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Javier E

Airplanes don't make you sick. Really. - The Washington Post - 0 views

www.washingtonpost.com/...anes-dont-make-you-sick-really

airline pandemic research measures response

shared by Javier E on 26 May 20 - No Cached
  • You don’t get sick on airplanes any more than anywhere else. Really, you don’t.
  • consider this fact: The ventilation system requirements for airplanes meet the levels recommended by the Centers for Disease Control and Prevention for u
  • There are fairly simple things you can do, if you do need to travel, to reduce the odds of getting sick.
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  • the fact that airplanes help spread disease across geographies does not mean that you are necessarily at risk during flight.
  • If planes made you sick, we would expect to see millions of people sick every year attributable to flights. We haven’t seen it because it’s just not happening.
  • Consider one study that examined a passenger with tuberculosis on an airplane. It found that the median risk of infection to the other 169 passengers on the airplane was between 1 in 10,000 to 1 in a million.
  • Wearing a mask, as some airlines now require, reduced the incidence of infection another 10-fold.
  • The required aircraft systems do a really good job of controlling airborne bacteria and viruses.
  • To get technical, airplanes deliver 10 to 12 air changes per hour. In a hospital isolation room, the minimum target is six air changes per hour for existing facilities and 12 air changes per hour for new.
  • Airplanes also use the same air filter — a HEPA filter — recommended by the CDC for isolation rooms with recirculated air. Such filters capture 99.97 percent of airborne particles.
  • What’s more, airplanes are essentially designed to isolate airflow. Even if someone coughs on your flight without a mask, it is likely those virus particles will travel one or two rows,
  • To guard against transmission via large droplets and contaminated surfaces, we do need to take some additional steps. Wearing a mask on planes should be mandated, and wiping down tables and arm rests with a disinfectant provides an additional layer of defense.
  • you are more at risk of getting sick when traveling, but it’s not the airplane that’s making you sick.
  • Every time you fly, you may also take a cab, bus or subway; stand in long lines in the airport; eat unhealthy foods; sit for extended durations; spend time in spaces with hundreds or thousands of other travelers; stay at a hotel or friend’s home; arrive in a different climate and change time zones, disrupting your sleep. All of these factors are known to affect your immune system.
  • In 2013, I was one of the lead authors of a report for the Transportation Research Board of the National Academies on infectious disease mitigation in airports and airplanes. Let me distill some of the recommendations from that report
  • For starters, airports should mandate mask wearing; increase ventilation rates; make bathrooms touchless; consider deploying upper-room germicidal UV fixtures in areas with high-occupant density; institute temperature screening; deploy hand-sanitizer stations; and, once passengers arrive at their gates, require that they stay in their designated area except for bathroom usage.
  • Airlines should ensure gate-based ventilation is operating during boarding and disembarkation; carefully choreograph the loading of airplanes; mandate mask use; and provide meals and bottled water during boarding and discontinue in-flight meal and drink service.
  • Individuals have an important role to play, too. First, stay home and do not travel if sick. Comply with rules for mask wearing; wash hands before and after each step at the airport; keep the personal overhead ventilation on and pointed down; and maintain physical distancing to the extent possible.
Javier E

We're That Much Likelier to Get Sick Now - The Atlantic - 0 views

www.theatlantic.com/...676173

covid flu RSV infectious season epidemiology

shared by Javier E on 15 Dec 23 - No Cached
  • Although neither RSV nor flu is shaping up to be particularly mild this year, says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, both appear to be behaving more within their normal bounds.
  • But infections are still nowhere near back to their pre-pandemic norm. They never will be again. Adding another disease—COVID—to winter’s repertoire has meant exactly that: adding another disease, and a pretty horrific one at that, to winter’s repertoire.
  • “The probability that someone gets sick over the course of the winter is now increased,” Rivers told me, “because there is yet another germ to encounter.” The math is simple, even mind-numbingly obvious—a pathogenic n+1 that epidemiologists have seen coming since the pandemic’s earliest days. Now we’re living that reality, and its consequences.
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  • ‘Odds are, people are going to get sick this year,’”
  • In typical years, flu hospitalizes an estimated 140,000 to 710,000 people in the United States alone; some years, RSV can add on some 200,000 more. “Our baseline has never been great,” Yvonne Maldonado, a pediatrician at Stanford, told me. “Tens of thousands of people die every year.”
  • this time of year, on top of RSV, flu, and COVID, we also have to contend with a maelstrom of other airway viruses—among them, rhinoviruses, parainfluenza viruses, human metapneumovirus, and common-cold coronaviruses.
  • Illnesses not severe enough to land someone in the hospital could still leave them stuck at home for days or weeks on end, recovering or caring for sick kids—or shuffling back to work
  • “This is a more serious pathogen that is also more infectious,” Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me. In the past year, COVID-19 has killed some 80,000 Americans—a lighter toll than in the three years prior, but one that still dwarfs that of the worst flu seasons in the past decade.
  • Globally, the only infectious killer that rivals it in annual-death count is tuberculosis
  • Rivers also pointed to CDC data that track trends in deaths caused by pneumonia, flu, and COVID-19. Even when SARS-CoV-2 has been at its most muted, Rivers said, more people have been dying—especially during the cooler months—than they were at the pre-pandemic baseline.
  • This year, for the first time, millions of Americans have access to three lifesaving respiratory-virus vaccines, against flu, COVID, and RSV. Uptake for all three remains sleepy and halting; even the flu shot, the most established, is not performing above its pre-pandemic baseline.
  • COVID could now surge in the summer, shading into RSV’s autumn rise, before adding to flu’s winter burden, potentially dragging the misery out into spring. “Based on what I know right now, I am considering the season to be longer,” Rivers said.
  • barring further gargantuan leaps in viral evolution, the disease will continue to slowly mellow out in severity as our collective defenses build; the virus may also pose less of a transmission risk as the period during which people are infectious contracts
  • even if the dangers of COVID-19 are lilting toward an asymptote, experts still can’t say for sure where that asymptote might be relative to other diseases such as the flu—or how long it might take for the population to get there.
  • it seems extraordinarily unlikely to ever disappear. For the foreseeable future, “pretty much all years going forward are going to be worse than what we’ve been used to before,”
  • although a core contingent of Americans might still be more cautious than they were before the pandemic’s start—masking in public, testing before gathering, minding indoor air quality, avoiding others whenever they’re feeling sick—much of the country has readily returned to the pre-COVID mindset.
  • When I asked Hanage what precautions worthy of a respiratory disease with a death count roughly twice that of flu’s would look like, he rattled off a familiar list: better access to and uptake of vaccines and antivirals, with the vulnerable prioritized; improved surveillance systems to offer  people at high risk a better sense of local-transmission trends; improved access to tests and paid sick leave
  • Without those changes, excess disease and death will continue, and “we’re saying we’re going to absorb that into our daily lives,” he said.
  • And that is what is happening.
  • last year, a CDC survey found that more than 3 percent of American adults were suffering from long COVID—millions of people in the United States alone.
  • “We get used to things we could probably fix.” The years since COVID arrived set a horrific precedent of death and disease; after that, this season of n+1 sickness might feel like a reprieve. But compare it with a pre-COVID world, and it looks objectively worse. We’re heading toward a new baseline, but it will still have quite a bit in common with the old one: We’re likely to accept it, and all of its horrors, as a matter of course.
Javier E

Quit Whining About Your Sick Colleague - NYTimes.com - 0 views

www.nytimes.com/...about-your-sick-colleague.html

work ethic culture values overwork psychology

shared by Javier E on 30 Dec 14 - No Cached
  • What motivates our colleague to show up in an unwell state, and why should his presence in the office make the rest of us so edgy, sometimes to the point of anger? Perhaps we all share a common ailment of the workplace, a condition whose major symptom is the morbid fear of downtime.
  • If overwork can be taken as a sickness in itself, then America is a bastion of infirmity. We clock in some 1,788 hours a year, 120 more than our counterparts in Britain, 300 more than our counterparts in France and 400 more than our counterparts in Germany.
  • Americans have always had a tendency to work strange hours, late at night or over weekends, notes Daniel S. Hamermesh, an economist at the University of Texas at Austin. He thinks the pattern arises from our heavy-handed office culture: If you’re not overworked — or won’t go into the office sick — you seem to be a slouch.
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  • America, notoriously, does not require employers to offer paid sick leave. Employers grant new employees just eight sick days, on average, down 20 percent since 1993, and that’s only what we have on paper.
  • In other words, the American workplace has gotten tangled up in endless searches for a dose of extra credit. Since we’re all in competition — if I slow down, you get ahead — no one has an incentive to untie the knot.
delgadool

What to Know About Moderna's Covid-19 Vaccine - The New York Times - 0 views

www.nytimes.com/...moderna-covid-19-vaccine

pandemic US

shared by delgadool on 17 Nov 20 - No Cached
  • Over time, some of the volunteers got sick with Covid-19. To get a preliminary sense of how the trial was going, an independent board of experts took a look at the first 95 participants who got sick. Ninety of them had received the placebo, and only five had been given the vaccine. Based on that data, the board estimated that the vaccine is 94.5 percent effective.
  • The soonest that coronavirus vaccines could possibly become widely available would be in the spring. But if effective vaccines do indeed become available — and if most people get them — the pandemic could drastically shrink. As coronavirus infections became rarer, life could gradually return to normal.
  • Out of the 95 people who got sick in the Moderna study, 11 experienced severe disease. None of those 11 people were vaccinated. In other words, the five vaccinated people who got sick experienced only mild symptoms, and all of the severe cases were participants from the placebo group.
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  • The split suggests that Moderna’s vaccine doesn’t just block the virus in most cases, but also shields the people who do get sick from the worst outcomes of the disease. It also eases concerns that a vaccine for Covid-19 may make the disease worse, not better.
  • Pfizer’s outside board of experts analyzed 94 volunteers and estimated that the effectiveness of its vaccine was over 90 percent. They did not specify how many people who got sick had received the vaccine or the placebo.
  • The Pfizer and Moderna vaccines are similar not only because they use mRNA but also because they coax our cells to make the same viral protein, called spike. Other vaccines that don’t use mRNA also make the spike protein their target. The success of Moderna and Pfizer may bode well for them as well.
  • AstraZeneca and Johnson & Johnson are also conducting Phase 3 trials on adenoviruses that carry the spike protein gene. And other companies, including Novavax and Medicago, are running advanced trials on vaccines that deliver the spike protein itself, or pieces of it, to the body.
  • While scientists have investigated mRNA vaccines for years, no vaccine has yet been licensed as safe and effective to use in people.
  • It’s possible that the distribution of one or both vaccines will begin by the end of the year.
  • “This is not going to dig us out of what’s ahead this next month,” Natalie Dean, a biostatistician at the University of Florida, warned about Thanksgiving and the coming holiday season.
Javier E

Which States Have Coronavirus Travel Restrictions? - The Atlantic - 0 views

www.theatlantic.com/...617321

quarantine

shared by Javier E on 10 Dec 20 - No Cached
  • Hawaii has one of the strictest quarantine laws in the country.
  • The state’s geographic isolation has helped and hurt its efforts to control the virus. On one hand, the state would be completely unequipped to deal with a coronavirus surge. There are no states nearby from which to borrow doctors or ICU capacity. The island of Kauai has just 15 ventilators. On the other hand, everyone enters Hawaii through its airports, which makes enforcing a quarantine easier there than in almost every other state.
  • There’s no national database of quarantine noncompliance, but in U.S. states other than Hawaii, quarantine violations rarely result in fines or jail time—or, really, any consequences at all,
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  • Yet quarantine compliance is essential for the combination of testing, contact tracing, and isolation of sick people to work. Simply telling people they’ve been exposed and letting them loose on the nation’s Outback Steakhouses is not sufficient
  • Public-health departments are reluctant to seem like bad cops—or cops at all.
  • Hawaii created its quarantine law as a travel quarantine, stopping everyone at the airport. These types of quarantines are logistically easier to implement—they don’t require contact tracers—than medical quarantines, in which the state orders a certain individual to stay in isolation
  • Some other countries have imposed much tougher travel restrictions and quarantine policies. At one point, Greeks were required to text authorities to explain why they needed to go out. Norway quarantined its own citizens under threat of a fine or imprisonment. Most foreigners still can’t fly to Vietnam.
  • Keen believes that Hawaii residents are on such high alert because of long-ago pandemics that came to the islands and killed large percentages of the population
  • “Generations of stories you hear, from great-grandparents, grandparents, parents, that the pandemics nearly killed off Native Hawaiians,” she told me. “So there is a great fear here of outsiders coming in and bringing it with them.”
  • On the mainland, states cite a combination of COVID-19 denial, logistical hurdles, and funding and personnel shortages to explain why they haven’t been willing or able to enforce quarantines.
  • scofflaws: Some people stay inside for three or four days, then decide, “I’m bored with staying home,”
  • Even if a North Dakotan wants to do the right thing, she might not be able to without going hungry or losing her job. Grocery delivery isn’t available in parts of the large and rural state
  • Some states can’t quarantine people, because they have too many cases to trace
  • In fact, many COVID-exposed Americans who want to stay home and quarantine have an intractable problem: Their bosses won’t let them
  • The Families First Coronavirus Response Act granted paid leave to recover from COVID-19 to many Americans. But the law doesn’t cover everyone: Large companies aren’t included, and small companies can claim an exemption. Because of these exemptions, only 47 percent of private-sector workers have guaranteed access to coronavirus-related sick leave,
  • The U.S. is the only country out of 193 nations to exclude workers from sick-leave benefits based on the size of the company they work for, according to a recent UCLA study.
  • “We don’t really pay people to stay at home to quarantine,” Polly Price, a global-health professor at Emory University, says. But that’s exactly the problem: In a study in Israel, people were more likely to quarantine after exposure to COVID-19 if they were paid during their isolation.
  • Months into the pandemic, half of Americans didn’t know they might have the right to stay home with pay if they contracted the coronavirus.
  • even if they did, employers might have pressured them to come to work if they were no longer showing symptoms,
  • “After testing positive, employees are being scheduled and expected to work as long as they don’t show symptoms and [are] not placed in quarantine,” a worker at a Georgia taco restaurant complained in July. OSHA has formally inspected just 11 of the employers in these incidents. “Under the Trump administration, OSHA decided to do almost no enforcement,”
  • America’s laissez-faire federal pandemic response has, in effect, treated each state like its own country
  • When it comes time to isolate sick people, though, it becomes painfully clear that states aren’t countries. Wisconsin can’t stop Iowans from driving into it. North Dakota doesn’t have enough health workers to trace all of its infected citizens. The governor can’t help you when your employer is—legally—dragging you back into the office.
  • the reason Hawaii has been so ruthlessly effective at quarantine is that it in some ways still acts as its own country with its own border controls.
  • The state consistently has some of the lowest case numbers in the nation. As with so many other pandemic rules, Americans might not like quarantine, but it works.
Javier E

