Opening to What?

            “I think right now, because there’s been good news really, that the opening up is starting to happen faster than we expected, appears to be doing so safely, then there is a chance that we won’t really need a Phase Four [Congressional support package].” White House economist Kevin Hassett, Fox News, Saturday

            “Is this guy serious?” Mayor Bill DeBlasio, later that day

            “It’s devastatingly worrisome to me personally because if they go home and infect their grandmother or their grandfather who has a co-morbid condition and they have a serious or a very — or an unfortunate outcome, they will feel guilty for the rest of our lives,” Dr. Deborah Birx, Sunday.

            “This is definitely government overreach.” Lockdown protester on social distancing

Dear Students,

Given our studies of evolution in disease (Darwinian medicine), you won’t be surprised to learn that the pandemic coronavirus is mutating and adapting, although fortunately more slowly than seasonal flu. Nor will you be surprised to see natural selection operating at different levels. We are not sure that a bat was the origin, but if bats have it you know they’ll be evolving too. And so will we. Here is how the city planning commissioner of Antioch, California put it in a Facebook post:

The shelter in place needs to end, we as a species need to move forward with our place on Earth…This virus is like a human version of a forest fire, a forest fire will burn through and burn off all the dead trees, old trees…The strong trees survive and the forest replenishes itself and flourishes once again… If we look at our population as the forest you will see many similarities. We have our old, we have our weak and we have our drains on our resources. This virus is targeting those sectors of our population. If we were to live our lives, let nature run its course, yes we will all feel hardship, we will all feel loss. I am sure everyone of us would lose a person who we hold dear. But as species, for our Nation and as a Planet we would we would strengthen when this is all settled. We would have significant loss of life, we would lose many elderly, that would reduce burdens in our defunct Social Security System, health care cost…make jobs available for others and it would also free up housing… We would lose a large portion of the people with immune and other health complications… But that would once again reduce our impact on medical, jobs and housing. Then we have our other sectors such as our homeless and other people who just defile themselves by either choice or mental issues. This would run rampant through them and yes I am sorry but this would fix what is a significant burden on our Society… Of course we would lose many of the “Healthy” maybe even myself but that is the way of the World!

I am sure you see the logic in this as clearly as you see its inhumanity. This is so-called Social Darwinism at its worst, and the end result is a Nazi-like culling of the “unfit” from our populations. Nazis carried out mass murders as “euthanasia,” and one of the ways they did it was to crowd Jews into ghettos where typhus and other deadly microbes were brewing and then (see above) “let Nature take its course.” A friend of mine, Tosia Szechter Schneider (now 92) lost her mother and other family members to typhus in one of those Nazi-encouraged experiments in letting Nature take its course. You may remember what Darwin said about this in The Descent of Man:

The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally acquired as part of the social instincts, but subsequently rendered…more tender and more widely diffused. Nor could we check our sympathy, if so urged by hard reason, without deterioration in the noblest part of our nature… If we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with a certain and great present evil.

In other words, Darwin rejected the moral lapses that some people argued should derive from his own theory. He understood that being human gives us choices that other animals don’t have, and he wanted us to use those choices to protect the weak, not “let Nature take its course.”

            But you might decide Darwin is wrong and the Antioch commissioner is right. I hear some young people have suggested COVID-19 parties where you can infect each other, get a (probably) mild illness, and get it over with! I suggest the following song after you’ve had a few beers. (It’s sung to the tune of the title song in the ‘60s musical Bye Bye Birdie.):

Bye bye Grannie,

We’re gonna miss you so!

Sorry, Grannie,

But ya gotta go!

If you’re curious about this tune click the link now, because after Nature takes its course, no one left alive will remember it, and you’ll never hear of it again.

[Important disclaimer! I don’t really advise you to have a COVID-19 party!]

