If you watch the news, the country seems deeply divided about the coronavirus. But polls have shown an uncommon unity among Americans. On this episode of the podcast Social Distance, the staff writer James Fallows joins to share some historical perspective and answer the question he’s found himself grappling with across his decades-long career: Is America going to make it? Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. Katherine Wells: Is this the worst time ever? James Fallows: The unemployment rates are going to be the highest that almost any living American has ever seen. I say almost because there are people who were around, of course, in the depths of the depression. When I was a little kid, just before I went to kindergarten, polio was still an active fear. I remember the summers when we couldn’t go to the pool and couldn’t go out and picnic, because of the fear. This is the first time since then where we’ve had such a widespread public-health fear. I would say that right now is not even the worst time overall for the U.S. in even my lifetime; 1968, I think, still has 2020 beat as the worst year in modern American history, with Martin Luther King Jr. being killed and Bobby Kennedy being killed and a president stepping down and all the tumult of Vietnam too. That was a worse year overall than this has been so far, but it’s only late May. Wells: I don’t mean to be cheeky with the question, because, of course, I know that we’ve been through horrific times in this country, but it feels incredibly critical right now. James Hamblin: People keep using the word unprecedented. And yet when I hear you talking about unprecedented times, I take it seriously. Fallows: I’ll give you my voice-of-history overview here. I did a piece for The Atlantic a couple of years ago where I said that I realized that every article or book I’d ever written had really been about just one question: Is America going to make it? The story of the U.S. is trouble and the response to trouble. But one thing that’s particular to this moment is that national leadership is the worst in my lifetime, and arguably the worst in our history. We’ve never had a head of federal government as unmatched to the duties of that role as we currently do. The question is how all the other sources of resilience and health in the country balance that singular but very important point of dysfunction and the party that supports him too. Wells: What does good leadership during a crisis look like? Fallows: In my sordid youth, I worked as a speechwriter in the Carter White House, and what’s interesting beyond party and beyond era is that in a time of crisis, every effective leadership message boils down to a very simple matrix. If you look at FDR’s Pearl Harbor speech or if you look at George W. Bush after 9/11 or Reagan after the Challenger explosion, they always do three things. First, they express empathy and compassion. We recognize this has been hard and terrible. We recognize you are scared. We recognize that people have lost loved ones and lost livelihoods. I recognize, as the sort of head of the national family, recognize how terrible this time is. The second thing they do is express long-term confidence. We’ve been through hard times before. This is hard. But we know how to persevere. The third thing they do is provide a plan. Tomorrow, we’re going to do this. Next week, we’re going to do that. A year from now, we’re going to be in this position. That is just the three-part summary of what any leader says in a time when that leader’s people are distressed, injured or wounded, afraid, et cetera. And we have not heard a single message of that sort from the White House. I think there’s kind of phantom-limb pain. People recognize they should be hearing it, and they are hearing it from mayors and they are hearing it from governors and they are hearing it in their communities. And that’s the contrast. Wells: Phantom-limb pain is an interesting way to describe that. I feel like I have totally felt that. Hamblin: I like that comparison as well. If governance has become so dysfunctional, how can we as a country unite against the virus? It feels like, initially, nearly everyone was unified around the need to shut down and take extreme measures to prevent this, but now it’s growing into a wedge issue. How do we keep that from getting worse? Fallows: Part of the responsibility is for all of us in the media to keep things proportional. There is a small group of people who think the disease is a hoax and won’t wear face masks, but it’s a small group. It’s a cinematic group and a dramatic group, but it shouldn’t be all over cable news all the time. Wells: I have often been totally locked up at home consuming national news sources, and it’s hard not to feel completely disempowered by it. You must have a method for somehow putting into context the things you hear in the national news. Fallows: I hadn’t thought about this until you all brought it up, but I’m realizing that we have a whole country right now of people whose firsthand experience is being attenuated. Most of us are seeing the world through the media or through Zoom calls, and there’s only so many Zoom calls you can stand. It’s a nationwide, maybe perilous experiment of what it’s like when most people can’t see the world except out their own windows. When I’m feeling overwhelmed, I find myself turning to historical times of trouble. The U.S. is in most ways a success story, but it’s a success story in constant turmoil, constant injustice, and constant trauma. I find it weirdly reassuring to read what people have been through before and how their struggles fit into our struggles too. Hamblin: We did an episode about the World Health Organization, which emerged in the late 1940s in the aftermath of unprecedented turmoil. What can we look forward to coming out of this moment, if indeed our history is as cyclical as you’ve suggested? Fallows: We have all the problems now that we did in the original Gilded Age, from grotesque inequality to dislocation to even pandemic. All of these fabulous reform movements that blossomed out of that, from the women’s rights-movements, the good-government movement to the environmental movement. That is the hope: that minus two world wars and a world depression, you could begin to build a better world. You can imagine that a year or two from now, people would be thinking, Yes, we’ve come through this horrible time. But let’s see what we can do. I worked on the Jimmy Carter campaign back in the 1970s, after the only president ever to resign, after the Vietnam War, after lots of economic shocks. But there was, for a while, a sense of possibility. The early Kennedy years had that same sense of promise and possibility. The question is converting that potential into reality. Wells: You said at the beginning of our conversation that all of your work has been about whether America will survive. What do we have to do to ensure that the answer is yes? Fallows: There’s a difference between complacent optimism and conditional optimism. Complacent optimism is the assumption that things will get better. Conditional optimism is the assumption that things could get better. The question is, what will it take to, again, to convert the potential to the actuality of a different republic? That specific task of converting the “could” to the “will” is what I feel most driven to work on in the months and years ahead. from https://ift.tt/36M6ydO Check out http://natthash.tumblr.com
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James Hamblin spent years writing a book on hygiene beliefs and the new science of the skin microbiome. In it, he suggests that some people overuse cleansers and soaps, and may benefit from doing less. But now, there’s a pandemic, and he also really wants to remind people to wash their hands. Jim tries to explain the nuances of good cleaning and bad cleaning—and why he does not shower in the traditional sense. On this episode of the Social Distance podcast, Katherine Wells asks Jim Hamblin about that new book, Clean, and how to approach nuanced health discussions during a pandemic. Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. James Hamblin: I have a book coming out. It’s called Clean. It’s about the history of hygiene and sanitation and our beliefs about cleanliness. Katherine Wells: You decided to study hygiene long before coronavirus. Why were you interested in hygiene? Hamblin: Because I was interested in skin microbes. We did an episode, back in 2016, of If Our Bodies Could Talk, the video series, and talked to this company that was selling a skin probiotic. [The company encouraged] spraying bacteria on to your skin [under the] pretense of it getting better and improving your health. The idea is that we wash off all these microbes, some of which are healthy, some which are fine, very similar to the gut microbiome. I started thinking after that, What if the answer is just to not wash off things so much? And then I did a lot of research, and it turns out that there are a lot of dermatologists and people who study skin and the skin microbiome that say yeah, actually, it would probably be good for a lot of people to just do less [washing]. Except for your hands. A lot of people are over-washing and over-applying things. You apply shampoo to remove oils from your hair and scalp and then conditioner to replace them. People use body wash all over and then use lotion or moisturizer to replace those oils. It’s this cycle of selling people products. I researched the origins of that. The soap makers started with important actual public-health interventions, like hand washing. One hundred years ago people needed to know: You’ve got to wash your hands. You’ve got to stop the cholera. Wells: And then the capitalist machine took over, and now it’s like, You must buy these things or else you're disgusting. Your book has a complex message about how what began as a clear good health intervention, soap and washing, has now become distorted into this sales machine where people are marketing you products you don’t actually need, or don’t need to use as much, with this health gloss over it. Hamblin: Yes. We sold people so much soap that we had to start selling conditioner. And now we’ve sold people so many anti-microbial skin products, we’re going to start selling probiotics. It upends a lot of concepts about what it means to be clean if you’re supposed to have microbes on you. Wells: But this is a hard message during a time when microbes are killing a bunch of people. Hamblin: I started working on this five years ago, and it’s just now coming out. The text has not been updated to include the term “coronavirus.” But I think the book holds up. I'm very clear on hand-washing, very clear on this idea of targeted hygiene: Doing things that actually prevent the spread of disease, and separating those from things that you just enjoy or that are social signifiers or culturally important. I did this TV interview on a show called This Morning in the U.K., which is really a