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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

On testing.

On testing.

UPDATE: Wow, this got a lot of readers! Honestly, though, I wrote a response to common questions and comments about this essay and it is probably a better read.

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My spouse recently sent me a link to the article “Concerns with that Stanford study of coronavirus prevalence” by Andrew Gelman, a statistician at Columbia University.  From reading this article, I got the impression that Gelman is a good mathematician.  And he raises some legitimate concerns. 

But I’ve noticed that many of the people criticizing the work coming out of the Ioannidis group – such as the study of how many people in Santa Clara county might have antibodies to Covid-19 – don’t seem to understand the biology underlying the numbers.

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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.

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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. 

That’s shocking. 

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. 

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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.

Many people have been put on ventilators, but that’s often the beginning of the end.  Most people put on ventilators will die.  Among patients over 70 years old, three quarters who are put on ventilators will 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.

Or, consider: cigarette smoking causes 480,000 deaths per year in the United States, including 41,000 people who die from second-hand smoke exposure.  Those 41,000 aren’t even choosing to smoke!  But cigarettes kill them anyway.

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 air quality 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.

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So, Covid-19.  We know how many people have died – already (CORRECTION AS OF APRIL 21) forty-two thousand in the United States

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.

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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.

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When we look at the age demographics for Covid-19 infections as measured by PCR test, the undercount becomes glaringly obvious.

Consider the PCR test data from the Diamond Princess cruise ship.  To date, this is our most complete set of PCR data – everyone on board was tested multiple times.  And from this data, it appears that very few children were exposed to the virus.

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.)

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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.

It can be dangerous to use antibody tests to address the wrong questions.

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.

The PCR test measured 23 cases.  The antibody test suggested there’d been at least 600.  And antibody tests, by design, will generally have a bunch of false negatives.  When a team at Stanford assessed the antibody tests manufactured by Premier Biotech in Minneapolis, they found that for every 3 people who’d been infected with Covid-19, the tests registered only 2 positives.

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.

And it’s why the data from the Stanford Santa Clara county study is so unsurprising. 

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.

If access to health care were considered a basic right in the United States, we might’ve done something like this. 

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In Italy, it seems like Covid-19 is three- or four-fold more dangerous than seasonal influenza.  My guess is that Italy might have had about 50,000 deaths if they hadn’t enacted the lockdown.

In the United States, on a population level, Covid-19 is probably also more dangerous than seasonal influenza.  But there’s a big difference in terms of the distribution of risk.

The New York Times is running a series with short biographies of people who’ve died of Covid-19.  As of noon on April 17, about 10% of the people profiled were younger than 35.

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. 

Indeed, when a team of researchers from Harvard’s School of Public Health modeled the Covid-19 epidemic, they found that social distancing was generally unhelpful.  That’s what their data show, at least – but in their abstract, they instead recommend that we continue social distancing for the better part of two years.

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.

But, unfortunately, there’s a problem.  Research done with other coronaviruses shows that immunity fades within a year.  Because the Harvard model would cause the epidemic to last longer than a year, people would have time to lose their immunity and get infected again.

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.  

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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.

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UPDATE: Wow, this got a lot of readers! Thanks if you made it this far. I’ve also written a response to common questions and comments about this essay.

On inequality and disease.

On inequality and disease.

I should preface these remarks by stating that my political views qualify as “extremely liberal” in the United States.

I’m a well-trained economist – I completed all but the residency requirement for a masters at Northwestern – but I don’t give two shits about the “damage we’re doing to our economy,” except insofar as financial insecurity causes psychological harm to people in poverty.  Our economy should be slower, to combat climate change and inequality.

One of my big fears during this epidemic is that our current president will accidentally do something correctly and bolster his chances of reelection.  The damage that his first term has already caused to our environment and our judiciary will take generations to undo – imagine the harm he could cause with two.

And yet, in arguing that our response to the Covid-19 epidemic is misguided, I seem to be in agreement with our nation’s far right. 

As far as I can tell, the far right opposes the shutdown because they’re motivated by philosophies that increase inequality.  Many of them adore Ayn Rand’s “Who will stop me?” breed of capitalism, as though they should be free to go outside and cough on whomever they want.  They dislike the shutdown because they think our lives are less important than the stock market.

By way of contrast, I care about fairness.  I care about the well-being of children.  I care about our species’ future on this planet.  It’s fine by me if the stock market tanks!  But I’ve written previously about the lack of scientific justification for this shutdown, and I’m worried that this shutdown is, in and of itself, an unfair response.

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Quarantine could have prevented this epidemic from spreading.  If we had acted in December, this coronavirus could have been contained.  But we did nothing until several months after the Covid-19 epidemic began in the United States. 

Then schools were closed: first for two weeks, then a month, then the entire year.

Stay-at-home orders were issued: first for two weeks, then extended to a month.  No data supports the efficacy of these orders – haphazard, partial attempts at social distancing, from which certain people, like my buddy doing construction for a new Amazon facility, have been exempted.  And no metrics were announced that might trigger an end to the shutdown.

Currently, the stay-at-home orders last until the end of April.  But, as we approach that date, what do people expect will be different?  In the United States, we still can’t conduct enough PCR tests – and even these tests yield sketchy data, because they might have false negative rates as high as 30%, and they’re only effective during the brief window of time — perhaps as short as one week — before a healthy patient clears the virus and becomes invisible to testing.

Based on research with other coronaviruses, we expect that people will be immune to reinfection for about a year, but we don’t know how many will have detectable levels of antibody in their blood.  As of this writing, there’s still no serum test.

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In the United States, New York City has the largest concentration of risk – densely populated elderly people with constant exposure to unclean air. But even the New York Times has begun to print articles describing the folly of our response to Covid-19.

The Italian government is considering the dystopian policy of drawing people’s blood to determine if they’ll be eligible for a permit to leave their homes.  If you were worried about the injustice that the virus itself imposed on people who are elderly or immunocompromised, this is worse!

We can’t evaluate our response without tests.  Missteps by the CDC (which was gutted by the Trump administration) have left us blind to the progression of the epidemic.  And we can’t evaluate our response if we have nothing to compare it to – we will have to end the shutdown to see what happens next (with the option of resuming these safety measures if our test shows they were necessary).

We know, clearly, that the shutdown has been causing grievous harm.  Domestic violence is on the rise.  This is particularly horrible for women and children in poverty, trapped in close quarters with abusers.  The shutdown is creating conditions that increase the risk of drug addiction, suicide, and the murder of intimate partners.

We don’t know whether the shutdown is even helping us stop the Covid-19 epidemic.  And we still don’t know whether Covid-19 is scary enough to merit this response.  As of this writing, our data suggest that it isn’t.

Covid-19 is a rare breed, though: a communicable disease where increased wealth correlates with increased risk.

And so we’re taking extreme measures to produce a small benefit for the most privileged generation to ever walk the face of this Earth, at the cost of great harm to vulnerable populations.  This is why I feel dismayed.

Hopefully I can present some numbers simply enough to explain.

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Many diseases are more likely to kill you if you’re poor.

Malaria kills between 400,000 and one million people every year.  The vast majority are extremely poor, and many are children – the World Health Organization estimates that a child dies of malaria every thirty seconds.

Wealth protects against malaria in two ways.  Wealthy people are less likely to live in parts of the world with a high prevalence of malaria (most of the deaths each year occur in Africa and India), and wealthy people can buy effective anti-malarial medications. 

I took prophylactic Malarone when I visited Ecuador and India.  Lo and behold, I did not get sick. 

I believe Malarone costs about a dollar per day.  I am very privileged.

HIV kills between 700,000 and one million people every year.  Again, the vast majority are poor.  HIV is primarily transmitted through intimate contact – exposure to blood, needle sharing, or sex – so this virus rarely spreads across social boundaries in stratified communities. 

In the United States, HIV risk is concentrated among people living in our dying small towns, people without homes in inner cities, and people trapped inside the criminal justice system. 

It seems that these people are all easy to ignore.

Wealth will protect you even if you do contract HIV.  We’ve developed effective antiretroviral therapies.  If you (or your government) can pay for these pills, you can still have a long, full life while HIV positive.  About 60% of the people dying of HIV happen to have been born in Africa, though, and cannot afford antiretrovirals.

Even the myriad respiratory infections that plague our species – of which Covid-19 is but one example – are more likely to kill you if you’re poor.  The World Health Organization lists the top causes of death for people living in low-income versus high-income countries.  The death rate from respiratory infections is twice as high for people living in low income countries.

