Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. The United States is once again at risk of outstripping its COVID-19 testing capacity, an ominous development that would deny the country a crucial tool to understand its pandemic in real time. The American testing supply chain is stretched to the limit, and the ongoing outbreak in the South and West could overwhelm it, according to epidemiologists and testing-company executives. While the country’s laboratories have added tremendous capacity in the past few months—the U.S. now tests about 550,000 people each day, a fivefold increase from early April—demand for viral tests is again outpacing supply. If demand continues to accelerate and shortages are not resolved, then turnaround times for test results will rise, tests will effectively be rationed, and the number of infections that are never counted in official statistics will grow. Any plan to contain the virus will depend on fast and accurate testing, which can identify newly infectious people before they set off new outbreaks. Without it, the U.S. is in the dark. [Read: A devastating new stage of the pandemic] The delays have already started. Yesterday, Quest Diagnostics, one of the country’s largest medical-testing companies, said that its systems were overwhelmed and that it would now be able to deliver COVID-19 test results in one day only for hospitalized patients, patients facing emergency surgery, and symptomatic health-care workers. Everyone else now must wait three to five days for a test result. “Despite the rapid expansion of our testing capacity, demand for testing has been growing faster,” Quest said in a statement last week warning of such a possibility. The company then said that orders for COVID-19 testing had grown by 50 percent in three weeks. “This is very bad,” Michael Mina, an epidemiology professor at Harvard, told us. Rapid test turnaround times are the only way to control the coronavirus without forcing every potentially contagious person—everyone who’s had contact with someone diagnosed with COVID-19—into quarantine, he said: “Our modeling efforts more or less show that if you don’t get results back in a day or so, outbreaks really can’t be stopped without isolating and quarantining all contacts preemptively.” Quest is not the only firm to report growing problems. “We hit the wall three weeks ago,” Jon Cohen, the executive chairman of BioReference Laboratories, a lab-services company that is testing patients for the virus in New York, New Jersey, and Florida, told us. “At that point, most laboratories were already running at capacity, as far as I can tell.” In mid-June, four changes hit all at once, Cohen said. Large companies began to test their employees en masse, hospitals started to test every patient who needed an elective procedure, and nursing homes started regularly testing their employees and some residents. The American public also seemed to seek out voluntary tests in greater numbers this month. The surge in testing overwhelmed both his testing company’s capacity and its equipment suppliers, he said. “We not only hit capacity, but any ability to increase our capacity became limited by the supply side,” he said. “The vendors, the suppliers can’t keep up.” [Read: America is giving up on the pandemic] LabCorp, another major testing company, also recognized the surging demand for tests in a statement this weekend. “We are doing everything we can to continue delivering results in a timely manner while continually increasing testing capacity,” it said. Unlike in the first days of the pandemic, when COVID-19 testing kits themselves were in short supply, now the problem lies with the equipment needed to get test results. The hardest-hit new areas do not have enough machines to process samples, leading to a growing backlog of tests, lab directors told us. Some are also running out of the chemical reagent that must react with a testing specimen. Labs in the U.S. use several different types of viral-testing machines to diagnose COVID-19, and each type has its own supply-chain issues and processing challenges, Lauren Sauer, an emergency-medicine professor at Johns Hopkins, told us by text message. With “so many platforms” in use, she said, resolving bottlenecks and shortages nationwide is especially hard. “What is currently happening [on testing] is so pocketed and disconnected,” she said. The American Clinical Laboratory Association, a trade group that represents testing labs, has also warned of shortages. “While our members are collectively performing hundreds of thousands of tests each day, the anticipated demand for COVID-19 testing over the coming weeks will likely exceed members’ testing capacities,” said Julie Khani, its president, in a statement. The group’s members conduct about half of the country’s daily coronavirus tests, according to information in her statement. The problems have not been felt everywhere. Dina Greene, the director of laboratory services for the health-care group Kaiser Permanente in Washington State, told us that supply-chain problems have not yet disrupted the group’s ability to work. But demand for tests was increasing, she confirmed, and she “wouldn’t be surprised” if shortages hit her team soon. [Read: ‘How could the CDC make that mistake?’] Testing has hobbled the American response since the earliest days of the pandemic. As our reporting revealed, the U.S. had tested fewer than 3,000 people for the coronavirus by March 5, even though community spread of the virus had been detected more than a week earlier. In the following weeks, states and hospitals rationed access to tests, granting them only to health-care workers and the sickest patients. This meant that many people who may have had the virus, especially in the Northeast, were never tested for it. Even after the initial crunch in March, the country’s testing apparatus continued to be beset by problems. For much of April, as the virus killed tens of thousands of Americans, testing plateaued at roughly 150,000 tests a day. Since then, the number of daily tests has increased, but not as fast as experts once hoped. Only in the past two weeks has the U.S. succeeded in testing more than 500,000 people a day, which the Harvard Global Health Institute once said would be a good goal for mid-May. The institute said today that the U.S. must test at least 1.2 million people a day to control the outbreak and at least 4.3 million people a day to eliminate it. In all that time, the federal government never solved the testing problem. In early April, for instance, researchers at Duke University and the American Enterprise Institute, a conservative think tank, called for the government to take charge of the crisis by establishing a task force that would consolidate information about testing and help states and companies understand what was possible. Such a task force could manage emerging shortages, and it could help the country understand how much testing capacity might be attainable by July, August, or September. But such an effort never took shape. “If this work has been done, I have not seen it, and I fear that neither have the governors and other state and local leaders who are having to make decisions about how and when to reopen,” Caitlin Rivers, an author of the report and a professor at Johns Hopkins University, told Congress last month. Since then, the Trump administration’s grip on testing has slackened. Brett Giroir, the White House’s testing czar, returned to his day job at the Department of Health and Human Services this month. And at a rally on June 20, President Donald Trump said he told members of his staff to “slow down the testing, please,” because he did not like the growing number of confirmed coronavirus infections. (The president’s staff said afterward that he was joking. After denying for several days that he meant the comment in jest, Trump said last week that he’d been speaking “sarcastically.” Deborah Birx, who is coordinating the White House response to the coronavirus, has said that Trump never asked her to slow down testing.) “We basically need a Manhattan Project for testing,” Sauer said. “A nationwide, systematic strategy with a clear agency lead is desperately needed. But it’s not happening and I think we all fear significant access issues and supply-chain disruptions in the near future.” The U.S. is seeing a new surge of cases in the South and West that threatens to overwhelm its health system anew. The country reported more new confirmed COVID-19 cases last week than in any week of the pandemic so far. While the administration’s focus has drifted elsewhere, demand for tests is only growing. Alex Greninger, a laboratory-medicine professor at the University of Washington, told us that it was little wonder the testing companies were overwhelmed. “The testing supply chain wasn’t meant for this kind of onslaught of volume across the world at the same time,” he said. from https://ift.tt/3gf0nlW Check out http://natthash.tumblr.com
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Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Updated at 9:30 a.m. ET on June 26, 2020. For the past few weeks in the United States, the awful logic of the coronavirus seemed to have lifted. Stores and restaurants reopened. Protesters flocked to the streets. Some people resumed going about their daily lives, and while many wore face masks, many others did not. Yet cases continued to ebb. Even though the U.S. had adopted neither the stringent lockdowns nor the trace-and-isolate strategies seen in other countries, its number of confirmed COVID-19 cases settled into a slow decline. Last week, Vice President Mike Pence bragged that the country had made “great progress” against the disease, highlighting that the average number of new cases each day had dropped to 25,000 in May, and 20,000 so far in June. [Read: The Sun Belt spikes could be a disaster for Trump] That holiday has now ended. Yesterday, the U.S. reported 38,672 new cases of the coronavirus, the highest daily total so far. Ignore any attempt to explain away what is happening: The American coronavirus pandemic is once again at risk of spinning out of control. A new and brutal stage now menaces the Sun Belt states, whose residents face a nearly unbroken chain of outbreaks stretching from South Carolina to California. Across the South and large parts of the West, cases are soaring, hospitalizations are spiking, and a greater portion of tests is coming back positive. The country’s second surge has arrived—and it is hammering states, such as Texas and Arizona, that escaped the first surge mostly unscathed. [Read: America is giving up on the pandemic] This new surge is large enough to shift the entire country’s top-line statistics. In terms of new confirmed cases, three of the 10 worst days of the U.S. pandemic so far have come since Friday, according to data collected by the COVID Tracking Project at The Atlantic. The seven-day average of new cases has now risen to levels last seen 11 weeks ago, during the worst of the outbreak in New York. The U.S. has seen more cases in the past week than in any week since the pandemic began. Since June 15, most of these new cases have come in the South. The ongoing outbreak there is the second-worst regional outbreak that the U.S. has seen so far. Only the springtime calamity that befell the Northeast—which was one of the worst coronavirus outbreaks anywhere in the world, if not the worst—exceeds what is now happening across the Sun Belt. Ominously, sparks from the Sun Belt outbreak may be landing in other parts of the country and igniting new blazes of infection. Since June 15, Ohio and Missouri have seen their average daily case counts increase by the hundreds. Virginia, which battled the virus in May but has so far escaped this month’s surge, has also seen cases rise in the past few days. [Read: A hidden COVID-19 risk factor: your boss] The national surge is driven primarily by potentially disastrous situations in Arizona, South Carolina, Texas, Florida, and Georgia. Many virus statistics in these states now look like straight lines pointing upward. In Arizona, where President Donald Trump held a large indoor rally this week, the situation is particularly bleak. Over the past month, the number of confirmed cases there has grown nearly fourfold; the number of people hospitalized has more than doubled. On Tuesday, the state reported more than 3,500 new cases in one day. That’s equal to 494 new cases for every 1 million residents, a figure that rivals New York State’s numbers in March and April. Were it not for Arizona’s terrifying surge, spikes in other states would register as major events. Texas has seen an explosion: On June 1, it reported about 600 new cases of COVID-19; yesterday, it reported more than 5,000. Its hospitalizations have more than doubled in the same period. Florida, for its part, has reported an average of 3,756 new COVID-19 cases each day for the past