For people whose past cultural experiences have led them to associate mint smells with sweet tastes, pairing the scent of mint with a sip of sucrose solution makes them believe that the drink is more sugary than it really is. When mint scent is paired with a sip of mildly acidic water, the drink seems less sour than it really is.
This experiment didn’t assess people’s perception of alcoholic drinks, but people in the United States probably make the same mistake about the bourbon in a mint julep.
Our assumptions – particular to our own cultural experience of the world – can powerfully deceive us.
A mint julep mixed perfectly for someone from the United States would taste bitter to someone from Vietnam.
Viet Thanh Nguyen – author of The Sympathizer, which I’ve written about previously – strives to draw attention to our cultural blindness. The way our minds’ innate self-deceptions allow us to overlook or misinterpret the experiences of others.
My spouse and I have often felt grateful for Nguyen’s work. His essay about the sinking sensation he felt after teaching his child to read was particularly beautiful. (I linked to it in my own essay about teaching a child to read.)
Which is why we felt so dismayed by Nguyen’s most recent New York Times editorial.
Nguyen explains why he enjoys teaching over Zoom. He’s prompted with students’ names; he can see their reactions up close; student voices contribute to the lecture from the same up-front position of power as his own; typed remarks can overlap without distracting; lectures are recorded for students to review later.
All well and good. Nguyen is quite intelligent. If he thinks Zoom is good for lectures, I’m inclined to believe him.
But lectures aren’t the best way to learn.
For many subjects, project-based learning is a more effective way to educate students. Many of my spouse’s resources – designed primarily for teaching college-level biology and introductory Earth & space science with a social justice bent – are available on her website, here.
For the better part of a decade, I’ve hosted a poetry class in the county jail. We read poems and discuss how they make us feel. Our discussions touch upon contemporary scientific research, mythology, economics – all safe enough topics, for most folks – but also religion, addiction, trauma, violence, relationships, loss – which can be tough for anyone to talk about, let alone a room full of men who won’t get to see their families for months.
Because people cycle through the county jail, I never know who will be coming to class each week until I get there. For a few months, I might be with mostly the same group of men. Other weeks, I won’t have met any of the dozen or so people previously.
And there’s a huge difference between what we can accomplish – between what sorts of things feel safe to discuss – when the people in class haven’t met me before, and haven’t been in a class like that with each other. If we haven’t built the necessary emotional connection, we can do less. The class is worse for all of us.
Recently, the jail has allowed a small number of classes over Zoom. But Zoom doesn’t let you make the same emotional connection.
People sometimes complain about the supposed invasiveness of Zoom – the camera snatches up your personal surroundings, the pictures on your wall, the books on your shelves, your family in the background – but it’s by no means the intimacy of being there.
My spouse says, “Over Zoom you can’t tell who’s hungry.”
It would be nice if she meant this metaphorically – that it’s hard to tell who’s eager to learn. But, no. Many students aren’t eating enough. They are hungry.
Worse, we read Nguyen’s paean to Zoom on a snow day.
Streets near my spouse’s high school school were well-salted and plowed, but we live in a sprawling, semi-rural area – the school district serves families from a mix of socioeconomic backgrounds. There are hills and valleys – not everyone can get a satellite signal at home. And the for-profit cable companies certainly haven’t connected those families to the modern world with wires.
Still, the pandemic has made “e-learning days” seem like a reliable alternative. If it snows, kids learn from home.
“What’s Zoom supposed to do,” my spouse asked, “for my students with no heat?”
This isn’t (only) a concern for fluke events like the avarice-fueled power outages and heat losses in Texas. My spouse grew up in Albany, New York. Every winter was cold. The infrastructure to heat homes there was secure – for children whose families had money.
My spouse’s family didn’t. Her father failed to pay the electric bill. The power was shut off. And then the district called a snow day.
If my spouse and her sibling had gone to school, it wouldn’t have been so bad. Warm classrooms, a hot meal.
Instead they were stuck at home, shivering. Wanting so badly to go to a neighbor’s house. But then the neighbors would know.
In the United States, where poverty is often stigmatized as a moral failing, people hide the ache of want.
Which is why Zoom is so horrible. Zoom makes it easy. When you only have to disguise a small corner of your life, you can convey the illusion that things are okay.
There’s broad scientific consensus that school closures hurt children, probably making a significant contribution to future increases in premature death.
There’s also broad scientific consensus that school closures – particularly elementary school closures – aren’t helpful in slowing the spread of Covid-19. Children aren’t major vectors for this virus. Adults just have to remember not to congregate in the teachers’ lounge.
Worldwide, a vanishingly small percentage of viral transmissions have occurred inside schools.
And … our district just closed in-person school for all children.
In-person indoor dining at restaurants is still allowed. Bars are still open.
Older people are sending a clear message to kids: “Your lives matter less than ours.”
For at-risk children, school closures are devastating. A disruption in social-emotional learning; lifelong education gaps; skipped meals.
But for my (privileged!) family, the closure will be pretty nice. I was recently feeling nostalgic about the weeks in August when my eldest and I spent each morning together.
Our youngest attends pre-K at a private school. Her school, like most private schools around the country, (sensibly) re-opened on time and is following its regular academic calendar.
My eldest and I will do two weeks of home schooling before winter break. And it’ll be fun. I like spending time with my kids, and my eldest loves school so much that she often uses up most of her energy during the day – teachers tell us what a calm, lovely, hard-working kid she is. And then she comes home and yells, all her resilience dissipated.
Which is normal! Totally normal. But it’s a little crummy, as a parent, to know you’ve got a great kid but that you don’t get to see her at her best.
Right now she’s sad about not going to school – on Monday, she came home crying, “There was an announcement that we all have to switch to online only!” – but I’m lucky that I can be here with her. Writing stories together, doing math puzzles, cooking lunch.
Maybe we’ll practice magic tricks. She loves magic.
Last month, I was getting ready to drive the kids to school. T. (4 years old) and I were in the bathroom. I’d just handed T. her toothbrush.
N. (6 years old) walked over holding a gallon-sized plastic bag.
“Father, do you want to see a magic trick?” she asked.
“Okay, but I have to brush my teeth while you’re doing it.”
“Okay,” she said, and opened the bag. She took out a multi-colored lump of clay. It was vaguely spherical. Globs of red, white, and blue poked up from random patches across the surface, as though three colors of clay had been haphazardly moshed together.
