Public education is almost always contentious in this country: Evolution! The pledge of allegiance! The Founding Fathers’ complicity in felonious (oft murderous) abduction & torture!
Now, we’re also arguing over whether it’s safe for schools to be open at all!
At the school board meeting, a white woman stood up at the podium, ripped off her mask, and said “I can’t breathe.”
(Unfortunately, I assume the resonance with the BLM protests was intentional. When I went to pick up my kids from school last week, a white mother was wearing a t-shirt with the traditional white on black BLM layout that said “Drunk Wives Matter.” My hometown is within a half hour’s drive of the national KKK headquarters.)
As is the way of things in our country right now, about half the parents in attendance were aghast. The other half cheered.
“The masks don’t work! Everybody knows the masks don’t work!” people shouted.
Oddly enough, though, the people saying “the masks don’t work” are actually correct. But so are the people who say that masks work. The word “work” is pretty nebulous!
As Joseph Allen & Helen Jenkins wrote in a recent New York Times editorial, many well-meaning people have been unhelpfully vague when defining goals for our pandemic response. Are we trying to minimize lifelong harms from all causes? Are we trying to minimize the number of deaths that occur this year? Are we trying to eradicate the virus that causes Covid-19?
Each of these goals would require that we take a different set of actions.
Masks “work” in the sense that when people are wearing face masks, there’s a lower probability of Covid-19 transmission during any interaction.
Masks reduce the number of viral particles that exit a person’s airspace as they speak or exhale. Of course, this presupposes that the person wearing a mask actually is shedding viral particles. But that’s the tricky thing about Covid-19 (or influenza)! Some people feel fine!
Masks also might reduce the likelihood of transmission when an unexposed person who is hoping to avoid or delay illness wears a mask. (Masks probably help with this, but it’s less well tested.)
Universal mask requirements are a great tool to delay transmission!
When worn selectively – for instance, only during hospital visits, or only when inside nursing homes – masks can also skew the demographics of transmission. With Covid-19, skewing the demographics of transmission is a great goal!
Even back before we had safe, effective vaccines, we could’ve saved huge numbers of lives by skewing the demographics of transmission! Some people are much more likely to recover from Covid-19 safely than others! (Major risk factors include advanced age, diabetes status, and probably smoking status. But there are also unknown risk factors – we don’t know why certain young healthy people can get so sick from this.)
Masks don’t “work,” though, if the goal is to prevent cases of Covid-19.
By May of 2020, it was already clear that Covid-19 would become endemic. We’d spread the virus too widely by then. The virus will never go away. Cases will never fall to zero.
Everyone alive today, and everyone born in the future, will be exposed to Covid-19 eventually. (With the possible exception of people who happen to die of other causes within the next few years.)
There’s still a strong argument for using masks to delay Covid-19 transmission: with more time, more people can be vaccinated! The vaccines work, by which I mean that the vaccines save lives.
Everyone will be exposed to Covid-19! The people who have been vaccinated are much more likely to survive! This front page article in my local newspaper is fear mongering; it’s a sort of fear mongering that I wholeheartedly endorse!
Vaccination is a safe, effective, time-tested medical practice. The principles behind vaccination were independently discovered centuries ago by scientists and healers in Africa, India, and China. Their discoveries were the basis for Edward Jenner’s smallpox vaccine.
When scientists say that vaccines “work” – vaccines save lives – we mean something very different than when we say that masks “work” – masks delay exposure!
In conjunction with vaccination, masks can be helpful!
Which is why the argument that children should currently wear masks in school is reasonable. Covid-19 tends not to be very dangerous for children, but occasionally it’s deadly. There’s a definite cost to wearing masks in school – muffled voices, hidden facial expressions, increased hassle – but children could be kept safer by delaying their exposure to Covid-19 until after a vaccine is approved for them.
(I feel lucky that my kids have already safely recovered from Covid-19 – I’m not beset by the same fear over this that other parents are navigating. But I understand their concern: raising children often feels terrifying because my heart would shatter if anything happened to these tiny, willful, fragile creatures.)
Most of the people who say “masks don’t work” are planning not to get the Covid-19 vaccine. Which means, weirdly, that they’re right! Without the end goal of eventual vaccination, masks don’t work! Even if universal masking policies were kept in place forever, Covid-19 is so infectious that everyone would still be exposed eventually!
The vaccines can save lives; masks cannot.
Obviously, I’m not arguing that you should ignore local mask requirements: I’m currently wearing a face mask as I type this! And there are lots of people who do want to be vaccinated who don’t have access yet – this isn’t much of an issue for adults in the United States, but vaccine access is an incredible privilege for most of the world’s population.
Because Covid-19 can be transmitted by people who feel fine, wearing a mask is a way to protect others. And personal preference isn’t a good reason to endanger the lives of the folks around us! That’s why we have traffic laws! Even if I think it’d be fun to go out driving while buzzed on booze, or to cruise on the left-hand side of the road, I shouldn’t be allowed to do it!
But also, I think it’s worth acknowledging that, within the full context of their actions, people’s denunciations of masks are actually scientifically accurate.
“Follow the science” is an unhelpful slogan – scientific analysis doesn’t result in a monolithic set of inarguable conclusions. At the heart of any policy, there are goals and priorities. These are set by philosophical or ethical considerations, not scientific fact.
“Follow the scientific findings that help us all achieve my goals for the world” doesn’t have the same pithy ring to it, though.
The shape of things determines what they can do. Or, as a molecular biologist would phrase it, “structure determines function.”
In most ways, forks and spoons are similar. They’re made from the same materials, they show up alongside each other in place settings. But a spoon has a curved, solid bowl – you’d use it for soup or ice cream. A fork has prongs and is better suited for stabbing.
In matters of self defense, I’d reach for the fork.
On a much smaller scale, the three-dimensional shapes of a protein determines what it can do.
Each molecule of hemoglobin has a spoon-like pocket that’s just the right size for carrying oxygen, while still allowing the oxygen to wriggle free wherever your cells need it. A developing fetus has hemoglobin that’s shaped differently – when the fetal hemoglobin grabs oxygen, it squeezes more tightly, causing oxygen to pass from a mother to her fetus.
Each “voltage-gated ion channel” in your neurons has a shape that lets it sense incoming electrical signals and pass them forward. Voltage-gated ion channels are like sliding doors. They occasionally open to let in a rush of salt. Because salts are electrically charged, this creates an electric current. The electrical current will cause the next set of doors to open.
Every protein is shaped differently, which lets each do a different job. But they’re all made from the same materials – a long chain of amino acids.
Your DNA holds the instructions for every protein in your body.
Your DNA is like a big, fancy cookbook – it holds all the recipes, but you might not want to bring it into the kitchen. You wouldn’t want to spill something on it, or get it wet, or otherwise wreck it.
Instead of bringing your nice big cookbook into the kitchen, you might copy a single recipe onto an index card. That way, you can be as messy as you like – if you spill something, you can always write out a new index card later.
And your cells do the same thing. When it’s time to make proteins, your cells copy the recipes. The original cookbook is made from DNA; the index-card-like copies are made from RNA. Then the index cards are shipped out of the nucleus – the library at the center of your cells – into the cytoplasm – the bustling kitchen where proteins are made and do their work.
When a protein is first made, it’s a long strand of amino acids. Imagine a long rope with assorted junk tied on every few inches. Look, here’s a swath of velcro! Here’s a magnet. Here’s another magnet. Here’s a big plastic knob. Here’s another magnet. Here’s another piece of velcro. And so on.
If you shake this long rope, jostling it the way that a molecule tumbling through our cells gets jostled, the magnets will eventually stick together, and the velcro bits will stick to together, and the big plastic knob will jut out because there’s not enough room for it to fit inside the jumble.