lovely show. The hosts were good and talked with me for about ten minutes about all of this. Wells: Did they ask you about coronavirus? Hamblin: They did not specifically. But I was very clear that I have never stopped washing my hands, and that washing your hands is important. But some blogger at the Daily Mail tried to make me seem like I was a doctor out there telling everyone they’re wrong and I’m unhygienic. [The story has since] been changed because I complained to them. Wells: This is the headline currently: “Doctor Who Hasn't Used Soap in FOUR YEARS Leaves This Morning Viewers Baffled As He Insists He DOESN'T SMELL And Claims Products Are a ‘Waste of Money.’” Every paragraph is about how you're insisting you don't smell. Hamblin: I think that was one sentence that I said because [the TV show hosts] asked me, “Do you smell bad?” As you’re weaning yourself off of these [products], you do [smell bad], but then you stop smelling with any sort of regularity or frequency. But there’s a reason you write 90,000 words about something like this. It needs to be a book for a reason: Because it’s complicated. The initial headline was something like: “Doctor Says Washing Bad for Health.” If they want to make fun of me, I don’t care. But when they suggested that I’m countering this extremely critical public-health message right now, that was infuriating to me, because this is what I live for, to do the opposite of that. So I went to their site to report a factual inaccuracy, and just reported that I literally did not say the thing that they put in quotes in their headline. And they changed the headline to say I don’t use soap, which is still inaccurate. Wells: This article initially suggested that washing was bad for your health, which was a very dangerous message at this time when washing is essential. Hand washing, specifically, is essential to health. It says you haven’t use soap in four years. Is that true? Hamblin: No, I use hand soap many, many times a day. Wells: You’re very concerned that this might suggest that you are somehow endorsing not hand washing at a time where it is essential for every person to be washing as much as possible. Hamblin: Exactly. [People are] looking for clear messages, and one of the few clear messages the public-health community has been able to give is: Do wash your hands. Do wear a mask. Do social distance. There’s not a lot we can say for certain. But we know those things. Every time people try to throw a wrench in those gears just to be provocative or rile people up, it does actual damage. Wells: This is complicated, though. Nuance does not work on the internet. This is the problem. Hamblin: Every force drives you toward de-contextualization. Wells: I do feel like in several of these phone calls, I’ve been asking you about some headline I read, which is essentially decontextualized, slightly hyperbolic information, and I’m having to help you like deconstruct it for me. For instance, about vaccines, [I'll read something where] it seems like we have a vaccine, but we don’t have a vaccine. We just have some very small study that showed some people were not harmed. Hamblin: A headline is always too distilled. But most places do a decent job. Wells: Is this just not the time to be talking about how actually, for parts of your body [other than your hands], soap is really stripping and harsh? Is that just way too nuanced of a message right now? Hamblin: No, I don't think so. Because also at the same time, this is a huge global industry. Sales are falling. People are changing their daily habits. They’re curious to know about what effect that has. It’s not life or death, but it’s part of our daily lives in which we spend time and money. Your skin is an ecosystem. Now we’re getting a virus that’s like an invasive species. You don’t clear-cut a forest because of an invasive species. Ideally, you try to eradicate the invasive species. But that’s generally most of our approach [to hygiene]: Let’s just obliterate everything. Things get so simplified, and we have this tendency to want to distill things throughout health into “good” or “bad.” Wells: I always want to know, do I do this or do I not do this? I can’t have a half-hour conversation about every possible health-related choice I could make in every day. Hamblin: Then my advice is: Wash your hands as often as possible and wash your body and hair only when you’d like to. from https://ift.tt/36INUDg Check out http://natthash.tumblr.com Editor’s Note: This article is part of “Uncharted,” a series about the world we’re leaving behind, and the one being remade by the pandemic. It’s Day One of the reopened future, and as people have always done when it’s time for a new start, you head to the gym. Well, hold on. We should begin before Day One, because you’ll actually have booked this time slot the week before. It’s good for 90 minutes. Don’t be late. You grab a door handle wrapped in germ-repelling vinyl and walk inside. A Bluetooth-enabled beacon at the front desk recognizes your phone and checks you in. The receptionist takes your temperature and hands you a towel, plus a colored wristband that’ll help the staff remind you when it’s time to go. Hopefully you brought some water with you, because touchless bottle fillers have replaced the drinking fountains. [Read: Pandemic dining: temperature checks, time limits, and dividers] You put your things in a locker and then walk out onto a fitness floor where alternating treadmills are unplugged, where roaming maintenance workers with specialized sprayers coat the equipment in clinging antiseptics, where extra-strength-Purell dispensers lurk in every sight line, where people lifting weights wear latex gloves, and where gym-logo masks dot the faces of all the people who forgot their own. Later, you’ll head into a yoga class with a dozen other students, spaced out in a studio built for 50. The teacher will be physically distant but attentive; you’ll sense the breathing around you and follow the lead of your classmates for the poses you don’t know. You’ll remember what it’s like to be in a room designed for a single thing, with other people who are also there for that thing. Then you’ll go back to the locker room, grab your stuff, and head home to shower. No flip-flops necessary! This is the gym of tomorrow (and the next day, at least). By the standards of a gym, it’s not terrible. Cleaner, quieter, less crowded. One question, though: Why are you here? [Read: Don’t close parks. Open up streets.] The pandemic locked up gyms and fitness studios, and inspired coaches, trainers, and teachers everywhere to take their livelihood online, many for the first time. Clients with abruptly altered schedules and budgets found themselves making adaptations of their own. Centralized digital platforms—some run by gym companies—have boomed, and now they have an opening to turn fitness into the same kind of collective, homogenized experience that league sports, office life, movies and television, dating, video games, and shouting at your relatives have become. Freed from the encumbrances of physical infrastructure, fitness can happen anywhere, in any form, anytime. In the short term, the costs and benefits are flying every which way. Over time, the options we have for working out—and the options we don’t—are likely to settle into something very different from what we might have expected only a few months ago, and to do so faster and under greater pressure than they would have without the coronavirus. I’m a person who exercises a lot, so I’ve been following these developments closely. I’ve found many things to love about working out in isolation. But still, I miss the gym. So I decided to try to figure out what exactly it is that I miss, and whether it’s gone forever. “Welcome to my house,” says Robin Arzon one Saturday morning over video, cackling. Robin—to her fans, she is just Robin—has a propulsive cackle, part of a small arsenal of affects that present, delightfully, in a kind of mathematical sequence, sprint by 30-second cycling sprint. Robin is a head instructor for the fitness platform Peloton: emperor and evangelist but also chief influencer. My colleague Amanda Mull wrote last year that she “works a crowd like Ariana Grande making a surprise appearance at your local mega-church.” In modern fitness, as in so much else, the operative entities are “brands,” and Robin is herself a significant brand—one tightly coupled with Peloton, the force behind a fleet of hundreds of thousands of stationary, digitally enabled bikes that retail for $2,245. (Peloton also makes treadmills, and an app that you can use for various activities without its equipment.) “Here together, in this safe space, in the intimacy of my home,” she says, “I hope you widen the aperture of what’s possible for yourself. That’s what we do here. That’s what we do here.” In Robin’s home, that’s what we do. Robin’s home is also, at the moment, a television studio that is broadcasting to a Peloton bike in my home. I ordered the device in March, when weeks of anxiety annealed into American lockdown. I am across the city from her. Both of us have cool plants next to our bikes. We’re in 23,000 other people’s homes, around the world, too. And where else are we? We’re at the gym. [Read: The fitness trend that is a mirror] If Robin had a class at the actual, regular gym and you stumbled into it without warning, you’d never stumble out: The wattage would fry you. Teachers on the major fitness platforms are, as a rule, highly telegenic; they’re broadcast talent, and their charisma has to carry. But Robin—Robin will get your heart beating three times a second, cackle, cue the tears (hers and yours), and be laughing again, all by the end of this Coldplay song. That’s what we do here. Peloton has been very successful at putting expensive fitness hardware in people’s homes, and the pandemic has compounded that advantage, at least among those who can still afford both the hardware and the fitness. Sales were up 66 percent last quarter. “To the extent that for so many years there was no competition, it was almost mind-boggling,” Tom Cortese told me. He is the company’s chief operating officer and one of its five founders, and lately his responsibilities have included shipping out the A/V equipment for emergency mini-studios to a handful of instructors so they can continue to teach new classes from their basement or living room. “Think about a swan, right?” the running instructor Jess Sims, who is broadcasting Peloton classes from her studio apartment, explained to me. “Above the water, the swan looks graceful and clear and calm and everything is beautiful. And then under the water, it’s going a mile a minute—the legs, they’re doing all these crazy things. And that’s kind of my apartment.” At the other end of the production-value spectrum, there’s Zoom—all legs, no swan. In March, every yoga and Pilates instructor you’ve ever encountered, every dance teacher, every personal trainer, plus a great number of people who aren’t any of these but influence as if they