our population infected. Nobody knows how many infections it would take, but many researchers guess a number around 60% to 70% of our population.

Even if Covid-19 were no more dangerous than seasonal influenza (and our data so far suggest that it’s actually about four-fold more dangerous than most years’ seasonal influenza), that would mean 200,000 deaths. A horrifying number.

But there’s no vaccine. Lots of people are working on making a vaccine. We have Covid-19 vaccines that work well in monkeys. But that doesn’t necessarily mean anything in terms of human protection. We’ve made many HIV vaccines that work well in monkeys – some of these increase the chance that humans will contract HIV.

It should be easier to make a vaccine against this coronavirus than against HIV. When making a vaccine, you want your target to mutate as little as possible. You want it to maintain a set structure, because antibodies need to recognize the shape of external features of the virus in order to protect you. HIV mutates so fast that its shape changes, like a villain constantly donning a new disguise. But the virus that causes Covid-19 includes a proofreading enzyme, so it’ll switch disguises less.

Still, “easier to make a vaccine against than HIV” is not the most encouraging news. Certain pharmaceutical companies have issued optimistic press briefings suggesting that they’ll be able to develop a vaccine in 18 months, but we should feel dubious. These press briefings are probably intended to bolster the companies’ stock prices, not give the general public an accurate understanding of vaccine development.

Realistically, a Covid-19 vaccine is probably at least four years away. And it’s possible – unlikely, but possible – that we’ll never develop a safe, effective vaccine for this.

If we end the shutdown at any time before there is a vaccine, the shutdown will increase the number of people who die of Covid-19. The longer the shutdown, the higher the toll. And a vaccine is probably years away.

The combination of those two ideas should give you pause.

If we’re going to end the shutdown before we have a vaccine, we should end it now.

#

To be absolutely clear, vaccination would be the best way to resolve this crisis. Vaccination saves lives. The basic principle of inoculation was used for hundreds of years in Africa, India, and China, before it was adapted by Edward Jenner to create the first smallpox vaccine.

For a vaccine to end the Covid-19 epidemic, enough people will need to choose to be vaccinated for us to reach herd immunity.

Unfortunately, many people in the United States distrust the well-established efficacy and safety of vaccines. It’s worth comparing Covid-19 to seasonal influenza. On a population level, Covid-19 seems to be about four-fold more dangerous than seasonal influenza. But this average risk obscures some important data – the risk of Covid-19 is distributed less evenly than the risk of influenza.

With influenza, healthy young people have a smaller risk of death than elderly people or people with pre-existing medical conditions. But some healthy young people die from seasonal influenza. In the United States, several thousand people between the ages of 18 and 45 die of influenza every year.

And yet, many people choose not to be vaccinated against influenza. The population-wide vaccination rate in the United States is only 40%, too low to provide herd immunity.

Compared to influenza, Covid-19 seems to have less risk for healthy young people. Yes, healthy young people die of Covid-19. With influenza, about 10% of deaths are people between the ages of 18 and 45. With Covid-19, about 2% of deaths are people in this age group.

I’m not arguing that Covid-19 isn’t dangerous. When I compare Covid-19 to seasonal influenza, I’m simply comparing two diseases that are both deadly.

I get vaccinated against influenza every year.

Yes, you might have heard news reports about the influenza vaccine having low efficacy, but that’s simply measuring how likely you are to get sick after being vaccinated. We also know that the vaccine makes your illness less severe.

The influenza vaccine saves lives. The data are indisputable.

But people don’t choose to get it! That’s why I think it’s unfortunately very likely that people whose personal risk from Covid-19 is lower than their risk from influenza will forgo vaccination. Even if we had access to 300 million doses of a safe, effective vaccine today, I doubt that enough people would get vaccinated to reach herd immunity.

Obviously, I’d love to be wrong about this. Vaccination saves lives.

Please, dear reader, get a flu vaccine each year. And, if we develop a safe, effective Covid-19 vaccine, you should get that too.

