The battle over masks in a pandemic: An all-American story

The battle over masks in a pandemic: An all-American story
By Lori Rozsa, Chelsea Janes, Rachel Weiner and Joel Achenbach
Jun 19 2020
https://www.washingtonpost.com/health/the-battle-over-masks-in-a-pandemic-an-all-american-story/2020/06/19/3ad25564-b245-11ea-8f56-63f38c990077_story.html

JACKSONVILLE, Fla. — Max Parsell hasn’t been wearing a mask during the coronavirus pandemic and doesn’t intend to start. It’s a matter of principle.

“Making individual decisions is the American way,” Parsell, a 29-year-old lineman for a power company, said as he picked up his lunch at a barbecue joint at a rural crossroads south of Jacksonville. “I’ll social distance from you if you want, but I don’t want the government telling me I have to wear a mask.”

Parsell need not worry: Gov. Ron DeSantis (R) has not made mask-wearingmandatory here in Florida. That’s in sharp contrast with what’s happening more than 2,000 miles away in California, where Gov. Gavin Newsom (D) on Thursday reacted to rising ­caseloads by making ­mask-wearing mandatory.

In this sprawling, heterogeneous country, the pandemic has become yet another thing on which Americans are divided.

Mask-wearing for some people is an identifier of broader beliefs and political leanings. Like so many issues rooted in science and medicine, the pandemic is now fully entangled with ideological tribalism. This has played out before: helmets for motorcyclists, seat belts in cars, smoking bans in restaurants. All of those measures provoked battles over personal liberty.

Now it’s masks and the coronavirus, with face coverings emerging as an emblem for what cleaves the nation. A flurry of recent studies supports wearing cloth face coverings as a means to limit transmission of the novel coronavirus, which causes the illness covid-19. To many people, masks represent adherence to civic duty and a willingness to make individual sacrifices for the greater good of public health. To others, masks symbolize government overreach and a violation of personal liberty.

President Trump does not wear a mask, even when in the company of staffers and other officials who do. His press secretary, Kayleigh McEnany, said Friday that she would not wear a mask at Saturday’s Trump rally in Tulsa.

“It’s a personal decision. I’m tested regularly,” McEnany said. “I feel that it’s safe for me not to be wearing a mask, and I’m in compliance with CDC guidelines, which are recommended but not required.”

The long-percolating politicization of masks reached a boiling point recently when a North Carolina activist in a group called Reopen N.C. plopped a mask in a pan, set it on fire and cooked a hot dog over the open flames.

That display came after Gov. Roy Cooper (D) said he was considering making mask-wearing mandatory in public spaces. Members of Reopen N.C. posted videos and graphics on Facebook instructing people to “remove your submission muzzle because you are not a sheep” and “douse submission muzzle with gasoline.”

Less theatrically, many people in the United States who two months ago were appropriately alarmed by the spread of this invisible pathogen have been more mobile in recent weeks and looser in their social distancing.

“It’s like this big, giant, hideous thing didn’t just happen,” said Jennifer Nuzzo, a Johns Hopkins University epidemiologist who has been staying near New York City and witnessed people congregating without masks.

But she said she understands that people have pandemic fatigue. They need options, she said, so they can resume important parts of their lives while remaining safe.

“Can we be creative? Seems like that is what is needed, because we can’t just continue to say ‘no.’ That only works so long as people feel it’s in their best interest to comply, but I’m afraid that is waning,” she said.

The nation’s traditional emphasis on the rights of individuals distinguishes the United States from many other countries, said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

“I don’t like to see people out in bars congregating without masks right now,” Fauci said in an interview, but he added, “We may have mayors and may have governors who are saying the right thing, but because of the individual spirit of our country, we don’t listen to authority. You go to Korea, you go to Japan, when the authorities say something, man, it gets done.”

The independent American trait can complicate public health measures, he acknowledged.

“When you’re dealing with infectious diseases, a small percentage of people who don’t comply can have an impact on the entire population,” he said.

The United States has far more coronavirus infections than any other country. It has the most covid-19 deaths.

Although New York City and other places in the Northeast have greatly reduced transmission of the virus and deaths linked to it, much of the country is still in its initial wave of infections.

The political structure of the country gave governors and mayors the power to decide how and when to reopen their economies, and some were more eager than others despite lingering community spread of the virus. An ongoing tug of war for authority between state and local officials has largely played out along partisan lines.

In Wisconsin, the Republican state legislature successfully sued to strike down Democratic Gov. Tony Evers’s stay-at-home order, which many local leaders declared they would ignore. And in several states with Republican governors, including Arizona, Arkansas and Oklahoma, Democratic mayors have expressed frustration with a lack of aggressive action to halt the viral spread.

In Orange County, Calif., the board of supervisors said it would no longer enforce mask mandates locally, going against the wishes of health department officials. In Nebraska, Gov. Pete Ricketts (R) told local authorities in his state not to mandate masks in municipal buildings — unless they wanted to lose out on their allocation of money from the federal Cares Act.

AMC, the sprawling movie house chain, made a proclamation of its own earlier in the week, declaring it would not mandate masks so as “not to be drawn into political controversy” — thereby drawing itself into political controversy anyway. But by Friday, reflecting the fluid nature of the pandemic and the decisions enveloping it, AMC had reversed course, announcing that it would insist on mask-wearing after all.

Compared with most countries, the United States has been quick to reopen, according to researchers at the Oxford University Blavatnik School of Government who have crafted a Stringency Index that tracks government shutdown orders and other interventions.

But multiple states, particularly in the South, Midwest and Southwest, are experiencing spikes in infections.

“We have right in front of us this unfolding crisis — this hurricane sitting there right on the radar,” said Michael T. Osterholm, an infectious-disease epidemiologist at the University of Minnesota. “Yet we’re still going about our business as though we’re still going to be planting petunias tomorrow.”

