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

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

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

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

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

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

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

I care about saving lives.

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

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

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

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

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

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

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

This policy caused huge numbers of deaths.

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

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

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

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

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

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

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

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

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

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

On re-watching The Matrix, twenty years later.

On re-watching The Matrix, twenty years later.

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

The Matrix also features many, many guns.

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

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

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

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

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

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

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

That’s rough. 

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

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

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

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

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

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

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

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

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

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

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

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

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

In The Matrix, a character named Morpheus explains:

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

The murderers saw their classmates as enemies.

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

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

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

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

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

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

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

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

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

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

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

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

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

On drinking.

On drinking.

In our poetry classes, we’ve had a lot of guys doing time or awaiting trial for domestic.  As you might expect, their troubles are often wrapped up with alcohol.  Nobody wants to think of himself as the kind of dude who’d hit his partner, but booze saps self-control.  Sober, we feel angry; drunk, we lash out.

Screen Shot 2018-05-24 at 7.20.19 PMWe began a recent class with Dave Johnson’s “Dave Gibson Makes His Way Down.”  Johnson teaches poetry in probation office waiting rooms, and he cares deeply about the ways so many of us struggle to be good.  His poem opens with the line,

image         Seven Sundays in a row he fell

         on his knees at the altar

         of Rocky Creek Presbyterian.

Each week, the protagonist of Johnson’s poem slips again.  He drinks then he repents.  At church, he’s “shaking his head / crying for forgiveness.”  But everyone knows that it won’t last, until one day his wife has had enough.  He staggered home drunk; she sewed him up inside a rug.

         And she beat him blue.  He swore he’d never

         drink anymore, and she beat him.

         And then he swore he’d go to church every Sunday.

         And she still beat him.

         He told her he’d love her forever.

         She kept on.

         And he said he’d repent.  She beat him harder.

         And he said he wanted to die.

         She beat him.

         And he said he’d never repent again.

         She stopped.

A man in class – back inside after only nine days out because he drank the night before a visit with his parole officer – hung his head.  “I should send this to my wife,” he said.  “I’m always telling her, I’ll stop, I’ll stop.  But then I hit that bottle.”

Apologizing isn’t enough.  We have to make sure we won’t apologize again.  “Sorry” doesn’t mean much if you have to say it again and again.

And, yes, it’s still mind boggling to me that MDMA and psilocybin – two low-risk chemicals that can help turn somebody’s life around – are illegal whereas alcohol, one of the world’s most dangerous drugs, is openly shilled with flashy television ads.

waterThen we read two poems by Raymond Carver.  “Woolworth’s 1954” has long been a favorite of mine – a man slips into reverie while he’s out walking with a buddy and the buddy’s young kids.  The man thinks about when he “was sixteen, working / for six bits an hour” as a stockboy in a department store.  An older man was training him; Carver writes,

        Most important memory

         of that whole time: opening

         the cartons of women’s lingerie.

         Underpants, and soft, clingy things

         like that.  Taking it out

         of cartons by the handful.  Something

         sweet and mysterious about those

         things even then.  Sol called it

         “linger-ey.”  “Linger-ey?”

         What did I know?  I called it

         that for a while, too.  “Linger-ey.”

Poets play with the difference between private and public language.  Some words mean almost the same thing no matter who hears them.  When I write “of,” chances are there are few strong associations in your mind that would cause you to misinterpret my intent.

But many words feel very different from one person to the next.  When the New York Times printed poems alongside photographs they inspired last summer, I brought them in to jail.  I had no idea that a line from Ada Limon’s “What It Looks Like to Us and the Words We Use” would jolt the men out of reading.

         And how we stood there,

         low beasts among the white oaks, Spanish moss,

         and spider webs, obsidian shards stuck in our pockets

But “shard” is slang for methamphetamine, apparently, and once the idea of meth has wormed into their brains, it’s hard to shake away.  That’s the whole problem with addiction. 

Blue_Crystal_Meth
A shard of crystal (in this case, meth).

For Carver, the private meaning of “lingerie” is safer.

        Then I got older.  Quit being

         a stockboy.  Started pronouncing

         that frog word right.

         I knew what I was talking about!

         Went to taking girls out

         in hopes of touching that softness,

         slipping down those underpants.

         And sometimes it happened.  God,

         they let me.  And they were

         linger-ey, those underpants.

