COVID-19 message to my students this evening

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Hi all,

I thought that our session yesterday was quite good and loved the chat contributions in the first

Photo by CDC on Unsplash

part of the class. I have thought most though about this comment from Garrett:

00:28:15 Garrett Canterbury: “I think the issue that Trump and other officials, including state and local, are struggling with is that at what point is putting millions of people out of work worth saving X amount of lives. I think the goal should be to move to the South Korean model where there is loads of testing, the economy is mostly re-opened, and the sick and vulnerable are isolating while the healthy are back to work.”

This is to me a vital question. I heard people who should know better say on TV in the past day or two that to weigh the economic consequences of social distancing and lockdown against the lifesaving public health measures many are taking is irrelevant or unethical.

There are things that I think are unethical to debate. This is not one of them. Take a look at this short column a couple of days ago by Tom Friedman, a liberal and no supporter of Trump: https://www.nytimes.com/2020/03/22/opinion/coronavirus-economy.html (Links to an external site.)

What is happening to our economy now, what will happen soon, really really hurts people. It will kill people.

But Garrett is not suggesting we do nothing. He is suggesting the South Korea model, which means social distancing based on testing, with one eye on getting people back to work. Here’s what I have to say about the balance:

  1. We must get the economy going again as soon as we safely can.

  2. The projected one to two million American deaths without strong social distancing would also tank the economy and rip the hearts out of millions of families. The overwhelming of hospitals and deaths of health care workers would do the same.

  3. We have missed the boat on testing at the right stage of the epidemic the way South Korea did, and we have missed the boat on timely mask and ventilator manufacturing BUT…

  4. We are where we are and we have to look forward. We must social distance to flatten the curve or this will destroy our hospitals, killing nurses, doctors, and other first responders.

  5. We have to hugely ramp up the things we haven’t done and still aren’t doing nearly well enough. The first is testing. We need tens of millions of tests, not tens of thousands, to follow the South Korean model as Garrett rightly suggests. We need two kinds of tests: one to find and isolate the currently infected, aggressively testing those they have been in contact with; and another one to identify those (now perhaps in the millions) who have had the virus and have successfully recovered. Those people are almost certainly no danger to anyone and can go back to work, socialize, and help others.

  6. We need manufacturing that is on a war footing. In World War II we did not ask auto makers to please make tanks. We ordered them to make tanks—and planes and helmets and bullets and uniforms. And by the way that project put a lot of people to work and saved the economy, as well as winning the war.

  7. We do not have medicine for COVID-19, but we have medicine for the economy, and it is being applied. The Federal Reserve bank has reduced interest rates to near-zero and is pumping unprecedented trillions into the economy. Even the dithering Congress has agreed to pass a two trillion dollar stimulus package and will do more. We know how to treat the economy when it is sick. Yesterday the Dow had its biggest increase since 1933, and another increase today. People will get paychecks in the mail that will be too small, but will help. Companies will get too much, but will be somewhat rewarded at least for not firing people and giving them paid sick leave.

McKenzie and others yesterday in saying we have the wrong kind of health care system to handle all this right. We also have the wrong kind of economy and a shameful lack of preparation. (See the previously assigned 2005 Scientific American article, “Preparing for the Next Pandemic.”  We didn’t.) But we are where we are. Go to this website to see what will happen to hospitals in your state under varying degrees of social distancing. Click on your state and see the date on which, with inadequate social distancing, your hospitals will be overwhelmed: https://covidactnow.org/ (Links to an external site.)

And please please learn the meaning of the word several of you supplied yesterday: exponential. We have more deaths from auto accidents right now, but they are not increasing exponentially. We have more deaths from seasonal flu, and this is a bad season, but they are not increasing exponentially. Our hospitals take care of patients in danger of dying from those two things every day, every year. They cannot take care of an exponentially increasing number of victims of COVID-19.

Take care of yourselves and protect yourself and others. Flatten the curve.