“So you think this is just this,” she said, but then …”
She took out a little wooden knife and began sawing at the lump. “This is just this?”, I wondered. It’s an interesting phrase.
Her sawing had little effect. The knife appeared useless. I’m pretty sure this wooden knife is part of the play food set she received as a hand-me-down when she was 9 months old. “Safe for babies” is generally correlated with “Useless for cutting.”
She was having trouble breaking the surface of her lump.
I spat out my toothpaste.
She kept sawing. She set down the knife and stared at the clay intently. A worthy adversary.
I stood there, watching.
She grabbed the knife again and resumed sawing. More vigorously, this time. She started stabbing, whacking. This was enough to make a tiny furrow. She tossed aside the knife and pulled with her fingertips, managing to pry two lobes of the strange lump away from each other.
“Okay,” she said, “it’s hard to see, but there’s some green in there.”
T. and I crouched down and peered closely. Indeed, there was a small bit of round green clay at the center of the lump.
“Wow!” exclaimed T. “I thought it was just a red, and, uh, blue, and white ball! But then, on the inside, there’s some green!”
“I know!” said N., happy that at least one member of her audience understood the significance of her trick. “And look, I might even get it back together!”
N. started performing magic when she was four. T. was asleep for her afternoon nap.
“Okay,” she said, “you sit there, and I’ll put on a magic show. Watch, I’ll make, um … this cup! See this cup? I’ll make it disappear.”
“Okay,” I said, curious. We’d just read a book that explained how to make a penny disappear from a glass cup – the trick is to start with the cup sitting on top of the penny, so that the coin looks like it’s inside the cup but actually isn’t.
I had no idea how she planned to make the cup itself disappear.
“Okay, so, um, now you’re ready, and …” she looked at the cup in her hands. Suddenly, she whisked it behind her back. And stood there, looking at me somberly, with her hands behind her back.
“I don’t have it,” she said.
Magic – convincing an audience to believe in an illusion.
Our species is blessed with prodigious longevity, probably because so many grandmothers among our ancestors worked hard to help their grandchildren survive.
(The long lives of men are probably an accidental evolutionary byproduct, like male nipples or female orgasms. Elderly men, with their propensity to commandeer resources and start conflicts, probably reduced the fitness of their families and tribes.)
After we reach our seventies, though – when our ancestors’ grandchildren had probably passed their most risky developmental years – our bodies fail. We undergo immunosenescence – our immune systems become worse at suppressing cancer and infections.
After my eldest was born, I spent the first autumn as her sole daytime caretaker. She spent a lot of time strapped to my chest, either sleeping or wiggling her head about to look at things I gestured to as I chittered at her.
We walked around our home town, visiting museums and the library. I stacked a chair on top of my desk to make a standing workspace and sometimes swayed from side to side while I typed. At times, she reached up and wrapped her little hands around my neck; I gently tucked them back down at my sternum so that I could breath.
She seemed happy, but it felt unsustainable for me. Actually getting my work done while parenting was nigh impossible.
And so our family bought a membership at the YMCA. They offer two hour blocks of child care for children between six weeks and six years old.
The people who work in our YMCA’s child care space are wonderful. Most seem to be “overqualified” for the work, which is a strange thing to write. Childhood development has huge ramifications for both the child’s and their family’s whole lifetime, and child psychology is an incredibly rich, complex subject. Helping to raise children is important, fulfilling work. No one is overqualified to do it.
Yet we often judge value based on salary. Childcare, because it was traditionally seen by European society as “women’s work,” is poorly remunerated. The wages are low, there’s little prestige – many people working in childcare have been excluded from other occupations because of a lack of degrees, language barriers, or immigration status.
I like to think that I appreciate the value of caretaking – I’m voting with my feet – but even I insufficiently valued the work being done at our YMCA’s childcare space.
Each time I dropped my children off – at which point I’d sit and type at one of the small tables in the snack room, which were invariably sticky with spilled juice or the like – I viewed it as a trade-off. I thought that I was being a worse parent for those two hours, but by giving myself time to do my work, I could be a fuller human, and maybe would compensate for those lapsed hours by doing better parenting later in the day.
I mistakenly thought that time away from their primary parent would be detrimental for my children.
Recently, I’ve been reading Sarah Blaffer Hrdy’s marvelous Mothers and Others, about the evolutionary roots of human childhood development, and learned my mistake.
Time spent in our YMCA’s childcare space was, in and of itself, almost surely beneficial for my children. My kids formed strong attachments to the workers there; each time my children visited, they were showered with love. And, most importantly, they were showered with love by someone who wasn’t me.
A team headed by the Israeli psychologist Abraham Sagi and his Dutch collaborator Marinus van IJzendoorn undertook an ambitious series of studies in Israel and the Netherlands to compare children cared for primarily by mothers with those cared for by both mothers and other adults.
Overall, children seemed to do best when they have three secure relationships – that is, three relationships that send the clear message “You will be cared for no matter what.”
Such findings led van IJzendoorn and Sagi to conclude that “the most powerful predictor of later socioemotional development involves the quality of the entire attachment network.”
In the United States, we celebrate self-sufficient nuclear families, but these are a strange development for our species. In the past, most humans lived in groups of close family and friends; children would be cared for by several trusted people in addition to their parents.
Kids couldn’t be tucked away in a suburban house with their mother all day. They’d spend some time with her; they’d spend time with their father; they’d spend time with their grandparents; they’d spend time with aunties and uncles, and with friends whom they called auntie or uncle. Each week, children would be cared for by many different people.
The world was a harsh place for our ancestors to live in. There was always a risk of death – by starvation, injury, or disease. Everyone in the group had an incentive to help each child learn, because everyone would someday depend upon that child’s contributions.
And here I was – beneficiary of some million years of human evolution – thinking that I’d done so well by unlearning the American propaganda that caretaking is unimportant work.
And yet, I still mistakenly believed that my kids needed it to be done by me.
Being showered with love by parents is important. Love from primary caretakers is essential for a child to feel secure with their place in the world. But love from others is crucial, too.
I am so grateful that our YMCA provided that for my kids.
And, now that they’re old enough, my kids receive that love from school. Each day when they go in, they’re with teachers who let them know: You will be cared for no matter what.
I was walking my eldest child toward our local elementary school when my phone rang.
We reached the door, shared a hug, and said goodbye. After I left, I called back – it was a friend of mine from college who now runs a cancer research laboratory and is an assistant professor at a medical school.