That’s what happens during protein folding. Some amino acids are good at being near water, and those often end up on the outside of the final shape. Some amino acids repel water – like the oil layer of an unshaken oil & vinegar salad dressing – and those often end up on the inside of the final shape.
Other amino acids glue the protein together. The amino acid cysteine will stick to other cysteines. Some amino acids have negatively-charged sidechains, some have positively-charged sidechains, and these attract each other like magnets.
Sounds easy enough!
Except, wait. If you had a long rope with dozens of magnets, dozens of patches of velcro, and then you shook it around … well, the magnets would stick to other magnets, but would they stick to the right magnets?
You might imagine that there are many ways the protein could fold. But there’s only a single final shape that would allow the protein to function correctly in a cell.
So your cells use little helpers to ensure that proteins fold correctly. Some of the helpers are called “molecular chaperones,” and they guard various parts of the long strand so that it won’t glom together incorrectly. Some helpers are called “glycosylation enzymes,” and these glue little bits and bobs to the surface of a protein, some of which seem to act like mailing addresses to send the protein to the right place in a cell, some of which change the way the protein folds.
Our cells have a bunch of ways to ensure that each protein folds into the right 3D shape. And even with all this help, something things go awry. Alzheimer’s disease is associated with amyloid plaques that form in the brain – these are big trash heaps of misfolded proteins. The Alzheimer’s protein is just very tricky to fold correctly, especially if there’s a bunch of the misfolded protein strewn about.
Many human proteins can be made by bacteria. Humans and bacteria are relatives, after all – if you look back in our family trees, you’ll find that humans and bacteria shared a great-great-great-grandmother a mere three billion years ago.
The cookbooks in our cells are written in the same language. Bacteria can read all our recipes.
Which is great news for biochemists, because bacteria are really cheap to grow.
If you need a whole bunch of some human protein, you start by trying to make it in bacteria. First you copy down the recipe – which means using things called “restriction enzymes” to move a sequence of DNA into a plasmid, which is something like a bacterial index card – then you punch holes in some bacteria and let your instructions drift in for them to read.
The bacteria churn out copies of your human protein. Bacteria almost always make the right long rope of amino acids.
But human proteins sometimes fold into the wrong shapes inside bacteria. Bacteria don’t have all the same helper molecules that we do,.
If a protein doesn’t fold into the right shape, it won’t do the right things.
If you were working in a laboratory, and you found out that the protein you’d asked bacteria to make was getting folded wrong … well, you’d probably start to sigh a lot. Instead of making the correctly-folded human protein, your bacteria gave you useless goo.
But fear not!
Yeast can’t be grown as cheaply as bacteria, but they’re still reasonably inexpensive. And yeast are closer relatives – instead of three billion years ago, the most recent great-great-grandmother shared between humans and yeast lived about one billion years ago.
Yeast have a few of the same helper proteins that we do. Some human proteins that can’t be made in bacteria will fold correctly in yeast.
So, you take some yeast, genetically modify it to produce a human protein, then grow a whole bunch of it. This is called “fermentation.” It’s like you’re making beer, almost. Genetically modified beer.
Then you spin your beer inside a centrifuge. This collects all the solid stuff at the bottom of the flask. Then you’ll try to purify the protein that you want away from all the other gunk. Like the yeast itself, and all the proteins that yeast normally make.
If you’re lucky, the human protein you were after will have folded correctly!
If you’re unlucky, the protein will have folded wrong. Your yeast might produce a bunch of useless goo. And then you do more sighing.
There’s another option, but it’s expensive. You can make your human protein inside human cells.
Normally, human cells are hesitant to do too much growing and dividing and replicating. After all, the instructions in our DNA are supposed to produce a body that looks just so – two arms, two eyes, a smile. Once we have cells in the right places, cell division is just supposed to replace the parts of you that have worn out.
Dead skin cells steadily flake from our bodies. New cells constantly replace them.
But sometimes a cell gets too eager to grow. If its DNA loses certain instructions, like the “contact inhibition” that tells cells to stop growing when they get too crowded, a human cell might make many, many copies of itself.
Which is unhelpful. Potentially lethal. A cell that’s too eager to grow is cancer.
Although it’s really, really unhelpful to have cancer cells growing in your body, in a laboratory, cancer cells are prized. Cancer cells are so eager to grow that we might be able to raise them in petri dishes.
Maybe you’ve heard of HeLa cells – this is a cancer cell line that was taken from a Black woman’s body without her consent, and then this cell line was used to produce innumerable medical discoveries, including many that were patented and have brought in huge sums of money, and this woman’s family was not compensated at all, and they’ve suffered huge invasions of their privacy because a lot of their genetic information has been published, again without their consent …
HeLa cells are probably the easiest human cells to grow. And it’s possible to flood them with instructions to make a particular human protein. You can feel quite confident that your human protein will fold correctly.
But it’s way more expensive to grow HeLa cells than yeast. You have to grow them in a single layer in a petri dish. You have to feed them the blood of a baby calf. You have to be very careful while you work or else the cells will get contaminated with bacteria or yeast and die.
If you really must have a whole lot of a human protein, and you can’t make it in bacteria or yeast, then you can do it. But it’ll cost you.
Vaccination is perhaps the safest, most effective thing that physicians do.
Your immune system quells disease, but it has to learn which shapes inside your body represent danger. Antibodies and immunological memory arise in a process like evolution – random genetic recombination until our defenses can bind to the surface of an intruder. By letting our immune system train in a relatively safe encounter, we boost our odds of later survival.
The molecular workings of our immune systems are still being studied, but the basic principles of inoculation were independently discovered centuries ago by scientists in Africa, India, and China. These scientists’ descendants practiced inoculation against smallpox for hundreds of years before their techniques were adapted by Edward Jenner to create his smallpox vaccine.
If you put a virus into somebody’s body, that person might get sick. So what you want is to put something that looks a lot like the virus into somebody’s body.
One way to make something that looks like the virus, but isn’t, is to take the actual virus and whack it with a hammer. You break it a little. Not so much that it’s unrecognizable, but enough so that it can’t work. Can’t make somebody sick. This is often done with “heat inactivation.”
Heat inactivation can be dangerous, though. If you cook a virus too long, it might fall apart and your immune system learns nothing. If you don’t cook a virus long enough, it might make you sick.
In some of the early smallpox vaccine trials, the “heat inactivated” viruses still made a lot of people very, very sick.
Fewer people got very sick than if they’d been exposed to smallpox virus naturally, but it feels different when you’re injecting something right into somebody’s arm.
We hold vaccines to high standards. Even when we’re vaccinating people against deadly diseases, we expect our vaccines to be very, very safe.
It’s safer to vaccinate people with things that look like a virus but can’t possibly infect them.
This is why you might want to produce a whole bunch of some specific protein. Why you’d go through that whole rigamarole of testing protein folding in bacteria, yeast, and HeLa cells. Because you’re trying to make a bunch of protein that looks like a virus.
Each virus is a little protein shell. They’re basically delivery drones for nasty bits of genetic material.
If you can make pieces of this protein shell inside bacteria, or in yeast, and then inject those into people, then the people can’t possibly be infected. You’re not injecting people with a whole virus – the delivery drone with its awful recipes inside. Instead, you’re injecting people with just the propeller blades from the drone, or just its empty cargo hold.
These vaccine are missing the genetic material that allow viruses to make copies of themselves. Unlike with a heat inactivated virus, we can’t possibly contract the illness from these vaccines.
This is roughly the strategy used for the HPV vaccine that my father helped develop. Merck’s “Gardasil” uses viral proteins made by yeast, which is a fancy way of saying that Merck purifies part of the virus’s delivery drone away from big batches of genetically-modified beer.
We have a lot of practice making vaccines from purified protein.