Fauci theorized that the disparate responses to the virus among people in the United States reflect a feature of the virus itself: Its effects are wildly variable. Some people remain asymptomatic after infection. Others become severely ill. Some die. That can be confusing for people.

“The nature of the disease makes you confused. The nature of the disease sets it open to multiple different interpretations of how serious this is, and with that how serious you should be taking the disease,” Fauci said.

Adding to that confusion is the fact that successful public health measures, including shutdowns and mandates to wear masks, can appear to be unnecessary. There is no easy way to calculate what might have happened if the measures hadn’t been imposed.

Memorial Day weekend facilitated an explosion of self-determination, as pictures of packed pools and overflowing clubs — all enjoyed by people bereft of masks — left public health officials wringing their hands. Pictures of crowds packed into a pool at Backwater Jack’s, a beloved local spot at Lake of the Ozarks in Missouri, drew national attention.

When the Camden County Sheriff’s Office announced it had no authority to disperse attendees or hold accountable those organizing the aptly named “Zero Ducks Given” party, dozens of commenters flooded the department’s Facebook page with messages of gratitude.

So far, health officials in the state say they do not think the gathering resulted in the catastrophic spread of the coronavirus that some predicted. Backwater Jack’s is planning a similar bash in a few weeks — “Zero Ducks Given, Fourth of July Edition.”

[snip]

Millions track the pandemic on Johns Hopkins’s dashboard. Those who built it say some miss the real story.

Millions track the pandemic on Johns Hopkins’s dashboard. Those who built it say some miss the real story.
Racial disparities — and the limitations of data — are visible if you look closely at the red and black screens.
By Kyle Swenson
Jun 29 2020
https://www.washingtonpost.com/local/johns-hopkins-tracker/2020/06/29/daea7eea-a03f-11ea-9590-1858a893bd59_story.html

She found herself listening for the sirens all the time. Before, they had been just background noise, ambulances regularly blasting through Beth Blauer’s neighborhood in Baltimore to or from a nearby critical-care facility for the elderly.

Now she knew every emergency trip from the nursing home could turn up later as a statistic on her computer screen.

The novel coronavirus was working its way through the United States, and Blauer — along with dozens of colleagues at Johns Hopkins University — was actively tracking its path.

“The sirens now feel different,” she said recently. “They come with a different flood of emotions.”

The noise outside her window was a tangible reminder of the human lives hidden in the maze of anonymous data that had come to dominate her days.

Since launching in January, the university’s Coronavirus Resource Center has exploded in scope and popularity, garnering millions of page views and popping up in news coverage and daily conversation. Through numbers, the tracker has told the story of what the virus is doing while the story is still unfolding, offering a nearly real-time picture of its silent march across the globe.

But even as data has jumped to the forefront of international discussions about the virus, the Johns Hopkins team wrestles with doubts about whether the numbers can truly capture the scope of the pandemic, and whether the public and policymakers are failing to absorb the big picture. They know what they are producing is not a high-resolution snapshot of the pandemic but a constantly shifting Etch a Sketch of the trail of covid-19, the disease caused by the virus.

Case counts are consistently inconsistent. Reporting practices differ from country to country, state to state, even county to county. If authorities fail to contextualize the virus with other factors — such as Zip codes, race or Medicaid usage — the hardest-hit communities can go unseen.

“Numbers in some ways instill this sense of comfort. But then on the other hand, they can be wrong,” said Lauren Gardner, the associate professor at Johns Hopkins’s Whiting School of Engineering who has spearheaded the global tracker since Day 1. “And they can be wrong for lots of different reasons.”

For those looking closely, the Hopkins project does lay out a clearly legible story about American life today, one involving economic inequality, racial disparities and poor access to health care. Many of the same issues flared up in street protests after the May 25 killing of George Floyd in Minneapolis police custody, an incident that sparked civil unrest and temporarily pushed the pandemic off the country’s front pages.

The tracker data can offer a bridge between the two news cycles, those working all hours to maintain it say. And as cases again begin to spike in the South and West, the Johns Hopkins project remains a key resource for understanding the virus’s impact.

“This is the first time data has been such a central part of the narrative,” said Blauer, the executive director of Johns Hopkins University’s Centers for Civic Impact. “The human connection — I think we need more of that in the larger national narrative. It just feels like the compassion is getting lost.”

Launching the project

The virus had clouded Ensheng Dong’s thoughts all January. Every time the first-year PhD student called home to China’s Shanxi province, he heard about the sickness spreading from Wuhan.

Dong modeled outbreaks as part of his studies. He had lived through China’s 2003 outbreak of severe acute respiratory syndrome, or SARS. Combing the available Chinese statistics, he realized each data point could be a former classmate or neighbor or family member.

So when Gardner, his adviser at Hopkins, suggested that Dong create a map to track the global reach of the infection, he readily agreed.

“I wanted to use my experience to collect data to show the public,” Dong said. “And the first member of the public was me.”

Gardner, an expert in modeling infectious-disease spread, initially had a fairly modest vision for the project. She knew disease reporting — or how authorities track and publicize the numbers — is inconsistent. She figured that by noting the data in real time, she and Dong could provide academic colleagues with statistics for later analysis.

“When we started this there was not a single dedicated covid-19 tracking website by a public health authority anywhere,” she said.

Dong went straight to work. For 12 hours, he collected data, translated information from Chinese, designed tables and bulldozed the statistics into a program that would create a map. His stark aesthetic choices — black for the background, red for dots indicating infections — were deliberate: “I wanted to alarm people that the situation was getting worse.”

The next morning, Jan. 22, Dong showed Gardner his results. After a few tweaks, the project went live, with red dots ballooning across countries — and states and provinces, when possible — to show numbers of known cases, and charts listing confirmed cases and deaths for each jurisdiction.

Gardner and Dong fished through media reports and Twitter accounts for updates, manually punching in the new figures. Early on, as the virus spread to Japan and South Korea, the project was a crowdsourced effort, with people from around the world emailing about new cases. The data feeding into the dashboard was open to the public in a Google Sheets file, so anyone could click through the numbers and pinpoint mistakes or offer suggestions.