Good News

  1. “Good to be with you,” said Gov. Cuomo Sunday to one of the four governors joining him virtually and pragmatically in a new consortium. New York, the tip of a severed starfish point, has regenerated much more of the point by bonding with Connecticut, New Jersey, Pennsylvania, and Delaware to coordinate rules and to bulk-buy protective and testing equipment at better prices.
  2. Remdesivir, an antiviral that was developed for Ebola, has reportedly shown its ability to reduce ICU stays from 15 to 11 days in very sick patients. This, if it holds up, is great news. The drug will not be withheld in new trials (now unethical), but will be added to other study drugs in continued research. Bill Gates’s foundation and others are working aggressively (“The Therapeutics Accelerator”) on a treatment that would use monoclonal antibody technology to derive drugs from convalescent plasma, among other treatments.
  3. Testing of two main types (for current virus and for antibodies raised by past virus) is ramping up, although not nearly fast enough. Home self-tests (like the ones we have for pregnancy) should soon be more widely available. Contact tracing, far behind testing, is slowly improving. Random-sample testing in a few places is beginning to clarify how the virus has spread and who (by age, location, ethnicity, and gender) is affected most.
  4. New cases in South Korea that appeared to be reinfections of people who already had it (i.e. they lost their protection in weeks to months) now appear to have been head fakes (false positives), caused by what one expert calls “viral litter”—non-dangerous fragments of viral RNA lingering from the infection.
  5. As many as a hundred labs worldwide are working as hard and fast as they can on vaccine candidates. 95 percent of these could fail in clinical trials (the hard part) and we would still have a few to use. Factories are being built and adapted long in advance of this to produce up to billions of doses that will eventually be needed. Up to 14 vaccines have already entered Phase 1 clinical trials, much sooner than most experts expected.
  6. The modelers at the University of Washington (IHME, led by Chris Murray) have detected a heat effect that is much less than it is with some other viruses but greater than previously thought for this one. Therefore a hot summer will work to a modest extent against the social factors making things worse.

Bad news

  1. Rules are being relaxed by states in an uncoordinated way, without a flicker of national leadership, except in the direction of greater risk. Few if any of the states reopening have met the national standard, put forth recently, of having declining cases for two weeks; most still have rising cases. The Federal government has ordered meatpacking plants, essentially petri dishes for the virus (like cruise ships and prisons), to reopen and stay open, and these are and will be places from which many American communities will become disaster areas.
  2. As Bill Gates remarked on CNN Friday, the so-far modest impact of remdesivir is not going to make us say, “Let’s go to the movies.” Experts note that a smaller study (but a good one, and large enough to show a substantial effect if there were any) in The Lancet found no effect of the same drug. The larger study praised by Dr. Fauci has not been published or peer-reviewed, and all we have so far is a press release and his word.
  3. Testing and contract tracing, the life blood of safe reopening (and therefore of economic recovery) is primitive in our country. We have around 200,000 tests a day nationally, done for the sick and a few others (like health care workers) in most places, but otherwise haphazardly. Expert opinion on how many tests we need range from 5 million a week to 20 million a day. Given that we are most infectious in the first few days of symptoms, or even before, tests that take days to get results are of limited value in controlling the pandemic. “What’s the point?” Bill Gates asked the other evening. “Do you just send apology notes to the people you infected in those 3 or 4 days?” The Gates foundation is supporting the scale-up of rapid testing.
  4. Perhaps the biggest unanswered question is what is the extent of our immunity after having had the virus and how long it will last. Could it be like chickenpox, one and done for life? Or more like flu, protection for a season? The same questions apply to vaccines; this year’s flu vaccine was 50 percent effective.
  5. Speaking of vaccines, the 12-18 month time-frame often mentioned for getting to distribution of a safe and effective vaccine would be by far the shortest in history. Animal models have limits; Dr. Sanjay Gupta reminded us the other day of an old doctors’ saying: Rats lie, monkeys exaggerate. Perhaps the brute force of a hundred labs parallel-processing various methods will accelerate the time to large human trials, but those trials take time. Many will fail and some may fail dangerously.
  6. Internal Trump administration memos revealed today project 3,000 cases per day in June, about double what we have today and higher than the highest peak so far (~2500 in mid-April). These new projections may to be what led President Trump to say yesterday that total deaths could go to 100,000. Given how optimistic he has been in the past, this could be interpreted as meaning that he is deliberately choosing economic activity over preventing mortality, and we should be prepared for more.

Almost half the country is officially open to some extent as of today. “Government overreach”—for your protection—is (temporarily) ending in many states. Watch the states, as well as other nations (with much better testing) that are opening and see what happens. It’s interesting that Dr. Birx (quote up top) misspoke slightly in expressing her worries about the people who don’t do social distancing in protests: “they will feel guilty for the rest of our lives”—the line between “their” and “our” indeed blurs.

Nationally, we’ve been stuck on a fairly stubborn plateau of cases and deaths as states with increases replace those with declines. Projected cases, hospitalizations, and deaths that two weeks ago gave me hope of a more normal summer before a possible fall wave were based on the assumption of serious social distancing through May. That hasn’t held, and all models are projecting more deaths. The latest today (May 4) from IHME projects 134,000 deaths by August, almost double the number projected 6 days ago. I wish I could tell you that college will be live in the fall. As Gov. Cuomo said today, “Know what you don’t know.”

I don’t know for sure, and I’m sorry to have to say it, but it seems to me we have chosen mobility over sheltering and death over life.