Opinion | We Should Have Known So Much About Covid From the Start - The New York Times - 0 views

www.nytimes.com/...vid-pandemic-michael-mina.html

covid summary overview lessons history policy pandemic culture

shared by Javier E on 11 Dec 23 - No Cached
  • I spoke to Mina about what seeing Covid as a textbook virus tells us about the nature of the pandemic off-ramp — and about everything else we should’ve known about the disease from the outset.
  • you can get exposed or you can get vaccinated. But either way, we have to keep building our immune system up, as babies do. That takes years to do. And I think it’s going to be a few more years at least.
  • And in the meantime?We’ve seen a dramatic reduction in mortality. We’ve even seen, I’d say, a dramatic decline in rates of serious long Covid per infection.
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  • But I do think it’s going to be a while before this virus becomes completely normal. And I’ve never been convinced that this current generation of elderly people will ever get to a place where it is completely normal. If you’re 65 or 75 or even older — it’s really hard to teach an immune system new tricks if you’re that age
  • And so while we may see excess mortality in the elderly decline somewhat, I don’t think we’ll see it ever disappear for this generation who was already old when the pandemic hit. Many will never develop that robust, long-term immunological memory we would want to see — and which happens naturally to someone who’s been exposed hundreds of times since they were a little baby.
  • There’s a similar story with measles. There is no routine later-life sequelae, like shingles, for measles. But what we do see is that, in measles outbreaks today, there are some people who were vaccinated who get it anyway. Maybe 5 to 15 percent of cases are not immunologically naïve people, but vaccinated people.
  • Is it really the case that, as babies, we are fighting off those viruses hundreds of times?The short answer is yeah. We start seeing viruses when we’re 2 months old, when we’re a month old. And a lot of these viruses we’ve seen literally tens, if not hundreds of times for some people by the time we’re adults. People tend to think that immunity is binary — you’re either immune or you’re not. That couldn’t be farther from the truth. It’s a gradient, and your protection gets stronger the more times you see a virus.
  • We used to think we just had this spectacular immune response when we first encountered the virus at, say, age 6, and that the immune response lasted until we were 70. But actually what we were seeing was the effect of an immune system being retrained every time it came into contact with the virus after the initial infection — at 6, and 7, and 8, and so on. Every time your friend got chickenpox, or your neighbor, you got a massive boost. You were re-upping your immune response and diversifying your immunological tools — potentially multiple times a year, a kind of natural booster.
  • But now, in America, kids get chickenpox vaccines. So you don’t have kids in America getting chickenpox today, and never will. But that means that older Americans, who did get it as kids, are not being exposed again — certainly not multiple times each year. And it turns out that, in the absence of routine re-exposures, that first exposure alone isn’t nearly as good at driving lifelong immunity and warding off shingles until your immune system begins to fall apart in old age — it can last until you’re in your 30s, for example but not until your 70s.
  • With Covid, when it infects you, it can land in your upper respiratory tract and it just start replicating right there. Immediately, it’s present and replicating in your lungs and in your nose. And that alone elicits enough of an immune response to cause us to feel really crappy and even cause us to feel disease.
  • But we could have just set the narrative better at the beginning: Look, you might get sick again, but your risk of landing in the hospital is going to be really low, and if you get a booster, you might still get sick again, but your risk of landing in the hospital is going to be even lower. That’s something I think humans can deal with, and I think the public could have understood it.
  • But it’s why we don’t see the severe disease as much, with a second exposure or an exposure after vaccination: For most people, it’s not getting into the heart and the liver and stuff nearly as easily.
  • But it doesn’t have to. It’s still causing symptomatic disease. And maybe mucosal vaccines could stop this, but without them we’re likely to continue seeing infections and even symptomatic infections.
  • through most of 2020 and into 2021, though. Back then, I think the conventional wisdom was that a single exposure — through infection or vaccination — would be the end of the pandemic for you. If this is basic virology and immunology, how did we get that so wrong?
  • The short answer is that epidemiologists are not immunologists and immunologists are not virologists and virologists are not epidemiologists. And, in general, physicians don’t know anything about the details.
  • But this failure had some pretty concrete impacts. When reinfections first began popping up, people were surprised, they were scared, and then, to some degree, they lost trust in vaccines. And the people they were turning to for guidance — not only did they not warn us about that, they were slow to acknowledge it, as well.
  • It had dramatic impacts and ripple effects that will last for years to limit our ability to get populations properly vaccinated.
  • the worst thing we can do during a pandemic is set inappropriately high expectations. These vaccines are incredible, they’ve had an enormously positive impact on mortality, but they were never going to end the pandemic.
  • And now, there’s a huge number of people questioning, do these vaccines even do anything?
  • For babies born today, though, I really think they’re not going to view Covid as any different than other viruses. By the time they are 20, it will be like any other virus to them. Because their immune systems will have grown up with it.
  • Instead, we set society up for failure, since people feel like the government failed everyone, that biology failed us, and that this was a crazy virus that has broken all the rules of our immune system, when it’s just doing what we’ve always known it would do.
  • How do you wish we had messaged things differently? What would it have meant to communicate early and clearly that Covid was a textbook virus, as you say?I think the biggest thing would have been just to say, we understand the enemy.
  • To say that this is a textbook virus, it doesn’t mean that it’s not killing people. Objectively, it’s still killing more people than any other infectious disease
  • What it means is that we could’ve taken action based on what we knew, rather than waiting around to prove everything and publish papers in Nature and Science talking about things we already knew.
  • We could have prepared for November and December of 2020 and then for November and December of 2021. But everyone kept saying, we don’t know if it’s going to come back. We knew it was going to come back and it makes me want to cry to think about it. We did nothing and hundreds of thousands of people died. We didn’t prepare nursing homes because we all got to the summer of 2020 and we said, cross our fingers.
  • We knew how tests worked. We knew about serial testing and why it was important for a public health approach. We knew that vaccines could have really good impacts once they were around. And if you were looking through the correct lens, we even knew that they weren’t going to stop transmission.
  • We didn’t have to live in a world where we were flying blind. We could have lived in a world where we’re knowledgeable. But instead, we chose almost across the board to will ourselves into this state of fear and anxiety.
  • And that really started in the earliest days. Almost the first experience I had was a lot like that movie with Jennifer Lawrence —Don’t Look Up.
  • none of this was complicated. You just had to ask a simple question: what would happen if you took away all immunity from an adult? Well, once you control for no immunity, adults are going to get very, very sick.
  • Of course, by and large, babies didn’t get very sick from this disease.Babies are immunologically naïve, but they are also resilient. A virus can tear up a baby, but a baby can repair its tissue so fast. Adults don’t have that. It’s just like a baby getting a cut. They’ll heal really quick
  • An adult getting a cut — you go by age, and every decade of age that you are, it’s going to take exponentially longer for that wound to heal. Eventually get to 80 or 90 and the wound can’t even heal. In the immunology world, this is called “tolerance.”
  • why are all these organ systems getting damaged when other viruses don’t seem to do that? It’s natural to think, it’s Covid — this is a weird disease. But it’s much more a story about immunity and how it develops than about the virus or the disease. None of our organ systems had any immune defenses around to help them out. And I think that the majority of post-acute sequelae and multi-organ complications and long Covid — they are not the result of the virus being a crazy different virus, but are a result of this virus replicating in an environment where there were such absent or exceedingly low defenses.
  • Is it the same whenever we encounter a virus for the first time?Think about travelers. Travelers get way more sick from a local disease than people who grew up with that virus. If you get malaria as a traveler, you’re much more likely to get really sick. You don’t see everyone in Nicaragua taking chloroquine every day. But you definitely see travelers taking it, because malaria can be deadly for adults.
  • What about, not severity, but post-acute complications — do we have long malaria? Do we have liver complications from dengue?
  • The really hard part of answering that question is there’s just not enough data on the frequency of long-term effects, because nothing like this has ever happened at such scale. It’s like everyone in Europe and North America suddenly traveled to a country where malaria was endemic.
  • Or think about H.I.V. It essentially kills your immune system, and once the immune barriers are down, other viruses that used to infect humans would get into tissues that we didn’t like them to get into. If there wasn’t such a clear signal of a loss of CD-4 T cells to explain it, people might still be scratching their heads and going, man, I wonder why all these patients are getting fungal infections. Well, there’s a virus there that’s depleting their immune system.
  • Covid is absolutely waking the world up to this — to the fact that there are really weird long-term sequelae to viruses when they infect organ systems that would normally be protected. And I think we’re going to find that more and more cancers are being attributed to viral infections.
  • It wasn’t that long ago that we first learned that most cases of cervical cancer were caused by H.P.V. — I think the 1980s. And now we have a vaccine for H.P.V. and rates of cervical cancer have fallen by two-thirds.
  • what about incidence? We’ve talked at a few points about how important it is to think about all of these questions in terms of the scale. What is the right scale for thinking about future long Covid, for instance, or other post-acute sequelae?
  • I think the absolute risk, per infection, is going down and down and down. That’s just true.
  • he U.K.’s Office of National Statistics, which shows a much lower risk of developing long Covid now, from reinfection, than from an initial infection earlier in the pandemic.
  • the worst is definitely behind us, which is a good thing, especially for people who worry that the problems will keep building and a lot of people — or even everyone — will get long Covid symptoms. I don’t think there’s a world where we’re looking at the babies of today dealing with long Covid at any meaningful scale.
  • a lot of the fear right now comes from the worst cases, and there’s a lot of worst cases. Even one of the people that I know well, I know in their mind they’re worried that they’ll never recover, but I think objectively they are recovering slowly. It might not be an eight month course. It might be a year and a half. But they will get better. Most of us will.
Javier E

What American Healthcare Can Learn From Germany - Olga Khazan - The Atlantic - 0 views

www.theatlantic.com/...360133

germany health-care system us comparative

shared by Javier E on 09 Apr 14 - No Cached
  • Every German resident must belong to a sickness fund, and in turn the funds must insure all comers. They’re also mandated to cover a standard set of benefits, which includes most procedures and medications. Workers pay half the cost of their sickness fund insurance, and employers pay the rest. The German government foots the bill for the unemployed and for children. There are also limits on out-of-pocket expenses, so it’s rare for a German to go into debt because of medical bills.
  • this is very similar to the health-insurance regime that Americans are now living under, now that the Affordable Care Act is four years old and a few days past its first enrollment deadline.
  • There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago
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  • nearly five million Americans fall into what’s called the “Medicaid gap”
  • In Germany, employees' premiums are a percentage of their incomes, so low-wage workers simply pay rock-bottom insurance rates.
  • Germany actually pioneered this type of insurance—it all started when Otto von Bismarck signed his Health Insurance Bill of 1883 into law. (It’s still known as the “Bismarck model” because of his legacy, and other parts of Europe and Asia have adopted it over the years.)
  • You can think of this setup as the Goldilocks option among all of the possible ways governments can insure health. It's not as radical as single-payer models like the U.K.’s, where the government covers everyone. And it's also not as brutal as the less-regulated version of the insurance market we had before the ACA.
  • Since there are no provider networks in Germany, doctors don’t know what other providers patients have seen, so there are few ways to limit repeat procedures.
  • All things considered, it’s good to be a sick German. There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in.
  • There’s also no money that changes hands during a medical appointment. Patients show their insurance card at the doctor’s office, and the doctors' association pays the doctor using money from the sickness funds. "You don’t have to sit at home and sort through invoices or wonder if you overlooked fine print,”
  • That insurance card, by the way, is good for hospital visits anywhere in Europe.
  • of all of the countries studied, Germans were the most likely to be able to get a same-day or next-day appointment and to hear back from a doctor quickly if they had a question. They rarely use emergency rooms, and they can access doctors after-hours with ease.
  • And Germany manages to put its health-care dollars to relatively good use: For each $100 it spends on healthcare, it extends life by about four months, according to a recent analysis in the American Journal of Public Health. In the U.S., one of the worst-performing nations in the ranking, each $100 spent on healthcare resulted in only a couple of extra weeks of longevity.
  • those differences aside, it’s fair to say the U.S. is moving in the direction of systems like Germany’s—multi-payer, compulsory, employer-based, highly regulated, and fee-for-service.
  • The German government is similarly trying to push more people into “family physician” programs, in which just one doctor would serve as a gatekeeper.
  • like the U.S., Germany may see a shortage of primary-care doctors in the near future, both because primary-care doctors there don’t get paid as much as specialists, and because entrenched norms have prevented physician assistants from shouldering more responsibility
  • With limitations on how much they can charge, German doctors and hospitals instead try to pump up their earnings by performing as many procedures as possible, just like American providers do.
  • Similarly, “In Germany, it will always be an operation,” Göpffarth said. “Meanwhile, France and the U.K. tend to try drugs first and operations later.”
  • With few resource constraints, healthcare systems like America's and Germany's tend to go with the most expensive treatment option possible. An American might find himself in an MRI machine for a headache that a British doctor would have treated with an aspirin and a smile.
  • Perhaps the biggest difference between our two approaches is the extent to which Germany has managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors’ associations negotiate their fees directly with all of the sickness funds in each state. That's part of the reason why an appendectomy costs $3,093 in Germany, but $13,000 in the U.S.
  • Now, Maryland is going a step further still, having just launched a plan to cap the amount each hospital can spend, total, each year. The state's hospital spending growth will be limited to 3.58 percent for the next five years. “We know that right now, the more [doctors] do, the more they get paid,” John Colmers, executive director of Maryland’s Health Services Cost Review Commission, told me. “We want to say, ‘The better you do, the better you get paid.’”
  • certain U.S. states have tried a more German strategy, attempting to keep costs low by setting prices across the board. Maryland, for example, has been regulating how much all of the state’s hospitals can charge since 1977. A 2009 study published in Health Affairs found that we would have saved $2 trillion if the entire country’s health costs had grown at the same rate as Maryland’s over the past three decades.
  • “In Germany, there is a uniform fee schedule for all physicians that work under the social code,” Schlette said. “There’s a huge catalogue where they determine meticulously how much is billed for each procedure. That’s like the Bible.”
  • “The red states are unlikely to follow their lead. The notion that government may be a big part of the solution, instead of the problem, is anathema, and Republican controlled legislatures, and their governors, would find it too substantial a conflict to pursue with any vigor.”
  • no other state has Maryland’s uniform, German-style payment system in place, “so Maryland starts the race nine paces ahead of the other 46 states,” McDonough said.
  • the unique spirit of each country is what ultimately gets in its way. Germany’s more orderly system can be too rigid for experimentation. And America’s free-for-all, where hospitals and doctors all charge different amounts, is great for innovation but too chaotic to make payment reforms stick.
  • rising health costs will continue to be the main problem for Americans as we launch into our more Bismarckian system. “The main challenge you’ll have is price control,” he said. “You have subsidies in health exchanges now, so for the first time, the federal budget is really involved in health expenditure increases in the commercial market. In order to keep your federal budget under control, you’ll have to control prices.”
bluekoenig

One policy that changes the coronavirus math - YouTube - 0 views

www.youtube.com/watch

politics us history trump crisis culture policy health medicine covid19 coronavirus

shared by bluekoenig on 27 Mar 20 - No Cached
  • bluekoenig on 27 Mar 20
     
    This video details the one policy held by most developed countries across the world except for the United States, paid sick leave for all employees, that may further determine how bad Covid-19's impact will be on the US. Most other developed countries, including Italy and Germany, have a policy where every employee must receive paid sick leave from either their employer, the government or both. This ensures that any disease an employee may have, not just Covid-19, doesn't spread to the company or anyone it serves. The US doesn't have a policy like this and many Americans make the choice every day to go to work sick in order to have enough money to live. This can prove to be detrimental in this outbreak as people continue to go to work and continue to get others sick or don't go to work and lose their job, house, and all their savings. Contingency plans have been in the works since the government started acting on this virus, but most if not all bills requiring paid sick leave have been edited to contain loopholes or become vague in order to appease republican lawmakers.
Javier E