The second-highest cause of death among people in low-income countries is diarrhea.  Diarrhea kills between one million and two million people each year, including about 500,000 children under five years old.

These deaths would be easy to treat and even easier to prevent. 

Seriously, you can save these people’s lives with Gatorade!  (Among medical doctors, this is known as “oral rehydration therapy.”)  Or you could prevent them from getting sick in the first place by providing clean water to drink.

We could provide clean water to everyone – worldwide, every single person – for somewhere between ten billion and one hundred billion dollars.  Which might sound like a lot of money, but that is only one percent of the amount we’re spending on the Covid-19 stimulus bill in the United States.

We could do it.  We could save those millions of lives.  But we’re choosing to let those people die.

Because, you see, wealthy people rarely die of diarrhea.  Clean water is piped straight into our homes.  And if we do get sick – I have, when I’ve traveled – we can afford a few bottles of Gatorade.

Instead, wealthy people die of heart disease.  Stroke.  Alzheimer’s.  Cancer.

If you’re lucky enough to live past retirement age, your body will undergo immunosenescence.  This is unfortunate but unavoidable.  In old age, our immune systems stop protecting us from disease.

Age-related immunosenescence explains the high prevalence of cancer among elderly people.  All of our bodies develop cancerous cells all the time.  Usually, our immune systems kill these mutants before they have the chance to grow into tumors.

Age-related immunosenescence also explains why elderly people die from the adenoviruses and coronaviruses that cause common colds in children and pre-retirement-age adults.  Somebody with a functional immune system will get the sniffles, but if these viruses are set loose in a nursing home, they can cause systemic organ failure and death.

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I haven’t seen this data presented yet – due to HIPAA protections, it can’t easily be collected – but Covid-19, on average, seems to kill wealthier people than influenza.

On a personal level, wealth will protect you from Covid-19.  We know that early treatment saves lives, which is a reason why Germany’s death rate is so low, and wealthy people are less likely to postpone going to the hospital.  Wealthy people can afford the Albuterol inhaler that might keep you out of the ICU. Wealthy people are less likely to experience the stresses, sleep loss, and discrimination that have caused disproportionate numbers of Black people in the United States to succumb to Covid-19.

But on a population level, wealth is correlated with increased risk.

Part of this wealth gap is due to age.  I’ve made a rough sketch of the risk of death versus age for both Covid-19 and seasonal influenza.  Currently we don’t have enough data to know exactly where these risk curves intersect, but it seems to be around retirement age.  If you’re younger than retirement age, seasonal influenza is more deadly.  If you’re older than retirement age, Covid-19 is more deadly.

In the United States, if you’re older than retirement age, you’re more likely to be wealthy.

Covid-19 is also more dangerous if you’re already sick.  A study of Covid-19 deaths found that 97% of the people killed were already sick with at least one serious medical condition.  The average person killed by Covid-19 had 2.7 other serious diseases.

Because these people were receiving expensive medical care, they were able to survive despite their other diseases.  Imagine what would have happened if these people had chanced to be born in low-income countries: they would already be dead. 

This is a tragedy: all over the world, millions of people die from preventable causes, just because they had the bad luck of being born in a low-income country rather than a rich one.

We don’t have data on this yet, but it’s likely that Covid-19 will have a much smaller impact in Africa than in Europe or the United States.

When my father was doing rounds in a hospital in Malawi, his students would sometimes say, “We admitted an elderly patient with …”  And then my father would go into the room.  The patient would be 50 years old.

Covid-19 is particularly dangerous for people in their 80s and 90s.  Great privilege has allowed so many people in Europe and the United States to live until they reached these high-risk ages.

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Our efforts to “flatten the curve,” in addition to increasing many people’s risk of death (from domestic violence, suicide, and the lifelong health repercussions of even a few months of sedentary living), will save relatively few lives, even among our country’s at-risk population.

The hope is that we won’t exceed the capacity of our hospitals.  If someone’s condition deteriorates after a Covid-19 infection, they need invasive ventilation.

Please note that we can often prevent people’s condition from deteriorating by giving them Albuterol inhalers.  And these used to be so cheap!  In the early 2000s, you could buy an inhaler for about five dollars.  But pharmaceutical companies were allowed to re-patent these and the price has soared to nearly four hundred dollars.

Many news reports have included sensational numbers about how many people in their 30s and 40s have gone to the hospital for Covid-19.  These reports rarely mention that many of these hospitalizations could be prevented with a five dollar inhaler.

But we’re allowing drug companies to charge people four hundred dollars a pop for these now, which puts them out of reach for many people.

When I caught what I assume to be Covid-19, I took an inhaler.  I am very privileged.

Some young people can’t afford an inhaler, and many elderly people develop symptoms too severe to be treated with Albuterol, so they need care in an ICU.

But the benefit of this shutdown is simply the difference between how many people would die if we did nothing, compared to how many people will die now. 

In a recent essay, I gave an estimate for how many people would die if we’d done nothing.  New data suggests that my estimate was too low – the numbers out of Italy (where they did nothing until it was probably too late) suggest that around 80,000 people might have died in the United States.  Hospitals would have been overwhelmed, and some people whose condition required invasive ventilation would have been denied that treatment.

Even with the shutdown, though, we’re doing a crappy job.  Our numbers are pretty much guaranteed to be worse than Germany’s, which has a more equitable health care system overall and is testing enough people to track the spread of the disease and treat people early.  With this shutdown, all we’re hoping for is that the severe cases will be spread enough in time that everyone whose condition deteriorates to the point of needing invasive ventilation can have it.

Maybe.  The shutdown is so slapdash that hospitals in certain high-risk areas, like New York City, will still be overwhelmed.

Assuming that our efforts to flatten the curve succeed – and neglecting all the other risks of this strategy – we’ll be able to provide ventilation to everyone.  But there will still be a lot of deaths.  The shutdown will not have helped those people.  The shutdown is only beneficial for the small number who would be treated in one scenario, would not be treated in another, and who actually benefit from the treatment.

The Lancet reported that in the initial wave of the Covid-19 epidemic, 97% of patients receiving invasive ventilation died.  Later on, the death rate among people receiving ventilation was still over 80%

So we’d actually be saving only a fifth of the people who would have to be triaged if we’d exceeded our hospitals’ capacity to provide care.  This could be as few as 10,000 at-risk people.

Their lives matter, too.  Many of us have a friend or relative whose life was cut short by this. But something that we have to accept is that we all die.  Our world would be horrible if people could live forever.  Due to immunosenescence, it becomes increasingly difficult to keep people alive after they reach their 70s or 80s.

And the priorities of elderly people are different from mine.  I care deeply about the well-being of children and our planet’s future.  That’s why I write a column for our local newspaper discussing ways to ameliorate our personal contribution to climate change.  That’s why my family lives the way we do.

These priorities may be quite different from what’s in the short-term best interests of an 80-year-old.

Schools are closed.  Children are suffering.  Domestic violence is on the rise.  All to protect a few thousand people who have experienced such exceptional privilege that they are now at high risk of dying from Covid-19.

Our national response to Covid-19 is being directed by a 79-year-old doctor.  I haven’t gotten to vote in the presidential primary yet, but if I get to vote at all, I’ll be allowed to choose whomever I prefer from a selection of a 77-year-old white man or a 78-year-old white man.  Then comes the presidential election, where there’ll be an additional 73-year-old white man to choose from.

It makes me wonder, what would our national response be like if we were facing a crisis as risky as Covid-19, but where elderly people were safe and children were most at risk?

And then I stop wondering.  Because we are facing a crisis like that. 

It’s climate change.

And we have done nothing.

On immunity.

On immunity.

Our efforts to “flatten the curve” of the Covid-19 epidemic are onerous. 

Children aren’t allowed to go to school.  We’re forcing small retailers out of business.  People aren’t hugging when they greet.

Some people think these sacrifices are worthwhile, though, if they reduce the number of people who die from Covid-19.

Unfortunately, the effort to “flatten the curve” can cause more people to die of Covid-19 — including more of our elders — than if we’d carried on with life as usual.

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Antibodies are like the memory of your immune system.  After you’ve been infected with a particular virus, your body can destroy further copies of that virus.

This memory doesn’t last forever.  Your body will “forget” how to fight off the coronavirus that causes the common cold within a year.

If we carried on with life as usual, the coronavirus that causes Covid-19 would probably make its rounds through the population of the United States within a few months.  After that, there would be no new people to infect, and so the virus would disappear.