were, made the jump to Zoom, to Instagram Live, to YouTube. This flourishing was a playful counterpoint to the surrounding catastrophe. One early-lockdown weekend, I took a free dance class from a teacher who seemed to be in a Scandinavian cabin. My friend Charlie had often told me about these classes in their live form, in a style called “gaga,” which is meant to rid the dancer of self-consciousness. There we were, dozens of us, swooping and whirling and leaping in little frames on everybody’s laptop. It was ridiculous. It was the kind of thing you could get away with in the first fresh days of apocalypse. One of the main differences between free gaga classes and a hardware-plus-subscription platform such as Peloton is hundreds of millions of dollars in revenue. Sensing an opportunity, the Equinox Group introduced Variis. I know: You’re thinking of the eunuch spymaster from Game of Thrones. But this a is pronounced like in a New England aunt. Variis is a digital fitness offering that incorporates the various brands—please refer to them thus—in Equinox’s portfolio: the SoulCycle brand (with its own $2,500 bike), the Equinox brand, the Pure Yoga brand, and so on. [Read: I joined a stationary-biker gang] These brands and others like them suddenly have even more riding on Variis and similar platforms than they did before, just as smaller studios and solo instructors are in thrall to Zoom and Instagram. Gyms the world over have been closed and dueless for months. Even established players will come through with scars, if they come through at all: Gold’s Gym is restructuring under bankruptcy, and 24 Hour Fitness is said to be considering the same. Planet Fitness, a franchise business, has softened its growth forecast. Equinox isn’t paying rent. More than 36 million Americans have filed for unemployment since March; many of them may decide that fitness is something they no longer want to—or can—pay for. “I can’t imagine that [if] we go through wave after wave of shelter in place that the companies will even exist,” Jim Rowley told me about gyms like these—including Crunch Fitness, where he is the CEO. (He described many of the reopening protocols I used to paint the picture at the beginning of this article.) Crunch has had a digital platform since 2011, and Rowley said it has seen a surge in usage since lockdown began. But he came up through the gym business, and he’s a gym guy. “I think Peloton’s great. I applaud them for what they’ve done,” Rowley said. But “I don’t want to ride a bike every single day for my exercise. I want variety. I want to do TRX, I want to do dumbbells, I want to take a class, I want to take yoga, I want to take a spin class, I want to lift weights, I want to do Olympic weight lifting. And that’s why the traditional, you know, big-box gym like Crunch—that’s all those things under one roof.” Okay, but for now, how about all those brands in one app? A Variis class unfolds like an Instagram ad for a moon colony, with what its press kit calls “dynamic, multi-camera shots and concert-grade lighting.” You have to give Equinox’s brand custodians credit: They understand that fitness is a story—challenges arrive, we conquer them, we are changed—and that it can be told big. I am certain that my cardiovascular system has never produced more energy, or done so with greater symmetry and ferocious steadiness, than at Equinox, in a dark cycling studio with a sweet sound system playing concert Beyoncé and a 30-person simulated race on the projector screen up front. It takes enormous discipline to edit an experience like that, to keep it tight—live or on a screen. Equinox, and its brands, is disciplined. If Robin is Ariana Grande, Variis is the movie with Robert Pattinson on a spaceship. [Read: The day the live concert returns] But perhaps concert and cinema metaphors aren’t the right ones in these Netflix days of fitness. “If you go to a gym, you’re there to work out,” the Equinox and Variis strength teacher Andrew Slane told me. That’s “a little more challenging when you’re doing it with your fiancé eating breakfast and you just moved your table out of the way in your 500-square-foot studio apartment. You really, really have to hold yourself accountable, and some days you’re just not feeling it.” Or as Michelle Green of Toronto put it when we asked our app and newsletter readers about fitness in quarantine:
This is true, of course, of any digital fitness experience. The antidotes—which are really antidotes to the complacency and inertia we battle in deciding to try to exercise at all—are simple and familiar: attentive teaching. Atmosphere. Other people to keep you honest. A narrative you can identify with. So now we have to figure out where to find our antidotes. Virtually every digital fitness experience is still a simulation of something people used to do together. The chemistry of in-person interaction is so important that Peloton, for example, normally records classes with live students in its Manhattan studios. (It barred those participants in March and shut down studio production altogether in early April, before starting up its home broadcasts.) “We feed off the energy in the room,” Denis Morton, a cycling and yoga instructor there, told me. “When there’s no people in the room with you, you really have to have a deep well.” Morton, who is Peloton’s joke-a-minute hunky-coach archetype, was businesslike when we spoke on the phone this month. So I was struck later when I replayed a class of his from the first half of March, one with people in it. His monologue included the illustrative economy of Jack White’s songs (“when you do something right, you don’t have to do it all day”); the architecture of glycogen reserves (“closets to store energy,” which we remodel and expand through careful training); a not-insubstantial anecdote about Lenny Kravitz’s drummer (“I bet she’s glad she had glycogen in those closets”); and a vivid sensorial depiction of what it’s like to have to pee very, very badly. It was the most fun you’ll ever have in 45 minutes of indoor endurance training. It’s not that you couldn’t spin a charming antic monologue and/or teach a fitness class in an empty room, but Morton is right about the resources you’d have to tap. Variis’s Slane told me that he’s taught himself to invest the camera with personhood, “like if you ever had an imaginary fight with somebody else in the shower.” Teaching for Variis got easier, he said, when the company started placing a few extra team members in the classes (filmed before the pandemic)—to model the instructor’s cues for the viewer, and to give the teacher a sense of how his instructions were landing. [Read: We need to stop trying to replicate the life we had] These are all work-arounds for a simple problem: the lack of physical co-presence. That problem radiates across the category: The Pilates teacher on Zoom asks whether a movement is okay for you to do with your injury, but you’re on mute. You wonder if the clicking noise on your Peloton crank is normal, but no one else is within earshot. You take a bathroom break and just never bother to go back, because who will ever know? “The student starts to feel like, I am just a blip on the screen,” my yoga teacher Cooper Chou told me. He’s the kind of person whose warmth reaches across every room he walks into. I went all the way to the gym for his class on Christmas Day. He’s not teaching online. Some approaches, intriguingly, embrace the fact that no one else is around, and just help you move. An app called Aaptiv gives audio cues that you can follow without staring at a screen. Fitbod logs your weight lifting and suggests fresh muscle groups to work out, with simple illustrative GIFs and tips on form; a year-long subscription costs less than an hour with a trainer. The game Zombies, Run! supplies a narrative reason to, well, run. Then, of course, there’s Nike Run Club, one of the most popular workout apps. And for all the frictions of Zoom, many thousands of flowers have bloomed there lately; some will survive, and some of those will be real innovations. I’ve personally connected with two yoga teachers I adore, and their dogs, through Zoom. (Speaking of flowers, I grew up in Utah and built my cycling legs on a hillside in Los Angeles; in many places, people will just keep exercising outdoors, as they’ve always done.) But what will this all look like in a year or two? The rosy version is that we get the best of it all—a long-lost yoga teacher here, a mountain hike there, mini-lectures on lactate thresholds in the morning, a sanitized and distanced trip to the gym at night. Proponents of digital fitness like to talk about convenience and flexibility and access, and they’re right: Going to the gym is a bit of a pain in the best of times, and not everyone feels welcome. If Peloton’s Christine D’Ercole had been on a bike in my basement when I was a geeky kid, opening her hill-climb ride with Enya and preaching a credible love for your body, I might have found a place among athletes before I was 24. Jim Rowley of Crunch is also right: We limit ourselves when we do the same thing every day. Think of all the hurdles to the mix-and-match vision, though. A key ingredient, the gym, is gravely imperiled—all these sanitary measures notwithstanding, you really couldn’t design a better place for the coronavirus to spread. The overproliferation of expensive, and expensively marketed, new digital platforms will quickly narrow in a world of drastically lower consumer spending. We may well end up in fitness, as we have in other areas of entertainment, with a few players that control most of it. They’ll know when and how we work out; they’ll know that a low-cadence hill climb chases people out of cycling class as fast as a Kanye West song brings them in; they’ll release new features every two weeks, like any tech company; they’ll find ways to cross-promote with all the other deep-pocketed brands that weathered the storm. The Peloton family will grow, and we’ll spend Saturday mornings at Robin’s house. (This weekend, in fact, ESPN and Peloton “have combined to bring celebrities and athletes together for an epic, all-out, 20-minute Peloton race.”) [Read: The fitness craze that changed the way women exercise] One of the quieter casualties of these pandemic months is dedicated space. Hospitals, grocery stores, and warehouses have held on to clear functions, but for everything else, there’s your apartment. Confinement leads to a kind of versatility; it means we figure out how to use the same room to work and raise kids and play and sleep, the same ingredients to make three dinners in a row, the same video software to conduct every kind of social exchange. It also means that the functions of office and restaurant and church and beach and bar hover over the same sad little seafoam Ikea carpet, mirrored in the same screen, shadowed by the same cool plant. Hold this in contrast to the gym, which is designed for only one thing: It’s where you go when you want to be with people who can help you get stronger, and who have the best tools to do it. It’s not incidental that being there means exposing yourself to the breath of others; that is, in fact, largely the point. The breath of language, the breath of yogic pacing, the heaving breath of the dead-lifter, the rhythmic breath of the cyclist in the studio, with the music thrumming through their every stroke: beat, breath, left; beat, breath, right. We who still have our breath: Where will we go? from https://ift.tt/3caW9sZ Check out http://natthash.tumblr.com On this episode of Social Distance, James Hamblin and Katherine Wells talk to Kelley Lee, professor of public health at Simon Fraser University, about the history, necessity, and vulnerability of the World Health Organization. Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. Katherine Wells: What exactly is the WHO? Kelley Lee: In a nutshell, it is the United Nations specialized agency for health. It was formed in 1948 and it was created to be the directing and coordinating body for international health cooperation. After the Second World War, there were a lot of epidemics because of the war. People were in very bad shape. Health systems were destroyed in many parts of the world, and there were outbreaks of all sorts of infectious diseases that needed to be brought under control. Wells: What does the WHO do? Lee: When it was created, it was an amalgamation of a lot of pre-existing organizations largely focused on collecting statistical data and standardizing practices. If you ever wondered why a disease like MERS is called MERS, there's a committee in the WHO that deals with the classification and naming of diseases. When people think of global health, they think of scientists peering down a microscope or frontline health workers swinging into action. But really, it's a lot of these people sitting around the table and figuring out how to classify and organize diseases. The WHO has also become more action-oriented, so it’s not just committees classifying diseases. WHO does a lot of work with disease eradication and disease control programs. The most successful one was smallpox, a disease we no longer have. It's the biggest achievement in the history of the WHO. Some say the biggest achievement of humanity in the 20th century was the eradication of that disease. Polio is the disease that the WHO has been focusing on now. It's something like 98 percent eradicated, but there are small pockets in countries where it's very difficult to access the cases, like Afghanistan, Pakistan, and Nigeria. Health workers have been attacked and killed trying to find these last cases and vaccinate children. And now we have COVID-19, so that's kind of shut down the polio eradication efforts. James Hamblin: What is the total budget of the World Health Organization? Lee: WHO is funded for about $2.2 to $2.3 billion a year. That's about the size of one medium-sized hospital, and it has to cover 194 countries. The objective of WHO, as stated in its constitution, is the attainment by all peoples of the highest possible level of health. That’s a huge goal, and you're spreading this budget extremely thin. The budget is made up of two pots of money. The first part is a membership fee, so every country that wants to be a member of WHO pays a certain amount depending on their population and on their wealth. That's why the U.S. pays more than, say, Sierra Leone. The second part of the budget is paid for by voluntary contributions. Member states or charities or even individuals can step up and put money into WHO. But the people that give the money decide what the money is spent on. It's not necessarily the most important things, it's just the favorite things. WHO doesn't really have a lot of control over most of its budget. Hamblin: What is the U.S. contributing to the WHO annually? Lee: The U.S. is the largest donor. It gives around like a third of the budget, so these threats about withdrawing money are very worrying. It's going to hurt WHO and now is not the best time to do that. If the US stopped funding WHO, it would hurt. I would hope that other countries would step up and fill the gap. But if the U.S. withdraws its voluntary contributions, all these programs, which the U.S. government earmarked these funds for, will lose out. The U.S. gives something like twenty-five percent of the money for polio eradication. So that program is going to really suffer. In my decades studying WHO, I've seen ups and downs, but I have not seen this kind of existential threat. Hamblin: What do you make of President Trump’s accusations about China? Is it just scapegoating, or is there something there? Lee: We’ll know who knew what when in due course, once there is an investigation, which everyone agrees is going to happen. There's just a lot of innuendo and accusations flying around right now, and this is not the time. When WHO alerts member states, it's the member states that need to act. Everyone got the same information from the WHO at the same time. An alert went out on December 30, and then in January, the public-health emergency was called. Member states have to then act. It's really disingenuous to say there was a week where we didn't have that information and that is why thousands of Americans have died. Hamblin: What does that history tell you about this moment? Lee: We're at a really important, defining historical point. This is not the last pandemic we're going to have, so what lessons are we going to learn? Are we going to go close down and hide away and cut the global connections we have created? Or are we going to say, look, the world is different. We value globalization, but we haven't invested enough in the kinds of protections that we need to make globalization work. We haven't invested enough in health security. We really barreled forward in terms of economic globalization and let the market drive that process. But we didn't value the roles governments play in globalization. We can't have economic globalization without strong societies, without strong governments. It's almost like the post-WWII conferences where world leaders came together and created the UN system. We may be at a moment where we needed another historical event like this to take us forward. from https://ift.tt/36BdRVh Check out http://natthash.tumblr.com Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Staying at home for months is an onerous thing to ask of people, but what it means is easy enough to understand: Unless necessary to keep your job or keep yourself alive, you just don’t leave. When American mayors and governors began asking people to shelter in place to combat the coronavirus pandemic, the United States, a country generally stewing in deep political acrimony, was unusually united in doing what was asked. Stay-at-home orders were implemented for many reasons: to stop the virus from silently spreading between people, to prevent the collapse of hospital systems, to allow public-health officials to build up testing capacity, to hire contact tracers to snuff out hot spots before they became full-fledged outbreaks. But at the most basic level, shutdowns bought some time for scientists faced with a novel pathogen to figure out what the hell was going on in the first place. How does the virus spread? What determines how sick someone gets? Full answers to those questions are still being determined, but preliminary research on outbreaks across the globe has provided some important clues about which behaviors and activities matter most for coronavirus transmission. Taken together, they create a rough sketch of risk and reward that can help people shake off mounting quarantine fatigue. These little bits of scientific relief have arrived just in time: Summer is here, and more states are starting to reopen, forcing people to figure out their own methods of risk assessment in their daily lives. Public-health experts now have to determine how to deliver the message of moderation in real time, and hope that phrases like spectrum of risk or contact budget will resonate. No matter what term ends up lodged in people’s brains alongside social distancing and flatten the curve, the reality is the same: Thinking about safety as binary isn’t going to cut it anymore. The key to responsibly reopening your life is understanding what makes you and those around you more or less safe at any given moment. All of the experts I spoke with emphasized that, overall, continuing to stay home as much as possible is still the safest thing anyone can do. “The appropriate precautions haven’t changed, in my view, until we have more data,” Stephen Morse, an epidemiologist at Columbia University’s Mailman School of Public Health, wrote in an email. But they all also acknowledged that many people have grown predictably weary of isolation, and that reopened businesses, like the now-infamous poolside bar at Lake of the Ozarks, will be attractive diversions for some this summer. Extreme isolation isn’t sustainable, and it has to be replaced with something. [Read: Pools will test the limits of social distancing] “Some people are in a near-panic still, whereas others are completely blasé about it, and we need to find sort of a middle ground,” Tara Kirk Sell, a professor and risk-communication researcher at the Johns Hopkins Center for Health Security, told me. “That’s a complicated dance, but it’s also going to be what everyone needs to do going forward.” First and foremost, she told me, people should be taking basic precautions to protect those around them: wearing masks in public, respecting other people’s space, and understanding that the people you encounter might be in far more danger from catching the disease than you or your immediate family. Once those precautions are in place, you can start to evaluate different types of errands or leisure. Of the handful of things to consider when deciding how safe a situation might be, Kirk Sell said ventilation is the first one to think about. “If I’m outdoors, my level of concern really goes way down,” Kirk Sell told me. “It’s not the beach that’s a problem; it’s if people then decide to pack bars and restaurants when coming off the beach.” Stick to the surf and sand; skip the boardwalk. [Read: Beach towns are next to take the hit] Similar outdoor activities—hiking, camping, jogging, reading a book on a blanket in the park—are all relatively innocuous for most people. Inside, walls and HVAC systems contain and recirculate air that may be full of contagious microbes. Outside, droplets disperse quickly in the open air, so you’re far less likely to unwittingly stick your face in a cloud of viral droplets and keep it there long enough to let a bunch of them inside your body. Globally, documented cases of outdoor transmission are exceedingly rare so far; the one most frequently cited involved two friends who had a lengthy, close interaction. In countries that have done widespread contact tracing, outbreaks have been squelched without information on the strangers that pass on the sidewalk or sneeze on one another at the park, which suggests those interactions