“Hey,” I said, “I was just dropping my kid off at school.”
“Whoa,” he said, “that’s brave.”
I was shocked by his remark. For most people under retirement age, a case of Covid-19 is less dangerous than a case of seasonal influenza.
“I’ve never heard of anybody needing a double lung transplant after a case of the flu,” my friend said.
But our ignorance doesn’t constitute safety. During this past flu season, several young, healthy people contracted such severe cases of influenza that they required double lung transplants. Here’s an article about a healthy 30-year-old Wyoming man nearly killed by influenza from December 2019, and another about a healthy 20-year-old Ohio woman from January 2020. And this was a rather mild flu season!
“One of the doctors told me that she’s the poster child for why you get the flu shot because she didn’t get her flu shot,” said [the 20-year-old’s mother].
These stories were reported in local newspapers. Stories like this don’t make national news because we, as a people, think that it’s normal for 40,000 to 80,000 people to die of influenza every year. Every three to five years, we lose as many people as have died from Covid-19. And that’s with vaccination, with pre-existing immunity, with antivirals like Tamiflu.
Again, when I compare Covid-19 to influenza, I’m not trying to minimize the danger of Covid-19. It is dangerous. For elderly people, and for people with underlying health issues, Covid-19 is very dangerous. And, sure, all our available data suggest that Covid-19 is less dangerous than seasonal influenza for people under retirement age, but, guess what? That’s still pretty awful!
You should get a yearly flu shot!
A flu shot might save your life. And your flu shot will help save the lives of your at-risk friends and neighbors.
For a while, I was worried because some of my remarks about Covid-19 sounded superficially similar to things said by the U.S. Republican party. Fox News – a virulent propaganda outlet – was publicizing the work of David Katz – a liberal medical doctor who volunteered in a Brooklyn E.R. during the Covid-19 epidemic and teaches at Yale’s school of public health.
The “problem” is that Katz disagrees with the narrative generally forwarded by the popular press. His reasoning, like mine, is based the relevant research data – he concludes that low-risk people should return to their regular lives.
You can see a nifty chart with his recommendations here. This is the sort of thing we’d be doing if we, as a people, wanted to “follow the science.”
And also, I’m no longer worried that people might mistake me for a right-wing ideologue. Because our president has once again staked claim to a ludicrous set of beliefs.
Here’s a reasonable set of beliefs: we are weeks away from a safe, effective Covid-19 vaccine, so we should do everything we can to slow transmission and get the number of cases as low as possible!
Here’s another reasonable set of beliefs: Covid-19 is highly infectious, and we won’t have a vaccine for a long time. Most people will already be infected at least once before there’s a vaccine, so we should focuson protecting high-risk people while low-risk people return to their regular lives.
If you believe either of those sets of things, then you’re being totally reasonable! If you feel confident that we’ll have a vaccine soon, then, yes, delaying infections is the best strategy! I agree! And if you think that a vaccine will take a while, then, yes, we should end the shutdown! I agree!
There’s no right answer here – it comes down to our predictions about the future.
But there are definitely wrong answers. For instance, our current president claims that a vaccine is weeks away, and that we should return to our regular lives right now.
That’s nonsense. If we could get vaccinated before the election, then it’d make sense to close schools. To wait this out.
If a year or more will pass before people are vaccinated, then our efforts to delay the spread of infection will cause more harm than good. Not only will we be causing harm with the shutdown itself, but we’ll be increasing the death toll from Covid-19.
On October 14th, the New York Times again ran a headline saying “Yes, you can be reinfected with the coronavirus. But it’s extremely unlikely.”
This is incorrect.
When I’ve discussed Covid-19 with my father – a medical doctor specializing in infectious diseases, virology professor, vaccine developer with a background in epidemiology from his masters in public health – he also has often said to me that reinfection is unlikely. I kept explaining that he was wrong until I realized that we were talking about different things.
When my father uses the word “reinfection,” he means clearing the virus, catching it again, and becoming sicker than you were the first time. That’s unlikely (although obviously possible). This sort of reinfection happens often with influenza, but that’s because influenza mutates so rapidly. Covid-19 has a much more stable genome.
When I use the word “reinfection” – and I believe that this is also true when most laypeople use the word – I mean clearing the virus, catching it again, and becoming sick enough to shed the viral particles that will make other people sick.
The more we slow the spread of Covid-19, the more total cases there will be. In and of itself, more cases aren’t a bad thing – most people’s reinfection will be milder than their first exposure. The dangerous aspect is that a person who is reinfected will have another period of viral shedding during which they might expose a high-risk friend or neighbor.
If our goal is to reduce the strain on hospitals and reduce total mortality, we need to avoid exposing high-risk people. Obviously, we should be very careful around nursing home patients. We should provide nursing homes with the resources they need to deal with this, like extra testing, and preferably increased wages for nursing home workers to compensate them for all that extra testing.
It’s also a good idea to wear masks wherever low-risk and high-risk people mingle. The best system for grocery stores would be to hire low-risk shoppers to help deliver food to high-risk people, but, absent that system, the second-best option would be for everyone to wear masks in the grocery store.
Schools are another environment where a small number of high-risk teachers and a small number of students living with high-risk family members intermingle with a large number of low-risk classmates and colleagues.
Schools should be open – regions where schools closed have had the same rates of infection as regions where schools stayed open, and here in the U.S., teachers in districts with remote learning have had the same rates of infection as districts with in-person learning.
Education is essential, and most people in the building have very low risk.
A preponderance of data indicate that schools are safe. These data are readily accessible even for lay audiences – instead of reading research articles, you could read this lovely article in The Atlantic.
Well, I should rephrase.
We should’ve been quarantining international travelers back in December or January. At that time, a shutdown could have helped. By February, we were too late. This virus will become endemic to the human species. We screwed up.
But, given where we are now, students and teachers won’t experience much increased risk from Covid-19 if they attend in person, and schools aren’t likely to make the Covid-19 pandemic worse for the surrounding communities.
That doesn’t mean that schools are safe.
Schools aren’t safe: gun violence is a horrible problem. My spouse is a teacher – during her first year, a student brought weapons including a chainsaw and some pipe bombs to attack the school; during her fourth year, a student had amassed guns in his locker and was planning to attack the school.
Schools aren’t safe: we let kids play football, which is known to cause traumatic brain injury.