The weather’s great, go out (seriously), enjoy a walk or a run alone or with someone you trust. Wear a mask (as Cuomo says, it’s a sign of love and respect for others, because it protects them from you), stay at least six feet (two meters) away from anyone not part of your household, go home as soon as you can, and wash your hands obsessively. While you’re out, observe the crowds who aren’t doing the above, and if you’re religious say a prayer for them, because in a couple of weeks they are going to need it.

As for you, please to take to heart what Tim Cook, head of Apple, said to the new Ohio State grads in his online commencement address: “I hope you wear these uncommon circumstances as a badge of honor.” This is my hope for you in your own futures. Do the right thing now, and live to brag for the rest of your lives about how you made it through COVID-19. As you have heard me say many times, you are lucky to have great gifts, and the world has a right to expect leadership from you.

Dr. K

Note: Please don’t just rely on me. I recommend the following good sources: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; This Week in Virology (TwiV) podcast; IHME (U. of Washington) model website; COVID-19 UpToDate for medical professionals; and for all readers: Why the Coronavirus is So Confusing. Dr. Ashish Jha of the Harvard School of Public Health said on Thursday, “I grew up as a public health person loving and admiring the CDC, arguing and believing that it is the best public health agency in the world… But in this entire pandemic, it’s been one fiasco after another. And it’s either possible that all of the scientists all of a sudden forgot their science, or there’s something at the leadership level that’s really hindering them.” 

 

 

 

 

 

 

 

 

 

 

 

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 Reply to Opening to What?

5 comments

  1. Geri-Ann Galanti says:

    Another great blog. As one of the “weak and elderly” (not how I think of myself, but probably true from the perspective of young people), I resent the cavalier attitude many young people have toward those like me. I also understand their frustration. My mother, who is 96, still remembers that her prom was cancelled after Pearl Harbor was bombed. She’s still sad about it. Today’s young people are missing out on so much because of the pandemic. Prom, graduation, the last summer vacation before college, the first year away at college … so much. I get it. But they need to see the bigger picture.

    • Mel says:

      Yes, I keep apologizing to my students, especially the graduating Seniors, for what they have had to miss of their youth, but then we want them to have the rest of their youth and their life.

      • Geri-Ann Galanti says:

        I was recently talking with a young woman. She had planned to get married in July, but is now rethinking it. In her culture, there are several huge ceremonies and parties leading up to the big wedding. (I attended some when my cousin married a man of her culture, and they’re really amazing.) She doesn’t want to miss out on the things she’s looked forward to for so many years. And yet, she doesn’t want to put off starting a family. I understand her dilemma. I suggested she could start a new tradition of a 5th or 10th anniversary and renewal of vows with the dancing down the aisle with their children. So many cultural traditions will have to be postponed and reworked due to the epidemic. But cultures are resilient and can adapt. They have to.