As the potential dimensions of the disaster took shape — millions sick, widespread lockdowns, a scorched-earth global economy — the public looked to the tracker to make sense of a frightful ordeal.

Lainie Rutkow, a professor of health policy and management at Hopkins’s Bloomberg School of Public Health, was reminded of the public anxiety she witnessed in the days after the attacks of Sept. 11, 2001, a cataclysmic event that had rerouted her from a career in law to one in public health.

“That same type of uncertainty, I see now,” she said, “those feelings of uncertainty about what happens next.”

She joined the team with the idea that what Gardner and Dong had started could grow into a more ambitious tool, one that could not only track the virus but also explain and contextualize the spread for a global audience desperate for information.

At the same time, the mechanics behind the project were rapidly changing. In February, governments began releasing virus statistics. Rather than ease the workload, the shift revealed a major shortcoming: There was no international body laying out criteria for how to tally coronavirus infections or deaths. Each country put out its own data, sometimes revising it weeks or months later in ways that dramatically changed the trends the tracker was trying to identify.

The pace of infection — faster every day — created more issues for the small team.

“Initially, I was trying to update it two to three times a day, at 12 p.m. and 12 a.m.,” Dong said. “But people were so anxious to see the dashboard, so I had to update every three to four hours. But sometimes by the time I had collected it all, the data had updated in the original data source, so I would have to tear down everything I’d done and collect it again.”

Charting inequity

Blauer first pulled up the tracker out of personal caution. It was February, and she was supposed to travel to Israel and India soon.

As she scanned the dashboard, Blauer recognized that what her colleagues were building hit on concerns central to her work at the Centers for Civic Impact, which helps local and state governments use data in decision-making.

She contacted Rutkow and asked to join the team.

Her own plunge into data started after college, when Blauer worked as a juvenile probation officer in Baltimore.

She would get called to police stations in the middle of the night and asked to determine whether a child who had just been arrested could go home with family or needed to spend the night in jail.

“I was asked to make a decision in the lives of these kids based on no information,” she said. “I didn’t know if the child had been in school that day, if they had access to food at home, if there was a social worker involved with the family.”

There had to be a better way, she decided.

In 2004, she became a key player in then-Mayor Martin O’Malley’s CitiStat program, a data-driven effort to track and monitor municipal work.

When O’Malley (D) became governor, Blauer ran a similar statewide effort from Annapolis, tracking everything from infant mortality rates to budget spending. The large-scale effort — one of the first of its kind in government — “became a kind of religion,” she said.

The experience schooled Blauer on the nitty-gritty complexities of American inequity. Any given Zip code was layered with the historical baggage of past policies. Discriminatory housing, health-care access, school stability — they were all baked in.

So when Blauer and others began plotting a U.S. dashboard to complement the global tracker in March, they decided a simple tally of infections and deaths would not be enough to fully explain what the virus was primed to do to black, Latino and Native American communities.

[snip]

Young people, bars and the coronavirus. What did we expect?

Young people, bars and the coronavirus. What did we expect?
By Mitch Albom
Jun 28 2020
https://www.freep.com/story/sports/columnists/mitch-albom/2020/06/28/mitch-albom-harpers-bar-east-lansing-michigan-coronavirus/3270100001/

And then the doors open.

You can plan all you want, test all you want, inform and educate your staff all you want, but customers are another matter, and young customers another matter altogether. The coronavirus that keeps tripping up our country grows almost giddy at the sight of college-aged kids swarming a bar or restaurant. Ready, set, outbreak!

Trisha Riley thought she had prepared. She, her husband, Pat, and two of their children operate Harper’s Restaurant and Brew Pub in East Lansing, a popular 10,000-square-foot indoor restaurant with a large outdoor deck.

“We did a whole day of training, we had every staff person come in, they got all the guides from the state and local governments, we let everybody ask questions, and we had them all wear their masks,” Riley told me Friday. “We actually gave them masks to go home with to get used to it.”

And then the doors opened. June 8th. Not surprisingly, the crowds were large. Riley and her staff kept the place at below half-capacity, which means around 225 people.

But on the deck, they noticed customers moving tables together on their own. And outside the restaurant, people in line were ignoring markers to maintain 6-foot distances — and most were not wearing masks.

“It was a full-time job of trying to monitor (the line) to keep people 6 feet apart,” Riley recalled. “The most difficult part was they know we don’t own the sidewalk. You get a lot people saying, ‘That’s great, but this is not your property.’ “

Not surprisingly, reports began to circulate of a cluster of positive COVID-19 tests coming from customers who’d been at Harper’s since it reopened. That number, originally reported as 14, had risen to 76 as of Friday, according to Ingham County health officials, as people continue to spread the virus from one to another.

Two weeks after Harper’s opened, it closed back down.

We are the carriers

Now, let’s say it right off the bat, this is not Harper’s fault. I spoke with Riley for some time, and it’s hard to imagine a restaurant doing more to prepare for operation during the COVID-19 crisis.

Since closing, the steps they are taking are even more vigilant. These include: investing in a new air filtration system; investing in a “virtual” line technology (to negate the sidewalk crowds); paying for all their employees to be tested, multiple times; screening all employees upon entering the building; bolting the deck tables to the ground at 7 feet apart; demanding masks on every employee; making all restrooms touchless, including hand-dryers, faucets and toilets; closing two days a week to do extensive deep cleaning and sanitizing; eliminating barstools; using only plastic utensils, plastic glassware, and disposable menus.

Honestly, it’s like setting up shop in a biohazard bubble. And all this has to be done with far less revenue than they used to bring in.

The sad part is, it may not make a difference.

Because this disease spreads from person to person, not plate to plate. We are the carriers. We are “the way you get it.” And therefore, our behavior is what determines its transmission.

If we keep ignoring warnings, we’ll keep getting sick. That’s especially true for a certain age group. You know how young people often want to race out front and lead the way?

