In Unique, neuroscientist David Linden describes the cultural associations between smell and taste.
Most people from the United States will say that vanilla, strawberry, or mint odors smell sweet.
On the face of it, this doesn’t make sense. Sweet is a taste, not a smell. A substance cannot smell sweet any more than something can sound red.
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There’s nothing intrinsically sweet about these odors – we’ve just learned to associate them with sweet taste.
As a counterexample, in Vietnam, where caramel and mint are used primarily in savory dishes, their odors are not typically described as sweet.
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This association is sufficiently powerful that its effect can be measured in the lab.
For people whose past cultural experiences have led them to associate mint smells with sweet tastes, pairing the scent of mint with a sip of sucrose solution makes them believe that the drink is more sugary than it really is. When mint scent is paired with a sip of mildly acidic water, the drink seems less sour than it really is.
This experiment didn’t assess people’s perception of alcoholic drinks, but people in the United States probably make the same mistake about the bourbon in a mint julep.
Our assumptions – particular to our own cultural experience of the world – can powerfully deceive us.
A mint julep mixed perfectly for someone from the United States would taste bitter to someone from Vietnam.
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Viet Thanh Nguyen – author of The Sympathizer, which I’ve written about previously – strives to draw attention to our cultural blindness. The way our minds’ innate self-deceptions allow us to overlook or misinterpret the experiences of others.
My spouse and I have often felt grateful for Nguyen’s work. His essay about the sinking sensation he felt after teaching his child to read was particularly beautiful. (I linked to it in my own essay about teaching a child to read.)
Which is why we felt so dismayed by Nguyen’s most recent New York Times editorial.
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Nguyen explains why he enjoys teaching over Zoom. He’s prompted with students’ names; he can see their reactions up close; student voices contribute to the lecture from the same up-front position of power as his own; typed remarks can overlap without distracting; lectures are recorded for students to review later.
All well and good. Nguyen is quite intelligent. If he thinks Zoom is good for lectures, I’m inclined to believe him.
But lectures aren’t the best way to learn.
For many subjects, project-based learning is a more effective way to educate students. Many of my spouse’s resources – designed primarily for teaching college-level biology and introductory Earth & space science with a social justice bent – are available on her website, here.
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For the better part of a decade, I’ve hosted a poetry class in the county jail. We read poems and discuss how they make us feel. Our discussions touch upon contemporary scientific research, mythology, economics – all safe enough topics, for most folks – but also religion, addiction, trauma, violence, relationships, loss – which can be tough for anyone to talk about, let alone a room full of men who won’t get to see their families for months.
Because people cycle through the county jail, I never know who will be coming to class each week until I get there. For a few months, I might be with mostly the same group of men. Other weeks, I won’t have met any of the dozen or so people previously.
And there’s a huge difference between what we can accomplish – between what sorts of things feel safe to discuss – when the people in class haven’t met me before, and haven’t been in a class like that with each other. If we haven’t built the necessary emotional connection, we can do less. The class is worse for all of us.
Recently, the jail has allowed a small number of classes over Zoom. But Zoom doesn’t let you make the same emotional connection.
People sometimes complain about the supposed invasiveness of Zoom – the camera snatches up your personal surroundings, the pictures on your wall, the books on your shelves, your family in the background – but it’s by no means the intimacy of being there.
screenshot from a video by Rose Bythrow
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My spouse says, “Over Zoom you can’t tell who’s hungry.”
It would be nice if she meant this metaphorically – that it’s hard to tell who’s eager to learn. But, no. Many students aren’t eating enough. They are hungry.
Worse, we read Nguyen’s paean to Zoom on a snow day.
Streets near my spouse’s high school school were well-salted and plowed, but we live in a sprawling, semi-rural area – the school district serves families from a mix of socioeconomic backgrounds. There are hills and valleys – not everyone can get a satellite signal at home. And the for-profit cable companies certainly haven’t connected those families to the modern world with wires.
Still, the pandemic has made “e-learning days” seem like a reliable alternative. If it snows, kids learn from home.
“What’s Zoom supposed to do,” my spouse asked, “for my students with no heat?”
This isn’t (only) a concern for fluke events like the avarice-fueled power outages and heat losses in Texas. My spouse grew up in Albany, New York. Every winter was cold. The infrastructure to heat homes there was secure – for children whose families had money.
My spouse’s family didn’t. Her father failed to pay the electric bill. The power was shut off. And then the district called a snow day.
If my spouse and her sibling had gone to school, it wouldn’t have been so bad. Warm classrooms, a hot meal.
Instead they were stuck at home, shivering. Wanting so badly to go to a neighbor’s house. But then the neighbors would know.
In the United States, where poverty is often stigmatized as a moral failing, people hide the ache of want.
Which is why Zoom is so horrible. Zoom makes it easy. When you only have to disguise a small corner of your life, you can convey the illusion that things are okay.
There’s broad scientific consensus that school closures hurt children, probably making a significant contribution to future increases in premature death.
There’s also broad scientific consensus that school closures – particularly elementary school closures – aren’t helpful in slowing the spread of Covid-19. Children aren’t major vectors for this virus. Adults just have to remember not to congregate in the teachers’ lounge.
Worldwide, a vanishingly small percentage of viral transmissions have occurred inside schools.
And … our district just closed in-person school for all children.
In-person indoor dining at restaurants is still allowed. Bars are still open.
Older people are sending a clear message to kids: “Your lives matter less than ours.”
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For at-risk children, school closures are devastating. A disruption in social-emotional learning; lifelong education gaps; skipped meals.
But for my (privileged!) family, the closure will be pretty nice. I was recently feeling nostalgic about the weeks in August when my eldest and I spent each morning together.
Our youngest attends pre-K at a private school. Her school, like most private schools around the country, (sensibly) re-opened on time and is following its regular academic calendar.
My eldest and I will do two weeks of home schooling before winter break. And it’ll be fun. I like spending time with my kids, and my eldest loves school so much that she often uses up most of her energy during the day – teachers tell us what a calm, lovely, hard-working kid she is. And then she comes home and yells, all her resilience dissipated.
Which is normal! Totally normal. But it’s a little crummy, as a parent, to know you’ve got a great kid but that you don’t get to see her at her best.
Right now she’s sad about not going to school – on Monday, she came home crying, “There was an announcement that we all have to switch to online only!” – but I’m lucky that I can be here with her. Writing stories together, doing math puzzles, cooking lunch.
Maybe we’ll practice magic tricks. She loves magic.
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Last month, I was getting ready to drive the kids to school. T. (4 years old) and I were in the bathroom. I’d just handed T. her toothbrush.
N. (6 years old) walked over holding a gallon-sized plastic bag.
“Father, do you want to see a magic trick?” she asked.
“Okay, but I have to brush my teeth while you’re doing it.”
“Okay,” she said, and opened the bag. She took out a multi-colored lump of clay. It was vaguely spherical. Globs of red, white, and blue poked up from random patches across the surface, as though three colors of clay had been haphazardly moshed together.
“So you think this is just this,” she said, but then …”
She took out a little wooden knife and began sawing at the lump. “This is just this?”, I wondered. It’s an interesting phrase.
Her sawing had little effect. The knife appeared useless. I’m pretty sure this wooden knife is part of the play food set she received as a hand-me-down when she was 9 months old. “Safe for babies” is generally correlated with “Useless for cutting.”
She was having trouble breaking the surface of her lump.
I spat out my toothpaste.
She kept sawing. She set down the knife and stared at the clay intently. A worthy adversary.
I stood there, watching.
She grabbed the knife again and resumed sawing. More vigorously, this time. She started stabbing, whacking. This was enough to make a tiny furrow. She tossed aside the knife and pulled with her fingertips, managing to pry two lobes of the strange lump away from each other.
“Okay,” she said, “it’s hard to see, but there’s some green in there.”
T. and I crouched down and peered closely. Indeed, there was a small bit of round green clay at the center of the lump.
“Wow!” exclaimed T. “I thought it was just a red, and, uh, blue, and white ball! But then, on the inside, there’s some green!”
“I know!” said N., happy that at least one member of her audience understood the significance of her trick. “And look, I might even get it back together!”
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N. started performing magic when she was four. T. was asleep for her afternoon nap.
“Okay,” she said, “you sit there, and I’ll put on a magic show. Watch, I’ll make, um … this cup! See this cup? I’ll make it disappear.”
“Okay,” I said, curious. We’d just read a book that explained how to make a penny disappear from a glass cup – the trick is to start with the cup sitting on top of the penny, so that the coin looks like it’s inside the cup but actually isn’t.
I had no idea how she planned to make the cup itself disappear.
“Okay, so, um, now you’re ready, and …” she looked at the cup in her hands. Suddenly, she whisked it behind her back. And stood there, looking at me somberly, with her hands behind her back.
“I don’t have it,” she said.
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Magic – convincing an audience to believe in an illusion.
Our species is blessed with prodigious longevity, probably because so many grandmothers among our ancestors worked hard to help their grandchildren survive.
(The long lives of men are probably an accidental evolutionary byproduct, like male nipples or female orgasms. Elderly men, with their propensity to commandeer resources and start conflicts, probably reduced the fitness of their families and tribes.)
After we reach our seventies, though – when our ancestors’ grandchildren had probably passed their most risky developmental years – our bodies fail. We undergo immunosenescence – our immune systems become worse at suppressing cancer and infections.
We’re fast approaching flu season, which is especially harrowing this year.