week, a fourfold surge in daily cases compared with a month ago. And in South Carolina, new cases have grown sevenfold since mid-May. The Palmetto State now records nearly 950 new COVID-19 cases every day, or about 184 new daily cases for every 1 million residents. Across the country, 10 states have set new records for case counts in the past three days. Why are these spikes happening? The answer is not completely clear, but what unites some of the most troublesome states is the all-or-nothing approach they took to pandemic suppression. The stay-at-home order in Texas, for instance, lifted on April 30. A day later, the state allowed nearly all of its businesses and public spaces—stores, malls, churches, restaurants, and movie theaters—to open with limited capacity. It has since further loosened those restrictions. Arizona allowed some stores and businesses to reopen in early May; it lifted its stay-at-home order on May 15 and allowed bars, gyms, churches, malls, and movie theaters to reopen around the same time. And while the state mandated some form of capacity restrictions, those rules were regularly breached: For weeks, photos and videos have shown scenes of crowded Arizona bars and nightclubs. [Read: COVID-19 can last for several months] A form of wishful thinking seemed to drive these decisions: If the virus could be ignored, then it might go away altogether. Even though polls show that most Republicans wear masks, the Republican leaders of Texas and Arizona catered to the party’s anti-mask fringe and waffled on their importance. When the government of Harris County, Texas—which includes Houston, the country’s fourth-largest city—mandated that residents wear masks in public or risk a $1,000 fine, the state government blocked the rule. Texas Lieutenant Governor Dan Patrick called a face-mask mandate “the ultimate government overreach,” and Representative Dan Crenshaw said it could lead to “unjust tyranny.” Eventually, Governor Greg Abbott of Texas and Governor Doug Ducey of Arizona went even further, blocking cities and counties from implementing any pandemic-related restriction more stringent than that required by the state.* This meant that when a video emerged of packed nightclubs in Phoenix, full of people who were not wearing masks, the mayor was unable to close or sanction the clubs—or even require them to force patrons to wear masks. Both governors finally reversed those policies last week. (“To state the obvious, COVID-19 is now spreading at an unacceptable rate in Texas, and it must be corralled,” Abbot said at a press conference on Monday. This had not been obvious to the governor less than a week earlier, when he told Texans that the state’s record-breaking number of new infections was “no reason today to be alarmed.”) Yet these decisions do not fully explain the surge. Governor Ron DeSantis of Florida, also a Republican, allowed some cities and counties to wait to reopen on May 18, weeks after the rest of the state; though he criticized face-mask rules, he has not blocked cities from imposing their own. Governor Gavin Newsom of California, a Democrat, imposed the country’s first stay-at-home order, on March 19, and didn’t begin lifting restrictions until May 8. But counties have had wide leeway to enforce their own rules, and Newsom kept some high-risk businesses, such as gyms and movie theaters, closed until June 12. Yet in both states, infections are increasing. [Read: A common snake oil reemerges for the coronavirus] No matter their cause, these outbreaks are now too significant to explain away with statistics. In the past few weeks, President Donald Trump and other officials have claimed that the rise in cases is illusory and due solely to an increase in testing. “Cases are going up in the U.S. because we are testing far more than any other country, and ever expanding,” Trump said on Twitter earlier this week. “With smaller testing we would show fewer cases!” This effect—if you test more people, you have more cases—is obvious enough, but it fails to explain the surge that we’re seeing now. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, disputed the idea that testing alone is responsible for the spiking case count. [Read: We don’t even have a COVID-19 vaccine, and yet the conspiracies are here] “Clearly, if you do more tests, you will pick up more cases that you would not have picked up if you don’t do the tests,” he told The Atlantic. “But—and this is a big but—what you look at is what percentage of the tests are positive. If the percentage of any given amount of tests in one week—take an arbitrary number, [if] 3 percent [are positive]—and the following week it’s 4 percent, and the week after that, it’s 5 percent: That can’t be explained by doing more tests. That can only be explained by more infections. “When you see hospitalizations, that’s a clear indication that you’re getting more infections,” he said. The South and West meet all of Fauci’s criteria: Cases, hospitalizations, and the test-positivity rate are spiking in both regions. A month ago, health-care workers in Arizona had to test about 11 people to find a new COVID-19 case; today, one in five people they test has the virus. In Florida, the number of tests per day has actually fallen in the past week while the number of new cases has spiked. The Sun Belt surge, in other words, is not a by-product of increased testing. In the South and West, finding people sick with COVID-19 is simply getting easier. Felicia Goodrum, a professor of immunobiology at the University of Arizona and the president-elect of the American Society for Virology, has found it painful to watch her state accept its rapidly surging infections with defeat. State leaders “look at the numbers, at the rise in cases, which are staggering, and they say, ‘There’s nothing we can do about this.’ And that’s just not true,” she told us. Face masks and social distancing could still slow the virus’s spread, she said last week, but the state was running out of time. “We’re reaching this critical point where the only way we’re going to reverse what’s happening is to do a complete shutdown again,” she said. “We’re playing with fire, and we will get burned.” So much for the fears of a resurgence in the fall. As the first official days of summer unfurl, American coronavirus infections are threatening to bubble over. The virus has not gone away with warm weather, as President Trump once mused that it might. It has gotten worse. Yet last week, as cases ticked up in the Southwest, Vice President Pence declared in The Wall Street Journal that “there isn’t a coronavirus ‘second wave.’” He pointed out that “more than half of states are actually seeing cases decline or remain stable.” This was the same op-ed in which he boasted that new cases have “stabilized” in the U.S., falling to 20,000 a day. [Read: So, what can we do now?] These numbers are not comforting. The vice president was still implicitly saying that nearly half of states are seeing an increase in new cases. He was also framing 20,000 new cases a day as an accomplishment, even though countries in Europe and East Asia have seen much lower daily case counts on a per capita basis. What Pence’s op-ed suggests but does not say is that the U.S. never brought its pandemic under control—the “first wave” never ended. And his timing turned out to be dreadful. That key number—20,000 new cases a day—quickly became outdated: The U.S. is now seeing an average of about 30,000 new cases a day. Because more people live in the South than the Northeast, the country could soon record more than 40,000 cases a day, if not more. [Read: The pandemic broke end-of-life care] A “second wave” was never a good yardstick, because the “first wave” that struck the greater New York area this spring was a disaster beyond reckoning. Consider that New York City, population 8.4 million, saw more than 22,300 confirmed and probable deaths from COVID-19; one of Europe’s worst outbreaks, in the Lombardy region of Italy, population 10 million, saw about 16,500. In three and a half months, in other words, a new virus killed one in every 400 New Yorkers. Among the elderly, the toll was even worse: One in every eight New Jersey nursing-home residents died this spring. The virus remains the virus. It can take up to 14 days for someone to show symptoms; it can take another two weeks for that person to appear in the data as a confirmed case. This means that, as the Northeast learned in the spring, virus statistics tell you what was happening in a community two to three weeks ago. The South, in other words, may have tens of thousands of COVID-19 infections that it cannot yet see. In the months to come, 20,000 new cases a day will look like a low point of new daily cases—a reprieve in the long horror of the American pandemic. [Read: Why the coronavirus is so confusing] The outlook is not entirely dismal. Last week, the U.S. met a long-sought milestone: It can now test half a million people each day for the virus. This is more than four times the number of people that could be tested in early April. This means that it may be possible to contain some outbreaks in the South. In addition, the U.S. death toll has been in a slow decline for weeks: About 600 Americans are dying of the coronavirus every day, the lowest daily total since March. This data point may mean that American hospitals are getting better at treating people sick with COVID-19—or it may simply mean that the Sun Belt surge has not yet shown its full lethal potential. For now, the data are impossible to interpret. Because COVID-19 itself can take weeks to kill its victims—and even then the data do not reflect them immediately—we should not expect to see victims of the Sun Belt surge appear in death data for as many as 28 days after it began. We still have time to save lives. After the outbreak in the Northeast, experts and officials identified several countermeasures that did not require sheltering in place. One of the most important was protecting long-term-care facilities. Because the virus is deadliest for older people, killing about one in every 20 infected adults ages 65 and up, keeping the virus out of nursing homes could considerably reduce the death toll from the surge. [Read: We’ll be wearing things on our faces for a long time] Yet in Arizona, for instance, we have little idea what is happening inside such facilities. Preliminary data from the COVID Tracking Project show that the number of long-term-care facilities and assisted-living facilities with outbreaks has grown from 192 to 268. The virus is still clearly getting in. The state governments in Arizona, Florida, and Texas must do everything they can to stop it—in part by regularly testing residents in these facilities and by building a centralized quarantine site for older adults who have COVID-19 but do not require hospitalization. [Read: ‘We’re literally killing elders now’] A month ago, our colleague Ed Yong wrote that the United States was facing a “patchwork pandemic,” an awful months-long period when the virus would afflict states, cities, and neighborhoods differently. The U.S. now must prove that it can contain one of these flare-ups. New York, New Jersey, and Connecticut—the site of the first major U.S. COVID-19 outbreak—yesterday imposed restrictions on travelers arriving from Texas, Arizona, and other states in the South and West with dangerously high caseloads. The three states will require people arriving from these places to quarantine for two weeks, but their ability to enforce that policy is questionable. The spring surge trained us to think that regional outbreaks could stay contained to a region. But the northeastern surge happened when the whole country was sheltering in place. This moment is different: Can the rest of the country continue to reopen their economies while the South boils over with cases? On Tuesday, Governor Abbott said that Texans have no reason to leave their homes—essentially asking them to voluntarily quarantine. He has since canceled elective surgeries in some of the state’s hospitals, but said that reimposing a formal shelter-in-place order in Texas is a measure of last resort. Such measures may seem unimaginable now. But if a coronavirus outbreak rips through the state, infecting a large portion of its 29 million residents, then more than just Texas’s health and economy will be on the line. [George Packer: We are living in a failed state] The spring surge resulted from a widespread failure of American governance. Yet a first coronavirus outbreak in the U.S. may have been unavoidable, and Americans eased its agony by choosing to act together: Our collective decision to stay at home averted an estimated 4.8 million additional COVID-19 cases. A second surge will allow for no such succor. It will reveal that our leaders, instead of wrestling the virus into submission, gave up on it halfway. That choice will have an unaccountable cost. If several large states plunge into full-scale coronavirus outbreaks, then Americans may need to again act as one—or we will see so much misery that we will yearn for the spring. *This article previously misstated the Arizona governor's first name. He is Doug Ducey, not Dan. from https://ift.tt/2BzHuuR Check out http://natthash.tumblr.com In the past few months, after the pandemic hit, many people chose to leave big cities—at least for now. Amanda Mull joins executive producer Katherine Wells and staff writer James Hamblin to talk about whether their departures will be permanent. 