Dr. K

PS: If you’re curious to see how long I’ve been fighting for a better health care system, go here: https://www.melvinkonner.com/new-york-times-op-ed-page-columns/

How an Anthropologist Looks at All This

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A doctor friend of mind sent me the following question last week: “Is your perspective  on the pandemic and the associated chaos different based on your knowledge of anthropology and medicine? If so how?” Here’s my answer:

Thanks very much for the question, Michael. I think part of the answer is that I think about behavior, culture, and evolution very prominently. In fact my big class right now is called “Disease & Human Behavior.” Some of my perspective would overlap with a public health perspective. One Scientific American article I assign in this class was written years ago, and asks: “Are We Ready for the Next Pandemic?” Answer: No.

But in no particular order:
The difference between the outbreaks in Singapore and Hong Kong vs. the disastrous one in Italy (or the one here soon) could have something to do with genetics, but I would say it’s mainly culture. That includes government, but it also includes a more collectivist culture in which people respect authority, follow orders, tend to fear others’ opinions, and act for the common good—not necessarily out of the goodness of their hearts, but because of deeply engrained habits they were raised in.
By contrast, look at the photo in the article linked here.
A number of US cities have done the “Behave Better Please” approach with little result, then issued decrees and laws, with a bit more result (most bars stayed open anyway), and then finally to enforcement. China blundered with initial coverups (one result of autocracy), but when they switched they came down hard with enforcement. I value democracy, but I would like to see Miami beach emptied by the National Guard if necessary. Today.
I just don’t believe that much in people’s intelligence and good will, I believe in their impulsiveness and selfishness. That I suppose is part of my anthropological outlook on human nature. “Drive Safely” signs are great, but seat belts are better, and air bags are best because they require no human cooperation. Voluntary social distancing is great, but enforced social distancing (quarantines, closures, etc.) is necessary eventually, and vaccination (including enforced vaccination for the idiots who will no doubt resist it) will be much better still.
I could say a lot of things about our government’s lack of preparedness and collossal failures of leadership in the past two months, but y’all see that clearly without anthropology. I expect the worst, they didn’t, we get screwed.
In terms of evolution, I would say two things.
First, new emerging viruses are guaranteed, an evolutionary opportunity for the virus that it can’t pass up, exacerbated by deforestation and intimacy between humans and wild animals in some places. The “emerging” part is when they evolve the ability to go from animals to humans. Then it’s to their great advantage to evolve to human-to-human transmissibility, also pretty much guaranteed sooner or later. Then there are interesting evolutionary questions for the virus.
Should I become airborne? Usually yes, but not if you’re universally deadly—your whole evolutionary project will be over in no time. Should I become very virulent? Usually no, because I want my human host to live long enough to spread me. Probably I should evolve a latency period (very long with HIV) or a spectrum of effects that includes asymptomatic people, like COVID-19. Ebola doesn’t have to be airborne even though it’s deadly because dead people can transmit it, especially in certain cultural contexts. Polio doesn’t have to be airborne because fecal-oral transmission is so effective in poor crowded environments. Malaria does very nicely with mosquitos, and there are 3 levels of evolution: the parasite evolves resistance to drugs, the mosquitos evolve resistance to pesticides, and humans evolved resistance via sickle cell & thalassemia genes.
Which brings me to the second evolutionary point, about humans. We spent most of our evolution in dispersed populations with a burden of worms and other parasites, plus a probably low level of percolating bacteria and viruses. Increased population with the evolution of “civilization”—high population densities—meant that tremendous new epidemic possibilities emerged. Poverty in stratified societies created an underclass of more vulnerable people. See the second link below for how this is working/will work in COVID-19. Finally, we evolve to our most civilized level, where bulldozing forests creates constant new evolutionary opportunities for microbes, and international air travel takes them wherever they want to go.
More than you wanted to know. But that’s how I think. Hope for the best, but for many reasons expect and prepare for the worst. This will not be the last pandemic of course. Will we be more ready for the next one? Anthropological answer: probably not. It requires foresight, which we humans are not good at. Instead, we discount the future and go with the hormonal flow.
See y’all on Miami Beach this weekend? In this group, I hope and trust not…
Mel