We, as a people, have struggled to respond to this calamity. We have a lot of scientific data about Covid-19 now, but science is never value-neutral. The way we design experiments reflects our biases; the way we report our findings, even more so.
For example, many people know the history of Edward Jenner inventing the world’s first vaccine. Fewer are aware of the long history of inoculation in Africa (essentially, low-tech vaccination) that preceded Jenner’s work.
So it’s worthwhile taking a moment to consider the current data on Covid-19.
Data alone can’t tell us what to do – the course of action we choose will reflect our values as a society. But the data may surprise a lot of people – which is strange considering how much we all feel that we know about Covid-19.
Indeed, we may realize that our response so far goes against our professed values.
Spoiler: I think we shouldn’t close in-person school.
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Since April, I’ve written severalessays about Covid-19. In these, I’ve made a number of predictions. It’s worthwhile to consider how accurate these predictions have been.
This, after all, is what science is. We use data to make an informed prediction, and then we collect more data to evaluate how good our prediction was.
Without the second step – a reckoning with our success or failure – we’re just slinging bullshit.
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I predicted that our PCR tests were missing most Covid-19 infections, that people’s immunity was likely to be short-lived (lasting for months, not years), and that Covid-19 was less dangerous than seasonal influenza for young people.
In my essays, I’ve tried to unpack the implications of each of these. From the vantage of the present, with much more data at our disposal, I still stand by what I’ve written.
But gloating’s no fun. So I’d rather start with what I got wrong.
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My initial predictions about Covid-19 were terrible.
I didn’t articulate my beliefs at the time, but they can be inferred from my actions. In December, January, and February, I made absolutely no changes to my usual life. I didn’t recommend that travelers be quarantined. I didn’t care enough to even follow the news, aside from a cursory glance at the headlines.
While volunteering with the high school running team, I was jogging with a young man who was finishing up his EMT training.
“That new coronavirus is really scary,” he said. “There’s no immunity, and there’s no cure for it.”
I shrugged. I didn’t know anything about the new coronavirus. I talked with him about the 1918 influenza epidemic instead.
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I didn’t make any change in my life until mid-March. And even then, what did I do?
I called my brother and talked to him about the pizza restaurant – he needed a plan in case there was no in-person dining for a few months.
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My next set of predictions were off, but in the other direction – I estimated that Covid-19 was about four-fold more dangerous than seasonal influenza. The current best estimate from the CDC is that Covid-19 is about twice as dangerous, with an infection fatality ratio of 0.25%.
But seasonal influenza typically infects a tenth of our population, or less.
We’re unlikely to see a significant disruption in the transmission of Covid-19 (this is the concept of “herd immunity”) until about 50% of our population has immunity from it, whether from vaccination or recovery. Or possibly higher – in some densely populated areas, Covid-19 has spread until 70% (in NYC) or even 90% (in prisons) of people have contracted the disease.
Population density is hugely important for the dynamics of Covid-19’s spread, so it’s difficult to predict a nation-wide threshold for herd immunity. For a ballpark estimate, we could calculate what we’d see with a herd immunity threshold of about 40% in rural areas and 60% in urban areas.
Plugging in some numbers, 330 million people, 80% urban population, 0.25% IFR, 60% herd immunity threshold in urban areas, we’d anticipate 450,000 deaths.
That’s about half of what I predicted. And you know what? That’s awful.
Each of those 450,000 is a person. Someone with friends and family. And “slow the spread” doesn’t help them, it just stretches our grieving to encompass a whole year of tragedy instead of a horrific month of tragedy.
If we don’t have a safe, effective vaccine soon enough, the only way to save some of those 450,000 people is to shift the demographics of exposure.
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Based on the initial data, I concluded that the age demographics for Covid-19 risk were skewed more heavily toward elderly people than influenza risk.
I may have been wrong.
It’s difficult to directly compare the dangers of influenza to the dangers of Covid-19. Both are deadly diseases. Both result in hospitalizations and death. Both are more dangerous for elderly or immunocompromised people, but both also kill young, healthy people.
Typically, we use an antigen test for influenza and a PCR-based test for Covid-19. The PCR test is significantly more sensitive, so it’s easier to determine whether Covid-19 is involved a person’s death. If there are any viral particles in a sample, PCR will detect them. Whereas antigen tests have a much higher “false negative” rate.
Instead of using data from these tests, I looked at the total set of pneumonia deaths. Many different viruses can cause pneumonia symptoms, but the biggest culprits are influenza and, in 2020, Covid-19.
So I used these data to ask a simple question – in 2020, are the people dying of pneumonia disproportionately more elderly than in other years?
I expected that they would be. That is, after all, the prediction from my claims about Covid-19 demographic risks.
For people under the age of 18, we’ve seen the same number of deaths (or fewer) in 2020 as in other years. The introduction of Covid-19 appears to have caused no increased risk for these people.
But for people of all other ages, there have been almost three times as many people dying of these symptoms in 2020 compared to other years.
In most years, one thousand people aged 25-34 die of these symptoms; in 2020, three thousand have died. In most years, two thousand people aged 35-44 die of these symptoms; in 2020, six thousand have died. This same ratio holds for all ages above eighteen.
Younger people are at much less risk of harm from Covid-19 than older people are. But, aside from children under the age of eighteen, they don’t seem to be exceptionally protected.
Of course, my predictions about the age skew of risk might be less incorrect than I’m claiming here. If people’s dramatically altered behavior in 2020 has changed the demographics of exposure as compared to other years – which is what we should be doing to save the most lives – then we could see numbers like this even if Covid-19 had the risk skew that I initially predicted.
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I predicted that four or more years would pass before we’d be able to vaccinate significant numbers of people against Covid-19.
I sure hope that I was wrong!
We now know that it should be relatively easy to confer immunity to Covid-19. Infection with other coronaviruses, including those that cause common colds, induce the production of protective antibodies. This may partly explain the low risk for children – because they get exposed to common-cold-causing coronaviruses so often, they may have high levels of protective antibodies all the time.
Several pharmaceutical companies have reported great results for their vaccine trials. Protection rates over 90%.
So the problem facing us now is manufacturing and distributing enough doses. But, honestly, that’s the sort of engineering problem that can easily be addressed by throwing money at it. Totally unlike the problem with HIV vaccines, which is that the basic science isn’t there – we just don’t know how to make a vaccine against HIV. No amount of money thrown at that problem would guarantee wide distribution of an effective vaccine.
We will still have to overcome the (unfortunately significant) hurdle of convincing people to be vaccinated.
For any individual, the risk of Covid-19 is about twice the risk of seasonal influenza. But huge numbers of people choose not to get a flu vaccine each year. In the past, the United States has had a vaccination rate of about 50%. Here’s hoping that this year will be different.
Covid-19 spreads so fast – and so silently, with many cases of infected people who feel fine but are still able to spread the virus – that it will almost certainly be a permanent resident of the world we live in. We’re unlikely to eradicate Covid-19.
Which means that elderly people will always be at risk of dying from Covid-19.
The only way to protect people whose bodies have gone through “age-related immunosenence” – the inevitable weakening of an immune system after a person passes the evolutionarily-determined natural human lifespan of about 75 years – will be to vaccinate everybody else.
Depending on how long vaccine-conferred immunity lasts, we may need to vaccinate people annually. I worry, though, that it will become increasingly difficult to persuade people to get a Covid-19 vaccine once the yearly death toll drops to influenza-like levels – 50,000 to 100,000 deaths per year in the United States.
(Note: you may have seen articles in the New York Times suggesting that we’ll have long-lasting protection. They’re addressing a different question — after recovery, or vaccination, are you likely to become severely ill with Covid-19? And the answer is “probably not,” although it’s possible. When I discuss immunity here, I mean “after recovery, or vaccination, are you likely to be able to spread the virus after re-infection?” And the answer is almost certainly “yes, within months.”)
And I wrote about the interplay between short-lived immunity and the transmission dynamics of an extremely virulent, air-born virus.
This is what the Harvard public health team got so wrong. When we slow transmission enough that a virus is still circulating after people’s immunity wanes, they can get sick again.
For this person, the consequences aren’t so dire – an individual is likely to get less sick with each subsequent infection by a virus. But the implications for those who have not yet been exposed are horrible. The virus circulates forever, and people with naive immune systems are always in danger.
It’s the same dynamics as when European voyagers traveled to the Americas. Because the European people’s ancestors lived in unsanitary conditions surrounded by farm animals, they’d cultivated a whole host of zoogenic pathogens (like influenza and this new coronavirus). The Europeans got sick from these viruses often – they’d cough and sneeze, have a runny nose, some inflammation, a headache.
In the Americas, there were fewer endemic diseases. Year by year, people wouldn’t spend much time sick. Which sounds great, honestly – I would love to go a whole year without headaches.
But then the disgusting Europeans reached the Americas. The Europeans coughed and sneezed. The Americans died.
And then the Europeans set about murdering anyone who recovered. Today, descendants of the few survivors are made to feel like second-class citizens in their ancestral homelands.
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In a world with endemic diseases, people who have never been exposed will always be at risk.
That’s why predictions made in venues such as the August New York Times editorial claiming that a six- to eight-week lockdown would stop Covid-19 were so clearly false. They wrote:
Six to eight weeks. That’s how long some of the nation’s leading public health experts say it would take to finally get the United States’ coronavirus epidemic under control.
For proof, look at Germany. Or Thailand. Or France.