If, however, we practice social distancing and slow the rate of transmission – the same number of infections spaced over eighteen months instead of eighteen weeks – your immune system has a chance “forget” how to fight off the virus while this virus is still circulating in the population.  By slowing the rate of transmission, you give yourself the opportunity to contract the infection twice

If we slow the rate of transmission enough, this coronavirus will survive indefinitely.  Then people will continue to die of Covid-19 forever.

Even if you are currently at risk — elderly or immunocompromised — you should still fear this possibility. Will you be less at risk when this virus hits your hometown again in another year?

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When a virus infects a cell, it uses that cell’s replicative machinery to make more copies of itself.  A virus can’t reproduce on its own – it can only co-opt its host’s cells into making more copies for it.

Each time the host makes a new copy, it must replicate the entire genome of the virus.  Our cells are pretty good at copying genomes – every time the cells of our own bodies divide, they produce a new copy of our 3-billion-base-pair genome, and the copies usually have only a handful of mistakes.

Of course, a handful of mistakes compounded over time can be deadly.  That’s what cancer is – your cells didn’t copy your DNA perfectly, and so you wound up with slightly mutated DNA, and this mutated DNA instructs cells to form a tumor that kills you.

The same accumulation of errors can change a virus.  In the 1918 influenza epidemic, huge numbers of people died because the virus mutated to become more deadly.

The longer we allow the Covid-19 outbreak to go on – the more we strive to “flatten the curve” – the more mutations will accrue in its genome. 

Consider a city in which ten people live, one of whom has the virus.  If they throw a party, the other nine will be infected all at once – they will all come down with the Nth generation of the virus, whatever the current sick person is shedding.  If, however, they practice social distancing and get sick one at a time, each passing the infection to the next, the last person in the chain will be infected with viral generation N+9.  It could be very different, and more dangerous, than the initial virus.

Mutation doesn’t always make a virus more dangerous.  It’s entirely random.  It was bad luck that a mutation in 1918 made that strain of influenza more deadly.

But the risk is real.  It’s a risk we aggravate if we “flatten the curve.”  Right now, very few young healthy people will be hurt by Covid-19, but no one can know what monstrosity we’ll produce if we allow this virus to cycle through enough generations.

Inconveniently for us, Covid-19 is caused by an RNA virus.  Our cellular machinary is pretty good at making copies of DNA – every round of cell division makes a few mistakes, but not so many.  Our cellular machinary is worse at making accurate copies of RNA.  A virus with an RNA genome will mutate faster.

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People are worried that, without drastic efforts to slow the rate of transmission of Covid-19, the influx of new cases would overwhelm our hospitals.  We might run out of ventilators and be forced to triage, providing heroic medical interventions only to those people most likely to survive.  Some number of elderly patients with a low chance of survival would not receive care.

Is this bad?

Most medical doctors have signed “do not resuscitate” orders.  I have, too.  Most medical doctors, who have seen over and over again what it’s like when elderly patients with a low chance of survival receive heroic medical interventions, don’t want it for themselves.  They would rather die in peace.

The New York Times – which, alongside the New York Review of Books, is my favorite news outlet, even though it’s been full of fear-mongering about Covid-19 – printed a quote from Giacomo Grasselli, who coordinates intensive care units throughout Lombardy, Italy.  Grasselli is working at the front-lines of the Italian Covid-19 outbreak.

“My father is 84 and I love him very much,” but it would be irresponsible, he said, to make him go through the invasive procedures of an I.C.U.

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In the United States, we spent over three trillion dollars on medical care in 2016.  A huge fraction of this spending is used for minuscule extensions of life.  A third of all Americans have surgery during their last month of life.  We often spend more on interventions that extend the life of wealthy patients by a month than we do on all the pre-natal, preventative, and acute care that other people receive, ever.

What’s been missing, in the United States, is a conversation about what constitutes a good life.  What needs to happen for people to be able to face death with the thought that their lives have been enough? 

Covid-19 has killed thousands of people who were privileged to live to extremely old age.  In the United States, the worst outbreak will be in New York City – a city that is so expensive to live in that it harbors huge concentrations of wealthy elderly people.

In the United States, the life expectancy is 78 years.  Of course, there are major inequalities.  If you are wealthy, you might live longer than that.  If you are poor, you’ll probably die younger.  My spouse’s parents both died in their 60s.

Covid-19 has a high mortality rate for people who have already exceeded this life expectancy.  For people under retirement age, Covid-19 is less dangerous than seasonal flu.

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In the United States, life expectancy has been falling.  This decline is primarily due to an epidemic of “deaths of despair”: Drug addiction.  Suicide. 

In the United States, around 40,000 to 50,000 people die of suicide each year.  Around 60,000 people die of drug overdose.  Around 70,000 people die from alcohol abuse.

Each year, the epidemic of “deaths of despair” kill somewhere between 100,000 and 200,000 people.

Our efforts to “flatten the curve” will probably increase the number of people who die from deaths of despair.

Small towns across the United states have been gutted by the internet.  People used to visit local retailers, which could employ local salespeople.  Then we switched to buying things on Amazon, giving Jeff Bezos our money instead.

Now, local retailers are being forced to close due to fears about Covid-19.  People have to buy things online.  But local retailers still have expenses.  They still have to pay rent.  The owners still have to eat.  Many small retailers will run out of money and never open again after the Covid-19 epidemic is over.

As if our small towns needed yet more punishment.

In general, people will experience more financial woes because of our response to Covid-19.  Businesses are closed.  Work has slowed.  The stock market has tanked. 

And financial instability increases the risk of deaths of despair.  That’s a major reason why there’s been such a dramatic rise in deaths of despair among young people.

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Thankfully, our efforts to “flatten the curve” aren’t guaranteed to make this coronavirus mutate.  Our efforts aren’t guaranteed to make this virus a permanent parasite on the human race. 

We might cause these calamities, but we don’t know for sure.

Indeed, we know very little about this illness.  We do know that tens of thousands of elderly people have died.  But we don’t know whether ten thousand died out of a hundred thousand who were infected, or a million, or tens of millions.

Our perception of the disease would be very different in each of those scenarios.  But we do not, and can not, know.  We have no retrospective testing, and we have never tested a random sample of the population to investigate viral prevalence.

The best we can do is estimate from small data sets, the way Stanford epidemiologist John Ioannidis has done.  Ioannidis is very clear about his methodology, so if you happen to disagree with any of his assumptions, you can re-work the math yourself.

He concludes that our response is a horrific over-reaction.

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The people recommending these policies – social distancing, school closure, stay-at-home orders, or total lockdown – aren’t doing so out of malice.  They’re making the decisions they feel to be best.  But no policy is neutral, obviously. 

These policies prioritize the short-term needs of wealthy people who have exceeded their expected lifespans, at the expense of everyone under retirement age.  In particular, these policies do not value the needs of children.

Many of our country’s policies prioritize the desires of wealthy older people over the needs of children, though  “Flatten the curve” is just another example.

#

In many places, we are probably attempting to “flatten the curve” after the epidemic has already run its course.

More likely than not, I already had Covid-19.  In early January, a co-worker of my children’s best friends’ parent left China, stayed briefly with her daughter in Seattle, then returned to Bloomington. 

A few days later, she came down with a high fever and a bad cough.  She went in for a flu test, but tested negative.  The doctors sent her home.

A week later, my children’s best friends’ parent – the sick woman’s co-worker – came down with a high fever and a bad cough.  His children were sick enough that they stayed home from school for a day.  He was sick enough that he missed a week of work.

A week later, on February 10th, my children and I got sick.  We had a high fever and a bad cough.  The kids felt better the next day.  I felt wretched for an entire week.  I am an endurance runner with strong lungs – still, I needed puffs of my spouse’s Albuterol inhaler four times a day.  I took naproxen but still had a hallucinatory fever.  I wouldn’t wish that illness on anyone.  For the next two weeks, I was vigilant about washing my hands and tried to minimize my contact with other people.

Over the next month, many other people in town came down with a cough and fever.  It would typically last a week, then they’d feel better.

But it was pretty scary for some people. I’d felt wrecked. Another friend of mine — 55 years old, cigarette smoker, & former methamphetamine addict — felt like he could barely breathe. The doctor said that if his oxygen flow had been any lower, she would’ve kept him at the hospital.

He wasn’t tested for Covid-19. There were still no tests available. And after a horrible week, he felt better.