Schools aren’t safe: the high stress of grades, college admissions, and even socializing puts some kids at a devastatingly high risk for suicide. We as a nation haven’t always done a great job of prioritizing kids’ mental health.
And the world isn’t safe – as David Katz has written,
“If inclined to panic over anything, let it be climate change … Not the most wildly pessimistic assessment of the COVID pandemic places it even remotely in the same apocalyptic ballpark.”
Last week, I wrote a reflection on the popular social deduction game Among Us. It’s a charming game, I had a lot of fun while playing, and I probably won’t play again.
In Among Us, players are assigned to be either interstellar scientists, attempting to complete a variety of mundane chores in order to return home, or evil aliens who sabotage the ship and slay the crew.
While the scientists complete their chores, they have to snoop for suspicious evidence, hoping to discover which of their crewmates are secretly aliens in disguise. At plurality-vote meetings, the crew can choose to fling people out the airlocks – if that person was an alien, perhaps the sabotage will cease! If that person was actually a hapless human scientist who couldn’t convince you of their innocence, well, your team is that much closer to doom.
Soon the aliens will vote you off your own ship.
I was brushing my teeth, staring at the black constellations of mold that have infiltrated our bathtub’s caulking. I thought, I should fix this.
It wouldn’t take so long. Scrape away the old caulking. Bleach everything. Run a dehumidifier to dry the room. Lay fresh caulk. Remind everyone not to use the bathtub that day.
An easy chore.
The chores in Among Us are all quite easy, too. The most difficult is just five rounds of the pattern-matching game Simon. Or clicking twenty asteroids as they hurtle across the screen. Most of the chores involve pressing a button and waiting.
But the chores become tense when aliens are constantly sabotaging your spacecraft. Or you might finish half a task when someone yells that they’ve found a dead body and interrupts your work with another meeting.
As I was looking at the moldy caulk, I heard that sound. The gut-wrenching alert noise, coming from our dining table.
Toothbrush still in mouth, I went to the table. Our eldest had poured a large quantity of almond milk directly on the tablecloth. Her cup was mostly empty. She was watching the milk drip from the edge of the table.
“Gmmph um dff cluff!” I said.
My kid just stared at me.
I sighed. You’re not supposed to swallow toothpaste.
I swallowed the toothpaste and said, “Get a dishcloth!”
“Ohhh,” she said, and went to the kitchen to find one. Nearly a minute passed while the milk drip, drip, dripped onto the floor. Eventually I went to get a dishcloth. My kid was sitting on the floor with several dishcloths in her lap, trying to pick her favorite.
Parenting small children is rather like Among Us. There’s an endless parade of tiny chores, each made more difficult by the fact that saboteurs are in your midst.
Except that it’s quite easy to identify the saboteurs. And I love them too much to vote them out the airlock.
I was driving away from the elementary school when I got a call from my kid’s teacher.
“I just noticed, she doesn’t have her glasses. She says she doesn’t need them, but …”
“Oh, man,” I said, ever the bumbling parent. My kid totally needs her glasses. When we took her in for an eye exam, the optometrists were pretty sure she didn’t know her letters. She was reading 400-page chapter books by then. “I’ll run them right over.”
Sometimes I wish that I was the sort of parent who’d notice whether his kid was wearing glasses. To be able to close my eyes and picture my children’s faces.
My kids have been research subjects for several studies conducted by Indiana University’s developmental psychology program. For one – conducted when my eldest was between nine months and two years old – my kid and I sat at opposite sides of a little table and played with some toys. We were wearing eye-tracking cameras. We were told, “Just play together the way you would at home.”
For two of the sessions, I brought my kid to the psychology lab. For one, my spouse brought her. The researchers said, “Yeah, no problem, data from both parents would be good.”
After the study was finished, they gave us a flash drive with the videos of us playing.
When I was playing with our kid, I only looked at the toys. There’s the little truck, front and center in my field of vision!
When my spouse was playing, she only looked at our child.
At least our kid was normal, looking back and forth as we played. Sometimes focusing on her parent, sometimes on the toy, while we said things like, “See the truck? The truck is driving toward the edge of the table, vroom vroom. Oh no, the truck is going to fall off the cliff! What a calamity!”
Actually, only one of her parents said things like this. The other parent asked whether she wanted to hold the blue truck.
We learned later that they had to throw out all our family’s data.
My children are lucky that my spouse and I have such dissimilar brains.
“Assortative mating” – when animals raise children with partners who closely resemble themselves in some way – probably explains the recent rise in autism rates. Many traits that are beneficial in small doses – creativity, analytical thinking, malaria resistance – make life harder for people who have a larger dose – schizophrenia, autism, sickle cell anemia.
Compared to prior generations, humans travel more now, and we choose romantic partners from a wider selection of people. So it’s easier to find someone who resembles us. Someone who is easy to live with. Easy to love. “We have so many similar interests!”
But children benefit from having dissimilar parents. My kids are being raised by an exceptional empath … and by me. I give them, um, their love of monsters? Lego-building prowess?
And the parents benefit, too. Love is a journey – romance helps us grow because we learn how to love a partner. We become richer, deeper people by welcoming someone who is dissimilar from us into our lives. When everything is easy, we don’t become stronger.
Which is, perhaps, a downside of the artificial-intelligence-based dating programs. These typically match people who are similar. And if things feel hard, well … there’s always another match out there. Instead of putting in the effort to build a life that fits everyone, you could just spin the wheel again.
My spouse and I have a good relationship. We also had years that were not easy.
We’re better people for it now.
And hopefully our kids will benefit from that, too. Even if they sometimes go to school without their glasses.
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.
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.
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.
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.
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.
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.
At about eleven a.m. on my birthday, I buckled the kids into the car to drive to our local print shop. Taking the kids with me for a fifteen minute errand seemed like a good gift for my spouse: she’d have some time in our house alone, which is rare to come by right now.
The print shop is just across the street from the (currently closed) services center for people experiencing homelessness, just down the street from the services center for people recently released from incarceration, a few blocks from the hospital. There’s a popular bus stop on the sidewalk out front. Across the street, a truck rental company has a large, mostly empty parking lot.
Large crowds of people have been hanging out near the print shop. Day and night.
I pulled into a shaded parking spot. We had the windows down. “I’ll just be a minute, can you sit in the car?” I asked.
The kids nodded, not looking up. A friend recently gave us a stack of Ranger Rick magazines, and we’ve been doling them out gradually for car rides.