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: Are people actually leaving cities right now in meaningful numbers? Amanda Mull: It sort of depends on the city you're talking about. There's a couple of things going on with New York, specifically. First, it was the epicenter of the global pandemic for a period of time, which is enough to make a lot of people skittish, especially people with options. New York is also just eye-wateringly expensive and along with the health implications of the pandemic, there have been a lot of economic implications for people who are working in the service industry, people working in hospitality, especially. You get sort of a perfect storm in New York City of people who might be tempted to leave right now, or at least were tempted to consider the possibility over the past few months. But then you try to square that with what we know about how people have been moving in and out of cities and in and out of different regions of the country in the United States in general over the past five years. And New York has a pretty high rate of attrition in normal times—when there's no century-defining disaster going on. You see a wider picture of migration in this country where especially wealthy, mostly white, younger adults move out of the biggest, most expensive cities—San Francisco, New York, L.A.—and toward generally Sunbelt cities; Atlanta, Nashville, Austin. James Hamblin: But the pandemic is going to make people want to be in cars and have yards, right? Mull: That is sort of the theory that a lot of people are working on. I talked to two different demographers for this story and one of them in particular was suspicious of this theory. She said that, in general, people move for life-stage reasons. It is because of things that are happening internally in their lives. She was really not buying the idea that this is going to set off a huge, noticeable, sustained trend of people moving who were not at all planning to do it beforehand. Wells: I feel like since the invention of the internet, and probably long before, people have been like remote work: you will be able to work from anywhere and jobs will be completely done with technology and blah, blah, blah. That obviously hasn't been the case. But now there's this whole idea that much office work can be done functionally from anywhere. Is there any nuance to the kind of remote office work shift that's going on? Mull: I believed this for a while too, but reporting this story dissuaded me from this belief. The labor expert who I talked to was very suspicious. This article was just a process of me calling people who were like, I don't think I buy that. When I asked him, are we going to work from home forever? And if we do, is that going to motivate a lot of people to move out of expensive cities where jobs are concentrated? He was like, I don't think so. As things are now, there is a high chance that a lot of people head back to offices sometime this year and that employers want to have at least part of their workforce in offices. Wells: It sounds like the experts you talked to said grooves of behavior and location run deep and it's not like there's a pandemic for three months and all of a sudden the cities empty out and we all live totally differently. Hamblin: But when you can't do the things that you love to do in the city and if it becomes apparent that those things are forever changed or going to be gone for a very long time—like a packed bar or club or a musical concert or a theater. Then doesn't that change the value proposition of the city? Mull: [The experts I spoke with] were not convinced that things would change enough to drive a lot of people out. If you are someone who really loves theater or really loves nightlife or something like that, there's not like there's a place you can move to get that back sooner. I think that they are going to have to wait it out wherever they go. And if they really liked what New York City provided them before it seems that right now their best option is to wait it out here if they can still afford it. Wells: We're at record high unemployment and it seems like there might be a migration happening with people who've been in the restaurant industry or in industries that are just clearly not going to come back the same way they were. Is that kind of migration happening? Mull: Yeah, I was also curious about this. And what I learned in talking to some demographers is that it's really only upper-middle class and wealthy people who tend to move between cities or between regions. People with less money move between dwellings very frequently, but they move between cities or between regions very infrequently. Wells: So this whole cities are going to empty out thing is a phenomenon because a certain very online group of people who have the kinds of jobs that could be done remotely are wondering out loud if their lives would be nice or somewhere else? Mull: Right. The people who get charged with telling the stories of how the pandemic is going, and especially in New York, are generally people who might be wondering themselves if they should leave. But that phenomenon, that flexibility, is largely a function of being college-educated, upper-middle class or wealthy and having family financial resources that could help them if they lose a job or something like that. People who have lived in New York for their entire lives and have working-class jobs are generally playing with a much different set of factors and incentives. I think the larger trend that's at play here is that cities need to figure out how they become hospitable places for people who want to have children. And I think that that is a problem that is sort of understood to be the thing that is pushing people out of cities like San Francisco and New York and L.A. That was true before the pandemic and it's true now. Wells: Yeah, but generation upon generation of people have been born and raised in New York City and most people don't leave to have a baby. So I know it's possible. Cities could definitely make it easier but most people don't leave the place they are from just to have a child, right? Mull: I think that in the past that has been true, but especially in these very expensive, very crowded cities, you see a disconnect in the past decade or two between housing prices and wages. That [disconnect] is larger and getting even bigger than it ever has been before in the country's history. So there's this tension increasing in a way that the previous generations of people didn't have to think about as much. People who are not rich enough to buy their way out of this problem in New York City, but who have enough flexibility and resources to move elsewhere to solve the problem—that's the tier of people who end up leaving. Wells: Yeah. So in summation, the rumors of the death of cities ... Mull: ... have been largely exaggerated. Hamblin: And for anyone out there who might be considering panic-moving, you'd say—don't? Mull: Yeah, I would say if you think you can tough it out for another year and see what happens I think that everybody who can do that who is considering moving now will be in a better position to make an informed decision. Every time I report a story on what the pandemic is doing to American life, the thing that experts of whatever kind tell me is that we don't know how this is going to play out and that there is not enough data yet to give us good indications by which we can make decisions. So, I think that if people can just white knuckle this like six months or a year or more, they are going to have so much more information. from https://ift.tt/3i8Hq5U Check out http://natthash.tumblr.com Editor’s Note: The data used in our COVID-19 tracker are updated daily around 5 p.m. ET. How many people have the coronavirus in your state, and how many people are being tested for it? The COVID Tracking Project at The Atlantic is monitoring vital information about the pandemic in each U.S. state, as well as the District of Columbia and Puerto Rico. All 50 states regularly report their new positive cases, as do Washington, D.C., and Puerto Rico. But some public-health departments aren’t providing as much information to the public as others. To help readers understand how thorough each one is in its reporting, we’ve assigned every state a letter grade. This grade does not assess the quality of a state’s testing, but rather the detail, transparency, and regularity of its data. As of June 25, the COVID Tracking Project assesses states on 16 different factors in five categories, and it revises state grades at least once a week. In our data, each state’s number of positive cases includes people who are currently ill with COVID-19, people who have recovered from it, and people who have died. We have also broken out the number of deaths into its own column, which you can find in the “Overall” view. You can explore the data by selecting a state in the chart below: Melissa DePuydt, Frankie Dintino, Tolulope Edionwe, Alexis C. Madrigal, Robinson Meyer, Gerald Rich, Quinn Ryan, and Jacob Stern contributed to this report. from https://ift.tt/31cUfq2 Check out http://natthash.tumblr.com When the term girlboss was foisted on the public in 2014, the United States was already well on its way to the series of cascading disasters that have shaped 2020, even if they had not yet come fully into focus. That year, an Ebola outbreak briefly seemed as though it might take root in America. Conspiracy theories about the safety of vaccines became popular enough to seed a measles flare-up in New York City. Donald Trump hinted at a future run for president. Michael Brown, a black teenager, was shot and killed by a white police officer in Ferguson, Missouri. Many people sensed a need for change, but not everyone agreed on how much. In her pop-feminist business memoir, #Girlboss, the entrepreneur Sophia Amoruso, who had parlayed an eBay account into the fast-fashion mini-empire Nasty Gal, proposed a convenient incrementalism. Instead of dismantling the power men had long wielded in America, career women could simply take it for themselves at the office. Like Sheryl Sandberg’s self-help hit Lean In before it, #Girlboss argued that the professional success of ambitious young women was a two-birds-one-stone type of activism: Their pursuit of power could be rebranded as a righteous quest for equality, and the success of female executives and entrepreneurs would lift up the women below them. Amoruso’s vision of female corporate supremacy was celebrated and emulated by other aspiring entrepreneurs for years. #Girlboss sold more than half a million copies, and Amoruso launched a media company of the same name, complete with networking conferences, branded merchandise, and a Netflix series. Soon, the girlboss ideal became a template for marketing and writing about powerful women in virtually every industry. For a time, female wealth was treated as feel-good news unto itself. [Read: Why women still can’t have it all] The reality of girlbossing, however, was always a little bit messier. Amoruso’s career at Nasty Gal was dogged by constant turnover, accusations of discrimination and abusive management, and the company’s eventual bankruptcy. (The company denied the allegations when they were made. Through a representative, Amoruso declined a request for comment for this article.) Over time, accusations of sinister labor practices among prominent businesswomen who fit the girlboss template became more common. The confident, hardworking, camera-ready young woman of a publicist’s dreams apparently had an evil twin: a woman, pedigreed and usually white, who was not only as accomplished as her male counterparts, but just as cruel and demanding too. Since #Girlboss’s publication, the country’s deep, long-standing divisions along race and class lines have led many people who might have been amenable to Amoruso’s remunerative quasi-feminist liberation fantasy to become more skeptical not just of their male bosses, but of power itself, and anyone who might possess it. Now, amid the chaos of 2020, people sense a need for change deeper than self-help career books could hope to offer. In recent months, a series of stylish young female entrepreneurs have left or been forced out of the companies they founded. This group even includes Amoruso herself: Earlier this week, she and most of her staff left Girlboss Media, citing