When it comes to spreading coronavirus, they are.

Young and restless

I have often warned that the biggest danger in this pandemic would be our impatience. Who has less patience than young people who want to party, visit, hang out? The vast majority of the Harper’s-connected cases are aged 16 to 28. Buoyed by a belief that they can’t be harmed — and often carrying the disease while they are asymptomatic — young people are increasingly responsible for the surge of cases in this country and elsewhere, bringing daily totals to alarming new levels.

In New Orleans, recent data shows 50% of new cases are in people under 30. In Florida, the new median age for people testing positive is 35, which is down from 65 just three months ago. In California, a surge in young people testing positive prompted Gov. Gavin Newsom to tell the media, “You’re young so you feel … invincible, but, respectfully … that can be a selfish mindset.”

He’s right. Because while youth may decrease your odds of dying from this virus, it does nothing to lower your chance of spreading it. And spreading it to someone more vulnerable — an older person, or someone with some underlying health issues — endangers lives.

Meanwhile, the burden falls unfairly on places like Harper’s, which, quite frankly, shouldn’t have to go through this many hoops just to serve customers who can ignore the guidelines anyhow.

Let’s be honest. It was a risky idea to reopen bars. They’re largely indoor facilities, often cramped, with loud music that makes people yell, and drinking and eating which renders masks untenable. Bars should have been the absolute last places to reopen. How is it that you still can’t go to a library or a movie theater in Michigan — where no one talks and social distancing is easy — but bars are open for business?

Behavioral transmission

Meanwhile, what happened at Harper’s should make the folks who run Michigan State University extremely nervous. And colleges everywhere should be taking note. They can plan all they want for distanced seating in classrooms, online learning, Zoom video conferences. But how on earth will they keep kids from partying at night, from hanging out in bars, restaurants or each other’s dorm rooms, sharing cups of beer, passing joints (it’s legal now) or having sex?

College sports like football, with as many as 100 players and staff, are kidding themselves if they think athletes will abstain from contact outside of the team. We’ve already seen some big COVID-19 numbers from major college football programs — and the campuses aren’t even open yet.

The word “surge” was supposed to come in the fall, when scientists anticipated a rise in coronavirus along with the flu. But we are surging right now, in early summer, the hot season which was supposed to provide relief.

We’re doing so simply because of how we behave. We’ve been warned. We’ve been told of the danger. But anxious to break loose, we let our guards down anyhow. Why? Are we that short on memory?

As Newsom suggested, it’s one thing to develop cabin fever, it’s another to develop amnesia.

And then the doors open. Listen: We all want the word “return” to mean “the way we were,” but there is no “way we were” until the virus is tamed — by vaccine and medication.

[snip]

‘The new gold’: demand for PPE soars again amid shortage as US cases rise

‘The new gold’: demand for PPE soars again amid shortage as US cases rise
Fragile supply chains and wary hospitals continue to push some workers to wear N95 masks and and gowns for up to a week
By Jessica Glenza
Jun 29 2020
https://www.theguardian.com/world/2020/jun/29/demand-ppe-soars-again-amid-shortage-us-cases-rise

Demand and prices for personal protective equipment is soaring again across the US as coronavirus cases continue to rise in more than half of states.

One of the nation’s largest organizations donating personal protective equipment (PPE) said they have received a surge in requests from Covid-19 hotspots, especially in Texas, which has paused it’s reopening plan following record increases in cases and hospitalizations.

Dr Megan Ranney, an emergency room doctor and researcher at Brown University in Rhode Island who co-founded the volunteer-run organization #GetUsPPE said as cases in Texas surged, requests for PPE from health facilities in the state shot up last week from less than 2,000 pieces of equipment requested to more than 220,000, though she says that may be partly due to increased awareness of the organization.

“Overall the need for N95 masks, and to a lesser degree surgical masks, are still the top requests and they consistently have been,” Ranney said.

Cases have also been surging in Florida, where Dequasia Canales, a vice president of the Service Employees International Union (SEIU) in Miami-Dade county has been delivering caravans of PPE to nursing homes.

“There is a general and persistent shortage of PPE across the state of Florida,” said Canales. She said for-profit hospitals in particular, “have some supplies, but they are being too conservative and crass with the way they are distributing and using their PPE”.

As the urgency of high-profile Covid-19 outbreaks in the north-east of the country and cities such as New York faded in late spring, so did attention to the acute PPE shortage for frontline health workers. But fragile supply chains and wary hospital administrators continue to push some workers to wear N95 masks and and gowns for up to a week, even though they are designed to be changed between patients.

Frontline health workers have long warned that re-using such equipment leaves them at higher risk of becoming infected.

“There is no question – there is PPE entering in the country or being manufactured at this point – but who it’s allocated to and how it’s allocated equitably is still an open question,” said said Andrew Stroup, co-founder of Project N95, which collects small orders for PPE and brings them together into bulk orders manufacturers will accept.

All this happens as Covid-19 cases climb in June to record levels, with some estimates putting the single-highest ever caseload this month.

Cases are particularly surging in Texas, Florida and Arizona, which pushed to reopen their economies early and had looser restrictions during the Memorial Day holiday weekend in late May, which many Americans consider the unofficial start of summer.

Jude Derisme, another SEIU vice president, in Palm Beach county, said some hospitals stopped forcing workers to wear N95 masks for days at a time when, “when the Covid numbers went down”. But with cases rising, “The majority of the hospitals I see here in Palm Beach county are reverting back to that practice because of the surge of Covid-19 cases,” either because they lack supplies or worry supply chains will again break down.

In Texas, Lubbock Kids Dental CEO Kay Kennel said: “I haven’t been able to buy any [PPE] in nine weeks.” Texas, like most other states, created a supply chain task force to deal with PPE shortages. But Kennel said she watches daily in disbelief as the governor updates the state on new PPE shipments, and yet she cannot obtain the supplies she needs. As of Thursday, she had nine days worth of PPE left for her staff.