Obviously, this didn’t work – in the presence of an endemic pathogen, the lockdowns preserved a large pool of people with naive immune systems, and they allowed enough time to pass that people who’d been sick lost their initial immunity. After a few months of seeming calm, case numbers rose again. For proof, look at Germany. Or France.
Case numbers are currently low in Thailand, but a new outbreak could be seeded at any time.
And the same thing is currently happening in NYC. Seven months after the initial outbreak, immunity has waned; case numbers are rising; people with mild second infections might be spreading the virus to friends or neighbors who weren’t infected previously.
All of which is why I initially thought that universal mask orders were a bad idea.
We’ve known for over a hundred years that masks would slow the spread of a virus. The only question was whether slowing the spread of Covid-19 would cause more people to die of Covid-19.
And it would – if a vaccine was years away.
But we may have vaccines within a year. Which means that I may have been wrong. Again, the dynamics of Covid-19 transmission are still poorly understood – I’ll try to explain some of this below.
In any case, I’ve always complied with our mask orders. I wear a mask – in stores, at school pickup, any time I pass within six feet of people while jogging.
To address global problems like Covid-19 and climate change, we need global consensus. One renegade polluting wantonly, or spewing viral particles into the air, could endanger the whole world. This is precisely the sort of circumstance where personal freedom is less important than community consensus.
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The transmission dynamics of Covid-19 are extremely sensitive to environment. Whether you’re indoors or outdoors. How fast the air is moving. The population density. How close people are standing. Whether they’re wearing masks. Whether they’re shouting or speaking quietly.
Because there are so many variable, we don’t have good data. My father attended a lecture and a colleague (whom he admires) said, “Covid-19 is three-fold more infectious than seasonal influenza.” Which is bullshit – the transmission dynamics are different, so the relative infectivity depends on our behaviors. You can’t make a claim like this.
It’s difficult to measure precisely how well masks are slowing the spread of this virus.
But here’s a good estimate: according to Hsiang et al., the number of cases of Covid-19, left unchecked, might have increased exponentially at a rate of about 34% per day in the United States.
That’s fast. If about 1% of the population was infected, it could spread to everyone within a week or two. In NYC, Covid-19 appear to spread to over 70% of the population within about a month.
(To estimate the number of infections in New York City, I’m looking at the number of people who died and dividing by 0.004 – this is much higher than the infection fatality rate eventually reported by the CDC, but early in the epidemic, we were treating people with hydroxychloraquine, an unhelpful poison, and rushing to put people on ventilators. We now know that ventilation is so dangerous that it should only be used as a last resort, and that a much more effective therapy is to ask people to lie on their stomachs – “proning” makes it easier to get enough oxygen even when the virus has weakened a person’s lungs.)
Masks dramatically slow the rate of transmission.
A study conducted at a military college – where full-time mask-wearing and social distancing were strictly enforced – showed that the number of cases increased from 1% to 3% of the population over the course of two weeks.
So, some math! Solve by taking ten to the power of (log 3)/14, which gives an exponential growth rate of 8% per day. Five-fold slower than without masks.
But 8% per day is still fast.
Even though we might be able to vaccinate large numbers of people by the end of next year, that’s not soon enough. Most of us will have been sick with this – at least once – before then.
I don’t mean to sound like a broken record, but the biggest benefit of wearing masks isn’t that we slow the rate of spread for everyone — exponential growth of 8% is still fast — but that we’re better able to protect the people who need to be protected. Covid-19 is deadly, and we really don’t want high-risk people to be infected with it.
I’ve tried to walk you through the reasoning here — the actual science behind mask policies — but also, in case it wasn’t absolutely clear: please comply with your local mask policy.
You should wear a mask around people who aren’t in your (small) network of close contacts.
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I’m writing this essay the day after New York City announced the end of in-person classes for school children.
A major problem with our response to Covid-19 is that there’s a time lag between our actions and the consequences. Human brains are bad at understanding laggy data. It’s not our fault. Our ancestors lived in a world where they’d throw a spear at an antelope, see the antelope die, and then eat it. Immediate cause and effect makes intuitive sense.
Delayed cause and effect is tricky.
If somebody hosts a party, there might be an increase in the number of people who get sick in the community over the next three weeks. Which causes an increase in the number of hospitalizations about two weeks after that. Which causes people to die about three weeks after that.
There’s a two-month gap between the party and the death. The connection is difficult for our brains to grasp.
As a direct consequence, we’ve got ass-hats and hypocrites attending parties for, say, their newly appointed Supreme Court justice.
But the problem with school closures is worse. There’s a thirty year gap between the school closure and the death. The connection is even more difficult to spot.
Even if you have relatively limited experience reading scientific research papers, I think you could make your way through this excellent article from Chistakis et al.
The authors link two sets of existing data: the correlation between school closures and low educational achievement, and the correlation between low educational achievement and premature death.
The public debate has pitted “school closures” against “lives saved,” or the education of children against the health of the community. Presenting the tradeoffs in this way obscures the very real health consequences of interrupted education.
These consequences are especially dire for young children.
The authors calculate that elementary school closures in the United States might have (already!) caused 5.5 million years of life lost.
Hsiang et al. found that school closures probably gave us no benefit in terms of reducing the number of Covid-19 cases, because children under 18 aren’t significant vectors for transmission (elementary-aged children even less so), but even if school closures had reduced the number of Covid-19 cases, closing schools would have caused more total years of life to be lost than saved.
The problem – from a political standpoint – is that Covid-19 kills older people, who vote, whereas school closures kill young people, who are intentionally disenfranchised.
And, personally, as someone with far-left political views, it’s sickening for me to see “my” political party adopt policies that are so destructive to children and disadvantaged people.
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So, here’s what the scientific data can tell us so far:
We will eventually have effective vaccines for Covid-19. Probably within a year.
Covid-19 spreads even with social distancing and masks, but the spread is slower.
You have no way of knowing the risk status of people in a stranger’s bubble. (Please, follow your local mask orders!)
Schools – especially elementary schools – don’t contribute much to the spread of Covid-19.
School closures shorten children’s lives (and that’s not even accounting for their quality of life over the coming decades).
An individual case of Covid-19 is about twice as dangerous as a case of seasonal influenza (which is scary!).
Underlying immunity (from prior disease and vaccination) to Covid-19 is much lower than for seasonal influenza, so there will be many more cases.
Most people’s immunity to Covid-19 probably lasts several months, after which a person can be re-infected and spread the virus again.
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So, those are some data. But data don’t tell us what to do. Only our values can do that.
After my eldest was born, I spent the first autumn as her sole daytime caretaker. She spent a lot of time strapped to my chest, either sleeping or wiggling her head about to look at things I gestured to as I chittered at her.
We walked around our home town, visiting museums and the library. I stacked a chair on top of my desk to make a standing workspace and sometimes swayed from side to side while I typed. At times, she reached up and wrapped her little hands around my neck; I gently tucked them back down at my sternum so that I could breath.
She seemed happy, but it felt unsustainable for me. Actually getting my work done while parenting was nigh impossible.
And so our family bought a membership at the YMCA. They offer two hour blocks of child care for children between six weeks and six years old.
The people who work in our YMCA’s child care space are wonderful. Most seem to be “overqualified” for the work, which is a strange thing to write. Childhood development has huge ramifications for both the child’s and their family’s whole lifetime, and child psychology is an incredibly rich, complex subject. Helping to raise children is important, fulfilling work. No one is overqualified to do it.
Yet we often judge value based on salary. Childcare, because it was traditionally seen by European society as “women’s work,” is poorly remunerated. The wages are low, there’s little prestige – many people working in childcare have been excluded from other occupations because of a lack of degrees, language barriers, or immigration status.
I like to think that I appreciate the value of caretaking – I’m voting with my feet – but even I insufficiently valued the work being done at our YMCA’s childcare space.
Each time I dropped my children off – at which point I’d sit and type at one of the small tables in the snack room, which were invariably sticky with spilled juice or the like – I viewed it as a trade-off. I thought that I was being a worse parent for those two hours, but by giving myself time to do my work, I could be a fuller human, and maybe would compensate for those lapsed hours by doing better parenting later in the day.
I mistakenly thought that time away from their primary parent would be detrimental for my children.
Recently, I’ve been reading Sarah Blaffer Hrdy’s marvelous Mothers and Others, about the evolutionary roots of human childhood development, and learned my mistake.
Time spent in our YMCA’s childcare space was, in and of itself, almost surely beneficial for my children. My kids formed strong attachments to the workers there; each time my children visited, they were showered with love. And, most importantly, they were showered with love by someone who wasn’t me.
Hrdy explains:
A team headed by the Israeli psychologist Abraham Sagi and his Dutch collaborator Marinus van IJzendoorn undertook an ambitious series of studies in Israel and the Netherlands to compare children cared for primarily by mothers with those cared for by both mothers and other adults.
Overall, children seemed to do best when they have three secure relationships – that is, three relationships that send the clear message “You will be cared for no matter what.”
Such findings led van IJzendoorn and Sagi to conclude that “the most powerful predictor of later socioemotional development involves the quality of the entire attachment network.”
In the United States, we celebrate self-sufficient nuclear families, but these are a strange development for our species. In the past, most humans lived in groups of close family and friends; children would be cared for by several trusted people in addition to their parents.
Kids couldn’t be tucked away in a suburban house with their mother all day. They’d spend some time with her; they’d spend time with their father; they’d spend time with their grandparents; they’d spend time with aunties and uncles, and with friends whom they called auntie or uncle. Each week, children would be cared for by many different people.