Even so, it’s a long, difficult, expensive process. You have to identify which part of the virus is often recognized by our immune systems. You have to find a way to produce a lot of this correctly-folded protein. You have to purify this protein away from everything else made by your bacteria or yeast or HeLa cells.
The Covid-19 vaccines bypass all that.
In a way, these are vaccines for lazy people. Instead of finding a way to make a whole bunch of viral protein, then purify it, then put it into somebody’s arm … well, what if we just asked the patient’s arm to make the viral protein on its own?
Several of the Covid-19 vaccines are made with mRNA molecules.
These mRNA molecules are the index cards that we use for recipes in our cells’ kitchens, so the only trick is to deliver a bunch of mRNA with a recipe for part of the Covid-19 virus. Then our immune system can learn that anything with that particular shape is bad and ought to be destroyed.
After learning to recognize one part of the virus delivery drone, we’ll be able to stop the real thing.
We can’t vaccinate people by injecting just the mRNA, though, because our bodies have lots of ways to destroy RNA molecules. After all, you wouldn’t want to cook from the recipe from any old index card that you’d found in the street. Maybe somebody copied a recipe from The Anarchist Cookbook – you’d accidentally whip up a bomb instead of a delicious cake.
I used to share laboratory space with people who studied RNA, and they were intensely paranoid about cleaning. They’d always wear gloves, they’d wipe down every surface many times each day. Not to protect themselves, but to ensure that all the RNA-destroying enzymes that our bodies naturally produce wouldn’t ruin their experiments.
mRNA is finicky and unstable. And our bodies intentionally destroy stray recipes.
So to make a vaccine, you have to wrap the mRNA in a little envelope. That way, your cells might receive the recipe before it’s destroyed. In this case, the envelope is called a “lipid nanoparticle,” but you could also call a fat bubble. Not a bubble that’s rotund – a tiny sphere made of fat.
Fat bubbles are used throughout cells. When the neurons in your brain communicate, they burst open fat bubbles full of neurotransmitters and scatter the contents. When stuff found outside a cell needs to be destroyed, it’s bundled into fat bubbles and sent to a cellular trash factories called lysosomes.
For my Ph.D. thesis, I studied the postmarking system for fat bubbles. How fat bubbles get addressed in order to be sent to the right places.
Sure, I made my work sound fancier when I gave my thesis defense, but that’s really what I was doing.
Anyway, after we inject someone with an mRNA vaccine, the fat bubble with the mRNA gets bundled up and taken into some of their cells, and this tricks those cells into following the mRNA recipe and making a protein from the Covid-19 virus.
This mRNA recipe won’t teach the cells how to make a whole virus — that would be dangerous! That’s what happens during a Covid-19 infection – your cells get the virus’s whole damn cookbook and they make the entire delivery drone and more cookbooks to put inside and then these spread through your body and pull the same trick on more and more of your cells. A single unstopped delivery drone can trick your cells into building a whole fleet of them and infecting cells throughout your body.
Instead, the mRNA recipe we use for the vaccine has only a small portion of the Covid-19 genome, just enough for your cells to make part of the delivery drone and learn to recognize it as a threat.
And this recipe never visits the nucleus, which is the main library in your cells that holds your DNA, the master cookbook with recipes for every protein in your body. Your cells are tricked into following recipes scribbled onto the vaccine’s index cards, but your master cookbook remains unchanged. And, just like all the mRNA index cards that our bodies normally produce, the mRNA from the vaccine soon gets destroyed. All those stray index cards, chucked unceremoniously into the recycling bin.
The Johnson & Johnson vaccine also tricks our cells into making a piece of the Covid-19 virus.
This vaccine uses a different virus’s delivery drone to send the recipe for a piece of Covid-19 into your cells. The vaccine’s delivery drone isn’t a real virus – the recipe it holds doesn’t include the instructions on how to make copies of itself. But the vaccine’s delivery drone looks an awful lot like a virus, which means it’s easier to work with than the mRNA vaccines.
Those little engineered fat bubbles are finicky. And mRNA is finicky. But the Johnson & Johnson vaccine uses a delivery drone that was optimized through natural selection out in the real world. It evolved to be stable enough to make us sick.
Now we can steal its design in an effort to keep people well.
Lots of people received the Johnson & Johnson vaccine without incident, but we’ve temporarily stopped giving it to people. Blood clots are really scary.
You might want to read Alexandra Lahav’s excellent essay, “Medicine Is Made for Men.” Lahav describes the many ways in which a lack of diversity in science, technology, and engineering fields can cause harm.
Cars are designed to protect men: for many years, we used only crash test dummies that were shaped like men to determine whether cars were safe. In equivalent accidents, women are more likely to die, because, lo and behold, their bodies are often shaped differently.
Women are also more likely to be killed by medication. Safety testing often fails to account for women’s hormonal cycles, or complications from contraceptives, or differences in metabolism, or several other important features of women’s bodies.
Although more than half our population are women, their bodies are treated as bizarre.
For most people, the Johnson & Johnson vaccine is safe. But this is a sort of tragedy that occurs too often – causing harm to women because we’re inattentive to the unique features of their bodies.
I haven’t been vaccinated yet, but I registered as soon as I was able – my first dose will be on April 26th. Although I’ve almost certainly already had Covid-19 before, and am unlikely to get severely ill the next time I contract it, I’m getting the vaccine to protect my friends and neighbors.
At the end of “Just Use Your Thinking Pump!”, a lovely essay that discusses the evolution (and perhaps undue elevation) of a particular set of practices now known as the scientific method, Jessica Riskin writes:
Covid-19 has presented the world with a couple of powerful ultimatums that are also strikingly relevant to our subject here. The virus has said, essentially, Halt your economies, reconnect science to a whole understanding of yourself and the world, or die.
With much economic activity slowed or stopped to save lives, let us hope governments find means to sustain their people through the crisis.
Meanwhile, with the din of “innovation” partially silenced, perhaps we can also use the time to think our way past science’s branding, to see science once again as integral to a whole, evolving understanding of ourselves and the world.
True, the world has presented us with an ultimatum. We must halt our economies, reconnect science to a whole understanding of ourselves and our world, or die.
Riskin is a professor at Stanford. Her skies are blackened with soot. In the words of Greta Thunberg, “Our house is on fire.”
For many years, we’ve measured the success of our economy in terms of growth. The idea that we can maintain perpetual growth is a delusion. It’s simple mathematics. If the amount of stuff we manufacture – telephones, televisions, air conditioners – rises by 3% each and every year, we’ll eventually reach stratospheric, absurd levels.
In the game “Universal Paperclips,” you’re put in control of a capitalist system that seeks perpetual growth. If you succeed, you’ll make a lot of paperclips! And you will destroy the planet.
Here in the real world, our reckless pursuit of growth has (as yet) wrought less harm, but we’ve driven many species to extinction, destroyed ancient forests, and are teetering at the precipice of cataclysmic climate change. All while producing rampant inequality with its attendant abundance of human misery.
We must reconnect science to a whole understanding of ourselves and the world, or die.
We are in danger. But Covid-19 isn’t the major threat we’re facing.
I consider myself to be more cautious than average – I would never ride a bicycle without a helmet – and I’m especially cautious as regards global pandemic. Antibiotic resistance is about to be a horrific problem for us. Zoogenic diseases like Covid-19 will become much more common due to climate change and increased human population.
I’m flabbergasted that these impending calamities haven’t caused more people to choose to be vegan. It seems trivial – it’s just food – but a vegan diet is one of our best hopes for staving off antibiotic resistant plagues.
A vegan diet would have prevented Covid-19. Not that eating plants will somehow turbocharge your immune system – it won’t – but this pandemic originated from a meat market.