  2. Thank you for sending me your notes, concerns, and insights on this unprecedented coronavirus pandemic, directed to your students but valuable for all your readers (including me). Between this and our larger context of climate change and international conflict, it is increasingly difficult to sustain hope. Like you, I think culture is a large part of the nightmarish situation that we are in today. On the other hand, culture could be what saves us from the worst of ourselves. You cut to the chase with your advice to expect the worst and hope for the best.
    We are fortunate to have talented, knowledgeable and wise human beings like you and others who recognize that there is a common good, despite its low profile. I am moved by the number of ordinary people who are demonstrating extraordinary caring for others in the face of high anxiety and fear for themselves and those close to them. Perhaps a few recalcitrant “leaders” may yet respond to the ancient tool of “shaming” although many seem beyond that capacity.
    I keep returning to the fact that our capacity for both altruism and selfishness have deep biological and psychological roots, part of our mammalian and eusocial primate heritage, and evident in studies of young children. Yet goodness does seem to be in short supply in the public sphere.
    As I venture out of my home each day for a solitary morning walk, birdsong arrests me, turns a switch deep inside me in this “silent spring” of 2020 in metropolitan St. Louis. Human sounds have diminished, as birds joyously sing “on the wing” and from rooftops and treetops, twittering back and forth as if their world were whole. With reduced motors and traffic, the beauty of this spring in Missouri looks and feels unusually vivid, almost unworldly in part because we are in “stay home” mode and life’s fragility is exposed. But mostly I think about our rapaciousness as a species and worry that we may squander our chances.
    It was long ago (in human but not geological history) that we learned to cooperate and extend human ties outward from our small scattered bands in the midst of nature’s forces. We descendants find ourselves once more under the control of a small bit of the natural world, this tiny new “predator”—SARS-CoV-2 replacing those formidable large predators that threatened our ancestors. Like them at that time, we are being challenged by significant climate and ecosystem changes that require new behaviors if we are to survive and thrive.
    David Attenborough recently called our current circumstances unprecedented and urgent, echoing your concerns about human behavior, our planet, fleeting time, and survival, stating: “The short-term we deal with and the long-term ‘we’ll do tomorrow.’ But tomorrow never comes. And then suddenly we discover it’s too late.” With my small voice here in “flyover country,” I made a similar argument in a prologue added to my 2015 book (Our Beleaguered Species: Beyond Tribalism.) Prologue 2018’s subtitle reads: “Awaken Homo sapiens! It’s Later Than We Think.”
    In recent decades we have failed to fund public institutions, infrastructure, and abandoned the common good (poignant example, public health). Businesses focus on short-term profit rather than long-term goals. Even scientists turn increasingly to business for employment and higher salaries, as when psychologists are hired to apply “nudges” toward improving a corporation’s “bottom line.” We have become a cultue of immediacy.
    The shift away from “big picture” and long-term thinking makes our circumstances seem almost inevitable. There is much talk about wisdom these days—the need for it and the lack of it. My see wisdom as akin to the wide perspective that we aim for in anthropology and what drew me into the field years ago. Like you, I fear that it may be too late to count on human wisdom to extricate us from the consequences of the deeds we’ve done. The longer we bicker and dawdle, the less likely we are to succeed.
    The upsurge of “toxic tribalism” that keeps people divided and at odds over scientific and social reality is a significant impediment to success, bolstered by our country’s current “leadership” and the 2010 Citizens United Supreme Court decision. The distrust of science, each other, and knowledge of experts dangerously influences national and international decision-making, calling for a major reset. I once hoped that we could get beyond tribalism by encouraging and/or putting in place a combination of personal and political and politico-economic fixes (Chapter 9, OBS). Even then, it would have required reframing of thinking and large structural changes to promote and safeguard justice.
    While our century’s two greatest threats—the coronavirus pandemic and the accelerating climate-environmental crisis—differ from each other, they pose similar challenges. Both are global in scope, both require large-scale cooperation to solve, and both depend on accurate, evidence-based scientific knowledge for their resolution. As you clearly argue too, the outcome depends on how we respond to this double crisis. The problem is not a lack of knowledge or expertise, but a deficiency of wisdom and will.
    Yet we are presented today with an opportunity like no other in our prehistory or history. We have the technological tools to turn things around, to nurture our Earth and life on it, and to test and gain some control of our current viral scourge. We have enough knowledge about group behavior to guide us in uniting as a global species. And now we have these two simultaneous crises—so urgent that they could be framed as a common “enemy” to defeat—that is if we do indeed need an enemy to move us. If this crisis is not big enough for us to unite around, then what is?
    The hardest thing for me to accept is that we have this wealth of scientific knowledge that could help us resolve our dilemma, including sociocultural strategies that would increase the chance of successful outcomes—but apparently not the sense of moral urgency required to build a sociocultural infrastructure that recognizes and supports a common good. The many intelligent, knowledgable, and dedicated people lack the power to make it happen. Yet using the strengths we have—flexible use of knowledge, creative thinking, and the capacity to care for others—seems eminently obvious and sensible.
    I applaud your work, your concerns, and your hopes. If we are to succeed, we must look at the big picture, pool our knowledge and resources, and develop solutions. “We” means all of us, serving and caring for each other. We can cooperate if we acknowledge that we have the same biological and psychological needs, and probably even dreams more similar than most of us imagine. If this were not true, why would persuaders and recruiters have to work hard to convince people to fear and hate and to turn young boys and girls into soldiers or terrorists? (Well, that’s another sad story.)
    Which way will we go? The state of humankind in this century could move us toward biological and social health, or it could take us down, depending on how we act. It is up to us—all of us!
    Here we are and here is our challenge. Let’s put our heads and our hearts together and it on. Given our situation, there will be more losses, but they can be fewer if we nurture the best and not the beast within us. Life is an extraordinary development that each of us has been lucky enough to experience, however temporarily. We do live here, after all, and there is no Planet B.

    —Elizabeth Crouch Zelman, Our Beleaguered Species: Beyond Tribalism, 2015, (2018)
    https://www.amazon.com/Our-Beleaguered-Species-Beyond-Tribalism/dp/1502769336

    I am attaching my prologue: “Prologue 2018: Awaken Homo sapiens: Its Later than We Think”

    • Mel says:

      Elizabeth, “toxic tribalism” indeed. You are right, “‘We’ means all of us.” Perhaps in the second wave of the pandemic we will realize it. Mel

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