Summary I sent my students on Wednesday, with preface/update Saturday

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Photo by CDC on Unsplash

Since Wednesday the number of identified cases in the US has gone from 3,500 to 20,000, partly because of increased testing. Testing remains woefully inadequate so the real number of cases must be much higher. The US deaths have passed 200. More young people are sick and dying. Mardi Gras (Feb. 26) made New Orleans a hot spot and Carnival encouraged transmission throughout Latin America. Spring Break on Miami Beach will have a similar effect. US hospitals are begging for supplies, personal protective equipment (PPE), and ventilators (respirators),  and the government in Washington is so far not demanding that factories repurpose to produce these items. Barring drastic action, hospitals will be overwhelmed in two or three weeks, heroic health professionals will be dying at higher rates, and remaining doctors will have to decide who lives and who dies. Don’t become one of those casualties. Protect them, yourself, and those around you.

Use this source for daily future updates, interactive maps, and reliable information in days to come: https://www.nytimes.com

COVID -19 UPDATES

WEDNESDAY March 18, 2020, 8am

Here is what has changed in the past week:

  1. The WHO declared a worldwide pandemic last Wednesday
  2. Italy is probably the worst hit, with hospitals completely overwhelmed; Iran may be worse, but we have no reliable information from there.
  3. France announced a nationwide lockdown two days ago, noting a rise in severe cases in young people around the country.
  4. The U.S. President announced a national emergency & discouraged gatherings of more than 10 people.
  5. Testing became more widespread, but still lags far behind that in other countries.
  6. Testing proved that the virus is being spread by people who have no symptoms, mainly the young; the young may not know it, but they are killing the old.
  7. Stock markets crashed & economies shut down in many countries and U.S. states.

Here is where we are this morning:

  1. Many leading U.S. hospitals are seeing a dramatic rise in cases and expect to be overwhelmed soon.
  2. Many governors are calling for U.S. army and other national aid that isn’t there yet.
  3. Approximately 3,500 cases are identified in the U.S.; experts say there are 10 unidentified cases for every identified one, so the real number is around 35,000.
  4. Despite lockdown in many areas & the closing of restaurants, bars, gyms, theaters, sports events, etc. by law, experts agree social distancing is far less than needed.
  5. Hospitals are running out of supplies needed to protect health care workers.
  6. Ventilators (respirators; breathing machines) cannot be manufactured fast enough to keep up with the need; doctors will have to decide who will get treatment & who will be let go of, just like in a war zone.
  7. Doctors and nurses are getting the virus from their patients and going home; they cannot be replaced, even if machines and supplies can.
  8. The Secretary of the Treasury now warns that U.S. unemployment can go from 3 to 20 percent.
  9. Economists widely agree that we are in or are “sliding into” a recession which cannot be avoided, and which could be worse than the Great Recession of 2008.
  10. No one can tell us how long this will last or how bad it will get.
  11. Epidemics in warm countries seem to disconfirm the hypothesis that summer weather reduces the number of cases.

My advice to you right now:

  1. Stay home and urge anyone in your family who is not performing a vital service (hospital work, food and medicine deliveries, grocery stores, pharmacies) to stay home too.
  2. Maintain contact with friends and family by phone, Skype, etc.
  3. If you must leave your home, stay six feet away from any other person.
  4. If you have traveled anywhere by air, train, or bus, stay away from your grandparents & all older people for at least 14 days. Stay in touch with older people by phone & have food and medicine delivered to them if you can.
  5. Develop, & urge everyone you know to develop, skills for working, preventing isolation & sadness, & being entertained at home. If you must get out, walk in the woods or in a park where you can avoid getting within 6 feet of another person. If you have to walk the dog, use the same precautions.
  6. If you are coughing & sneezing without a fever, stay home & call your doctor. Do not just show up at a medical office or emergency room. Get a test if you can find one.
  7. If you develop a fever and feel very weak, call 911.
  8. If you are in the U.S., check the CDC web page every day:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-in-us.html (Links to an external site.)