And then, on March 12thafter the epidemic had probably run its course in our town – our schools closed.  The university students left for spring break, and the remaining populace of our small town began to practice social distancing.

And yet, in mid-March, the first case of Covid-19 was diagnosed here.  This patient could not trace the social connections that would have led back to a known Covid-19 outbreak.  As should be expected by that late stage of an epidemic.

All around the country, reported Covid-19 cases are exponentially rising.  But that doesn’t mean that Covid-19 infections are exponentially rising.  It only means that access to Covid-19 testing has risen.

When the epidemic likely spread through my town, it went undetected – no Covid-19 tests were available in the United States, and there’s no way to test whether someone was infected in the past.  The reported numbers of Covid-19 cases are guaranteed to be lower than the true number of people infected, because you can only be counted as a Covid-19 if you feel sick enough to visit a doctor, and then somehow manage to get access to the test.

The test will only register positive during the acute phase of the illness.  There is no possible way to test whether someone who isn’t currently shedding virus has been infected.

#

A useful way to consider this epidemic is to imagine what would happen if the Covid-19 PCR test wasn’t invented. 

People would still get Covid-19.  We would take no extraordinary protective measures, because we wouldn’t realize what they were sick with.

This is like what happened at the beginning of the HIV crisis in the United States.  Medical doctors called the disease GRD, or “gay-related disease,” and it was terrifying.  Healthy young people suddenly wasted away.

If we lacked a PCR test to accurately diagnose Covid-19, though, we wouldn’t call it “age-related disease.”  We would call it “seasonal flu.”  This year, about 30,000 people will die of seasonal flu, including many healthy young people.  This year, my nephew almost died of the flu.  He couldn’t breathe.  He needed invasive ventilation to survive.

If we did nothing to staunch the Covid-19 outbreak, somewhere between 15,000 and 30,000 people probably would die from it.  Combined with the 30,000 deaths actually caused by influenza, we would think that between 45,000 and 60,000 people had died from seasonal flu.  No more than a dozen or so of the additional deaths would have been healthy young people.

That’s many more deaths!  But nothing exceptional.  In 2017, 60,000 people died of seasonal flu.

In 2017, we still let children go to school.  I’m not sure I read any news articles about seasonal flu in 2017.  And in the following years – after huge numbers of people died! –  about half our population didn’t bother to get a flu vaccine.

Influenza is a more dangerous illness, and it’s preventable.  But our country’s vaccination rate is too low to confer herd immunity.  Even if you are young and healthy, a bad case of the flu can kill you.  Even if you are young and healthy, your vaccination protects others.

Social distancing would protect people from the flu, also.  Every flu season, we could stay six feet away from each other for a few weeks, and then we’d vanquish the flu.  But social distancing comes at a tremendous cost, as we’re now learning.

Or we could get the vaccine.  But we, as a people, don’t.

On panic.

On panic.

Note: As we’ve gathered more data, it’s become clear that, on a population level, Covid-19 causes approximately five-fold more deaths than seasonal influenza. Because it is more infectious, an unaddressed outbreak of Covid-19 in the United States probably would have caused between 750,000 and 1,000,000 deaths. My original estimates were incorrect.

The front cover of The Hitchhiker’s Guide to the Galaxy is emblazoned with the words “DON’T PANIC.”  The authors knew that you might forget some of their advice during an emergency.  If you can keep those two words in mind, though, you’ll often be all right.

Don’t panic.

#

Right now, the world is experiencing a viral pandemic.  Last year alone, 770,00 people – almost a million! – died from this viral infection.  There are treatments, but no cure.  And the known treatments are out of reach for many people who contract the disease.

In a recent outbreak in my home state of Indiana, an additional 235 people were infected with this fatal virus.

HIV is really, really scary.

#

Right now, the world is also experiencing an outbreak of oppressive government control.  In many European countries, the citizens are on lockdown.  In France, people must apply for authorization in order to visit the grocery store.

In the United States, “non-essential” businesses have been forced to close.   Children have lost access to their schools.  University students were locked out of their dormitories.  People are suffering psychological damage from the effects of social isolation and fear.

That sounds scary, too.

But also strange.  Because schools didn’t close in response to the HIV pandemic, or the outbreak of gun violence, or lead-tainted drinking water.  Schools closed in order to combat the spread of a new zoogenic coronavirus – a virus that appears to be less dangerous than seasonal influenza.

And yet, even though data suggests that Covid-19 is less dangerous than seasonal influenza, lives are being up-ended. 

The New York Times has been full of sensational scaremongering.  But the subtitle for today’s article about Seattle tells the story of the real calamity:

In a state that has seen more deaths from the coronavirus than any other, the stress has started to multiply.  Jobs lost.  Kids underfoot.  Parents at risk.  “It’s exhausting,” one woman said.

Jobs lost, children barred from continuing their education – that’s a problem!

#

Schools were not closed in response to the seasonal influenza.  Why would they be?  That happens every single year – the seasonal flu isn’t news.  Although the deaths are sometimes noticed.  In early January, The Seattle Times reported that:

Of the people who have died so far this season, one was younger than 5 years old and another was between the ages of 5 and 17, state health officials report.  Two adults between the ages of 30 and 49 have died, and the remaining 17 were people 50 or older.

The seasonal flu is scary!  It can kill you even if you are young and healthy.  Already, this year’s seasonal influenza has killed something like 30,000 people in the United States alone. 

Compared to influenza, Covid-19 is less likely to kill you if you are young and healthy.  From Nell Greenfieldboyce’s article, “Who Faces the Greatest Risk of Severe Illness from Coronavirus?

The person who died in Placer County, California was described by officials as “an elderly adult with underlying health conditions.”  Most of the people who died in Washington were residents of Life Care Center, a nursing facility.  All but three of the victims in Washington were over age 70.

The younger people who died include one man in his 40s and two men in their 50s.  Officials said these individuals had underlying medical problems.

#

Worldwide, only one (1) person younger than 21 has died of Covid-19.  By way of comparison, this year’s not-particularly-deadly seasonal flu, as of March 14, had already killed 6 children in Washington State alone.  Washington state, the epicenter of the United States’ Covid-19 outbreak.

ABC News reported that:

The data in the U.S. is similar to Italy, which has been particularly hard-hit by coronavirus […] found the average age among the 105 patients who died from the virus as of March 4 was 81 years old.

And yet, even though the data suggest that Covid-19 is not exceptionally dangerous – less dangerous than seasonal flu for people under 50 – many news organizations have published sensational numbers about the high chance of death.  Even the World Health Organization claimed that Covid-19 had a 3.4% fatality rate.

These numbers are obviously false.  This is the percentage fatality rate of people who tested positive for Covid-19 … but the only way to receive a test was to have a high fever, cough, and difficulty breathing, and feel sick enough that it seemed prudent to go to a hospital to be tested.

Many other people also had the virus.  Those people didn’t get very sick, though, so they didn’t go to the hospital to be tested.

When Stanford epidemiologist John Ioannidis analyzed the available data in detail, he estimated that the actual fatality rate might be as low as 0.05%, and that the upper bound was probably 1%.  Ioannidis writes:

That huge range markedly affects how severe the pandemic is and what should be done.  A population-wide case fatality rate of 0.05% is lower than seasonal influenza.  If that is the the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational.  It’s like an elephant being attacked by a house cat.  Frustrated and trying to avoid the cat, the elephant accidentally jumps of a cliff and dies.

#

Even if Covid-19 is as dangerous as the upper bound suggests, however, the advice to “flatten the curve” seems misguided.  In the United States, people repeated the phrase “it would be better to have the same number of infections spread out over 18 months instead of 18 weeks,” and proposed the (initial) cure of a 3-week school closure.

A 3-week closure would not magically cause infections to be spaced over 18 months.  It would simply delay the exponential growth phase of the epidemic by 3-weeks.  To actually space infections over 18 months, you would need at least a year of social isolation.

Spacing infections over 18 months also makes them more dangerous.  In the 1918 flu epidemic, the virus mutated midway through the season and became much more lethal.  Right now, Covid-19 poses very low risk to people who are under 50 years old and in good health.  But there’s a chance that it could mutate and become more dangerous.

The probability of mutation increases with the number of viral generations.  Let’s say we start with a sick person and nine people who have not yet been exposed.  If these people all go to a party together and get infected, the nine new cases will all wind up with the same viral generation.  Then they’ll clear it, and there’ll be nobody new to infect.

If they instead practice “social isolation,” then the virus will hop from one person to the next.  The tenth person receives a virus that has undergone many additional replications, potentially mutating to become more dangerous.