The world was a harsh place for our ancestors to live in. There was always a risk of death – by starvation, injury, or disease. Everyone in the group had an incentive to help each child learn, because everyone would someday depend upon that child’s contributions.
And here I was – beneficiary of some million years of human evolution – thinking that I’d done so well by unlearning the American propaganda that caretaking is unimportant work.
And yet, I still mistakenly believed that my kids needed it to be done by me.
Being showered with love by parents is important. Love from primary caretakers is essential for a child to feel secure with their place in the world. But love from others is crucial, too.
I am so grateful that our YMCA provided that for my kids.
And, now that they’re old enough, my kids receive that love from school. Each day when they go in, they’re with teachers who let them know: You will be cared for no matter what.
I was walking my eldest child toward our local elementary school when my phone rang.
We reached the door, shared a hug, and said goodbye. After I left, I called back – it was a friend of mine from college who now runs a cancer research laboratory and is an assistant professor at a medical school.
“Hey,” I said, “I was just dropping my kid off at school.”
“Whoa,” he said, “that’s brave.”
I was shocked by his remark. For most people under retirement age, a case of Covid-19 is less dangerous than a case of seasonal influenza.
“I’ve never heard of anybody needing a double lung transplant after a case of the flu,” my friend said.
But our ignorance doesn’t constitute safety. During this past flu season, several young, healthy people contracted such severe cases of influenza that they required double lung transplants. Here’s an article about a healthy 30-year-old Wyoming man nearly killed by influenza from December 2019, and another about a healthy 20-year-old Ohio woman from January 2020. And this was a rather mild flu season!
“One of the doctors told me that she’s the poster child for why you get the flu shot because she didn’t get her flu shot,” said [the 20-year-old’s mother].
These stories were reported in local newspapers. Stories like this don’t make national news because we, as a people, think that it’s normal for 40,000 to 80,000 people to die of influenza every year. Every three to five years, we lose as many people as have died from Covid-19. And that’s with vaccination, with pre-existing immunity, with antivirals like Tamiflu.
Again, when I compare Covid-19 to influenza, I’m not trying to minimize the danger of Covid-19. It is dangerous. For elderly people, and for people with underlying health issues, Covid-19 is very dangerous. And, sure, all our available data suggest that Covid-19 is less dangerous than seasonal influenza for people under retirement age, but, guess what? That’s still pretty awful!
You should get a yearly flu shot!
A flu shot might save your life. And your flu shot will help save the lives of your at-risk friends and neighbors.
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For a while, I was worried because some of my remarks about Covid-19 sounded superficially similar to things said by the U.S. Republican party. Fox News – a virulent propaganda outlet – was publicizing the work of David Katz – a liberal medical doctor who volunteered in a Brooklyn E.R. during the Covid-19 epidemic and teaches at Yale’s school of public health.
The “problem” is that Katz disagrees with the narrative generally forwarded by the popular press. His reasoning, like mine, is based the relevant research data – he concludes that low-risk people should return to their regular lives.
You can see a nifty chart with his recommendations here. This is the sort of thing we’d be doing if we, as a people, wanted to “follow the science.”
And also, I’m no longer worried that people might mistake me for a right-wing ideologue. Because our president has once again staked claim to a ludicrous set of beliefs.
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Here’s a reasonable set of beliefs: we are weeks away from a safe, effective Covid-19 vaccine, so we should do everything we can to slow transmission and get the number of cases as low as possible!
Here’s another reasonable set of beliefs: Covid-19 is highly infectious, and we won’t have a vaccine for a long time. Most people will already be infected at least once before there’s a vaccine, so we should focuson protecting high-risk people while low-risk people return to their regular lives.
If you believe either of those sets of things, then you’re being totally reasonable! If you feel confident that we’ll have a vaccine soon, then, yes, delaying infections is the best strategy! I agree! And if you think that a vaccine will take a while, then, yes, we should end the shutdown! I agree!
There’s no right answer here – it comes down to our predictions about the future.
But there are definitely wrong answers. For instance, our current president claims that a vaccine is weeks away, and that we should return to our regular lives right now.
That’s nonsense. If we could get vaccinated before the election, then it’d make sense to close schools. To wait this out.
If a year or more will pass before people are vaccinated, then our efforts to delay the spread of infection will cause more harm than good. Not only will we be causing harm with the shutdown itself, but we’ll be increasing the death toll from Covid-19.
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On October 14th, the New York Times again ran a headline saying “Yes, you can be reinfected with the coronavirus. But it’s extremely unlikely.”
This is incorrect.
When I’ve discussed Covid-19 with my father – a medical doctor specializing in infectious diseases, virology professor, vaccine developer with a background in epidemiology from his masters in public health – he also has often said to me that reinfection is unlikely. I kept explaining that he was wrong until I realized that we were talking about different things.
When my father uses the word “reinfection,” he means clearing the virus, catching it again, and becoming sicker than you were the first time. That’s unlikely (although obviously possible). This sort of reinfection happens often with influenza, but that’s because influenza mutates so rapidly. Covid-19 has a much more stable genome.
When I use the word “reinfection” – and I believe that this is also true when most laypeople use the word – I mean clearing the virus, catching it again, and becoming sick enough to shed the viral particles that will make other people sick.
This sense of the word “reinfection” describes something that happens all the time with other coronaviruses, and has been documented to occur with Covid-19 as well.
The more we slow the spread of Covid-19, the more total cases there will be. In and of itself, more cases aren’t a bad thing – most people’s reinfection will be milder than their first exposure. The dangerous aspect is that a person who is reinfected will have another period of viral shedding during which they might expose a high-risk friend or neighbor.
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If our goal is to reduce the strain on hospitals and reduce total mortality, we need to avoid exposing high-risk people. Obviously, we should be very careful around nursing home patients. We should provide nursing homes with the resources they need to deal with this, like extra testing, and preferably increased wages for nursing home workers to compensate them for all that extra testing.
It’s also a good idea to wear masks wherever low-risk and high-risk people mingle. The best system for grocery stores would be to hire low-risk shoppers to help deliver food to high-risk people, but, absent that system, the second-best option would be for everyone to wear masks in the grocery store.
Schools are another environment where a small number of high-risk teachers and a small number of students living with high-risk family members intermingle with a large number of low-risk classmates and colleagues.
Schools should be open – regions where schools closed have had the same rates of infection as regions where schools stayed open, and here in the U.S., teachers in districts with remote learning have had the same rates of infection as districts with in-person learning.
Education is essential, and most people in the building have very low risk.
A preponderance of data indicate that schools are safe. These data are readily accessible even for lay audiences – instead of reading research articles, you could read this lovely article in The Atlantic.
Well, I should rephrase.
We should’ve been quarantining international travelers back in December or January. At that time, a shutdown could have helped. By February, we were too late. This virus will become endemic to the human species. We screwed up.
But, given where we are now, students and teachers won’t experience much increased risk from Covid-19 if they attend in person, and schools aren’t likely to make the Covid-19 pandemic worse for the surrounding communities.
That doesn’t mean that schools are safe.
Schools aren’t safe: gun violence is a horrible problem. My spouse is a teacher – during her first year, a student brought weapons including a chainsaw and some pipe bombs to attack the school; during her fourth year, a student had amassed guns in his locker and was planning to attack the school.
Schools aren’t safe: we let kids play football, which is known to cause traumatic brain injury.
Schools aren’t safe: the high stress of grades, college admissions, and even socializing puts some kids at a devastatingly high risk for suicide. We as a nation haven’t always done a great job of prioritizing kids’ mental health.
And the world isn’t safe – as David Katz has written,
“If inclined to panic over anything, let it be climate change … Not the most wildly pessimistic assessment of the COVID pandemic places it even remotely in the same apocalyptic ballpark.”
At the end of “Just Use Your Thinking Pump!”, a lovely essay that discusses the evolution (and perhaps undue elevation) of a particular set of practices now known as the scientific method, Jessica Riskin writes:
Covid-19 has presented the world with a couple of powerful ultimatums that are also strikingly relevant to our subject here. The virus has said, essentially, Halt your economies, reconnect science to a whole understanding of yourself and the world, or die.
With much economic activity slowed or stopped to save lives, let us hope governments find means to sustain their people through the crisis.
Meanwhile, with the din of “innovation” partially silenced, perhaps we can also use the time to think our way past science’s branding, to see science once again as integral to a whole, evolving understanding of ourselves and the world.
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True, the world has presented us with an ultimatum. We must halt our economies, reconnect science to a whole understanding of ourselves and our world, or die.
Riskin is a professor at Stanford. Her skies are blackened with soot. In the words of Greta Thunberg, “Our house is on fire.”
For many years, we’ve measured the success of our economy in terms of growth. The idea that we can maintain perpetual growth is a delusion. It’s simple mathematics. If the amount of stuff we manufacture – telephones, televisions, air conditioners – rises by 3% each and every year, we’ll eventually reach stratospheric, absurd levels.
In the game “Universal Paperclips,” you’re put in control of a capitalist system that seeks perpetual growth. If you succeed, you’ll make a lot of paperclips! And you will destroy the planet.
Here in the real world, our reckless pursuit of growth has (as yet) wrought less harm, but we’ve driven many species to extinction, destroyed ancient forests, and are teetering at the precipice of cataclysmic climate change. All while producing rampant inequality with its attendant abundance of human misery.