I had my wallet in my pocket with a twenty and a ten, and we’d already been sent the bill for our print order. $20.49 for a stack of postcards to send to my spouse’s future AP biology students, explaining their summer assignment.
Normally she’d give kids a slip of paper with their assignment sometime during finals week, but this year had no finals. For many kids, no school.
But don’t worry. The assignment isn’t too bad. Students choose from a set of things like “fill an old sock with trash, bury it, then dig it up six weeks later” or “take a walk and look for things that match each of these different colors.”
I looked in the center console of the car for a pair of quarter. We keep them in a little pouch, ready to pay for parking. Haven’t been using them recently – the meters are still on, but there’d be nowhere to go after parking the car.
I thought it would be a nice gesture to pay in cash with exact change. The credit card company wouldn’t be taking a cut of the profits, and exact change would minimize the length of our transaction.
As I was zipping the pouch closed, a man ambled over. I’d guess he was a little over six feet tall, a little over two hundred pounds, with light brown skin, a buzzed head, and a bristly beard. He leaned down to the open passenger-side window and said something to me, but I couldn’t parse it – his words sounded mushy, thick with saliva.
“Hang on,” I said, “I’m hopping out of the car, let me come around.”
I walked around the back of the car, stopping a few feet away from him. He said the same thing again. I shrugged and shook my head. My brain takes a while to process spoken words, even under the best of circumstances. I can’t listen to audiobooks – whole chapters wash over me without any understanding. I can’t listen to podcasts – when people recommend them, I’ll search for a transcript, then read it and pretend that I too listened while riding an exercise bike or something.
By the fourth time he repeated himself, I understood him better. I think part of the problem was that he was speaking too quickly – almost everybody gets nervous when approaching a stranger.
I can relate. I doubt I’d ever be able to flirt with strangers in a bar.
“I like your hair,” he said. “I grew up in Gary, came down fifteen years ago for Indiana University, but I caught that bipolar. Just got out of the hospital, today’s my birthday, five twenty-six, and I just got out.
He still had a white plastic bracelet on his arm, which seemed to be printed with his name and age. He didn’t gesture to it or anything, which felt nice. As though the two of us would need no evidence to trust each other.
“Your birthday? How old are you?”
“Thirty-seven,” he said, without hesitation.
Indeed, the bracelet was printed with the number 37 in a fairly large font. But it seemed like this was a nice thing to ask.
“No shit,” I said, “thirty-seven. Same as me. Today’s my birthday, I just turned thirty-seven.”
“Naw, man, you’re shitting me.”
“It’s true.” I turned to the car, shouted to the kids, “Whose birthday is it today?”
The kids said something, but neither the man nor I could hear them. The crowd across the street was loud.
The man reached into his pocket, pulled out a jumble of stuff. Dice, some black beaded necklaces, a keychain, a tiny flashlight, nail clippers, a tube of toothpaste. He put the toothpaste back into his pocket.
“Don’t need this yet,” he mumbled.
“You got a toothbrush?” I asked. We actually have some spare ones in the car to give to people.
“Yeah,” he said, pulling out the green plastic handle of a toothbrush, “but I used that already. See these, my teeth so fucking white.”
He smiled for me and I nodded approvingly, murmuring that his teeth were indeed very white. A full smile. Several teeth were stained dark near the edges, but I’ve met lots of men with worse teeth than that.
“Hey, you paint your nails, too,” he said, noticing. “See this, look at this.” He reached out, his hands still full of stuff, to show me his fingers. They had tiny remnants of polish, pink on several but a pointer finger with a mix of red and black, just like I use on mine. My nails were barely even chipped, because I’d painted them the week before. I usually do them about once a month these days. Hard to find time for the little things since having kids.
“I got … here, how about this,” he said, handing me the nail clippers. “They good, they good ones, I haven’t even used them yet, they’re clean.”
As he spoke, spittle flew from his mouth. Luckily, I’m not much of a germophobe. Luckier still, I think I already had the disease that’s going around right now. Between a pair of kids in preschool, a spouse at the high school, and me teaching in jail, I catch most of the viruses that come through town.
I turned the clippers over in my hand. A large pair, space-age iridescent top glimmering in loops of purple and blue, big letters “Made in China” etched into the metal.
“They’re beautiful,” I said. “I like the look of that metal. But we’ve got so much stuff already. Meeting you, that’s present enough today.”
I handed the clippers back. As he took them, one of his dice tumbled from his hand. I bent down to pick it up, gave that back to him, too.
“You play craps?” he asked.
“Hey, I’ll teach you. Come on, here, you gotta get a seven, eleven, don’t want snake eyes.” He bent down, blew on the dice, and rolled. A five and a six.
“Eleven, hey, that’s good,” he said. Then picked up the dice, blew on them again, and rolled. A two and a six.
“Eight. Now I got to roll an eight before I get a seven, see, that’s crap out.” And he rolled about four more times before he hit his seven.
“Now it’s your turn,” he said, and handed them to me.
I rolled, got a two and a four.
“That’s a six, that’s a hard one, got to roll a six again before you crap out.”
I rolled again, same two and a four. Maybe I didn’t shake the dice enough – they didn’t really tumble on the ground, they just sort of plopped down on the asphalt in front of me.
And I found myself thinking how strange it is that dice are a big thing for both the toughest and the wimpiest groups of people in town. Street people and folks in jail gamble with dice, and then there’s Dungeons & Dragons, fantasy buffs rolling 2d6 as they tell stories.
I’ve heard that Dungeons & Dragons is pretty big in some prisons, too. A few prisons have banned D&D or roleplaying books from being sent in – reputedly, people got killed over developments in their games. Somebody’s elf cleric was betrayed and a few days later guards found a body in the showers.
I don’t know how much truth there is to that. But, when people at those prisons ask for D&D books, I have to write an apology and send some fantasy novels instead.
I tried to give the dice back after rolling my second six, but he said I had to keep playing. “I got two, hey, you got to see where you go on this next roll.”
“Okay,” I said, “but then I got to pick up, my spouse is a high school teacher, she has this print order, some post cards to send to her students.” I gestured with my head toward the shop. And then I rolled.
An eight. Followed by a seven. I was done.
“Thanks for teaching me,” I said.
“And, hey, hey, I was thinking, for my birthday, you help me get something at Rally’s. I’m trying to get a pair of ice cones, for me and my girl.”
