Category: pandemic

Two easy pieces on the pandemic and science

April 21, 2020 • 10:45 am

Here are two science-related pieces for today’s reading. The first, by a group of people writing in the journal Science, is a fairly concise summary of what coronavirus does to our bodies, emphasizing how much we don’t know about how it wreaks havoc on us. It’s free, so click on the screenshot to read it. Warning: if you don’t like medical details about a deadly virus and how if affects our bodies, don’t read it. But I think you should.

Beginning with the depressing statement, “. . a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen,” it gets even more depressing as it lists all the organ systems the coronavirus can attack. In many cases we don’t know exactly how it works, though we do know that the virus hooks onto ACE2, a cell-surface receptor especially prevalent in the nasal passages, and thereby gets itself into the body. After that, it can latch onto any cell with the same receptor, inject its RNA into that cell, and make more copies of itself.

Much of what happens then is mysterious. The famous “cytokine storm” caused by some viruses, in which the body’s immune system overreacts, possibly severely damaging many organ systems, has been frequently mentioned as a cause of COVID-19 mortality. But, as the authors note, there’s doubt about even this.

But there’s no doubt that the damage to the body extends far beyond the lower respiratory tract. Here are some other areas liable to failure or destruction:

  • damage to the heart and blood vessels, including production of blood clots
  • kidney failure: why dialysis machines may be as important as respirators
  • damage to the brain and possibly the central nervous system
  • damage to the lower gastrointestinal tract (diarrhea is a common symptom). This raises the frightening possibility of viral transmission via fecal contamination, though there’s no evidence for this and the probability seems low.
  • liver damage
  • inflammation of the eye (conjunctivitis)

Understanding the various ways the virus damages the body will be immensely useful in palliative care and in the design of medicine. But of course a successful vaccine, which requires only using part of the virus’s protein coat to activate the immune system, requires little knowledge of what the virus does to the body. All it requires is knowing what part of the viral proteins can provoke an antibody reaction that can successfully immunize one against future infections. But, depressingly, an effective vaccine might be impossible to design, and even a good one may be countered by mutations in the virus.

After you’ve read that bit, buck yourself up by reading a Guardian paean to science by Jim Al-Khalili, a physicist best known in the UK as a writer of popular science (click on the screenshot):

Although you might be put off, as I was, by Al-Khalili’s first sentence (“As a regular Twitter user, I choose the people and organisations I follow online carefully”), do persist. You may already know these lessons about how science works (I cover them in Faith Versus Fact), but you can always send the piece to your conspiracy-minded friends who think that the Chinese government designed the virus as a bioweapon.

A few excerpts. The first is a pet peeve of mine: the “expertise” of non experts. I, no expert either, have stopped discussing the best way to attack this pandemic, or even how to protect myself against it—save staying away from people and keeping my hands clean:

During the coronavirus crisis, everyone online seems to have a “scientific” opinion. We are all discussing modelling, exponential curves, infection rates and antibody tests; suddenly, we’re all experts on epidemiology, immunology and virology. When the public hears that new scientific evidence has informed a sudden change in government policy, the tendency is to conclude that the scientists don’t know what they’re doing, and therefore can’t be trusted. It doesn’t help that politicians are remarkably bad at communicating scientific information clearly and transparently, while journalists are often more adept at asking questions of politicians than they are of scientists.

Remember when Trump mentioned antibiotics in connection with the virus, apparently unaware of the fact that antibiotics attack bacteria, not viruses? But al-Khalili’s point is to draw a distinction between the doubt and questioning inherent in science and the unwarranted certainty expressed by conspiracy theorists (and, of course, by religionists, who claim to be “immunized by Jesus”).

A second important feature of the scientific method is valuing doubt over certainty. . .

This approach still informs how we do science today. Indeed, this is how the scientific method differs from the stance of conspiracy theorists. Conspiracists will argue that, like scientists, they too are sceptics who question everything and value the importance of evidence. But in science, while we can be confident that our theories and descriptions of the world are correct, we can never be completely certain. After all, if an observation or new experimental result comes along and conflicts with an existing theory, we have to abandon our old presuppositions. In a very real sense, conspiracy theorists are the polar opposite of scientists; they assimilate evidence that contradicts their core beliefs, and interpret this evidence in a way that confirms, rather than repudiates, these beliefs.