We must reconnect science to a whole understanding of ourselves and the world, or die.
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We are in danger. But Covid-19 isn’t the major threat we’re facing.
I consider myself to be more cautious than average – I would never ride a bicycle without a helmet – and I’m especially cautious as regards global pandemic. Antibiotic resistance is about to be a horrific problem for us. Zoogenic diseases like Covid-19 will become much more common due to climate change and increased human population.
I’m flabbergasted that these impending calamities haven’t caused more people to choose to be vegan. It seems trivial – it’s just food – but a vegan diet is one of our best hopes for staving off antibiotic resistant plagues.
A vegan diet would have prevented Covid-19. Not that eating plants will somehow turbocharge your immune system – it won’t – but this pandemic originated from a meat market.
And a vegan diet will mitigate your contribution to climate change, which has the potential to cause the full extinction of the human race.
Make our planet uninhabitable? We all die. Make our planet even a little less habitable, which leads to violent unrest, culminating in warring nations that decide to use nukes? Yup, that’s another situation where we all die.
By way of contrast, if we had made no changes in our lives during the Covid-19 pandemic – no shutdown, no masks, no social distancing, no PCR tests, no contact tracing, no quarantines – 99.8% of our population would have survived.
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Indeed, we often discuss the Covid-19 crisis in a very imprecise way. We say that Covid-19 is causing disruptions to learning, that it’s causing domestic violence or evictions. On the front page of Sunday’s New York Times business section, the headline reads, “The Other Way that Covid Kills: Hunger.”
Covid-19 is a serious disease. We need to do our best to avoid exposing high-risk people to this virus, and we should feel ashamed that we didn’t prioritize the development of coronavirus vaccines years ago.
But there’s a clear distinction between the harms caused by Covid-19 (hallucinogenic fevers, cardiac inflammation, lungs filling up with liquid until a person drowns, death) and the harms caused by our response to Covid-19 (domestic violence, educational disruption, starvation, reduced vaccination, delayed hospital visits, death).
Indeed, if the harms caused by our response to Covid-19 are worse than the harms caused by Covid-19 itself, we’re doing the wrong thing.
In that New York Timesbusiness article, Satbir Singh Jatain, a third-generation farmer in northern India, is quoted: “The lockdowns have destroyed farmers. Now, we have no money to buy seeds or pay for fuel. …. soon they will come for my land. There is nothing left for us.”
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Covid-19 is awful. It’s a nasty disease. I’m fairly confident that I contracted it in February (before PCR tests were available in the United States), and my spouse says it’s the sickest she’s ever seen me.
Yes, I’d done something foolish – I was feeling a little ill but still ran a kilometer repeat workout with the high school varsity track team that I volunteer with. High intensity workouts are known to cause temporary immunosuppression, usually lasting from 3 to 72 hours.
My whole family got sick, but I fared far worse than the others.
It was horrible. I could barely breathe. Having been through that, it’s easy to understand how Covid-19 could kill so many people. I wouldn’t wish that experience on anyone.
And I have very low risk. I don’t smoke. I don’t have diabetes. I’m thirty-seven.
I wish it were possible to protect people from this.
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Obviously, we should have quarantined all international travelers beginning in December 2019. Actually, ten days probably would have been enough. We needed to diecitine all international travelers.
By February, we had probably allowed Covid-19 to spread too much to stop it.
By February, there were probably enough cases that there will always be a reservoir of this virus among the human species. 80% of people with Covid-19 feel totally fine and don’t realize they might be spreading it. By talking and breathing, they put viral particles into the air.
By the end of March, we were much, much too late. If you look at the numbers from New York City, it’s pretty clear that the preventative measures, once enacted, did little. Given that the case fatality rate is around 0.4%, there were probably about 6 million cases in New York City – most of the population.
Yes, it’s possible that New York City had a somewhat higher case fatality rate. The case fatality rate depends on population demographics and standard of care – the state of New York had an idiotic policy of shunting Covid-19 patients into nursing homes, while banning nursing homes from using Covid-19 PCR tests for these patients, and many New York doctors were prescribing hydroxychloroquine during these months, which increases mortality – but even if the case fatality rate in New York City was as high as 0.6%, a majority of residents have already cleared the virus by now.
The belated public health measures probably didn’t help. And these health measures have caused harm – kids’ schooling was disrupted. Wealthy people got to work from home; poor people lost their jobs. Or were deemed “essential” and had to work anyway, which is why the toll of Covid-19 has been so heavily concentrated among poor communities.
The pandemic won’t end until about half of all people have immunity, but a shutdown in which rich people get to isolate themselves while poor people go to work is a pretty shitty way to select which half of the population bears the burden of disease.
I am very liberal. And it’s painful to see that “my” political party has been advocating for policies that hurt poor people and children during the Covid-19 pandemic.
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Because we did not act soon enough, Covid-19 won’t end until an appreciable portion of the population has immunity – at the same time.
As predicted, immunity to Covid-19 lasts for a few months. Because our public health measures have caused the pandemic to last longer than individual immunity, there will be more infections than if we’d done nothing.
The shutdowns, in addition to causing harm on their own, will increase the total death toll of Covid-19.
Unless – yes, there is a small glimmer of hope here – unless we soon have a safe, effective vaccine that most people choose to get.
This seems unlikely, though. Making vaccines is difficult. And we already know that most people don’t get the influenza vaccine, even though, for younger people, influenza is more dangerous than Covid-19.
Look – this is shitty. I get an influenza vaccine every year. It’s not just for me – vaccination protects whole communities.
Yes, there are clear positive externalities to vaccination, but I think this sounds like a terrible idea. Ethically, it’s grim – the Covid-19 vaccines being tested now are a novel type, so they’re inherently more risky than other vaccines. By paying people to get vaccinated, we shift this burden of uncertainty onto poor communities.
We already do this, of course. Drug trials use paid “volunteers.” Especially phase 1 trials – in which drugs are given to people with no chance of medical benefit, only to see how severe the side effects are – the only enrollees are people so poor that the piddling amounts of money offered seem reasonable in exchange for scarfing an unknown, possibly poisonous medication.
Just because we already do an awful thing doesn’t mean we should make the problem worse.
And, as a practical matter, paying people to do the right thing often backfires.
To illustrate, consider the recent introduction, in many Indian states, of schemes of cash incentives to curb sex-selective abortion. The schemes typically involve cash rewards for the registered birth of a girl child, and further rewards if the girl is vaccinated, sent to school, and so on, as she gets older.
These schemes can undoubtedly tilt economic incentives in favor of girl children. But a cash reward for the birth of a girl could also reinforce people’s tendency to think about family planning in economic terms, and also their perception, in the economic calculus of family planning, that girls are a burden (for which cash rewards are supposed to compensate).
Further, cash rewards are likely to affect people’s non-economic motives. For instance, they could reduce the social stigma attached to sex-selective abortion, by making it look like some sort of ‘fair deal’ — no girl, no cash.
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What happens if it takes a few years before there are sufficient doses of an effective vaccine that people trust enough to actually get?
Well, by then the pandemic will have run its course anyway. Masks reduce viral transmission, but they don’t cut transmission to zero. Even in places where everyone wears masks, Covid-19 is spreading, just slower.
I’ve been wearing one – I always liked the Mortal Kombat aesthetic. But I’ve been wearing one with the unfortunate knowledge that masks, by prolonging the pandemic, are increasing the death toll of Covid-19. Which is crummy. I’ve chosen to behave in a way that makes people feel better, even though the science doesn’t support it.
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We, as a people, are in an awful situation right now. Many of us are confronting the risk of death in ways that we have not previously.
More than 37 percent of deaths in 1900 were caused by infectious diseases, but by 1955, this had declined to less than 5 percent and to only 2 percent by 2009.
Of course, this trend will still hold true in 2020. In the United States, there have been about 200,000 Covid-19 deaths so far, out of 2,000,000 deaths total this year. Even during this pandemic, less than 1% of deaths are caused by Covid-19.
And I’m afraid. Poverty is a major risk factor for death of all causes in this country. Low educational attainment is another risk factor.
My kids am lucky to live in a school district that has mostly re-opened. But many children are not so fortunate. If we shutter schools, we will cause many more deaths – not this year, but down the road – than we could possibly prevent from Covid-19.
Indeed, school closures, by prolonging the pandemic (allowing people to be infected twice and spread the infection further), will increase the death toll from Covid-19.
School closures wouldn’t just cause harm for no benefit. School closures would increase the harm caused by Covid-19 and by everything else.
Recently, a friend who works in the ER wrote to ask me about hydroxychloroquine.
Yes, I know. I was shocked, too. But my friend was sincere. Although most reputable news outlets have publicized that hydroxychloroquine doesn’t work against Covid-19, my friend read an article from Harvey Risch in Newsweek that seemed really compelling.
Risch has impeccable credentials – he’s an M.D. Ph.D. and a professor of epidemiology at Yale’s School of Public Health. And a lot of what he wrote for his July 23rd article is quite sensible:
Why has hydroxychloroquine been disregarded?
First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed.
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Medical data isn’t perfect, and confirmation bias is very real. So there’s a chance that medical doctors really could hoodwink themselves into discounting a helpful medication, the same way that so many medical doctors get suckered into overprescribing drugs after pharmaceutical companies bribe them with gifts. Yup, medical doctors are human, too.
I know that I’m so dismayed by our current president that I’m inclined to distrust hydroxychloroquine just because he says the drug is great.
