Tag: New York Times

Responses to “On testing.”

Responses to “On testing.”

My spouse posted my previous essay on social media, and I’d like to address some of people’s comments.  There were some excellent points! 

My apologies if I failed to address everything that people said, but I tried my best.

Scroll to find my responses to:

  1. A shutdown could have prevented the Covid-19 epidemic.
  2. We know that the current shutdown is either delaying or preventing deaths due to Covid-19. 
  3. Ending this epidemic with a vaccine would be ideal. 
  4. Ending the shutdown while requesting that at-risk people continue to self-isolate would save lives.
  5. Why is it urgent to end the shutdown soon?
  6. Why might more people die of Covid-19 just because we are slowing the spread of the virus?
  7. How is the shutdown causing harm?
  8. What about the rate at which people get sick?  Isn’t the shutdown worthwhile, despite the risks described above, if it keeps our hospitals from being overwhelmed?
  9. Don’t the antibody tests have a lot of false positives?
  10. What about the political ramifications of ending the shutdown?

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1: “A shutdown could have prevented the Covid-19 epidemic.”

If we’d acted early enough, we could have isolated all cases of Covid-19 and prevented this whole debacle.

But we didn’t.

Covid-19 is highly infectious, and we made no effort toward containment or quarantine until the virus was already widespread.  We took action in March, but we already had community transmission of Covid-19 by January.  Given where we are now, current models predict that the epidemic will continue until the level of immunity reaches somewhere near 70%.

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2: “We know that the current shutdown is either delaying or preventing deaths due to Covid-19.”

To date, the data suggests that the virus has only reached saturation inside a few closed environments, such as prisons.  In Italy, both the timecourse of mortality and the results of antibody studies suggest that infections were still rising at the time of their lockdown. 

Among the passengers of the Diamond Princess cruise ship, deaths peaked 21 days after infections peaked – if the virus had already reached saturation in Italy, we’d expect to see deaths peak sooner than 21 days after the lockdown began.  They did not.

So, again, this much is clear: worldwide, there was a significant new cause of death.  When we look at mortality data, we see the curves suddenly rise in many locations.  Some researchers, such as John Ioannidis, have speculated that Covid-19 causes death primarily in people with low life expectancy, in which case we would expect to see these mortality curves drop to lower-than-average levels after the epidemic ends.  But even then, it’s unprecedented to see a number of deaths that would usually occur over the course of a year all within a matter of weeks.

Covid-19 is killing people, and the shutdown is either delaying or preventing people’s death from Covid-19.

For the shutdown to actually prevent death, one of the following needs to happen:

1.) We create a vaccine, allowing our population to reach 70% immunity without as many people contracting the illness.

2.) We take action to change which segment of the population is exposed to the virus, allowing us to reach 70% immunity without as many at-risk people being exposed.

See #3 and #4, below.

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3: “Ending this epidemic with a vaccine would be ideal.”

Vaccination is great science.  Both my spouse and I love teaching about vaccines, in part because teaching the history of vaccine use is a good component of anti-racist science class.

Developing vaccines often takes a long time.  I’ve read predictions of a year or two; my father, an infectious disease doctor, epidemiologist, research physician who runs vaccine trials, and co-developer of Merck’s HPV vaccine, guesses that it will take about five years.

And then, for the vaccine to end this epidemic, enough people will need to choose to be vaccinated that we reach approximately 70% immunity.

The reason it’s worthwhile to compare Covid-19 to seasonal influenza is that a vaccine will only end the epidemic if enough people choose to get it.  Many people’s personal risk from Covid-19 is lower than their risk from seasonal influenza.  Will those people choose to be vaccinated?

Obviously, I would be thrilled if the answer were “yes.”  I’d love to live in a nation where people’s sense of altruism and civic duty compelled them to get vaccinated.  My family is up-to-date on all of ours.

But many privileged families in the United States have elected to be freeloaders, declining the (well tested, quite safe) measles vaccine with the expectation that other people’s immunity will keep them safe.  And, despite the well-documented dangers of influenza, only 40% of our population gets each year’s influenza vaccine.

Yes, the influenza vaccine tends to be less effective than many others – some years it gives as little as ten percent protection, other years about sixty percent protection.  By way of comparison, the HPV vaccine has over 90% efficacy.

A vaccine with low efficacy will still offer better protection when more people get it.  If a higher percentage of our population were vaccinated against influenza, then influenza transmission would drop, and so each person’s immunity, whether high or low, would be less likely to be challenged.

Also, the efficacy of influenza vaccines is measured in terms of the likelihood that vaccination prevents infection.  The influenza vaccine is not great at keeping people from getting sick.  But vaccination also tends to reduce the severity of your illness, even if you do catch influenza.  Because you got sick, it seems as though the vaccine “failed,” but your case might have been far more severe if you hadn’t been vaccinated.

The influenza vaccine saves lives.  In Italy, where fewer people choose to get vaccinated against influenza (about 15% compared to our 40% of the population), the death rate from influenza is higher.  Although it’s worth noting that this comparison is complicated by the fact that our health care system is so bad, with poor people especially having limited access to health care.  In the United States, people between the ages of 18 and 49 comprise a higher proportion of influenza deaths than anywhere in Europe.  Either our obesity epidemic or limited access to health care is probably to blame; possibly a combination of both.

In summary, for this plan to help us save lives, we will need to develop an effective vaccine, and then people will have to get it. 

I am quite confident that we can eventually develop a vaccine against Covid-19.  The virus includes a proofreading enzyme, so it should mutate more slowly than most RNA viruses.  We don’t know how long it will take, but we can do it.

I am unfortunately pessimistic that people will choose to get the vaccine.  And, unfortunately, when a low-risk person chooses to forgo vaccination, they’re not just putting themselves in harm’s way, they are endangering others.  Most vaccines elicit a weaker immune response in elderly or immunocompromised recipients – exactly the group most at risk from Covid-19 – which is why we spend so much time harping about herd immunity.

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4: “Ending the shutdown while requesting that at-risk people continue to self-isolate would save lives.“

This plan has major downsides, too.  Because we didn’t take action soon enough, every plan we have now is bad.

Low-risk people can still die of Covid-19.  Even if they don’t die, Covid-19 can cause permanent health effects.  Covid-19 reduces your ability to get oxygen to your body and brain.  Even a “mild” case can leave your breathing labored for weeks – you’re not getting enough oxygen.  Your muscles will ache.  Your thoughts will be sluggish.

With a more severe case, people can be looking at heart damage.  Renal failure.  It would be cruel to look at all these long-term consequences and blithely call them “recovery.”

If our health care system were better, we’d treat people sooner.  The earlier you intervene, helping to boost people’s oxygen levels, the better outcome you’ll have.  There’s a great editorial from medical doctor Richard Levitan recommending that people monitor their health with a pulse oximeter during this epidemic.

If you notice your oxygen levels declining, get help right away.  Early intervention can prevent organ damage.  And you’ll be helping everyone else, too – the sooner you intervene, the less medical care you will need.

Because medical debt can derail lives, many people in this country delay treatment as long as possible, hoping that their problems will go away naturally.  That’s why people are often so sick when they show up at the ER.  I imagine that this is yet another reason – alongside air pollution, food deserts, sleep loss, and persistent stress exacerbated by racism – that poor communities have had such a high proportion of people with severe cases of Covid-19.

And I imagine – although we don’t yet have enough data to know – that financial insecurity caused by the shutdown is making this worse.  It’s a rotten situation: you have a segment of population that has to continue working during the shutdown, which means they now have the highest likelihood to be exposed to the virus, and they’re now under more financial strain, which might increase the chance that they’ll delay treatment.

We know that early treatment saves lives, and not everyone is sufficiently privileged to access that.

All this sounds awful.  And it is.  But, if we took action to shift exposure away from high risk groups, the likelihood that any individual suffers severe consequences is lower.

And there is another caveat with this plan – some people may be at high risk of complications for Covid-19 and not even realize it.  In the United States, a lot of people either have type 2 diabetes or are pre-diabetic and don’t yet realize.  These people have elevated risk.  Both smoking and air pollution elevate risk, but people don’t always know which airborn pollutants they’ve been exposed to.  (Which, again, is why it’s particularly awful that our administration is weakening air quality standards during this epidemic.)

Even if we recommended continued self-isolation for only those people who know themselves to have high risk from Covid-19, though, we would be saving lives.  The more we can protect people in this group from being exposed to the virus – not just now, but ever – the more lives we will save.

We won’t be able to do this perfectly.  It’ll be a logistical nightmare trying to do it at all.  People at high risk from Covid-19 needs goods and services just like everybody else.  We might have to give daily Covid-19 PCR tests to anyone visiting their homes, like doctors, dentists, and even delivery workers. 

At that point, the false negative rate from Covid-19 PCR tests becomes a much bigger problem – currently, these false negatives reduce the quality of our data (but who cares?) and delay treatment (which can be deadly).  A false negative that causes inadvertent exposure could cost lives.

Stores will need to set aside morning hours for at-risk shoppers, and undertake rigorous cleaning at night.  We know that infectious viral particles can persist for days on a variety of surfaces.

Some people will be unable to work, either because they or a close relative has high risk of Covid-19.  Some children will be unable to go to school.  We will need a plan to help these people.

We will have to work very hard to keep people safe even after the shutdown ends for some. 

But, again, if everyone does the same thing, then the demographics of people infected with Covid-19 will reflect our population demographics.  We can save lives by skewing the demographics of the subset of our population that is exposed to Covid-19 to include more low-risk individuals, which will require that we stratify our recommendations by risk (at least as well as we can assess it).