And a vegan diet will mitigate your contribution to climate change, which has the potential to cause the full extinction of the human race.
Make our planet uninhabitable? We all die. Make our planet even a little less habitable, which leads to violent unrest, culminating in warring nations that decide to use nukes? Yup, that’s another situation where we all die.
By way of contrast, if we had made no changes in our lives during the Covid-19 pandemic – no shutdown, no masks, no social distancing, no PCR tests, no contact tracing, no quarantines – 99.8% of our population would have survived.
Indeed, we often discuss the Covid-19 crisis in a very imprecise way. We say that Covid-19 is causing disruptions to learning, that it’s causing domestic violence or evictions. On the front page of Sunday’s New York Times business section, the headline reads, “The Other Way that Covid Kills: Hunger.”
Covid-19 is a serious disease. We need to do our best to avoid exposing high-risk people to this virus, and we should feel ashamed that we didn’t prioritize the development of coronavirus vaccines years ago.
But there’s a clear distinction between the harms caused by Covid-19 (hallucinogenic fevers, cardiac inflammation, lungs filling up with liquid until a person drowns, death) and the harms caused by our response to Covid-19 (domestic violence, educational disruption, starvation, reduced vaccination, delayed hospital visits, death).
Indeed, if the harms caused by our response to Covid-19 are worse than the harms caused by Covid-19 itself, we’re doing the wrong thing.
In that New York Timesbusiness article, Satbir Singh Jatain, a third-generation farmer in northern India, is quoted: “The lockdowns have destroyed farmers. Now, we have no money to buy seeds or pay for fuel. …. soon they will come for my land. There is nothing left for us.”
Covid-19 is awful. It’s a nasty disease. I’m fairly confident that I contracted it in February (before PCR tests were available in the United States), and my spouse says it’s the sickest she’s ever seen me.
Yes, I’d done something foolish – I was feeling a little ill but still ran a kilometer repeat workout with the high school varsity track team that I volunteer with. High intensity workouts are known to cause temporary immunosuppression, usually lasting from 3 to 72 hours.
My whole family got sick, but I fared far worse than the others.
It was horrible. I could barely breathe. Having been through that, it’s easy to understand how Covid-19 could kill so many people. I wouldn’t wish that experience on anyone.
And I have very low risk. I don’t smoke. I don’t have diabetes. I’m thirty-seven.
I wish it were possible to protect people from this.
Obviously, we should have quarantined all international travelers beginning in December 2019. Actually, ten days probably would have been enough. We needed to diecitine all international travelers.
By February, we had probably allowed Covid-19 to spread too much to stop it.
By February, there were probably enough cases that there will always be a reservoir of this virus among the human species. 80% of people with Covid-19 feel totally fine and don’t realize they might be spreading it. By talking and breathing, they put viral particles into the air.
By the end of March, we were much, much too late. If you look at the numbers from New York City, it’s pretty clear that the preventative measures, once enacted, did little. Given that the case fatality rate is around 0.4%, there were probably about 6 million cases in New York City – most of the population.
Yes, it’s possible that New York City had a somewhat higher case fatality rate. The case fatality rate depends on population demographics and standard of care – the state of New York had an idiotic policy of shunting Covid-19 patients into nursing homes, while banning nursing homes from using Covid-19 PCR tests for these patients, and many New York doctors were prescribing hydroxychloroquine during these months, which increases mortality – but even if the case fatality rate in New York City was as high as 0.6%, a majority of residents have already cleared the virus by now.
The belated public health measures probably didn’t help. And these health measures have caused harm – kids’ schooling was disrupted. Wealthy people got to work from home; poor people lost their jobs. Or were deemed “essential” and had to work anyway, which is why the toll of Covid-19 has been so heavily concentrated among poor communities.
The pandemic won’t end until about half of all people have immunity, but a shutdown in which rich people get to isolate themselves while poor people go to work is a pretty shitty way to select which half of the population bears the burden of disease.
I am very liberal. And it’s painful to see that “my” political party has been advocating for policies that hurt poor people and children during the Covid-19 pandemic.
Because we did not act soon enough, Covid-19 won’t end until an appreciable portion of the population has immunity – at the same time.
As predicted, immunity to Covid-19 lasts for a few months. Because our public health measures have caused the pandemic to last longer than individual immunity, there will be more infections than if we’d done nothing.
The shutdowns, in addition to causing harm on their own, will increase the total death toll of Covid-19.
Unless – yes, there is a small glimmer of hope here – unless we soon have a safe, effective vaccine that most people choose to get.
Yes, there are clear positive externalities to vaccination, but I think this sounds like a terrible idea. Ethically, it’s grim – the Covid-19 vaccines being tested now are a novel type, so they’re inherently more risky than other vaccines. By paying people to get vaccinated, we shift this burden of uncertainty onto poor communities.
We already do this, of course. Drug trials use paid “volunteers.” Especially phase 1 trials – in which drugs are given to people with no chance of medical benefit, only to see how severe the side effects are – the only enrollees are people so poor that the piddling amounts of money offered seem reasonable in exchange for scarfing an unknown, possibly poisonous medication.
Just because we already do an awful thing doesn’t mean we should make the problem worse.
And, as a practical matter, paying people to do the right thing often backfires.
To illustrate, consider the recent introduction, in many Indian states, of schemes of cash incentives to curb sex-selective abortion. The schemes typically involve cash rewards for the registered birth of a girl child, and further rewards if the girl is vaccinated, sent to school, and so on, as she gets older.
These schemes can undoubtedly tilt economic incentives in favor of girl children. But a cash reward for the birth of a girl could also reinforce people’s tendency to think about family planning in economic terms, and also their perception, in the economic calculus of family planning, that girls are a burden (for which cash rewards are supposed to compensate).
Further, cash rewards are likely to affect people’s non-economic motives. For instance, they could reduce the social stigma attached to sex-selective abortion, by making it look like some sort of ‘fair deal’ — no girl, no cash.
What happens if it takes a few years before there are sufficient doses of an effective vaccine that people trust enough to actually get?
Well, by then the pandemic will have run its course anyway. Masks reduce viral transmission, but they don’t cut transmission to zero. Even in places where everyone wears masks, Covid-19 is spreading, just slower.
I’ve been wearing one – I always liked the Mortal Kombat aesthetic. But I’ve been wearing one with the unfortunate knowledge that masks, by prolonging the pandemic, are increasing the death toll of Covid-19. Which is crummy. I’ve chosen to behave in a way that makes people feel better, even though the science doesn’t support it.
We, as a people, are in an awful situation right now. Many of us are confronting the risk of death in ways that we have not previously.
More than 37 percent of deaths in 1900 were caused by infectious diseases, but by 1955, this had declined to less than 5 percent and to only 2 percent by 2009.
Of course, this trend will still hold true in 2020. In the United States, there have been about 200,000 Covid-19 deaths so far, out of 2,000,000 deaths total this year. Even during this pandemic, less than 1% of deaths are caused by Covid-19.
And I’m afraid. Poverty is a major risk factor for death of all causes in this country. Low educational attainment is another risk factor.
My kids am lucky to live in a school district that has mostly re-opened. But many children are not so fortunate. If we shutter schools, we will cause many more deaths – not this year, but down the road – than we could possibly prevent from Covid-19.
Indeed, school closures, by prolonging the pandemic (allowing people to be infected twice and spread the infection further), will increase the death toll from Covid-19.
School closures wouldn’t just cause harm for no benefit. School closures would increase the harm caused by Covid-19 and by everything else.
I live in a college town. Last week, students returned.
Yesterday’s paper explains that dire punishment awaits the students who attended a Wednesday night party. In bold letters atop the front page, “IU plans to suspend students over party.”