I gave a wan smile. Normally I don’t give money to people. It’s a tricky situation – people have things they need to buy, and even the chemical escape can seem necessary. My life is really good, and even I struggle with the sense of being trapped inside my head sometimes. And yet, I don’t really like the thought of my money being part of the whole cycle, keeping drugs in town. I’m even pro-drug, mostly, but meth and heroin typically do bad things to people’s lives.
A few days earlier, when I crossed paths with a friend from jail while my dog and I were out running, I’d asked if my friend was eating enough. He laughed at me and said, “Fuck, no!”
It’s true, I’m pretty bad at looking at people’s faces when I talk to them. When my friend started laughing, I finally met his eyes and realized how gaunt he looked.
“Is it a money problem, or …?”
“Oh, dude, don’t give me any money. I could eat, I think I can eat, I just don’t. You give me anything, I’d just spend it on meth.”
Instead of handing money to people on the street, we buy paper and pencils for folks in jail; we support our local food bank; we give time. Building human connection takes time, and there’s no shortcut.
Still, on my birthday, I was standing there in the print shop parking lot next to a man who’d just given me a present – nice nail clippers, even if I didn’t keep them. And we’d played craps. Maybe he’d won – I’m not sure what the rules are about draws. And I had a pair of quarters in my hand.
I’d hoped to have exact change. But I shrugged and gave him the quarters.
“Thanks, man,” he said, and I told him “Thanks for the game,” and walked over to ring the doorbell at the print shop, ready to pick up my order. The kids had been doing a great job of waiting patiently in the car.
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.
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.
First, some background: in case you haven’t noticed, most of the United States is operating under a half-assed lockdown. In theory, there are stay-at-home orders, but many people, such as grocery store clerks, janitors, health care workers, construction workers, restaurant chefs, delivery drivers, etc., are still going to work as normal. However, schools have been closed, and most people are trying to stand at least six feet away from strangers.
We’re doing this out of fear that Covid-19 is an extremely dangerous new viral disease. Our initial data suggested that as many as 10% of people infected with Covid-19 would die.
That’s terrifying! We would be looking at tens of millions of deaths in the United States alone! A virus like this will spread until a majority of people have immunity to it – a ballpark estimate is that 70% of the population needs immunity before the epidemic stops. And our early data suggested that one in ten would die.
My family was scared. We washed our hands compulsively. We changed into clean clothes as soon as we came into the house. The kids didn’t leave our home for a week. My spouse went to the grocery store and bought hundreds of dollars of canned beans and cleaning supplies.
And, to make matters worse, our president was on the news saying that Covid-19 was no big deal. His nonchalance made me freak out more. Our ass-hat-in-chief has been wrong about basically everything, in my opinion. His environmental policies are basically designed to make more people die. If he claimed we had nothing to worry about, then Covid-19 was probably more deadly than I expected.
Five weeks have passed, and we now have much more data. It seems that Covid-19 is much less dangerous than we initially feared. For someone my age (37), Covid-19 is less dangerous than seasonal influenza.
Last year, seasonal influenza killed several thousand people between the ages of 18 and 49 in the United States – most likely 2,500 people, but perhaps as many as 5,800. People in this age demographic account for about 10% of total flu deaths in the United States, year after year.
Seasonal influenza also killed several hundred children last year – perhaps over a thousand.
There’s a vaccine against influenza, but most people don’t bother.
Seasonal influenza is more dangerous than Covid-19 for people between the ages of 18 and 49, but only 35% of them chose to be vaccinated in the most recently reported year (2018). And because the vaccination rate is so low, our society doesn’t have herd immunity. By choosing not to get the influenza vaccine, these people are endangering themselves and others.
Some people hope that the Covid-19 epidemic will end once a vaccine is released. I am extremely skeptical. The biggest problem, to my mind, isn’t that years might pass before there’s a vaccine. I just can’t imagine that a sufficient percentage of our population would choose to get a Covid-19 vaccine when most people’s personal risk is lower than their risk from influenza.
When I teach classes in jail, dudes often tell me about which vaccines they think are too dangerous for their kids to get. I launch into a tirade about how safe most vaccines are, and how deadly the diseases they prevent.
Seriously, get your kids vaccinated. You don’t want to watch your child die of measles.
And, seriously, dear reader – get a flu vaccine each year. Even if you’re too selfish to worry about the other people whom your mild case of influenza might kill, do it for yourself.
We already know how dangerous seasonal influenza is. But what about Covid-19?
To answer that, we need data. And one set of data is unmistakable – many people have died. Hospitals around the world have experienced an influx of patients with a common set of symptoms. They struggle to breathe; their bodies weaken from oxygen deprivation; their lungs accumulate liquid; they die.
For each of these patients saved, three others are consigned to an agonizing death in the hospital, intubated among the flashing lights, the ceaseless blips and bleeps. At home, they’d die in a day; in the hospital, their deaths will take three weeks.
And the sheer quantity of deaths sounds scary – especially for people who don’t realize how many tens of thousands die from influenza in the United States each year.
Indeed, when people die of Covid-19, it’s often because their lungs fail. Smoking is obviously a major risk factor for dying of Covid-19 – a significant portion of reported Covid-19 deaths could be considered cigarette deaths instead. Or as air pollution deaths – and yet, our current president is using this crisis as an opportunity to weaken EPA airquality regulations.
Air pollution is a huge problem for a lot of Black communities in the United States. Our racist housing policies have placed a lot of minority neighborhoods near heavily polluting factories. Now Covid-19 is turning what is already a lifelong struggle for breath into a death sentence.
I would enthusiastically support a shutdown motivated by the battle for clean air.
But if we want to know how scary this virus is, we need to know how many people were infected. If that many people died after everyone in the country had it, then Covid-19 would be less dangerous than influenza. If that many people died after only a hundred thousand had been infected, then this would be terrifying, and far more dangerous than influenza.
Initially, our data came from PCR testing.
These are good tests. Polymerase chain reaction is highly specific. If you want to amplify a certain genetic sequence, you can design short DNA primers that will bind only to that sequence. Put the whole mess in a thermocycler and you get a bunch of your target, as long as the gene is present in the test tube in the first place. If the gene isn’t there, you’ll get nothing.
PCR works great. Even our lovely but amnesiac lab tech never once screwed it up.