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5: “Why is it urgent to end the shutdown soon?“

1.) By delaying Covid-19 deaths, we run to risk of causing more total people to die of Covid-19.

2.) The shutdown itself is causing harm.

See #6 and #7, below.

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6: “Why might more people die of Covid-19 just because we are slowing the spread of the virus?“

[EDIT: I wrote a more careful explanation of the takeaways of the Harvard study. That’s here if you would like to take a look!]

This is due to the interplay between duration of immunity and duration of the epidemic.  At one point in time, seasonal influenza was a novel zoogenic disease.  Human behavior allowed the influenza virus to become a perpetual burden on our species.  No one wants for humans to still be dying of Covid-19 in ten or twenty years.  (Luckily, because the virus that causes Covid-19 seems to mutate more slowly than influenza, it should be easier to design a single vaccine that protects people.)

In the Harvard model, we can see that there are many scenarios in which a single, finite shutdown leads to more deaths from Covid-19 than if we’d done nothing. Note the scenarios for which the colored cumulative incidence curves (shown on the right) exceed the black line representing how many critical cases we’d have if we had done nothing.

Furthermore, their model does not account for people’s immunity potentially waning over time.  Currently, we do not know how long people’s immunity to Covid-19 will last.  We won’t know whether people’s immunity will last at least a year until a year from now.  There’s no way to test this preemptively.

We’ve seen that immunity to other coronaviruses fades within a year.  If immunity to Covid-19 is similar, we really don’t want to prolong the epidemic past a year.

If we could all go into stasis and simply not move for about a month, there’d be no new cases of Covid-19, and this virus would be gone forever.  But people still need to eat during the shutdown.  Many people are still working.  So the virus is still spreading, and we have simply slowed the rate of transmission.

This seems good, because we’re slowing the rate at which people enter the hospital, but it’s actually bad if we’re increasing the number of people who will eventually enter the hospital.

Based on our research with other coronaviruses, we expect that re-infection will cause a person to experience symptoms less severe than their first case of Covid-19.  But a re-infected person can still spread the disease to others.  And we don’t know what will happen if a person’s risk factors – such as age, smoking status, diabetes status, etc. – have increased in the time since their last infection.

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7: “How is the shutdown causing harm?“

If you turn on Fox News, I imagine you’d hear people talking about the damage we’re doing to our economy.  They might discuss stock market numbers.

Who gives a shit?  In my opinion, you’d have to be pretty callous to think that maintaining the Nasdaq bubble is more important than saving lives.

At the same time, I think you’d have to be pretty callous to not feel extremely concerned by the United Nations’ policy brief, “The impact of Covid-19 on children.”

In this report, they estimate that the shutdown we’ve had so far will cause hundreds of thousands of children to die, many from malnutrition and the other health impacts of poverty.  The longer the shutdown continues, the more children will die.

That’s a worldwide number, and most of those children live outside the United States.  But I’d like to think that their lives matter, too.

The report also discusses the lifelong harm that will be inflicted on children from five months (or more!) of school closure.  Drop-outs, teen pregnancy, drug abuse, recruitment of child soldiers, and the myriad health consequences of low educational attainment.

I live in a wealthy college town, but even here there is a significant population of students who don’t have internet access.  Students with special needs aren’t getting the services they deserve.  Food insecurity is worse.

You’re lucky that privacy protections prevent me from sharing a story about what can happen to poor kids when all the dentists’ offices are closed.  I felt ashamed that this was the best my country had to offer.

As the shutdown continues, domestic violence is rising.  We can assume that child abuse is rising, also, but we won’t know until later, when we finally have a chance to save children from it.  In the past, levels of child abuse have been correlated with the amount of time that children spend in the presence of their abusers (usually close family), and reporting tends to happen during tense in-person conversations at school.

We know that online sex work has increased during the shutdown.  There is an increased supply of sex workers who are experiencing increasing financial insecurity.  We don’t yet have data on this, but I’d be shocked if the shutdown hasn’t led many to feel pressured into riskier acts for lower amounts of money, including meeting clients in isolated (and therefore unsafe) spaces.

The shutdown has probably made our drug epidemic worse (and this was already killing about 70,000 people per year in the U.S.).  When people are in recovery, one of the best strategies to stay sober is to spend a lot of time working, out of the house, and meeting with a supportive group in communal space.  Luckily, many of the people I know who are in recovery have been categorized as essential workers.

But any slip can kill someone recovering from addiction.  One of my friends froze to death last year.

A neighbor recently sent me a cartoon suggesting that the biggest harm caused by the shutdown is boredom.  (I’m going to include it, below, but don’t worry: I won’t spend too much time rattling sabers with a straw man.) And, for privileged families like mine, it is.  We’re safe, we’re healthy, we get to eat.  My kids are still learning – we live in a house full of computers and books.

But many of the 75 million children in the United States don’t live in homes like mine, with the privilege we have.  Many of our 50 million primary and secondary school students are not still learning academically during the shutdown.

Whether the shutdown is preventing or merely delaying the deaths of people at risk of serious complications from Covid-19, we have to remember that the benefit comes at a cost.  What we’ve done already will negatively impact children for the rest of their lives.  And the longer this goes on, the more we’re hurting them.

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8: “What about the rate at which people get sick?  Isn’t the shutdown worthwhile, despite the risks described above, if it keeps our hospitals from being overwhelmed?“

In writing this, I struggled with how best to organize the various responses.  I hope it doesn’t seem too ingenuous to address this near the end, because slowing the rate of infection so that our hospitals don’t get overwhelmed is the BEST motivation for the shutdown.  More than the hope that a delay will yield a new vaccine, or new therapies to treat severe cases, or even new diagnostics to catch people before they develop severe symptoms, we don’t want to overwhelm our hospitals.

If our physicians have to triage care, more people will die.

And I care a lot about what this epidemic will be like for our physicians.  My father is a 67-year-old infectious disease doctor who just finished another week of clinical service treating Covid-19 patients at the low-income hospital in Indianapolis.  My brother-in-law is an ER surgeon in Minneapolis.  These cities have not yet had anything like the influx of severe cases in New York City – for demographic and environmental reasons, it’s possible they never will.  But they might. 

Based on the case fatality rate measured elsewhere, I’d estimate that only 10% of the population in Minneapolis has already been infected with Covid-19, so the epidemic may have a long way yet to go.

If we ended the shutdown today for everyone, with no recommendation that at-risk groups continue to isolate and no new measures to protect them, we would see a spike in severe cases.

If we ended the shutdown for low-risk groups, and did a better job of monitoring people’s health to catch Covid-19 at early, more-easily-treatable stages (through either PCR testing or oxygen levels), we can avoid overwhelming hospitals.

And the shutdown itself is contributing toward chaos at hospitals.  Despite being on the front lines of this epidemic, ER doctors in Minneapolis have received a 30% pay cut.  I imagine my brother-in-law is not the only physician who could no longer afford day care for his children after the pay cut.  (Because so many people are delaying care out of fear of Covid-19, hospitals are running out of money.)  Precisely when we should be doing everything in our power to make physicians’ lives easier, we’re making things more stressful.

We could end the shutdown without even needing to evoke the horrible trolley-problem-esque calculations of triage.  Arguments could be made that even if it led to triage it might be worthwhile to end the shutdown – the increase in mortality would be the percentage of triaged cases that could have survived if they’d been treated, and we as a nation might decide that this number was acceptable to prevent the harms described above – but with a careful plan, we need not come to that.

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9: “Don’t the antibody tests have a lot of false positives?“

False positives are a big problem when a signal is small.  I happen to like a lot of John Ioannidis’s work – I think his paper “Why Most Published Research Findings Are False” is an important contribution to the literature – but I agree that the Santa Clara study isn’t particularly convincing. 

When I read the Santa Clara paper, I nodded and thought “That sounds about right,” but I knew my reaction was most likely confirmation bias at work.

Which is why, in the essay, I mostly discussed antibody studies that found high percentages of the population had been infected with Covid-19, like the study in Germany and the study in the Italian town of Robbio.  In these studies, the signal was sufficiently high that false positives aren’t as worrisome. 

In Santa Clara, when they reported a 2% infection rate, the real number might’ve been as low as zero.  When researchers in Germany reported a 15% infection rate, the real number might’ve been anywhere in the range of 13% to 17% – or perhaps double that, if the particular chips they used had a false negative rate similar to the chips manufactured by Premier Biotech in Minneapolis.

I’m aware that German response to Covid-19 has been far superior to our bungled effort in the United States, but an antibody tests is just a basic ELISA.  We’ve been doing these for years.

Luckily for us, we should soon have data from good antibody studies here in the United States.  And I think it’s perfectly reasonable to want to see the results of those.  I’m not a sociopath – I haven’t gone out and joined the gun-toting protesters.

But we’ll have this data in a matter of weeks, so that’s the time frame we should be talking about here.  Not months.  Not years.  And I’ll be shocked if these antibody studies don’t show widespread past infection and recovery from Covid-19.

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10: “What about the political ramifications of ending the shutdown?“

I am, by nature, an extremely cautious person.  And I have a really dire fear.

I’m inclined to believe that ending the shutdown is the right thing to do.  I’ve tried to explain why.  I’ve tried to explain what I think would be the best way to do it.

But also, I’m a scientist.  You’re not allowed to be a scientist unless you’re willing to be proven wrong.

