Ensuring Uptake of Vaccines against SARS-CoV-2

[Note:  This item comes from friend David Rosenthal.  DLH]

Ensuring Uptake of Vaccines against SARS-CoV-2
By Michelle M. Mello, J.D., Ph.D., Ross D. Silverman, J.D., M.P.H., and Saad B. Omer, M.B., B.S., M.P.H., Ph.D.
Jun 26 2020

As Covid-19 continues to exact a heavy toll, development of a vaccine appears the most promising means of restoring normalcy to civil life. Perhaps no scientific breakthrough is more eagerly anticipated. But bringing a vaccine to market is only half the challenge; also critical is ensuring a high enough vaccination rate to achieve herd immunity. Concerningly, a recent poll found that only 49% of Americans planned to get vaccinated against SARS-CoV-2.1

One option for increasing vaccine uptake is to require it. Mandatory vaccination has proven effective in ensuring high childhood immunization rates in many high-income countries. However, except for influenza vaccination of health care workers, mandates have not been widely used for adults.

Although a vaccine remains months to years away, developing a policy strategy to ensure uptake takes time. We offer a framework that states can apply now to help ensure uptake of the vaccine when it becomes available — including consideration of when a mandate might become appropriate. Our approach is guided by lessons from U.S. experiences with vaccines for the 1976 “swine flu,” H1N1 influenza, smallpox, and human papillomavirus (HPV).

We believe that six substantive criteria should be met before a state imposes a SARS-CoV-2 vaccine mandate (see box). The first is the existence of evidence that Covid-19 is inadequately controlled in the state by other measures, such as testing, contact tracing, and isolation and quarantine — as indicated by sustained, troubling trends in new cases, hospitalizations, or deaths. Principles of public health law and ethics require that interventions that impinge on autonomy be reasonable and necessary; therefore, Covid-19 must present an ongoing threat. By the time a vaccine is available, more will be known about natural immunity in the population, the consequences of relaxing community mitigation measures, and the feasibility of scaling up test-and-trace strategies. There should be a reasonable indication as to whether further measures are needed.

Six Trigger Criteria for State Covid-19 Vaccination Mandates.

• Covid-19 is not adequately contained in the state.

• The Advisory Committee on Immunization Practices has recommended vaccination for the groups for which a mandate is being considered.

• The supply of vaccine is sufficient to cover the population groups for which a mandate is being considered.

• Available evidence about the safety and efficacy of the vaccine has been transparently communicated.

• The state has created infrastructure to provide access to vaccination without financial or logistic barriers, compensation to workers who have adverse effects from a required vaccine, and real-time surveillance of vaccine side effects.

• In a time-limited evaluation, voluntary uptake of the vaccine among high-priority groups has fallen short of the level required to prevent epidemic spread.

The second criterion is that the Advisory Committee on Immunization Practices (ACIP), after reviewing the safety and efficacy evidence, has recommended vaccination for the persons who would be covered by a mandate. Currently available evidence suggests that the elderly, health professionals working in high-risk situations or working with high-risk patients (e.g., nursing home residents and patients with severe respiratory symptoms), and persons with certain underlying medical conditions may be high-priority groups for the ACIP’s consideration, along with other workers with frequent, close, on-the-job contacts and persons living in high-density settings such as prisons and dormitories. When a vaccine nears approval, the ACIP should review the updated evidence and develop recommendations. Only recommended groups should be considered for a vaccination mandate, though health officials can encourage voluntary uptake for others, using means such as public education campaigns and free vaccination.

The fact that a vaccine has received Food and Drug Administration (FDA) approval — whether under an Emergency Use Authorization (EUA) or ordinary review processes — is an insufficient basis on which to conclude that it should be required. FDA approval reflects a determination that clinical trial evidence shows that the benefits of a vaccine outweigh its risks. ACIP recommendations reflect broader considerations, including values and preferences of affected groups, implementation issues, and health economic analyses. Overweighting FDA decisions would be particularly problematic for SARS-CoV-2 vaccines because EUAs may be based on very limited evidence and consciously or unconsciously influenced by the intense pressure to speed countermeasures to market.2

The third criterion is that there is an adequate supply of vaccine to cover the groups for which a mandate is being considered. Initially, global demand for SARS-CoV-2 vaccines will outstrip supply, making the salient question not who must get them but who will be granted access to them. New York State’s unsuccessful attempt to mandate H1N1 influenza vaccination for health care workers demonstrates that imposing requirements before adequate supply has been secured needlessly provokes controversy and alienates people who have already made sacrifices to fight an epidemic.3

The fourth criterion is that there has been transparent communication of the best available evidence about the vaccine’s safety and efficacy.4 Particularly given the possibility that the evidence underlying FDA approval of SARS-CoV-2 vaccines may be more modest than usual, policymakers and the public will need to understand the limits of what is known. Public trust has already been compromised by federal officials’ endorsement of hydroxychloroquine as a Covid-19 treatment without evidentiary support; the same must not occur for vaccines.