Our society would be better off if every young healthy person were exposed as quickly as possible – this would get the epidemic over with as quickly as possible, and reduce the pool of potential carriers.

It’s reasonable for people who feel like they are at high risk of death from the virus to practice social isolation until the epidemic is over.  But it’s not reasonable for everyone else to do it.

Out of misguided fear, though, we are causing real harm.  We have disrupted children’s schooling.  We’re destroying businesses.  Local retailers have struggled for years – now many cities are forcing them to close, shifting even more business to Amazon.  Out of misguided fear, we’re accelerating the forces that are destroying our country.

#

Ioannidis ends his analysis with a warning:

In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.

The vast majority of this hecatomb would be people with limited life expectancies.  That’s in contrast to 1918, when many young people died.

One can only hope that, much like in 1918, life will continue.  Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

#

To be perfectly honest, I was spooked, too.  It’s hard to stay calm when so many news organizations are publishing sensational stories.  When I went out to the climbing gym with friends, my spouse asked me to change out of my potentially-infected clothes as soon as I got home.

Then we looked up the data, and realized we’d been hoodwinked.  We had panicked over nothing. 

Except, wait, no – there is reason to panic.  Because this lockdown is scary!  Needless social isolation for the masses is scary! 

And the chance that our proto-fascist president uses this faux-crisis to commandeer even more control?  That is really scary.

On the Golden Record.

On the Golden Record.

I have yet to master the art of pillow talk.  The other night, after my spouse and I turned off our bedside reading lights — at a time when a more reasonable soul might murmur a sultry something or whisper sweet dreams — I said:

“The Golden Record was a terrible idea!”

Apropos of nothing!  Seriously, what is wrong with my brain?

Luckily, instead of sighing, or pretending to be asleep (as a normal person might have done), my spouse continued the conversation.

“What, Carl Sagan’s?”

“Yeah,” I said.  “It’s terrible.”

“Well, nobody’s going to find it, but that’s not really the point.”

My spouse was alluding to the fact that our universe is really, really big.  We launched the Golden Record aboard the Voyager spacecraft in 1972, and it has traveled something like 13 billion miles since then.

13 billion miles sounds pretty impressive!  But miles are not very practical units for describing outer space.  13 billion miles is the same distance as 0.002 light years.  Our galaxy is a flat disc of stars, approximately 1,000 light years  thick and 100,000 light years across.  Compared to those distances, the Golden Record may as well still be here on Earth.

And it’s not as though finding the Golden Record would be the easiest way for an extraterrestrial intelligence to learn of our existence.  The Golden Record is traveling slowly and is trapped inside a small spacecraft.  Our television and radio broadcasts move much faster, and they’ve been radiating in a ever-growing sphere for decades.

Still, I argued.

“They probably won’t find it, but isn’t it a bad idea to send a message that you are hoping won’t be found?  Either no one sees it, and so it’s a waste, or else they do find it, and that’s worse, because then we’re doomed … “

“Doomed?”

“Right?  I mean, maybe it’s silly to extrapolate from human history to predict what an alien species might do.  But in human history … in prehistory, even … it seems like every time a voyaging people found a stationary culture, it ended in disaster for the people who weren’t traveling.”

“Every time?”

Homo sapiens traveled north and found the Neanderthal.  The Neanderthal died.  We traveled east and found the Denisovians.  Denisovians died.  Chinese people displaced the native Taiwanese, Europeans wrecked havoc all through North and South America.”

Given that it was bedtime, and all our lights were off, I definitely shouldn’t have been raising my voice. 

“About the only example I can think of where the voyagers were eventually driven away was the Vikings in Greenland.  Inuits lived there before, during, and after some twenty generations of Viking occupation.  But, really, the Inuits won through luck.  The Vikings pretty much refused to eat fish.  Hmm, we’re big strong Vikings, we eat sheep!  Well, Greenland’s not for grazing, so the sheep all died, and then the Vikings starved.  Not that they had to.  They could’ve switched to eating fish, just like their neighbors.  But they were too proud.  And then dead.”

My bedtime tirade wasn’t an accurate description of the Inuit diet – a lot of their calories came from seals and whales, which are generally considered less palatable than fish, and also rather more difficult to catch.

In recent years, some archaeologists have begun to argue that it wasn’t the Vikings’ fault that they all died.  I’m sure it’s sheer coincidence that many of these contemporary Viking apologists are of vaguely Norse descent.  Their theory is the Greenland Vikings had a stable civilization but were doomed by climate change. A huge volcano erupted half the world away — the whole planet cooled. Life was miserable for everyone. Greenland’s Vikings were abandoned by the mainland, which meant they lost their major trading partner. 

These archaeologists claim that small farmers switched their diet early on, and that only the wealthiest of Greenland’s Vikings continued to raise cows and sheep until the end.

In any case, the Vikings died.  Their conquest failed.  But other times, voyagers brought devastation to stationary cultures.

The movie Independence Day had it wrong.  The encounter wouldn’t have ended with Homo sapiens celebrating.  If an extraterrestrial species was so technologically advanced that they could reach our planet, they would simply extract whatever resources they needed before moving along to harvest yet another insufficiently advanced world.

We should expect extraterrestrials to show the same forbearance toward us that a chimpanzee shows toward ants – chimpanzees are more clever than ants, and chimps use sticks to dig up anthills for food.  Homo sapiens are more clever than chimpanzees, and we’ve harried chimps to extinction, cutting down their forests because we wanted wood.

An extraterrestrial species that was able to travel to our planet within a single individual’s lifetime would be more clever than us, and if they needed to extract something from our world, we’d be powerless to stop them.

“But the Golden Record was never really about aliens,” my spouse said.  “It was about us.  Whether we would change, if we knew we might have guests.”

That makes sense – given that my spouse and I are always exhausted, our home fluctuates between live-ably messy and an absolute disaster depending on how long it’s been since we’ve had grown-up friends over. 

“If the goal is togetherness, though,” I said, “aren’t there better ways?  Especially since a lot of people don’t even know about the Golden Record.”

“I still teach about it!”

“Yeah, but I mentioned the Golden Record in jail, and nobody knew what I was talking about.  And, even then, is that the best we can do?  The tiny chance of visitors sometime in the next few billion years?  I mean, shouldn’t we be working on climate change, a global wealth tax, guaranteed basic income, wealth transfers to preserve natural wonders like the Serengeti or the Amazon Rain Forest?”

“Sure, I like having the Rain Forest.”

The Amazon rain forest. Image by the Center for International Forestry Research on Flickr.

“So we should pay for it!  But, right, I think those plans would do more than launching a recording of laughter.  And none of those plans has the risk that we’d lure the cause of our own extinction.”

My spouse sighed.  “Don’t we have a rule about not talking about human extinction at bedtime?”

“Do we?  I thought it was just that I couldn’t talk about thermodynamic heat death of the universe.”

“No, it was more than that.  No collapse of civilization as we know it, no heat death, nothing about the lifespan of our star.  Not right when I’m trying to fall asleep.”

“Whoops.”

“It’s okay.  I still love you.  I just wish you hadn’t said all that at bedtime.”

“Well, I wish they hadn’t launched the Golden Record.”

It’s true that the risk is low.  But why risk the Earth’s destruction at all when there are better plans available?

That’s what I was thinking while I fell asleep.  As it happens, I wound up answering my own question.  One virtue of the Golden Record is that it invites us to imagine Earth being destroyed – marauding aliens could learn our address and then come to stamp us out.

That’s a sad thought.  So perhaps we should do what we can to protect the Earth.  And not just from those unlikely marauders – maybe we should protect Earth from ourselves.

Otherwise we, as an entire species, will seem far more foolish than Greenland’s Vikings.  Hmm, we’re big strong Americans, we eat sheep!  We fly airplane, we buy new big screen TV, we stream video from satellite!

What can you say about a people who refuse to change their culture in the face of absolute calamity?

On unintended consequences.

On unintended consequences.

After our current president ordered the assassination of an Iranian general by drone, my class in jail discussed excerpts from Gregoire Chamayou’s A Theory of the Drone.

Chamayou argues that drone warfare is qualitatively distinct from other forms of state violence.  The psychological rift stems from asymmetry – one side risks money, the other risks life. 

The use of drones keeps U.S. soldiers safer.  But in Chamayou’s opinion (translated by Janet Lloyd, and slightly modified by me for students to read aloud),

If the U.S. military withdraws from the battlefield, enemy violence will turn against targets that are easier to reach.  Even if soldiers are safe, civilians are not.