So, do the PCR test and you’ll know whether a certain gene is present in your test tube. Target a viral gene and you’ll know whether the virus is present in your test tube. Scoop out some nose glop from somebody to put into the test tube and you’ll know whether the virus is present in that nose glop.
The PCR test is a great test that measures whether someone is actively shedding virus. It answers, is there virus present in the nose glop?
This is not the same question as, has this person ever been infected with Covid-19?
It’s a similar question – most people infected with a coronavirus will have at least a brief period of viral shedding – but it’s a much more specific question. When a healthy person is infected with a coronavirus, the period of viral shedding can be as short as a single day.
A person can get infected with a coronavirus, and if you do the PCR test either before or after that single day, the PCR test will give a negative result. Nope, no viral RNA is in this nose glop!
And so we know that the PCR test will undercount the true number of infections.
When we look at the age demographics for Covid-19 infections as measured by PCR test, the undercount becomes glaringly obvious.
Friends, it is exceedingly unlikely that such a low percentage of children were exposed to this virus. Children are disgusting. I believe this is common knowledge. Parents of small children are pretty much always sick because children are so disgusting.
Seriously, my family has been doing the whole “social distancing” thing for over a month, and yet my nose is dripping while I type this.
Children are always touching everything, and then they rub their eyeballs or chew on their fingers. If you take them someplace, they grubble around on the floor. They pick up discarded tissues and ask, “What’s this?”
“That’s somebody’s gross kleenex, is what it is! Just, just drop it. I know it’s trash, I know we’re not supposed to leave trash on the ground, but just, just drop it, okay? Somebody will come throw it away later.”
The next day: “Dad, you said somebody would throw that kleenex away, but it’s still there!”
Bloody hell. Children are little monsters.
It seems fairly obvious that at least as high a percentage of children would be infected as any other age demographic.
But they’re not showing up from the PCR data. On the Diamond Princess cruise ship, the lockdown began on February 5th, but PCR testing didn’t begin until February 11th. Anyone who was infected but quickly recovered will be invisible to that PCR test. And even people who are actively shedding viral particles can feel totally well. People can get infected and recover without noticing a thing.
We see the same thing when we look at the PCR data from Italy. If we mistakenly assumed that the PCR data was measuring the number of infections, and not measuring the number of people who were given a PCR test while shedding viral particles, we’d conclude that elderly people went out and socialized widely, getting each other sick, and only occasionally infected their great-grandchildren at home.
Here in the United States, children are disgusting little monsters. I bet kids are disgusting in Italy, too. They’re disgusting all over the world.
A much more likely scenario is that children spread this virus at school. Many probably felt totally fine; some might’ve had a bad fever or the sniffles for a few days. But then they recovered.
When they got their great-grandparents sick – which can happen easily since so many Italian families live in multigenerational homes – elderly people began to die.
So we know that the PCR test is undercounting the true number of infections. Unless you’re testing every person, every day, regardless of whether or not they have symptoms, you’re going to undercount the number of infections.
In a moment, we can work through a way to get a more accurate count. But perhaps it’s worth mentioning that, for someone my age, Covid-19 would seem to be about as dangerous as influenza even if we assumed that the PCR data matched the true number of infections.
If you’re a healthy middle-aged or young person, you should not feel personally afraid.
That alone would not be an excuse to go out and start dancing in the street, though. Your actions might cause other people to die.
(NOTE & CORRECTION: After this post went up, my father recommended that I add something more about personal risk. No one has collected enough data on this yet, but he suspects that the next most important risk factor, after smoking and age, will be type 2 diabetes. And he reminded me that many people in their 30s & 40s in this country are diabetic or prediabetic and don’t even realize it yet. Everyone in this category probably has elevated risk of complications from Covid-19.)
After you’ve been infected with a virus, your body will start making antibodies. These protect you from being infected again.
Have you read Shel Silverstein’s Missing Piece book? Antibodies work kind of like that. They have a particular shape, and so they’ll glom onto a virus only if that virus has outcroppings that match the antibody’s shape. Then your body sees the antibodies hanging out on a virus like a GPS tracker and proceeds to destroy the virus.
So to make an antibody test, you take some stuff that looks like the outcroppings on the virus and you put it on a chip. Wash somebody’s blood over it, and if that blood contains antibodies that have the right shape to glom onto the virus, they’ll stick to the chip. All your other antibodies, the ones that recognize different viruses, will float away.
An antibody test is going to be worse than a PCR test. It’s easier to get a false positive result – antibodies are made of proteins, and they can unfold if you treat them roughly, and then they’ll stick to anything. Then you’ll think that somebody has the right antibodies, but they don’t. That’s bad.
You have to be much more careful when you’re doing an antibody test. I wouldn’t have asked our lab tech to do them for me.
An antibody test is also going to have false negatives. A viral particle is a big honking thing, and there are lots of places on its surface where an antibody might bind. If your antibodies recognize some aspect of the virus that’s different from what the test manufacturers included on their chip, your antibodies will float away. Even though they’d protect you from the actual virus if you happened to be exposed to it.
If you’re a cautious person, though – and I consider myself to be pretty cautious – you’d much rather have an antibody test with a bunch of false negatives than false positives. If you’re actually immune to Covid-19 but keep being cautious, well, so what? You’re safe either way. But if you think you’re immune when you’re not, then you might get sick. That’s bad.
Because antibody tests are designed to give more false negatives than false positives, you should know that it’d be really foolish to use them to track an infection. Like, if you’re testing people to see who is safe to work as a delivery person today, use the PCR test! The antibody test has a bunch of false negatives, and there’s a time lag between the onset of infection and when your body will start making antibodies.
If you use the antibody test on a bunch of people, though, you can tell how many were infected. And that’s useful information, too.
In the town of Robbio in Italy (pop. 6,000), the PCR test showed that only 23 people had been infected with Covid-19. But then the mayor implored everyone to get an antibody test, and 10% of people had actually been infected with – and had recovered from – Covid-19. Most of them couldn’t even recall having been sick.
I don’t know who made the tests used in Robbio – maybe they were a little better, maybe they were a little worse. Based on my experience, I wouldn’t be so surprised if the true infection rate with Covid-19 in that town was really just 10% – nor would I be surprised to hear that the chips had a high false-negative rate and that the infection rate was 20% or more.
If you calculate the fatality rate of Covid-19 in Italy by assuming that the PCR tests caught every infection, you’d get a terrifying 10%.
If you instead assume that many other towns had a similar infection rate to Robbio, you’ll instead calculate that the fatality rate was well under one percent.