financial losses due to the pandemic. Even before Amoruso’s announcement, the end of the girlboss was nigh. When a country is grappling with mass death, racist state violence, and the unemployment and potential homelessness of millions of people, it becomes inescapably clear that when women center their worldview around their own office hustle, it just re-creates the power structures built by men, but with women conveniently on top. In the void left after the end of the corporate feminist vision of the future, this reckoning opens space to imagine success that doesn’t involve acing performance reviews or getting the most out of your interns. [Read: What America lost as women entered the workforce] For the girlboss theory of the universe to cohere, women have to be inherently good and moral creatures, or at least inherently better than men. For some young women who find inspiration in the concept, that assertion might simply feel like a vote of confidence. But the presumption of that difference between women and men is also what made girlbosses marketable to those who might patronize their businesses: If these women could succeed while upholding feminist values and treating their employees humanely, then maybe the patriarchy was just a choice that savvy consumers could shop their way around. Maybe people could vote for equality by buying a particular set of luggage or joining a particular co-working space. For white, affluent Millennial women who desired to become girlbosses themselves, their particular ambition was tailor-made for the moment in which the concept flourished. Girlbossing provided a tenuous bridge in the mid-2010s: on one end, the reality of social upheaval and stagnant wage growth that met young people in the job market after the Great Recession; on the other, the long-gone world of predictable corporate success that these women had been promised by the professional progress of their mothers. Many of those women rushed over that bridge, hopeful that the future they had been promised was on the other side. That same basis in self-interest, however, makes girlbosses particularly unsuited to a moment that has stopped prioritizing their personal achievement—and is instead focused on the national reckoning over racial injustice. “The white girlboss, and so many of them were white, sat at the unique intersection of oppression and privilege. She saw gender inequity everywhere she looked; this gave her something to wage war against,” Leigh Stein wrote recently in an essay on the era’s end. “Racial inequity was never really on her radar. That was someone else’s problem to solve.” [Read: How sexism shaped corporate culture] Women are still people, which means we can respond in similar ways to the incentives and privileges of power that sometimes make male bosses tyrants or harassers or wealth-hoarders. Slotting mostly white women into the power structures usually occupied by men does not de facto change workplaces, let alone the world, for the better, if the structures themselves go untouched. This is all too apparent in the ways that the social upheaval of recent years—and especially the past few months—has shaken out in companies run by some of the country’s most ballyhooed female entrepreneurs. Steph Korey, the CEO of the luggage brand Away, has been locked in a power struggle at the company over her allegedly tyrannical management style since late 2019. (She resigned and issued a lengthy apology, but then called the reporting “inaccurate” and announced a few weeks later that she would stay on at the company.) Audrey Gelman, a founder of the women-only co-working space the Wing—itself an incubator of sorts for girlbosses--resigned from her role as CEO earlier this month amid an uproar over low pay and poor treatment of the people, largely women of color, tasked with the day-to-day operations of the company’s membership clubs. (Gelman declined to comment on the record, and in the interest of full disclosure, I hosted an event at a Wing location last year.) Miki Agrawal, the founder of Thinx underwear, was forced to leave the company in 2017 after former employees accused her of sexual harassment. (Agrawal has denied the allegations.) As these stories have surfaced, they’ve met an audience less willing than any in recent memory to excuse the thoughtless or harmful behavior of those in power, no matter the gender of the perpetrators. In the past, when an Anna Wintour or Arianna Huffington climbed to the top, their widely reported maltreatment of their employees was waved away for decades as an unfortunate but necessary by-product of executive genius, an indicator of just how much women had to harden themselves to excel in a man’s world. (Wintour recently apologized to her staff in an internal email; in the past, Huffington has declined to comment on complaints about her management style.) [Read: Why do women bully each other at work?] The current cultural pushback against girlbosses isn’t a desire to be done pursuing equality, or to stop trying to eliminate workplace disparities. This mode of empowerment was briefly successful exactly because people had become more aware of—and uncomfortable with—the way power functions in America. During Donald Trump’s presidency, that feeling has only intensified among exactly the group #Girlboss was supposed to inspire: young progressive women with a will toward action. The push to move beyond the girlboss is an acknowledgment that a slight expansion of college-educated women’s access to venture capital or mentoring opportunities was never a meaningful change to begin with, or an avenue via which meaningful change might be achieved. Being belittled, harassed, or denied fair pay by a woman doesn’t make the experience instructive instead of traumatic. With all the attention given to the alleged misdeeds by female executives and entrepreneurs, it would be easy to feel like they are being disproportionately targeted for things that men in their positions have always done, or that people take a bit too much glee in their downfall. Certainly, gendered discrimination at every rung of the corporate ladder is still rampant. But this time, there’s evidence that the shift is larger: It’s not just girlbosses who are being called to account. Crossfit CEO Greg Glassman, Bon Appétit editor in chief Adam Rapoport, and the New York Times Opinion editor James Bennet, a former editor of The Atlantic, were all forced out of their jobs this month by those below them. For most people, an equal-opportunity reckoning for those in power offers a glimmer of hope. America’s workplace problems don’t begin and end with the identities of those atop corporate hierarchies—they’re embedded in the hierarchies themselves. Making women the new men within corporations was never going to be enough to address systemic racism and sexism, the erosion of labor rights, or the accumulation of wealth in just a few of the country’s millions of hands—the broad abuses of power that afflict the daily lives of most people. Disasters disrupt the future people expected to have, but they also give those people the space to imagine a better one. Those who seek power most zealously might not be the leaders people need. As Americans survey a nation torn apart and make plans to stitch it back together, admitting this, at the very least, can be an easy first step in the much harder process of doing the things that actually work. Structural change is a thing that happens to structures, not within them. from https://ift.tt/2Z3qncY Check out http://natthash.tumblr.com Jennifer Nuzzo hopes to send her kids to camp this summer, but like many parents, she’s a little worried about it. The camp she selected for her son requires kids to wear masks, and she thinks he might get overheated. Other than that, though, she sees little problem with kids attending an outdoor camp this summer. And the same goes for schools—most districts haven’t yet announced when and how they’ll resume in-person classes, but she thinks they should open up in the fall. Nuzzo, an epidemiologist at Johns Hopkins University and a leading expert on the coronavirus, is one of a number of scientists vocally advocating for summer camps and schools to reopen, with some precautions, even if there’s no vaccine yet. “The idea of keeping kids at home, and having parents work at home, for however long, until we get a vaccine,” Nuzzo told me, “it seems to me that there are harms that kids are experiencing that we are not accounting for.” Some public-health experts say that having in-person classes in a few months is still too risky, citing countries like Israel and China that have had to shut down schools after opening them up. The experts who disagree—call them the “reopeners”—aren’t blind to the dangers of the virus, but they believe the hazards should be weighed against the costs of changing children’s lives so dramatically. [Read: Closing the schools is not the only option] This message likely has a friendly ear in many parents, especially those who have been Zooming into meetings while chasing after toddlers. Even parents who have been enjoying the extra family time might be ready for a break. I recently talked by phone with a friend, a father of two, and could hardly make out what he was saying, because he was yawning so much and slurring his words. He was exhausted from homeschooling all day, he said. (I don’t have children, a decision some parents constantly berated me for—until they suspiciously stopped in March.) But beyond relieving exasperated parents, in-person schooling confers all sorts of societal benefits that students are currently missing. With schools shifted to distance learning, 7 million kids have been stuck at home without the internet they need for their Zoom lessons. Research suggests that some low-income students are losing a year of academic gains. School feeds kids; it socializes them. There are good schools and bad schools, but even the worst ones tend to be better than no school at all. Apart from the benefits of school, the reopeners point to evidence that children are less affected by the coronavirus than adults are. A recent study in Nature found that children and teenagers are only about half as likely as adults to get infected with the coronavirus. Though the long-term implications of a mild case of COVID-19 are still not known, when kids do get infected, only 21 percent show symptoms, compared with 69 percent of infected adults over 70. In May, some parents worried for their kids’ safety when about 100 children in the U.S. came down with a delayed, severe reaction to the coronavirus called “multisystem inflammatory syndrome.” Reopeners say this disorder has been so rare as to be worth the risk. While more than 120,000 Americans have died of COVID-19, only about two dozen deaths have been children under the age of 15. Meanwhile, more than 1,700 children die in the United States each year from child abuse and neglect--two issues that have been harder for children to report while they haven’t been seeing teachers regularly. A major reason schools are reluctant to reopen isn’t just the potential danger to children, but also that to the teachers and parents whom students might infect. Just how likely children are to transmit the virus is still an area of debate, and the stakes are high: If kids are found to pass the virus easily, even though they rarely show symptoms, they might become major spreaders of coronavirus to their communities. According to Nuzzo, and some studies, there’s little evidence that infected kids are as contagious as infected adults. However, Jeffrey Shaman, an epidemiologist at Columbia University, believes that opening up schools and day cares would be risky, pointing to other studies suggesting that kids might indeed serve as vectors, passing the virus onto others in their family as they do with stomach bugs and sniffles. “I haven’t seen enough evidence to convince me that children are less involved in the transmission of COVID-19,” Shaman told me in an email. Most summer camps have likely already decided whether to open this year. But to the reopening crowd, the call on camp is even easier, since research suggests that the virus is not transmitted as easily outdoors as it is indoors. If camps avoid crowded indoor bunks and dining halls, as well as the potentially contagious toilet clouds in the bathrooms, campers might not have much to worry about. “It’s logical that schools should open in the fall and summer camps, if it’s still possible, should open,” Daniel Halperin, an adjunct professor of public health at the University of North Carolina, told me. “I’m worried about my daughter driving, but I wouldn’t keep her home because there’s a one-out-of-a-million chance that she’s gonna die in a car accident.” [Read: Summer Is Approaching. Bring Camp Back.] I pointed out to Halperin that Israel recently reopened schools and then promptly had to close them again when the virus ripped through