So it was a shock for me to read Risch’s article. He wrote that there was data showing that hydroxychloroquine, when used in a combination therapy early during a high-risk person’s Covid-19 infection, could dramatically reduce the risk of serious complications. If more people took hydroxychloroquine, he wrote, fewer would die.
Risch acknowledges that hydroxychloroquine is dangerous – it might kill 1 out of each 10,000 people who take it – but Covid-19 is obviously dangerous, too – it kills 3 out of each 1,000 people who contract it:
In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence.
But for now, reality demands a clear, scientific eye of the evidence and where it points. For the sake of high-risk patients, for the same of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionately affected, we must start treating immediately.
Those are strong words. And, really, the Newsweek article felt persuasive to me. And so I looked up Risch’s research in the American Journal of Epidemiology, hoping to see the actual data in support of his claims.
I’m lucky, that way. I’m a scientist, so I don’t have to trust the words of a supposed expert. I’m an expert. I get to look at the data.
The data are much less compelling than Risch’s words.
Risch discusses the results of an uncontrolled study by Vladimir Zelenko, a medical doctor in Monroe, New York: “For example, among Connecticut cases 60 years of age or older, at present the mortality is 20%. Thus it would be ballpark to estimate that some 20% of the 1466 treated high-risk patients in the Zelenko cohort would have died without outpatient hydroxychloroquine plus antibiotic.”
This is an egregiously inaccurate statement. The high death rate cited – 20 – is for older patients who test positive for Covid-19 and have such severe symptoms that they need to be hospitalized.
As described in the short statement released by Zelenko, he treated 405 people who visited his office complaining of mild cough, fever, headache, sore throat, or diarrhea. His patients were not given a Covid-19 test. Presumably, many were never infected with Covid-19.
It is not a surprise to see that a 60-year-old patient who takes hydroxychloroquine after developing a sore throat from seasonal allergies is less likely to die than a 60-year-old patient who is diagnosed with Covid-19 in the hospital.
Of Zelenko’s 405 patients, at least two 2 died. This is lower than the expected 1% mortality rate of high-risk patients who contract Covid-19. But this set of 405 patients included low-risk patients experiencing shortness of breath and high-risk patients experiencing mild headache, many of whom never had Covid-19.
Zelenko’s report is two pages long and written in extremely lucid prose. Risch either totally misread it, which is galling, or intentionally mis-described it, which is worse.
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So, why was Zelenko giving people hydroxychloroquine in the first place?
Well, I’d heard that an in vitro study – which means “inside a test tube or petri dish, not a person” – showed that hydroxychloroquine reduced Covid-19 viral replication. But I hadn’t read the original paper. So I looked it up.
It should have taken me less than a minute to find this paper. Unfortunately, people have been pretty sloppy with their references. I get it. Covid-19 is scary, and it’s urgent, so people are publishing faster than usual.
I assumed that I could pull up almost any paper on hydroxychloroquine and Covid-19 and quickly find the citation for the original study. Indeed, most purport to be citing it. But in this, the citation that ought to have pointed to that study instead sent me to a paper on the differentiation of lung stem cells, and in this, the relevant citation incorrectly points to a paper on the drug lopinavir.
Ugh. I mean, these bungled citations aren’t that big a deal for me, personally – just means I had to give up on piggybacking and instead search Pubmed. But it undermines trust when you can’t get the little things right.
Liu et al. used Vero cells – a cell line derived from a kidney cancer in African green monkeys – and for Figure 1, they measured both how much hydroxychloroquine it takes to kill cells (about 200 micromolar is a cytotoxic dose) and how much hydroxychloroquine it takes to inhibit viral infection (about a 10 micromolar dose).
Okay. To me, that’s already sounding a little spooky. The bigger the difference between an effective dose and a lethal dose, the safer you are.
That’s why a bunch of hippies died after The Teachings of Don Juan was published. That book touted jimsomweed as a psychedelic. Indeed, the plant contains a high concentration of scopolamine, which can give people nightmarish visions of flying. It’s a powerful hallucinogen. But the effective dose is quite close to the lethal dose – when curious kids try to get high off it, they’re flirting with death.
Everyone’s body is a little different from everyone else’s. Maybe a dose that’s safe for you would kill me. The odds of disaster are worse when the effective dose and lethal dose are similar.
So, Liu et al. saw cytotoxicity kick in at around 100 micromolar hydroxychloroquine, getting pretty high by 200 micromolar. And for their visual assay of viral infection, they bathed their Vero cells in 50 micromolar hydroxychloroquine.
To block viral entry, they were coming pretty close to just killing these cells with the drug.
And the problem is even worse inside a human body. You take a drug and it gets into your bloodstream. It’ll reach some concentration there. This is the concentration that matters most for toxicity.
But the drug will only be effective against Covid-19 when it reaches your lungs. When Marzolini et al. used mass spectrometry to measure how much of hydroxychloroquine was actually getting from a patient’s blood to their lungs, they found that it wasn’t at a high enough concentration to reproduce any effects seen in vitro.
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Indeed, a randomized clinical study showed that hydroxychloroquine fails as a post-exposure prophylaxis. The drug was given to people who were worried about exposure because they’d spent time with someone who tested positive for Covid-19. The drug didn’t help – these people contracted the infection at the same rate as people who were given a placebo.
A randomized clinical study also showed that hydroxychloroquine fails as a cure. People who visited a hospital and tested positive for Covid-19 but had mild symptoms were given the drug. Their disease was just as likely to progress as people who received a placebo.
Hydroxychloroquine doesn’t work, and it’s toxic.
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I was left wondering: why would Risch write these things? Why would he write that article for Newsweek? He’s clearly intelligent, and, from the tone of his writing, I feel confident that he wants to help people.
He might even believe wholeheartedly in the conclusion he’s presenting.
That’s generally true among scientists. Confirmation bias is insidious.
That paper from the team at Harvard? They did some modeling and argued that, if Covid-19 is seasonal, we will save most lives by periodically shutting down. But their model left out the waning immunity that would cause Covid-19 to be seasonal! Whoops. That’s why they reached the wrong conclusion.
Or the recent New York Times editorial from Iwasaki and Medzhitov, both professors of immunobiology at Yale, reassuring readers that they won’t get Covid-19 twice. Well, that’s not correct.
Some antigens confer immunity that lasts about as long as our lives. Most don’t. Influenza immunity lasts months, not years. The paper that Iwasaki and Medzhitov cited in their article, a study in which people were intentionally infected with a less dangerous coronavirus, found that immunity to that virus lasted months, not years.
Covid-19 immunity will not last forever. The relevant question isn’t whether you can be infected again, it’s how soon you can be re-infected. With the data we have so far, it’s reasonable to expect that the answer will be measured in months, not years.
There’s some good news – the second time you contract Covid-19, it’ll probably be less severe than the first. In addition to antibodies, your immune system has “T cell memory” to help you fight off subsequent infections. But, as is also described in the paper cited by Iwasaki and Medzhitov, even people who felt fine were shedding virus again the second time they were infected.
During the second infection, the research subjects were shedding viral particles for a shorter period of time. But, especially with Covid-19 – a virus that can be transmitted simply by talking – a person who sheds virus for a short time while feeling fine is probably more likely to transmit the disease than somebody who sheds virus for a whole week while feeling like garbage.
The person who feels like garbage will stay home. The person who feels fine won’t.
Still, though, I was left wondering – what underlying beliefs would sway Risch enough that he’d make these blunders?
Eventually, I decided to lump his motivation in with mine. Maybe that’s fair, maybe it’s not. Really, I have no idea what he was thinking, so this is just my best guess.
But I imagine that many of these people – Risch, Iwasaki, Medzhitov, John Ioannidis, David Katz, all of whom are very smart, and all of whom mean well – understand that the strategies we’re using against Covid-19 are both ineffectual and are causing harm.
No shutdown will eliminate Covid-19 – the best we can do is to delay it. And we can delay it only as long as we maintain the shutdown. Maybe that seems fine if you’re an older, wealthy person brimming with optimism about vaccine development, like Anthony Fauci who thinks we’ll have a working vaccine early next year, but it’s unconscionable if you think a working vaccine might be five or more years away.
I don’t think we should try to pause children’s development for five years.
Still, there’s no mathematical or logical way to prove what we should do. School closures definitely slow the spread of Covid-19. How do you balance the good of delaying an elderly person’s infection by three months (which is equivalent to a drug that extends a patient’s life by three months) with the harms we’re causing?
I know what I’d do, but other people have different priorities than me. And that’s okay!
I’d like to think, though, that I’m not trying to hoodwink anybody about the science in order to deceptively get them to do the thing I think is right.
Like, yes, I think schools should be open. I think we owe it to children. Right now, children are suffering, but this is our fault, the fault of grown-ups.
We have known for over a decade that we ought to make coronavirus vaccines – we didn’t devote enough resources to it, and now we don’t have one. We’ve known for decades that eating animals – both those sold in meat markets like in Wuhan and the ones raised in “concentrated animal feeding operations” throughout the U.S. – will create more zoogenic diseases, and we kept doing it. We know that a guaranteed basic income would’ve given people the resources they needed to self-isolate during an epidemic – we don’t have one. We know that guaranteed access to health care would keep our death rate down.
Climate change will make pandemics more frequent, in addition to making our world unliveable for future generations. And we haven’t taken action to stop it.
None of these failings are children’s fault. We, older people, have failed. We fucked up. And now we’re asking children to make sacrifices to dampen the impact of our mistake (although, again, it won’t work – it’ll just delay the eventual repercussions).
