Tag: covid response

On magic.

On magic.

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.

This is just this.

I don’t have the cup – it’s gone.

Much of our Covid-19 response has been magic-based. We repeat illusory beliefs – schools are dangerous, reinfections are rare, death at any age is a tragedy – and maybe our audience is swayed.

But that doesn’t change the underlying reality.

The cup still exists – it was behind her back.

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Everyone will die. Mortality is inescapable.

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 will die. Expensive interventions can stave off death for longer – we can now vaccinate 90-year-olds against Covid-19 – but we will still die.

Dying at the end of a long, full life shouldn’t feel sad, though. Everybody dies. Stories end. That’s the natural arc of the world.

What’s sad is when people die young.

Children will face the risk of dying younger due to unnecessary school closures.

Children will face the risk of dying younger due to unmitigated climate change.

Children will face the risk of dying younger due to antibiotic resistant bacteria.

These are urgent threats facing our world. And we’re not addressing them.

The cup is still there.

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For my daughter, of course, I played along. I smiled, and laughed. She stood there beaming, holding the cup behind her back.

“Magic!” I said.

N. nodded proudly, then asked, “Do you want me to bring it back?”

It’ll take the same measure of magic to bring back schools.

On reinfection.

On reinfection.

If you’ve been reading about Covid-19 in the New York Times, you’ve probably learned that reinfection is very unlikely.

What you’ve learned is incorrect.

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Don’t get me wrong – I love the New York Times. Within the spectrum of United States politics, I am very far to the left. Anti-consumerist, prison abolitionist, environmentalist, feminist, climate activist, etc., etc. I fit into all those categories.

I’m also a scientist. I am staunchly pro-vaccine. I don’t like pesticides, but I’m a huge fan of GMO crops. (Honestly, I wish there was a category at the grocery store where you could pay to support genetically-modified organisms grown without environmental toxins – “organic” doesn’t have the nuance I’d like.)

So my goal here isn’t to rag on the New York Times. I’m including screenshots of their headlines only to give us a common frame of reference.

This is what the news is saying. And it’s wrong.

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It was going to be very difficult to demonstrate reinfection with Covid-19.

Why?

In general, reinfection with any virus will produce a milder illness the second time.

Most people’s first infection with Covid-19 is so mild that they don’t realize they have it – perhaps 80% of infections are “asymptomatic,” in which a person has been infected with the virus, is probably shedding the virus (thereby infecting other people), but feels totally fine. So, people’s second infection? Some percentage higher than 80% are likely to feel totally well, even though they might be shedding virus.

When people develop severe complications from Covid-19, the illness can linger for weeks or even months.

I don’t know for certain whether my family contracted Covid-19 in February, because there were no tests available here at the time. All I know is that we were two close contacts removed from someone who had just returned from China, that this close contact tested negative for influenza, that my family had been vaccinated for influenza, and that our symptoms precisely mirrored the common suite for Covid-19. But in any case, we felt horrible for about three weeks, and we experienced lingering fatigue with occasional coughing for about two months.

Lengthy recovery is so common that there’s a colloquial name for it: “long-haulers.” If we’re trying to identify whether someone was re-infected, we’d need to make sure that we weren’t looking at continued viral shedding during a lengthy recovery.

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To demonstrate that someone was re-infected with Covid-19, the following would have to happen:

  • A person gets tested for Covid-19 during their first infection.
  • The genome of the virus is sequenced after that first infection.
  • The person is re-infected.
  • The person happens to get a Covid-19 test during the second infection (even though it’s highly likely that this person feels well at the time).
  • The genome of the virus is sequenced after the second infection.
  • The genome of the virus that infected the person on the second occasion is noticeably different from the first (even though Covid-19 includes a proofreading enzyme that slows genetic drift).

That’s all very unlikely!

There are just so many coincidences involved – that you happen to get infected with an easily distinguishable virus the second time, that you happen to get a test the second time, that anyone took the (significant) trouble and expense to sequence both genomes.

And what I mean is, proving re-infection is very unlikely. Which is totally independent of the likelihood of re-infection itself.

And yet, even though it’s so unlikely we’d be able to prove that re-infection is occurring, we have.

We know, with 100% certainty, that people can be reinfected. We’ve documented it.

Given how unlikely it was that we’d be able to document reinfection, the fact that we’ve seen this at all indicates that it’s probably quite common. As you would expect based upon our bodies’ responses to other coronaviruses.

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Given that re-infection definitely occurs, and is probably quite common, why have you read that it’s unlikely?

The underlying probably is language usage. When my father – an infectious diseases specialist – talks about re-infection, he’s thinking about contracting severe symptoms during a second infection. Which is reasonable. He’s a medical doctor. He cares about helping sick people get better.

But when we’re thinking about how to respond, as a nation, to this pandemic, we’re thinking about the dynamics of transmission. We’re trying to answer questions like, “Can kids go to school without people dying?”

(Yup, they can! And should!)

From this perspective, we’re thinking about who is going to spread the virus, and where. We need to know whether a person who is protected from severe disease – either from prior recovery or vaccination – might shed viral particles. Will that individual register as a positive case on a PCR test? Will that individual get classmates or co-workers sick?

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Re-infections are probably the underlying cause of the current rise in cases in New York City.

70% or more of the population of New York City was infected with Covid-19 during April. That’s a huge percentage, well above what most researchers consider the “herd immunity threshold” for similar respiratory viruses.

For there to be another spike in cases now, many of those 70% would need to have lost their initial immunity. That’s also why you’d expect to see a higher “test positivity rate” – if many of the current cases are reinfections, then they’re likely to be milder. People with milder (or asymptomatic) infections are less likely to seek out a test.

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For general audiences, the phrasing I’d recommend is to say “Severe illness is unlikely during Covid-19 reinfections” as opposed to “Reinfection is unlikely.”

There have been a few cases of people’s second infection being more severe than the first, but these cases indeed appear to be quite rare.

But re-infection itself?

The fact that we’ve documented any instances of re-infection suggests that it’s quite common. Which we could have predicted from the beginning – indeed, I did. And that’s why I’ve been recommending – for months – policies very different from what we’ve done.

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

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

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

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

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

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

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

I care about saving lives.

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

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

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

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

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

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

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

This policy caused huge numbers of deaths.

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

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

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

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

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

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

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

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

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

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