probably aren’t major drivers of coronavirus contagion. Meanwhile, documentation of indoor transmission is widespread: at choir practices, exercise classes, religious services, birthday parties, and funerals, and in nursing homes, conventions, offices, restaurants, nightclubs, meatpacking plants, and prisons. Those indoor activities and spaces have been the sites of what researchers call “super-spreading events,” in which a single infected person—who might be asymptomatic or very mildly sick—can pass on the coronavirus to a large group of unsuspecting people, who then go out into the world with their new dangerous germs. In addition to taking place somewhere with a lack of ventilation, super-spreading events often have three more characteristics that Kirk Sell said each make any activity or interaction more risky: large groups of people, close proximity, and interactions that last for an extended period of time. Taken together, these conditions create what’s currently believed to be a worst-case scenario for coronavirus transmission. A growing body of evidence suggests that super-spreader events are responsible for a disproportionately large number of infections. If you live in a state that now allows people to go out to bars, return to work in open-plan offices, or attend religious services, even in reduced numbers, the best and simplest thing you can do is to protect your health is to avoid those situations like, well, the plague. The confluence of these conditions matters because catching the coronavirus requires more than simply encountering a single viral particle. The number of viral particles present when someone is exposed to the coronavirus seems to matter a great deal in not only whether a person becomes sick with COVID-19, but in how sick they become. Changing any of the characteristics that makes these interactions so dangerous—improving ventilation, decreasing the number of people present, shortening interactions, or giving people more space to spread out—helps reduce risk. Changing more than one is even better. [Read: The healthiest way to sweat out a pandemic] Doing yoga with a friend in the park isn’t totally risk-free, but it’s much less risky than taking an hour-long spin class in a closed studio with a bunch of strangers. The same goes for having a beer with a couple of friends in your backyard rather than going to a bar on a Saturday night. A short outdoor wedding ceremony with a handful of healthy, well-distanced guests? Not recommended, but not nearly as big of a problem as an indoor wedding and reception with a couple hundred people. All of these things are more dangerous than just staying at home and minding your business, but they’re not all the same. Understanding how they compare can help people focus on controlling the risk factors that matter most and provide a bit of relief from the exhaustion of endless pandemic perfection. How much risk you assume should also depend on how extensive the coronavirus outbreak is in your town, who you are, and whom you might encounter when you go out. “If you are someone who falls into a high-risk group based on age or comorbidities, I would be more cautious in decision making,” Rachael Piltch-Loeb, a research scientist at New York University’s College of Global Public Health, told me. “Similarly, are you someone who lives with or provides for those that may be at higher risk? If so, I would also be more cautious.” Even with these basic guidelines in place, Kirk Sell told me that some situations are difficult to assess. In particular, “the verdict is still out on what’s happening for transmission in schools,” she said. Should many schools reopen in the fall, some parents could nevertheless resist sending their kids in over fears they could bring home the coronavirus. Although the disease is far less deadly for children, some kids have died in the U.S. and hundreds more have come down with a mysterious inflammatory condition believed to be a complication of COVID-19. In general, it’s still not clear whether children are less likely to catch the coronavirus than adults, less likely to exhibit symptoms, or both. Visits to grandma aren’t safe just yet. [Read: The kids aren’t all right] Ideally, all of this advice would come early and often from public-health authorities at the Centers for Disease Control and Prevention or the National Institutes of Health. It would be reiterated regularly in press briefings and interviews by health-department officials at the state and local levels. Politicians would abdicate their starring roles in the spotlight and become members of the supporting cast. Almost none of this has gone according to plan. Instead, many Americans have begun to calcify at the extremes, believing that staying home 24 hours a day for months on end is the only morally defensible thing to do, or that refusing to wear a mask in a grocery store is an essential expression of personal freedom. For those people, a new recommendation for moderate precautions based on new data might look like an intolerable win for their opponents. To avoid that, leaders need to “set the expectation that things will change, we’re going to learn more, and that guidelines are going to change,” Tom Hipper, a risk-communications professor at the Drexel University School of Public Health, told me. “A level of honesty and openness about the unknowns of where we are now is really important.” Changing rules don’t necessarily mean that the government or scientists were lying to you before. Far more likely is that the rules have shifted to reflect what’s been learned about a rapidly evolving crisis. It might seem counterintuitive that moderation can make people safer in a situation that, by its very nature, requires an extreme response. But when faced with a long-haul crisis like a pandemic, figuring out exactly what works to keep people healthy shouldn’t be thought of as moderation—it’s progress. A person only has so much energy and focus to put into pandemic fastidiousness, and better guidelines on how they should use it make safety more efficient and people’s mid-crisis lives more livable. “People are going to start making steps toward doing some more things,” Kirk Sell told me. “We can’t forever be in our houses.” from https://ift.tt/2TLjdIp Check out http://natthash.tumblr.com In our new series “Behind the Byline,” we’ll be chatting with Atlantic staffers to learn more about who they are and how they approach their work. First up, we have Amanda Mull, staff writer on the Health desk and “Material World” columnist. We spoke with her in April. This interview has been edited and condensed. Aberra: What do you cover for The Atlantic? Mull: There’s no great way to describe my beat, I’m pretty convinced. But I write about how people experience life. So, how they think about themselves and their identities, the things around them, their social relationships, and their relationships to the economy, politics, society, and culture. I do sort of write about everything. Aberra: What inspired your column, “Material World,” and what’s your favorite story from that series? Mull: My background is in fashion, so I started taking on stories about how people shop, how people think about buying things, and how people think about solving their problems with their bodies or with their emotions or with their everyday lives. Often in the United States, that happens by buying something or trying to buy the right thing. Also, I loved the article about free shipping. I think now we are seeing that a generalized understanding of supply chains, and how that sausage is made, how things get to us, how things are sold to us, is really important for understanding the society we live in. So I am retroactively glad I wrote that. It seemed important at the time. It seems even more important now. Aberra: What is Generation C, and how are things going to shake out for them? Mull: I think that the generation that is young, that is in school or just barely out of school right now, will certainly want better for themselves. I think we have an opportunity to, out of tragedy, grow a better, fairer society. It doesn’t happen every time. It might not happen this time; it’s impossible to say now. But I think that it would be wise for people who are dissatisfied with what’s going on now to keep that in mind. Aberra: Have you bought anything that’s been important to you while quarantined? Mull: I’ve tried to limit my online shopping to necessities because I know that delivery guys are overburdened right now. But several months before this happened, I did buy a new couch that I’m very happy I got. I’m glad that I did not wait any longer, because now so much of my life is conducted on it. Aberra: What does your cooking life in quarantine look like? Mull: I have always liked to cook. That’s a normal weekend activity for me. I make at least one thing that I can pick at over the week. Filing a story is nice, but there is no satisfaction like finishing something and holding it in your hand and then having it be useful to you for the foreseeable future. With cooking there’s that. Before, the time to do bigger projects just sort of evaporated. That doesn’t really happen right now. Even if I have to get on my computer and have to write something up real quick for work, I’m still here to monitor my focaccia dough. Aberra: How is Midge? Mull: The quarantine has been great for Midge. It’s the greatest thing that ever happened to her. I’m here constantly, and I’m always eating in the house, so there’s always a bite for her. She gets to take a lot of naps. She loves the quarantine. She hates going outside. A lot of chihuahuas do. from https://ift.tt/2B2yNsB Check out http://natthash.tumblr.com Here in the plague, we are living a story that is global and yet intensely local. While all of us get reams of reporting about national and international COVID-19 trends, most of us get little or no reporting about what’s happening in the communities where we actually live. Local news has largely disappeared—the phenomenon of news deserts is by now well known. And yet never has the need for local information been greater. The big news can be completely at odds with the small news—and for individuals, it’s the small news that matters most. The crucial virus data is hyper-local. In my neighborhood, hidden within a larger geographic picture whose trends give cause for hope, the disease is spiking dramatically, even scarily. And almost nobody knows. I live in Kennett Square, Pennsylvania, a borough of about 6,000 souls southwest of Philadelphia. It is part of Chester County, an outer-ring suburb. With a few exceptions, the county is characterized by rolling green hills, pastures, and farms—mostly horse farms. The county was made famous by the paintings of Andrew Wyeth. It is mostly white and relatively affluent. Kennett Square Borough is anomalous. It encompasses a densely populated area of just over one square mile. About half its residents are Latino, many of them families who immigrated here from Mexico and Guatemala to work in