So, yes.  I might be wrong.  New data might indicate that writing this essay was a horrible mistake.

Still, please bear with me for a moment.  If ending the shutdown soon turns out to be the correct thing to do, and if only horrible right-wing fanatics have been saying that we should end the shutdown soon, won’t that help our current president get re-elected?

There is a very high probability that his re-election would cause even more deaths than Covid-19.

Failing to address climate change could kill billions.  Immigration controls against migrants fleeing war zones could kill millions.  Weakened EPA protections could kill hundreds of thousands.  Reduced access to health care could kill tens of thousands.

And, yes, there are horrible developments that neither major political party in the United States has talked about, like the risk that our antibiotics stop working, but I think it’s difficult to argue that one political party isn’t more dangerous than the other, here.

I feel pretty confident about all the scientific data I’ve discussed above.  Not as confident as I’d like, which would require more data, but pretty confident.

I feel extremely confident that we need to avoid a situation in which the far right takes ownership of an idea that turns out to have been correct.  And it’ll be dumb luck, just a bad coincidence.  The only “data” they’re looking at are stock market numbers, or maybe the revenue at Trump-owned hotels.

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EDIT: I also wrote a more careful explanation of the takeaways of the Harvard study. That’s here if you would like to take a look!

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Header image by Goran Paunovic.

On testing.

On testing.

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

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

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

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First, some background: in case you haven’t noticed, most of the United States is operating under a half-assed lockdown.  In theory, there are stay-at-home orders, but many people, such as grocery store clerks, janitors, health care workers, construction workers, restaurant chefs, delivery drivers, etc., are still going to work as normal.  However, schools have been closed, and most people are trying to stand at least six feet away from strangers.

We’re doing this out of fear that Covid-19 is an extremely dangerous new viral disease.  Our initial data suggested that as many as 10% of people infected with Covid-19 would die.

That’s terrifying!  We would be looking at tens of millions of deaths in the United States alone!  A virus like this will spread until a majority of people have immunity to it – a ballpark estimate is that 70% of the population needs immunity before the epidemic stops.  And our early data suggested that one in ten would die.

My family was scared.  We washed our hands compulsively.  We changed into clean clothes as soon as we came into the house.  The kids didn’t leave our home for a week.  My spouse went to the grocery store and bought hundreds of dollars of canned beans and cleaning supplies.

And, to make matters worse, our president was on the news saying that Covid-19 was no big deal.  His nonchalance made me freak out more.  Our ass-hat-in-chief has been wrong about basically everything, in my opinion.  His environmental policies are basically designed to make more people die.  If he claimed we had nothing to worry about, then Covid-19 was probably more deadly than I expected.

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Five weeks have passed, and we now have much more data.  It seems that Covid-19 is much less dangerous than we initially feared.  For someone my age (37), Covid-19 is less dangerous than seasonal influenza.

Last year, seasonal influenza killed several thousand people between the ages of 18 and 49 in the United States – most likely 2,500 people, but perhaps as many as 5,800.  People in this age demographic account for about 10% of total flu deaths in the United States, year after year.

Seasonal influenza also killed several hundred children last year – perhaps over a thousand.

There’s a vaccine against influenza, but most people don’t bother. 

That’s shocking. 

Seasonal influenza is more dangerous than Covid-19 for people between the ages of 18 and 49, but only 35% of them chose to be vaccinated in the most recently reported year (2018).  And because the vaccination rate is so low, our society doesn’t have herd immunity.  By choosing not to get the influenza vaccine, these people are endangering themselves and others.

Some people hope that the Covid-19 epidemic will end once a vaccine is released.  I am extremely skeptical.  The biggest problem, to my mind, isn’t that years might pass before there’s a vaccine.  I just can’t imagine that a sufficient percentage of our population would choose to get a Covid-19 vaccine when most people’s personal risk is lower than their risk from influenza.

When I teach classes in jail, dudes often tell me about which vaccines they think are too dangerous for their kids to get.  I launch into a tirade about how safe most vaccines are, and how deadly the diseases they prevent. 

Seriously, get your kids vaccinated.  You don’t want to watch your child die of measles.

And, seriously, dear reader – get a flu vaccine each year.  Even if you’re too selfish to worry about the other people whom your mild case of influenza might kill, do it for yourself. 

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We already know how dangerous seasonal influenza is.  But what about Covid-19?

To answer that, we need data.  And one set of data is unmistakable – many people have died.  Hospitals around the world have experienced an influx of patients with a common set of symptoms.  They struggle to breathe; their bodies weaken from oxygen deprivation; their lungs accumulate liquid; they die.

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

For each of these patients saved, three others are consigned to an agonizing death in the hospital, intubated among the flashing lights, the ceaseless blips and bleeps.  At home, they’d die in a day; in the hospital, their deaths will take three weeks.

And the sheer quantity of deaths sounds scary – especially for people who don’t realize how many tens of thousands die from influenza in the United States each year.

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

Indeed, when people die of Covid-19, it’s often because their lungs fail.  Smoking is obviously a major risk factor for dying of Covid-19 – a significant portion of reported Covid-19 deaths could be considered cigarette deaths instead.  Or as air pollution deaths – and yet, our current president is using this crisis as an opportunity to weaken EPA air quality regulations.

Air pollution is a huge problem for a lot of Black communities in the United States.  Our racist housing policies have placed a lot of minority neighborhoods near heavily polluting factories.  Now Covid-19 is turning what is already a lifelong struggle for breath into a death sentence.

I would enthusiastically support a shutdown motivated by the battle for clean air.

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

But if we want to know how scary this virus is, we need to know how many people were infected.  If that many people died after everyone in the country had it, then Covid-19 would be less dangerous than influenza.  If that many people died after only a hundred thousand had been infected, then this would be terrifying, and far more dangerous than influenza.

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Initially, our data came from PCR testing.

These are good tests.  Polymerase chain reaction is highly specific.  If you want to amplify a certain genetic sequence, you can design short DNA primers that will bind only to that sequence.  Put the whole mess in a thermocycler and you get a bunch of your target, as long as the gene is present in the test tube in the first place.  If the gene isn’t there, you’ll get nothing.

PCR works great.  Even our lovely but amnesiac lab tech never once screwed it up.

So, do the PCR test and you’ll know whether a certain gene is present in your test tube.  Target a viral gene and you’ll know whether the virus is present in your test tube.  Scoop out some nose glop from somebody to put into the test tube and you’ll know whether the virus is present in that nose glop.

The PCR test is a great test that measures whether someone is actively shedding virus.  It answers, is there virus present in the nose glop?

This is not the same question as, has this person ever been infected with Covid-19? 

It’s a similar question – most people infected with a coronavirus will have at least a brief period of viral shedding – but it’s a much more specific question.  When a healthy person is infected with a coronavirus, the period of viral shedding can be as short as a single day.

A person can get infected with a coronavirus, and if you do the PCR test either before or after that single day, the PCR test will give a negative result.  Nope, no viral RNA is in this nose glop!

And so we know that the PCR test will undercount the true number of infections.

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

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

Friends, it is exceedingly unlikely that such a low percentage of children were exposed to this virus.  Children are disgusting.  I believe this is common knowledge.  Parents of small children are pretty much always sick because children are so disgusting. 

Seriously, my family has been doing the whole “social distancing” thing for over a month, and yet my nose is dripping while I type this.

Children are always touching everything, and then they rub their eyeballs or chew on their fingers.  If you take them someplace, they grubble around on the floor.  They pick up discarded tissues and ask, “What’s this?”

“That’s somebody’s gross kleenex, is what it is!  Just, just drop it.  I know it’s trash, I know we’re not supposed to leave trash on the ground, but just, just drop it, okay?  Somebody will come throw it away later.”

The next day: “Dad, you said somebody would throw that kleenex away, but it’s still there!”

Bloody hell.  Children are little monsters.

It seems fairly obvious that at least as high a percentage of children would be infected as any other age demographic.

But they’re not showing up from the PCR data.  On the Diamond Princess cruise ship, the lockdown began on February 5th, but PCR testing didn’t begin until February 11th.  Anyone who was infected but quickly recovered will be invisible to that PCR test.  And even people who are actively shedding viral particles can feel totally well.  People can get infected and recover without noticing a thing.

We see the same thing when we look at the PCR data from Italy.  If we mistakenly assumed that the PCR data was measuring the number of infections, and not measuring the number of people who were given a PCR test while shedding viral particles, we’d conclude that elderly people went out and socialized widely, getting each other sick, and only occasionally infected their great-grandchildren at home.

Here in the United States, children are disgusting little monsters.  I bet kids are disgusting in Italy, too.  They’re disgusting all over the world.

A much more likely scenario is that children spread this virus at school.  Many probably felt totally fine; some might’ve had a bad fever or the sniffles for a few days.  But then they recovered.

When they got their great-grandparents sick – which can happen easily since so many Italian families live in multigenerational homes – elderly people began to die.

So we know that the PCR test is undercounting the true number of infections.  Unless you’re testing every person, every day, regardless of whether or not they have symptoms, you’re going to undercount the number of infections.

In a moment, we can work through a way to get a more accurate count.  But perhaps it’s worth mentioning that, for someone my age, Covid-19 would seem to be about as dangerous as influenza even if we assumed that the PCR data matched the true number of infections.

If you’re a healthy middle-aged or young person, you should not feel personally afraid. 

That alone would not be an excuse to go out and start dancing in the street, though.  Your actions might cause other people to die. 