In the decade that I’ve lived here, many parties have led to sexual assaults, racist hate speech, and violence. The offending students were rarely punished. But this party was egregious because “there were about 100 people there.”
IU officials “have seen a photo … that shows a large group of young people standing close together outside a house at night, many of them not wearing masks.”
I’ve seen the images – someone filmed a video while driving by. There they are – a group of young people, standing outside.
Science magazine recently interviewed biologist Dana Hawley about social distancing in the animal kingdom.
When spiny lobsters are sick, their urine smells different. Healthy lobsters will flee the shared den. Leaving is dangerous, since the lobsters will be exposed to predators until they find a new home, but staying would be dangerous, too – they might get sick. To survive, lobsters have to balance all the risks they face.
My favorite example of social distancing in the animal kingdom wasn’t discussed. When an ant is infected with the cordyceps fungus, it becomes a sleeper agent. Jennifer Lu writes in National Geographic that “as in zombie lore, there’s an incubation period where infected ants appear perfectly normal and go about their business undetected by the rest of the colony.”
Then the fungus spreads through the ants body, secreting mind control chemicals. Eventually, the fungus will command the infected ant to climb to a high place. A fruiting body bursts from the ant’s head and rains spores over the colony.
Infection is almost always lethal.
If an ant notices that a colony member has been infected, the healthy ant will carry the infected ant away from the colony and hurl it from a cliff.
The herd immunity threshold isn’t an inherent property of a virus – it depends upon our environment and behaviors. In prisons, we’ve seen Covid-19 spread until nearly 90% of people were infected. In parts of New York City where many essential workers live in crowded housing, Covid-19 spread until 50% of people were infected.
In a culture where everyone kissed a sacred statue in the center of town each morning, the herd immunity threshold would be higher. If people wear masks while interacting with strangers, the herd immunity threshold will be lower.
In a world that maintains a reservoir of the virus, though, someone who hasn’t yet been exposed will always be at risk.
The New York Times recently discussed some of the challenges that colleges face when trying to reopen during the epidemic.
Most schools ban … socializing outside “social pods” – the small groups of students that some colleges are assigning students to, usually based on their dorms.
Most administrators seem to believe that a rule banning sex is unrealistic, and are quietly hoping that students will use common sense and refrain from, say, having it with people outside their pod.
In 2012, The Huffington Post published a list of the “Top 10 sex tips for college freshmen.” Their fourth piece of advice (#1 and #2 were condoms, #3 was not having sex while drunk) is to avoid having sex with people who live too close to you. “Students in other dorms = fair game. Students in same dorm = proceed with caution.”
I had a big group of friends for my first two years of college. After a breakup, I lost most of those friends.
This is crummy, but it would be much worse if I’d lost my friendships with the only people whom the administrators allowed me to spend time with.
We can slow the spread of Covid-19, but slowing the spread won’t prevent deaths, not unless we can stave off infection until there is a highly effective vaccine. That might take years. We might never have a highly effective vaccine – our influenza vaccines range in efficacy from about 20% to 80%, and we have much more experience making these.
Our only way to reduce the eventual number of deaths is to shift the demographics of exposure. If we reach the herd immunity threshold without many vulnerable people being exposed, we’ll save lives.
A college would best protect vulnerable students and faculty by allowing the students who are going to socialize to host dense parties for a few weeks before mingling with others. This would allow the virus to spread and be cleared before there was a risk of transferring infections to vulnerable people.
I’d draft a waiver. Are you planning to socialize this semester? If so, come do it now! By doing so, you will increase your risk of contracting Covid-19. This is a serious disease – it’s possible for young, healthy people to die from it. But, look, if you’re gonna socialize eventually, please just get it over with so that you don’t endanger other people.
With this plan, some young people might die of Covid-19. But some young people will die of Covid-19 even if everyone practices social distancing – slowing the spread of infections doesn’t save lives, it delays deaths. And fewer young people would die of Covid-19 than die of influenza each year.
When confronting cordyceps, which is almost always fatal, ants throw sick colony members off cliffs.
When ants confront less lethal fungal infections, they protect the colony by shifting the demographics of exposure and by ramping up to the herd immunity threshold as quickly as possible.
Malagocka et al. discuss demographics in their review article, “Social immunity behavior among ants infected by specialist and generalist fungi.”
Outside-nest foragers, who have the highest risks of acquiring pathogens from the environment, have limited access to the brood area with the most valuable groups, and are recruited from older individuals, who are less valuable from the colony survival perspective.
Konrad et al. discuss intentional exposure in their research article, “Social transfer of pathogenic fungus promotes active immunization in ant colonies.”
When worker ants encounter an infected colony member, they intentionally inoculate themselves. “Social immunization leads to faster elimination of the disease and lower death rates.”
It feels disquieting for me to defend the behavior of frat guys. Personally, I’d like to see the whole fraternity system abolished. And in March, when we knew less about Covid-19, I was appalled that people went out partying over spring break. But I was wrong. Perhaps inadvertently, those young people were behaving in the way that would save most lives.
the nurse called back and told us to use bleach on anything we touch, she said wash everything in hot water, insisted we won’t treat you if you’re asymptomatic, we won’t, and made us an appointment anyway. so we waited and waited with the dog-eared magazines and recall posters
It’s horrible to face the end. It’s almost worse to know that the things you fear are harmless to others. All the asymptomatic cases are like a slap in the face to those whose friends and family have died.
Braun et al. recently published a study in Nature showing that a large number of people who’ve never encountered Covid-19 may already have significant immunity. Parts of the Covid-19 virus are similar to the viruses that cause common colds, and exposure to those viruses might provide the immunity that lets people recover without ever feeling sick.
I believe we should be doing more to protect young people. Gun control, ending farm subsidies, fighting climate change. Enacting privacy laws to reign in the surveillance capitalists. Breaking up monopolies. Providing good careers despite automation. Making sure that everyone has clean air to breathe and clean water to drink. Getting nutritious food into our nation’s many food deserts. Providing equitable access to health care.
But, punishing young people for socializing?
We’re not making them safer. And we’re not making ourselves safer, either.
Seriously, I know we humans are selfish, but we have to be able to handle an epidemic better than ants.
During most of human evolution, children died regularly. In some cultures, the risk was so high that children weren’t named until they’d survived their second birthday.
But the advent of modern medicine – vaccines, antibiotics, sterile technique – has dramatically reduced childhood mortality. Wealthy parents in the U.S. expect their children to survive. And yet, this expectation can increase anxiety. Families are smaller; children are less replaceable. Parents pour so much of themselves into children’s early years that we’d be devastated if something went wrong.
And so modern parents hover. Rather than letting children roam free, comforted by the thought that out of six kids, surely one will be fine, wealthy parents in the U.S. strive to control the development of their one or two offspring.
In the book On Immunity, Eula Biss describes how difficult it can be to relinquish that control.
I already practiced some intuitive toxicology before my pregnancy, but I became thoroughly immersed in it after my son was born. As long as a child takes only breast milk, I discovered, one can enjoy the illusion of a closed system, a body that is not yet in dialogue with the impurities of farm and factory. Caught up in the romance of the untainted body, I remember feeling agony when my son drank water for the first time. “Unclean! Unclean!” my mind screamed.
Because I didn’t breastfeed my child, I glossed over this passage when I first read it. Even early on, I sometimes used water to dilute the milk that my partner pumped at work – when my kid was thirsty, I needed to offer something.
But I found myself thinking about this passage recently, when our eldest learned to read. Our family loves books – we’ve probably read to our children for an hour or more each day, and they spend more time flipping through the pages on their own.
When I read to my kids, I reflexively alter texts. In our version of James Marshall’s Fox on the Job, Fox had a bicycle accident while showing off for “his friends,” not “the girls.” In Fox is Famous, a character bemoans the challenges of baton twirling by saying “I’m just not good at this yet,” that (unprinted) final word used to convey a growth mindset.