the county’s thriving mushroom industry, which produces about half the mushrooms consumed in the United States. Each fall we celebrate with a weekend Mushroom Festival, where hundreds of thousands of people jam State Street, the borough’s main thoroughfare. Kennett Square has also become a vibrant center for craft beer, fine restaurants, and live music, which has made the community a draw for the well-heeled—young and old—looking for a walkable, fun, and affordable place to live. All of these attractions have, of course, gone dark. Philadelphia itself has been hard hit by the virus, with more than 17,000 infections and 1,217 deaths. Chester County has so far gotten off easiest in the metropolitan area, with just under 2,500 infections and 241 deaths, mostly in the townships closest to the city. Kennett Township, the rural area that surrounds my borough, has had just 27 cases and one death. I read The Philadelphia Inquirer every day, which links to maps and charts that record the progress of the disease. For me, COVID-19 stats have replaced my morning immersion in the sports pages. A color-coded map online shows where the virus has appeared throughout the county. There are bar charts showing the number of tests, negative and positive, each day, and for those wanting a closer look at the numbers, there are totals for each of the county’s 73 municipalities. I have been keeping an eye on the numbers for Kennett Square because these are the most important ones for me and my family. It indicates our immediate risk level. It’s the kind of thing a local reporter would write about, if there were any local reporters. [Read: Local news is dying, and most Americans have no idea] If you look only at the regional data, the picture at the moment is almost cheerful. In the past week, new infections in Chester County have declined from a daily average of close to 40, two weeks ago, to an average of about 10 for the past few days. Last Saturday there were just four new cases in the entire county. The weather is turning warm, flowers are in bloom, and more and more people here are venturing out. In my little corner of the borough, within earshot, there were several fairly large Memorial Day gatherings last weekend. Until about two weeks ago, the picture of Kennett Square painted by the county health department’s maps was astonishingly good. As the county numbers climbed, our borough consistently reported only two infections and no deaths. This didn’t make sense to me, given the density of our population and the number of residents who work close together in the local mushroom houses. Last week, the numbers jumped shockingly, to the 30s, then the 40s, then the 50s. At the very moment when Pennsylvania Governor Tom Wolf began easing some restrictions in our region, the number of infections in the borough has jumped, as of yesterday, to 65—more than 30 times what it was at the beginning of May. I was startled enough to start calling around. “It’s really alarming,” said Whitney Hoffman, the vice chair of the local board of supervisors, who has been posting COVID-19 data on a community website that attracts a tiny fraction of the audience a good local-news operation would, whether in print or online. “We aren’t sure what’s really causing it, but I’m concerned that one reason might be that people are relaxing their social distancing. I walk in Nixon Park and I see all kinds of people without masks, some of them eating at picnic tables that are roped off because we are unable to disinfect them regularly. Bad idea.” We all know that these numbers are imprecise. Most people have not been tested. Some of those who have been tested were tested for active infections and others for antibodies that signal old infections--numbers that have been combined, for no good reason. Some of the jump might simply be because more tests are being administered. La Comunidad Hispana, a health center serving the Latino community, received a grant last week to bring mobile testing units to area mushroom farms. The results were predictable. Read: America’s patchwork pandemic is fraying even further “Right now we’re at a peak,” said Mariana Izraelson, the organization’s CEO, in a video message she posted on its website this weekend. “It has taken until now for us to see a surge. And we strongly recommend to everyone who is not an essential employee to stay at home … If you can stay at home, please stay at home.” So while the masks are coming off and the backyard barbecues are firing up, we’re in something of a silent emergency here. There is not a word drawing attention to this local spike on the county health department’s website, which is tracking a much larger area. It hasn’t been noted by the Inquirer, which is tracking the larger regional story hard. None of the paltry local-news outfits appears to have even noticed. So far no one has died of the infection in Kennett Square. That we know of. from https://ift.tt/2TGT5OM Check out http://natthash.tumblr.com The word I keep hearing is numbness. Not necessarily a sickness, but feeling ill at ease. A sort of detachment or removal from reality. Deb Hawkins, a tech analyst in Michigan, describes the feeling of being stuck at home during the coronavirus pandemic as “sleep-walking through my life” or “wading through a physical and mental quicksand.” Even though she has been living in what she calls an “introvert heaven” for the past two months—at home with her family, grateful they are in good health—her brain has dissented. “I feel like I have two modes,” Hawkins says: “barely functioning and boiling angry.” Many people are even more deeply unmoored. Michael Falcone has run an acupuncture clinic for the past decade in Memphis, Tennessee. When he temporarily shut it down, the toll on his mental health was immediate. “I went into a pretty instant depression when I realized that my actual purpose was disintegrating,” he says. He began spending his days staring at his bookshelves. Falcone and I have exchanged emails for weeks now, and while his notes have been full of whimsical musings about adjusting to home life, one included a jarring line: “I’ve lost faith in myself. I don't know if I can actually justify taking up space and resources.” After I confirmed with Falcone that he had no intent to harm himself, I recommended that he seek medical help. But given the unprecedented circumstances we’re all in, I’m not sure whether I under- or overreacted—or even what “help” should look like, exactly. The pandemic is a moment of historic loss: unemployment, isolation, stasis, financial devastation, medical suffering, and hundreds of thousands of deaths globally. Suddenly a droves of people are being thrown into a state like Falcone's, feeling lost, hopeless—in his words, “depressed.” Over the past month, Jennifer Leiferman, a researcher at the Colorado School of Public Health, has documented a tidal wave of depressive symptoms in the U.S. “The rates we’re seeing are just so much higher than normal,” she says. Leiferman’s team recently found that people in Colorado have, during the pandemic, been nine times more likely to report poor mental health than usual. About 23 percent of Coloradans have symptoms of clinical depression. As a rough average, during pre-pandemic life, 5 to 7 percent of people met the criteria for a diagnosis of depression. Now, depending how you define the condition, orders of magnitude more people do. Robert Klitzman, a professor of psychiatry at Columbia University, extrapolates from a recent Lancet study in China to estimate that about 50 percent of the U.S. population is experiencing depressive symptoms. “We are witnessing the mental-health implications of massive disease and death,” he says. “This has the effect of altering the social norm by which depression and other conditions are defined. Essentially, this throws off the whole definitional rubric.” Feelings of numbness, powerlessness, and hopelessness are now so common as to verge on being considered normal. But what we are seeing is far less likely an actual increase in a disease of the brain than a series of circumstances that is drawing out a similar neurochemical mix. This poses a diagnostic conundrum. Millions of people exhibiting signs of depression now have to discern ennui from temporary grieving from a medical condition. Those at home Googling symptoms need to know when to seek medical care, and when it’s safe to simply try baking more bread. Clinicians, meanwhile, need to decide how best to treat people with new or worsening symptoms: to diagnose millions of people with depression, or to more aggressively treat the social circumstances at the core of so much suffering. Clearly articulating the meaning of medical depression is an existential challenge for the mental-health profession, and for a country that does not ensure its people health care. If we fail, the second wave of death from this pandemic will not be directly caused by the virus. It will take the people who suffered mentally from its reverberations. Like COVID-19, depression takes erratic courses. Some predictable patterns exist, but no two cases are exactly alike. Depression can percolate for long periods then quickly become severe. Some people will barely notice it, and others will be tested in the extreme. Andrew Solomon, the author of The Noonday Demon: An Atlas of Depression, groups people based on four basic ways they’re responding to the current crisis. Two are straightforward. In the first are people who are drawing on huge stockpiles of resilience and truly doing okay. When you ask how they feel and they say “eh, fine,” they actually mean it. In the second, at the opposite end of things, are people who already have a clinical diagnosis of major depressive disorder or a persistent version known as dysthymia. Right now, their symptoms are at high risk of escalating. “They develop what some clinicians call ‘double depression,’ in which the underlying disorder coexists with a new layer of fear and sorrow,” Solomon says. Such people may need higher levels of medical care than usual, and may even need to be hospitalized. The remaining two groups constitute more of a gray area. One group consists of the millions of people now experiencing depressive symptoms in a real way, but who nonetheless will return to their baseline eventually, as long as their symptoms are addressed. People in this group are in urgent need of basic interventions that help create routine and structure. Those might involve regularizing sleep and food, minimizing alcohol and other substances, exercising, avoiding obsessions with the news, and cutting back on other aimless habits that might be easier to moderate in normal times. The fourth group encompasses people who are starting to develop clinical depression. More than simply a wellness regimen or a Zoom with friends, they need some type of formal medical intervention. They may have seemed fine and had adequate resilience in normal times, to deal with normal difficulties, but they’ve always had a propensity to develop overt depression. Solomon