Italy has higher risk than the United States due to age demographics, smoking rates, and multigenerational households – and even in Italy, the fatality rate was probably well under one percent.
When researchers in Germany randomly chose people to take a Covid-19 PCR test (many of whom had no symptoms), they found that 2% of the population was actively shedding virus – a much higher number of cases than they would have found if they tested only sick people. And when they randomly chose people to take an antibody test, they found that 15% had already recovered from the infection (again, many of whom had never felt sick). According to these numbers – which are expected to be an undercount, due to false negatives and the time lag before antibody production – they calculated a case fatality rate of 0.37%.
That would be about three-fold more dangerous than seasonal influenza.
In the United States, our bungling president gutted the CDC, leaving us without the expertise needed to address Covid-19 (or myriad other problems that might arise). During the first few months of this epidemic, very few people managed to get a PCR test. That’s why our data from the PCR tests is likely to be a dramatic undercount – indeed, when we finally started producing accurate tests, the apparent growth in Covid-19 caseload superimposed with the growth in test availability.
In the absence of good PCR data, we have to rely on antibody data to track infections after the fact. Which is why a town in Colorado with zero reported infections, as measured by PCR, had sufficiently widespread exposure that 2% of the population had already recovered from Covid-19.
Yes, there were problems with the Stanford study’s data collection – they displayed advertisements to a random selection of people, but then a self-selected subset responded. The pool of respondents were enriched for white women, but Santa Clara’s outbreak probably began among Asian-Americans. And we all know that random sampling doesn’t always give you an accurate depiction of the population at large – after all, random polling predicted that a competent president would be elected in 2016.
Now look at us.
It’s also likely that people with a poor understanding of the biology could misinterpret the result of the Stanford study. They found that PCR tests had undercounted the infection rate in Santa Clara county, at the time of this study, by 85-fold.
It would be absurd to assume that you could simply multiply all PCR results by 85 to determine the true infection rate, but some people did. And then pointed out the absurdity of their own bad math.
In places where more people are being tested by PCR, and they’re being tested more often, the PCR results will be closer to the true infection rate. If you gave everyone in the United States a PCR test, and did it every day, then the PCR data would be exactly equal to the true infection rate.
If we had data like that from the beginning, we wouldn’t have been scared. We would’ve known the true case fatality rate early on, and, also, at-risk people could’ve been treated as soon as they got infected. We’d be able to save many more lives.
10% is roughly the proportion of young people who die of seasonal influenza. But only 1% of Covid-19 deaths are people younger than 35. The news reports don’t always make clear how much the risk of Covid-19 is clustered in a small segment of the population.
This has serious implications for what we should do next. If we were dealing with a virus that was about three-fold more dangerous than seasonal influenza for everyone, we might just return to life as normal. (Indeed, we carried on as normal during the bad years when seasonal influenza killed 90,000 people instead of last year’s 30,000.)
Because the risk from Covid-19 is so concentrated, though, we can come up with a plan that will save a lot of lives.
Healthy people under retirement age should resume most parts of their lives as normal. Schools should re-open: for students, Covid-19 is much less dangerous than seasonal influenza. I think that people should still try to work from home when possible, because it’s the right thing to do to fight climate change.
At-risk people should continue to isolate themselves as much as possible.
This sounds crummy, but at-risk people would just continue to do the thing that everyone is doing currently. And the plan would save many lives because the epidemic would end in about 3 months, after the virus had spread to saturation among our nation’s low-risk cohort.
Their data are easy enough to understand. In each of these graphs, they show a blue box for how long social distancing would last, and then four colored lines to represent how many infections we’d see if we did no social distancing (black), medium quality social distancing (red), good social distancing (blue), or excellent social distancing (green).
So, from top to bottom, you’re looking at the graphs of what happens if we do a month of social distancing … or two months … or three, or four … or forever.
And you can see the outcomes in the panels on the right-hand side. The black line shows what would happen if we did nothing. Infections rise fast, then level off after the virus has reached saturation. There are two important features of this graph – the final height that it reaches, which is the total number of severe cases (and so a good proxy for the number of deaths), and the slope of the line, which is how fast the severe cases appear. A steeper hill means many people getting sick at the same time, which means hospitals might be overwhelmed.
So, okay. Looking at their graphs, we see that social distancing saves lives … if we do it forever. If you never leave your house again, you won’t die of Covid-19.
But if social distancing ends, it doesn’t help. The slopes are nearly as steep as if we’d done nothing, and the final height – the total number of people who die – is higher.
(Often, one of their curves will have a gentler slope than the others — usually the good-but-not-excellent social distancing seems best. So you’d have to pray that you were doing a precisely mediocre job of not infecting strangers. Do it a little better or a little worse and you cause people to die. This isn’t an artifact — it’s based on the density of uninfected people when social distancing ends — but let’s just say “mathematical models are wonky” and leave it at that.)
In a subsequent figure, the Harvard team tried to model what might happen if we occasionally resumed our lives for a month or so at a time, but then had another shutdown. This is the only scenario in which their model predicts that social distancing would be helpful.
Even in the extreme case that we mostly stayed in our homes for the better part of two years, social distancing would case more deaths from Covid-19 than if we had done nothing.
That’s not even accounting for all the people who would die from a greater risk of domestic violence, hunger, drug addiction, suicide, and sedentary behavior during the shutdown.
When our data was limited, the shutdown seemed reasonable. We wouldn’t be able to undo the damage we’d done by waiting.
Except, whoops, we waited anyway. We didn’t quarantine travelers in January. The shutdown didn’t begin March, when the epidemic was well underway in many places.
Now that we have more data, we should re-open schools, though. For most people, Covid-19 is no more dangerous than seasonal influenza. We already have enough data from antibody testing to be pretty confident about this, and even if we want to be extremely cautious, we should continue the shutdown for a matter of weeks while we conduct a few more antibody studies. Not months, and certainly not years.
At the same time, we need to do a better job of protecting at-risk people. This means providing health care for everyone. This means cleaning our air, staunching the pollution that plagues low-income neighborhoods. This might mean daily medical checkups and PCR tests for people who work closely with at-risk populations.
Our country will have to be different in the future, but mostly because we, as a people, have done such a shitty job of creating justice and liberty for all. We need to focus on addressing the inequities that we’ve let fester for generations. That’ll help far more than using a bandanna to cover up your smile.