(NOTE & CORRECTION: After this post went up, my father recommended that I add something more about personal risk. No one has collected enough data on this yet, but he suspects that the next most important risk factor, after smoking and age, will be type 2 diabetes. And he reminded me that many people in their 30s & 40s in this country are diabetic or prediabetic and don’t even realize it yet. Everyone in this category probably has elevated risk of complications from Covid-19.)

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After you’ve been infected with a virus, your body will start making antibodies.  These protect you from being infected again.

Have you read Shel Silverstein’s Missing Piece book?  Antibodies work kind of like that.  They have a particular shape, and so they’ll glom onto a virus only if that virus has outcroppings that match the antibody’s shape.  Then your body sees the antibodies hanging out on a virus like a GPS tracker and proceeds to destroy the virus.

So to make an antibody test, you take some stuff that looks like the outcroppings on the virus and you put it on a chip.  Wash somebody’s blood over it, and if that blood contains antibodies that have the right shape to glom onto the virus, they’ll stick to the chip.  All your other antibodies, the ones that recognize different viruses, will float away.

An antibody test is going to be worse than a PCR test.  It’s easier to get a false positive result – antibodies are made of proteins, and they can unfold if you treat them roughly, and then they’ll stick to anything.  Then you’ll think that somebody has the right antibodies, but they don’t.  That’s bad.

You have to be much more careful when you’re doing an antibody test. I wouldn’t have asked our lab tech to do them for me.

An antibody test is also going to have false negatives.  A viral particle is a big honking thing, and there are lots of places on its surface where an antibody might bind.  If your antibodies recognize some aspect of the virus that’s different from what the test manufacturers included on their chip, your antibodies will float away.  Even though they’d protect you from the actual virus if you happened to be exposed to it.

If you’re a cautious person, though – and I consider myself to be pretty cautious – you’d much rather have an antibody test with a bunch of false negatives than false positives.  If you’re actually immune to Covid-19 but keep being cautious, well, so what?  You’re safe either way.  But if you think you’re immune when you’re not, then you might get sick.  That’s bad.

Because antibody tests are designed to give more false negatives than false positives, you should know that it’d be really foolish to use them to track an infection.  Like, if you’re testing people to see who is safe to work as a delivery person today, use the PCR test!  The antibody test has a bunch of false negatives, and there’s a time lag between the onset of infection and when your body will start making antibodies.

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

If you use the antibody test on a bunch of people, though, you can tell how many were infected.  And that’s useful information, too.

In the town of Robbio in Italy (pop. 6,000), the PCR test showed that only 23 people had been infected with Covid-19.  But then the mayor implored everyone to get an antibody test, and 10% of people had actually been infected with – and had recovered from – Covid-19.  Most of them couldn’t even recall having been sick.

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

I don’t know who made the tests used in Robbio – maybe they were a little better, maybe they were a little worse.  Based on my experience, I wouldn’t be so surprised if the true infection rate with Covid-19 in that town was really just 10% – nor would I be surprised to hear that the chips had a high false-negative rate and that the infection rate was 20% or more.

If you calculate the fatality rate of Covid-19 in Italy by assuming that the PCR tests caught every infection, you’d get a terrifying 10%.

If you instead assume that many other towns had a similar infection rate to Robbio, you’ll instead calculate that the fatality rate was well under one percent. 

Italy has higher risk than the United States due to age demographics, smoking rates, and multigenerational households – and even in Italy, the fatality rate was probably well under one percent.

When researchers in Germany randomly chose people to take a Covid-19 PCR test (many of whom had no symptoms), they found that 2% of the population was actively shedding virus – a much higher number of cases than they would have found if they tested only sick people.  And when they randomly chose people to take an antibody test, they found that 15% had already recovered from the infection (again, many of whom had never felt sick).  According to these numbers – which are expected to be an undercount, due to false negatives and the time lag before antibody production – they calculated a case fatality rate of 0.37%. 

That would be about three-fold more dangerous than seasonal influenza.

In the United States, our bungling president gutted the CDC, leaving us without the expertise needed to address Covid-19 (or myriad other problems that might arise).  During the first few months of this epidemic, very few people managed to get a PCR test.  That’s why our data from the PCR tests is likely to be a dramatic undercount – indeed, when we finally started producing accurate tests, the apparent growth in Covid-19 caseload superimposed with the growth in test availability.

In the absence of good PCR data, we have to rely on antibody data to track infections after the fact.  Which is why a town in Colorado with zero reported infections, as measured by PCR, had sufficiently widespread exposure that 2% of the population had already recovered from Covid-19.

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

Yes, there were problems with the Stanford study’s data collection – they displayed advertisements to a random selection of people, but then a self-selected subset responded.  The pool of respondents were enriched for white women, but Santa Clara’s outbreak probably began among Asian-Americans.  And we all know that random sampling doesn’t always give you an accurate depiction of the population at large – after all, random polling predicted that a competent president would be elected in 2016.

Now look at us.

It’s also likely that people with a poor understanding of the biology could misinterpret the result of the Stanford study.  They found that PCR tests had undercounted the infection rate in Santa Clara county, at the time of this study, by 85-fold.

It would be absurd to assume that you could simply multiply all PCR results by 85 to determine the true infection rate, but some people did.  And then pointed out the absurdity of their own bad math.

In places where more people are being tested by PCR, and they’re being tested more often, the PCR results will be closer to the true infection rate.  If you gave everyone in the United States a PCR test, and did it every day, then the PCR data would be exactly equal to the true infection rate.

If we had data like that from the beginning, we wouldn’t have been scared.  We would’ve known the true case fatality rate early on, and, also, at-risk people could’ve been treated as soon as they got infected.  We’d be able to save many more lives.

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

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

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

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

10% is roughly the proportion of young people who die of seasonal influenza.  But only 1% of Covid-19 deaths are people younger than 35.  The news reports don’t always make clear how much the risk of Covid-19 is clustered in a small segment of the population.

This has serious implications for what we should do next.  If we were dealing with a virus that was about three-fold more dangerous than seasonal influenza for everyone, we might just return to life as normal.  (Indeed, we carried on as normal during the bad years when seasonal influenza killed 90,000 people instead of last year’s 30,000.)

Because the risk from Covid-19 is so concentrated, though, we can come up with a plan that will save a lot of lives. 

Healthy people under retirement age should resume most parts of their lives as normal.  Schools should re-open: for students, Covid-19 is much less dangerous than seasonal influenza.  I think that people should still try to work from home when possible, because it’s the right thing to do to fight climate change.

At-risk people should continue to isolate themselves as much as possible.

This sounds crummy, but at-risk people would just continue to do the thing that everyone is doing currently.  And the plan would save many lives because the epidemic would end in about 3 months, after the virus had spread to saturation among our nation’s low-risk cohort. 

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

Their data are easy enough to understand.  In each of these graphs, they show a blue box for how long social distancing would last, and then four colored lines to represent how many infections we’d see if we did no social distancing (black), medium quality social distancing (red), good social distancing (blue), or excellent social distancing (green).

So, from top to bottom, you’re looking at the graphs of what happens if we do a month of social distancing … or two months … or three, or four … or forever.

And you can see the outcomes in the panels on the right-hand side.  The black line shows what would happen if we did nothing.  Infections rise fast, then level off after the virus has reached saturation.  There are two important features of this graph – the final height that it reaches, which is the total number of severe cases (and so a good proxy for the number of deaths), and the slope of the line, which is how fast the severe cases appear.  A steeper hill means many people getting sick at the same time, which means hospitals might be overwhelmed.

So, okay.  Looking at their graphs, we see that social distancing saves lives … if we do it forever.  If you never leave your house again, you won’t die of Covid-19.

But if social distancing ends, it doesn’t help.  The slopes are nearly as steep as if we’d done nothing, and the final height – the total number of people who die – is higher.

(Often, one of their curves will have a gentler slope than the others — usually the good-but-not-excellent social distancing seems best. So you’d have to pray that you were doing a precisely mediocre job of not infecting strangers. Do it a little better or a little worse and you cause people to die. This isn’t an artifact — it’s based on the density of uninfected people when social distancing ends — but let’s just say “mathematical models are wonky” and leave it at that.)

In a subsequent figure, the Harvard team tried to model what might happen if we occasionally resumed our lives for a month or so at a time, but then had another shutdown.  This is the only scenario in which their model predicts that social distancing would be helpful.

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

Even in the extreme case that we mostly stayed in our homes for the better part of two years, social distancing would case more deaths from Covid-19 than if we had done nothing.

That’s not even accounting for all the people who would die from a greater risk of domestic violence, hunger, drug addiction, suicide, and sedentary behavior during the shutdown.  

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When our data was limited, the shutdown seemed reasonable.  We wouldn’t be able to undo the damage we’d done by waiting.

Except, whoops, we waited anyway.  We didn’t quarantine travelers in January.  The shutdown didn’t begin March, when the epidemic was well underway in many places. 

Now that we have more data, we should re-open schools, though.  For most people, Covid-19 is no more dangerous than seasonal influenza.  We already have enough data from antibody testing to be pretty confident about this, and even if we want to be extremely cautious, we should continue the shutdown for a matter of weeks while we conduct a few more antibody studies.  Not months, and certainly not years.

At the same time, we need to do a better job of protecting at-risk people.  This means providing health care for everyone.  This means cleaning our air, staunching the pollution that plagues low-income neighborhoods.  This might mean daily medical checkups and PCR tests for people who work closely with at-risk populations.