classrooms. Four children in Israel have developed COVID-19 related heart problems. Halperin seemed unfazed. After all, those infections are cases, he said. Given how rare COVID-19 deaths are in children, “what’s the likelihood that would actually lead to one death in a child?” Such rhetoric can sound startling at a time when lots of people—health experts in particular—are being cautious about a return to normalcy. And some are less sanguine about just throwing open the schoolhouse gates. In an opinion article he co-authored for JAMA, Josh Sharfstein, the vice dean at the Johns Hopkins Bloomberg School of Public Health, acknowledged the “urgency” of reopening schools, but said it should be done with some modifications. Kids should be kept six feet apart, drop-offs should be staggered, common areas should be closed, and many extracurriculars should be canceled. Oh yeah, and have your teen wear a mask, won’t you? Sharfstein told me he envisions that, to facilitate social distancing, “kids will be in school one day, out of school the next day; in school one week, out of school the next week.” And even the reopeners want schools to proceed with caution. Teachers who are older or immunocompromised should be given the option to work in different jobs for the time being, several of them told me. Perhaps reopening could start with younger children, who have a greater need for in-person instruction. Maybe schools in hot-spot areas should remain closed. And if kids start getting sick, Jeffrey Klausner, an epidemiologist at UCLA and a reopener, suggested “hitting pause” on school for a few weeks. The decision of whether to open up schools is going to take a clear-eyed assessment of all the risks. The way Nuzzo sees it, we have to think about not only the societal health benefits of keeping a generation of kids at home for a year, but also the detriment to kids of doing so. And so far, she thinks we’ve been underestimating the detriment part of the equation. But calculating those risks is precisely what’s been so difficult about the pandemic. Do you let the elderly wither in nursing homes without human contact, or do you risk infecting them? Do you kneecap the economy to encourage people to stay home? If so, for how long? Should you protest? Should you go to church? It’s hard for anyone, including experts, to know exactly what you should do now, let alone how your actions will affect people in months or years. Everyone is staring at a slightly different crystal ball, wondering which path will be the least dangerous. For some scientists, it’s the one that puts kids back in the classroom. from https://ift.tt/3iaZMUa Check out http://natthash.tumblr.com Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at [email protected]. Dear Dr. Hamblin, As an Atlantic reporter covering the White House, I’ll soon be traveling to cover things like Trump rallies. Am I at any risk of contracting the virus if I stay at a hotel? Could the virus be passed through the hotel’s HVAC system? Peter Nicholas Washington, D.C. The last thing anyone wants to do after a long day of vigilant mask wearing is worry that, even alone in the solace of your room in some Comfort Inn, it’s not safe to take off your mask. But although building ventilation hasn’t gotten a lot of attention during this pandemic, it could pose problems. Unlike when you open a window and allow air to pass through, air-conditioning recirculates a lot of the same air inside a building. Though the exact risks are still unknown, this has the potential to create a virus-laden stew in offices and, yes, hotels. Earlier this month, two researchers from Harvard Medical School argued in JAMA that, beyond washing hands and wearing masks, “air disinfection” has been a largely missing element of the strategy to prevent coronavirus transmission. The issue could be especially important as we head into summer: Hotter temperatures will drive people indoors just as many places are reopening and we’re supposed to go about our “normal life.” The airborne spread of the coronavirus has been well documented. Famously, outbreaks have emerged from choir practices and other indoor gatherings, with infection rates so uniquely high that it’s unlikely everyone got infected by touching the same surface. Over a long period in an enclosed space, it seems, singing can spew virus into the air until it accumulates to the point of danger for people who are well over six feet away. Once a virus is hanging in the air—and we know that the coronavirus can linger for hours—it will travel with air currents. One ominous study of a restaurant in Guangzhou, China, documented how air-conditioning appeared to spread the virus between tables at opposite sides of the room. The issue wasn’t that the virus was traveling through the air-conditioning unit, but that it was getting pushed around the room by the stream of air. The takeaway is that while airflow is good when it’s coming from open windows, it could make things worse when it’s coming from an AC unit that’s blowing air around a closed room. Coughing in a well-ventilated room is sort of like peeing in a river as opposed to a hot tub: Ideally you wouldn’t do either, but one is definitely worse. [Read: The moral history of air-conditioning] There’s currently no clear evidence of this virus spreading from room to room through air conditioning, as you’re curious about, Peter. I’d be more concerned about the air at the rallies themselves. But the presumption is that it could, and buildings should take precautions to prevent that possibility. “In a high-functioning building with a well-conditioned HVAC, you shouldn’t expect that there would be spread between different rooms,” Krystal Pollitt, an epidemiologist at the Yale School of Public Health, told me. But that’s only if things are up to code and working properly. For example, commercial building codes in many places require “negative-pressure ventilation” in bathrooms—meaning air is propelled outside by an exhaust fan. This is especially important during the pandemic because of something called “toilet plume,” which I wish I’d never read about. Basically, when you flush a toilet with the lid up, the rush of water can aerosolize the contents of the bowl and send some of them up into the air, kind of like an enormous cough. During the SARS coronavirus outbreak, in 2003, a cluster of cases in Hong Kong were attributed to one person with diarrhea in a poorly ventilated apartment building. In light of the pandemic, various professional organizations have issued new recommendations for building ventilation, but how widely they’ll be followed is unclear. The fixes aren’t actually groundbreaking: They’re mostly things that everyone was supposed to be doing all along, such as ensuring that bathrooms have exhaust fans and that air filters are changed regularly and of high-enough quality to catch the virus. That means they should be high-efficiency particulate air (HEPA) filters or MERV-rated 13 or 14, which are essentially the N-95 masks of air filters. [Read: A Frightening New Reason to Worry About Air Pollution] Hotels, offices, restaurants, and commercial venues of all sorts could also augment their HVAC systems with localized air purifiers. They’re incredibly effective at removing viral material from the air, and could be a useful tool when people have to share rooms. I could see them being placed between desks in an office or tables in a restaurant. But these are just recommendations, not legally mandated standards. Sometimes recommendations are adopted by cities as building codes, and sometimes they aren’t. “These new recommendations haven’t been looked at widely,” Pollitt told me. “I don’t think they’re going to widely be in place.” And even if new codes are adopted, businesses won’t be expected to meet them overnight. Nor are cities equipped to inspect and enforce them assiduously. Without more stringent government protections, the best you can do while traveling is look for third-party certifications such as LEED or WELL. Buildings that have gone through those certification processes are guaranteed to have ventilation systems that go well beyond the typical standards. As you can tell, this is a problem that isn’t going to be fixed by you or me: It’s going to require investment by businesses and governments. On top of all the anxieties of pandemic life, no one should have to worry about the air filters in their hotel room or workplace. With proper regulations and enforcement, ideally we could just assume that the systems are properly maintained wherever we go. That’s not the case now in many places, and the issue goes well beyond this pandemic: More than one million people die globally every year from exposure to indoor air pollution. All sorts of health benefits come from the exact upgrades that would help contain the spread of the coronavirus. Now would be a perfect time to set in motion a new standard for clean air. “Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity. from https://ift.tt/3dyJmkO Check out http://natthash.tumblr.com I first encountered Erik Seidel the way many poker newbies do. I was watching Rounders, the 1998 Matt Damon movie about a brilliant law student who pays his way through school with his poker prowess, and in the end quits law altogether to play full-time. In several scenes, a real-life poker match plays in the background. It’s the 1988 World Series of Poker final table showdown, between a young Seidel and Johnny Chan, the “master,” as Chan is repeatedly described by the commentators. This is the most famous poker match in the nonpoker world, in which Seidel’s set of queens falls to Chan’s straight, after the older player sets an expert trap for his less experienced victim. At the time, Chan was the reigning world champion and Seidel was at his first-ever major tournament. He’d made it past 165 other contenders to make the final table, the last man standing save one. Thirty years later, Seidel has become the master. He holds eight WSOP bracelets—only five players in the tournament’s history have more—and a World Poker Tour title. He is in the Poker Hall of Fame, one of just 32 living members. He boasts the fourth-highest tournament career winnings in the history of the game, and is fourth in the number of times he cashed in the WSOP (114). Many consider him the GOAT—the greatest of all time. Seidel stands out from other players for his longevity: He still contends for No. 1, as he has since his career first started, in the late ’80s. That takes some doing. The game has changed a lot in the past 30 years. As with so many facets of modern life, the qualitative elements of poker have taken a back seat to the quantitative. Caltech Ph.D.s now line the tables. Printouts of stats columns are a common sight. A conversation rarely goes for more than a beat without someone mentioning GTO (game theory optimal) or +EV (positive expected value). But despite predictions that his psychological style of play would render him a dinosaur, Seidel stays on top. Three years ago, Seidel began to teach me how to play poker. Why on earth would a professional poker player--the professional poker player—agree to let a random journalist follow him around like an overeager toddler? It’s not for money or exposure. Seidel is notoriously reticent, and he hates sharing his tactics. I was, however, an ideal pupil in a few ways. Most important, I have a Ph.D. in psychology, and so I was well positioned to understand Seidel’s style of play. I also never had much of an interest in cards, meaning Seidel wouldn’t have to rid me of any bad habits. My academic training and my inexperience made me a perfect vehicle for an experiment to see if Seidel’s psychological game could still triumph over a strictly mathematical style. At the time, I was at sea in my personal life. It wasn’t an ideal moment to pursue an abstract question about a game I knew almost nothing about. My husband had been recently laid off, and a lot of our lives were in flux. But I quickly found myself consumed by poker. The game served as the perfect laboratory for my own questions about the role of luck in our lives. Poker isn’t the roulette wheel of pure chance, nor is it the chess of mathematical elegance and perfect information. Apart from the underlying mathematics, poker depends on the nuanced reading of human intention, interactions, and deceptions. It gives you parameters that are just clean enough to allow you to grapple with that uncertainty. And so Seidel and I hatched a plan: He would train me to play in the game’s single biggest competition, the World Series of Poker, with its notorious $10,000 entry fee. This is the tournament that so dramatically jump-started his own career, with his second-place finish to Chan. I would have less than a year to prepare for it. My first day of training, I wake up at six in the morning, bleary-eyed, with my tail decidedly un-bushy. The WSOP takes place inside a casino, with tables, chairs, green