Almost half of the U.S. population does not have a job

[Note:  This item comes from friend David Rosenthal.  DLH]

Almost half of the U.S. population does not have a job
By Dion Rabouin
Jun 30 2020
The percentage of Americans who are employed sits at just over 50%, according to the Bureau of Labor Statistics’ employment-population ratio. The figure plunged to 51.3% in April (the lowest level on record) and edged up to 52.8% in May.
The backdrop: The ratio was as high as 61.2% in January, but has fallen precipitously since coronavirus-induced lockdowns shuttered businesses across the United States.
  • The measure reached its peak in April 2000 when 64.7% of eligible American adults were employed.
  • What it means: While the BLS’ jobs report categorizes people as “employed,” “unemployed” or “out of the labor force,” the employment-to-population ratio simply captures those who are and are not employed.

The intrigue: Torsten Sløk, chief economist at Deutsche Bank Securities notes, “To get the employment-to-population ratio back to where it was at its peak in 2000 we need to create 30 million jobs.”

The 3 Weeks That Changed Everything

The 3 Weeks That Changed Everything
Imagine if the National Transportation Safety Board investigated America’s response to the coronavirus pandemic.
By James Fallows
Jun 29 2020

Coping with a pandemic is one of the most complex challenges a society can face. To minimize death and damage, leaders and citizens must orchestrate a huge array of different resources and tools. Scientists must explore the most advanced frontiers of research while citizens attend to the least glamorous tasks of personal hygiene. Physical supplies matter—test kits, protective gear—but so do intangibles, such as “flattening the curve” and public trust in official statements. The response must be global, because the virus can spread anywhere, but an effective response also depends heavily on national policies, plus implementation at the state and community level. Businesses must work with governments, and epidemiologists with economists and educators. Saving lives demands minute-by-minute attention from health-care workers and emergency crews, but it also depends on advance preparation for threats that might not reveal themselves for many years. I have heard military and intelligence officials describe some threats as requiring a “whole of nation” response, rather than being manageable with any one element of “hard” or “soft” power or even a “whole of government” approach. Saving lives during a pandemic is a challenge of this nature and magnitude.

It is a challenge that the United States did not meet. During the past two months, I have had lengthy conversations with some 30 scientists, health experts, and past and current government officials—all of them people with firsthand knowledge of what our response to the coronavirus pandemic should have been, could have been, and actually was. The government officials had served or are still serving in the uniformed military, on the White House staff, or in other executive departments, and in various intelligence agencies. Some spoke on condition of anonymity, given their official roles. As I continued these conversations, the people I talked with had noticeably different moods. First, in March and April, they were astonished and puzzled about what had happened. Eventually, in May and June, they were enraged. “The president kept a cruise ship from landing in California, because he didn’t want ‘his numbers’ to go up,” a former senior government official told me. He was referring to Donald Trump’s comment, in early March, that he didn’t want infected passengers on the cruise ship Grand Princess to come ashore, because “I like the numbers being where they are.” Trump didn’t try to write this comment off as a “joke,” his go-to defense when his remarks cause outrage, including his June 20 comment in Tulsa that he’d told medical officials to “slow the testing down, please” in order to keep the reported case level low. But the evidence shows that he has been deadly earnest about denying the threat of COVID-19, and delaying action against it.

“Look at what the numbers are now,” this same official said, in late April, at a moment when the U.S. death toll had just climbed above 60,000, exceeding the number of Americans killed in the Vietnam War. By late June, the total would surpass 120,000—more than all American military deaths during World War I. “If he had just been paying attention, he would have asked, ‘What do I do first?’ We wouldn’t have passed the threshold of casualties in previous wars. It is a catastrophic failure.”

As an amateur pilot, I can’t help associating the words catastrophic failure with an accident report. The fact is, confronting a pandemic has surprising parallels with the careful coordination and organization that have saved large numbers of lives in air travel. Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong. In deciding whether to fly if I’m tired or if the weather is marginal, I rely on a tie-breaking question: How would this look in an NTSB report?