Our country will have to be different in the future, but mostly because we, as a people, have done such a shitty job of creating justice and liberty for all.  We need to focus on addressing the inequities that we’ve let fester for generations.  That’ll help far more than using a bandanna to cover up your smile.

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

On inequality and disease.

On inequality and disease.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hopefully I can present some numbers simply enough to explain.

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

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

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

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

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

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

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

It seems that these people are all easy to ignore.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The benefit of this shutdown is simply the difference between how many people would die if we did nothing, compared to how many people will die if we “flatten the curve.” 

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

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

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

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

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

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

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

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

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

It’s climate change.

And we have done nothing.

On substitutes.

On substitutes.

When I started bouldering, I had the pleasure of attending a gym run by Jess McCauley.  He was an excellent climbing coach – although this was a very small gym in Mountain View, California, many of the kids he taught excelled at national competitions.

Then Jess decided to become a school teacher.  He was clearly great at working with kids, and had a B.A. in history focusing on African studies, so he figured he could do more good inside a classroom than a gym.  As he finished his education degree, Jess began working as a substitute teacher.

His first job was in my spouse’s high school “Biotechnology” class.  The day before, she exhorted her students: “The sub tomorrow is a good friend of mine, and I’m gonna be really upset if you’re hard on him.”

Everybody knew Jess was great with kids.  He’s a funny, charming, knowledgeable, muscular dude.  But every time a substitute teacher steps into a classroom, the chance that something will go wrong increases dramatically.

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Teachers build relationships with students over the course of a year.  As you work with a group of people, you learn to read subtle social cues – you’ll know when two students need to be separated from each other, when somebody might need to take a momentary breather in the hallway.  There’s a lot going on inside a high school beyond content education, and teachers develop an intuitive feel for the social dynamics inside their own rooms.

With experience, most people get better at this.  I imagine my spouse’s content knowledge didn’t improve much over her first five years in the classroom, but she became a better teacher.  She learned how to read and work a room.

And I know how much effort she puts into establishing a culture of trust inside her room.  But there are still problems.

In the morning, she teaches AP biology to her school’s “best and brightest,” kids bound for college at top-tier universities.  Many of those students would probably learn fine if you gave them all textbooks and put a straw-filled scarecrow behind the teacher’s desk.  Their neurochemistry tends to mesh well with the norms of public education.

In the afternoon, she teaches “Earth and space science” to kids who actually need a good teacher.  (Unfortunately, many schools pair their best teachers with the honors students and assign whomever’s left to the kids who need the most.)  These are students whom administrators often expect to fail – and yet, when given appropriate challenges (like a recent assignment engineering challenge to build a functional solar still), they shine.

Still, when a substitute steps into these classrooms, there’s a major risk that something will go wrong.

Last year, when our family traveled to St. Louis for the National American Biology Teacher meeting, one of my spouse’s students punched a classmate in the head.

During another of our trips, a student flipped a desk.  The year before, some students locked a sub out of the room and looped twine between the door handle and a lab table, tightening their barricade with a bar from the coat closet.  Those same kids stole the fire extinguisher that day (which my spouse only knew because they gleefully hugged her and told her so at graduation – nobody expected for these kids to receive diplomas, so they were understandably elated to be there).

When my spouse plans trips, she requests that only experienced substitutes be assigned to cover her classes, but there’s only so much that somebody unfamiliar with the room can do.  I imagine that if she were subbing for somebody else, the chance of something going wrong would still jump, even though she can keep her own classrooms orderly.  Those are students she’s grown familiar with.

High school is a stressful environment.  And putting a new face into that kind of situation can trigger trouble.

But, what’s a little worse than high school?  In terms of, like, people don’t want to be there, emotions flare, you’ve got massive numbers of athletic young men crammed into a cramped little space?

Oh.  Right.  Prison.

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One consequence of the federal hiring freeze is that many prisons have been relying on substitute guards.  These subs might be trained guards who usually work other blocks – or they might be classroom instructors, medical staff, clerks.  Female secretaries dressed in their office clothes (i.e. skirt, button-down blouse) might be suddenly assigned to patrol the halls of a men’s prison.

When a substitute steps into my spouse’s classroom, kids might get hurt.  When a substitute enters a prison, people could die.  According to a terrifying article from the New York Times,

As the shortage of correctional officers has grown chronic under President Trump – and the practice of drawing upon other workers has become routine – many prisons have been operating in a perpetual state of staffing turmoil, leaving some workers feeling ill-equipped and unsafe on the job, according to interviews and internal documents from the Bureau of Prisons.

Dozens of workers from prisons across the country said inmates had become more brazen with staff members and more violent with one another.

The traditional rules go unenforced, which emboldens people to push the limits further.  When guards can’t be relied on to keep a prison orderly, gang violence often takes over as an alternate form of control.

In My Brother Moochie, journalist Issac J. Bailey describes the emotional fallout that accompanied his older brother’s violent crime.  After this brother, Moochie, was sent to prison, Bailey’s family crumbled.  Several of his younger brothers got involved with petty crime and have been cycling in and out of prison ever since.  For instance, Bailey’s younger brother James, who is traumatized by the violence he witnesses in prison:

The man who was killed was “a little Asian dude smaller than me, so about fifteen of them ran into the room and started stabbing him,” James said.  “Dude was supposed to go home the next week.  What’s crazy is dude is from California and he can’t even speak his family’s original language.  They stabbed him out of fear.”

A shortage of prison guards throughout the state’s correctional system meant the few on duty didn’t always manage to make the rounds through the dorms on schedule.

I teach at our local county jail.  During a staffing shortage two summers ago, the jail became much less safe.  According to former inmate (and excellent human being) Max Smith, “Guys learned to time things.  A guard would be walking through for the count, some guys would be wailing on somebody inside a cell, they’d have somebody go up, ask the guard a question, distract him right when he got to that window.  Then he’d keep walking and they’d continue beating the shit out of somebody.  It was a scary place to be.”

Maybe there’s more that my spouse could be doing to establish a culture that will stay calm even when substitutes come into her classroom.  But I know that she’s already trying awfully hard, and she’s one of our country’s best teachers.

I think it’s safe to assume that the average prison guard puts less energy than she does into cultivating a safe and respectful environment.  When subs cover for them, bad things are going to happen.

Maybe we as a country don’t want to spend so much money on our prisons.  If so, we should probably be spending a whole lot more on education, so that we won’t feel the need to lock people up – public schooling is a chance to turn people’s lives around, but it’s not like we’re pouring money into that.  And there’s sentencing reform.  With shorter prison sentences, we wouldn’t need so many guards.

But I can’t imagine that the best solution is to conscript secretaries, teachers, and medical staff into patrolling the halls.

On perception and learning.

On perception and learning.

Cuddly.

Fearful.

Monstrous.

Peering with the unwavering focus of a watchful overlord.

A cat could seem to be many different things, and Brendan Wenzel’s recent picture book They All Saw a Cat conveys these vagrancies of perception beautifully. Though we share the world, we all see and hear and taste it differently. Each creature’s mind filters a torrential influx of information into manageable experience; we all filter the world differently.

They All Saw a Cat ends with a composite image. We see the various components that were focused on by each of the other animals, amalgamated into something approaching “cat-ness.” A human child noticed the cat’s soft fur, a mouse noticed its sharp claws, a fox noticed its swift speed, a bird noticed that it can’t fly.

All these properties are essential descriptors, but so much is blurred away by our minds. When I look at a domesticated cat, I tend to forget about the sharp claws and teeth. I certainly don’t remark on its lack of flight – being landbound myself, this seems perfectly ordinary to me. To be ensnared by gravity only seems strange from the perspective of a bird.

theyallsawThere is another way of developing the concept of “cat-ness,” though. Instead of compiling many creatures’ perceptions of a single cat, we could consider a single perceptive entity’s response to many specimens. How, for instance, do our brains learn to recognize cats?

When a friend (who teaches upper-level philosophy) and I were talking about Ludwig Wittgenstein’s Philosophical Investigations, I mentioned that I felt many of the aims of that book could be accomplished with a description of principal component analysis paired with Gideon Lewis-Kraus’s lovely New York Times Magazine article on Google Translate.

My friend looked at me with a mix of puzzlement and pity and said, “No.” Then added, as regards Philosophical Investigations, “You read it too fast.”

wittgensteinOne of Wittgenstein’s aims is to show how humans can learn to use language… which is complicated by the fact that, in my friend’s words, “Any group of objects will share more than one commonality.” He posits that no matter how many red objects you point to, they’ll always share properties other than red-ness in common.

Or cats… when you’re teaching a child how to speak and point out many cats, will they have properties other than cat-ness in common?

In some ways, I agree. After all, I think the boundaries between species are porous. I don’t think there is a set of rules that could be used to determine whether a creature qualifies for personhood, so it’d be a bit silly if I also claimed that cat-ness could be clearly defined.

But when I point and say “That’s a cat!”, chances are that you’ll think so too. Even if no one had ever taught us what cats are, most people in the United States have seen enough of them to think “All those furry, four-legged, swivel-tailed, pointy-eared, pouncing things were probably the same type of creature!”

Even a computer can pick out these commonalities. When we learn about the world, we have a huge quantity of sensory data to draw upon – cats make those noises, they look like that when they find a sunny patch of grass to lie in, they look like that when they don’t want me to pet them – but a computer can learn to identify cat-ness using nothing more than grainy stills from Youtube.