felt, real cards, chips, all of it. The online version, where I start to learn to play, is a not-very-persuasive replica. The poker table is flat and pixelated, surrounded by avatars—hard-to-make-out photos uploaded by the users to represent their virtual selves. Virtual cards zip from a central spot and flip over in front of you. A small number underneath the cards tells you how many chips each player has. It’s all kind of drab, and made more so by the fact that I had to schlep to a coffee shop in New Jersey, where online poker is legal, to play. But it’s the quickest path to learning from zero: hundreds of hands, hundreds of scenarios, all unfolding as quickly as I can click with a mouse. After playing all morning, I make my way to Upper Manhattan to meet with Seidel and review how I’ve played. There are no lesson plans. There are no specific topics to cover or goals to hit. Instead, Seidel and I walk. Ever since he got a Fitbit, some years ago, he has been religious in hitting his daily step count, come rain or shine, in New York or Vegas or anywhere else in the world, whether he’s in between playing or in the middle of a tournament. It’s not just for exercise. Walking is his way of thinking. As the majestic Hudson glitters blue on our left and the flowered carpets of Riverside Park open up on the right, I try my best to keep up with Seidel’s long strides while strategically perching my phone on the side of my bag to record the conversation. I alternate between fishing a dog-eared poker-strategy book—right now, Harrington on Hold ’em--out of said bag to find the pertinent pages and holding a mini notebook to jot down especially important thoughts that I want to revisit. We must look like a very odd duo. Our earliest walking conversations are, as you’d expect, among the most basic. I’ve already drilled down the ground rules of Texas Hold’em: You are dealt two cards. You decide whether to play them or to fold. If you do play them, you call the “blind” bet or raise. Everyone else follows the same decision process, going in a clockwise direction starting from the player to the left of the big blind, a position called, appropriately enough, “under the gun.” And then you make that decision again every time new information, in the form of new cards, appears. At the end, if only one person holds cards when the betting is done, she wins the pot. If the hand goes to showdown—that is, the final bet is called—the person holding the best cards will win. But that’s about where the simplicity ends. To the untrained eye, poker seems deceptively easy. It seems like every time I talk to Erik, he has a new story of a bartender or server or Uber driver who recognizes him and offers up the wisdom that he could play just as well; that “lucky break” simply hasn’t manifested itself. Seidel doesn’t give me much in the way of concrete advice, and our conversations remain more theoretical than I would prefer. He focuses more on process than prescription. When I complain that it would be helpful to know at least his opinion on how I should play a hand, he gives me a smile and tells me a story. Earlier that year, he says, he was talking to one of the most successful high-stakes players currently on the circuit. That player was offering a very specific opinion on how a certain hand should be played. Erik listened quietly and then told him one phrase: “Less certainty. More inquiry.” [Read: How casinos enable gambling addicts] “He didn’t take it well,” he tells me. “He actually got pretty upset.” But Seidel wasn’t criticizing. He was offering the approach he’d learned over years of experience. Question more. Stay open-minded. These Zen koans can be frustrating. I do want answers. I do want a guide for what to do with my pocket 10s from the small blind following a raise from under the gun and a re-raise from the hijack. Enough philosophy! I want to yell. Give me certainty! Tell me if I’m supposed to call or shove or fold. Tell me if I’m making a big mistake! But Seidel will not be shaken. And I’m left with that frustrating not-quite-rage that, weeks later, miraculously coalesces into knowledge. Poker is all about comfort with uncertainty, after all. Only I didn’t quite realize it wasn’t just uncertainty about the outcome of the cards. It’s uncertainty about the “right” thing to do. A number of years ago, Erik heard about a seminar led by Mike Caro. Caro is famous for his book on tells—live, in-the-moment reads of others at the table. “He’s a pretty eccentric guy,” Erik says. “And he’s walking around the stage and starts off by saying, ‘What is the object of poker?’” I nod in agreement. A question I’ve been asking myself frequently. Erik continues, “Somebody says, ‘Winning money.’ He says, ‘No.’ Somebody else says, ‘Winning a lot of pots.’ ‘No.’ He says, ‘The object of poker is making good decisions.’ I think that’s a really good way to look at poker.” He thinks for a bit. “When you lose because of the run of the cards, that feels fine. It’s not a big deal. It’s much more painful if you lose because you made a bad decision or a mistake.” Seidel won’t tell me how to play a hand not because he’s being mean but because that answer comes at the expense of my developing ability to make good decisions. I have to learn to think through everything for myself, on my own. All he can give me are the tools. I’m the one who has to find the way through. And then, perhaps, I’ll be ready to play for real stakes, in a real casino, one step closer to the World Series of Poker. Las Vegas shouldn’t exist. The incongruity hits you from the moment you first glimpse it from the airplane. First mountains, then desert, then neat squares of identical houses that look as if they were plucked straight from Monopoly. And suddenly, green, lush oases in the midst of it all: golf courses. This stark contrast between the vibrant green forms with the yellows and browns is the most prominent visual cue that you are entering a place that was not intended by nature. I hate Vegas, I think to myself as I wheel my suitcase away from the slot machines, toward the airport’s exit. The cold air hits me in a burst of disbelief. It’s full-on Vegas winter. No one ever told me that Vegas can get cold, and that in addition to all the other unpleasantness, I’d also be shivering. Goes to show what I know about desert climates. “I think I hate Vegas,” I tell Erik as I hoist the suitcase into the back of his car. For my first foray out West, he’s decided to pick me up at the airport. “I know the feeling,” he says. [Read: Hunting the Taliban in Las Vegas] If flying is an exercise in perspective, seeing the tiny Earth from above and realizing just how tiny you yourself are as part of it, the Vegas casino is the opposite. It’s designed to capture your attention and make itself look like the world in its entirety. Its interiors are conceived in a way that depletes your decision-making abilities and emotional reserves. The slot machines, the free alcohol, the amenities crafted so that you never need to look outside the casino walls. (“So casinos aren’t designed for great decision making?” Erik asks me when I share my reservations. “Who would’ve thought.”) It’s November, and I’ll be here on and off for weeklong stretches over the next few months. It’s my first time trying my hand at real poker—actual casinos, actual tournaments, players who’ve been doing this for years, some for longer than I’ve been alive. I guess I’ll have to get over my distaste for the place. I write out a poker schedule in my notebook: Caesars or Planet Hollywood at 10 a.m., Monte Carlo or Mirage or MGM Grand at 11. I’m looking through the daily tournaments and seeing what I can fit in so that I still have time to watch Erik play with the high rollers. There are dozens to choose from. Ooh, here’s one at the Aria! That’s where Erik plays. It’s a beautiful poker room, and I’m excited they host something that’s closer to my budget than his $25,000 and $50,000 buy-ins. I eagerly write it down with a star next to it. “No,” Erik responds. “You can’t play that one.” But why? It’s so convenient and exciting. “You’re not ready for Aria,” he says. Why not? I’ve been playing online almost daily. And I’ve even made almost $2,000 doing it! How does he want me to play a $10,000 buy-in down the line if I can’t even play this? “First of all, the players here are too good. You need to start at a lower level.” Hmph. “And second of all, $140 is way too expensive. You need to build a bigger bankroll before you can play that high.” I feel a blow to my ego. He doesn’t think I can pull off a baby tournament. Also, what’s a bankroll? My first few weeks in Vegas don’t go particularly well. After an inauspicious start at the Golden Nugget—I promptly bust out of my first-ever live tournament without much fanfare—I try my luck at Excalibur, at Harrah’s (Erik laughs when I tell him where I’m going, not because of the location but because I’ve pronounced it “hurrah”), at the Mirage. Each venue offers a slightly different experience, and with each hand, even asI lose more and more money—funny how expensive a fifty-dollar tournaments become once you realize how many you’ll be entering without so much as a cent for your efforts—I start seeing more and more of the patterns I’ve been learning about play out in real life. There are the passive players, the aggressive players, the conservative players, the active players, the loose players. There are the ones who like to drink. There are the ones who like to play and never fold. There are the ones who are vacationing and here to have fun, the ones who take it seriously and are here to win, the ones who are here to take advantage of others, and the ones who simply want to make a few friends at the table. There are the talkers, the stalkers, the bullies, the friendlies. I watch all of them and, after the game, I take careful notes. I enter a $60 daily tournament at Bally’s. It’s small, only two tables’ worth of players, but I feel a certain pride in watching the numbers dwindle to a single table, then eight, seven, six, until finally, I find myself in the final four. And it’s hard for me to contain my excitement when I flop a set (three of a kind) of nines, an excellent hand if ever there were. There’s a bet before me, and I joyously shove all my chips into the middle. This is it. All my learning is paying off. I will finally have my first tournament cash. I get called by a player who is hoping the dealer completes his flush, and to my horror, the flush hits. I’m out, and devastated. I almost leave it all right then and there. This game is so damn unfair. But there’s the knowledge, somewhere deep down, that it’s to confront that very seeming unfairness that I turned to poker in the first place; I resolve to play on. I spend the next week playing day after day after day, taking conscientious notes, and talking them through with Erik. I’m a warrior, a storyteller, an explorer—not a lost minnow about to be eaten by the sharks. It’s a mantra I repeat over and over, hoping that it will eventually stick. Tuesday morning, I wake up early to make my next tournament: a 10 a.m. start at Planet Hollywood. I’m surprised that any actual poker players are awake this early. I make my way across the walkway over the Strip that connects CityCenter and the Miracle Mile Shops, promptly get lost in a two-story Walgreens that I had thought was the entrance to the casino, and eventually emerge into the actual Planet Hollywood. The poker room is in the center of the casino floor. I head to the desk and ask to register for the daily. It’s a good turnout today. Over the weeks, I’ve learned that sometimes these morning events get only a table or two of players, and we have three already. Every 20 minutes, the blind bets increase. It’s a “turbo” structure, built for aggression and quick resolution. If you sit around too long, you’ll find yourself without any chips at all, so you have to act quickly—but act too quickly, and you’ll find yourself out. I’ve slowly acclimated to the fast pace of the daily tournaments and trying to follow my lessons as best I can within the time constraints. Today, it finally feels like it’s coming together. I focus. I pay attention to the players. I try not to panic with the rising blinds. As each hand is dealt, I imagine myself explaining the why of any action before I act. Some players start busting. I’m still in. We are down to just one table and I look down at pocket queens, an excellent hand. I raise. I get called. Another player decides to shove, pushing all his chips to the center. Past me might have just folded, assuming one of the two players had me beat and not wanting to risk my entire tournament. But today’s me knows enough to call. I’ve been bluffed all week. [Read: The man who broke Atlantic City] The player after me folds, and we flip over our cards. My opponent has ace-king. It’s about as good a situation as I could hope for, short of him having a worse