“There’s no excuse for this – none, none,” she said.

Kennel said a trailer she had obtained to store bulk orders of PPE was broken into and equipment stolen. She called masks “the new gold”. Other healthcare providers have reported receiving delivery of fake PPE and having their orders go unfulfilled.

Experts described supply chain “mismatch,” where small hospitals and healthcare providers could not access PPE, because suppliers demand minimum orders for tens of millions of masks, and normal distributors have no supply.

“It’s a very, very, very challenging market, and you have to be very careful,” said Brent Skoda, whose company Urgent Response Network has handled massive purchasing orders for states. “You have to deal with vetted, legitimate US companies that have insurance.”

State officials have said supply chains in some early hotspots, such as Connecticut, are normalizing. But other states are still begging for federal assistance. In Washington, Governor Jay Inslee said his state tried to buy $400m worth of PPE “domestically and internationally” but less than 10% of orders have been filled. In a letter to President Trump, Inslee said “PPE shortages are widespread”, in his state.

“The pandemic [is] a representation of how the normal operating model became broken,” said Stroup.

The Federal Emergency Management Agency (Fema), which is in charge of distributing medical supplies such as masks, appeared to struggle to distribute supplies in the spring. In June, the agency said it distributed millions of surgical masks, gloves and gowns nationally, but some nursing homes which received them said the products were defective and unusable. As of June, one in five nursing homes in Florida told the federal government they still have almost no masks or gowns, according to the Miami Herald.

“It’s completely unacceptable that nearly four months into this pandemic, healthcare workers in hospitals, nursing homes and in the home care profession are still being put at risk due to a lack of personal protective equipment,” said President of SEIU International, Mary Kay Henry.

[snip]

U.S. Politicians Still Do Not Understand the Coronavirus Time Lag

U.S. Politicians Still Do Not Understand the Coronavirus Time Lag
If state governors don’t learn what a time lag is between cases and hospitalizations and deaths, we are in trouble
By Andy Slavitt
Jun 29 2020
https://coronavirus.medium.com/u-s-politicians-still-do-not-understand-the-coronavirus-time-lag-eff7057ea08b

It turns out that understanding basic math is important to fighting the virus. Short-term memory doesn’t hurt either.

I hate to sound like one of those “elite intellectual” types, but if state governors don’t learn to understand (or remember from two months ago, but whatever) what a time lag is between cases and hospitalizations and deaths, we will keep repeating second grade over and over.

Recent news — massive growth of cases, increased hospitalizations — is not the result of today’s action. It is a result is actions in May.

Florida Gov. Ron DeSantis said the spike in cases has “nothing, nothing” to do with the reopening. (I think his explanation was “goblins” or “magic fairies.”) But definitely not him. He and others fail to understand time.

Vice President Pence, forced out of his “I know nothing” slumber on Friday, was forced to have a media session on the “task force.” He came out, took a bow, and praised how well things were going. Also not much for telling time.

He insisted that deaths were still not increasing. Again I can’t stress enough the concept of a time lag is a difficult one. You know those 20% of people immune to Covid-19 in New York? They are all the untested people who were infected in March.

Those later became older people and then hospitalizations. But the stop-testing-take-away-health-care-its-all-rosy administration is taking the lying and praying approach to the pandemic. Unfortunately they’re also aiding and abetting.

Did Pence once say, “Be careful?” Did he say, “Wear a mask?” Did he mourn the losses? Did he warn how contagious this is? Did he ask America to pull together? Did he tell us to brace for tough times? No. He said “America. It’s not as bad as you think.” He’s talking about May.

Pence performs for only one audience. And no taxpayers, it turns out.

He was pushed out for one reason and one reason only. The stock market. And he spent some time trying to talk the stock market up. I think it worked about as well as praying away “evil” thoughts.

A word about the stock market. The stock market doesn’t care about you. It cares about your productivity. Trump views the stock market as his hope for reelection. Unless your last name is Trump, he doesn’t care about you either. (And he doesn’t care about you, Don Junior.)

He’s happy to have you not wear a mask, gather in crowds, risk your life. But in the Oval, everyone wears a mask but one person.

Because Trump, Pence, and many governors can’t tell time very well, they didn’t put out surveillance tools. They didn’t believe it when people told them cases were growing. They didn’t believe it when hospitals started to fill. They waited until they were tipping over.

Remember when “alarmist” Andrew Cuomo warned they needed to act or their hospitals would be overrun? That’s because you’re supposed to pull the alarm when you smell smoke, not wait until you see fire. Unless you’re Trump, Pence, or one of the three not-so-wise men.

In the middle of May when a number of us put together our Open Safely guidelines, I asked many people to endorse them. And many did.

One prominent Republican, however, who was advising a number of governors, refused. He told me the Republican governors had had enough of the public health. They were opening the economy. And it was unrealistic to ask them to Open Safely.

“You’re tone deaf Andy,” he emailed. Maybe. I was asking that they have tools in place to contain the virus and commit to pulling back before hospitals were 70% full. Now no contact tracing is possible in Arizona. You see time. Give yourself time.

This week I received a call from a familiar voice. “Andy, what do you suggest they do?” “Simple arithmetic.” I wanted to a say that, but see I’m not a smart-ass. I actually couldn’t find any coherent words worth saying.

Gov. Doug Ducey, you will now be dealing with this likely through the end of the summer at a minimum. You are not New York at peak given your density. But that leads to the next “math-y” point. Exponential growth.

There’s more to learn besides addition, cause and effect, short-term memory, science, and humility. Although that is a lot to learn. There’s also the concept of exponential math. Things will get worse, much much worse, for every day you don’t change course.

The lag between opening, people testing boundaries, feeling symptoms, deciding to get a test, and getting a result is weeks. Hospitalizations a couple weeks later. If you don’t understand how two becomes four becomes 16 become 256 then and you’re a governor, stop what you’re doing.