Often, in the case of such ideological beliefs, we hear the term “cognitive dissonance”, whereby someone feels genuine mental discomfort when confronted with evidence that contradicts a view they hold. This can work to reinforce pre-existing beliefs. Ask a conspiracy theorist this: what would it take for them to change their minds? Their answer, because they are so utterly committed to their view, is likely to be that nothing would. In science, however, we learn to admit our mistakes and to change our minds to account for new evidence about the world.

This is crucial in the current pandemic. Clearly, the world cannot wait to learn everything about the virus before taking action; at the same time, stubborn adherence to a particular strategy despite new evidence to the contrary can be catastrophic. We must be prepared to shift our approach as more data is accumulated and our model predictions become more reliable. That is a strength, not a weakness of the scientific method.

This is what has apparently happened with hydroxychloroquine, touted by some (including Trump) as a panacea. Tests are showing that it’s almost certainly not that useful, and may even be harmful—one reason that you must do double-blind studies to have good confidence in a new drug.

Al-Khalili’s final paragraph:

I have spent my career stressing the importance of having a scientifically literate society. I don’t mean that everyone should be well-versed in cosmology or quantum physics, or understand the difference between RNA and DNA. But we should certainly all know the difference between bacteria and viruses. Even more importantly, if we are to get through this crisis, we must all have a basic understanding of how science works – and an acknowledgement that during a crisis like this, admitting doubt, rather than pretending certainty, can be a source of strength.

Although I like the rhetoric of that ending, I’m not as certain as he that to get through this crisis, all of us must understand how science works. Yes, it would help us make sense of the confusing back-and-forth recommendations we hear on the news, but to get through an airplane flight, we needn’t know the principles of aerodynamics nor the way airplanes work. We simply must have confidence in the engineers and pilots.

Likewise, if we have trust in the doctors, scientists, and epidemiologists, we’ll get through this crisis. We needn’t know how their fields work, or even that doubt is an important part of their work. Of course, as a superannuated scientist, science lover, and popularizer of science, I would be delighted if people would understand how scientists work, at least in rough outline. And if they’ve had a decent education, they should.

But many people can’t be arsed to care about science, and in that case I’d just tell them, “Eventually the scientists and doctors will work it out. Just heed the latest advice.”  And when that advice is conflicting, like about when to wear masks, play on the safe side.  Or, you can heed the ubiquitous but unrealistic television advice: “Ask your doctor.” Of course you have to have a doctor who responds, and also one who’s up on the latest science.

h/t: Paul (for second piece) and several readers (for the first)

 

More on coronavirus: ask the doctor!

April 17, 2020 • 12:00 pm

My primary care physician, Dr. Alex Lickerman, has written the sixth part of his series on coronavirus and the pandemic, which you can access by clicking on the screenshot below. It also links to the previous five pieces. And, as with part 5, Alex has kindly offered to answer readers’ questions in the comments. Ask him anything (about the virus and pandemic, that is)! He might not have time to respond to everyone, but he’s told me he will have some discussion with the readers here.

Be aware that when Alex refers to SARS-CoV-2, that is the virus that causes the disease COVID-19.

Do read the piece, though, before posing any questions. The topics covered include the following:

  • Why do we have to do those onerous double-blind tests of antiviral drugs? Why can’t we just give them to people if they look propitious?
  • What’s the value of antibody testing to see who’s had the virus? Should you get an antibody test?
  • What’s the best way to estimate the prevalence of Covid-19? This tells you your likelihood of getting the virus.
  • If you’ve had Covid-19-like symptoms, what’s the probability that you’ve had the virus?
  • When should we start mass testing for antibodies to the virus?

As Alex says, the post has a lot of math and statistics, but if you want the bottom line, well, skip to the “bottom line” part of each section, and to the “Conclusion” at the end of the post.

Then put your questions in the comments. Alex will be looking at them from time to time. Again, don’t be shy. You can ask about anything related to the pandemic or the virus, not just about what’s in the post.

Straight talk about coronavirus, and a chance to ask questions of a primary-care doctor

April 3, 2020 • 9:00 am

I don’t intend to fill this site with information or bad news about coronavirus, as you can get that most everywhere, including the New York Times, and most of the detailed stuff is above my pay grade. But I thought the information below was well worth passing along.