And our kids would probably be puzzled by Raquel D’Apice’s essay about Go Dog Go because the voices I’ve used while reading led them to assume that the pink poodle was a fashionable male asking a female friend for advice (“Well, maybe he doesn’t have a mirror at home,” I explained when N was curious, “Why does he keep asking that?”).
I could control the stereotypes that my children were fed.
But books are dangerous! At the beginning of summer, our eldest learned how to read. A week later, I hid all the Calvin and Hobbes. She loves these! So do I. But four is too young to really understand concepts like “irony” or “anti-hero” – her behavior promptly tanked in mimicry of Calvin.
About a week after that, I hid the Peanuts. And Garfield (“He shouldn’t kick Odie off the table, right? Just like you shouldn’t have hit your sibling”).
She loves comics, but the only books we kept out were good, wholesome Mutts by vegan artist Patrick McDonnell.
And I hid others, like James Howe’s Howliday Inn (too scary – she could hardly sleep that night). We look over the front-page headlines of our local newspaper before deciding whether it can be left on the table.
Like Viet Thanh Nguyen, I’ve felt a little sad to see my child venture off into the intellectual world of books without me. I still worry what she’s ready for.
For much of human history, the paternal impulse to restrict access to books was blatantly evil. The medieval Christian church was reticent to use local languages because then poor people could interpret religious precepts for themselves. And the written word was considered exceptionally dangerous in the U.S. It was illegal to teach literacy to the people who were being tortured on sweltering plantations.
I’d like to think that my motivation for wanting to sculpt my child’s library is more benign. More akin, perhaps, to the scientists dismayed when the untrained general public dabble with misleadingly curated excerpts from research journals.
On Immunity documents the efforts that Eula Biss made to learn about vaccination. She writes that:
Unvaccinated children, a 2004 analysis of CDC data reveals, are more likely to be white, to have an older married mother with a college education, and to live in a household with an income of $75,000 or more – like my child.
The mothers I knew began debating whether or not to vaccinate our children against the novel influenza virus long before any vaccine became available to us.
Another mother said that her child had screamed frighteningly all night following her first vaccination and she would not risk another vaccination of any kind.
Although many of these women have received extensive schooling in the humanities, and clearly care deeply for their offspring, they are putting lives at risk, including those of their own children.
It’s possible to remain ignorant even after extensive schooling.
When my son was six months old, at the peak of the H1N1 flu pandemic, another mother told me that she did not believe in herd immunity. It was only a theory, she said, and one that applied mainly to cows. That herd immunity was subject to belief had not yet occurred to me, though there is clearly something of the occult in the idea of an invisible cloak of protection cast over the entire population.
In Biss’s social circle, people doubted demonstrable principles. Herd immunity, like the theory of evolution, is not only correct, it is the mathematical implication of uncontroversial assumptions. In the case of herd immunity, that viral diseases are communicable and that severe symptoms tend to make a virus more contagious. In the case of evolution, that the DNA replication process producing gametes has a non-zero error rate, that heritable DNA gives rise to traits, and that individuals with different traits might have different numbers of offspring (perhaps because one critter was eaten as a child, whereas the other survived).
But the people making ignorant decisions in Biss’s social circle certainly don’t think of themselves as ignorant. After all, they’re trying their best to stay informed. They aren’t scientists, but they read. They look up information, ingest it as best they can, and try to make good decisions.
When people read (and spin) articles in scientific journals without putting forth the effort to understand what the data really mean, they create an incentive for scientists to hide their findings. Sometimes there are caveats to the truth. For instance, each year’s flu vaccine is often much less effective than other vaccinations. Some years, the flu vaccine is dramatically ineffective.
If people are using papers like this as propaganda, though – trying, for whatever reason, to convince people not to get vaccinated (you want an evil conspiracy theory? Vaccines are cheap, and they prevent deadly, expensive illnesses. Are wealthy imbeciles recommending you forgo vaccination simply so that you’ll need to pay for more medical care?) – it stifles scientific discourse.
Roald Dahl wrote an open letter urging parents to have their children vaccinated. He describes his own family’s tragedy – before a vaccine was developed, his seven-year-old daughter died of measles. He thought she was getting better; he was wrong.
“Are you feeling all right?” I asked her.
“I feel all sleepy,” she said.
In an hour, she was unconscious. In twelve hours, she was dead.
Incidentally, I dedicated two of my books to Olivia, the first was James and the Giant Peach. That was when she was still alive. The second was The BFG, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.
This isn’t as scary as it sounds – the local mall Santa happens to be a developer for Dungeons & Dragons. Unfortunately, our daughter has a bit of trouble with impulse control. I’ve heard that this is normal for three year olds.
“What would you say to other kids about Santa?” we asked her.
“I’d tell them that Santa isn’t real.”
“But, remember, only their parents are supposed to tell them that.”
“Well, you should know that we will always tell you the truth. If we’re telling you a story, we’ll let you know that it’s a story. But some other families are different. They want their kids to believe the dungeon master lives on the North Pole with an army of elves.”
“I … I dunno, dude. But don’t tell the other kids, okay?”
I’ve written previously about the harm in conspiring against children – belief in one conspiracy theory makes people more likely to believe in another. People who believe that the government is covering up evidence of UFOs are also more likely to believe that vaccines cause autism, fluoride in the water enables mind control, and the Earth is flat.
And, sadly, we start our citizens early. The Santa story is a vast conspiracy, a large number of authority figures (grown-ups) collaborating to keep the child in a state of ignorance. A local philosophy professor told me that he felt the story was valuable as a measure of intellectual development – at first the child believes, but then begins to notice flaws in the story.
“Uh, if it takes two minutes to deliver presents, it would take a thousand years to visit everyone in the United States, or two million Santas on Christmas Eve – but not every house has a chimney!”
I think it would be cynical to lie to children as a developmental metric. This measurement changes the child (which is not Heisenberg’s uncertainty principle, f.y.i.). The experience of uncovering one conspiracy will train children to search for conspiracies elsewhere. Perhaps a child is supposed to realize that there’s no Santa at seven years old, that there are no gods at eleven, that the moon landing was faked at thirteen, that JFK is smoking blunts in the Illuminati’s underground lair at seventeen.
After all, the Santa story isn’t the final time we conspire against children. In my school’s health classes, all sexuality outside of marriage was described as fundamentally bad. Even if we somehow dodged pregnancy and disease, disrobed physical affection would break our hearts and leave us feeling guilty and ashamed. Recreational drug use was described in similarly bleak terms (by a teacher who drank coffee every morning).
Students grow up, get laid, drink beer, smoke pot. Grown-ups were hypocritically hiding the truth. Sex is fun. Drugs are fun.
What else were they hiding?
(Have you seen all those children’s books with pictures of happy animals on the farm?)
A lot of the guys in jail believe in conspiracy theories. Despite a plenitude of dudes with Aryan tattoos, I’ve never heard anybody on a full-tilt ZOG rant, but I’ve been told about Nostradamus, Biblical prophecy, the CIA (to be fair, I’ve spent a fair bit of time talking about MK Ultra, too).
To an extent, I understand why. The people in jail are being conspired against by judges, informants, and the police. With lives in thrall to the overt conspiracy of our criminal justice system, covert conspiracy seems probable, too.
And so, in preparation for this essay, I took a few minutes at the beginning of class to say, “There’s an administrator at the local school who thinks the Earth is flat. Says so to kids. You guys hear anybody talking about that?”
“Oh, yeah, there was this dude in A block! He was talking about it like all the time!”
“Now he’s in seg.”
“It’s like, has he never seen a globe?”
And the guys wondered what that administrator was doing inside a school.