Texas didn’t need to start building field hospitals. But now they do. Florida and Texas are now closing bars and building hospitals. We are certainly not unique in getting hurt by the virus. But we are unique in not understanding the lesson after it unfolded.

If you live in a state outside of the hot zones, don’t let your governor get puzzled by the fact that things aren’t getting better worse yet. Or if in a hot zone, that they close the bars but the numbers keep going up. But if they play dumb you shouldn’t have to.

Now we know why we studied these complicated subjects in grade school. They do apply to real life. While Trump was in the hall picking on kids who didn’t have nice watches and Pence and Ducey were cheering him on, something important was going on.

Others were learning how to be basically numerate. Not to mention at least a little bit kind.

Why venture capital doesn’t build the things we really need

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

Why venture capital doesn’t build the things we really need
The funding model that made Silicon Valley a global hub excels at creating a certain kind of innovation—but the pandemic has exposed its broader failures.
By Elizabeth MacBride
Jun 17 2020
https://www.technologyreview.com/2020/06/17/1003318/why-venture-capital-doesnt-build-the-things-we-really-need/

I felt bad asking Zack Gray to repeat his story. He was used to it, he said. It’s the founding tale of his startup, Ophelia; he’d already told part of it in his commencement speech at Wharton, and to potential investors.

“There was a girl in my life,” he started. “I call her my girlfriend. We met when I was 14.” They dated, on and off, and stayed friends.

She was one of a generation who slid into opioid addiction through painkillers. A user for five years, she had the means to seek treatment after her addiction grew, but she didn’t want rehab or therapy.

Then, last spring, the call came: she had overdosed. By the time Gray got to the hospital, she was gone.

“I just started thinking, ‘What could I have done to prevent this?’” he said.

To answer that question, he researched. Since he was finishing up his MBA, the approach that seemed obvious was to build some kind of business or service. What if his friend had been able to get medicine to treat the chemical condition of addiction, without the embarrassment and hassle of group therapy? Would insurance companies buy in to his concept? Could he build a big company to help a lot of people like her? He’d need investors to believe in the idea.

As I listened to Gray explain what he was doing, headlines were washing over America. “A Torrent of Job Losses Threatens to Overwhelm the US Economy.” “Doctors Say Shortage of Protective Gear Is Dire.” “Coronavirus Hitting Homeless Population.”

It didn’t seem like a great time to be raising money.

I had originally planned to meet Gray in person. I was scheduled to fly out to California in March to attend the startup accelerator Y Combinator’s famous Demo Day. The event would host 1,000 investors and introduce them to nearly 200 vetted and prepped startups from around the globe. Ophelia was one of those startups.

I was going to Demo Day because venture capital had been America’s financial engine of innovation for years, and I wanted to see if that was still true. Many stats suggested it was: the number of venture capital firms in the US had risen from 946 in 2007 to 1,328 in 2019, and the amount of money they were managing had swollen from $170.6 billion in 2005 to $444 billion in 2019. 

Not all the numbers were so positive, however. This largely white, largely male corner of finance has backed software companies that grow fast and generate large amounts of money for a shrinking number of Americans—companies like Google, Facebook, Uber, and Airbnb. But they don’t create many jobs for ordinary people, especially compared with the companies or industries they disrupt. And things have been slowing down. Recently, venture capitalists have found fewer and fewer ideas that fit their preferred pattern. By the end of 2019, the industry had $121 billion in “dry powder,” money in search of an entrepreneur or idea to invest in. I wanted to know what was going on.

As covid-19 took hold of the world, my plans to meet Gray and his peers changed. And suddenly, the questions became more urgent. Was venture capital producing the kinds of inventions society needs? Sure, when we have to (or want to) stay home, Zoom helps us work remotely, DoorDash keeps us fed, and Netflix gives us something to watch. But where was the cure, or the better protective gear, and why hadn’t venture capital—the financial engine of innovation—funded those ideas?

In the 1950s and ’60s, technology took us to space. In the 1980s and ’90s, technology helped spread democracy. Now our national mission was … to be able to never leave the house?

What capital wants
When I want to understand finance, I call my friend Charley Ellis. He was on the boards of the investment management company Vanguard and the Yale Endowment, and he wrote a bible for investors called Winning the Loser’s Game.

“The fact that it’s called venture capital is a terrible distraction,” he told me. “It’s really human resources.”

What he means is that successful venture capitalists aren’t necessarily those who find and fund the most innovative ideas, but the ones who know how to spot founders capable of building a company that will eventually be acquired or go public. The $1 million that might be spent to buy a 10% share of an early-stage business turns into much more if that company ends up being worth $10 billion.

Venture capital firms sell their services to investors like hedge funds, pension funds, and wealthy individuals, who take most of the returns. It’s a hard, fast process: to get even one or two big winners within the standard 10-year time frame, a venture capital fund invests in dozens of startups. Most companies that don’t grow fast enough get no more investment and die.

Venture capitalists sell themselves as the top of the heap in Silicon Valley. They are the talent spotters, the cowboys, the risk takers; they support people willing to buck the system and, they say, deserve to be richly rewarded and lightly taxed for doing so.

The image, however, doesn’t strictly match the history of the Valley, because it was “the system” that got everything started. After Sputnik launched the space race, the federal government poured money into silicon chip companies. Historian Margaret O’Mara documents this well in her book The Code: In the early 1960s, the US government spent more on R&D than the rest of the world combined. While that fire hose of cash flowed, the first venture capitalists found many winners to bankroll.

The link to government is still very much there in today’s technology companies. Google’s early work came out of the Clinton-era Digital Libraries project at Stanford, and the CIA was Palantir’s first customer in 2003—and its only one until 2008. 

O’Mara says there isn’t anything wrong with tech companies’ being built through US research dollars. In fact, she argues, the most important decision of that era was for the government to pour money in without exerting too much control. But, she adds, a mythology has grown up that focuses on lone heroes and rule breakers rather than the underlying reasons for a company’s or technology’s success. “Hooray for the internet that it’s still cranking,” she says. “But you did not do this by yourself.”