Drone warfare compels enemy combatants to engage in terrorism.  They cannot shoot back at the soldier who is shooting them – that soldier might be sitting in a nondescript office building thousands of miles away, unleashing lethal force as though it were a video game.

I don’t mean to trivialize the suffering of U.S. soldiers who are involved in drone warfare.  Pilots have an extremely high suicide rate – they are expected to placidly shift from the battlefield to the civilian world each evening, and this is deeply disturbing to most people.

But enemy soldiers cannot fight back.  They could shoot down the drone, but the U.S. military would launch a new one.  There’s no comparison between that and the drone shooting a missile at your family’s home.

Image by Debra Sweet on Flickr.

An enemy combatant can only put U.S. lives at risk by attacking the general public.

Our policies don’t always have the outcomes we want.

Not unexpectedly, somebody in class mentioned the War on Drugs.  Banning marijuana caused a lot of problems, he said.

Somebody else disagreed – he’s been in and out of prison on drug charges for seventeen years, but has high hopes that this next stint of rehab is going to take.  “I still think marijuana’s a gateway drug.  That’s what I started with.”

“It’s not pot, it’s the lying about pot.  They say over and over that marijuana’s as bad as heroin.  What do they think will happen once kids realize marijuana’s safe?”

“If people could’ve bought pot, maybe nobody would’ve invented spice.  Like that K2 stuff was sold as incense or whatever, but everybody knew it was pot replacer.”

“You take this,” a guy said, holding up a sheet of paper, “spray it with spice, send it into prison.  Two thousand dollars, easy.  You get somebody to OD, then everybody’s gonna want some.  People like that feeling, right at the brink between life and death.”

Somebody sighed.  “I know.  I’ve done a lot of drugs, and with most drugs, I could take it or leave it.  But that spice, man.  No offense to anyone, but I’ve never sucked cock for drugs.  For spice, though, I’d think about it.”

“You just get so sick.”

“So sick!  I’ve kicked heroin, and that feeling sick was bad.  But not like this.  There were weeks when I had to set an alarm, get up every two hours to take another hit.  Otherwise I’d wake up puking and shitting myself.  And I’d be in there, you know, sitting on the toilet with a bag, still taking my hit.”

“I got that too.  I was waking up every ninety minutes.”

“Would you have started smoking spice if marijuana was legal?” I asked.

“I mean, yeah, now you’re gonna have people who would.  Because everybody knows about it.  Like you had that summer two years ago, people all along the street, up and down Kirkwood, smoking it right out in the open.  But, like, before it all started?  Nobody would’ve sat down and tried to invent spice if they could’ve sold pot.”

“I remember reading a review of K2 spice on Amazon,” I said, “must’ve been in 2008, before it was banned, all full of puns and innuendo.  The reviewer was talking about how it made him feel so ‘relaxed,’ in quotes.”

“ ‘Relaxed,’ shit, I get that.  I never touched the stuff before this last time I came to jail.  But I’ve smoked hella marijuana.  So somebody handed it to me and I took this giant hit, the way I would, and I shook my head and said, ‘Guys, that didn’t do shiii …’ and, BAM, I fell face first into the table.”

“You were so out of it!”

“It was like, WHOA, blast off.  I was lying there, like flopping all over.  That night I pissed myself.”

“That sounds … “ I said, “… bad.  A whole lot worse than smoking pot.”

“But you can get it!”

And there lies the rub.  With so many technologies, we’re playing whack-a-mole.  We solve one problem and create another.  But sometimes what comes up next isn’t another goofy-eyed stuffed animal mole – the arcade lights flash and out pops a hungry crocodile. 

Since people couldn’t buy pot, they started smoking a “not-for-human consumption” (wink wink) incense product that you could order online.  Since enemy combatants can’t shoot back at soldiers, they plant more bombs in subways.

As one American soldier explains, “We must understand that attempts to isolate our force against all potential enemy threats shifts the ‘burden of risk’ from a casualty-averse military force onto the populace.  We have lifted the burden from our own shoulders and placed it squarely upon civilians who do not have the material resources to bear it.”

On auctions, politics, quantum computing, and waste.

On auctions, politics, quantum computing, and waste.

I recently played the board game Fists of Dragonstone.  It was fun – the premise is that each turn a spell is revealed and players will make a simultaneous, secret bid to acquire its effect.  The spells might earn victory points, increase your future income, or help you thwart other players’ plans.

Each turn felt tense because Fists of Dragonstone uses “all pay” auctions.  If you bid two dollars, you’ll lose this money whether or not you get the prize you wanted.  This type of auction is a slippery beast – inherently stressful in the real world, but psychologically compelling within the safe confines of a game.

Fists of Dragonstone. Image by hal_99 on Flickr.

When most people think of auctions, they imagine the type that eBay uses – only the winner pays, and the amount paid is equal to the second-highest bid.  In this type of auction, you ought to state your intentions honestly.  If you would get $15 worth of joy from owning an item, you should bid $15 – you’ll either get to have it for that amount of money (or less), or else learn that someone else values the item more.

If we didn’t have such rampant wealth & income inequality, this type of auction would arguably improve the world.  Objects would wind up in the hands of whomever valued them most, boosting overall happiness.

In practice, of course, things don’t work out so well.  Some people have access to far more money than others.  Even if a wealthy person estimates that a blanket would provide $60 of happiness, and a poor person estimates that the same blanket would provide $10 of happiness, it might be that the poor person would actually get more happiness from the blanket.  Inequality means that there’s no universal way to convert between money and joy, but the marketplace treats all our dollars the same.

Image by Todd Huffman on Flickr.

In a board game, you can address inequality by doling out the same set of initial resources to each player.  But the standard auction type – which rewards honest valuation – wouldn’t be much fun.  Everyone should value each item equivalently, and so the game is reduced to a puzzle.  It might be fun to solve once, but there wouldn’t be a reason to play again.

In an “all pay” auction, though, you benefit by being unpredictable.  Because you lose your bid whether or not you win the auction, you should often bid zero even if there’s an item you’d like.  You’re throwing away money if you make a non-zero bid but someone else bids higher.

You could still attempt to “solve” this sort of game, but the optimal solution invokes random behavior.  You should make a bid somewhere between zero and your true valuation, with a certain probability assigned to each.  That’s what a robot would do.

Most humans are pretty terrible at doing things that are actually random, though.  When we try to create a fake list of outcomes from a set of coin flips, for instance, we usually hew to an alternating pattern of heads and tails.

Since we’re bad at making random choices – and we know that other players are bad at it too – we fall back on misguided psychological reasoning.  She bid nothing the last two rounds, so maybe I can sneakily win this next auction with a $1 bid!  We get to feel clever when our stratagems succeed.  We get to curse when they fail.  All much more fun than the honest appraisal encouraged by auctions in which only the winner pays!

In the real world, though, an “all pay” auction is a recipe for waste.

This type of auction is a good proxy for many types of adversarial encounters.  Political contests, computer security, sporting events.  Even restaurant management, if people have a discrete budget set aside for eating out and are simply choosing which establishment to frequent. 

In each of these situations, every player has to pay – to run for political office, you invest years of your life and spend a whole bunch of money on advertisements.  It’s not as though you get that time or money back when you lose.  All players spend their total bids, but only one gets the prize of elected office.

Contemporary political campaigns are incredibly expensive.  So many people have already devoted years of their lives to the 2020 presidential campaign.  The efforts of the losing side will have been wasted.  Because major platforms are willing to air totally fraudulent advertisements, candidates have little chance of victory if they spend much less than their opponents.

Sure, sometimes people will console themselves with the thought that “We may not have won the election, but we changed the tenor of political discourse!”   In our country, this is a fantasy.  U.S. politics is sufficiently polarized that the winners rarely concern themselves with the expressed desires of the losing side.  Two of our past three presidents lost the popular vote and still proceeded with their agendas as though they’d received an overwhelming mandate.

Security is another form of “all pay” auction.  This is an asymmetrical game – your initial resources and victory conditions are clearly different if you happen to be playing as a homeowner or a thief – but the basic principle remains the same.  One player bids an amount on security; the other player bids time and money to undermine it; depending on who bids more, a break-in succeeds or it doesn’t.

As in Fists of Dragonstone, players have an incentive to randomize their behavior.  Sometimes a homeowner should display signs for a security system that hasn’t actually been installed.  Sometimes a thief should pass by a house even if it looks like a juicy target.  If players are too predictable, they can be narrowly outbid.