         They tended to linger a little

         sometimes, as they slipped down 

Raymond_CarverCarver thinks back to those bright early years, when everything felt charged with possibility.  Dangerous, but navigable.  Undergarments “kicked free / onto the floor of the car and / forgotten about.  Until you had / to look for them.

But his past is gone.  He’s grown up, made mistakes, worked crummy jobs and started drinking.  He has more freedoms now – a house to take dates to, instead of fumbling in the car – and yet fewer possibilities.  Those women he knew have grown up too; they have families and responsibilities.  Or they’ve died.  Some of us find less luck than others. 

Carver is left lamenting his mistakes, knowing that some things he’ll never fix.

Then we read Carver’s “Fear.”  One man read the first half of the poem, but when he reached the line “Fear of my children’s handwriting on envelopes”, he paused, blinked, started again, and found he had no voice.  We sat in silence for about ten seconds, then he said, “Yeah, that one got me.  Somebody else is gonna have to read the rest of this.”

He was too broke for bail and had spent almost a year inside (waiting on a case that would wind up dismissed when the witnesses didn’t show), and each week said something to me about his daughter, seven years old, living a state away, whom he hadn’t seen in years.  On his good days, he’d tell me, “When I get out, I’m gonna get myself on a bus, go up and see her.”

On his bad days, he’d say, “I don’t know if she’s gonna want to see me.  Cause it’s been years, you know?”

After reading the poem, I thought we’d use “Fear” as a writing prompt.  “Jot down five things,” I said.  “What are you afraid of?” 

This was a terrible writing prompt.

Seriously.  Only two people wrote anything (“I’m afraid of being killed by an ex / I’m afraid of dying broke / I’m afraid of dying alone”).  It can’t feel safe to write about your fears in jail. 

Mea culpa.

But some of what the guys said while telling me that they couldn’t write was heartbreaking.  Like the guy with the seven-year-old daughter he wanted to visit:

I’m afraid that when they let me out I’m not gonna want to go, cause I’ll have forgotten how to live any place but here.

Or another guy, who said that his first grandchild was born while he was stuck there.

The only thing I’m scared of is that I’m gonna drink again and my daughter won’t let me see my grandkid.  Because she says that if I get back to drinking, she won’t let me around.  I’m an alcoholic, and I’m a mean alcoholic.

And yet, the week before he left, he told me, “When I get out, first thing I’m gonna do, I’m gonna walk down to that liquor store and buy myself a beer.”

At the end of class I told him, “I don’t have anything against drugs, you know.  But some of us, some drugs, we just don’t mix well.  So I wish you’d go, maybe buy that grandkid a present, go down to see her instead of buying yourself a drink.”

“I know, I know … but it’s something I told myself, to get me through this time here.  That I’d get out, and when I got out, I’d get to have a beer.”

“I mean, if it’s just one …” I said.

“Yeah, but I’m an alcoholic.”

 

On fear.

On fear.

cta_brown_line_060716We recently visited my brother and our Auntie Ferret in Chicago.  Traveling with two young kids was difficult, but not impossible.  N held my hand while we strolled down the sidewalk and we did the five-hour drives to and from the city while she and her brother were sleeping in their car seats.

When we returned to Bloomington, I excitedly regaled staff at the YMCA “play and learn” childcare area with our adventures: we went to Restaurant Depot!  A grocery store where you can buy a six-pound tub of chili garlic paste!  It was magical!

One woman shuddered slightly: “Chicago?  I’m afraid to go there.”

Based on that statement alone, I’d bet large sums of money that she voted for Donald Trump.

Which isn’t such a bad bet.  He lost the popular vote, and Bloomington is a liberal isle in the midst of southern Indiana, but… this is southern Indiana, after all.  Trump garnered a lot of votes here.

And he campaigned on fear.

It’s not the best emotion, fear.  It’s no hope, for instance.  I’d say fear is far worse than whatever emotion best characterizes the recent Clinton campaign, even though I’m not quite sure what that emotion is… scorn?  Which isn’t good, but I’d swallow my pride and vote for smarmy self-satisfied scorn over fear any day (as in fact I did).

banksyfollowyourdreamsWe’re already seeing the awful consequences of fear: an executive order barring immigrants and refugees from a few (poor, Trump-property-less) countries that people here fear.  Yes, it looks like children are drowning as families flee the civil war (sparked by climate change from our pollution).  But what if those deaths are all part of an evil ploy by ISIS (not Daesh, not ISIL) operatives to infiltrate the United States?