COVID-19 Vaccines Won't Stop All Infections - The Atlantic - 0 views

www.theatlantic.com/...618330

pandemic vaccine results

shared by Javier E on 20 Mar 21 - No Cached
  • Breakthrough infections, which occur when fully vaccinated people are infected by the pathogen that their shots were designed to protect against, are an entirely expected part of any vaccination process. They’re the data points that keep vaccines from reaching 100 percent efficacy in trials; they’re simple proof that no inoculation is a perfect preventative.
  • nearly 40 million Americans have received the jabs they need for full immunization. A vanishingly small percentage of those people have gone on to test positive for the coronavirus. The post-shot sicknesses documented so far seem to be mostly mild, reaffirming the idea that inoculations are powerful weapons against serious disease, hospitalization, and death.
  • The goal of vaccination isn’t eradication, but a détente in which humans and viruses coexist, with the risk of disease at a tolerable low.
  • ...17 more annotations...
  • “Being vaccinated doesn’t mean you are immune. It means you have a better chance of protection.”
  • Immunity is not a monolith, and the degree of defense roused by an infection or a vaccine will differ from person to person, even between identical twins. Some people might have underlying conditions that hamstring their immune system’s response to vaccination; others might simply, by chance, churn out fewer or less potent antibodies and T cells that can nip a coronavirus infection in the bud.
  • An ideal response to vaccination might create an arsenal of immune molecules and cells that can instantaneously squelch the virus, leaving no time for symptoms to appear. But sometimes that front line of fighters is relatively sparse
  • Should the virus make it through, “it becomes a race [against] time,” Ellebedy told me. The pathogen rushes to copy itself, and the immune system recruits more defenders. The longer the tussle drags on, the more likely the disease is to manifest.
  • The range of vaccine responses “isn’t a variation of two- to threefold; it’s thousands,”
  • dislikes the term breakthrough case, which evokes a barrier walling humans off from disease. “It’s very misleading,” she told me. “It’s like the virus ‘punches’ through our defenses.”
  • The number of post-vaccination infections is also contingent on “the ongoing transmission situation,” Omer told me. “It depends on how much people are mixing.”
  • Vaccination is actually more like a single variable in a dynamic playing field—a layer of protection, like an umbrella, that might guard better in some situations than others. It could keep a lucky traveler relatively dry in a light drizzle, but in a windy maelstrom that’s whipping heavy droplets every which way, another person might be overwhelmed.
  • under many circumstances, vaccines are still best paired with safeguards such as masks and distancing—just as rain boots and jackets would help buffer someone in a storm.
  • Even excellent vaccines aren’t foolproof, and they shouldn’t be criticized when they’re not. “We can’t expect it’s going to be perfect, on day one, always,” Borio said.
  • The numbers for asymptomatic infections are still crystallizing, but they’re likely to be lower.
  • “Whenever someone tests positive, the real question is, are they sick, and how sick are they? That’s a big difference.”
  • Efficacy, a figure specific to clinical trials, also doesn’t always translate perfectly to the messiness of the real world, where there’s immense variability in how, when, where, by whom, and to whom shots are administered
  • The vaccine’s performance under these conditions is tracked by a separate measure, called effectiveness. Studies rigorously examining vaccine effectiveness are challenging, but early data suggest that the Pfizer-BioNTech and Moderna shots are living up to their initial hype.
  • he circumstances of exposure to any version of the coronavirus will also make a difference. If vaccinated people are spending time with groups of unvaccinated people in places where the virus is running rampant, that still raises their chance of getting sick. Large doses of the virus can overwhelm the sturdiest of immune defenses, if given the chance.
  • A vaccine with a recorded efficacy of 95 percent, for example, doesn’t give everyone who’s vaccinated a 5 percent chance of getting sick. Not all of those people will even encounter the virus
  • The key is how vaccination changes the outcome for those who are meaningfully exposed: Among 100 individuals who might have fallen ill without the vaccine, just five symptomatic cases might appear.
gaglianoj

More than a third of American workers don't get sick leave, and they're making the rest... - 0 views

www.washingtonpost.com/...eyre-making-the-rest-of-us-ill

shared by gaglianoj on 17 Jan 15 - No Cached
  • Nationally, nearly 4-in-10 private sector workers -- 39 percent -- do not have access to any sick leave at all.
  • that amounts to 43.5 million workers who may be compelled by financial reasons to come into the office when they're sniffling, sneezing, barfing, and generally feeling under the weather, making the rest of us ill in the process.
Javier E

Opinion | The Best-Case Outcome for the Coronavirus, and the Worst - The New York Times - 0 views

www.nytimes.com/...coronavirus-outcomes.html

pandemic model outcome crisis

shared by Javier E on 21 Mar 20 - No Cached
  • About four out of five people known to have had the virus had only mild symptoms, and even among those older than 90 in Italy, 78 percent survived.
  • Two-thirds of those who died in Italy had pre-existing medical conditions and were also elderly
  • “I’m not pessimistic. I think this can work.” She thinks it will take eight weeks of social distancing to have a chance to slow the virus, and success will depend on people changing behaviors and on hospitals not being overrun. “If warm weather helps, if we can get these drugs, if we can get companies to produce more ventilators, we have a window to tamp this down,”
  • ...18 more annotations...
  • Dr. Neil M. Ferguson, a British epidemiologist who is regarded as one of the best disease modelers in the world, produced a sophisticated model with a worst case of 2.2 million deaths in the United States.
  • I asked Ferguson for his best case. “About 1.1 million deaths,” he said.
  • one can argue that the U.S. is not only on the same path as Italy but is also less prepared, for America has fewer doctors and hospital beds per capita than Italy does — and a shorter life expectancy even in the best of times.
  • up to 366,000 I.C.U. beds might be needed in the United States for coronavirus patients at one time, more than 10 times the number available. A Harvard study reached a similar conclusion.
  • This is an interval of quiet when the United States should be urgently ramping up investment in vaccines and therapies, addressing the severe shortages of medical supplies and equipment, and giving retired physicians and military medics legal authority to practice in a crisis
  • During World War II, the Ford Motor Company turned out one B-24 bomber every 63 minutes; today, we should be rushing out ventilators and face masks, but there’s nothing like the same sense of urgency.
  • After initial missteps in Wuhan, where the coronavirus was first discovered, China adopted protocols for protective gear that are more rigorous than those in the United States, involving N95 masks and face shields, double gowns, gloves and shoe covers, plus special areas to remove protective clothing — and all this worked. Not one of the 42,000 health workers sent to Wuhan is known to have become infected with the coronavirus. The United States isn’t protecting health workers with the same determination; it seems to be betraying them.
  • In Italy, 8.3 percent of coronavirus cases involve health workers. A doctor in the Seattle area who is forced to reuse N95 masks told me that she and her colleagues fear that the lack of supplies will be deadly.
  • “We are all making dying contingency plans at this point just in case,” she said. “Wills, backup people to take care of kids, recording bedtime stories.”
  • The United States is in a weaker position than some other countries to confront the virus because it is the only advanced country that doesn’t have universal health coverage, and the only one that does not guarantee paid sick leave
  • with infectious diseases, the burden will be shared by all Americans
  • This crisis should be a wake-up call to address long-term vulnerabilities. That means providing universal health coverage and paid sick leave — and if you think that the coronavirus legislation Trump signed on Wednesday achieves that, think again. It guarantees sick leave to only about one-fifth of private-sector workers. It’s a symbol of the inadequacy of America’s preparedness.
  • We may dodge a bullet this time, but experts have been warning for decades that a killer pandemic will come;
  • if we, too, can be scared enough to invest in public health and fix our health care system, then something good can come from this crisis — and in the long run, that may save lives.
  • Ferguson questions whether South Korea and other countries can sustain their success for 18 months until a vaccine is ready, even as new cases are constantly being imported
  • America and South Korea reported their first Covid-19 cases on the same day, but South Korea took the epidemic seriously, promptly created an effective test, used it widely and has seen cases go down more than 90 percent from the peak.
  • In contrast, the United States badly bungled testing, and President Trump repeatedly dismissed the coronavirus, saying it was “totally under control” and “will disappear,” and insisting he wasn’t “concerned at all.” The United States has still done only a bit more than 10 percent as many tests per capita as Canada, Austria and Denmark.
  • Peter Hotez, an eminent vaccine scientist at Baylor College of Medicine, told me that he and his colleagues have a candidate vaccine for the coronavirus but still haven’t been able to line up sufficient funding for clinical trials.
bluekoenig

Why fighting the coronavirus depends on you - YouTube - 0 views

www.youtube.com/watch

politics US history crisis culture medicine health covid19 coronavirus

shared by bluekoenig on 24 Mar 20 - No Cached
  • bluekoenig on 24 Mar 20
     
    Here is a video about the Covid-19 epidemic that details the symptoms, how it's spreading, and how we can and should keep the disease from overwhelming the health system and causing unnecessary deaths. It's slightly out of date with some of its information but it still contains information valuable and universal about this epidemic. Avoidable deaths occur when the health system is overwhelmed by huge amounts of cases in short periods of time and can not care for those who are sick and could be saved as well as people who are in desperate need of hospital care for other reasons like car accidents or shootings. More avoidable deaths occur when more people get sick so the biggest thing that prevents them is preventing the spread of the disease. This means not leaving your home if you are sick or have had contact with someone who was sick, act as though you already have it even if you don't. Social distancing saves lives by preventing avoidable deaths and slowing the pandemic in a way that doesn't overwhelm hospitals with cases, it keeps those with a chance who would have died because they couldn't get medical help alive.
katherineharron

Georgia's new law suppressing the vote is a victory for Trump - CNNPolitics - 0 views

www.cnn.com/...index.html

georgia

shared by katherineharron on 26 Mar 21 - No Cached
  • Former President Donald Trump's campaign of lies about a stolen election just delivered a huge victory with a new Georgia law that could suppress the votes of many of the citizens who helped eject him from the White House.
  • The move confirms the Peach State as the epicenter of the fight for American democracy that raged through Trump's presidency and during the insurrection he incited against the US Capitol -- and now threatens to taint future elections as Republicans in multiple states pursue new laws to limit voting.
  • "What I'm worried about is how un-American this whole initiative is. It's sick. It's sick," President Joe Biden said at the first news conference of his presidency that afternoon. The Georgia law raises the question of whether election safeguards that prevented Trump's energetic efforts to rig the 2020 White House race after the fact in the state will stand firm in future elections amid false claims of electoral fraud by a president.
  • ...31 more annotations...
  • GOP leaders justify the voter suppression measures by arguing that they are needed to crack down on fraud and to restore the public's faith that US elections are fair. But multiple courts and Trump's own Justice Department found there was no widespread electoral fraud in 2020.
  • The Georgia bill is only one example of GOP efforts in multiple states -- including many crucial electoral battlegrounds -- to hold back a diverse demographic tide in cities that favor Democrats, which critics see as an attempt to cement minority rule in the United States.
  • Georgia Republicans also lost two US Senate seats that handed Democrats control of the 50-50 chamber on the basis of huge Black turnout in runoff elections in January.close dialogSign up for CNN's CNN's Chris Cillizza cuts through the political spin and tells you what you need to know. Sign Me UpNo ThanksBy subscribing, you agree to ourprivacy policy.Sign up for CNN's CNN's Chris Cillizza cuts through the political spin and tells you what you need to know. Please enter above Sign Me UpNo ThanksBy subscribing, you agree to ourprivacy policy.You're on the list for CNN'sCNN's Chris Cillizza cuts through the political spin and tells you what you need to know. close dialog/* effects for .bx-campaign-1245919 *//* custom css .bx-campaign-1245919 *//* custom css from creative 47804 */@-ms-keyframes bx-anim-1245919-spin { from {
  • "This should be marked as Exhibit A in making the case that discriminatory voter suppression is alive and well, and makes clear why we need federal voting rights legislation to stop these laws in their tracks," Hewitt said. "We stand ready to take action and protect the fundamental right to vote through the courts."
  • as a remnant of the Jim Crow era that institutionalized racism and hinted that he could ultimately back abolishing the Senate filibuster to get the Democrats' House-passed bill through the chamber. But Biden declined to reveal his strategy for getting the voting rights bill into law.
  • Georgia's action threw a political grenade into the debate over a Washington campaign by many Democrats to abolish Senate supermajority rules that Republicans could use to block their sweeping election bill, known as the For the People Act.
  • In a statement to CNN, Georgia Secretary of State Brad Raffensperger, a Republican who defied Trump's pleas in a telephone call to find votes to overturn Biden's victory, said he would still stand up for voter freedoms but did not criticize the law."In implementing this law, I will ensure that no eligible Georgia voter is hindered in exercising their right to vote, and I will continue to further secure our elections so that every Georgian can have confidence in the results of our elections," Raffensperger said
  • "As the FBI continue to round up seditionists who spilled blood to defend a lie about our elections, Republican state leaders willfully undermine democracy by giving themselves authority to overturn results they do not like," Abrams said in a statement. "Now, more than ever, Americans must demand federal action to protect voting rights as we continue to fight against these blatantly unconstitutional efforts that are nothing less than Jim Crow 2.0."
  • Black voters hampered by the restrictions of voting in urban areas have often found themselves lining up for hours to vote in inclement weather. The clear targeting of African American voters in Georgia and elsewhere recalls some of the ugliest racial episodes of America's past, and is fueling claims of open Republican racism.
  • Former President Donald Trump's campaign of lies about a stolen election just delivered a huge victory with a new Georgia law that could suppress the votes of many of the citizens who helped eject him from the White House.
  • Republican state lawmakers rushed through a broad law Thursday making it harder to vote that disproportionately targets Democratic and Black voters
  • The move confirms the Peach State as the epicenter of the fight for American democracy
  • The Georgia law raises the question of whether election safeguards that prevented Trump's energetic efforts to rig the 2020 White House race after the fact in the state will stand firm in future elections amid false claims of electoral fraud by a president.
  • "What I'm worried about is how un-American this whole initiative is. It's sick. It's sick," President Joe Biden
  • Republicans in multiple states pursue new laws to limit voting.
  • Georgia Republicans also lost two US Senate seats that handed Democrats control of the 50-50 chamber on the basis of huge Black turnout in runoff elections in January.close dialogSign up for CNN What Matters NewsletterEvery day we summarize What Matters and deliver it straight to your inbox.Sign me upNo thanksBy subscribing you agree to ourprivacy policy.By subscribing you agree to ourprivacy policy.Sign up for CNN What Matters NewsletterEvery day we summarize What Matters and deliver it straight to your inbox.Please enter aboveSign me upNo thanksBy subscribing you agree to ourprivacy policy.By subscribing you agree to ourprivacy policy.Sign up for CNN What Matters NewsletterEvery day we summarize What Matters and deliver it straight to your inbox.//assets.bounceexchang
  • After leaving office, Trump demanded that Republican state legislatures pass laws to ban mail-in voting and to prevent courts from weighing in on electoral disputes.
  • the former President has made the acceptance of his false conspiracy theories about voter fraud in 2020 a litmus test for Republican candidates
  • Iowa has already passed a measure to limit absentee balloting and voting hours. Texas is taking steps to cut voting hours and absentee balloting in big Democratic cities like Houston. New voting laws are being pushed by Republicans in another swing state Trump lost, Arizona.
  • GOP leaders justify the voter suppression measures by arguing that they are needed to crack down on fraud and to restore the public's faith that US elections are fair. But multiple courts and Trump's own Justice Department found there was no widespread electoral fraud in 2020.
  • voter mistrust was largely fueled by Trump's blatantly false claims
  • Georgia's action threw a political grenade into the debate over a Washington campaign by many Democrats to abolish Senate supermajority rules that Republicans could use to block their sweeping election bill, known as the For the People Act.
  • The drama in the Georgia Legislature unfolded as Biden condemned restrictive state legislation as a remnant of the Jim Crow era that institutionalized racism and hinted that he could ultimately back abolishing the Senate filibuster to get the Democrats' House-passed bill through the chamber.
  • The law allows any Georgian to make unlimited challenges to voter registrations, and, incredibly, makes it a misdemeanor crime for anyone to offer food and water to voters stuck in long lines to cast ballots.
  • The clear targeting of African American voters in Georgia and elsewhere recalls some of the ugliest racial episodes of America's past, and is fueling claims of open Republican racism.
  • The Georgia law was quickly signed by Republican Gov. Brian Kemp, who incurred the wrath of Trump last year for refusing to play along with his attempt to override Biden's victory by 12,000 votes in the state, which was confirmed by several audits.
  • "In implementing this law, I will ensure that no eligible Georgia voter is hindered in exercising their right to vote, and I will continue to further secure our elections so that every Georgian can have confidence in the results of our elections," Raffensperger said.
  • Kemp is up for reelection in 2022 and could face Democrat Stacey Abrams, a former state lawmaker and prominent voting rights advocate
  • "As the FBI continue to round up seditionists who spilled blood to defend a lie about our elections, Republican state leaders willfully undermine democracy by giving themselves authority to overturn results they do not like," Abrams said in a statement. "Now, more than ever, Americans must demand federal action to protect voting rights as we continue to fight against these blatantly unconstitutional efforts that are nothing less than Jim Crow 2.0."
  • the measure directly targeted voters of color who took part in record numbers in the 2020 election.
  • The For the People Act awaiting action in the Senate would create automatic voter registration nationwide and restore portions of the Voting Rights Act that were gutted by the Supreme Court. It would also strengthen mail-in voting and permit early voting across the country, while taking steps to cut wait times at the polls.
aniyahbarnett