I think today’s children deserve a fair shot at a good life, and I think that school is an essential part of that.
But don’t let anybody try to convince you that it’s safe to re-open schools because hydroxychloroquine will stop Covid-19.
Recently, a local science teacher sent me an essay written by a climate change skeptic.
Well, okay. I figured that I could skim the essay, look over the data, and briefly explain what the author’s errors were. After all, it’s really important to help teachers understand this topic, because they’re training our next generation of citizens.
And I thought to myself, how hard can this be? After all, I’m a scientist. I felt unconcerned that I’ve never read research papers about climate science before, and that it’s been years since I’ve worked through the sort of differential equations you need for even basic fluid mechanics calculations, and that I’ve never run any simulations on oceanic heat transfer or glacier melting.
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Since then, I’ve read a fair bit about climate science. I’ll be honest: I didn’t go through the math. All I did was read the papers and look over the processed data.
This is lazy, I know. I’m sorry. But my kids are at home. At the moment, this is the best I’ve got.
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Prominent climate change skeptic Richard Lindzen, an emeritus professor of meteorology, recently delivered a lecture to the Global Warming Policy Foundation. I wholeheartedly agreed with Lindzen when he stressed that the science behind climate change is really, really complicated.
Former senator and Secretary of State John F. Kerry is typical when he stated, with reference to greenhouse warming, ‘I know sometimes I can remember from when I was in high school and college, some aspects of chemistry or physics can be tough. But this is not tough. This is simple. Kids at the earliest age can understand this.’
As you have seen, the greenhouse effect is not all that simple. Only remarkably brilliant kids would understand it. Given Kerry’s subsequent description of climate and its underlying physics, it was clear that he was not up to the task.
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Climate science is tricky. In a moment, I’ll try to explain why it’s so tricky.
When people make predictions about what’s going to happen if the average global temperature rises by half a degree – or one degree, or two – their predictions are probably incorrect.
My assumption that I could skim through somebody’s essay and breezily explain away the errors was incredibly arrogant. I was a fool, I tell you! A fool!
But my arrogance pales in comparison to the hubris of climate change skeptics. Once I started learning about climate science, I realized how maddeningly difficult it is.
Lindzen, who should know better, has instead made brash claims:
So there you have it. An implausible conjecture backed by false evidence and repeated incessantly has become politically correct ‘knowledge,’ and is used to promote the overturn of industrial civilization. What we will be leaving our grandchildren is not a planet damaged by industrial progress, but a record of unfathomable silliness as well as a landscape degraded by rusting wind farms and decaying solar panel arrays.
There is at least one positive aspect to the present situation. None of the proposed policies will have much impact on greenhouse gases. Thus we will continue to benefit from the one thing that can be clearly attributed to elevated carbon dioxide: namely, its effective role as a plant fertilizer, and reducer of the drought vulnerability of plants.
Meanwhile, the IPCC is claiming that we need to prevent another 0.5ºC of warming, although the 1ºC that has occurred so far has been accompanied by the greatest increase in human welfare in history.
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So. What aspects of climate science can we understand, and what’s too hard?
Let’s start with the easy stuff. Our planet gets energy from the sun. The sun is a giant ball of thermonuclear fire, spewing electromagnetic radiation. When these photons reach Earth, they’re relatively high energy – with wavelengths mostly in the visible spectrum – and they’re all traveling in the same direction.
What we do – “we” here referring to all the inhabitants of our planet, including the rocks and plants and other animals and us – is absorb a small number of well-organized, high-energy photons, and then release a larger number of ill-organized, low-energy photons. This is favorable according to the Second Law of Thermodynamics. We’re making chaos.
And here’s the greenhouse effect: if the high-energy photons from the sun can pass through our atmosphere, but then the low-energy photons that we release get absorbed, we (as a planet) will retain more of the sun’s energy. Our planet heats up.
Easy!
And, in defense of former senator John Kerry, this is something that a kid can understand. My children are four and six, and this summer we’re going to build a solar oven out of a pane of glass and a cardboard box. (After all, we need stuff to do while all the camps are closed.)
If we fill our air with more carbon dioxide, which lets the sun’s high-energy photons in but then won’t let our low-energy photons out, the planet should heat up, right? What’s the hard part?
Well, the problem – the reason why climate science is too difficult for humans to predict, even with the most powerful computers at our command – is that there are many feedback loops involved.
Some of these are “negative feedback loops” – although atmospheric carbon dioxide causes us to absorb more energy from the sun, various mechanisms can buffer us from a rise in temperature. For example, warm air can hold more water vapor, leading to more cloud formation, which will reflect more sunlight back into space. If the sun’s high-energy photons can’t reach us, the warming stops.
And some are “positive feedback loops” – as we absorb extra energy from the sun, which causes the planet to heat up a little, various mechanisms can cause us to absorb even more energy in the future, and then the planet will heat up a lot. This may be what happened on Venus. The planet Venus may have been habitable, a long long time ago, but then runaway climate change led to the formation of a thick layer of smog, and now it’s broiling, with sulfuric acid drizzling from the sky.
On Earth, an example of a positive feedback loop would be the melting of polar ice caps. As polar ice melts, it reflects less light, so our planet absorbs more of the sun’s energy. Heat made the ice melt in the first place, but then, once the ice has melted, we heat up even more.
And it turns out that there are a huge number of different positive and negative feedback loops. After all, our planet is really big!
For instance, the essay I was sent included graphs of ice core data suggesting that, in the ancient past, changes in average global temperatures may have preceded changes in the concentration of atmospheric carbon dioxide.
Holding a demo ice core like my spouse uses in her classroom. The real ones drilled from glaciers are several miles long! I haven’t spent enough time at the gym to lift those.
But this is just another feedback loop. In the past, there was no mechanism for carbon dioxide to pour into our atmosphere before temperatures rose – dinosaurs didn’t invent internal combustion engines. This is the first time on Earth when carbon dioxide levels could rise before temperatures, and we don’t know yet what the effect will be.
Extra carbon dioxide will probably cause an increase in temperature, but a planet’s climate is really complicated. We have huge quantities of poorly mixed water (otherwise known as oceans). Our topography is jagged, interspersed with valleys and mountains. There are huge forests (only some of which are on fire). The air is turbulent.
We might find that temperatures are buffered more than we thought. The ocean might act like a giant heat sink.
Or then again, the ocean might warm up, accelerate polar ice loss by lapping at the undersides of glaciers, and magnify the changes.
The mathematics underlying fluid mechanics and heat transfer within an enormous, inhomogeneous system are so complex that it’s almost impossible to say. Nobody knows how much detail you’d need to put into a simulation to get accurate results – all we know for sure is that we can’t simulate the world with as much detail as actually exists. All our models are approximations. Some of them contradict each other.
With my admittedly limited understanding, I don’t think anybody knows enough to assert with confidence whether our climate will exhibit either buffered or switch-like behavior. Maybe we can muck about without hurting much. Or we might bring about our own doom with a tiny mistake.
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Our planet’s climate is so complex that you could make a similar argument – we really don’t know whether we’re going to be buffered from future changes, or whether we’re at the precipice of doom – no matter what evidence we obtain.
Maybe sea levels start rising – well, perhaps that will somehow reduce the further heating of our planet. Maybe we get more horrible tropical storms – well, perhaps they’re linked to a greater density of sunlight-reflecting clouds.
Maybe things seem to be changing fast for a little while, but then we enter another stable state.
Or, insidiously, maybe it will seem like we’re in a well-buffered system – pumping large amounts of carbon dioxide and methane into the atmosphere without seeing much harm – until, suddenly, we tip over the edge. We often see that sort of behavior from positive feedback loops. Nothing seems to happen, for a while, then everything changes at once. That’s how cooperative binding of oxygen to hemoglobin works in your body.
Another problem is that climate change will probably happen on a very different rhythm from our lives. Weather happens on timescales that we can understand. A decade of droughts. Two years of tropical storms. A few hard winters, or hot summers. But climate happens over hundreds or thousands of years. Most of the time, it changes more slowly than we’d notice.
A two degree shift in average global temperatures, spread out over a few decades? That’s bad, but it’s boring. Which was the main focus of Jonathan Safran Foer’s We Are the Weather.
History not only makes a good story in retrospect; good stories become history. With regard to the fate of our planet – which is also the fate of our species – that is a profound problem. As the marine biologist and filmmaker Randy Olson put it, “Climate is quite possibly the most boring subject the science world has ever had to present to the public.”
Climate science doesn’t fit our culture. Especially not now, when the pressures of surveillance capitalism have forced even the New York Times to run like an advertising company. They earn more from news that gets clicks. Stories need to be sensational. Yes, they run stories about climate change. For these, the polar bears need to be dying, now, and there needs to be an evil villain like Exon lurking in the shadows.
Nobody wants to click on a story explaining that we, collectively, have made and are making a whole lot of small shabby decisions that will cause grizzly bears and polar bears to re-mix and de-speciate.
I got bored even typing that sentence.
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Life is incredibly robust.
Our planet has swung through many extremes of temperature. At times, it’s been much hotter than it is now. At times, it was much colder. And life has marched on.
The human species is much less robust than life itself, though. Our kind has flourished for only a brief twinkling of time, during which our climate has been quite stable and mild. A small change could drive us to extinction. An even smaller change could cause our nations to collapse.