“Cause kids go there to learn, right?”
Kids do need to learn critical thinking. They should question whether the things they’re taught make sense. I’ve heard plenty of teachers make erroneous claims, and not just in Indiana’s public schools – some professors at Northwestern and Stanford didn’t know what they were talking about either. Even so, I think it’s unhelpful to train children by having them uncover the Santa story. That experience is a step along the way to thinking your sensory experience has primacy over abstract data.
After all, the planet feels flat enough. It looks flat from most human vantages. And it would be cheaper to deceive people than to send spacecraft to the moon (a former colleague recently went to the International Space Station for some incredibly expensive molecular biology experiments. This was a huge undertaking – and she was only 0.1% of the way to the moon).
If you take a kid for his MMR vaccine, and shortly after vaccination he seems to regress into autism, that narrative – which you watched with your own eyes! – is more compelling than a bunch of medical statistics proving there’s no connection. If you comb the Bible and find lines mirroring current events, that narrative also must seem more compelling than the thought that history is chaotic. Physicists from Einstein till the present day have been dismayed that quantum mechanics feels so unintuitive.
It’s tricky to find a balance between our own senses and expert opinion. It’s even harder in a world where numerous authority figures and media outlets have been caught spreading lies.
And so, while I try not to judge others’ parenting decisions, please, take a few minutes to think about the holiday stories you tell. If you’d like to live in a country where the citizenry can agree on basic facts, lying to your kids might be not be the way to get there.
Let’s get one thing out of the way first, shall we? Vaccines don’t cause autism. If you’ve got a kid with a standard operating immune system, you oughta get that sucker vaccinated. If you yourself have a standard operating immune system, and you’re considering living in a place where certain diseases that you aren’t immune to are prevalent, you oughta get yourself vaccinated.
But, okay, now that we’ve stated that much, there is an essay about vaccines and autism that I’ve been meaning to write. Prompted, at the moment, by my turn in the queue for Eula Biss’s On Vaccination finally arriving. Biss writes, with a lack of emphasis that I assume is ironic, though I am of course only a quarter of the way through her book at the time of this writing and so cannot know for certain, “Even so, the evidence reviewed by the committee ‘favors rejection’ of the theory that the MMR vaccine causes autism.”
Sure. Let’s reject that theory. There’s no evidence that vaccines cause autism; a scientist might use the word “hypothesis” to describe the idea that one might, but never “theory,” not given the data we have (by way of contrast, evolution is a theory. Gravity is a theory; the next thing you drop, unless you’re on the space station, is probably gonna fall). The conjecture that vaccines cause autism is a hypothesis, one that’s been tested and rejected. Unless we accumulate a lot of new data that’s very dissimilar from the data we have now, rejected is how that hypothesis will stay.
And yet. I wanted to write an essay about my favorite contemporary model for the cause of autism, and the idea that vaccination (or “mock vaccination,” actually, in which a child undergoes the ritual of vaccination but nothing is injected) might trigger the onset of autism. This would happen only in children who were more or less guaranteed to have autism, but I can envision a compelling narrative in which the parents of many such children would all be able to point to an incidence of vaccination as the triggering moment.
There are, you may have noticed, many theories about what causes autism. There’s the hippocampal under-pruning hypothesis; people with autism might have too many neural connections, trigger too many memories when it’s time to make decisions! And of course there is also the over-pruning hypothesis; yup, the exact opposite idea has been proposed as the cause of autism, too! It’s been proposed that autism results in underactivation of the fusiform gyrus, which is a part of the brain associated with processing faces and emotions. And, yes, it’s been proposed that autism results in overactivation of the fusiform gyrus in emotional contexts, as though it’s hard to make eye contact, process emotions, etc., because they are perceived too strongly, not too weakly. It’s been proposed that the condition is akin to a defensive response to stress, or that it’s linked to a deficit of oxytocin (the “cuddle molecule,” which K is planning to get a tattoo of once she’s done nursing), or that there are insufficient GABA-mediated inhibitory signals.
In short, many proposals, and nobody knows what’s correct.
Honestly, we don’t even how many people have autism. You could read the CDC report and say, ah, 1 in 68 children have an autism spectrum disorder, but there are clear peculiarities in their numbers. For instance, the huge increase relative to prior reports. For instance, massive regional disparities; should we believe that autism is 4-fold more common in New Jersey than Alabama, or is there a difference in diagnostic capabilities? And, as a point of contention near and dear to my own heart, the possibility that autistic children learn to mask their own condition. If you asked K, for instance, she’d tell you that I have a mild autism spectrum disorder, but I’ve never been diagnosed.
And there are many proposed cures for autism. Exogenous oxytocin (would hugs work instead, to promote endogenous oxytocin?); suramin, which reduces stress response (this hasn’t been proposed as a cure for humans, because the compound is toxic, but it seems to ameliorate autism-like symptoms in a mouse model); behavioral therapies …
… and my nomination for the all-time absolute WORST proposed cure, daily injection of massive doses of LSD. (This was first tested in humans, orphaned children, primarily, and was sometimes coupled with electroshock therapy. But I should point out that our definition of the word “autism” has evolved somewhat in the time since these experiments were performed; if we go by modern usage, I think a more accurate description of these children would be “surly” rather than “autistic.” Still, reason enough to give them daily LSD. For months.)
All of which I’m mentioning so that you know to take everything I say about a possible “link” between autism and the practice of vaccination with a hefty dose of salt. Clearly, nobody knows what’s up.
So, with all our caveats carefully stipulated, let’s get to it! My current favorite model for the cause of autism, and how that might also relate to vaccines!
(Do I need to mention, here, that my use of the word model, singular, is somewhat silly since it seems very likely that there are multiple causes, perhaps multiple brain states that all get referred to as “autism” but which have differing neurological mechanisms? I’m not sure. I’ll mention it coyly, like this, in a parenthetical aside… that’s a good halfway approach, right?)
A fetus’s brain activity is supposed to be suppressed during delivery, a process mediated by K’s favorite molecule. But something might be awry in autism, causing the suppression of brain activity to fail. Seems there are suspicious clues speckled throughout the literature, like the fact that diazepam (Valium) often excites people with autism instead of calming them. Indeed, my sister and I took an overnight bus ride through the mountains when I visited her in Ecuador (she was there for a three-year stint in the Peace Corps before medical school), and one of her friends lent us some Valiums. My sister slept soundly. I spent twelve hours chittering and jabbing her in the side with my elbow.
And, yeah, birth seems like it’d be incredibly traumatic… definitely seems like a good thing for babies’ brains to be conked. Why not imagine that someone would be constantly musing “The horror, the horror” if there was any trace of memory about that whole ordeal? There’s an increased percentage chance of autism after birth complications, though it’s difficult for me to say what types of delivery a baby would consider most stressful (like, would a baby think that a Cesarean delivery was easier? Dunno, but Cesarean delivery is correlated with higher autism incidence, not lower like you might predict if your only working model were this highly speculative one I’m expounding upon).
In rodent models where pretreatment (either genetic or chemical) of fetuses tends to produce animals with some of the social disorders considered to be hallmarks of autism, it seems you can reduce the chance of producing an autistic-like animal by giving the birthing mothers a drug that stills the mind of the fetus. Conk the baby chemically, it won’t remember its own birth, it grows into a neurotypical adult.
Within this framework, it seems possible that any episodes involving extreme stress could trigger autism onset in highly-susceptible individuals. Vaccination, typically involving a shot, is stressful for some children. So, there you go. If you want to believe that there is *any* correlation between vaccination and autism beyond a coincidence in timing (i.e. when it’s first possible to diagnose autism and the standard vaccination schedule) this speculative hypothesis is the best I can come up with. And it suggests that even if you believe there’s a link between autism and vaccination, there’s a strategy you could employ other than refusing vaccination, which endangers your own child and others. You can simply make vaccination not stressful.