Are you tired of hearing the advice to wash your hands and keep social distance, given that you’ve already heard it a gazillion times on Facebook and we already know what to do? Then it’s time to educate yourself further.  My primary care physician, Dr. Alex Lickerman, is the best doctor I’ve ever met, and I’ve known many. He’s not only extremely knowledgeable (he’s young but was head of primary care at the University of Chicago Hospital for seven years, leaving because he didn’t like the strictures of rapid patient turnover), but reads the scientific literature thoroughly and bases his advice on both that and his own experience. He also posts on his two-doctor practice’s website (he calls it a “blog”), ImagineMD, and has been putting up his thoughts and recommendations about Covid-19, updating them as new information becomes available. (You can sign up for a free email subscription.)

The post below, which just came out, is the sixth update in a Covid-19 series that started in February (links to the first five are at the bottom of this post).

Now I know that not everyone will be on board with any doctor’s take (it seems that everyone is an expert on coronavirus!), but do read it and take what you want from it (click on screenshot). I asked Alex if he’d be willing to answer readers’ questions, and he said “Yes. My aim is to stamp out misinformation and spread correct information wherever possible. I’ll answer as I have time.”

So I can’t guarantee that all readers’ questions will be answered or addressed, but if you want to know something, by all means put your query in the comments. But first read the article (click on the screenshot).

Topics covered in the post above include:

  • What are the symptoms and typical course of the disease?
  • How does testing for the virus work and how reliable is it?
  • How is the virus transmitted?
  • Should you wear a mask in public?
  • Can pets carry coronavirus?
  • How do you deal with “coronachondria”—the extreme anxiety associated with people experiencing this pandemic?
  • How do you deal with the possibility of gaining weight now that our normal activities, and much of our exercise, has been curtailed?
  • How long is this pandemic going to last?

After you read it, feel free to leave questions on these topics and others related to coronavirus in the comments.

Finally, the video below is proffered by Professor Ceiling Cat (Emeritus): Masks may soon be required or recommended for anyone going out in public, at least if you’re to meet other people. I found this video on how to make a dust mask, and given that it’s not easy for non-doctors or non-scientists to buy “regular” masks, this one looks acceptable, and has the advantage of being washable and therefore reusable. I offer this, again, for what it’s worth: I’m not a doctor or epidemiologist. It’s surely not great protection from inhaling aerosolized virus, but will keep you from touching your face (except for your eyes), and it should be a good reminder, when worn, not to do so.

 

Advice about Covid-19 from a pulmonary critical-care doctor

March 29, 2020 • 11:15 am

Reader Rick sent me this video, which I’ve listened to in its entirety (57 minutes). It’s made by Dr. David Price, a critical pulmonary-care specialist at Weill Cornell Hospital in New York City. Usually he deals with all kinds of respiratory ailments, but, as he says, now he’s dealing only with COVID-19 patients. Here Price offers advice, and it’s somewhat reassuring, as the precautions you need are not onerous but are IMPORTANT. Reader Rick added this information.

I found this encouraging.

Dr. David Price is a critical care pulmonologist. He does a conference call describing  his experience.  It’s a long video, but quite valuable.

Bottom line: COVID-19 is becoming well understood.  If you practice good hand cleanliness procedures and distancing, you have nothing to worry about.

  1. Hand to face is the critical path. Spray, rarely.
  2. Get into the habit of knowing where your hands are and be sure they are clean. (sanitizer)
  3. Wear a mask, not to protect you, but simply to avoid hand to face contact.
  4. You don’t need an N-95 mask. Anything will do.  Give N-95 to your local hospital.
  5. Carry sanitizer with you when you go out.
  6. Be friendly and social, just stay 6′ away.
  7. Shrink your social circle.  You don’t want to be in large groups.
  8. Go to the hospital only if you are short of breath. Headache, fever, muscle ache, cough – stay home.
  9. Course of the disease is 7 -14 days. Immunity then follows.

If  you follow the simple rules, you will not get COVID-19.  This should be liberating.