#

We don’t have a vaccine. The shutdown is causing harm – the shutdown is even increasing the total number of people who will eventually die of Covid-19.

Is there anything we can do?

Luckily, yes. We do have another way to save lives. We can change the demographics of exposure.

Our understanding of Covid-19 still has major gaps. We need to do more research into the role of interleukin 6 in our bodies’ response to this disease – a lot of the healthy young people who’ve become critically ill with Covid-19 experienced excessive inflammation that further damaged their lungs.

But we already know that advanced age, smoking status, obesity and Type 2 diabetes are major risk factors for complications from Covid-19. Based on the data we have so far, it seems like a low-risk person might have somewhere between a hundredth or a thousandth the chance of becoming critically ill with Covid-19 as compared to an at-risk person. With influenza, a low-risk person might have between a tenth and a hundredth the chance of becoming critically ill.

The risk of Covid-19 is more concentrated on a small segment of the population than the risk of influenza.

To save lives, and to keep our hospitals from being overwhelmed, we want to do everything possible to avoid exposing at-risk people to this virus.

But when healthy young people take extraordinary measures to avoid getting sick with Covid-19 – like the shutdown, social distancing, and wearing masks – they increase the relative burden of disease that falls on at-risk people. We should be prioritizing the protection of at-risk people, and we aren’t.

Because this epidemic will not end until we reach the population-wide threshold for herd immunity, someone has to get sick. We’d rather it be someone who is likely to recover.

Tragically, we already have data suggesting that a partial shutdown can transfer the burden of infection from one group to another. In the United States, our shutdown was partial from the beginning. People with white-collar jobs switched to working remotely, but cashiers, bus drivers, janitors, people in food prep, and nurses have kept working. In part because Black and brown people are over-represented in these forms of employment, they’ve been over-represented among Covid-19 deaths.

There is absolutely no reason to think that poor people would be more likely to safely recover from Covid-19 – indeed, due to air pollution, stress, sleep deprivation, limited access to good nutrition, and limited access to health care, we should suspect that poor people will be less likely to recover – but, during the shutdown, we’ve shifted the burden of disease onto their shoulders.

This is horrible. Both unethical and ineffective. And, really, an unsurprising outcome, given the way our country often operates.

#

If we want to save lives, we need for healthy younger people to use their immune systems to protect us. The data we have so far indicates that the shutdown should end now — for them.

It will feel unfair if healthy younger people get to return to work and to their regular lives before others.

And the logistics won’t be easy. We’ll still need to make accommodations for people to work from home. Stores will have to maintain morning hours for at-risk shoppers, and be thoroughly cleaned each night.

If school buildings were open, some teachers couldn’t be there – they might need substitutes for months – and neither could some students, who might switch to e-learning to protect at-risk family.

We’ll need to provide enough monetary and other resources that at-risk people can endure a few more months of self-isolation. Which is horrible. We all know, now that we’ve all been doing this for a while, that what we’re asking at-risk people to endure is horrible. But the payoff is that we’ll be saving lives.

Indeed, the people who self-isolate will have lowest risk. We’ll be saving their lives.

And no one should feel forced, for financial reasons or otherwise, to take on more risk than they feel comfortable with. That’s why accommodations will be so important. I personally would feel shabby if I took extreme measures to protect myself, knowing that my risk is so much lower than other people’s, but you can’t look at someone in a mask and know their medical history, much less whom they might be protecting at home.

#

All told, this plan isn’t good. I’m not trying to convince you that this is good. I’m just saying that, because we bungled things in January, this is the best we have.

If we could go back in time, we’d obviously do things differently. It’s only based on where we are now that physicians like David Katz argue we need to end the shutdown based on the principle of “harm minimization.”

Based on the data we have, I agree.

Ending the shutdown now, but only for some, will save lives.

#

So, those selfish young people crowding on beaches? I looked at the photos and hated them.

But it turns out that their selfish actions were actually the exact plan that will save most lives.

I’ve had to swallow my moral indignation. I hope you can too.