The Covid-19 pandemic is getting worse. What happens next is up to you. - CNN - 0 views

www.cnn.com/...index.html

crisis pandemic

shared by aniyahbarnett on 15 Jan 21 - No Cached
  • experts warned the start of 2021 would be a very rough time in this pandemic.
  • The United States just shattered its all-time records for the most Covid-19 infections, hospitalizations and deaths reported in one day:
  • On January 2, a record-high 302,506 new infections were reported in one day, according to Johns Hopkins University.
  • ...23 more annotations...
  • "These viruses may be able to infect people who are further than 6 feet away from the person who is infected or after that person has left the space," the CDC said.
  • Many hospitals are now filled beyond capacity,
  • pandemic fatigue.
  • And many of those who are sick of taking precautions are getting sick.
  • , more people are socializing indoors.
  • "linger in the air for minutes to hours,"
  • A variant first detected in South Africa
  • Gathering with multiple friends indoors can be dangerous.
  • "If you go to a party with five or more people, almost certainly there's going to be somebody with Covid-19 at that party,"
  • more than 50% of all infections are transmitted from people who aren't showing symptoms.
  • That's an average of 3.5 people getting infected every second.Read More
  • The United States has confirmed at least 76 cases of a highly transmissible variant of the coronavirus that was first detected in the United Kingdom.
  • And the United States ranks 61st in how quickly virus samples are collected from patients, analyzed and then posted to an international database to find new variants.
  • While it may be more transmissible, there's no evidence this variant first detected in the UK is deadlier or causes more severe disease, the CDC said.
  • Some patients have been put in hospital break rooms, parking garages and gift shops.
  • As of Thursday, it has not been detected in the United States.
  • That didn't happen. Not even close.
  • As of Thursday morning, about 10.2 million vaccine doses had been administered, out of roughly 29.3 million doses that have been distributed across the United States, according to the CDC.
  • You can test
  • negative
  • but still be infected and contagious.
  • And don't think you're invincible -- even if you're young and healthy.
  • "We see severe illness among healthy, young adults with no apparent underlying causes," Hotez said.
Javier E

The dark side of Dubai - Johann Hari - Commentators - The Independent - 0 views

www.independent.co.uk/...ark-side-of-dubai-1664368.html

dubai globalization economics politics slavery history

shared by Javier E on 26 Jul 12 - Cached
  • the secrets of Dubai are slowly seeping out. This is a city built from nothing in just a few wild decades on credit and ecocide, suppression and slavery. Dubai is a living metal metaphor for the neo-liberal globalised world that may be crashing – at last – into history.
  • There are three different Dubais, all swirling around each other. There are the expats, like Karen; there are the Emiratis, headed by Sheikh Mohammed; and then there is the foreign underclass who built the city, and are trapped here. They are hidden in plain view. You see them everywhere, in dirt-caked blue uniforms, being shouted at by their superiors, like a chain gang – but you are trained not to look. It is like a mantra: the Sheikh built the city. The Sheikh built the city. Workers? What workers?
  • Sahinal Monir, a slim 24-year-old from the deltas of Bangladesh. "To get you here, they tell you Dubai is heaven. Then you get here and realise it is hell," he says. Four years ago, an employment agent arrived in Sahinal's village in Southern Bangladesh. He told the men of the village that there was a place where they could earn 40,000 takka a month (£400) just for working nine-to-five on construction projects. It was a place where they would be given great accommodation, great food, and treated well. All they had to do was pay an up-front fee of 220,000 takka (£2,300) for the work visa – a fee they'd pay off in the first six months, easy. So Sahinal sold his family land, and took out a loan from the local lender, to head to this paradise. As soon as he arrived at Dubai airport, his passport was taken from him by his construction company. He has not seen it since. He was told brusquely that from now on he would be working 14-hour days in the desert heat – where western tourists are advised not to stay outside for even five minutes in summer, when it hits 55 degrees – for 500 dirhams a month (£90), less than a quarter of the wage he was promised. If you don't like it, the company told him, go home. "But how can I go home? You have my passport, and I have no money for the ticket," he said. "Well, then you'd better get to work," they replied.
  • ...12 more annotations...
  • "There's a huge number of suicides in the camps and on the construction sites, but they're not reported. They're described as 'accidents'." Even then, their families aren't free: they simply inherit the debts. A Human Rights Watch study found there is a "cover-up of the true extent" of deaths from heat exhaustion, overwork and suicide, but the Indian consulate registered 971 deaths of their nationals in 2005 alone. After this figure was leaked, the consulates were told to stop counting.
  • Since the recession hit, they say, the electricity has been cut off in dozens of the camps, and the men have not been paid for months. Their companies have disappeared with their passports and their pay. "We have been robbed of everything. Even if somehow we get back to Bangladesh, the loan sharks will demand we repay our loans immediately, and when we can't, we'll be sent to prison." This is all supposed to be illegal. Employers are meant to pay on time, never take your passport, give you breaks in the heat – but I met nobody who said it happens. Not one. These men are conned into coming and trapped into staying, with the complicity of the Dubai authorities.
  • The work is "the worst in the world," he says. "You have to carry 50kg bricks and blocks of cement in the worst heat imaginable ... This heat – it is like nothing else. You sweat so much you can't pee, not for days or weeks. It's like all the liquid comes out through your skin and you stink. You become dizzy and sick but you aren't allowed to stop, except for an hour in the afternoon. You know if you drop anything or slip, you could die. If you take time off sick, your wages are docked, and you are trapped here even longer."
  • Sheikh Mohammed turned Dubai into Creditopolis, a city built entirely on debt. Dubai owes 107 percent of its entire GDP. It would be bust already, if the neighbouring oil-soaked state of Abu Dhabi hadn't pulled out its chequebook. Mohammed says this will constrict freedom even further. "Now Abu Dhabi calls the tunes – and they are much more conservative and restrictive than even Dubai. Freedom here will diminish every day." Already, new media laws have been drafted forbidding the press to report on anything that could "damage" Dubai or "its economy"
  • For Emiratis, this is a Santa Claus state, handing out goodies while it makes its money elsewhere: through renting out land to foreigners, soft taxes on them like business and airport charges, and the remaining dribble of oil. Most Emiratis, like Ahmed, work for the government, so they're cushioned from the credit crunch. "I haven't felt any effect at all, and nor have my friends," he says. "Your employment is secure. You will only be fired if you do something incredibly bad." The laws are currently being tightened, to make it even more impossible to sack an Emirati.
  • What we see now didn't occur in our wildest dreams. We never thought we could be such a success, a trendsetter, a model for other Arab countries. The people of Dubai are mighty proud of their city, and rightly so. And yet..." He shakes his head. "In our hearts, we fear we have built a modern city but we are losing it to all these expats." Adbulkhaleq says every Emirati of his generation lives with a "psychological trauma." Their hearts are divided – "between pride on one side, and fear on the other."
  • t is an open secret that once you hire a maid, you have absolute power over her. You take her passport – everyone does; you decide when to pay her, and when – if ever – she can take a break; and you decide who she talks to. She speaks no Arabic. She cannot escape.
  • heikh Maktoum built his showcase city in a place with no useable water. None. There is no surface water, very little acquifer, and among the lowest rainfall in the world. So Dubai drinks the sea. The Emirates' water is stripped of salt in vast desalination plants around the Gulf – making it the most expensive water on earth. It costs more than petrol to produce, and belches vast amounts of carbon dioxide into the atmosphere as it goes. It's the main reason why a resident of Dubai has the biggest average carbon footprint of any human being – more than double that of an American.
  • Dubai only has enough water to last us a week. There's almost no storage. We don't know what will happen if our supplies falter. It would be hard to survive." Global warming, he adds, makes the problem even worse. "We are building all these artificial islands, but if the sea level rises, they will be gone, and we will lose a lot. Developers keep saying it's all fine, they've taken it into consideration, but I'm not so sure."
  • The water quality got worse and worse. The guests started to spot raw sewage, condoms, and used sanitary towels floating in the sea. So the hotel ordered its own water analyses from a professional company. "They told us it was full of fecal matter and bacteria 'too numerous to count'. I had to start telling guests not to go in the water, and since they'd come on a beach holiday, as you can imagine, they were pretty pissed off." She began to make angry posts on the expat discussion forums – and people began to figure out what was happening. Dubai had expanded so fast its sewage treatment facilities couldn't keep up. The sewage disposal trucks had to queue for three or four days at the treatment plants – so instead, they were simply drilling open the manholes and dumping the untreated sewage down them, so it flowed straight to the sea.
  • She continued to complain – and started to receive anonymous phone calls. "Stop embarassing Dubai, or your visa will be cancelled and you're out," they said. She says: "The expats are terrified to talk about anything. One critical comment in the newspapers and they deport you. So what am I supposed to do? Now the water is worse than ever. People are getting really sick. Eye infections, ear infections, stomach infections, rashes. Look at it!" There is faeces floating on the beach, in the shadow of one of Dubai's most famous hotels.
  • Perhaps Dubai disturbed me so much, I am thinking, because here, the entire global supply chain is condensed. Many of my goods are made by semi-enslaved populations desperate for a chance 2,000 miles away; is the only difference that here, they are merely two miles away, and you sometimes get to glimpse their faces? Dubai is Market Fundamentalist Globalisation in One City.
Javier E