Again, I’m not a doctor and so you must make your own judgment about this doctor’s advice.  The first 20 minutes of the video are recommendations for general behavior (i.e., wear a mask in public, but only to keep you from touching your face. Price doesn’t mention gloves).  From 20-30 minutes in, Price discusses what you should do if you think your’e infected, or if you have a family member who is infected. From 30 minutes to the end, Price deals with general questions.

Public-health physician urges more targeted and less of a “shotgun” approach to stemming the pandemic

March 23, 2020 • 9:00 am

Update: This new article largely echoes the one below: it emphasizes the need to get healthy people back to work, which requires more testing, and to provide adequate protection to healthcare workers. Both pieces emphasize fighting the pandemic in ways to minimize long-term damage to our economy caused by extended periods of people staying at home while businesses are closed. As the article notes, “Paul Romer, who received the Nobel Prize in Economics in 2018, is a professor at N.Y.U. Alan M. Garber, a physician and economist, is the provost of Harvard University.”

A quote:

In the long run, we are likely to have better options — a vaccine perhaps, or effective drug treatments. And at some point, herd immunity, when so many people have immunity that others are unlikely to encounter and fall victim to the virus, will make this coronavirus a far more manageable threat.

But we cannot afford to wait and hope. John Maynard Keynes famously quipped that in the long run, we are all dead. If we keep up our current strategy of suppression based on indiscriminate social distance for 12 to 18 months, most of us will still be alive. It is our economy that will be dead.

______________________________

David L. Katz (see also here) is a public-health physician and, according to Wikipedia, “the founding director of the Yale-Griffin Prevention Research Center that was founded at Griffin Hospital in Derby, Connecticut in 1998.” I can’t assess his credentials as an epidemiologist, but he’s surely no quack. In an article in yesterday’s New York Times (click on screenshot below), Katz argues that the U.S. is fighting the coronavirus pandemic all wrong. By using a scattershot approach in which everyone is forced to stay home and virtually everything is closed, he argues that we are depriving the most vulnerable (the elderly and immunocompromised) of essential care and equipment, exposing them to younger and healthier people who may carry the disease, and wrecking the American economy by forcing businesses (and maybe schools) to go under. 

Yet just today, the U.S. Surgeon General said of America, “This week it’s going to get really bad.”  I present Katz’s article because it’s worth thinking about, not to urge people to avoid the guidelines which have been laid down by American authorities, both federal and local.

You should read the article for yourself. I’m sure that many of you, like me, have wondered if mass closures of businesses and requiring everyone, young, old, sick, or healthy, to shelter at home, is an effective way to shut down the pandemic—and also maintain the fabric of our society. Katz argues no: that by getting the healthier population to acquire “herd immunity” while removing the susceptible from exposure to the virus, and by testing only the susceptible for the virus, we could stop the plague without wrecking the nation.

Now I doubt that anybody is going to follow Katz’s recommendations, as the “sequester-everyone-and-shut-down-every-nonessential business” mentality is too widespread and ingrained. Still, have a look at his arguments, which I excerpt below (again, read the whole thing). Katz’s quotes are indented.

The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.

Why does this matter?

I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.

Worse, I fear our efforts will do little to contain the virus, because we have a resource-constrained, fragmented, perennially underfunded public health system. Distributing such limited resources so widely, so shallowly and so haphazardly is a formula for failure. How certain are you of the best ways to protect your most vulnerable loved ones? How readily can you get tested?

We have already failed to respond as decisively as China or South Korea, and lack the means to respond like Singapore. We are following in Italy’s wake, at risk of seeing our medical system overwhelmed twice: First when people rush to get tested for the coronavirus, and again when the especially vulnerable succumb to severe infection and require hospital beds.

Yes, in more and more places we are limiting gatherings uniformly, a tactic I call “horizontal interdiction” — when containment policies are applied to the entire population without consideration of their risk for severe infection.

But as the work force is laid off en masse (our family has one adult child home for that reason already), and colleges close (we have another two young adults back home for this reason), young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents. If there are any clear guidelines for behavior within families — what I call “vertical interdiction” — I have not seen them.

. . . There is another and much overlooked liability in this approach. If we succeed in slowing the spread of coronavirus from torrent to trickle, then when does the society-wide disruption end? When will it be safe for healthy children and younger teachers to return to school, much less older teachers and teachers with chronic illnesses? When will it be safe for the work force to repopulate the workplace, given that some are in the at-risk group for severe infection?