Controlling the risks of flight may not be as complex as fighting a pandemic, but it’s in the ballpark. Aviation is fundamentally a very dangerous activity. People are moving at high altitudes, at high speed, and in high volume, with a guarantee of mass casualties if things go wrong. Managing the aviation system involves hardware—airframes, engines, flight control systems—and “software,” in the form of training, routing, and coordinated protocols. It requires recognition of hazards that are certain—bad weather, inevitable mechanical breakdowns—and those that cannot be specifically foreseen, from terrorist episodes to obscure but consequential computer bugs. It involves businesses and also governments; it is nation-specific and also worldwide; it demands second-by-second attention and also awareness of trends that will take years to develop.

The modern aviation system works. From the dawn of commercial aviation through the 1990s, 1,000 to 2,000 people would typically die each year in airline crashes. Today, the worldwide total is usually about one-10th that level. Last year, before the pandemic began, more than 25,000 commercial-airline flights took off each day from airports in the United States. Every one of them landed safely.

In these two fundamentally similar undertakings—managing the skies, containing disease outbreaks—the United States has set a global example of success in one and of failure in the other. It has among the fewest aviation-related fatalities in the world, despite having the largest number of flights. But with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

Consider a thought experiment: What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude? I’ll jump to the answer before laying out the background: This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

The organization below differs from that of a standard NTSB report, but it covers the key points. Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf. As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

But what happened in the two months before Trump’s statement, when the United States still had a chance of containing the disease where it started or at least buffering its effects, is if anything worse.

1. The Flight Plan

The first thing an airplane crew needs to know is what it will be flying through. Thunderstorms? Turbulence? Dangerous or restricted airspace? The path of another airplane? And because takeoffs are optional but landings are mandatory, what can it expect at the end of the flight? Wind shear? An icy runway? The biggest single reason flying is so much safer now than it was even a quarter century ago is that flight crews, air traffic controllers, and the airline “dispatchers” who coordinate with pilots have so many precise tools with which to anticipate conditions and hazards, hours or days in advance.

And for the pandemic? Since at least the early years of the George W. Bush administration, the U.S. government has devoted scientific, military, and intelligence tools toward refining its understanding of what diseases might be emerging and where, and what might be done about them. One reason for this increased emphasis was the overall heightened (and sometimes overhyped) domestic-security awareness after the 9/11 terrorist attacks. Another was the series of anthrax attacks soon after 9/11, in which envelopes containing toxins were mailed to media and political figures on the East Coast.

But the most important event was the H5N1 “bird flu” outbreak, in 2005. It originated in Asia and was mainly confined there, as the SARS outbreak had been two years earlier. Bush-administration officials viewed H5N1 as an extremely close call. “We were deeply and genuinely concerned about the potential for human-to-human transmission of the bird flu,” John R. Allen, now president of the Brookings Institution, told me. Allen is a retired four-star Marine Corps general who during the Bush administration was an early participant in the contingency-planning efforts to assess the lessons of the H5N1 threat. “We realized that if it had spread worldwide, the numbers would have been enormous. So the national-security system was pulled right into the process of improving our awareness mechanisms, and developing a national pandemic strategy.”

The awareness mechanisms were a combination of military and civilian, structured and informal, open-source and classified, with a heavy emphasis on the then-infant tools of artificial intelligence, or AI. For instance, in Bush’s second term, an unclassified government-funded project called Global Argus—named for the all-seeing giant of Greek mythology—began sifting through news reports, radio broadcasts, road-traffic patterns, business data, and other kinds of open-source information for signs of abnormalities that, in turn, could be early indicators of disease.


More on T Cells, Antibody Levels, and Our Ignorance

[Note:  This item comes from friend David Rosenthal.  DLH]

More on T Cells, Antibody Levels, and Our Ignorance
By Derek Lowe
Jul 7 2020

I wrote here about the reports of rather short antibody persistence in recovering coronavirus patients, and what’s been coming out in the two weeks since then has only made this issue more important. In that post, I was emphasizing that although we can measure antibody levels, we don’t know how well that correlates with exposure to the virus nor to later immunity from it, and that T cells are surely a big part of this picture that we don’t have much insight into.

This Twitter thread by Eric Topol is exactly what I mean, and this article that he references is an important read. Its schematic at right (see also here) will help make clear that antibody levels are only one aspect of the immune response to the infection – it’s an important one, but we’re making it look even more important than it is because it’s by far the easiest part of the process to measure. The T-cell response (much harder to get good data on) is known to be a key player in viral infections, and is also known to be highly variable, both between different types of pathogens and among individuals themselves. The latter variations are also beginning to be characterized among patients in the current pandemic. We have to get more data on it across a broader population of patients in order to make sense of what we’re seeing.