Quoc Le et al. fed a few million images from Youtube videos to a computer algorithm that was searching for commonalities between the pictures. Even though the algorithm was given no hints as to the nature of the videos, it learned that many shared an emphasis on oblong shapes with triangles on top… cat faces. Indeed, when Le et al. made a visualization of the patterns that were causing their algorithm to cluster these particular videos together, we can recognize a cat in that blur of pixels.

The computer learns in a way vaguely analogous to the formation of social cliques in a middle school cafeteria. Each kid is a beautiful and unique snowflake, sure, but there are certain properties that cause them to cluster together: the sporty ones, the bookish ones, the D&D kids. For a neural network, each individual is only distinguished by voting “yes” or “no,” but you can cluster the individuals who tend to vote “yes” at the same time. For a small grid of black and white pixels, some individuals will be assigned to the pixels and vote “yes” only when their pixels are white… but others will watch the votes of those first responders and vote “yes” if they see a long line of “yes” votes in the top quadrants, perhaps… and others could watch those votes, allowing for layers upon layers of complexity in analysis.

three-body-problem-by-cixin-liu-616x975And I should mention that I feel indebted to Liu Cixin’s sci-fi novel The Three-Body Problem for thinking to humanize a computer algorithm this way. Liu includes a lovely description of a human motherboard, with triads of trained soldiers hoisting red or green flags forming each logic gate.

In the end, the algorithm developed by Le et al. clustered only 75% of the frames from Youtube cat videos together – it could recognize many of these as being somehow similar, but it was worse at identifying cat-ness than the average human child. But it’s pretty easy to realize why: after all, Le et al. titled their paper “Building high-level features using large scale unsupervised learning.”

Proceedings of the International Conference on Machine Learning 2010
You might have to squint, but there’s a cat here. Or so says their algorithm.

When Wittgenstein writes about someone watching builders – one person calls out “Slab!”, the other brings a large flat rock – he is also considering unsupervised learning. And so it is easy for Wittgenstein to imagine that the watcher, even after exclaiming “Now I’ve got it!”, could be stymied by a situation that went beyond the training.

Many human cultures have utilized unsupervised learning as a major component of childrearing – kids are expected to watch their elders and puzzle out on their own how to do everything in life – but this potential inflexibility that Wittgenstein alludes to underlies David Lancy’s advice in The Anthropology of Childhood that children will fair best in our modern world when they have someone guiding their education and development.

Unsupervised learning may be sufficient to prepare children for life in an agrarian village. Unsupervised learning is sufficient for chimpanzees learning how to crack nuts. And unsupervised learning is sufficient to for a computer to develop an idea about what cats are.

But the best human learning employs the scientific method – purposefully seeking out “no.”

I assume most children reflexively follow the scientific method – my daughter started shortly after her first birthday. I was teaching her about animals, and we started with dogs. At first, she pointed primarily to creatures that looked like her Uncle Max. Big, brown, four-legged, slobbery.

IMG_5319.JPG
Good dog.

Eventually she started pointing to creatures that looked slightly different: white dogs, black dogs, small dogs, quiet dogs. And then the scientific method kicked in.

She’d point to a non-dog, emphatically claiming it to be a dog as well. And then I’d explain why her choice wasn’t a dog. What features cause an object to be excluded from the set of correct answers?

Eventually she caught on.

Many adults, sadly, are worse at this style of thinking than children. As we grow, it becomes more pressing to seem competent. We adults want our guesses to be right – we want to hear yes all the time – which makes it harder to learn.

The New York Times recently presented a clever demonstration of this. They showed a series of numbers that follow a rule, let readers type in new numbers to see if their guesses also followed the rule, and asked for readers to describe what the rule was.

A scientist would approach this type of puzzle by guessing a rule and then plugging in numbers that don’t follow it – nothing is ever really proven in science, but we validate theories by designing experiments that should tell us “no” if our theory is wrong. Only theories that all “falsifiable” fall under the purvey of science. And the best fields of science devote considerable resources to seeking out opportunities to prove ourselves wrong.

But many adults, wanting to seem smart all the time, fear mistakes. When that New York Times puzzle was made public, 80% of readers proposed a rule without ever hearing that a set of numbers didn’t follow it.

Wittgenstein’s watcher can’t really learn what “Slab!” means until perversely hauling over some other type of rock and being told, “no.”

We adults can’t fix the world until we learn from children that it’s okay to look ignorant sometimes. It’s okay to be wrong – just say “sorry” and “I’ll try to do better next time.”

Otherwise we’re stuck digging in our heels and arguing for things we should know to be ridiculous.

It doesn’t hurt so bad. Watch: nope, that one’s not a cat.

16785014164_0b8a71b191_z
Photo by John Mason on Flickr.

On David Lancy’s The Anthropology of Childhood, and violence against women (again!), and proscriptive parenting advice.

On David Lancy’s The Anthropology of Childhood, and violence against women (again!), and proscriptive parenting advice.

Despite being my family’s primary daytime parent, I’ve read extremely few parenting guides.  Zero, as it happens, unless you count Everywhere Babies (if you’re interested, here is a previous post where I discussed this baby-wrangling treasure) or Far from the Tree.

51E2pM00dFLPersonally, I count Andrew Solomon’s Far from the Tree as a parenting guide.  I was very nervous about the prospect of having a kid.  I worried that I’d be a rubbish parent.  I worried that I’d have an unmanageable kid.  Then I read Far from the Tree, and I stopped worrying.  K & I decided to forgo prenatal genetic testing; Solomon had convinced me that we could love whomever we received.  And he taught me the one essential lesson I needed to set me on my journey to becoming at least a tolerable (I hope!) parent: relax.

I’d recommend that any parent-to-be (or parent, or person, honestly … it’s a lovely book) read Far from the Tree.  But for the moment, here’s my favorite passage from the book, one that both stresses the importance of accepting what happens and accepting people, including your own children, for who they are:

People of higher socioeconomic status tend toward perfectionism and have a harder time living with perceived defects.  One French study said baldly, “The lower classes show a higher tolerance for severely handicapped children.”  An American study bears out that conclusion, inasmuch as higher-income families are “more apt to stress independence and self-development,” while lower-income families emphasize “interdependence among family members.”  Better-educated more-affluent families are more likely to seek placement for their children, and white families do so more often than minority families, though disturbingly high numbers of minority parents lose children to foster care.  I did back-to-back interviews with a white woman who had a low-functioning autistic son, and an impoverished African-American woman whose autistic son had many of the same symptoms.  The more privileged woman had spent years futilely trying to make her son better.  The less advantaged woman never thought she could make her son better because she’d never been able to make her own life better, and she was not afflicted with feelings of failure.  The first woman found it extremely difficult to deal with her son.  “He breaks everything,” she said unhappily.  The other woman had a relatively happy life with her son.  “Whatever could be broken got broken a long time ago,” she said.  Fixing is the illness model; acceptance is the identity model; which way any family goes reflects their assumptions and resources.

A child may interpret even well-intentioned efforts to fix him as sinister.  Jim Sinclair, an intersex autistic person, wrote “When parents say, ‘I wish my child did not have autism,’ what they’re really saying is, ‘I wish the autistic child I have did not exist, and I had a different (non-autistic) child instead.’  Read that again.  This is what we hear when you mourn over our existence.  This is what we hear when you pray for a cure.  This is what we know, when you tell us of your fondest hopes and dreams for us: that your greatest wish is that one day we will cease to be, and strangers you can love will move in behind our faces.”

Once I had Solomon’s advice in hand (& re-typed & ready to share with you, dear reader!), why would I bother reading another parenting guide?  Any time I come to a situation that Solomon didn’t address, I simply close my eyes and imagine what a cave person attempting to raise a daughter to participate in our technologically-magical information-based economy would do.  Most of the time that imagined cave person (me, in fact) would simply feel perplexed (you’re telling me that your telephone is also a camera??), but sometimes cave dad would probably coo & pat his daughter’s belly, or else read her another book.

I love learning, though.  If I had access to a good book on parenting, I’d read it!  I simply assumed that I wouldn’t like most of the ones I could find at the bookstore.

onlybabybookThat’s why I was so excited when I read Michael Erand’s New York Times article earlier this year, titled “The Only Baby Book You’ll Ever Need.”  Here, let me quote a few lines from the introduction:

Professor Lancy, who teaches at Utah State University, has pored over the anthropology literature to collect insights from a range of culture types, along with primate studies, history and his own fieldwork in seven countries.  He’s not explicitly writing for parents.  Yet through factoids and analysis, he demonstrates something that American parents desperately need to hear: Children are raised in all sorts of ways, and they all turn out just fine.

That sounds exactly like what I’d enjoy reading!  A book about parenting that’s descriptive, not proscriptive.  And I’ve loved reading pop anthropology books ever since paying a quarter for a lovely hardcover edition of Desmond Morris’s The Naked Ape at a library book sale in Evanston, Illinois.

CaptureI have to assume that the first edition of the recommended book, David Lancy’s The Anthropology of Childhood: Cherubs, Chattel, Changelings, was very different from the current second edition, which was published in February of this year.  Because the book I read was intensely proscriptive.  Yes, Lancy documents a wide variety of parenting strategies.  But he also makes abundantly clear his opinion that those parenting strategies would not be appropriate in our culture.

I didn’t mind.  Lancy’s book is quite good, and his ideas about what makes good parenting align closely with my own.  But someone who’d read the Times article might expect the book to be very different from what it is.