  1. Wherever you are, check your national, state or provincial, and city or local health department websites every day.
  2. Wash your hands for 20 seconds many times a day; avoid touching your face as much as possible; frequently wipe down all surfaces from cell phones to kitchen counters with alcohol wipes; gloves & masks are in short supply, so use them wisely.

(Note: the photo above shows viruses in the coronavirus family, not SARS-COV-2, the causal agent of COVID-19, currently pandemic.)

The Day After

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Note: This appeared as one of my contributions last week to a private email group including a number of lawyers. Three of them, including a retired Democratic Congressional Representative, endorsed my proposals. A fourth, a former Republican member of the Georgia State House, was “appalled.” The photo was included in my email. The proposal was emailed to the group Thursday, October 5, 2018, and I haven’t altered it for this posting.

Three illegitimate “Justices,” now one third of the court and three fifths of the ultra-right majority

Here’s what I think will and should happen the day after Kavanaugh is confirmed: Read more

Charles Darwin’s Happy Birthday

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As we mark Charles Darwin’s birthday on February 12th, our culture is riding a wave that should take us back to his theory. The #MeToo and #TimesUp movements are the crest of the wave, which may represent a turning point against men’s chronic exploitation of women. It’s one aspect of the decline of male supremacy predicted and fought for by Elizabeth Cady Stanton, the pioneering women’s rights activist born just a few years after Darwin.

Stanton, like Darwin, was a realist when it came to gender differences. She thought that some were intrinsic and fundamental, but that these were to women’s advantage. Indeed, in a powerful 1869 speech, she held that the strongest argument for women’s equality was “the difference between man and woman.”

Read more

Psychologist Ann Kruger Boosts Girls’ Self-esteem to Prevent Sexual Exploitation

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ann_in_jaffa_port_cropped_medium
Dr. Ann Cale Kruger

Most of us are concerned now about the sexualization of childhood—toddler beauty queens, Rihanna outfits in preschool. But three just-published articles still shock.

They come from the laboratory of developmental psychologist Ann Cale Kruger at Georgia State University—I’m happy to disclose I’m married to her—and concern Project PREVENT, a program she launched to explore the vulnerabilities of girls and to try to strengthen their resilience. Read more

The Case that Clinched the Zika-Brain Connection

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Normal male fetus EKP
Normal fetus

Rita Levi-Montalcini, the first Nobel laureate to reach 100, graduated from the Turin medical school in 1936, and soon started working on the developing nervous system. Two years later, when Mussolini barred Jews from faculties, she set up a lab in her bedroom—such was her passion for understanding brain growth, for discoveries that might someday help prevent brain defects.

I thought of her on April 13th, when the CDC released its statement confirming that Zika causes microcephaly. It seems they were awaiting Read more

“Mom and Mommy, Where Do Babies Come From?”

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Venus symbolsThe 1989 book, Heather Has Two Mommies, normalized for my kids the idea that two women could care for a child and create a fine family. The controversy it met with seemed increasingly quaint as research showed that kids like Heather grow up very much like average children, although they are less homophobic.

Even quainter now seems the battle over the first “test-tube baby.” Louise Brown, born in 1978, was hailed in headlines as “Superbabe” and “The Lovely Louise,” but she also met with many negative expectations. Yet in 2010 Robert Edwards shared the Nobel Prize for the work that led to her birth, celebrating with Ms. Brown and her own son. Today five million people conceived in this way walk among us, indistinguishable except in the luck of their existence.

But suppose these two lines of research could be joined. Suppose Heather had two biological mothers—because one of their eggs was fertilized with the DNA  of the other. Since the offspring of such a union could have only X chromosomes, Read more

Women’s Suffrage is 95 Years Old!

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o-ELIZABETH-CADY-STANTON-edit
Elizabeth Cady Stanton in her proper place

It’s a great day to celebrate women’s movements past and present, but does feminism require the belief that women are basically like men?

This was at least an implicit claim of Second Wave feminists, modeled on prior movements for ethnic and racial equality. Read more