Many readers will have seen, for example, this new paper from The Lancet on a large study in Spain. Testing tens of thousands of people across the country continues to show that (on average) only about 5% of the population is seropositive (that is, has antibodies to the virus). There are a lot of interesting findings – such as rather large differences in those positive testing rates in different regions of the country, as well as the realization that at least one-third of the people who now test positive never showed any symptoms at all. But we are still not sure if this means that 95% of the Spanish population has never been exposed to the virus, because we don’t know how many people might have cleared it without raising enough of an antibody response to still be detectable. This paper does show that seroprevalence was about 90% in people 14 days after a positive PCR test, which indicates that most people do raise some sort of antibody response, but we don’t know how many of these people will still show such antibodies at later testing dates. Remember the paper discussed in that link in the first paragraph above, which found that 40% of asymptomatic patients went completely seronegative during their convalescence.

In other words, the Spanish survey may appear to show that 95% of the country has not yet been exposed to the coronavirus, but that’s almost certainly not true. The authors do mention that cellular immunity is important and not something that they were able to address, but the combination of that factor plus the apparent dropoff in antibody levels with time makes these large IgG surveys almost impossible to interpret. But note that if there are indeed many people who have been exposed but do not read out in such surveys, that we also have no idea how immune they are to further infection. At a minimum, you’d want to know antibody levels over time, T-cell response over time, and (importantly) what a protective profile looks like for both of those. We barely have insight into any of this: the large-scale data are just a snapshot of antibody levels, and that’s not enough.


The Only Options are Panic or Feeding Frenzy

The Only Options are Panic or Feeding Frenzy
What kind of choice is that?
By Mike Meyer
Jul 7 2020

What do you call a panicked feeding frenzy? Typically a feeding frenzy is created by the presence of a lot of food for a group of significant predators. Panic in the face of threats, causes the opposite of a feeding frenzy. Somehow the Trump regime has managed to screw this up also.

While Trump Party congressional members are struggling to hide their growing panic in the face of full Insanity and white supremacy, not to mention massive infections and coming deaths, there is nowhere for them to turn. I don’t think they are eating or sleeping well, not that I have any sympathy.

Concurrently Trump and his cohort of stooges are in full cry to destroy as much of the US and the planet as they can in a death orgy of hate while feasting on human suffering. What do you do when you find yourself in the middle of a completely evil feeding frenzy when the only other option is panic and collapse?

This frenzy is approaching historic levels of national horror, and there seems to be no end and no one who can stop this. Meanwhile, Black communities are leading the most massive demonstrations in the history of the country to stop the murders, end the spread of the pandemic, and defund increasingly criminal police forces. But you would never know that from the national media that has lost interest or, maybe, decided to avoid upsetting anyone.

Joe Biden has come into his destiny by being an old white guy from the political elite who is reasonably nice and not bug fuck crazy. We have all accepted that there is no other hope at this point. Unfortunately, Joe is polite and will wait for his turn after the election, but I cannot see him in a military assault on the White House to end a coup attempt. Joe would go back home and maybe stop off to see some friends. Yes, he is all we have but is that enough?

As is being very openly discussed, the crazy gap between Trump-led insanity with his mindless hoard and the shell shocked majority of the country, is so vast it is hard to make any sense of it. One possible explanation comes from a New York Times reporter, Maggie Haberman, on CNN, who suggests that Trump is now actively trying to lose the election. This choice is not conscious; the man has a mental age of three but fits his pattern of quitting if he cannot be the only winner. Denial of life with great suffering is a consolation prize for Trump.

This scorched earth denialism is a known characteristic of Trump and similar psychopaths and suggested from the beginning as a possible outcome of a Trump presidency. We would all have whatever is left after he went home in a sulk. No one, I think, ever imagined the extent of the devastation that one lazy and ignorant mentally defective person in the wrong position could achieve when supported by a corrupt, failed political party in a collapsing nation.

Viciously forcing businesses to reopen in the middle of a pandemic is already starting to pale. The monster is now working to force schools to open without funding for necessary safety as the pandemic builds. What is needed is funding for communities, schools, and the population in general to survive this hellscape that could have been controlled and managed.

No one wants to say that it is too late, but it certainly looks that way to me. Yes, many communities will pull together and get through this, but many more will not. They all will be badly damaged for decades. This debacle has nothing good to offer. It is pure hatred, destruction, and death ending in suicide for whole communities that will never be able to restore what Trump and his party are destroying. The percentage of the population lured into social insanity will poison communities for a generation.

As so many people have been repeating over and over, the future is not on our side. This tragedy is a self-inflicted fatal injury amid a species self-inflicted planetary injury and economic collapse. It doesn’t get much bigger than that short of comet strikes or the next evolutionary change to the coronaviruses. We’ve neatly bundled all of this together. And Insanity is not an excuse.