Computer encryption is an auction like this.  Equifax bid less than the people trying to hack its servers; a huge amount of personal data was stolen.  Mine too.  As an apology for low-balling their security bid, Equifax will send me a settlement check for some amount between $125 and $0.03, depending on how many of the other victims they choose to compensate.

What could I do with three pennies?

I glued pennies together to make little legs for my laptop computer – three cents for the back legs, two for the front – hoping to improve air flow for the exhaust fan.  When a computer overheats, programs malfunction.  The operating system might freeze, the same way I do when I’m typing and somebody says “Hi” to me.  My brain stutters – processing, processing – unable to determine whether I know this person, and, if so, from where.

Shut down, reboot.

Anyway, building these laptop stilts out of pennies seemed cheaper than any other materials.  I’ve already built them, though.  I don’t really need another $0.03 check from Equifax.

But this situation must feel frustrating for the people at Equifax, too.  Improved encryption isn’t valuable in and of itself.  This is an adversarial contest that produces only waste.  A world in which companies spent little or nothing on computer security and other people simply chose not to breach their nonexistent defenses would be better than our world, in which data needs to be scrupulously guarded.

A world in which politicians didn’t advertise, trusting voters to learn about their platforms from impartial sources, would be better than our world.

That’s not where we live, though.  Instead, scientists are working to create quantum computers.  These are marvels of engineering.  In contrast to the behavior of macroscopic objects, certain properties of a quantum transistor can remain undefined during a calculation, collapsing into a discrete binary value only at the end.  To accomplish this, the transistor must be guarded from its environs – you may have heard that “measurement” collapses wavefunctions, but measurement doesn’t mean that a human is looking at something.  Measurement simply means that the state of an object becomes coupled with the state of its environment.

If a photon approaches, the state of the object becomes linked with the state of the photon.  They might’ve collided or not, which narrows the range of space in which the object might exist, which narrows the set of wavefunctions that could be summed to give its momentum.  A collision-less encounter restricts us to a different set of futures than if the photon hit the thing.

In practice, that means a quantum computer needs to be kept dark, and atmosphere-less, and very, very cold.  For a long time – the transistors have to stay unmolested for the entire duration of a calculation.

IBM’s Quantum Q. Photo by IBM research on Flickr.

Obviously, these devices are very expensive to build and run.

And why might we want them?  Well, they’d be better than conventional computers at … um … at factoring the large numbers that are used for computer encryption! 

Quantum computers are fascinating.  Our attempts to build them have helped us learn more about the workings of our world.  But the actual existence of quantum computers – at least until we think of an application other than cracking computer security – will make the world worse.

Worried that people might copy data and then use quantum computers to decode it later — you know, after these computers have been invented — security experts say that we need to start spending more money on encryption now

While playing Fists of Dragonstone, my friends would curse and shout after making an exorbitantly high bid and then seeing that every other player bid zero.  I could have won with $1! 

That’s basically what security experts are encouraging us to do. Not curse — overbid. They say that we should make extremely high bids on encryption now, to protect ourselves from a technology that might never exist.  Otherwise, undesirables might gain access to the password-protected folder of risqué photographs that you and your partner(s) took.  Or break into your bank account.

Occasionally, adversarial work improves the world.  When restaurants compete, service might get better. The food, tastier.

But most adversarial contests are engines for waste.  High-speed stock trading makes the market more fluid – you can log on and purchase a few dozen shares of whatever you’d like since AI algorithms are ready to facilitate transactions between buyers and sellers. 

That’s a small service, though.  High-speed trading firms shouldn’t be extracting as much wealth as they are in this country.  Mostly they eavesdrop on others’ conversations, sneak in front of people who’re trying to buy something, then scalp it back at higher prices.  Trading firms pay exorbitant rent on shelf space that’s close as possible to the stock exchange mainframes – if one scalper is microseconds faster than another, that’s the one who gets to shake you down.

In a board game, cooperation is generally less fun than adversarial play.  For the former, players are trying to solve a puzzle created by the designer.  With adversarial rules, players are using their intelligence to create puzzles for each other in real time.

In a game, the waste is the entire point.  Nothing tangible is produced, but the expended time leads to social camaraderie.  The expended brainpower can give you a sense of satisfaction from having worked through intellectual puzzles.  And, hopefully, you’ll have fun.

But – whoops – we’ve used the principles of good game design and mistakenly applied them to the real world.  Fists of Dragonstone was fun; our political system shouldn’t be based on all-pay auctions.  With major politicians poised to ravage the Amazon, cull the world’s few remaining old-growth forests, and dredge up Arctic oil fields, the people wealthy enough to make high bids on upcoming elections might well destroy us.

NASA image revealing the ongoing deforestation of the Amazon rainforest.  Just f.y.i., the forest is being cleared to make space for cows.  Each time you choose eat beef or dairy cheese, you’re contributing to the destruction of the “Lungs of our Planet.”

Featured image for this post: “Auction Today” by Dave McLean on Flickr.

On the moon landing, and who benefits if you believe it was faked.

On the moon landing, and who benefits if you believe it was faked.

If you’re worried that you don’t feel enough stress and anxiety, there’s an easy chemical fix for that.  Habitual methamphetamine use will instill intense paranoia. 

In our poetry classes in jail, I’ve talked with a lot of guys who stayed up for days watching UFO shows on TV.  A few were also stockpiling military grade weaponry. One man used strings and pulleys to link his shotgun’s trigger to a doorknob, ensuring that anyone who tried to enter the house would be rudely greeted. 

They’ve dismantled dozens of computers and phones: sometimes out of suspicion, sometimes because there are valuable components. Although they were rarely organized enough to hawk the proceeds of their dissections.

Suffice it to say that, deprived of sleep and dosed with powerful stimulants, their brains became tumultuous places.

Which is why we spend so much time talking about conspiracy theories.

I’ve written several previous essays about conspiracy theories – that the Santa myth teaches people to doubt expertise (children learn that a cabal of adults really was conspiring to delude them); that oil company executives have been conspiring to destroy the world; that, for all the ways Thomas Pynchon’s Gravity’s Rainbow probes at the undercurrents of truth beneath government conspiracy, the text blithely incorporates metaphors from a Disney-promulgated nature conspiracy.

But, with the fiftieth anniversary coming up, the men in my class have been talking more about whether the moon landing was faked.

There’s only so much I can say.  After all, I, personally, have never been to the moon. 

One of my colleagues from Stanford recently conducted molecular biology experiments on the International Space Station, but that’s only zero point one percent of the way to the moon … and she and I were never close enough for me to feel absolutely certain that she wouldn’t lie to me.

Visiting the moon does seem much easier than faking it, though.  Our government has tried to keep a lot of secrets, over the years.  Eventually, they were leaked.

But that line of reasoning is never going to sway somebody. The big leak might be coming soon.

Instead, the strategy that’s worked for me is to get people worried about another layer of conspiracy.

“Let’s just say, hypothetically,” I say, “that we did send people to the moon.  Why would somebody want to convince you, now, that we didn’t?”

When NASA’s project was announced, a lot of people were upset.  Civil rights activist Whitney Young said, “It will cost $35 billion to put two men on the moon.  It would take $10 billion to lift every poor person in this country above the official poverty standard this year.  Something is wrong somewhere.”  (I learned about this and the following quote from Jill Lepore’s excellent review of several new books about the moon landing.)

During John F. Kennedy’s presidential campaign, he argued that we needed to do it anyway.  Despite the challenge, despite the costs.  “We set sail on this new sea because there is new knowledge to be gained, and new rights to be won, and they must be won and used for the progress of all people.

We did reach the moon. But, did we use that knowledge to benefit the rights and progress of all people?  Not so much.

A lot of the guys in jail went to crummy schools.  They grew up surrounded by violence and trauma.  They didn’t eat enough as kids. They’ve never had good medical care.  They’ve struggled to gain traction in their dealings with government bureaucracies … we’ve spent years underfunding post offices, schools, the IRS, the DMV, and, surprise, surprise!, find that it’s arduous interacting with these skeletal agencies.

To keep these men complacent, the people in power would rather have them believe that we didn’t visit the moon.  “Eh, our government has never accomplished much, we faked that shit to hoodwink the Russians, no wonder this is a horrible place to live.”

The fact that people in power are maliciously undermining our country’s basic infrastructure would seem way worse if you realized that, 50 years ago, with comically slapdash technologies and computers more rudimentary than we now put into children’s toys, this same government sent people to the moon. 