Disrupt our food supply – which could happen with just a few years of bad weather, let alone climate change – and there will be war.
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So. I tried to learn about climate change, focusing on the work of skeptics. And in the end, I partly agreed with the skeptics:
I agree that climate science is too complicated for anyone to understand.
I appreciate that people are trying. I had fun learning about ice cores, atmospheric modeling, energy absorption, and the like. Well, sometimes I was having fun. I also gave myself several headaches along the way. But also, my kids were being wild. They’ve been home from school for three months now! I was probably on the precipice of headaches before I even began.
Here’s where I disagree with the skeptics, though: given that climate science is too complicated for us to understand – and given that we know that small changes in average temperature can make the world a much worse place to live – why would be blithely continue to perturb our climate in an unprecedented way?
Maybe things will be fine. Yay buffers! Or maybe we’ll reduce the carrying capacity of the planet Earth from a few billion humans to a few million, dooming most of our kind.
I know, I know – eventually our universe will dwindle into heat death, so our species is terminal anyway. We will go extinct. It’s guaranteed.
I still think it would be neat if our great-great-grandchilden were out there among the stars. At least for a little while.
Or even, if they stay here on Earth, it’s nice to imagine them living on a comfortable planet with lots of beautiful trees, and interesting animals to see.
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Also, I’m biased.
After all, what are the things that you’re supposed to do if you want to reduce your carbon emissions?
Eat fewer animal products. Live in a smaller home. Drive less. Fly less. Buy less stuff.
Those are all things that I’d recommend to most Americans, for ethical and philosophical reasons, even if we weren’t concerned about climate change. So for me, personally, I don’t need to see much proof that we’ll ruin our climate unless we do these things. I think we should be doing them anyway.
Instead, I think the burden of proof should fall to the people hawking Big Macs. I’d want them to show that a world full of CAFO-raised cows won’t cause climate change, won’t propagate antibiotic resistant bacteria, won’t condemn billions of conscious beings to a torturous existence.
I spent most of my time during high school doodling in notebooks – during an entire year of biology, the only thing I learned was that the word for several fish of a single type is “fish,” but the word for several fish of different species is “fishes.”
For dissections – earthworms, giant crickets, pig hearts, and frogs – we were partnered with whomever sat at the table with us. My partner always brought the newspaper and ostentatiously checked stock prices during class. The kid in front of me spent a few weeks reading A Confederacy of Dunces.
My eyesight wasn’t good enough to read over her shoulder.
At least the distinction between fish and fishes turned out to be correct. My statistics teacher was a baseball coach – he didn’t know calculus, so the only explanation he gave for the workings of a Gaussian distribution was that the numbers were printed on a chart.
The baseball team had a winning record, though.
Even in English class, my brain was filled with junk. We were taught not to split infinitives or end sentences with prepositions. These are sensible rules in Latin. An infinitive – like “to read” – is a single word in Latin, so it would be quite strange to put another word in the middle. Latin also has strict rules about word order — a sentence would be garbled if the preposition was in the wrong place.
But we weren’t learning Latin! We were learning English, and – lo and behold! – the grammar rules of English are different. In English, word order is flexible. A lot of nuance comes from the arrangement of our sentences. English doesn’t have as many tenses as other languages – there’s no subjunctive – so we English speakers need to scrape out nuance where we can.
In my high school English class, we were also taught not to use “their” as a singular possessive. Even now, I rarely do – I don’t write “Each student brought their book,” I instead sacrifice the meaning of my sentences and write things like “Students brought their books.”
I was hoodwinked! Instead of using the word “their” as a singular pronoun – which it is, in English – I trusted my teachers when they claimed that this word was exclusively plural.
Hogwash! The equivalent claim would be to say that it’s incorrect to write:
You are reading this essay.
After all, “you” is a plural pronoun. And “are” is the plural conjugation of the verb “to be,” which I used only to match the expected conjugation of the pronoun “you.” The correct thing to write is:
Thou is reading this essay.
See? There’s only one person reading, so I need a singular pronoun, “thou,” and a singular conjugation, “is.”
From What’s Your Pronoun? by Dennis Baron, I learned that the pronoun “they” has been used as a singular since the 1300s.
In a sense, singular you is even more of a newcomer on the pronoun scene. The plural you was applied as a singular pronoun to address royalty as early as the thirteenth century and was used in other situations demanding deference and formality – call the monarch thy majesty instead of your majesty and it could mean off with your head.
But you doesn’t appear as a singular in all contexts until the 1600s, when it slowly, slowly starts pushing out thou, thee, thy, and thine, second-person singulars that English speakers had been using since the days of Beowulf. The th- singulars persist even now in some English dialects, and nineteenth-century grammar books regularly demanded singular thou and thee, along with thy and thine, even though these pronouns were no longer considered standard English.
It consoled me somewhat to read that students have long been taught outdated, inaccurate information. It’s not just my brain that was filled with rubbish.
When a cabal of misogynistic grammarians worked to replace singular they with he in English textbooks, people tried to protest.
In 1885, in an article titled “The New Pronoun,” the Atlanta Constitution printed:
There is nothing awkward or ungrammatical in [singular they] so far as the construction of English is concerned. It is ungrammatical when measured by the Latin method – but what has Latin grammar to do with the English tongue?
If you wanted, you could even make a scientific argument for the validity of singular they – in quantum mechanics, the state of each single particle is described by a superposition of states. Immediately after a measurement, wavefunctions can “collapse” to be composed primarily of a unique form – after a photon passes through a polarizer, it’s fluctuation will be parallel to the polarizer’s axis. But even this “up and down” state can be expressed as an equal superposition of two perpendicular polarizations tilted forty-five degrees. Indeed, the latter expression is the only useful way to describe this photon if it’s about to pass through a second polarizer tilted forty-five degrees from the first.
We are not monolithic. Each and all of us can be described as an amalgam of many different traits.
But we don’t need any scientific justification for the use of singular they in English. This grammatical usage is deeply enshrined in our language, and the singular pronoun “they” can best convey the plenitude of many individual humans’ identity & experience.
It’s still difficult for me to use the word “they” as a singular pronoun in formal sentences – my crummy education was pernicious. The proscriptions are deeply ingrained in my brain. But I’d like to think that I’m not totally calcified in my ways. And I’m quite grateful that Denis Baron prepared such an erudite history of English pronoun usage. What’s Your Pronoun? is a lovely little book.
I hope that my kids’ brains will be less muddled than my own. When we read stories aloud, we typically correct unnecessarily gendered language. Girls and boys become kids. An actress is an actor, too. Our Curious George lives in a world of fire fighters and police officers.
I was reading Rob Harrell’s gorgeous Monster on the Hill to our kids when our three-year-old interrupted me. At first, I couldn’t understand what she was saying. I asked her to repeat herself.
“You should say spouse.”
from Rob Harrell’s Monster on the Hill
She was right, of course. I’d unthinkingly read the text as written. So I felt embarrassed … for a moment. Then I remembered to feel proud.
My spouse is a high school teacher, and because her students are no longer attending class, they have more time to make TikTok videos.
I’m not quite sure what a TikTok video is. I think it’s something like a Vine video, but longer. Or perhaps something like a YouTube video, but shorter. Or perhaps something like a Music Video, but not introduced by Kurt Loder.
Last year I was volunteering with a local sixth grader once a week, working mostly on music theory and game design, and every so often he’d eye me as though I were a Homo erectus freshly emerged from a block of glacial ice. My gaffes weren’t even that egregious! I just don’t know about TikTok!
So it goes.
While working on a TikTok video, one of my spouse’s students messaged her to ask, “Would you still teach me if I was a worm?”
My spouse wrote back, “I don’t know. One of my kids had ringworm last year and it was awful!”
Ask a silly question, you get a silly answer.
And that’s where it should end, right? But the student persisted – after all, my spouse’s answer was insufficient basis for a good TikTok video.
“No, I mean like a regular earthworm.”
So, here’s the deal. If you ask a silly question – once – you get a silly answer. But the second time?
If I were working with a student interested in the educational capabilities of earthworms, I’d first mention Charles Darwin’s experiments on earthworm intelligence. Worms dig little burrows in the dirt, and they often plug the entrances of these with leaves.
So Darwin gave the worms novel building materials – not space-age polymer fabrics or anything, just different types of leaves – and let the worms choose which to use to plug up their burrows. In his estimation, the worms made sensible choices. You can read a lovely description of this experiment in Eileen Crist’s “The Inner Life of Earthworms.”
Then I might slide into a discussion of equality among worms, perhaps citing the recent children’s picture book, Worm Loves Worm. I imagine that, like the other characters of that story, our worm’s schoolmates would benefit by having more diversity in class.
And then, because my thoughts tend to careen suddenly to darkness, I might mention my unfinished horror novel, “Our Heroic Annelid Makes a Daring Escape.”
You see, moles often capture worms and save them for later. The doomed worms are stored inside the mole’s burrow.
The mole doesn’t kill the worms – then they’d rot. But worms can’t just be left inside a mud-lined burrow – then they’d dig their way out.
So moles mutilate their captives. An injured worm is unable to dig free, and, because worms rely largely on their sematosensory system to construct a mental image of the world, the worm is partially blinded.
But worms can regenerate. So the tension of the story becomes, will the worm heal before the mole returns to eat it?
All told, I would be willing to teach an earthworm. It seems that worms have the cognitive capacity to learn at least a little. But it would be heartbreaking to have one of my students captured by a mole.
Frank Brown Cloud 