WHO underplaying risk of airborne spread of Covid-19, say scientists

WHO underplaying risk of airborne spread of Covid-19, say scientists
Open letter says there is emerging evidence of potential for aerosol transmission
By Hannah Devlin
Jul 5 2020

The potential for Covid-19 to spread through airborne transmission by lingering in the air is being underplayed by the World Health Organization, a group of scientists have said.

In an open letter due to be published this week, 239 scientists from 32 countries call for greater acknowledgement of the role of airborne spread of Covid-19 and the need for governments to implement control measures.

WHO guidance states that the virus is transmitted primarily between people through respiratory droplets and contact. Aerosol transmission involves much smaller particles that can remain in the air for long periods of time and can be transmitted to others over distances greater than one metre.

Members of the WHO’s infection prevention committee have said that while aerosol transmission may play some role, there is overwhelming evidence that the primary routes of transmission are through direct contact and respiratory droplets expelled during coughing, sneezing or speech. They said introducing new measures to guard against aerosol transmission was unfeasible and unlikely to make much difference to the spread of infection.

The letter due to be published in the journal Clinical Infectious Diseases is authored by Lidia Morawska, of the Queensland University of Technology in Brisbane, and Donald Milton, of the University of Maryland, and has been endorsed by more than 200 scientists, including some who have been involved in drawing up the WHO’s advice.

They say emerging evidence, including from settings such as meat processing plants where there have been outbreaks, suggests that airborne transmission could be more important than the WHO has acknowledged.

Linsey Marr, an expert in airborne transmission of viruses at Virginia Tech and a co-signatory of the letter, told the New York Times that the WHO had relied on studies from hospitals that suggested low levels of virus in the air. This underestimated the risk, she said, because in most buildings “the air-exchange rate is usually much lower, allowing virus to accumulate in the air”.

The WHO says certain medical procedures, such as intubation, are known to raise the risk of aerosol transmission, but that outside of this context the evidence is less clear. “This is an area of active research,” the WHO says.

Paul Hunter, a professor in medicine at the University of East Anglia and a member of the WHO’s infection prevention committee, said the WHO had struck the right balance in its advice.

“Aerosol transmission can occur but it probably isn’t that important in the grand scheme of things. It’s all about droplets,” he said. “Controlling airborne transmission isn’t going to do that much to control the spread of Covid-19. It’s going to impose unnecessary burdens, particularly in countries where they don’t have enough trained staff or resources already.”


I predicted 2020 would be a mess for the U.S. Could that help prevent a second civil war?

[Note:  This item comes from friend David Rosenthal.  DLH]

I predicted 2020 would be a mess for the U.S. Could that help prevent a second civil war?
By Peter Turchin
Jul 3 2020

Peter Turchin is the author of Ages of Discord: A Structural-Demographic Analysis of American History, a professor at the University of Connecticut’s department of ecology and evolutionary biology, and the leader of a research group on social complexity and collapse at Complexity Science Hub Vienna.

Ten years ago, I predicted that 2020 would mark “a new peak of violence” in the United States and Western Europe. It may have seemed like an unusual call, at the time; Western countries had actually been enjoying more stability prior to 2010.

But even I didn’t imagine that things could be as bad as they’ve gotten.

Political polarization and “rampage killings” – what have since been redefined as “domestic terrorism” – have risen dramatically. Accelerating climate change has exacerbated crises around refugees, food security, housing and more. The COVID-19 pandemic has left half a million people dead and shuttered economies. Anti-government demonstrations and violent riots, sparked by a Minneapolis police officer’s killing of George Floyd, have swept the U.S. It’s all added up to the worst outbreak of social instability since the 1960s.

Historians like to say that failing to understand history dooms us to repeat it. There is truth in that axiom, but it tends to assume that cycles will just happen, without analyzing their causes using the rigorous scientific method. So if we don’t know which parts of history do repeat, or why – that is, which social theories about underlying causes are correct or not – the axiom falls short: We remain doomed.

That’s why scientists such as myself make scientific predictions based on theories, to test which ones turn out to be right; the theory that results in an accurate prediction is much more likely to be true than the theory that makes a poor one. This, effectively, is the field of cliodynamics. That’s where my 2010 forecast came from: It was a test of a theory that my colleagues and I developed by studying past societies, to determine what factors are responsible for historical states falling into crises, such as revolutions or civil wars.

From our research, we had a question we wanted to answer: Does inequality breed instability?

Granted, some degree of inequality is probably unavoidable, and may not even be bad; for example, most human beings agree that those who work harder should be rewarded for their efforts. The problem arises, we theorized, when inequality increases beyond the level that most people would consider fair.