In 2011, one of the bigger cowboys of venture capital, Marc Andreessen—the Netscape cofounder who now runs Andreessen Horowitz, one of Silicon Valley’s most influential investment firms—wrote a famous essay titled “Why Software Is Eating the World,” in which he described the destruction of middle–class jobs in America and predicted the venture profits of the following decade. 

He was right: software companies are attractive to investors because they can generate large returns, often by replacing people in industries those software firms come to dominate—for example, travel agents, whose work is now done by flight booking websites.

Venture capitalists look for companies that can reach IPO size, which means they need an idea that can find a big market. These factors combine to produce a very specific set of requirements, which Y Combinator has reverse-engineered to great success.

“Investors are a simple-state machine,” Michael Siebel, the accelerator’s CEO, told me. “They have simple motivations, and it’s very clear the kind of companies they want to see.” 

But some of the other inputs, either consciously or subconsciously, have been assumptions about the kind of person who can help generate outsize returns. The top founders “all seem to be white, male nerds who’ve dropped out of Harvard or Stanford and they absolutely have no social life,” John Doerr of Kleiner Perkins—one of the most influential investors in the Valley—noted in 2008. “So when I see that pattern coming in … it was very easy to decide to invest.”

[snip]

EFF & Heavyweight Legal Team Will Defend Internet Archive’s Digital Library Against Publishers

EFF & Heavyweight Legal Team Will Defend Internet Archive’s Digital Library Against Publishers
By Andy Maxwell
Jun 26 2020
https://torrentfreak.com/eff-heavyweight-legal-team-will-defend-internet-archives-digital-library-against-publishers-200626/

The EFF has revealed it is teaming up with law firm Durie Tangri to defend the Internet Archive against a lawsuit targeting its Open Library. According to court filings, the impending storm is shaping up to be a battle of the giants, with opposing attorneys having previously defended Google in book scanning cases and won a $1bn verdict for the RIAA against ISP Cox.

In March and faced with the chaos caused by the coronavirus pandemic, the Internet Archive (IA) launched its National Emergency Library (NEL) 

Built on its existing Open Library, the NEL provided users with unlimited borrowing of more than a million books, something which the IA hoped would help “displaced learners” restricted by quarantine measures.

Publishers Sue Internet Archive

After making a lot of noise in opposition to both the Open and Emergency libraries, publishers Hachette, HarperCollins, John Wiley and Penguin Random House filed a massive copyright infringement lawsuit against the Internet Archive.

Declaring the libraries little more than ‘pirate’ services that have no right to scan books and lend them out, even in a controlled fashion, the publishers bemoaned the direct threat to their businesses and demanded millions of dollars in statutory damages.

Earlier this month the IA announced the early closure of the NEL, with IA founder Brewster Kahle calling for an end to litigation and the start of cooperation. There are no public signs of either. Indeed, the opposing sides are preparing for action.

EFF and Attorneys Team Up to Defend IA

Last evening the EFF announced that it is joining forces with California-based law firm Durie Tangri to defend the Internet Archive against a lawsuit which they say is a threat to IA’s Controlled Digital Lending (CDL) program.

The CDL program allows people to check out scanned copies of books for which the IA and its partners can produce physically-owned copies. The publishers clearly have a major problem with the system but according to IA and EFF, the service is no different from that offered by other libraries.

“EFF is proud to stand with the Archive and protect this important public service,” says EFF Legal Director Corynne McSherry.

“Controlled digital lending helps get books to teachers, children and the general public at a time when that is more needed and more difficult than ever. It is no threat to any publisher’s bottom line.”

Durie Tangri partner Joe Gratz agrees, noting that there is no issue with the Internet Archive lending books to one patron at a time.

“That’s what libraries have done for centuries, and we’re proud to represent Internet Archive in standing up for the rights of libraries in the digital age,” he adds.

With Gratz on the team, the IA and EFF are clearly taking matters seriously. His profile states that he’s as “comfortable on his feet in court as he is hashing over source code with a group of engineers”, adding that he represented Google in the Google Book Search copyright cases.

Also on the team, according to the lawsuit docket, is Harvard Law School graduate Adi Kamdar, who was an affiliate with the Berkman Klein Center for Internet & Society. Before that, Kamdar was an EFF activist advocating on issues of privacy, speech, and intellectual property policy.

Publishers Have Brought in the Big Guns Too

The docket reveals some prominent veterans acting for the publishers too.

Matthew Jan Oppenheim, for example, served as lead counsel in the record-breaking $1 billion jury verdict against Cox Communications for the music industry, and the $34 million verdict against Book Dog Books for the publishing industry.

A former partner at the music industry law firm Jenner & Block, Oppenheim previously worked at the RIAA, handling landmark cases against Napster and Grokster.

Meredith Santana represented Miley Cyrus in the “We Can’t Stop’ copyright infringement lawsuit while Linda Steinman represents and counsels content providers on how to protect their work from “challenges ranging from aggregators to ad blockers.”

[snip]

Why Changing COVID-19 Demographics in the US Make Death Trends Harder to Understand

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

Why Changing COVID-19 Demographics in the US Make Death Trends Harder to Understand
COVID-19 death data lags behind testing data in ways we mostly understand. What we only partly understand is how an infection rate that seems to be skewing younger will affect the death toll in surging regional outbreaks.
By Whet Moser
Jun 26 2020
https://covidtracking.com/blog/why-changing-covid-19-demographics-in-the-us-make-death-trends-harder-to

On June 18, new daily COVID-19 cases in the US exceeded 27,000 for the first time since May 8, and stayed over 27,000 for the next four days. This was the first five-day run of new cases above that number since April 22-26. The 32,325 new cases reported on June 20 were the most since May 1, when just over 33,000 cases were reported. After plateauing in May, the trend is heading in the wrong direction.