We all know the pandemic is going to last longer than they tell us, at least based on when schools are set to re-open. But Katz’s alternative: get business back to normal while keeping the most susceptible people out of circulation, and limiting testing to that group or to people who show clear Covid-19 symptoms (my own doctor tells me it’s shortness of breath). Here’s what he suggests (I have to admit it lacks specificity, but differs substantially from what is being done now):

So what is the alternative? Well, we could focus our resources on testing and protecting, in every way possible, all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic diseases and the immunologically compromised. Those that test positive could be the first to receive the first approved antivirals. The majority, testing negative, could benefit from every resource we have to shield them from exposure.

To be sure, while mortality is highly concentrated in a select groups [sic], it does not stop there. There are poignant, heart-rending tales of severe infection and death from Covid-19 in younger people for reasons we do not know. If we found over time that younger people were also especially vulnerable to the virus, we could expand the at-risk category and extend protections to them.

However, from what I hear, younger people can die from this virus without any underlying conditions. And if those people are at risk, then “expanding the at-risk category” pretty much means shutting down all schools and businesses—what we’re doing now. Katz doesn’t address this further.

He does, however, make the good points that current policy involves inundating the medical establishment with lower-risk people who don’t need treatment, burdening families with the job of educating and doing extra care of the young while schools and universities are closed, and, above all, forcing susceptible older people to mingle with their younger relatives at home.

One more bit of Katz’s solution:

If we were to focus on the especially vulnerable, there would be resources to keep them at home, provide them with needed services and coronavirus testing, and direct our medical system to their early care. I would favor proactive rather than reactive testing in this group, and early use of the most promising anti-viral drugs. This cannot be done under current policies, as we spread our relatively few test kits across the expanse of a whole population, made all the more anxious because society has shut down.

This focus on a much smaller portion of the population would allow most of society to return to life as usual and perhaps prevent vast segments of the economy from collapsing. Healthy children could return to school and healthy adults go back to their jobs. Theaters and restaurants could reopen, though we might be wise to avoid very large social gatherings like stadium sporting events and concerts.

And there you have it. Of course, this sounds good to those of you who are younger and healthy, as we’re all going stir-crazy, and psychologists warn of an epidemic of loneliness (certainly better than an epidemic of death). But would it work? I do worry, like Katz, that if everything shuts down for months or even longer, we’ll never recover socially or economically, and Katz’s solution deals with that by trading off employment and well-being against the possibility of extra deaths if his policy is implemented. That’s nothing new: we make such societal decisions all the time.

Again, assessing Katz’s recommendations is above my pay grade, and I am not about to tell people that he’s right and it’s fine to flout the regulations. After all, I’m following them, too. But as the months of quarantine draw on, and people start feeling the severe pinch of unemployment, no school, and social isolation, we might wonder whether there’s a kernel of truth to Katz’s arguments.

Please weigh in below.

Coronavirus updates: three easy pieces

March 22, 2020 • 9:15 am

Today we have an article by Nick Cohen to read, a panegyric by Andrew Sullivan, and an epidemiological website to peruse and fret about. Cohen and Sullivan worry that, although Trump’s response to the viral pandemic has been erratic, hamhanded, and even duplicitous, the Prez could come out of this even stronger. (I predicted the opposite, but what do I know?)

First, a piece by Nick Cohen in the Guardian (is there an American equivalent of this liberal journalist who doesn’t fall prey to wokeness?). Click on the screenshot to read (h/t Jeremy):

Cohen argues, correctly, that both Boris Johnson and Donald Trump, the former described as a “clown in a morgue” and the latter as a “cornered conman,” have grossly mishandled the pandemic, with Trump’s behavior being describe as “close to criminal.” I, for one, have never seen such an blatant display of ignorance, waffling, and lying from a President (including Nixon), and I’m counting on the fact that even benighted Americans can see through Trump’s woeful performance. When they start losing their jobs and the stock market tanks, then Trump loses the only substantial card he had: the economy was doing well. That’s why I bet $100 that he’d lose in November, though most readers seemed to think that was a bad bet.