As with Dorothy Dinnerstein’s The Mermaid and the Minotaur (would you count a work of feminist philosophy as a parenting guide?  If so, perhaps I’d read one after all.  My previous post about Dinnerstein’s book and parenting is here), Lancy’s foremost prescription is equality — most conspicuously, since not all cultures have multiple races, castes, or tiers of wealth, he’s referring to gender equality:

There is a world in which children almost always feel “wanted” and where “there is no cultural preference for babies of either sex.”  Infants are suckled on demand by their mothers and by other women in her absence.  They are indulged and cosseted by their fathers, grandparents, and siblings.  Children wean themselves over a long period and are given nutritious foods.  They are subject to little or no restraint or coercion.  Infants and toddlers are carried on long journeys and comforted when distressed.  If they die in infancy, they may be mourned.  They are rarely or never physically punished or even scolded.  They are not expected to make a significant contribution to the household economy and are free to play until the mid to late teens.  Their experience of adolescence is relatively stress free.  This paradise exists among a globally dispersed group of isolated societies — all of which depend heavily on foraging for their subsistence.  They are also characterized by relatively egalitarian and close social relations, including relative parity between men and women.**

  ** Thinking of Malinowki’s ethnography of the Trobriand Islanders, I’m tempted to argue that any society with conspicuous gender parity is likely to be a paradise for children.

And shortly thereafter, Lancy makes explicit that many of the parenting practices he’s documenting are horrible.  For instance, misogyny is rampant throughout the world, to such an extent that a significant fraction of female children are never even born.  This is rotten, & if enough parents choose to do this they’re even dooming their own (male, presumed heterosexual) children.  There parallels between this behavior and choosing not to vaccinate a child with a healthy immune system — in both cases, children are doomed if all parents make the same selfish choice, either because there won’t be enough women for the next generation to form families, or because the herd immunity relied upon to protect freeloaders will be lost.

Both China & India, where sex-selection of unborn children is rampant, are attempting legislative correctives.  In China, they’ve outlawed the practice, and in India they’ve instituted monetary incentives for female progeny… although that is conceptually problematic as well.  Here’s Jean Dreze & Amartya Sen from their book An Uncertain Glory:

j10175To 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 favour 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.  The fact that the cash incentives are typically lower for a second girl child, and nil for higher-order births, also sends confusing signals.  In short, it is not quite clear what sort of message these cash incentives are supposed to convey about the status and value of the girl child, and how they are supposed to affect social attitudes towards sex-selective abortion.  As mentioned earlier, the workings of social norms is critically important in this kind of area of values and actions, and it is important to think about the possible effects of cash transfers on social norms and their role, and not just about economic self-interest.

Paying parents for their misfortune of raising a girl still perpetuates misogyny.  And setting minimum standards on her care (you receive money if she’s vaccinated, if she attends school) likely results in that bare minimum being given.

And now, let me get back to Lancy’s horror:

More commonly, we find that the infant’s sex is highly salient in determining its fate.  Some years ago, I came across a United Nations report, on the cover of which was a picture of a mother holding on her lap a boy and a girl of about the same age, possibly twins.  The girl was skeletal, obviously in an advanced state of malnutrition, the boy robust and healthy.  He sat erect, eyes intent on the camera; she sprawled, like a rag doll, her eyes staring into space.  That picture and what it represented has haunted me ever since.

That’s not a value-less scientific description.  Which is fine.  I’m happy that Lancy’s book (the current edition, at least) is proscriptive.  Because Erand’s article, which included lines such as, “The book does not render judgments, like other parenting books we know,” also mentioned tidbits like, “In Gapun, an isolated village in Papua New Guinea, children are encouraged to hit dogs and chickens, and to raise knives at siblings.”

Really?  David Lancy doesn’t judge parents who give their children unsupervised access to knives?

Oh, wait.  He does.  He thinks that letting kids play with knives is bad.  From The Anthropology of Childhood:

On Vanatinai Island in the South Pacific, “children … manipulate firebrands and sharp knives without remonstrance … one four year old girl had accidentally amputated parts of several fingers on her right hand by playing with a bush knife.”

And, later, Lancy is even more explicit.  Yes, different cultures use different parenting strategies.  To prepare a child for relatively simple life in an agrarian village — especially if you give birth to eight children and will be happy if only four of them survive — it’s fine to ignore them and expect them to learn what they need to know by watching their elders.  But attempting equivalent parenting strategies in our culture would, in Lancy’s opinion, invite disaster:

At the outset of this chapter, I set up a juxtaposition.  One view holds that, to succeed in life, children require the near-full-time attention of a mother who treats childrearing as a vocation and prepares herself assiduously.  A contrary view is that this is a task best shared among a variety of individuals, a village.  What can we conclude?  I would argue that, to prepare a child for life in the village, it is neither necessary nor an efficient use of scarce resources to put the burden on any one individual.  However, to prepare a child for the modern world, spreading the responsibility among a variety of individuals — none of whom is in charge — invites disaster.  Hillary Clinton, in It Takes a Village, tries to apply the village model to the modern situation.  She argues for improvements in schools and social service agencies, an increase in library and playground facilities, and after-school programs — among other things.  All these proposals are helpful, but all these agents — teachers, librarians, playground supervisors, Boys & Girls Club volunteers — cannot, collectively, substitute for a dedicated, resourceful parent.  They are not related to the child and, in our society, the village is not responsible.  The parent is.  At best, these agents can only assist the parent in fulfilling their plan for the child.

Having said that much, I want immediately to disavow any claim that this task requires the full-time ministrations of the child’s biological mother.  There is overwhelming evidence — not reviewed here — that fathers, adoptive parents, lesbian partners of the biological mothers, and grandparents can all do a fine job.  Any of them, or the child’s mother, can and usually do avail themselves of an array of supplementary caretakers.  A working mother, in particular, may well bring home cultural, intellectual, and, certainly, economic resources that a non-working mother cannot provide.

So parenting in contemporary society is at least somewhat like physics, as it is tough to insure the child’s future success and a close, lasting filial relationship.  But, ultimately, we come full circle in that, as long as a reasonably competent and caring individual is in charge, the more loving, intelligent, and dedicated helpers surrounding the nest, the better off the twenty-first-century child will be.

Lancy writes that those village children’s lives are often bad, and that imported practices from Western nations have made them even worse:

Numerous studies have shown the deleterious effects on children’s health in the agriculturalist’s pursuit of the “production” strategy.  However, as the land is brought fully into cultivation, population-limiting mechanisms (such as the post-partum sex taboo) should develop to curtail further growth.  And this seems to have happened in many, many cases.  However, Western influence in the past hundred years seems to have dismantled these mechanisms, including, especially, abortion and infanticide.  Improved nutrition and healthcare for mothers has no doubt brought benefits.  But missionary efforts to stamp out “pagan” practices like polygyny also undermined the post-partum taboo on intercourse, even while they simultaneously blocked the introduction of modern contraceptives.  Additionally, “fashion” and commercial interests pushing infant “formula” have drastically reduced the number of infants being breastfed [breastfeeding is often an effective contraceptive.  Also, my computer marks “breastfed” and “breastfeeding” as spelling errors.  Yeah paternalistic misogyny!].  The result has been, in many parts of the world, population growth outstripping opportunities for either employment or improved food production.

Lancy even ends The Anthropology of Childhood with a powerful statement about economic & medical ethics.  Indeed, it’s difficult to read this as being anything but proscriptive:

Even though we recoil from discussions of children as chattel, our current policies, in fact, turn children into commodities with a precise dollar value.  Effectively, we embrace the notions that anyone can have a child, everyone can have as many children as they want, infertility can be circumvented, and the fetus is human and deserves whatever measures are available to keep it alive, regardless of any handicaps or defects it may harbor.  The net result of our mindset is that the marketplace decides the fate of children.  In poor countries, food shortages mean many potentially sound children will suffer malnutrition and neglect.  Wealth in the “North” that might be sent “South” to vaccinate, educate, and feed these children is, instead, spent at home on expensive technologies and caretakers to keep alive children whose quality of life is non-existent.  While sick, premature babies born to the well-off will survive through “miracles” of modern medicine, the poor will lose their otherwise healthy children to preventable diseases.

To me, this is a sensible proscription to make — it is similar to my own reasoning for abandoning a career in biomedical research.  Medical spending will continue to spiral out of control if we focus on preserving life at all costs with no concern for quality of life, and by wasting that money we perpetuate egregious harm through economic hardship.

So, I was thrilled to read David Lancy’s book.  I assume you’d like it too, given that you still seem to be reading my post about it.

Just, don’t go into it expecting a descriptive work devoid of value claims.  Because that’s not what you’re getting, at least not if you read the current edition.

And I’m still trying to figure out why Erand had such a different impression.  Because, sure, it’s possible that the first edition was extremely different.  But I think the confusion is more likely related to a point I made at the beginning of this essay: when I imagine myself as a cave person trying to raise his daughter, I have to imagine that cave dad raising his daughter for our world.  Not his world.

It’s a common mistake when people discuss human evolution.  Like, paleo diets?  Seems like a reasonable idea, trying to eat what humans evolved to eat.  But humans also evolved for constant motion & early death.  If that’s the way you’re planning to live, then, sure, you’ve got a valid argument for eating that way.  If not, the argument seems much less compelling.

Here’s where the problem comes from in Erand’s piece.  He writes:

caIn the ‘pick when ripe’ culture, babies and toddlers are largely ignored by adults, and may not be named until they’re weaned.  They undergo what he calls a ‘village curriculum’: running errands, delivering messages and doing small-scale versions of adult tasks.  Only later are they ‘picked,’ or fully recognized as individuals.  In contrast, in ‘pick when green’ cultures, including our own, it’s never too early to socialize babies or recognize their personhood.