pocket pair. Sure, he can hit an ace or a king, and sure, I’m not exactly thrilled. I’d much rather he have ace-queen or ace-jack, reducing his chances of beating me. But at least as of now, I’m a little bit ahead. It’s what’s known as a classic race, a coin flip: Does the pocket pair hold, or does the ace-king outdraw it to win? The variance this time around is on my side. I more than double my stack of chips. Suddenly, I’m the table chip leader. There are five of us left. I catch some looks going on between the four others. All of them, of course, are men. “So you want to talk about a chop?” the player to my right asks me. A chop is when the remaining players in a tournament agree to divide up the money rather than continue playing. Sometimes, it’s done in a way known as a chip chop—you get the amount of the prize pool proportional to your portion of the chips. Other times, it’s done according to a principle known as ICM, or the Independent Chip Model, in which each chip is not created equal: Your payout also takes into account the tournament payout structure (the percentage of the prize pool designated to each place) and your likelihood of finishing in your current position. Either way, you divide the money and call it a day. As the chip leader, I’m the one to persuade to chop. I look around at the other players. I have more than twice the next stack. I shake my head. “No, thank you. I’d like to play.” Another player busts. “Come on, let’s chop,” says my neighbor. “Yeah. Let’s just chop,” says my other neighbor. “It’s in your best interest to just chop,” says the third remaining player. “You’re in a position of power now. You’ll get more money. But you know you’re gonna lose all those chips just as quick as you won them. Just you wait.” That does it. I adamantly shake my head no, not trusting myself to make a coherent verbal argument. (Little do I know this is just mild banter compared with what I’ll soon encounter—being propositioned; being called a cunt; being dismissed as a “little girl”; poker is a man’s world, and if you ever forget it, someone will remind you right quick.) Soon, we’re down to three players—again the others ask: Chop, chop? No—then two, and then, miracle of miracles, only one. I have won my first ever tournament, along with some $900. I am over the moon. “Will this be reported to the Hendon Mob?” I ask the man who’s counting out my payout. The Hendon Mob is the website that tracks all poker players’ tournament winnings, and I’m excited at the thought that I will be Hendon-official, a badge of honor in my mind. He looks at me with something like pity. “Sorry, honey. We don’t report our dailies to Hendon.” I’m momentarily saddened by the news—but the feeling of more than $900 in my hands and the knowledge that I have my first-ever victory is enough to get me to forget the slight. I’ve now paid for my whole trip with one win. I have a bankroll! I am a player! Somehow, this is far more exciting than winning online. I emerge into the sunlight and send two text messages—to Erik and to my husband. The texts are identical: “I won my first tournament!!!!” To Erik, I send a follow-up. “Can I play the Aria tourney now?” “You’ve earned it.” That evening, I’m sitting at Aria—not watching, sitting!—at last. I feel exuberant. I bust quickly enough; there hasn’t been some sort of miracle switch from losing to winning. But the next day, I play again. And the day after that. And then I finally have it: my first ever Hendon cash. I place second, and this time, it’s far more than $900. I have $2,215 newly added to my name, and I am on fire. “It would be good for you to start playing a few higher buy-ins and see how those feel,” Erik tells me. Even I’m not naive enough to think that the game I’m playing at my level is the same one played at tournaments with higher buy-ins, where the skill level and complexity increase. These small successes in the Vegas dailies aren’t enough to guarantee success elsewhere, nor are they enough to sustainably fund any sort of move up in stakes. But they are a start, and for my purposes, that is good enough. I realize now how grateful I should be that Erik limited me to sub-$100 buy-ins to start. I’ve been in Vegas, on and off, for almost two months—and that’s how long it’s taken to get here. When I get back from Vegas, a change, it seems, has already taken place. A few weeks later, I find my husband quietly observing me after I get off the phone with my speaking agency. I’ve just turned down an engagement—the first time I’ve ever done so in my entire speaking career—and told them that I was worth more than what they were offering. “Is everything okay?” I ask him. “You know, you take much less shit from people than you used to,” he says thoughtfully, with something I take for admiration. “That’s really good.” Over the coming months, I return to Vegas time and time again. I travel to Monte Carlo for my first major international event. I find myself in Dublin, in Barcelona, in the wilds of Connecticut. I have some small successes. And some bigger failures. But I keep going. I want to earn Erik’s faith in me. In January of 2018, almost a year since I played my first hand of live poker, I alight on one of the oldest and most prestigious stops on the poker tour, the PCA, or PokerStars Caribbean Adventure. The Bahamas are beautiful, but I see them only for the few minutes I spend walking outside between my room and the casino. They say the more sightseeing you’re doing on a poker stop, the worse you’re likely playing. I’ve been spending a lot of time indoors. After 16 hours of grueling play, I have made it to day two of the tournament. I stumble into bed, only to realize I can’t actually sleep for more than a few hours. The adrenaline rush is too much. I enter the familiar spiral of I need to sleep to play well, oh no, I’m not sleeping, this is terrible that anyone who has ever dealt with insomnia knows so well. And sleep or not, it’s on to day two. Today, my caffeine-fueled mind is a muddle running on its last fumes, but I make some hands and somehow avoid busting. Which means that—drumroll—I have managed to make the final table. I’m among the last of eight players standing at a major international tournament. That night, I jerk awake with the sense of dread that comes from a particularly disturbing nightmare. When I realize I’d dreamt of playing out a bad beat in my head, I start laughing, a hint of hysteria creeping in. At 11 a.m., my phone pings. It’s Erik. “Job today: relax, focus, think. You worked hard for this. Don’t allow distraction.” I nod, forgetting for a second that he can’t see me. My phone pings again. “I’m very excited and so is Ru.” Ru is Ruah—Erik’s wife. I gather my things and walk down to the casino. I’ve been to final tables before, but never at a major event. When I look around me, it seems like I must have entered an alternate timeline. There’s Chris Moorman sitting to the left of the dealer. Moorman is a feared tournament crusher who has been ranked in the past as the No. 1 online-tournament player in the world. Harrison Gimbel is two seats to my left. I don’t know him, but I do know that he has won the coveted Triple Crown of poker—a WSOP bracelet, a WPT (World Poker Tour) title, and an European Poker Tour title. Actually, he won the main event at this very stop. He’s on familiar turf. To my right is Loek van Wely, whom I recognize from looking him up the previous night—a basic step in preparation. Van Wely is a chess grand master and Dutch chess champion, who was once ranked in the top 10 chess players in the world. Another player is a Canadian pro with almost a million in earnings. Yet another is a pro from Chicago with over a million in earnings. I feel like a total impostor. Jared Tendler, my mental-game coach, wouldn’t approve of my thinking, but I can’t help myself. We worked on this very thing. “Everyone got lucky at some point,” he told me. “Strip down the mythology around their greatness. They still have weaknesses. They are humans first, players second.” I try to collect myself. I take deep breaths. I reflect on how far I’ve come. Improbably, I’m second in chips, with over 70 big blinds to work with—exactly where you want to be heading into a final table. I get a boost from a big surprise: When I walk into the tournament room, Seidel is there to greet me. He hadn’t told me he’d come. He has a final table today, too, but not for a few hours. He could be resting. I’m chuffed. I tell him that I’m so nervous I couldn’t eat breakfast, and I’m worried I might actually vomit. “One hand at a time,” he says. “The nerves go away when you are paying close attention to play. You’ve got this.” Easy for him to say, what with his countless final tables and titles. I put on a brave smile and ask him if he has any last-minute advice. He does. “Don’t be a fish,” using poker slang for a weak player. And with that, he’s off to start his day and to watch the action from afar. Final tables are hell to watch in person, because you can’t see hole cards. Don’t be a fish, I repeat silently as I sit down and smile for the cameras. Don’t be a fish. Don’t be a fish. The hours pass. I lose some pots. I make mistakes. I rally. I focus. I retrench and build my stack back up. I should rightly bust when I get a pair of sevens all in pre-flop, only to find myself against a pair of aces. I’m halfway out of my seat, and I get lucky with a miraculous sequence of cards that help me make a straight. I make more mistakes. But somehow, the players keep busting, one by one, and I am still here. I pick up chips. I double up against an opponent I’ve been calling Aggro Oldie in my head, on account of his overly aggressive approach that takes advantage of his image of an older man who wouldn’t possibly bluff. He tries to bully me pre-flop, but I take a stand with a suited king-jack and hold against his queen-10. A few hands later, I knock him out of the tournament. He raises from the small blind, and I find myself in the big blind with the ace-king of hearts, a monster hand under any circumstances, especially so now. I make a large bet, and he decides he’s had enough of me and goes all in. I call instantly. He has ace-deuce, off suit: I’m in great shape going to the flop. I make a straight, and suddenly there are only two of us. I am at my first major final table, playing heads up for a major title. Before we restart play, I text Seidel. “Heads up! I’m chip leader.” I ask him if I should consider talking about a deal. “If you think he’s good,” he writes back. After a pause, he adds: “You’ve been practicing though.” He’s right. I have, indeed. “I think I’ll stick it out for now,” I write back. I’m feeling this. “That’s the spirit!” Seidel replies. “We are walking over! So damn exciting.” He and Ruah are making their way over to the casino to cheer me on. The thought of them watching gives me an energy boost that propels me through the next few hands, until I face what could be a tournament‐changing decision. I raise before the flop, holding the ace of clubs and king of spades. My opponent, Alexander Ziskin, a professional player from Chicago, calls. The flop is two 10s and a seven, with two spades. He checks. I bet again: My hand is still very strong, and even if he has a pair, I have plenty of opportunity to improve. But instead of folding or calling, the easy options, Alexander raises, to almost three times my bet. I hesitate. Does he have a 10? If he does, I’m in bad shape. I decide that he would call with a 10 instead—on a board that dry, why not let me hang myself? I have two overcards and a chance at a flush. I call the raise. The turn is the deuce of spades, putting a third spade on the board. “All in,” he announces. Oh no. I have just ace‐high. What do I do? My brain starts calculating. If I call and I’m wrong, he has the chip lead and the momentum. This is a huge decision, especially without so much as a pair in my hand. But I do have a spade, and not just any spade—the king of spades. That means I could improve to the best hand, if yet another spade is turned over on the final card, even if I’m now behind. I agonize for several minutes, counting the combinations of possible bluffs he might have and whether or not they outweigh his value hands, before deciding that I simply can’t fold. The pot odds are in my favor. The math is on my side. And he probably knows how hard this is for me, making him that much more likely to try to pull a move. He’s the pro. I’m the amateur. He’s been here. I haven’t. I call. Alexander turns over the jack of diamonds and the eight of spades. He has a gutshot straight draw (one card can give him a straight) and a flush draw—but my hand is still best. And my flush draw beats his. All I have to do is hold on, to avoid one of the eight cards that will give him the winner (a nine, a jack, or an eight, as long as they are not spades). The cameras rush closer. The reporters huddle around. I look for Erik and Ruah, but everything is