Ronald Reagan said, “Government is not the solution to our problem; government is the problem.”  And he was in a position to make his words true – he was the government, so all he had to do was be incompetent.  And then people would hate the government even more, and become even more distrustful of anyone who claimed that good governance could improve the world.

Needless to say, 45 has taken strategic incompetence to a whole new stratosphere.  Beyond the stories of corruption that pepper the news, there’s also the fact that many appointments were never made; there are agencies that, as of July 2019, still don’t have anybody running them.  These agencies will perform worse.

If people knew how good our government used to be, they might revolt.  Better they believe the moon landing was a sham, that the faked photographs are as good as anybody ever got.

Our one and only.

On re-watching The Matrix, twenty years later.

On re-watching The Matrix, twenty years later.

The Matrix is an incredible film.  The cinematography is gorgeous. The major themes – mind control, the nature of free will, and what it means to reject the system – are no less relevant today than when the Wachowski sisters first made their masterpiece.

The Matrix also features many, many guns.

Graffiti in a tunnel in London. Photograph by Duncan C. on Flickr.

I recently read many of Grant Morrison’s comics.  After The Invisibles, which was rumored to have a major impact on the visual style of The Matrix, I felt inspired to re-watch the film. 

For the most part, I still loved it.  But the action scenes were, for me, a person whose spouse is a school teacher, viscerally unpleasant.

On my spouse’s second day of student teaching in northern California, a child arrived at her school with an assortment of lethal weapons that included a chain saw and several pipe bombs.  The child was tackled; the bombs did not explode; nobody died.  Media coverage was minimal, even in the local news.

On multiple occasions, classes at her schools have been canceled due to credible threats of violence.  A few years ago, a student lingered after the bell, wanting to talk.  “I have a friend who I’m a little worried about …”  Later, after this kid had unspooled more details to a guidance counselor, police officers came.  The troubled student was sent away for treatment.  Once again, nobody died.  Media coverage was, to the best of my knowledge, nonexistent, even in the local paper.

Crisis averted, right?  No need to alarm everyone with a write-up, a terrifying enumeration of the arsenal retrieved from a student’s locker.  Although, in a town this small (population: one hundred thousand), plenty of people heard rumors through the whisper network.

Students today are growing up with far more stress than I experienced.  Among top students, more emphasis is placed on applying for college, and the process of getting accepted to the “best” schools is more arduous.  There are more AP classes, more clubs to join, more service projects to undertake, plus the pressure of having some uniquely-honed skill that marks the possessor as somehow deserving of a spot at schools like Harvard, Stanford, or Yale.

That’s rough. 

Only a subset of students are subject to those particular torments, though.

But also, simply existing has grown more stressful for kids.  For every single student inside the building.

Growing up in a house where the parents are seething with rage, slowly and arduously divorcing, is pretty hard on children.  That is now a burden that all students have to bear.  The political atmosphere of the United States is like a nation-wide divorce, with the two dominant political parties unwilling to agree on common norms, or even facts. 

When individual people argue, they often cloister their perceptions inside bubbles of internally-consistent narration.  It’s quite common for each parent to sincerely believe that the other is doing less than a fair share of the housework.  There obviously is an objective truth, and you could probably figure out what it is – by installing security cameras throughout their home, a couple could calculate exactly how many chores were being done by each person.  But in the moment, they just shout.  “Well, I unloaded the dishwasher five times this week, and I was cooking dinner!”

I have a pretty extreme political bias – I’m against regulating behaviors that don’t seem to hurt anyone else (which adult(s) a person marries, what drugs a person consumes), and I’m in favor of regulating behaviors that endanger a person’s neighbors (dumping pollutants, possessing weaponry).  But I also talk to a lot of different folks, and I live in the Midwest.  It’s pretty easy to see why a person with different religious beliefs than mine would find my political stance immoral, if not downright nonsensical.

The Republican Party – which by and large espouses political beliefs that I disagree with vehemently – is correct that the United States was originally founded as a Christian nation.  The underlying philosophy of our constitution draws upon the Bible.  And the Bible does not promote gendered or racial equality.  In the Old Testament, the Bible tells the story of a people who were chosen by God for greatness.  In the New Testament, the story is revised such that all people, by accepting Jesus as lord and savior, can join the elect; still, the New Testament draws a stark contrast between us and them.

From a Biblical point of view, it’s reasonable to subject outsiders to harm in order to improve the circumstances of your own people.  Indeed, it would be immoral to do otherwise. 

It’s like Alan Greenspan’s devotion to the concept of Pareto Optimality, in a way (“Pareto Optimality” is the idea that a distribution of goods and resources, no matter how unequal, is “optimal” if there is no way to improve anyone’s circumstances without making at least one other person worse off.  Even a situation in which one person owns the world and no one else has anything is Pareto Optimal, because you can’t help the masses without taking something from that singular world owner). 

Using an expensive jar of oil to anoint Jesus’s feet is fine: she was helping the elect.  It was be worse to sell that oil and use the money to aid non-Christians, because then your actions only reduce the well-being of God’s people.  (Within a New Testament worldview, the possibility for future conversion complicates things somewhat, but if you knew that someone would never embrace the Lord, then you’d be wrong to help that person at the expense of your fellow Christians.)

And so it’s perfectly reasonable that people who vote for the Republican Party support policies that I abhor.  I wouldn’t want to be married to those people … but, by virtue of the social contract that we were born into, we are constitutionally bound together.  And we’re bickering.  Endlessly, maliciously, in ways that are damaging our children.

Worse, kids at school are subject to the constant fear that they’ll be murdered at their desks.  Horrific stories are routinely broadcast on the national news … and, as I’ve realized from my spouse’s teaching career, the stories we’ve all heard about are only a fraction of the terrifying incidents that students live in dread of.

Student protest at the White House to protest gun laws. Image from Wikimedia Commons.

It’s not the fault of The Matrix.  But this film sculpted the initial style for school shootings.  The Matrix was released on March 31st, 1999.  Twenty days later, on the day celebrated both by potheads (based on the police code for marijuana) and white nationalists (because it’s Hitler’s birthday), a pair of students murdered many classmates at Colombine High School.

In The Matrix, a character named Morpheus explains:

The Matrix is a system, Neo.  That system is our enemy.  But when you’re inside, you look around, what do you see?  Businessmen, teachers, lawyers, carpenters.  The very minds of the people we are trying to save.  But until we do, these people are still a part of that system and that makes them our enemies.

The murderers saw their classmates as enemies.

You have to understand, most of these people are not ready to be unplugged.  And many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.

Within the world of the film, this mutability is made explicit: any character who has not joined the heavily-armed heroes could blur and become an Agent.  The beautiful woman in red, an unhoused alcoholic man bundled in blankets – either might suddenly mutate into a threat. 

And so Neo kills.  He and Trinity acquire military-grade weaponry; they stroll into a government building and murder everyone inside.

Anyone willing to complacently work there is, after all, the enemy.

I teach poetry classes inside a jail.  Through Pages to Prisoners, I send free books to people throughout the country.  I think that the criminal justice system in the United States is pretty abhorrent.

But that doesn’t mean the people who work within that system as corrections officers are bad. They have families to feed.  And many are surely aware that if too few people worked as corrections officers, leading the facilities to be understaffed, the people incarcerated inside would be much less safe.

Experience lets me appreciate nuance.  I am an ethical vegan; good people choose to become butchers.  I don’t like our criminal justice system; good people work inside.

When I was a teenager, though, I felt moral certitude.  I didn’t like school.  And so, if you were the sort of drone who could sit contentedly at your desk, I didn’t like you.  And, yes, I too had notebooks where I’d written the sort of vitriolic short stories about leveling the place with a Golden-Eye-(the N64 game, not the movie)-style grenade launcher, an onscreen point counter tracking deaths.  Yes, my friends and I made short films with BB gun props full of senseless killings.

One of my old notebooks that I must have deemed sufficiently innocuous to save.

I remember one of the films we made as being pretty good.  But after Colombine, we destroyed the video tapes.  I threw my notebooks away.

And I was pissed to be called so often to the principal’s office.  I understand now why they were worried.  Moral certainty is dangerous; it lets you consider people who disagree as the enemy.

Twenty years later, my body stiffened and my heart sank when I watched The Matrix.  I loved that movie; I’m not sure I’ll ever see it again.

And, glory be, I am now blessed to live in a nation led by a president who feels nothing if not moral certainty.