As scientists do, we used our theory to make predictions about other historical societies, and they were borne out when we looked at ancient Rome and medieval France. However, predictions about the future are hard to make, since bygone eras do not always make for fair parallels to modern day.

During the past four decades, while the U.S. economy has grown very substantially, wages of most Americans stagnated and even declined. If we look at the median wage – how much a “typical” worker makes – and divide that by the GDP per capita, this indicator has been declining for decades; it has now fallen to historically low levels. This means that economic growth is not benefiting the majority of the American population. And it’s not just economic well-being that has been declining: Life expectancies of large swaths of the American population have started to decline, as well. Is it surprising that a feeling of pessimism now pervades our society?

Yes, the U.S.‘s economy grew significantly over the past four decades, but one outcome of that is the creation of three to five times as many millionaires, billionaires. Many – including the new millionaires, naturally enough – don’t see this as a problem. And they could have a case, had the wealth of the top 1 per cent grown in parallel with the wealth of the median earner. But that’s not what happened.

There is another, subtler and even more serious problem with too many millionaires. Our theory suggests that a certain proportion of people with great wealth will decide to convert their economic power into political power at some point in their lives; in other words, they either run for office themselves or invest in candidates of their choice. Four times as many millionaires, compared with 40 years ago, means that four times as many are now involved in politics. There are many more candidates, but the number of power positions hasn’t changed: There are still 435 seats in the U.S. House of Representatives, 100 senators and just one U.S. president. When intra-elite competition reaches such a feverish pitch, it generates many more losers than before. Cutthroat competition corrodes the co-operation on which our societies are based, while the social norms that govern the smooth functioning of a democracy unravel. Ultimately, increasing numbers of those who cannot get ahead by legitimate means feel abandoned by the institutions, often becoming radicals and revolutionaries who aim to overthrow the unjust regime, as they perceive it, by any means necessary.

This was our theory of how revolutions are made – in ancient Rome, medieval France and now, the modern-day U.S. It requires high levels of discontent among the masses, but also leaders – and now there are many, thanks to the abundance of intra-elite competition and conflict, perhaps expressed most clearly by President Donald Trump, who spun his personal wealth into a divisive presidency.


U.S. to force out foreign students taking classes fully online

[Note:  This item comes from friend Judi Clark.  DLH]

U.S. to force out foreign students taking classes fully online
By Mimi Dwyer
Jul 6 2020

NEW YORK (Reuters) – Foreign students must leave the United States if their school’s classes this fall will be taught completely online or transfer to another school with in-person instruction, the U.S. Immigration and Customs Enforcement (ICE) agency announced on Monday.

It was not immediately clear how many student visa holders would be affected by the move, but foreign students are a key source of revenue for many U.S. universities as they often pay full tuition.

ICE said it would not allow holders of student visas to remain in the country if their school was fully online for the fall. Those students must transfer or leave the country, or they potentially face deportation proceedings, according to the announcement.

Colleges and universities have begun to announce plans for the fall 2020 semester amid the continued coronavirus pandemic. Harvard University on Monday announced it would conduct course instruction online for the 2020-2021 academic year.

The ICE guidance applies to holders of F-1 and M-1 visas, which are for academic and vocational students. The State Department issued 388,839 F visas and 9,518 M visas in fiscal 2019, according to the agency’s data.

The guidance does not affect students taking classes in person. It also does not affect F-1 students taking a partial online course-load, as long as their university certifies the student’s instruction is not completely digital. M-1 vocational program students and F-1 English language training program students will not be allowed to take any classes online.

President Donald Trump’s administration has imposed a number of new restrictions to legal and illegal immigration in recent months as a result of the coronavirus pandemic.


How Google Docs became the social media of the resistance

How Google Docs became the social media of the resistance
Facebook and Twitter might have the bells and whistles, but the word processing software’s simplicity and accessibility have made it a winning tool.
By Tanya Basu
Jul 6 2020

In the week after George Floyd’s murder, hundreds of thousands of people joined protests across the US and around the globe, demanding education, attention, and justice. But one of the key tools for organizing these protests is a surprising one: it’s not encrypted, doesn’t rely on signing in to a social network, and wasn’t even designed for this purpose. It’s Google Docs.

In just the last week, Google Docs has emerged as a way to share everything from lists of books on racism to templates for letters to family members and representatives to lists of funds and resources that are accepting donations. Shared Google Docs that anyone can view and anyone can edit, anonymously, have become a valuable tool for grassroots organizing during both the coronavirus pandemic and the police brutality protests sweeping the US. It’s not the first time. In fact, activists and campaigners have been using the word processing software for years as a more efficient and accessible protest tool than either Facebook or Twitter.