12 Rules for Life: An Antidote to Chaos (Jordan B. Peterson) - 0 views

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  • RULES? MORE RULES? REALLY? Isn’t life complicated enough, restricting enough, without abstract rules that don’t take our unique, individual situations into account? And given that our brains are plastic, and all develop differently based on our life experiences, why even expect that a few rules might be helpful to us all?
  • “I’ve got some good news…and I’ve got some bad news,” the lawgiver yells to them. “Which do you want first?” “The good news!” the hedonists reply. “I got Him from fifteen commandments down to ten!” “Hallelujah!” cries the unruly crowd. “And the bad?” “Adultery is still in.”
  • Maps of Meaning was sparked by Jordan’s agonized awareness, as a teenager growing up in the midst of the Cold War, that much of mankind seemed on the verge of blowing up the planet to defend their various identities. He felt he had to understand how it could be that people would sacrifice everything for an “identity,”
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  • the story of the golden calf also reminds us that without rules we quickly become slaves to our passions—and there’s nothing freeing about that.
  • And the story suggests something more: unchaperoned, and left to our own untutored judgment, we are quick to aim low and worship qualities that are beneath us—in this case, an artificial animal that brings out our own animal instincts in a completely unregulated way.
  • Similarly, in this book Professor Peterson doesn’t just propose his twelve rules, he tells stories, too, bringing to bear his knowledge of many fields as he illustrates and explains why the best rules do not ultimately restrict us but instead facilitate our goals and make for fuller, freer lives.
  • Peterson wasn’t really an “eccentric”; he had sufficient conventional chops, had been a Harvard professor, was a gentleman (as cowboys can be) though he did say damn and bloody a lot, in a rural 1950s sort of way. But everyone listened, with fascination on their faces, because he was in fact addressing questions of concern to everyone at the table.
  • unlike many academics who take the floor and hold it, if someone challenged or corrected him he really seemed to like it. He didn’t rear up and neigh. He’d say, in a kind of folksy way, “Yeah,” and bow his head involuntarily, wag it if he had overlooked something, laughing at himself for overgeneralizing. He appreciated being shown another side of an issue, and it became clear that thinking through a problem was, for him, a dialogic process.
  • for an egghead Peterson was extremely practical. His examples were filled with applications to everyday life: business management, how to make furniture (he made much of his own), designing a simple house, making a room beautiful (now an internet meme) or in another, specific case related to education, creating an online writing project that kept minority students from dropping out of school by getting them to do a kind of psychoanalytic exercise on themselves,
  • These Westerners were different: self-made, unentitled, hands on, neighbourly and less precious than many of their big-city peers, who increasingly spend their lives indoors, manipulating symbols on computers. This cowboy psychologist seemed to care about a thought only if it might, in some way, be helpful to someone.
  • I was drawn to him because here was a clinician who also had given himself a great books education, and who not only loved soulful Russian novels, philosophy and ancient mythology, but who also seemed to treat them as his most treasured inheritance. But he also did illuminating statistical research on personality and temperament, and had studied neuroscience. Though trained as a behaviourist, he was powerfully drawn to psychoanalysis with its focus on dreams, archetypes, the persistence of childhood conflicts in the adult, and the role of defences and rationalization in everyday life. He was also an outlier in being the only member of the research-oriented Department of Psychology at the University of Toronto who also kept a clinical practice.
  • Maps of Meaning, published nearly two decades ago, shows Jordan’s wide-ranging approach to understanding how human beings and the human brain deal with the archetypal situation that arises whenever we, in our daily lives, must face something we do not understand.
  • The brilliance of the book is in his demonstration of how rooted this situation is in evolution, our DNA, our brains and our most ancient stories. And he shows that these stories have survived because they still provide guidance in dealing with uncertainty, and the unavoidable unknown.
  • this is why many of the rules in this book, being based on Maps of Meaning, have an element of universality to them.
  • We are ambivalent about rules, even when we know they are good for us. If we are spirited souls, if we have character, rules seem restrictive, an affront to our sense of agency and our pride in working out our own lives. Why should we be judged according to another’s rule?
  • And he felt he had to understand the ideologies that drove totalitarian regimes to a variant of that same behaviour: killing their own citizens.
  • Ideologies are simple ideas, disguised as science or philosophy, that purport to explain the complexity of the world and offer remedies that will perfect it.
  • Ideologues are people who pretend they know how to “make the world a better place” before they’ve taken care of their own chaos within.
  • Ideologies are substitutes for true knowledge, and ideologues are always dangerous when they come to power, because a simple-minded I-know-it-all approach is no match for the complexity of existence.
  • To understand ideology, Jordan read extensively about not only the Soviet gulag, but also the Holocaust and the rise of Nazism. I had never before met a person, born Christian and of my generation, who was so utterly tormented by what happened in Europe to the Jews, and who had worked so hard to understand how it could have occurred.
  • I saw what now millions have seen online: a brilliant, often dazzling public speaker who was at his best riffing like a jazz artist; at times he resembled an ardent Prairie preacher (not in evangelizing, but in his passion, in his ability to tell stories that convey the life-stakes that go with believing or disbelieving various ideas). Then he’d just as easily switch to do a breathtakingly systematic summary of a series of scientific studies. He was a master at helping students become more reflective, and take themselves and their futures seriously. He taught them to respect many of the greatest books ever written. He gave vivid examples from clinical practice, was (appropriately) self-revealing, even of his own vulnerabilities, and made fascinating links between evolution, the brain and religious stories.
  • Above all, he alerted his students to topics rarely discussed in university, such as the simple fact that all the ancients, from Buddha to the biblical authors, knew what every slightly worn-out adult knows, that life is suffering.
  • chances are, if you or someone you love is not suffering now, they will be within five years, unless you are freakishly lucky. Rearing kids is hard, work is hard, aging, sickness and death are hard, and Jordan emphasized that doing all that totally on your own, without the benefit of a loving relationship, or wisdom, or the psychological insights of the greatest psychologists, only makes it harder.
  • focused on triumphant heroes. In all these triumph stories, the hero has to go into the unknown, into an unexplored territory, and deal with a new great challenge and take great risks. In the process, something of himself has to die, or be given up, so he can be reborn and meet the challenge. This requires courage, something rarely discussed in a psychology class or textbook.
  • Jordan
  • views of his first YouTube statements quickly numbered in the hundreds of thousands. But people have kept listening because what he is saying meets a deep and unarticulated need. And that is because alongside our wish to be free of rules, we all search for structure.
  • the first generation to have been so thoroughly taught two seemingly contradictory ideas about morality, simultaneously—at their schools, colleges and universities, by many in my own generation. This contradiction has left them at times disoriented and uncertain, without guidance and, more tragically, deprived of riches they don’t even know exist.
  • morality and the rules associated with it are just a matter of personal opinion or happenstance, “relative to” or “related to” a particular framework, such as one’s ethnicity, one’s upbringing, or the culture or historical…
  • The first idea or teaching is that morality is relative, at best a…
  • So, the decent thing to do—once it becomes apparent how arbitrary your, and your society’s, “moral values” are—is to show tolerance for people who think differently, and…
  • for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an adult can…
  • That emphasis on tolerance is so paramount that for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an…
  • And so a generation has been raised untutored in what was once called, aptly, “practical wisdom,” which guided previous generations. Millennials, often told they have received the finest education available anywhere, have actually…
  • professors, chose to devalue thousands of years of human knowledge about how to acquire virtue, dismissing it as passé, “…
  • They were so successful at it that the very word “virtue” sounds out of date, and someone using it appears…
  • The study of virtue is not quite the same as the study of morals (right and wrong, good and evil). Aristotle defined the virtues simply as the ways of behaving that are most conducive to happiness in life. Vice was…
  • Cultivating judgment about the difference between virtue and vice is the beginning of wisdom, something…
  • By contrast, our modern relativism begins by asserting that making judgments about how to live is impossible, because there is no real good, and no…
  • Thus relativism’s closest approximation to “virtue” is “tolerance.” Only tolerance will provide social cohesion between different groups, and save us from harming each other. On Facebook and other forms of social media, therefore, you signal your so-called…
  • Intolerance of others’ views (no matter how ignorant or incoherent they may be) is not simply wrong; in a world where there is no right or wrong, it is worse: it is a sign you are…
  • But it turns out that many people cannot tolerate the vacuum—the chaos—which is inherent in life, but made worse by this moral relativism; they cannot live without a moral compass,…
  • So, right alongside relativism, we find the spread of nihilism and despair, and also the opposite of moral relativism: the blind certainty offered by ideologies…
  • Dr. Norman Doidge, MD, is the author of The Brain That Changes Itself
  • so we arrive at the second teaching that millennials have been bombarded with. They sign up for a humanities course, to study the greatest books ever written. But they’re not assigned the books; instead they are given…
  • (But the idea that we can easily separate facts and values was and remains naive; to some extent, one’s values determine what one will pay…
  • For the ancients, the discovery that different people have different ideas about how, practically, to live, did not paralyze them; it deepened their understanding of humanity and led to some of the most satisfying conversations human beings have ever had, about how life might be lived.
  • Modern moral relativism has many sources. As we in the West learned more history, we understood that different epochs had different moral codes. As we travelled the seas and explored the globe, we learned of far-flung tribes on different continents whose different moral codes made sense relative to, or within the framework of, their societies. Science played a role, too, by attacking the religious view of the world, and thus undermining the religious grounds for ethics and rules. Materialist social science implied that we could divide the world into facts (which all could observe, and were objective and “real”) and values (…
  • it seems that all human beings are, by some kind of biological endowment, so ineradicably concerned with morality that we create a structure of laws and rules wherever we are. The idea that human life can be free of moral concerns is a fantasy.
  • given that we are moral animals, what must be the effect of our simplistic modern relativism upon us? It means we are hobbling ourselves by pretending to be something we are not. It is a mask, but a strange one, for it mostly deceives the one who wears it.
  • Far better to integrate the best of what we are now learning with the books human beings saw fit to preserve over millennia, and with the stories that have survived, against all odds, time’s tendency to obliterate.
  • these really are rules. And the foremost rule is that you must take responsibility for your own life. Period.
  • Jordan’s message that each individual has ultimate responsibility to bear; that if one wants to live a full life, one first sets one’s own house in order; and only then can one sensibly aim to take on bigger responsibilities.
  • if it’s uncertain that our ideals are attainable, why do we bother reaching in the first place? Because if you don’t reach for them, it is certain you will never feel that your life has meaning.
  • And perhaps because, as unfamiliar and strange as it sounds, in the deepest part of our psyche, we all want to be judged.
  • Instead of despairing about these differences in moral codes, Aristotle argued that though specific rules, laws and customs differed from place to place, what does not differ is that in all places human beings, by their nature, have a proclivity to make rules, laws and customs.
  • Freud never argued (as do some who want all culture to become one huge group therapy session) that one can live one’s entire life without ever making judgments, or without morality. In fact, his point in Civilization and Its Discontents is that civilization only arises when some restraining rules and morality are in place.
  • Aleksandr Solzhenitsyn, the great documenter of the slave-labour-camp horrors of the latter, once wrote that the “pitiful ideology” holding that “human beings are created for happiness” was an ideology “done in by the first blow of the work assigner’s cudgel.”1 In a crisis, the inevitable suffering that life entails can rapidly make a mockery of the idea that happiness is the proper pursuit of the individual. On the radio show, I suggested, instead, that a deeper meaning was required. I noted that the nature of such meaning was constantly re-presented in the great stories of the past, and that it had more to do with developing character in the face of suffering than with happiness.
  • I proposed in Maps of Meaning that the great myths and religious stories of the past, particularly those derived from an earlier, oral tradition, were moral in their intent, rather than descriptive. Thus, they did not concern themselves with what the world was, as a scientist might have it, but with how a human being should act.
  • I suggested that our ancestors portrayed the world as a stage—a drama—instead of a place of objects. I described how I had come
  • to believe that the constituent elements of the world as drama were order and chaos, and not material things.
  • Order is where the people around you act according to well-understood social norms, and remain predictable and cooperative. It’s the world of social structure, explored territory, and familiarity. The state of Order is typically portrayed, symbolically—imaginatively—as masculine.
  • Chaos, by contrast, is where—or when—something unexpected happens.
  • As the antithesis of symbolically masculine order, it’s presented imaginatively as feminine. It’s the new and unpredictable suddenly emerging in the midst of the commonplace familiar. It’s Creation and Destruction,
  • Order is the white, masculine serpent; Chaos, its black, feminine counterpart. The black dot in the white—and the white in the black—indicate the possibility of transformation: just when things seem secure, the unknown can loom, unexpectedly and large. Conversely, just when everything seems lost, new order can emerge from catastrophe and chaos.
  • For the Taoists, meaning is to be found on the border between the ever-entwined pair. To walk that border is to stay on the path of life, the divine Way. And that’s much better than happiness.
  • trying to address a perplexing problem: the reason or reasons for the nuclear standoff of the Cold War. I couldn’t understand how belief systems could be so important to people that they were willing to risk the destruction of the world to protect them. I came to realize that shared belief systems made people intelligible to one another—and that the systems weren’t just about belief.
  • People who live by the same code are rendered mutually predictable to one another. They act in keeping with each other’s expectations and desires. They can cooperate. They can even compete peacefully, because everyone knows what to expect from everyone else.
  • Shared beliefs simplify the world, as well, because people who know what to expect from one another can act together to tame the world. There is perhaps nothing more important than the maintenance of this organization—this simplification. If it’s threatened, the great ship of state rocks.
  • It isn’t precisely that people will fight for what they believe. They will fight, instead, to maintain the match between what they believe, what they expect, and what they desire. They will fight to maintain the match between what they expect and how everyone is acting. It is precisely the maintenance of that match that enables everyone
  • There’s more to it, too. A shared cultural system stabilizes human interaction, but is also a system of value—a hierarchy of value, where some things are given priority and importance and others are not. In the absence of such a system of value, people simply cannot act. In fact, they can’t even perceive, because both action and perception require a goal, and a valid goal is, by necessity, something valued.
  • We experience much of our positive emotion in relation to goals. We are not happy, technically speaking, unless we see ourselves progressing—and the very idea of progression implies value.
  • Worse yet is the fact that the meaning of life without positive value is not simply neutral. Because we are vulnerable and mortal, pain and anxiety are an integral part of human existence. We must have something to set against the suffering that is intrinsic to Being.*2 We must have the meaning inherent in a profound system of value or the horror of existence rapidly becomes paramount. Then, nihilism beckons, with its hopelessness and despair.
  • So: no value, no meaning. Between value systems, however, there is the possibility of conflict. We are thus eternally caught between the most diamantine rock and the hardest of places:
  • loss of group-centred belief renders life chaotic, miserable, intolerable; presence of group-centred belief makes conflict with other groups inevitable.
  • In the West, we have been withdrawing from our tradition-, religion- and even nation-centred cultures, partly to decrease the danger of group conflict. But we are increasingly falling prey to the desperation of meaninglessness, and that is no improvement at all.
  • While writing Maps of Meaning, I was (also) driven by the realization that we can no longer afford conflict—certainly not on the scale of the world conflagrations of the twentieth century.
  • I came to a more complete, personal realization of what the great stories of the past continually insist upon: the centre is occupied by the individual.
  • It is possible to transcend slavish adherence to the group and its doctrines and, simultaneously, to avoid the pitfalls of its opposite extreme, nihilism. It is possible, instead, to find sufficient meaning in individual consciousness and experience.
  • How could the world be freed from the terrible dilemma of conflict, on the one hand, and psychological and social dissolution, on the other? The answer was this: through the elevation and development of the individual, and through the willingness of everyone to shoulder the burden of Being and to take the heroic path. We must each adopt as much responsibility as possible for individual life, society and the world.
  • We must each tell the truth and repair what is in disrepair and break down and recreate what is old and outdated. It is in this manner that we can and must reduce the suffering that poisons the world. It’s asking a lot. It’s asking for everything.
  • the alternative—the horror of authoritarian belief, the chaos of the collapsed state, the tragic catastrophe of the unbridled natural world, the existential angst and weakness of the purposeless
  • individual—is clearly worse.
  • a title: 12 Rules for Life: An Antidote to Chaos. Why did that one rise up above all others? First and foremost, because of its simplicity. It indicates clearly that people need ordering principles, and that chaos otherwise beckons.
  • We require rules, standards, values—alone and together. We’re pack animals, beasts of burden. We must bear a load, to justify our miserable existence. We require routine and tradition. That’s order. Order can become excessive, and that’s not good, but chaos can swamp us, so we drown—and that is also not good. We need to stay on the straight and narrow path.
  • I hope that these rules and their accompanying essays will help people understand what they already know: that the soul of the individual eternally hungers for the heroism of genuine Being, and that the willingness to take on that responsibility is identical to the decision to live a meaningful life.
  • RULE 1   STAND UP STRAIGHT WITH YOUR SHOULDERS BACK
  • Because territory matters, and because the best locales are always in short supply, territory-seeking among animals produces conflict. Conflict, in turn, produces another problem: how to win or lose without the disagreeing parties incurring too great a cost.
  • It’s winner-take-all in the lobster world, just as it is in human societies, where the top 1 percent have as much loot as the bottom 50 percent11—and where the richest eighty-five people have as much as the bottom three and a half billion.
  • This principle is sometimes known as Price’s law, after Derek J. de Solla Price,13 the researcher who discovered its application in science in 1963. It can be modelled using an approximately L-shaped graph, with number of people on the vertical axis, and productivity or resources on the horizontal.
  • Instead of undertaking the computationally difficult task of identifying the best man, the females outsource the problem to the machine-like calculations of the dominance hierarchy. They let the males fight it out and peel their paramours from the top.
  • The dominant male, with his upright and confident posture, not only gets the prime real estate and easiest access to the best hunting grounds. He also gets all the girls. It is exponentially more worthwhile to be successful, if you are a lobster, and male.
  • dominance hierarchies have been an essentially permanent feature of the environment to which all complex life has adapted. A third of a billion years ago, brains and nervous systems were comparatively simple. Nonetheless, they already had the structure and neurochemistry necessary to process information about status and society. The importance of this fact can hardly be overstated.
  • evolution works, in large part, through variation and natural selection. Variation exists for many reasons, including gene-shuffling (to put it simply) and random mutation. Individuals vary within a species for such reasons. Nature chooses from among them, across time. That theory, as stated, appears to account for the continual alteration of life-forms over the eons.