But, Lancy makes clear why “pick when ripe” cultures made the choices they did.  As in, huge infant mortality meant that high-investment parenting would probably be wasted: why should that parent care that a kid was on track for greatness if the kid then dies at three?  And the potential “greatness” that was perceived to be within reach was pretty meager anyway — even a neglected child could eventually catch up and learn to farm well enough.

Whereas a parent who expects his or her children to survive, and who will only attempt to raise one to three (instead of seven to ten, with 60% of them dying young), should invest a lot of time.  Especially if you’re hoping for some complex, modern version of “success,” something involving happiness, for instance, and money.

And, yes, Lancy also thinks you should teach your children to do chores.

On attempts to see the world through other eyes.

On attempts to see the world through other eyes.

flowers

Most writers spend a lot of time thinking about how others see the world.  Hopefully most non-writers spend time thinking about this too.  It’s easier to feel empathy for the plights of others if you imagine seeing through their eyes.

So I thought it was pretty cool that the New York Times published an article about processing images to represent how they might appear to other species.

The algorithm shifts the color distribution of images to highlight which objects appear most distinct for an animal with different photoreceptors.  I thought it was cool even though the processing they describe fails in many ways to convey how differently various animals perceive the world.

For one thing, image processing can only affect visuals.  Another species may rely more on sound, scent, taste (although perhaps it’s cheating to list both scent and taste — they are essentially the same sense, chemodetection, with the difference being that humans respond more sensitively, and to a wider variety of chemicals, with our noses than our tongues), touch, sensing magnetic fields, etc.

If we assume that other animals will also place maximal trust in the detection of inbound electromagnetic radiation from the narrow band we’ve deemed “the visual spectrum,” we can fool ourselves regarding their most likely interpretations.  For an example, you could read my previous post about why rattlesnakes might assume that humans employ chameleon-like camouflage (underlying idea courtesy of Jesus Rivas & Gordon Burghardt).

The second problem with assuming that an image with shifted colors represents how another animal would view the world is on the level of neurological processing.  When a neurotypical human looks at an image and something resembles a face, that portion of the image will immediately dominate the viewer’s attention; a huge amount of human brainpower is devoted to processing faces.  Similarly, some dogs, if another dog enters their visual field, have trouble seeing anything else.  And bees: yes, they see more blues & ultraviolets than we do, but it’s also likely that flowers dominate their attention. I imagine it’s something like the image below, taken with N and her Uncle Max on a recent walk. Although, depending on your personality, you might have some dog-style neurological processing, too.

unnamed

Even amongst humans this type of perceptual difference exists.  A friend of mine who does construction (ranked the second-best apprentice pipefitter in the nation the year he finished his training, despite being out at a buddy’s bachelor party, i.e. not sleeping, all night before the competition), when he walks into a room, immediately notices all exposed ductwork, piping, etc.  Most people care so little about these features as to render them effectively invisible.  And I, after three weeks of frantic itching and a full course of methylprednisolone, could glance at any landscape in northern California and immediately point out all the poison oak.  My daughter can spot a picture or statue of an owl from disconcertingly far away and won’t stop yelling “owww woo!” until I see it too.

The color processing written up in the New York Times, though, was automated.  Given the current state of computerized image recognition, you probably can’t write a script that would magnify dogs or flowers or poison oak effectively.  Maybe in a few years.

There’s one last big problem, though.  And the last problem is about the colors alone.  There is simply no way to re-color images so that a dichromatic (colloquially, “colorblind”) human would see the world like a trichromat.

(A brief aside: Shortly after I wrote the above sentence, I read an article about glasses marketed to colorblind people to let them see color.  And the basic idea is clever, but I don’t think it invalidates my claim.

glasses

Here’s how it works: most colorblind people are dichromats, meaning they have two different flavors of color receptors.  Colored light stimulates these receptors differentially: green light stimulates green receptors a lot and blue receptors a little.  Blue light stimulates blue receptors a lot and green receptors a little.  The brain processes the ratio of receptor stimulation to say, “Ah ha!  That object is blue!”

A typical human, however, is a trichromat.  This means that the brain uses three datapoints to determine an object’s color instead of two.  The red and green receptors absorb maximally near the same part of the spectrum, though… the red vs. blue & green vs. blue ratios are generally very similar.  So the third receptor type mostly helps a trichromat distinguish between red and green.

This means a dichromat will have a narrower range of the electromagnetic spectrum that they are good at distinguishing color within.  For a dichromat, reds and greens both will be characterized by “green receptor stimulated a lot, blue receptor only a little.”

Now, if you imagine that the visual spectrum is number line that runs from 0 to 100, a dichromat would be good at distinguishing colors in the first 0 to 50 segment, and not good at distinguishing color beyond that point — everything with green wavelength, ca. 500 nanometers, and longer, would appear to be green.

But you could take that 0 to 100 number line and just divide everything by 2.  Then every color would look “wrong” — no object would appear to be the same color as it was before you put on the wacky glasses — and you’d be less able to distinguish between close shades — if two colors needed to be 15 nanometers apart to seem different, now they’d need to be 30 nanometers apart — but a dichromat could distinguish between colors over the same full visual spectrum as trichromats.

That’s roughly how the glasses should work — inbound light is shifted such that all colors are made blue & greenish, and the visual spectrum is condensed).

Of course, even though you can’t change an image in a way that will allow you (I’m assuming that you, dear reader, are a trichromat.  But my assumption has a 10% chance of being wrong.  My apologies!  I care about you, too, dichromatic reader!) and a dichromatic friend to see it the same way.  But you can change your friend.  You can inject a DNA-delivering retrovirus into your friend’s eyeball, and after a short neurological training period, you and your friend will see colors the same way!

Only in the eyeball!
Only in the eyeball!

It’s possible that your friend won’t like you any more if you do this.  But here’s how it works: the retrovirus encodes for the flavor of photoreceptor that none of your friend’s cone cells were expressing.  Upon infection, the virus will initiate production of that receptor… so now a subpopulation of cone cells will be sending new signals to the brain.  They’ll be stimulated by different wavelengths of light than they were before.  And brains, magically plastic things that they are, rapidly rewire themselves to incorporate any new data they have access to.

(If you’re interested in this sort of thing, you should look up biohacking.  Like implanting magnets in your fingers to “feel” electric or magnetic fields.  But I’m not going to link to anything.  Wrestling your friend to the ground in order to inject recombinant DNA into his eyeball?  That makes me smile.  But slicing open your own fingertips to put magnets under the skin?  That’s too creepy for me).

If a brain is suddenly receiving different signals after exposure to red versus green light, it’ll use that information.  Which means: Color vision achieved!  Unfortunately, viral DNA integrates randomly, so a weird eye cancer might’ve been achieved as well.  You win some, you lose some.

What we call “color vision,” though, is still only trichromatic.  With three flavors of cone cells, humans can do a pretty good job distinguishing colors from about 400 to 700 nanometers.  But some species have more flavors of cone cells, which means they can distinguish the world’s colors more precisely.  Even some humans are tetrachromats, although their fourth cone cell flavor is maximally stimulated by light midway between red and green, a part of the electromagnetic spectrum that trichromatic humans are already good at parsing.  And tetrachromatic humans are rare: to the best of my knowledge no languages have a word for that secret color between red and green.  I don’t know any words for it, at least, but maybe this too is a secret guarded by those who see it.

Still, no amount of image processing would allow you, dear reader, even if you’re one of those rare tetrachromatic individuals, to see the world in all the spangled glory seen by a starling or a peacock.  This graph shows the stimulation of each flavor of cone cell receptor by different wavelengths of light.

bird eyes

And even the splendorous beauty seen by birds pales in comparison to the way we thought mantis shrimps perceive the world.  Because mantis shrimps, see, have twelve flavors of photoreceptors, which means that if their brains processed colors the same ways ours do, by considering the ratio of cone cell flavors that are stimulated by incident light, they’d be exquisitely sensitive to color.  Here: compare the spectral sensitivity graph for humans and starlings, shown above, to the equivalent graph for mantis shrimps.  This makes humans look pathetic!

mantis shrimp spectral sensitivity

If you haven’t see it, you should definitely read this cartoon about mantis shrimp perception from The Oatmeal.

oatmealIt’s possible that mantis shrimps process color differently from humans, though.  Instead of computing ratios of cone-flavor activation to determine the color of an object, they might decide that an object is the color of whatever single cone flavor is most stimulated.  In other words, while humans use stimulation ratios from our mere three flavors of cone cells to identify thousands of hues, a species with a dozen photoreceptor flavors might regard every object as being one of those dozen discrete colors.

Indeed, that’s what a recent study from Thoen et al. (“A Different Form of Color Vision in Mantis Shrimp”) suggests.  They trained mantis shrimps to attack a particular color of light in order to win a treat, then tested how well it could distinguish that color from nearby wavelengths.  In their hands, the shrimps needed approximately 50 nanometers separating two colors to distinguish them, whereas humans, with our meager three flavors of photoreceptors, can often distinguish colors as close as 1 or 2 nanometers apart.

Still, it’s hard to know exactly what a shrimp is thinking.  Testing human cognition and perception is easier because we can, you know, talk to each other.  Describe what we see.

With humans, the biggest barrier to empathy is that sometimes we forget to listen.