Deaths, on the other hand, continue to decline: from June 18-22, fewer than 700 people in the US died each day, a first for a five-day period since March. The disconnect between case and death trends is striking; in Brazil and India, the two other large countries reporting a rapid increase in infections, deaths have been rising in recent weeks as well.

What we know: the death lag

According to the CDC, the average period from symptom onset to death is about two weeks. The average lag between death and the reporting of a death is just over seven days.

[snip]

‘Like leaning into a left hook’: coronavirus calamity unfolds across divided US

‘Like leaning into a left hook’: coronavirus calamity unfolds across divided US
In a week that saw the worst day on record for new cases, Trump shrugs as experts warn Americans not to follow his lead
By Ed Pilkington
Jun 28 2020
https://www.theguardian.com/world/2020/jun/27/coronavirus-cases-us-trump-politics-masks

A disaster is unfolding in Montgomery, Alabama, where Martin Luther King preached and where Rosa Parks was arrested for refusing to give up her seat on the bus. Hospitals are running short of drugs to treat Covid-19, intensive care units are close to capacity, and ventilators are running short.

Between 85% and 90% of the very sick and dying are African American.

Amid this gathering storm, the city council met to decide whether to require people to wear masks, a basic protection the US Centers for Disease Control and Prevention (CDC) strongly recommends. Doctors lined up to plead their case.

“This is beyond an epidemic in this area,” said the pulmonologist Bill Saliski. “Our units are full of critically ill covid patients. We have to slow this down.”

His colleague, Nina Nelson-Garrett, described watching undertakers carrying out corpses, 30 minutes apart.

“Something as simple as a mask can save someone’s life,” she said.

Dr Kim McGlothan recounted how she was frequently stopped by white people asking, “Is the media sensationalizing this, is it really as bad as they are making out?”

McGlothan told the council: “People don’t believe the hype. Until you mandate masks, we won’t be able to stop this – we just won’t.”

Then a black resident stood up. Six of his relatives had died from Covid-19. His brother was on a ventilator. “This is not about masks,” he said. “The question on the table is, ‘Do black lives matter?’ I lost six of my family to Covid. How would it feel if it was your family?”

The council debated for two hours. White council members asked if young children could get carbon monoxide poisoning from masks – no, the doctors firmly told them – and spoke portentously about individual rights.

“At the end of the day,” said councilman Brantley Lyons, “if a pandemic comes through, we do not throw our constitutional rights out the window.”

When the vote was called, it divided on largely racial lines. Black members voted for masks, in order to prevent more families losing six loved ones. White members voted against masks, to preserve the fundamental right not to attach a cloth to your face.

In a 4-4 tie, the ordinance failed. As he left the chamber, Dr Saliski uttered just one word: “Unbelievable.”

Unbelievable accurately describes America today. The country is on the brink of a huge surge of Covid-19, as the virus tears through the heartlands while the president praises himself for having done “a great job” and blithely predicts the scourge will “fade away”.

Ask Alabama whether the virus is fading away. Or Arizona, Florida, South Carolina or Texas. The disease is venting its fury on these states, which all reopened their economies – with Donald Trump’s avid blessing – before the contagion was contained.

“Opening while cases are increasing is like leaning into a left hook,” said Tom Frieden, a former CDC director. “You are basically asking to get hit – and that’s what these states did.”

Alabama is enduring a pummeling. It has recorded 32,000 cases and its curve is on a steep upward path.

The Republican governor of Texas, Greg Abbott, who ushered in one of the earliest and most aggressive reopenings, insisted a few days ago that his state “remains wide-open for business”. Yet he has been unable to ignore reality: that the virus has spread its lethal tentacles to every corner of the stateoverwhelming hospitals to the point that Houston medical centers are running out of ICU beds. Now, once again, Texas’ bars are closing. One town, near Houston, has even brought in a curfew.

The Lone Star state recorded 6,584 cases on Wednesday alone – a heart-sinking figure that makes its curve look almost vertical.

Florida’s malaise would be wryly amusing were so many lives not at stake. On 20 May the conservative magazine the National Review ran the gloating headline: “Where Does Ron DeSantis Go to Get His Apology?” The article scolded liberal critics of the Republican governor’s lax approach to coronavirus – he famously allowed beaches to remain open in spring break and has permitted shops and restaurants to get back to business – for having got it wrong: there was no spike in Florida.

On 20 May, Florida’s daily infection load stood at 527 new cases. Five weeks later, it reported a record 8,942 on Friday and broke the record again on Saturday with 9,585.

‘It’s getting worse, not better’

Though states such as Florida and Texas are bearing the brunt of the beating, this is not a catastrophe that can be dismissed as the problem of just a few places. Across the nation, at terrifying speed, a similar picture is revealing itself.

Every important data point, including positivity rates and hospitalizations, is surging across most states. A map produced by a team of epidemiologists and health experts, Covid Act Now, shows only four states, all in the north-east, including New York, which used to be at the center of the pandemic but has wrestled it under control, as being on track to contain the disease. Twenty-one states are at risk or facing active or imminent outbreaks.

It is troubling enough that the US now has 2.4m confirmed cases – double the number of the next highest country in the world, Brazil, and almost certainly a huge underestimate. The death toll has passed 125,000, with another 20,000 at least expected this month.

The death rate is still trending downwards – one bit of positive news in this sorry picture. But deaths lag behind confirmed cases by a month, and that spells trouble ahead.

One crumb of comfort had been that for almost three months the daily rate of new infections held steady at around 20,000 cases a day. Then, two weeks ago, the monster began to stir.

The tally of new cases ticked upwards, and on Thursday it reached a stomach-churning 40,000 – the worst day on record since the pandemic began.

“It’s getting worse, not better,” said Frieden, who now heads the global health initiative Resolve to Save Lives. “The contrast with other countries is striking. South Korea had 30 cases a day and they flipped out. The US now has 30,000 cases a day and there are people shrugging and saying ‘It’s no big deal’.”

[snip]