describes this group as “hanging on the precipice of what could be considered pathologic.” It can be especially precarious because people in this state—what some researchers refer to as “subclinical depression”—have not dealt with depression before, and may not have the capacity or resources to proactively seek treatment. The earlier specific types of depression can be identified, the better people can be directed toward proper treatment. The mental-health system has always had barriers to identifying and helping people early—issues like access to care and stigma around seeking it out. In the midst of this pandemic, not only is the current population of psychiatrists insufficient to suddenly treat several times as many people as usual, but their basic capacities of diagnosis are also hindered by distance, volume, and confounding variables. “It takes considerable wisdom to delineate who has a clinical condition and needs medication and therapy, and who is just stressed out within the bounds of good mental health,” Solomon says. Clinicians train for years to understand that line, and placing people on one side or the other typically requires long interviews in which every element of a person’s affect is noted. Even for people who manage to connect with clinicians, subtleties are difficult to read over video calls, says Meghan Jarvis, a trauma therapist who has been seeing a spectrum of reactions to the pandemic, including depression. Normally, Jarvis sends maybe one patient a year to the hospital for a pathologic response to trauma. Since March, she has already had to hospitalize four people. Typically, she explains, symptoms of depression are considered problematic if they last six weeks after a traumatic event. The precise length is arbitrary, but is meant to generally help distinguish depression from periods of grieving, such as after the death of a loved one. That distinction is largely useless in the pandemic. “I mean, we're all going to have that,” Jarvis says, “because we've been in this mode for more than six weeks.” Now Jarvis and others have to develop new thresholds. Just as, in the time of COVID-19, not everyone with a cough can go to the hospital, clinicians are working to identify and prioritize those who truly need in-person mental-health attention. Jennifer Rapke, the head of inpatient consultation at Upstate Golisano Children's Hospital in New York, has seen a surge in teenagers reporting suicidal ideation and instances of self-harm, so she has been carefully turning away the less severe cases to make sure that inpatient facilities aren’t overwhelmed. “We’re only seeing people who absolutely need to be here,” she says. Meanwhile, those with milder, emerging cases are sometimes left in limbo. “The places we would normally send people, the things we would put in place to address the depression or the anxiety in early phases—they don't exist or they’re unavailable,” Rapke says. With less preventive and maintenance care accessible, people are more likely to come to hospitals in more severe states. During crises, extreme events like self-harm and suicide lag in time. At first, being anxious about the proximity of death, or sad about the loss of loved ones is logical; any other reaction would be bizarre. Our minds and bodies can’t endure that state for too long, though. The United States was slow to test for the coronavirus, and COVID-19 cases accumulated before we knew just how widespread it was. Rapke and others are now bracing for a similarly delayed wave of severe depression—and the difficult decisions they will have to make about treatments. The elusive definition of depression has always been a source of academic tension with serious consequences. Among the many challenges the pandemic is posing, it is exposing the borders of medicine’s ability to distill human suffering into a billable diagnostic code. Some people with symptoms of depression will be told, “Everyone feels that way,” or advised to try breathing exercises when they need urgent medical attention. Others will be diagnosed with clinical depression, changing their life and self-conception indefinitely, when the problems were truly circumstantial. The system has never been flawless, but its limitations are now brought into stark relief. For most of human history, depression was not treated in the same medical model as were diseases of the body. People with mental illnesses were written off as morally bankrupt or simply “insane.” Only in the latter half of the 20th century did the profession of psychiatry become a medical specialty and create systematic approaches to treatment. The process for diagnosing a condition in psychiatry and clinical psychology will never be as straightforward and objective as saying whether a bone is broken or not, or whether a person has had a heart attack. But it provides a common, basic language for what a clinician means when he or she diagnoses a patient with something like depression. It also helps patients get the insurance coverage and health-care service they need. Today, depression—the clinical condition, otherwise known as major depressive disorder—is defined by the American Psychological Association in its Diagnostic and Statistical Manual as a mood disorder. To receive the diagnosis, a person must have five or more symptoms such as the following, nearly every day during a two-week period: fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, reduced physical movement, indecisiveness or impaired concentration, a decreased or increased appetite, and a greatly diminished interest or pleasure in regular activities. Experts are trained to identify exactly how much “impaired concentration” or “loss of energy” is enough to qualify for a diagnosis, and the criteria are intentionally flexible enough to factor in patients’ individual circumstances. But as the pandemic has made clear, the DSM-5 and medical model as a whole don't provide the richness of language to account for all the nuanced ways people might look or feel depressed, even when they don’t need medical intervention. Well-meaning attempts to standardize the diagnostic process have created a false binary wherein you are a person with depression, or you are not. Outside of medicine, depression has been most cogently defined through metaphor. As Sylvia Plath wrote: “The silence depressed me. It wasn't the silence of silence. It was my own silence.” David Foster Wallace described depression as feeling that “every single atom in every single cell in your body is sick.” Even some clinical models reach for alternative ways of articulating despair beyond the conventional medical model. James Hollis, a psychodynamic analyst and the author of Living Between Worlds: Finding Resilience in Changing Times, says that depression is sometimes the result of “intrapsychic tension,” a conflict between two areas of our psyche, or identity. The tension is created, Hollis observes, “when we’re forced to try to make acquaintances with ourselves in new ways.” Many Americans do seem to be experiencing something like this tension during the pandemic. People who define themselves by their work can lose a basic sense of self if that work disappears. In such moments, Hollis says, many people regress. Many also try to escape—whether by organizing an already well-organized sock drawer, baking bread they don’t even want, or endlessly scrolling through Instagram. Jarvis, the trauma therapist, is seeing similar escapist tendencies: “For someone's response to a huge global pandemic to be like, I’m going to work out really hard, is just as pathological and sort of dissociative as if you went to bed and didn't get up for five days.” For people whose response to the pandemic turns from acute anxiety into general malaise, Jarvis recommends facing the numbness head-on. It’s treatable, and not necessarily with medication. First, she says, create regimens of simple tasks that give structure to the day. The approach is working for Falcone, the acupuncturist. He starts every day with 30 minutes of stretching, no matter what. Then he walks his dog, makes coffee, and sits down to teach massage via Zoom. Deb Hawkins, the tech analyst, sent me a list of things she’s doing to help others and stay busy: She donated money to a couple of worthy causes, and made an appointment to give blood. She has created a small social bubble and signed up for an online ballet class. She says her sense of self is returning. Small steps like these will not work for everyone, but they may help many in the subclinical realm to mitigate a dangerous slide. With the medical system already stretched thin, these could buy some time to build its capacity to care for the people who will emerge from the pandemic with severe and lasting symptoms. As important as preventive behaviors can be, human resilience has limits. Those will be tested for months to come. The individual model of depression was never meant to address a significant percentage of a population. When the diagnosis seems to apply so widely, it’s not the people or the entire medical system that’s broken, but the social context. While many people will find ways to recalibrate their expectations and individual thresholds for joy in the pandemic, ultimately basic needs still have to be met. This means eliminating sources of anxiety, such as by ensuring financial, housing, and food security. In Colorado, Leiferman’s group is among those scrambling to help stem the tide of depressive symptoms. “Our nation is under stress. It may be that more people need [medical] treatment,” she says. “It may be that we need to, as a population, do more to relieve the stress.” from https://ift.tt/2WRLNKg Check out http://natthash.tumblr.com If you think about it, “the face mask is the condom of our generation,” says Brian Castrucci, the president of the de Beaumont Foundation, a public-health nonprofit. Castrucci spent a decade working in state and local health departments, and he remembers when the HIV epidemic made condoms mainstream in the United States. No one was especially thrilled about it, but as the dangers of unprotected sex became clear, people came to accept them. The same can now be said of face masks, which have gone from seeming like a silly overreaction to a ubiquitous pandemic necessity. Parents are pulling them onto their toddlers. Waiters are wearing them. Pool-goers might don them. There’s even a disturbing-looking contraption that lets you eat with one on. We’ll probably keep having to wear masks in public for the foreseeable future. Ben Cowling, the head of epidemiology at the University of Hong Kong’s School of Public Health, told me he recommends wearing masks on public transit or in crowded areas even after it’s safe to leave our homes again. Trish Greenhalgh, a primary-care professor at the University of Oxford, told me people should wear masks in public until “there are no new cases, or very few cases,” a goal that the U.S. is still very far from reaching. But while masks are good for public health, they also make our interactions