  • But there’s an additional question lurking under the surface: what exactly is the “nature” in “natural selection”? What exactly is “the environment” to which animals adapt?
  • Nature “selects.” The idea of selects contains implicitly nested within it the idea of fitness. It is “fitness” that is “selected.” Fitness, roughly speaking, is the probability that a given organism will leave offspring (will propagate its genes through time). The “fit” in “fitness” is therefore the matching of organismal attribute to environmental demand.
  • But nature, the selecting agent, is not a static selector—not in any simple sense.
  • As the environment supporting a species transforms and changes, the features that make a given individual successful in surviving and reproducing also transform and change. Thus, the theory of natural selection does not posit creatures matching themselves ever more precisely to a template specified by the world. It is more that creatures are in a dance with nature, albeit one that is deadly.
  • Nature is not simply dynamic, either. Some things change quickly, but they are nested within other things that change less quickly (music
  • It’s chaos, within order, within chaos, within higher order. The order that is most real is the order that is most unchanging—and that is not necessarily the order that is most easily seen. The leaf, when perceived, might blind the observer to the tree. The tree can blind him to the forest.
  • It is also a mistake to conceptualize nature romantically.
  • Unfortunately, “the environment” is also elephantiasis and guinea worms (don’t ask), anopheles mosquitoes and malaria, starvation-level droughts, AIDS and the Black Plague.
  • It is because of the existence of such things, of course, that we attempt to modify our surroundings, protecting our children, building cities and transportation systems and growing food and generating power.
  • this brings us to a third erroneous concept: that nature is something strictly segregated from the cultural constructs that have emerged within it.
  • It does not matter whether that feature is physical and biological, or social and cultural. All that matters, from a Darwinian perspective, is permanence—and the dominance hierarchy, however social or cultural it might appear, has been around for some half a billion years.
  • The dominance hierarchy is not capitalism. It’s not communism, either, for that matter. It’s not the military-industrial complex. It’s not the patriarchy—that disposable, malleable, arbitrary cultural artefact. It’s not even a human creation; not in the most profound sense. It is instead a near-eternal aspect of the environment, and much of what is blamed on these more ephemeral manifestations is a consequence of its unchanging existence.
  • We were struggling for position before we had skin, or hands, or lungs, or bones. There is little more natural than culture. Dominance hierarchies are older than trees.
  • The part of our brain that keeps track of our position in the dominance hierarchy is therefore exceptionally ancient and fundamental.17 It is a master control system, modulating our perceptions, values, emotions, thoughts and actions. It powerfully affects every aspect of our Being, conscious and unconscious alike.
  • The ancient part of your brain specialized for assessing dominance watches how you are treated by other people. On that evidence, it renders a determination of your value and assigns you a status. If you are judged by your peers as of little worth, the counter restricts serotonin availability. That makes you much more physically and psychologically reactive to any circumstance or event that might produce emotion, particularly if it is negative. You need that reactivity. Emergencies are common at the bottom, and you must be ready to survive. Unfortunately, that physical hyper-response, that constant alertness, burns up a lot of precious energy and physical resources.
  • It will leave you far more likely to live, or die, carelessly, for a rare opportunity at pleasure, when it manifests itself. The physical demands of emergency preparedness will wear you down in every way.21
  • If you have a high status, on the other hand, the counter’s cold, pre-reptilian mechanics assume that your niche is secure, productive
  • You can delay gratification, without forgoing it forever. You can afford to be a reliable and thoughtful citizen.
  • Sometimes, however, the counter mechanism can go wrong. Erratic habits of sleeping and eating can interfere with its function. Uncertainty can throw it for a loop. The body, with its various parts,
  • needs
  • to function like a well-rehearsed orchestra. Every system must play its role properly, and at exactly the right time, or noise and chaos ensue. It is for this reason that routine is so necessary. The acts of life we repeat every day need to be automatized. They must be turned into stable and reliable habits, so they lose their complexity and gain predictability and simplicity.
  • It is for such reasons that I always ask my clinical clients first about sleep. Do they wake up in the morning at approximately the time the typical person wakes up, and at the same time every day?
  • The next thing I ask about is breakfast. I counsel my clients to eat a fat and protein-heavy breakfast as soon as possible after they awaken (no simple carbohydrates, no sugars,
  • I have had many clients whose anxiety was reduced to subclinical levels merely because they started to sleep on a predictable schedule and eat breakfast.
  • Other bad habits can also interfere with the counter’s accuracy.
  • There are many systems of interaction between brain, body and social world that can get caught in positive feedback loops. Depressed people, for example, can start feeling useless and burdensome, as well as grief-stricken and pained. This makes them withdraw from contact with friends and family. Then the withdrawal makes them more lonesome and isolated, and more likely to feel useless and burdensome. Then they withdraw more. In this manner, depression spirals and amplifies.
  • If someone is badly hurt at some point in life—traumatized—the dominance counter can transform in a manner that makes additional hurt more rather than less likely. This often happens in the case of people, now adults, who were viciously bullied during childhood or adolescence. They become anxious and easily upset. They shield themselves with a defensive crouch, and avoid the direct eye contact interpretable as a dominance challenge.
  • With their capacity for aggression strait-jacketed within a too-narrow morality, those who are only or merely compassionate and self-sacrificing (and naïve and exploitable) cannot call forth the genuinely righteous and appropriately self-protective anger necessary to defend themselves. If you can bite, you generally don’t have to. When skillfully integrated, the ability to respond with aggression and violence decreases rather than increases the probability that actual aggression will become necessary.
  • Naive, harmless people usually guide their perceptions and actions with a few simple axioms: people are basically good; no one really wants to hurt anyone else; the threat (and, certainly, the use) of force, physical or otherwise, is wrong. These axioms collapse, or worse, in the presence of
  • individuals who are genuinely malevolent.27
  • I have had clients who were terrified into literally years of daily hysterical convulsions by the sheer look of malevolence on their attackers’ faces. Such individuals typically come from hyper-sheltered families, where nothing
  • terrible is allowed to exist, and everything is fairyland wonderful (or else).
  • When the wakening occurs—when once-naïve people recognize in themselves the seeds of evil and monstrosity, and see themselves as dangerous (at least potentially)— their fear decreases. They develop more self-respect. Then, perhaps, they begin to resist oppression. They see that they have the ability to withstand, because they are terrible too. They see they can and must stand up, because they begin to understand how genuinely monstrous they will become, otherwise,
  • There is very little difference between the capacity for mayhem and destruction, integrated, and strength of character. This is one of the most difficult lessons of life.
  • even if you came by your poor posture honestly—even if you were unpopular or bullied at home or in grade school28—it’s not necessarily appropriate now. Circumstances change. If you slump around, with the same bearing that characterizes a defeated lobster, people will assign you a lower status, and the old counter that you share with crustaceans, sitting at the very base of your brain, will assign you a low dominance number.
  • the other, far more optimistic lesson of Price’s law and the Pareto distribution: those who start to have will probably get more.
  • Some of these upwardly moving loops can occur in your own private, subjective space.
  • If you are asked to move the muscles one by one into a position that looks happy, you will report feeling happier. Emotion is partly bodily expression, and can be amplified (or dampened) by that expression.29
  • To stand up straight with your shoulders back is to accept the terrible responsibility of life, with eyes wide open.
  • It means deciding to voluntarily transform the chaos of potential into the realities of habitable order. It means adopting the burden of self-conscious vulnerability, and accepting the end of the unconscious paradise of childhood, where finitude and mortality are only dimly comprehended. It means willingly undertaking the sacrifices necessary to generate a productive and meaningful reality (it means acting to please God, in the ancient language).
  • So, attend carefully to your posture. Quit drooping and hunching around. Speak your mind. Put your desires forward, as if you had a right to them—at least the same right as others. Walk tall and gaze forthrightly ahead. Dare to be dangerous. Encourage the serotonin to flow plentifully through the neural pathways desperate for its calming influence.
  • Thus emboldened, you will embark on the voyage of your life, let your light shine, so to speak, on the heavenly hill, and pursue your rightful destiny. Then the meaning of your life may be sufficient to keep the corrupting influence of mortal despair at bay. Then you may be able to accept the terrible burden of the World, and find joy.
  • RULE 2   TREAT YOURSELF LIKE SOMEONE YOU ARE RESPONSIBLE FOR HELPING
  • People are better at filling and properly administering prescription medication to their pets than to themselves. That
  • It is difficult to conclude anything from this set of facts except that people appear to love their dogs, cats, ferrets and birds (and maybe even their lizards) more than themselves. How horrible is that? How much shame must exist, for something like that to be true? What could it be about people that makes them prefer their pets to themselves?
  • To understand Genesis 1, the Priestly story, with its insistence on speech as the fundamental creative force, it is first necessary to review a few fundamental, ancient assumptions (these are markedly different in type and intent from the assumptions of science, which are, historically speaking, quite novel).
  • those who existed during the distant time in which the foundational epics of our culture emerged were much more concerned with the actions that dictated survival (and with interpreting the world in a manner commensurate with that goal) than with anything approximating what we now understand as objective truth.
  • Before the dawn of the scientific worldview, reality was construed differently. Being was understood as a place of action, not a place of things.31 It was understood as something more akin to story or drama. That story or drama was lived, subjective experience, as it manifested itself moment to moment in the consciousness of every living person.
  • subjective pain. That’s something so real no argument can stand against it. Everyone acts as if their pain is real—ultimately, finally real. Pain matters, more than matter matters. It is for this reason, I believe, that so many of the world’s traditions regard the suffering attendant upon existence as the irreducible truth of Being.
  • In any case, that which we subjectively experience can be likened much more to a novel or a movie than to a scientific description of physical reality.
  • The Domain, Not of Matter, but of What Matters
  • the world of experience has primal constituents, as well. These are the necessary elements whose interactions define drama and fiction. One of these is chaos. Another is order. The third (as there are three) is the process that mediates between the two, which appears identical to what modern people call consciousness.
  • Chaos is the domain of ignorance itself. It’s unexplored territory. Chaos is what extends, eternally and without limit, beyond the boundaries of all states, all ideas, and all disciplines. It’s the foreigner, the stranger, the member of another gang, the rustle in the bushes in the night-time,
  • It is, in short, all those things and situations we neither know nor understand.
  • Chaos is also the formless potential from which the God of Genesis 1 called forth order using language at the beginning of time. It’s the same potential from which we, made in that Image, call forth the novel and ever-changing moments of our lives. And Chaos is freedom, dreadful freedom, too.
  • Order, by contrast, is explored territory. That’s the hundreds-of-millions-of-years-old hierarchy of place, position and authority. That’s the structure of society. It’s the structure provided by biology, too—particularly insofar as you are adapted, as you are, to the structure of society. Order is tribe, religion, hearth, home and country.
  • Order is the public façade we’re called upon to wear, the politeness of a gathering of civilized strangers, and the thin ice on which we all skate. Order is the place where the behavior of the world matches our expectations and our desires; the place where all things turn out the way we want them to.
  • But order is sometimes tyranny and stultification, as well, when the demand for certainty and uniformity and purity becomes too one-sided.
  • In order, we’re able to think about things in the long term. There, things work, and we’re stable, calm and competent. We seldom leave places we
  • understand—geographical or conceptual—for that reason, and we certainly do not like it when we are compelled to or when it happens accidentally.
  • When the same person betrays you, sells you out, you move from the daytime world of clarity and light to the dark underworld of chaos, confusion and despair. That’s the same move you make, and the same place you visit, when the company you work for starts to fail and your job is placed in doubt.
  • Before the Twin Towers fell—that was order. Chaos manifested itself afterward. Everyone felt it. The very air became uncertain. What exactly was it that fell? Wrong question. What exactly remained standing? That was the issue at hand.
  • Chaos is the deep ocean bottom to which Pinocchio voyaged to rescue his father from Monstro, whale and fire-breathing dragon. That journey into darkness and rescue is the most difficult thing a puppet must do, if he wants to be real; if he wants to extract himself from the temptations of deceit and acting and victimization and impulsive pleasure and totalitarian subjugation; if he wants to take his place as a genuine Being in the world.
  • Chaos is the new place and time that emerges when tragedy strikes suddenly, or malevolence reveals its paralyzing visage, even in the confines of your own home. Something unexpected or undesired can always make its appearance, when a plan is being laid out, regardless of how familiar the circumstances.
  • Our brains respond instantly when chaos appears, with simple, hyper-fast circuits maintained from the ancient days, when our ancestors dwelled in trees, and snakes struck in a flash.32 After that nigh-instantaneous, deeply reflexive bodily response comes the later-evolving, more complex but slower responses of emotions—and, after that, comes thinking, of the higher order, which can extend over seconds, minutes or years. All that response is instinctive, in some sense—but the faster the response, the more instinctive.
  • Things or objects are part of the objective world. They’re inanimate; spiritless. They’re dead. This is not true of chaos and order. Those are perceived, experienced and understood (to the degree that they are understood at all) as personalities—and that is just as true of the perceptions, experiences and understanding of modern people as their ancient forebears. It’s just that moderners don’t notice.
  • Perception of things as entities with personality also occurs before perception of things as things. This is particularly true of the action of others,34 living others, but we also see the non-living “objective world” as animated, with purpose and intent.
  • This is because of the operation of what psychologists have called “the hyperactive agency detector” within us.35 We evolved, over millennia, within intensely social circumstances. This means that the most significant elements of our environment of origin were personalities, not things, objects or situations.
  • The personalities we have evolved to perceive have been around, in predictable form, and in typical, hierarchical configurations, forever, for all intents and purposes. They have been…
  • the category of “parent” and/or “child” has been around for 200 million years. That’s longer than birds have existed. That’s longer than flowers have grown. It’s not a billion years, but it’s still a very long time. It’s plenty long enough for male and female and parent and child to serve as vital and fundamental parts of the environment to which we have adapted. This means that male and female and parent and child are…
  • Our brains are deeply social. Other creatures (particularly, other humans) were crucially important to us as we lived, mated and evolved. Those creatures were…
  • From a Darwinian perspective, nature—reality itself; the environment, itself—is what selects. The environment cannot be defined in any more fundamental manner. It is not mere inert matter. Reality itself is whatever we contend with when we are striving to survive and reproduce. A…
  • as our brain capacity increased and we developed curiosity to spare, we became increasingly aware of and curious about the nature of the world—what we eventually conceptualized as the objective…
  • “outside” is not merely unexplored physical territory. Outside is outside of what we currently understand—and understanding is dealing with and coping with…
  • when we first began to perceive the unknown, chaotic, non-animal world, we used categories that had originally evolved to represent the pre-human animal social world. Our minds are far older than mere…
  • Our most…
  • category—as old, in some sense, as the sexual act itself—appears to be that of sex, male and female. We appear to have taken that primordial knowledge of structured, creative opposition and…
  • Order, the known, appears symbolically associated with masculinity (as illustrated in the aforementioned yang of the Taoist yin-yang symbol). This is perhaps because the primary…
  • Chaos—the unknown—is symbolically associated with the feminine. This is partly because all the things we have come to know were born, originally, of the unknown, just as all beings we encounter were born of mothers. Chaos is mater, origin, source, mother; materia, the substance from which all things are made.
  • In its positive guise, chaos is possibility itself, the source of ideas, the mysterious realm of gestation and birth. As a negative force, it’s the impenetrable darkness of a cave and the accident by the side of the road.
  • Chaos, the eternal feminine, is also the crushing force of sexual selection.
  • Most men do not meet female human standards. It is for this reason that women on dating sites rate 85 percent of men as below average in attractiveness.40
  • Women’s proclivity to say no, more than any other force, has shaped our evolution into the creative, industrious, upright, large-brained (competitive, aggressive, domineering) creatures that we are.42 It is Nature as Woman who says, “Well, bucko, you’re good enough for a friend, but my experience of you so far has not indicated the suitability of your genetic material for continued propagation.”
  • Many things begin to fall into place when you begin to consciously understand the world in this manner. It’s as if the knowledge of your body and soul falls into alignment with the knowledge of your intellect.
  • And there’s more: such knowledge is proscriptive, as well as descriptive. This is the kind of knowing what that helps you know how. This is the kind of is from which you can derive an ought. The Taoist juxtaposition of yin and yang, for example, doesn’t simply portray chaos and order as the fundamental elements of Being—it also tells you how to act.
  • The Way, the Taoist path of life, is represented by (or exists on) the border between the twin serpents. The Way is the path of proper Being. It’s the same Way as that referred to by Christ in John 14:6: I am the way, and the truth and the life. The same idea is expressed in Matthew 7:14: Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.
  • We eternally inhabit order, surrounded by chaos. We eternally occupy known territory, surrounded by the unknown. We experience meaningful engagement when we mediate appropriately between them. We are adapted, in the deepest Darwinian sense, not to the world of objects, but to the meta-realities of order and chaos, yang and yin. Chaos and order make up the eternal, transcendent environment of the living.
  • To straddle that fundamental duality is to be balanced: to have one foot firmly planted in order and security, and the other in chaos, possibility, growth and adventure.
  • Chaos and order are fundamental elements because every lived situation (even every conceivable lived situation) is made up of both.
  • you need to place one foot in what you have mastered and understood and the other in what you are currently exploring and mastering. Then you have positioned yourself where the terror of existence is under control and you are secure, but where you are also alert and engaged. That is where there is something new to master and some way that you can be improved. That is where meaning is to be found.
  • The serpent in Eden therefore means the same thing as the black dot in the yin side of the Taoist yin/yang symbol of totality—that is, the possibility of the unknown and revolutionary suddenly manifesting itself where everything appears calm.
  • The outside, chaos, always sneaks into the inside, because nothing can be completely walled off from the rest of reality. So even the ultimate in safe spaces inevitably harbours a snake.
  • We have seen the enemy, after all, and he is us. The snake inhabits each of our souls.
  • The worst of all possible snakes is the eternal human proclivity for evil. The worst of all possible snakes is psychological, spiritual, personal, internal. No walls, however tall, will keep that out. Even if the fortress were thick enough, in principle, to keep everything bad whatsoever outside, it would immediately appear again within.
  • I have learned that these old stories contain nothing superfluous. Anything accidental—anything that does not serve the plot—has long been forgotten in the telling. As the Russian playwright Anton Chekhov advised, “If there is a rifle hanging on the wall in act one, it must be fired in the next act. Otherwise it has no
  • business being there.”50