The ban is misguided and heartless, obviously.  But it’s hardly the worst that fear can do.  Because fear inspires attack.

Which is a fascinating research finding.  Terrifying, yes, given our current political situation.  But still fascinating.  You get it all here: mind control… senseless violence… and… killer mice?

Back in 2005, Comoli et al. found that hunting seemed to activate a pattern of neurons in the amygdala, the brain region responsible for fear in a wide variety of mammals, including humans.

So… what would happen if you suddenly activated those neurons?

Usually, neurons are activated only when we think.  Our thoughts are patterns of neuron activations, and they cause further activations, which means we get to keep thinking, on and on as we learn and grow… until we die.  Then the activations stop.

picture-1Each of these “activations” is a flow of electricity from one of the cell to the other.  Neurons are lined by “voltage-gated ion channels,” and these let signals flow.  Ions entering through one gate cause nearby gates to open.  After a gate opens, though, it takes a while to recharge, which causes the current flow in a single direction.

And that’s how you can create a Manchurian candidate.  Instead of hypnosis – conditioning Sinatra to flip when he spots a playing card – you infect neurons with new ion channels that open when you shine laser light on them.  Make a recombinant virus, load it into a syringe, and plunge that needle into the brain!

The laser causes your new ion channels to open, and then, once they do, all the others respond, creating a flow of current.  The signal becomes indistinguishable from any other thought.  Except that whoever holds the laser is in control.

Wenfei Han et al., for the study “Integrated Control of Predatory Hunting by the Central Nucleus of the Amygdala,” took some mice and infected their amygdalas with these light-activated channels… and found that they’d created killing machines.  In their words:

When a non-edible item was placed in the cage, laser activation caused the otherwise indifferent mice to immediately assume a ‘capture-like’ body posture and seize the object, which was then held with the forepaws and bitten.  Behavior was interrupted immediately upon laser deactivation.

Light on… attack!  Light off… whoa, what was I doing?

mouse attacking.jpg

From Han et al.:

Generally, upon laser activation, mice readily seize, bite, and often ingest, non-edible objects, an effect that was modulated by internal state.  Laser activation also abolished natural preferences for edible over non-edible items.

When left to their own devices, mice will hunt crickets (although it’s worth noting that “Consistently, by employing the cricket-hunting paradigm, [laser activation] shortened the time needed for mice to capture and subdue their prey.  Captured crickets were immediately eaten.”), but the mind-control lasers cause them to hunt anything.

Well, almost anything.

Activation did not induce attacks on “conspecifics,” that is, their fellow mice.  But human psychology seems to allow great flexibility in distinguishing between our own kind and others.  When a mouse sees a mouse, it’ll know it’s a mouse.  But we are so tribal that when one Homo sapiens sees another, the knowledge of shared humanity is often clouded over.  Instead of recognizing a human, we might see a Syrian, or a Muslim, or an “illegal,” or a Republican, or a criminal.

A mouse won’t hunt another mouse, but we humans are great at attacking our own.

Of course, we don’t know for certain that humans would attack so single-mindedly if we activated neurons in the amygdala.  We conduct only voluntary research on humans, and it seems unlikely that many people would sign up for an experiment involving the injection of viruses into the brain (which causes the infected neurons to become light-activated), intentional lesions between various brain regions (to isolate activities like hunting and eating – a quick slice lets researchers permanently uncouple those thought patterns), and euthanasia (to dissect the brain at the experiment’s end).

mouse-801843_1920The mice used in these studies – or any other research studies, since mice aren’t even considered “animals” for the purposes of the Laboratory Animal Welfare Act – did not fare particularly well.  Far worse than the impoverished or imprisoned Homo sapiens whose “voluntary” research participation is induced by the offer of a piddling amount of cash or less mistreatment inside.

But now we know.  Inspire sufficient fear, trigger attack.  We’ll find an other – edible or not, deserving or not – and try to kill it.

People who felt afraid voted for Trump… and he has been using his social media megaphone to inflame their fears further ever since… and if we don’t calm those fears, war is coming.

Terrorism is scary.  But can we get a little more “The only thing we have to fear is fear itself” around here?