more difficult by concealing the lower part of our face. The constant social ambiguity might get harder to take once states start opening up more fully, and we resume some of our regular activities. Some experts say that might portend a push toward different types of coverings that don’t hide our face. Or, it might mean that our norms of communication will change, perhaps forever. [Read: The real reason to wear a mask] David Matsumoto, a psychologist who runs a body-language-training company called Humintell, told me that we might be losing a lot of context if we’re communicating with only our eyes, especially from six feet away. “A lot of the visual cues that you see in normal interaction is that large part of the face from the bridge of the nose down,” Matsumoto said. Without these cues, there’s a much greater chance of misunderstanding. Whether you’re being genuine or sarcastic, for instance, stems from the shape of your mouth when you say it. Even the most expert “smizer” has probably worried that they look mad with a mask on. It’s also harder to develop and maintain social bonds when you’re not talking with your full face. “That’s why we have ‘face-to-face interactions’ and not ‘knee-to-knee interactions,’” Matsumoto said. If people get fed up with masks, one option might be to use face shields: clear-plastic guards attached to a headband. These at least allow you to see your interlocutor’s face, and for the hearing impaired, they allow for lip-reading. For people working in jobs that require a face covering, face shields might simply be more pleasant to wear all day. “I can imagine that if you were bagging groceries six hours a day that it would be probably much more comfortable to wear a face shield,” says Angela Rasmussen, a virologist at Columbia University. No studies have yet compared whether masks or face shields are more effective at preventing coronavirus transmission, but it’s possible that shields might keep us safer. Michael Edmond, a University of Iowa epidemiologist, has written that face shields reduce exposure to more than 90 percent of flu droplets from a cough, and unlike masks, they have the added benefit of keeping viral droplets out of a person’s eyes. People wearing masks might also be tempted to scratch or touch their face, but people wearing shields physically can’t. Yet Cowling said he doesn’t think a face shield would be as effective as a mask for this pandemic. While a shield could protect the wearer from large droplets, he said, it wouldn’t prevent them from spewing the virus. (Edmond points out that a cloth mask does not perfectly keep in droplets, either.) Then there is face shields’ distinctive look. They are, well, dorky. Edmond says many of the staffers at the hospital where he works wear face shields, and they’ve gotten used to walking around looking like Lego welders. But regular people might not be ready. [Read: Everyone thinks they’re right about masks] Even though they make social interactions more challenging, masks might continue to be more common than face shields simply because they can be made at home without any special supplies. If that’s the case, it might be necessary to change the way we communicate in order to convey what we mean without using facial expressions. The small smirks and grimaces we rely on to get the real point across might soon go the way of the bow or curtsy. To overcome these hurdles, Matsumoto recommends people gesture more—and really just say more—when they’re wearing masks. People should ask one another more questions and confirm one another’s understanding: I’m hearing you say this; am I understanding that right? It’s important to not assume someone will know what you mean. Perhaps these tricks will even help us communicate more clearly long after we can finally take our masks off. If not, there are always emoji hats. from https://ift.tt/2TtgjIk Check out http://natthash.tumblr.com On the latest episode of the Social Distance podcast, James Hamblin and Katherine Wells ask the infectious-disease expert Stephen Thomas to explain the medical and ethical issues involved in developing a new vaccine. Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. Katherine Wells: I don’t actually understand how vaccines are developed on any sort of granular level. James Hamblin: How do you go from this tiny prototype in eight people where they didn’t seem to be harmed, to a billion people with a needle in their arm? It is a technical process that could go a few different ways, depending on our capacity or willingness to incur risk. We can play it really safe and do it really slow, but lots of people are dying every day of this disease. There are incentives right now to take risks that usually vaccine-development people wouldn’t take. An idea that is being discussed in vaccine circles is “human challenge trials,” which we’ve done for some other viruses, but they are not being done right now for this coronavirus. They involve giving people one of these test vaccines and then purposefully exposing them, in a standardized way, to the virus. When you have a disease like this, you have to get a huge number of people with the test vaccine and then see what percentage gets sick and what percentage doesn’t. But [with a regular trial] you don’t really know who is actually exposed [to the virus]. How many of those people who didn’t get sick just didn’t get sick because they were staying at home with their huge bag of Purell? Wells: So a challenge trial would speed up [the development process] because we would know exactly who was exposed? Hamblin: Right. You could say, 70 percent of the people who got the vaccine were protected, and 30 percent of them got sick. The problem is that would mean people got sick with a disease like this, and potentially even people died or had lasting complications. There’s obviously a big ethical dilemma there. But it could theoretically really speed up this process and make it more scientifically valid more quickly. It’s not happening right now, but some people are proposing that it should. Stephen Thomas is the chief of infectious disease at SUNY Upstate Medical University. His focus has been on researching vaccines. Wells: What is a challenge trial? And should we do it? Stephen Thomas: This is where we give a healthy human being a mild form of the disease that we are trying to study so that we can hasten the development of a countermeasure drug or a vaccine, or we can fill in some critical gap in information that we are not able to fill using standard, benchtop science or small animals like rats and mice. Challenge trials have been around for well over 100 years, and multiple diseases use challenge trials to support their development. Each disease has particular reasons why human challenge makes sense. Wells: A challenge trial is where you vaccinate someone and then you expose them deliberately to the virus to see if they get it. Is that right? Thomas: That’s the second step. The first step is exposure without the vaccine. Hamblin: You have people who have volunteered to be infected. How do you navigate that space about how someone can really consent to that, and who is willing, and why they would be willing to go through that? Thomas: There needs to be what we call “democratic deliberation.” There needs to be consensus among interested and disinterested parties, to include physicians and scientists and ethicists and regulators, that the disease that you’re talking about is appropriate for a human challenge. You’re not going to have a human challenge model for a chronic, incurable disease. You’re not going to have a human challenge trial where the risk to the individual is unacceptably high—that’s a whole discussion in and of itself. You’re not going to have a human challenge model where the risk to others, not just the person who volunteers, but other people, is unacceptably high. Then you propose a plan to the ethical review committees and the FDA. Part of that plan is the informed-consent process, where you explain to the potential volunteers what the risks are and what the benefits are. And oftentimes, the only benefit is that they will be advancing science and that they might be able, through their sacrifice, to help somebody else. Wells: Do you think it’s likely that this global pandemic will create the necessary urgency to make whatever risks worth it? Do you think a challenge is going to happen? Thomas: There are too many unanswered questions about how we would actually do them. For me personally, I absolutely think it should be thought about, and it should be discussed. Challenge trials, in the right circumstances and under the right conditions, can be incredibly valuable. I put my money where my mouth is, not just because I do challenge trials, but I have volunteered for a challenge trial. Hamblin: What did you get? Thomas: Malaria. I was an infectious-disease fellow at the time, and I knew what I was going to do with my life. And I said, “Someday you’re going to have to say that you stepped up and actually did what you’re asking other people to do.” Hamblin: How did they expose you? Thomas: I got three vaccinations over a period of weeks and then waited for a month. And then I came back in, and they had five malaria-infected, very hungry mosquitoes in a little cup with a screen on top of it. I put my arm on the top of the cup, and the mosquitoes came up and fed on my blood. And then [the researchers] took the mosquitoes and took the salivary glands out of the mosquitoes, and they confirmed that each of the five mosquitoes had malaria. Wells: Did the vaccine work, or no? Thomas: As a matter of fact, it did. Wells: I imagined that there would be some highly scientific, tech-heavy process. But no, we just take malaria-infected mosquitoes and have them bite you. Thomas: This is a great point that you raise, because ideally, you would want to deliver the virus the same exact way that somebody would be exposed. Hamblin: Oh no. So for COVID-19, would people be coughed on? Thomas: That’s one of the questions: How are you going to deliver the virus? Wells: How much time do you save by going straight to a challenge? Thomas: If it worked really well, and the FDA believed that it worked really well, and the FDA said, “Listen, we will give you a license and allow you to sell your vaccine based on challenge data alone.” Then I think that’s one of the scenarios where we potentially could meet this warp-speed benchmark that has been put out there: [a vaccine] by the end of the year. Wells: I imagine even if we did challenge trials, it’s not guaranteed. A lot of other things would have to go really, really right for us to have a vaccine widely available by the end of the year. Thomas: That’s correct. Is it possible that we could be on the doorstep of having a vaccine by the end of the year? Sure, it’s possible. Is it likely? No. There’s a lot of open boxes that you have to check between now and then. from https://ift.tt/2ZwY60p Check out http://natthash.tumblr.com |
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