It’s not that hard, actually. Yes, your kid is getting jabbed with a needle. And it hurts, a little bit. Not that much. About as much as a hard pinch, which is crummy, and makes most kids cry, but easily fixable. I’d say N has cried on average for about three seconds with each of her vaccinations, then we cuddle her some, she nurses, she’s happy again. Part of why this works so well is that K stays calm and placid and cheerful throughout (I wish I could say the same about myself, but I have that thing where my blood pressure drops and I feel faint around needles. K doesn’t; she performed thousands of injections on frogs during her doctorate and that experience washed away her needlephobia for good). And our pediatrician is great. And we sing, before, during, and after shots.
In summary… vaccinate your kids, kids.
p.s. Was this all too chipper? I do want people to be vaccinated against preventable diseases. But, here, let me throw in a brief passage that I had to cut from an early draft of my novel to show that I understand why people are afraid of doctors; obviously bad things have been done. Bad enough that any reasonable human would feel distrustful. It’s just that, as regards contemporary pediatric vaccination, I don’t think the mistrust needs to be acted upon. But, here you go, a little bit of horror to mitigate the preceding essay’s good cheer.
In early vaccine trials, orphaned children drank the pureed spinal chords of smallpox-infected monkeys. Doctors put it in their milk. The initial vaccination attempts failed: the virus was “insufficiently inactivated.” Some of the children got sick. Some were crippled for life.
Of course, they were living in an orphanage. Not the most sanitary of conditions: some number of them were going to get sick anyway. And for that study, the intent was therapeutic. The drink might have been a vaccine. Much more respectful toward what might’ve been the children’s wishes than, say, the hepatitis studies, in which orphans were deliberately infected so that attending doctors could track progression of the disease. In that study, they were fed a slurry of pooled feces from other already-sick children. Also in their milk, although for that study the noxious agent was blended into chocolate milk. Probably seemed like a special treat.
K and I have been watching that new Cosmos television show. The library had the whole set of DVDs, and she and I have both been tired enough that it’s felt nice to zonk out with some television in the evening while N is having her fifth dinner.
K really likes the show. Things were perhaps stacked in her favor: she is a scientist, she likes Neil deGrasse Tyson, and she teaches Earth & Space Science, which covers a lot of the same topics as the Cosmos show (and is, incidentally, not the field of science either she or I was trained in – E&SS just happens to be what you need to teach if you want to work with people who get signed up for the most introductory level science class in this state. Elsewhere I think the equivalent course is Integrated Chemistry & Physics or something?).
So, K likes Cosmos.
Whereas I have mostly failed to enjoy the show as much, even though it’s clear that a lot of people worked very hard on it and it has some very redeeming qualities, too.
So, last night we watched the episode about Faraday’s experiments with electricity and magnetism. And then this morning I went berserk and had to set N up for some self-directed play while I watched a video deriving the Maxwell equations. Which is something I used to know, and probably still should, but almost a decade has passed since I last used them. And when they were flashed up on the screen at the end of the Cosmos episode, I realized that I couldn’t think through the derivation. That felt sad. I’ve already been feeling sad about being very unpracticed with my math these days, to the point that shortly before N was born I picked up a book on differential equations and another covering specifically Fourier transforms. I did not work through very much of either before she was born and have not picked them up since – as it happens, taking care of a baby can be a fair bit of work.
But my reason for feeling uncomfortable about Cosmos isn’t just that it reminds me of my own current ineptitude.
For me, the problem is that the show often seems to be contrasting stories from mythology, often Christian mythology, against stories as elucidated by science. But all of it is presented without math, and much of it is presented without data of any kind, or even descriptions of the necessary experiments. I have to admit, the particular episode that made me sad did a better job of that than most – many of Faraday’s experiments were described. But, still, the Maxwell equations were tossed up at the end with no attempt at an explanation.
And I know that mathematical and scientific literacy is often described as, um, not good in this country. And television is not a very good medium for conveying math. I’ve watched some math videos online (Dr. Arthur Mattuck at MIT made some charming ones), and, yes, sometimes you might space out, or maybe want to pause them, or glance at the screen and read an equation wrong and feel confused. But not everybody can pause broadcast television. And a lot of mathematics presupposes familiarity with basic concepts that many people haven’t had a chance to feel comfortable with.
But the problem is, in my opinion, that science without math is very akin to mythology.
It becomes an expert telling you what you ought to think because he happens to be blessed with great truths, either because he can do the math or because he has studied his bible or communed with god or read the portents from an eagle overhead. I am teaching you, and you should believe. Whereas I think that science should be presented more humbly.
Yes, to my mind, having (once upon a time) worked through the math, science is more real than any religious claims. But for someone who has not worked through the math, and currently can not work through it, I can see how scientific or religious claims would seem like equal mysteries. You have to trust an expert. Maybe you choose an expert in a white coat, maybe you chose one in a black cassock.
So I would much rather see science outreach like Cosmos attempt to guide people through the details – this is how the math works, and these are resources you could consult if this is hard, and these are experiments that you could do to reproduce these findings. Which is hard, obviously. I am (was?) pretty good at math, but I don’t have the training to follow serious astrophysics. I did well with the physics of small things (quantum mechanics) during college and graduate school, but I’ve never studied the physics of big things. I don’t really know gravity, for instance. That’s something I’d like to take a few courses in, after I finish the novel I’m working on. So, sure, there is a lot of complicated math involved.
But I’d like to think there are better ways to convey a respect for people’s lack of exposure to math than trying to convey science without it. Obviously, it’s tricky. I’m not trying to argue that the team that made Cosmos didn’t try very hard, or aren’t clever, or anything like that. I’m just not super happy with the final product, even if I couldn’t necessarily do it better. Like, okay, the introduction to Christian Rudder’s Dataclysm seem to do a good job of walking cheerily through some basic statistics. And, sure, there are differences – statistics is an easier branch of mathematics for people to understand visually than some of the math you need for astrophysics, and, more importantly, Dataclysm is a book, which means there’s less worry that someone will get bored and change the channel during a brief math interlude – but I felt as though Rudder conveyed a more respectful attitude about wanting his audience to know where his claims were coming from.
And, right, it’s not as though this problem – trying to convey science sans numbers to non-scientists – is unique to Cosmos. I feel a lot of similar frustration in reading editorials by scientists or medical doctors regarding the recent upsurge in Americans opting out of vaccines. Which, again, I should make clear: I am a scientist. I have been vaccinated against many diseases. My daughter has received all her recommended vaccines on time. But my impression is that scientists and medical doctors promoting vaccines do not always show sufficient sympathy.
Like, okay, there was a research paper claiming that vaccines cause autism, which I am not linking here. There are research papers claiming that vaccines do not cause autism. Sure, there are more of the latter, but for someone without enough scientific literacy to evaluate the data for themselves, you’re stuck picking someone to trust. And, honestly, scientists and medical doctors have done some pretty terrible things, often in the guise of vaccines – you could have a pretty unpleasant weekend reading about some of these in Against Their Will: The Secret History of Medical Experimentation on Children in Cold War America. So there are reasons why someone who was just picking whom to trust would not choose the doctors.
So, it’s not that I think the Earth is only 6000 years old. Or that I think anyone should believe that. I just think that, by trying to present science without math, the product is a competing narrative that still relies on faith. As with vaccines, as with climate change. And, who knows, maybe I am watching their show with the wrong attitude – maybe they were not hoping that people would watch and say, “oh, the Earth was actually formed 4.5 billion years ago,” maybe they were hoping that people would watch and think, “gee, that’s cool, I should learn how to figure this stuff out myself.” But that’s not the impression that I got.