Google Docs was launched in October 2012. It quickly became popular, not only because Google email accounts were so widespread already, but also because it allows multiple users to collaborate and edit simultaneously. Microsoft Word, the incumbent, finally had a real rival.

But it has always been used for purposes beyond simple word processing. Teens have long used Google Docs as a way of exchanging notes during dull lectures, for example. More recently, during the pandemic, Google Docs were widely shared to help people deal with the stress of lockdown. Shelter-in-place orders led to a series of feel-good lists on the platform, ranging from the one the New York Times ran of activities and reporters’ thoughts (“Notes from Our Homes to Yours”) to virtual escape rooms, socially distant comedy shows, crowdsourced and collaborative crosswords, and community grocery lists for people in need.

It wasn’t until the 2016 elections, when misinformation campaigns were rampant, that the software came into its own as a political tool. Melissa Zimdars, an assistant professor of communication at Merrimack College, used it to createa 34-page document titled “False, Misleading, Clickbaity-y, and/or Satirical ‘News’ Sources.’”

Zimdars inspired a slew of political Google Docs, written by academics as ad hoc ways of campaigning for Democrats for the 2018 midterm elections. By the time the election passed, Google Docs were also being used to protest immigration bans and advance the #MeToo movement.

Now, in the wake of George Floyd’s murder on Memorial Day weekend, communities are using the software to organize. One of the most popular Google Docs to emerge in the past week is “Resources for Accountability and Actions for Black Lives,” which features clear steps people can take to support victims of police brutality. It is organized by Carlisa Johnson, a 28-year-old graduate journalism student at Georgia State University.

Johnson created the Google Doc in the immediate aftermath of George Floyd’s death, but she had been compiling resources since the death of Ahmaud Arbery, whose murder by a father and son in February didn’t lead to arrests until video of the incident was released in May. “I’ve been doing this [sharing links for direct action] since 2014 with my own network of friends and family,” Johnson says. She’d never created a public Google Doc like this, and chose it over Facebook and Twitter because it is so accessible: “Hyperlinks are the most succinct and quickest way to access things, and you can’t do that on Facebook or Twitter. When you say ‘Contact your representative,’ a lot of people don’t know how to do that.” Direct links in the Google Doc make it much easier for people to get involved, she says.

Another viral Google Doc that emerged in the wake of George Floyd’s murder, listing resources for protestors and organizations accepting donations, was created by an activist known as Indigo, who identifies as nonbinary and uses a pseudonym so as not to be outed to family members. Indigo said accessibility and live editing were the primary advantages of a Google Doc over social media: “It’s important to me that the people on the ground can access these materials, especially those seeking legal counsel, jail support, and bail support. This is a medium that everyone I’ve organized with uses and many others use.”

Like Johnson, Indigo had been collecting resources after Floyd’s murder—“bookmarking and emailing myself tons of links” —and found that “I just couldn’t keep up with it. It seemed like no one else could either.” Indigo was frustrated with Twitter, though: “On the off-chance you find something phenomenal, you have to retweet, like, or share it in that moment or else it’s gone forever.” Google Docs was the answer.

“What’s special about a Google Doc versus a newsfeed is its persistence and editability,” says Clay Shirky, the vice provost for educational technology at New York University. In 2008, Shirky wrote Here Comes Everybody: The Power of Organizing Without Organizations, detailing how the internet and social media helped shape modern protest movements.

Shirky says that while social media has been great for publicizing movements, it’s far less efficient at creating stable shelves of information that a person can return to. What makes Google Docs especially attractive is that they are at once dynamic and static, he says. They’re editable and can be viewed simultaneously on countless screens, but they are easily shareable via tweet or post.

“People want a persistent artifact,” Shirky says. “If you are in an action-oriented network, you need an artifact to coordinate with those outside of the conversation and the platform you’re using, so you can actually go outside of the feed and do something.”

Johnson experienced that firsthand. Within days, her Google Doc had made it to actor Cole Sprouse’s Instagram stories and actress Halle Berry’s Twitter feed, multiplying its viewership.

It helps that Google Docs are fairly straightforward to access and simple to use. But anonymity is an important advantage over Twitter or Facebook. Users who click on a publicly shareable link are assigned an animal avatar, hiding their identity. “No one can put you on blast on Google Docs,” says Shirky. “Google Docs allows for a wider breadth of participation for people who are not looking to get into a high-stakes political argument in front of millions of people.”