  • Eve immediately shares the fruit with Adam. That makes him self-conscious. Little has changed. Women have been making men self-conscious since the beginning of time. They do this primarily by rejecting them—but they also do it by shaming them, if men do not take responsibility. Since women bear the primary burden of reproduction, it’s no wonder. It is very hard to see how it could be otherwise. But the capacity of women to shame men and render them self-conscious is still a primal force of nature.
  • What does it mean to know yourself naked
  • Naked means vulnerable and easily damaged. Naked means subject to judgment for beauty and health. Naked means unprotected and unarmed in the jungle of nature and man. This is why Adam and Eve became ashamed, immediately after their eyes were opened. They could see—and what they first saw was themselves.
  • In their vulnerability, now fully realized, they felt unworthy to stand before God.
  • Beauty shames the ugly. Strength shames the weak. Death shames the living—and the Ideal shames us all.
  • He tells the woman that she will now bring forth children in sorrow, and desire an unworthy, sometimes resentful man, who will in consequence lord her biological fate over her, permanently. What might this mean? It could just mean that God is a patriarchal tyrant, as politically motivated interpretations of the ancient story insist. I think it’s merely descriptive.
  • women pay a high price for pregnancy and child-rearing, particularly in the early stages, and that one of the inevitable consequences is increased dependence upon the sometimes unreliable and always problematic good graces of men.
  • then God banishes the first man and the first woman from Paradise, out of infancy, out of the unconscious animal world, into the horrors of history itself. And then He puts cherubim and a flaming sword at the gate of Eden, just to stop them from eating the Fruit of the Tree of Life.
  • Perhaps Heaven is something you must build, and immortality something you must earn.
  • so we return to our original query: Why would someone buy prescription medication for his dog, and then so carefully administer it, when he would not do the same for himself?
  • Why should anyone take care of anything as naked, ugly, ashamed, frightened, worthless, cowardly, resentful, defensive and accusatory as a descendant of Adam? Even if that thing, that being, is himself?
  • We know how we are naked, and how that nakedness can be exploited—and that means we know how others are naked, and how they can be exploited. We can terrify other people, consciously. We can hurt and humiliate them for faults we understand only too well. We can torture them—literally—slowly, artfully and terribly. That’s far more than predation. That’s a qualitative shift in understanding. That’s a cataclysm as large as the development of self-consciousness itself. That’s the entry of the knowledge of Good and Evil into the world.
  • Only man could conceive of the rack, the iron maiden and the thumbscrew. Only man will inflict suffering for the sake of suffering. That is the best definition of evil I have been able to formulate.
  • with this realization we have well-nigh full legitimization of the idea, very unpopular in modern intellectual circles, of Original Sin.
  • Human beings have a great capacity for wrongdoing. It’s an attribute that is unique in the world of life. We can and do make things worse, voluntarily, with full knowledge of what we are doing (as well as accidentally, and carelessly, and in a manner that is willfully blind). Given that terrible capacity, that proclivity for malevolent actions, is it any wonder we have a hard time taking care of ourselves, or others—or even that we doubt the value of the entire human enterprise?
  • The juxtaposition of Genesis 1 with Genesis 2 & 3 (the latter two chapters outlining the fall of man, describing why our lot is so tragedy-ridden and ethically torturous) produces a narrative sequence almost unbearable in its profundity. The moral of Genesis 1 is that Being brought into existence through true speech is Good.
  • The original Man and Woman, existing in unbroken unity with their Creator, did not appear conscious (and certainly not self-conscious). Their eyes were not open. But, in their perfection, they were also less, not more, than their post-Fall counterparts. Their goodness was something bestowed, rather than deserved or earned.
  • Maybe, even in some cosmic sense (assuming that consciousness itself is a phenomenon of cosmic significance), free choice matters.
  • here’s a proposition: perhaps it is not simply the emergence of self-consciousness and the rise of our moral knowledge of Death and the Fall that besets us and makes us doubt our own worth. Perhaps it is instead our unwillingness—reflected in Adam’s shamed hiding—to walk with God, despite our fragility and propensity for evil.
  • The entire Bible is structured so that everything after the Fall—the history of Israel, the prophets, the coming of Christ—is presented as a remedy for that Fall, a way out of evil. The beginning of conscious history, the rise of the state and all its pathologies of pride and rigidity, the emergence of great moral figures who try to set things right, culminating in the Messiah Himself—that is all part of humanity’s attempt, God willing, to set itself right. And what would that mean?
  • And this is an amazing thing: the answer is already implicit in Genesis 1: to embody the Image of God—to speak out of chaos the Being that is Good—but to do so consciously, of our own free choice.
  • Back is the way forward—as T. S. Eliot so rightly insisted
  • We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.
  • If we wish to take care of ourselves properly, we would have to respect ourselves—but we don’t, because we are—not least in our own eyes—fallen creatures.
  • If we lived in Truth; if we spoke the Truth—then we could walk with God once again, and respect ourselves, and others, and the world. Then we might treat ourselves like people we cared for.
  • We might strive to set the world straight. We might orient it toward Heaven, where we would want people we cared for to dwell, instead of Hell, where our resentment and hatred would eternally sentence everyone.
  • Then, the primary moral issue confronting society was control of violent, impulsive selfishness and the mindless greed and brutality that accompanies it.
  • It is easy to believe that people are arrogant, and egotistical, and always looking out for themselves. The cynicism that makes that opinion a universal truism is widespread and fashionable.
  • But such an orientation to the world is not at all characteristic of many people. They have the opposite problem: they shoulder intolerable burdens of self-disgust, self-contempt, shame and self-consciousness. Thus, instead of narcissistically inflating their own importance, they don’t value themselves at all, and they don’t take care of themselves with attention and skill.
  • Christ’s archetypal death exists as an example of how to accept finitude, betrayal and tyranny heroically—how to walk with God despite the tragedy of self-conscious knowledge—and not as a directive to victimize ourselves in the service of others.
  • To sacrifice ourselves to God (to the highest good, if you like) does not mean to suffer silently and willingly when some person or organization demands more from us, consistently, than is offered in return. That means we are supporting tyranny, and allowing ourselves to be treated like slaves.
  • I learned two very important lessons from Carl Jung, the famous Swiss depth psychologist, about “doing unto others as you would have them do unto you” or “loving your neighbour as yourself.”
  • The first lesson was that neither of these statements has anything to do with being nice. The second was that both are equations, rather than injunctions.
  • If I am someone’s friend, family member, or lover, then I am morally obliged to bargain as hard on my own behalf as they are on theirs.
  • there is little difference between standing up and speaking for yourself, when you are being bullied or otherwise tormented and enslaved, and standing up and speaking for someone else.
  • you do not simply belong to yourself. You are not simply your own possession to torture and mistreat. This is partly because your Being is inexorably tied up with that of others, and your mistreatment of yourself can have catastrophic consequences for others.
  • metaphorically speaking, there is also this: you have a spark of the divine in you, which belongs not to you, but to God. We are, after all—according to Genesis—made in His image.
  • We can make order from chaos—and vice versa—in our way, with our words. So, we may not exactly be God, but we’re not exactly nothing, either.
  • In my own periods of darkness, in the underworld of the soul, I find myself frequently overcome and amazed by the ability of people to befriend each other, to love their intimate partners and parents and children, and to do what they must do to keep the machinery of the world running.
  • It is this sympathy that should be the proper medicament for self-conscious self-contempt, which has its justification, but is only half the full and proper story. Hatred for self and mankind must be balanced with gratefulness for tradition and the state and astonishment at what normal, everyday people accomplish
  • You have some vital role to play in the unfolding destiny of the world. You are, therefore, morally obliged to take care of yourself.
  • To treat yourself as if you were someone you are responsible for helping is, instead, to consider what would be truly good for you. This is not “what you want.” It is also not “what would make you happy.”
  • You must help a child become a virtuous, responsible, awake being, capable of full reciprocity—able to take care of himself and others, and to thrive while doing so. Why would you think it acceptable to do anything less for yourself?
  • You need to know who you are, so that you understand your armament and bolster yourself in respect to your limitations. You need to know where you are going, so that you can limit the extent of chaos in your life, restructure order, and bring the divine force of Hope to bear on the world.
  • You need to determine how to act toward yourself so that you are most likely to become and to stay a good person.
  • Don’t underestimate the power of vision and direction. These are irresistible forces, able to transform what might appear to be unconquerable obstacles into traversable pathways and expanding opportunities.
  • Once having understood Hell, researched it, so to speak—particularly your
  • own individual Hell—you could decide against going there or creating that.
  • You could, in fact, devote your life to this. That would give you a Meaning, with a capital M. That would justify your miserable existence.
  • That would atone for your sinful nature, and replace your shame and self-consciousness with the natural pride and forthright confidence of someone who has learned once again to walk with God in the Garden.
  • RULE 3   MAKE FRIENDS WITH PEOPLE WHO WANT THE BEST FOR YOU
  • It would be more romantic, I suppose, to suggest that we would have all jumped at the chance for something more productive, bored out of our skulls as we were. But it’s not true. We were all too prematurely cynical and world-weary and leery of responsibility to stick to the debating clubs and Air Cadets and school sports that the adults around us tried to organize. Doing anything wasn’t cool.
  • When you move, everything is up in the air, at least for a while. It’s stressful, but in the chaos there are new possibilities. People, including you, can’t hem you in with their old notions. You get shaken out of your ruts. You can make new, better ruts, with people aiming at better things. I thought this was just a natural development. I thought that every person who moved would have—and want—the same phoenix-like experience.
  • What was it that made Chris and Carl and Ed unable (or, worse, perhaps, unwilling) to move or to change their friendships and improve the circumstances of their lives? Was it inevitable—a consequence of their own limitations, nascent illnesses and traumas of the past?
  • Why did he—like his cousin, like my other friends—continually choose people who, and places that, were not good for him?
  • perhaps, they don’t want the trouble of better. Freud called this a “repetition compulsion.” He thought of it as an unconscious drive to repeat the horrors of the past
  • People create their worlds with the tools they have directly at hand. Faulty tools produce faulty results. Repeated use of the same faulty tools produces the same faulty results.
  • It is in this manner that those who fail to learn from the past doom themselves to repeat it. It’s partly fate. It’s partly inability. It’s partly…unwillingness to learn? Refusal to learn? Motivated refusal to learn?
  • People choose friends who aren’t good for them for other reasons, too. Sometimes it’s because they want to rescue someone.
  • it is not easy to distinguish between someone truly wanting and needing help and someone who is merely exploiting a willing helper. The distinction is difficult even for the person who is wanting and needing and possibly exploiting.
  • When it’s not just naïveté, the attempt to rescue someone is often fuelled by vanity and narcissism.
  • But Christ himself, you might object, befriended tax-collectors and prostitutes. How dare I cast aspersions on the motives of those who are trying to help? But Christ was the archetypal perfect man. And you’re you.
  • How do you know that your attempts to pull someone up won’t instead bring them—or you—further down?
  • The same thing happens when well-meaning counsellors place a delinquent teen among comparatively civilized peers. The delinquency spreads, not the stability.65 Down is a lot easier than up.
  • maybe you’re saving someone because you want to convince yourself that the strength of your character is more than just a side effect of your luck and birthplace. Or maybe it’s because it’s easier to look virtuous when standing alongside someone utterly irresponsible.
  • Or maybe you have no plan, genuine or otherwise, to rescue anybody. You’re associating with people who are bad for you not because it’s better for anyone, but because it’s easier.
  • You know it. Your friends know it. You’re all bound by an implicit contract—one aimed at nihilism, and failure, and suffering of the stupidest sort.
  • Before you help someone, you should find out why that person is in trouble. You shouldn’t merely assume that he or she is a noble victim of unjust circumstances and exploitation. It’s the most unlikely explanation, not the most probable.
  • Besides, if you buy the story that everything terrible just happened on its own, with no personal responsibility on the part of the victim, you deny that person all agency in the past (and, by implication, in the present and future, as well).
  • It is far more likely that a given individual has just decided to reject the path upward, because of its difficulty. Perhaps that should even be your default assumption, when faced with such a situation.
  • failure is easy to understand. No explanation for its existence is required. In the same manner, fear, hatred, addiction, promiscuity, betrayal and deception require no explanation. It’s not the existence of vice, or the indulgence in it, that requires explanation. Vice is easy.
  • Failure is easy, too. It’s easier not to shoulder a burden. It’s easier not to think, and not to do, and not to care. It’s easier to put off until tomorrow what needs to be done today,
  • Success: that’s the mystery. Virtue: that’s what’s inexplicable. To fail, you merely have to cultivate a few bad habits. You just have to bide your time. And once someone has spent enough time cultivating bad habits and biding their time, they are much diminished.
  • I am not saying that there is no hope of redemption. But it is much harder to extract someone
  • from a chasm than to lift him from a ditch. And some chasms are very deep. And there’s not much left of the body at the bottom.
  • Carl Rogers, the famous humanistic psychologist, believed it was impossible to start a therapeutic relationship if the person seeking help did not want to improve.67 Rogers believed it was impossible to convince someone to change for the better. The
  • none of this is a justification for abandoning those in real need to pursue your narrow, blind ambition, in case it has to be said.
  • Here’s something to consider: If you have a friend whose friendship you wouldn’t recommend to your sister, or your father, or your son, why would you have such a friend for yourself?
  • You are not morally obliged to support someone who is making the world a worse place. Quite the opposite. You should choose people who want things to be better, not worse. It’s a good thing, not a selfish thing, to choose people who are good for you.
  • It is for this reason that every good example is a fateful challenge, and every hero, a judge. Michelangelo’s great perfect marble David cries out to its observer: “You could be more than you are.”
  • Don’t think that it is easier to surround yourself with good healthy people than with bad unhealthy people. It’s not. A good, healthy person is an ideal. It requires strength and daring to stand up near such a person.
  • RULE 4   COMPARE YOURSELF TO WHO YOU WERE YESTERDAY, NOT TO WHO SOMEONE ELSE IS TODAY
  • IT WAS EASIER FOR PEOPLE to be good at something when more of us lived in small, rural communities. Someone could be homecoming queen. Someone else could be spelling-bee champ, math whiz or basketball star. There were only one or two mechanics and a couple of teachers. In each of their domains, these local heroes had the opportunity to enjoy the serotonin-fuelled confidence of the victor.
  • Our hierarchies of accomplishment are now dizzyingly vertical.
  • No matter how good you are at something, or how you rank your accomplishments, there is someone out there who makes you look incompetent.
  • We are not equal in ability or outcome, and never will be. A very small number of people produce very much of everything.
  • People are unhappy at the bottom. They get sick there, and remain unknown and unloved. They waste their lives there. They die there. In consequence, the self-denigrating voice in the minds of people weaves a devastating tale. Life is a zero-sum game. Worthlessness is the default condition.
  • It is for such reasons that a whole generation of social psychologists recommended “positive illusions” as the only reliable route to mental health.69 Their credo? Let a lie be your umbrella. A more dismal, wretched, pessimistic philosophy can hardly be imagined:
  • Here is an alternative approach (and one that requires no illusions). If the cards are always stacked against you, perhaps the game you are playing is somehow rigged (perhaps by you, unbeknownst to yourself). If the internal voice makes you doubt the value of your endeavours—or your life, or life itself—perhaps you should stop listening.
  • There will always be people better than you—that’s a cliché of nihilism, like the phrase, In a million years, who’s going to know the difference? The proper response to that statement is not, Well, then, everything is meaningless. It’s, Any idiot can choose a frame of time within which nothing matters.
  • Standards of better or worse are not illusory or unnecessary. If you hadn’t decided that what you are doing right now was better than the alternatives, you wouldn’t be doing it. The idea of a value-free choice is a contradiction in terms. Value judgments are a precondition for action.
  • Furthermore, every activity, once chosen, comes with its own internal standards of accomplishment. If something can be done at all, it can be done better or worse. To do anything at all is therefore to play a game with a defined and valued end, which can always be reached more or less efficiently and elegantly.
  • We might start by considering the all-too-black-and-white words themselves: “success” or “failure.” You are either a success, a comprehensive, singular, over-all good thing, or its opposite, a failure, a comprehensive, singular, irredeemably bad thing.
  • There are vital degrees and gradations of value obliterated by this binary system, and the consequences are not good.
  • there is not just one game at which to succeed or fail. There are many games and, more specifically, many good games—
  • if changing games does not work, you can invent a new one. I
  • and athletic pursuits. You might consider judging your success across all the games you play.
  • When we are very young we are neither individual nor informed. We have not had the time nor gained the wisdom to develop our own standards. In consequence, we must compare ourselves to others, because standards are necessary.
  • As we mature we become, by contrast, increasingly individual and unique. The conditions of our lives become more and more personal and less and less comparable with those of others. Symbolically speaking, this means we must leave the house ruled by our father, and confront the chaos of our individual Being.
  • We must then rediscover the values of our culture—veiled from us by our ignorance, hidden in the dusty treasure-trove of the past—rescue them, and integrate them into our own lives. This is what gives existence its full and necessary meaning.
  • What is it that you actually love? What is it that you genuinely want? Before you can articulate your own standards of value, you must see yourself as a stranger—and then you must get to know yourself. What
  • Dare to be truthful. Dare to articulate yourself, and express (or at least become aware of) what would really justify your life.
  • Consult your resentment. It’s a revelatory emotion, for all its pathology. It’s part of an evil triad: arrogance, deceit, and resentment. Nothing causes more harm than this underworld Trinity. But resentment always means one of two things. Either the resentful person is immature, in which case he or she should shut up, quit whining, and get on with it, or there is tyranny afoot—in which case the person subjugated has a moral obligation to speak up.
  • Be cautious when you’re comparing yourself to others. You’re a singular being, once you’re an adult. You have your own particular, specific problems—financial, intimate, psychological, and otherwise.
  • Those are embedded in the unique broader context of your existence. Your career or job works for you in a personal manner, or it does not, and it does so in a unique interplay with the other specifics of your life.
  • We must see, but to see, we must aim, so we are always aiming. Our minds are built on the hunting-and-gathering platforms of our bodies. To hunt is to specify a target, track it, and throw at it.
  • We live within a framework that defines the present as eternally lacking and the future as eternally better. If we did not see things this way, we would not act at all. We wouldn’t even be able to see, because to see we must focus, and to focus we must pick one thing above all else on which to focus.
  • The disadvantage to all this foresight and creativity is chronic unease and discomfort. Because we always contrast what is with what could be, we have to aim at what could be.
  • The present is eternally flawed. But where you start might not be as important as the direction you are heading. Perhaps happiness is always to be found in the journey uphill, and not in the fleeting sense of satisfaction awaiting at the next peak.
  • Called upon properly, the internal critic will suggest something to set in order, which you could set in order, which you would set in order—voluntarily, without resentment, even with pleasure.
  • “Excuse me,” you might say to yourself, without irony or sarcasm. “I’m trying to reduce some of the unnecessary suffering around here. I could use some help.” Keep the derision at bay. “I’m wondering if there is anything that you would be willing to do? I’d be very grateful for your service.” Ask honestly and with humility. That’s no simple matter.
nrashkind