Cohen goes on to claim that Trump might save his popularity via populism: blaming the virus on the Chinese and thus arousing “America first” sentiments and intensifying the culture wars. A few excerpts:

Instead, an escape attempt began with the right-wing deploying the language policing it so often deplores on the politically correct left. Trump is now insisting that coronavirus should not be called coronavirus but “Chinese virus”.

The side benefits he could expect to bank ought to be obvious. Trump could count on US liberals playing his game by accusing him of being an anti-Chinese racist. Liberals duly walked into the trap and Trump’s supporters were transported from the fear of living in an unprepared country with a demonstrably inadequate leader to the familiar ground of culture war. They could mutter: “Oh, these people call everything they don’t like racist; they’ll be saying it’s racist to call Chinese food ‘Chinese’ next.”

. . . However much critics may want to say Trump is a semi-senile fool – and I do – it is worth remembering that he remains a brilliant political operator, who has destroyed all opponents within and without the Republican party who made the mistake of underestimating him. In this instance his cleverness, and the major benefit he expects to enjoy, lies in shifting the blame for his folly on to the Chinese.

And this is unbelievable:

It does not stop there. If the virus is China’s fault, then domestic critics of his administration are traitors aiding the Chinese communists. You think I’m exaggerating? On 16 March, Trump tweeted a link to an article on the paranoid Federalist site. The author, one Madeline Osburn, was explicit. The Atlantic, a serious American magazine, had joined “China’s anti-American disinformation efforts”, she said. Osburn, who would have had a glittering career on the People’s Daily if she had been born Chinese, cited the work of The Atlantic’s Anne Applebaum, without appearing to know that Applebaum has written two devastating histories of the atrocities of communism. Describing how the pandemic has exposed America’s weaknesses in general, and its president’s weaknesses in particular, made Applebaum a useful idiot at best and traitor at worst, Osburn said.

Well, the “Trump tweeted a link” goes not to Trump but to a tweet by Mark Levin, a conservative commenter, but the article in the Federalist takes us back to the days of McCarthy-ite Red-baiting. Cohen goes on to somewhat extol Trump’s cleverness in deflecting his own incompetence onto the Chinese, and criticizing journalists for “siding with China.” In the end, Cohen is less certain than I about the effect of Trump’s competence on his electability come November. But I’m hoping that America’s pocketbook will outweigh its jingoism.

Cohen:

The hope that events will justify your beliefs is an ineradicable delusion. Surely, now the British will see through Johnson, liberals say, rather than blindly rally to his government in a time of crisis. Surely, the Americans will toss Trump on the scrap heap in November. But political battles do not win themselves. Democrats still have to unseat a sitting president – a feat they have not managed since 1992. Labour still has to turn itself from a serial election-loser into an election-winning machine. As the US shows, coronavirus can become the “China virus”. And what seems an irrefutable argument for a comprehensive welfare state can become an excuse for nationalist tricksters to wrap themselves in their tattered flags.

My own reading of the press, both right and left, doesn’t show this kind of “Chinese excuse”, at least in the U.S., but readers here aren’t so sanguine. My bet is that as the pandemic continues, lasting longer than our public officials are telling us, Trump’s popularity rating will fall, and come November we’ll have Biden in the White House. You may not be elated at that prospect (I’m not), but it sure beats the hamburger-fed tuchas now sitting there.

************

Every Friday, reader Simon sends me a link to Andrew Sullivan’s weekly column, and every Friday I read it, for Sullivan, however you feel about him, is a man worth reading. His latest, replacing his usual tripartite column, is a meditation on the pandemic—especially poignant because Sullivan (who is HIV positive) lived through the AIDS epidemic of the Eighties. Click on the screenshot to read:

According to Sullivan, the “plague of AIDS” changed people in many ways: making some fearful, others resolute and compassionate, and showing “whom you can trust and whom you can’t, and also reveals what matters.” It also brought gay rights, for which we have no equivalent with coronavirus—except, perhaps, a fix of the healthcare system and greater readiness to deal with these emergencies.