The Pandemic Experts Are Not Okay

The Pandemic Experts Are Not Okay
Many American public-health specialists are at risk of burning out as the coronavirus surges back.
Jul 7 2020

Saskia Popescu’s phone buzzes throughout the night, waking her up. It had already buzzed 99 times before I interviewed her at 9:15 a.m. ET last Monday. It buzzed three times during the first 15 minutes of our call. Whenever a COVID-19 case is confirmed at her hospital system, Popescu gets an email, and her phone buzzes. She cannot silence it. An epidemiologist at the University of Arizona, Popescu works to prepare hospitals for outbreaks of emerging diseases. Her phone is now a miserable metronome, ticking out the rhythm of the pandemic ever more rapidly as Arizona’s cases climb. “It has almost become white noise,” she told me.

For many Americans, the coronavirus pandemic has become white noise—old news that has faded into the background of their lives. But the crisis is far from over. Arizona is one of the pandemic’s new hot spots, with 24,000 confirmed cases over the past week and rising hospitalizations and deaths. Popescu saw the surge coming, “but to actually see it play out is heartbreaking,” she said. “It didn’t have to be this way.”

Popescu is one of many public-health experts who have been preparing for and battling the pandemic since the start of the year. They’re not treating sick people, as doctors or nurses might be, but are instead advising policy makers, monitoring the pandemic’s movements, modeling its likely trajectory, and ensuring that hospitals are ready.

By now they are used to sharing their knowledge with journalists, but they’re less accustomed to talking about themselves. Many of them told me that they feel duty-bound and grateful to be helping their country at a time when so many others are ill or unemployed. But they’re also very tired, and dispirited by America’s continued inability to control a virus that many other nations have brought to heel. As the pandemic once again intensifies, so too does their frustration and fatigue.

America isn’t just facing a shortfall of testing kits, masks, or health-care workers. It is also looking at a drought of expertise, as the very people whose skills are sorely needed to handle the pandemic are on the verge of burning out.

To work in preparedness, Nicolette Louissaint told me, is to constantly stare at society’s vulnerabilities and imagine the worst possible future. The nonprofit she runs, Healthcare Ready, works to steel communities for outbreaks and disasters by ensuring that they have access to medical supplies. She started revving up her operations in January. By March, when businesses and schools started closing and governors began issuing stay-at-home orders, “we were already running on fumes,” she said. Throughout March and April, she got two hours of sleep a night. Now she’s getting four. And yet “I always feel like I’m never doing enough,” she said. “Like one of my colleagues said, I could sleep for two weeks and still feel this tired. It’s embedded in us at this point.”

But the physical exhaustion is dwarfed by the emotional toll of seeing the imagined worst-case scenarios become reality. “One of the big misconceptions is that we enjoy being right,” Louissaint said. “We’d be very happy to be wrong, because it would mean lives are being saved.”

The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”

The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.

The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.

The U.S. frittered away that chance. Through social distancing, the American public bought the country valuable time at substantial personal cost. The Trump administration should have used that time to roll out a coordinated plan to ramp up America’s ability to test and trace infected people. It didn’t. Instead, to the immense frustration of public-health advisers, leaders rushed to reopen while most states were still woefully unprepared.

When Arizona Governor Doug Ducey began reviving businesses in early May, the intensive-care unit of Popescu’s hospital was still full of COVID-19 patients. “Within our public-health bubble, we were getting nervous, but then you walked outside and it was like Pleasantville,” she said. “People thought we had conquered it, and now it feels like we’re drowning.”

The COVID-19 unit has had to expand across an entire hospital wing and onto another floor. Beds have filled with younger patients. Long lines are snaking around the urgent-care building, and people are passing out in the 110-degree heat. At some hospitals, labs are so inundated that it takes several days to get test results back. “We thought we could have scaled down instead of scaling up,” Popescu said. “But because of poor political decisions that every public-health person I know disagreed with, everything that could go wrong did go wrong.”

“I feel like I’ve been making the same recommendations since January,” says Krutika Kuppalli, an infectious-disease physician who works in public health. The last time she felt this tired was in 2014, after spending three months in West Africa helping with the region’s historic Ebola outbreak. Everyone who experienced that crisis, she told me, was deeply shaken; she herself suffered from post-traumatic stress upon returning home.

The same experts who warned of the coronavirus’s resurgence are now staring, with the same prophetic worry, at a health-care system that is straining just as hurricane season begins. And they’re demoralized about repeatedly shouting evidence-based advice into a political void. “It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire,” Carlson says.

A pandemic would have always been a draining ordeal. But it is especially so because the U.S., instead of mounting a unified front, is disjointed, cavalier, and fatalistic. Every week brings fresh farce, from Donald Trump suggesting that the country should do less testing to massive indoor gatherings of unmasked people.

“One by one, people are seeing something so absurd that it takes them out of commission,” Carlson says.