NYPD coronavirus deaths: A 3rd NYPD member dies after hundreds of officers test positiv... - 0 views

www.cnn.com/...index.html

shared by nrashkind on 29 Mar 20 - No Cached
  • New York City police lost its first detective to Covid-19, marking the third NYPD death to the disease that has afflicted the department.
  • Detective Cedric Dixon, a 23-year veteran, worked in the 32nd Precinct in Harlem, NYPD Commissioner Dermot Shea said.
  • Two other members of the department have died from coronavirus, which has infected at least 512 NYPD employees.
  • ...5 more annotations...
  • Dennis C. Dickson, a custodian who worked at police headquarters, died Thursday, Shea said.
  • On Friday, 4,122 NYPD employees were out sick, a senior NYPD official said. That's about 11% of the department's workforce.
  • At least 442 uniformed NYPD members and 70 civilian members have tested positive for coronavirus, the official said.
  • Officers have been looking for groups of people congregating and telling them to disperse.
  • "Men and women of the New York Police Department are stepping up. They're here for you. They're out there putting themselves -- uniform and civilian -- at risk to keep you safe," Shea added.
Javier E

How Will the Coronavirus End? - The Atlantic - 0 views

www.theatlantic.com/...608719

strategies effects pandemic culture politics history crisis

shared by Javier E on 25 Mar 20 - No Cached
  • A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk.
  • We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.
  • “No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,”
  • ...56 more annotations...
  • To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
  • That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,”
  • The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases.
  • None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country.
  • With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency.
  • That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition
  • Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear.
  • Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,”
  • “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
  • it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April
  • A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.
  • The first and most important is to rapidly produce masks, gloves, and other personal protective equipment
  • it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems.
  • This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests.
  • These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing.
  • There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission.
  • Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.
  • Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps.
  • when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need
  • Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.
  • A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care.
  • There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.
  • If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”
  • there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
  • The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
  • The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting
  • The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans,
  • The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
  • there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch.
  • The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
  • The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
  • No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.
  • as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.
  • First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect.
  • Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer.
  • scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
  • Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs.
  • “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”
  • The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,”
  • After infections begin ebbing, a secondary pandemic of mental-health problems will follow.
  • But “there is also the potential for a much better world after we get through this trauma,”
  • Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be.
  • Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements.
  • Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.
  • Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,”
  • Years of isolationist rhetoric had consequences too.
  • “People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”
  • Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.
  • After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies.
  • The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions.
  • “The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”
  • One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero.
  • One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation
  • The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.
  • In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.
  • On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.
Javier E

Experts fear coronavirus will become a pandemic - The Washington Post - 0 views

www.washingtonpost.com/...a-9e47-59804be1dcfb_story.html

pandemic epidemic virus china

shared by Javier E on 22 Feb 20 - No Cached
  • There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously. The novel coronavirus that causes the disease named covid-19 is on the verge of that third, globe-shaking stage
  • Amid an alarming surge in cases with no clear link to China, infectious disease experts believe the flulike illness may soon be impossible to contain
  • the language coming from the organization’s Geneva headquarters has turned more ominous in recent days as the challenge of containment grows more daunting.
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  • “The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said on Friday. “We need to act quickly before it closes completely.”
  • At the beginning of any disease outbreak, public health experts painstakingly trace the contacts of every person who becomes sick. The experts build a family tree of possible illness, with branches that include anyone who might have shaken hands with, or been sneezed on by an infected person
  • with confirmed infections approaching 80,000 people, contact tracing on a case-by-case basis could soon be impractical.
  • “What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”
  • The word ‘pandemic’ invokes fear, but it describes how widespread an outbreak may be, not its deadliness.
  • “I think we should assume that this virus is very soon going to be spreading in communities here, if it isn’t already, and despite aggressive actions, we should be putting more efforts to mitigate impacts,”
  • The virus would be easier to contain if people who are contagious were obviously so, as was the case with SARS, which started an outbreak that burned itself out in 2003. But the new virus appears to spread among people who in some cases are not noticeably sick.
  • among the more than 600 passengers from the Diamond Princess cruise ship who have tested positive, about half had no obvious symptoms.
  • If the coronavirus becomes a true pandemic, a large proportion of the human population — a third, a half, two-thirds even — could become infected
  • Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick
  • The novel coronavirus may be particularly suited for stealth community transmission since its symptoms can be indistinguishable from those of a cold or flu, and testing capabilities are still being ramped up.
  • Experts estimate it takes about a week for the number of people infected in a given community to double. Based on that, it would likely take several weeks for a new infection cluster to be picked up by a local health department
  • By mid-March, he estimated, officials should know if there is community transmission and a true pandemic.
  • “I want to be clear that we are not seeing community spread here in the United States yet,” she said Friday. “But it’s very possible, even likely, that may eventually happen.”
  • “If a large number of countries are unsuccessful in preventing sustained multi-generation transmissions, then we could witness the next pandemic.”
  • A pandemic is a line in the sand, and every expert has a slightly different definition for when an outbreak crosses it. Generally, it means that there are self-sustaining lines of infection in multiple countries and continents — where the family tree of possible illness begins to encompass the entire population.
  • I think we’re not in as dire straits as we might be, and that’s because everyone is pulling together internationally.”
  • Public health experts are devising strategies on how to conserve N95 respirators, specialized masks that are in a limited supply amid surging demand.
  • “Extrapolating from some of the numbers we’ve seen on the impact to the health care system in China, it means we’ll have to surge fast.”
brickol

Coronavirus heroes: the doctors carrying an immense burden to care for us | World news ... - 0 views

www.theguardian.com/...s-coronavirus-pandemic-stories

us COVID-19 crisis

shared by brickol on 25 Mar 20 - No Cached
  • Doctors across North America are bracing for a surge of critically ill patients, knowing that the more patients they see, the greater their risk of becoming infected with Covid-19.Their commitment to work comes with a heavy psychological burden that their many hours in hospitals could harm their families.
  • Five weeks ago, Dr Erin Bruce, an anesthesiologist, and her husband, Dr Michael Szava-Kovats, had their first child, a daughter. He agonizes over the thought of exposing his young daughter and wife to infection. He accepts that he may get coronavirus. The risks to his family are outside his comfort zone, he says.Last weekend, he moved into an empty condo owned by friends.
  • He worked five days in a row after his move. On his first day off, the sadness of their separation hit him. He feels a combination of guilt that he’s not there to help with a newborn and heartache that he missing out on the first months of his daughter’s life. He longs to be with his wife during an event that’s changing their lives and history.
  • ...6 more annotations...
  • Drs Bonnie Larson and Alan Chu met at medical school and bonded over their shared interest in global health. They’re married with two children.Larson is a frontline physician working with the city’s homeless. She’s working to keep Covid-19 out of local shelters. Chu is leading online training for residents about coronavirus and airway management, but is readying for a crush of sick patients to arrive in the ICU.They wonder what it will be like for their kids, ages eight and 10, to go through the pandemic without at least one parent home all the time.
  • Dr Zara Mathews is 34 weeks pregnant and mother of a toddler. She plans to work for another week and half, keeping to the schedule that she set out months ago.Her home and work lives have never felt so intertwined, she says. Now there’s this question of whether doing what I need to at work is potentially going to put my family at risk “Normally, when I’m at work, my patients are my priority and when I’m at home, my family is my priority,” she says. “But now there’s this question of whether doing what I need to at work is potentially going to put my family at risk.”
  • Dr Mathews says her parents and husband worry about her, but she is more concerned for her kids and her patients. Most physicians feel the same, she said. Everyone has concerns about risks that they bring to our family but the primary focus is doing everything they can for our patients.
  • Dr Christine Carter Toevs, who has worked in medicine for more than 30 years, says she always worries about bringing home illnesses that could affect her husband. He has respiratory issues and diabetes. When he gets a cold, it lasts for ages.
  • She is concerned about what will happen if high numbers of staff get sick, or she gets sick. Even if one trauma surgeon becomes unable to work in a community of this size, it affects the hospital’s ability to provide care.
  • Everybody has a responsibility in this pandemic, she says. Non-essential workers have a social obligation to stay home to minimize the risk for everyone. Her responsibility is to care for patients. “I get up every day and make a commitment to take care of people. To sit at home and live in fear is a terrible way to live life.”
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