Mourning the lose of closeness (Sullivan says it’s been two weeks since he got a hug), he also tries to find the silver lining, which isn’t all that convincing to me, much as I want to find good in the bad. But there’s no law of nature—only the feel-good homilies of faith—that says that tragedy will be compensated with joy. Perhaps it’s because of Andrew’s Catholicism that he feels this way, and indeed, he gives a shout-out to religion:

Good will happen too. Surely it will. The silence in the streets portends something new. The other day, I realized I’d been texting a lot less and calling a lot more. I wanted to make sure my friends and family were okay, and I needed to see their faces and hear their voices to be reassured. As we withdraw from each other in the flesh, we may begin to appreciate better what we had until so recently: friendship and love made manifest by being together, simple gifts like a shared joint, a head resting on your shoulder, a hand squeezed, a toast raised. And in this sudden stop, we will also hear the sounds of nature — as our economic machine pauses for a moment and the contest for status or fame or money is canceled for just a while. “All of humanity’s problems stem from man’s inability to sit quietly in a room alone,” Pascal said. Well, we’ll be able to test that now, won’t we?

These weeks of confinement can be seen also, it seems to me, as weeks of a national retreat, a chance to reset and rethink our lives, to ponder their fragility. I learned one thing in my 20s and 30s in the AIDS epidemic: Living in a plague is just an intensified way of living. It merely unveils the radical uncertainty of life that is already here, and puts it into far sharper focus. We will all die one day, and we will almost all get sick at some point in our lives; none of this makes sense on its own (especially the dying part). The trick, as the great religions teach us, is counterintuitive: not to seize control, but to gain some balance and even serenity in absorbing what you can’t. [JAC: That, by the way, is taught not just by religions but also by philosophies like Stoicism. “Don’t sweat the small stuff” is not a religious homily.]

All fine and good, but if we were God and could have stopped the plague (clearly an issue for theologians who must explain why he didn’t), we would have. The loss of lives cannot be outweighed by a slight increase in the quality of lives that remain. And the lessons learned about life’s fragility, as when you survive a medical crisis, are often forgotten quickly, and it’s back to business as usual.

Finally, Andrew doesn’t see Trump’s incompetence during this time as having doomed his political prospects, but for reasons different from those given by Cohen:

 But a lot is at stake, and I suspect that those who think COVID-19 all but kills Donald Trump’s reelection prospects are being, as usual, too optimistic. National crises, even when handled at this level of incompetence and deceit, can, over time, galvanize public support for a national leader. As Trump instinctually finds a way to identify the virus as “foreign,” he will draw on these lizard-brain impulses, and in a time of fear, offer the balm of certainty to his cult and beyond. It’s the final bonding: blind support for the leader even at the risk of your own sickness and death. And in emergencies, quibbling, persistent political opposition is always on the defense, and often unpopular. It requires pointing out bad news in desperate times; and that, though essential, is rarely popular.

Watching Fox News operate in real time in ways Orwell described so brilliantly in Nineteen Eighty-Four — compare “We had always been at war with Eastasia” with “I’ve felt that it was a pandemic long before it was called a pandemic” —  you’d be a fool not to see the potential for the Republican right to use this plague for whatever end they want. If Trump moves to the left of the Democrats in handing out big non-means-tested cash payments, and provides a stimulus far bigger than Obama’s, no Republican will cavil. And since no sane person wants the war on COVID-19 to fail, we will have to wish that the president succeed. Pulling this off as an opposition party, while winning back the White House, will require a political deftness I don’t exactly see in abundance among today’s Democrats.

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Finally, as if you need another reason to be depressed (I’m watching the evening news through my palms, but my hands are clean), reader Charles sent me this ProPublica guide to the readiness of American hospitals to deal with coronavirus.

As Charles wrote, the source seems reputable: “The infection rate scenarios are based on estimates from leading epidemiologist Dr. Marc Lipsitch, head of the Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics, who made the projections of how many people globally would be infected.”

Read and weep:

The metric is what percentage of hospital beds would be filled (from 0% to over 200%) under all nine permutations of infection rate and time: 20%, 40%, and 60% of American infected, combined with those infection rates occurring over 6 months, 12 months, and 18 months. Here’s the scenario for 18 months; you don’t want to look at the others! Anything that is yellow is bad, indicating 100% hospital-bed occupancy. And it’s almost certain that at least 20% of Americans will become infected.

 

You can also enter your locality and see how ready the hospitals around you are. This is for Chicago. Only under the most optimistic scenario will we not fill more than 100% of the hospital beds. The red line is full capacity.

Oy!