happening so quickly that they haven’t yet made it to the table. The dealer waits until the floor manager tells her she can flip the next card. We sit and wait. It seems to drag on forever. And finally, she gets the signal. The river is dealt. It’s the king of hearts. I can’t believe it. Alexander is getting up and walking over to shake my hand, and I still haven’t quite registered it. I’ve just won. $84,600 is mine. I’m the 2018 PCA National champion. And I’ve got my buy-in for the World Series of Poker. This article was excerpted from Konnikova’s recent book, The Biggest Bluff. from https://ift.tt/3hSKcfv Check out http://natthash.tumblr.com To the silver salesmen, moms must have seemed like an ideal demographic. Last year, Candy Keane, a 44-year-old lifestyle blogger in Florida, heard about colloidal silver—silver particles suspended in liquid—from a mom’s group she’s part of. A company called My Doctor Suggests was sending out free samples of its products, including colloidal-silver solution, lozenges, lotion, and soap, to bloggers who might be willing to review the products online. Keane spoke with Doug Godkin, the vice president of My Doctor Suggests, who she says assured her that taking the silver was as harmless as taking a vitamin, and that the solution could help with all kinds of ailments. She remembers him saying it would be safe to drink up to a bottle a day. Keane thought the silver might clear up some white splotches that had spread across her skin. She tried all the products and sipped the metallic-tasting “silver solution” daily. While they didn’t seem to do much, they didn’t make anything worse, either. She wrote up her results, such as they were, in a blog post. When she later read an (erroneous) online claim that silver can kill the coronavirus as it enters the mouth, she let her 5-year-old son eat the rest of the lozenges—he liked their sweet taste. [Read: Paging Dr. Hamblin: Does vitamin D help fight COVID-19?] Before I called her, Keane hadn’t realized that in April, a federal court in Utah shut down My Doctor Suggests for allegedly fraudulently promoting their colloidal-silver products as a treatment for COVID-19. Godkin and My Doctor Suggests’s founder, a self-proclaimed naturopathic doctor named Gordon Pedersen, released videos and podcasts in which they suggested that colloidal silver could protect against the coronavirus because “the silver can isolate and eliminate that virus.” Pedersen has no medical license, and he has been cited in the past for the unauthorized practice of medicine. (Godkin declined to comment, and lawyers for Godkin and Pedersen did not return requests for comment. A spokesperson for Pedersen has previously said that “all the statements he has made are supported by scientific documents.”) Pedersen’s efforts may have been halted, but he’s far from the only one selling this substance. The state of Missouri recently filed suit against the televangelist Jim Bakker for promoting a “Silver Solution” for the coronavirus on his show. And last month, the U.S. Food and Drug Administration went to court to stop an Oklahoma company called N-Ergetics from allegedly touting colloidal silver as a cure for everything from the coronavirus to yeast infections. (“Jim Bakker is being unfairly targeted by those who want to crush his ministry and force his Christian television program off the air,” Jay Nixon, Bakker’s attorney and the former governor of Missouri, said in a statement. “Bakker did not claim or state that Silver Solution was a cure for COVID-19.” And in a statement to the Tulsa World, N-Ergetics said, “To the best of our knowledge, we are in compliance.”) [Read: A much-hyped COVID-19 drug is almost identical to a black-market cat cure] What’s happening here seems deeper than snake-oil salesmen foisting useless potions on people. All of these silver peddlers are tapping into a real interest in the stuff. Colloidal silver enjoys a devout following online among people who believe it can cure a number of diseases. Before the site was shut down, demand for My Doctor Suggests’s products was surging, and Pedersen was paying a separate company an average of $10,000 a week to fulfill orders. Unlike Pedersen’s or Bakker’s, though, most colloidal-silver brewers are homespun operations in which people make the silver themselves or buy it in small quantities from a trusted source. Devotees say its effects have been nearly miraculous for various ailments, including suspected COVID-19 cases. They flock to Facebook groups to discuss the best ways to prepare the solution and share success stories. Though topical silver can be used in wound care, almost all mainstream scientists say colloidal silver doesn’t do much of anything—except, in extreme cases, turn a person’s skin blue. Most doctors would say these individuals’ positive experiences are most likely the result of a placebo effect, or of the disease resolving on its own. According to the National Center for Complementary and Integrative Health, silver has “no known function or benefits in the body when taken by mouth.” [Jeffrey Goldberg: The Conspiracy Theorists Are Winning] Nevertheless, people’s deep faith in colloidal silver speaks to how the uncertainty of COVID-19 has fueled a desire for alternative remedies. Crises such as the current pandemic are a prime time for sham cures, fraud experts told me, because people are isolated, afraid, and willing to do whatever it takes to protect themselves. More so now than normally, people feel let down and ripped off by medical professionals. There’s no proven treatment for the coronavirus, and advice about how to stave it off seems to shift from week to week. Some people now look at “natural” remedies such as silver and think, At least this won’t hurt me. In April, Alyss H. had spent weeks gasping for breath, and she was desperate for relief. Alyss, a 34-year-old who lives in Oklahoma City, had been following the spread of the novel coronavirus since it was first identified in China in December. (She asked me to use only her first name and last initial to protect her family’s privacy.) She learned about the R0 number, and understood that quarantines were a possibility in the United States. She was worried about her family. Her nightmare, it seemed, had come true. Alyss had body aches, a bad sore throat, and a persistent burning in her chest, and antibiotics weren’t working. She started researching colloidal silver in medical journals, and she began corresponding on Facebook with a British man, Jim Ryan, who appeared to have a lot of information on the subject. She followed the instructions for making colloidal silver the way Ryan suggested. She placed two strands of silver wire in a flask of water on top of a hot plate set to 160 degrees. She hooked a battery to the silver, and kept the wire submerged until the water turned urine yellow. This process, Ryan said, releases the silver particles into the water. Then, Alyss drank the water, making sure to keep it in her mouth for a few minutes and sloshing it under her tongue. [Read: What you need to know about the coronavirus] Two days later, she told me, she felt better. She still drinks about 20 milliliters of colloidal silver two or three times daily—five times a day if she’s feeling sick. Alyss seems to understand why the FDA is cracking down on colloidal-silver manufacturers. But, she said, what other options are there? She’s still not sure whether she had COVID-19, but doctors sent her home to convalesce alone for weeks. “My recommendation is to fight it,” she said. “Fight it with everything you have.” Including silver. Ryan, the man who taught her about the silver, has been into colloidal silver for more than two decades. A 48-year-old tattoo artist and a helicopter pilot from Devon, Ryan blasted me with a torrent of silver’s glories during our phone call. “It doesn’t actually kill the virus,” he explained, sounding like a rapid-fire Ozzy Osbourne. “It literally stops, it prevents the bacteria or the virus from doing its job, which is to cause that chest infection that leads to pneumonia.” He and others I interviewed wanted to let me know that the infamous “blue man”—Paul Karason, who appeared on the Today show in 2008 with violet skin from a supposed silver overdose—was actually drinking too much of it, and in the wrong formulation, and for decades. But, they were sure to add, he didn’t get sick. [Read: COVID-19 can last for several months] Ryan, too, used a colloidal-silver solution on himself and his daughter when they had what he thought was COVID-19. “It turns COVID into a mere sniffle,” he assured me. Perhaps expectedly, doctors push back against this idea. David Gorski, a surgical oncologist at the Karmanos Cancer Institute and the managing editor of the pseudoscience-debunking blog Science-Based Medicine, told me via email that Ryan and others are simply confusing correlation and causation. “Without a placebo or no-treatment control, there’s no way of knowing if the person would have gotten better anyway,” he said. “This is particularly true for a disease with such a variable level of severity as COVID-19, which can range from asymptomatic to mild symptoms to life-threatening.” Still, there’s an element of seeing-for-yourself-ness among the silver stans. Ryan emphasized that he likes to research “both sides of the coin” and to question official narratives. His daughter is unvaccinated. He and others said they did months of research before they jumped into the silver world. They had this sense that there was a body of information that experts don’t want you to know, and they were lucky to have figured it out. [Read: The Facebook groups where people pretend the pandemic isn’t happening] In central Wisconsin, Dawn Louise—who also didn’t want me to use her full name for privacy reasons—says she found success using colloidal silver for her Lyme disease and shingles. When her 40-year-old daughter started having COVID-19 symptoms recently, with plummeting oxygen and shortness of breath, Dawn gave some to her. In 48 hours, Dawn told me, her daughter could breathe again. When I told Dawn that Pedersen and others had been shut down because they were considered fraudulent, she wasn’t surprised at all—nor was she daunted. In her mind, it was a sign that the substance works, but there wasn’t an opportunity for Big Pharma to capitalize on it. “They don’t want that found out, the truth that it actually does work,” she said. “They want to get their patent on it so they can make it a prescription.” COVID-19 is a brand-new, deadly condition about which little is known, which can appear to strike at random, and which has no cure. “It’s very fear-arousing,” Michael Goldstein, a sociologist and a complementary- and alternative-medicine expert at UCLA, told me. That kind of situation primes people to seek out unconventional remedies, to try to regain some of the power that’s been stripped away by a scary new menace. Or as Alyss put it to me, “we all wanted to have control in our lives, and it felt like a possibility to have control.” People who are into untested treatments such as colloidal silver—or even ever-so-slightly-more-evidence-based treatments such as Reiki or acupuncture—are commonly derided as crackpots. But in many cases, experts say, they are drawn to these New Age-y cures because of bad experiences they’ve had with conventional medicine. “Most people don’t start by going to some kind of alternative provider,” Goldstein said. “They start by going to the doctor, and they find that whatever the doctor has to offer doesn’t really help them in a way that they want to be helped. So that skepticism is one of the things that leads people to say, Well, the next time I have this problem, I’m going to go to a chiropractor or an acupuncturist.” [Read: Reiki can’t possibly work. So why does it?] This is especially true when people are weighing what seems like a safe medication—and silver does seem safe, to them—against the deadly consequences of certain prescription drugs, such as opioids. Though few responsible doctors would prescribe opioids for COVID-19, President Donald Trump has recently encouraged people to take the antimalarial hydroxychloroquine. When a man in Arizona tried to take a fish-tank cleaner with a similar name, he died. Some experts warn that untested remedies such as colloidal silver may, too, become more damaging once a coronavirus vaccine becomes available. If people begin rejecting the vaccine in favor of “alternative” treatments, it will greatly reduce our ability to reach herd immunity and reopen society. “One of the things that I will be monitoring is whether or not some of that group that plans to refuse the vaccine is doing so because they think that other treatments—alternative treatments—will get the job done,” Matthew Motta, a political-science professor at Oklahoma State University, told me. “That to me is potentially very scary.” Compared with prescription drugs, silver might seem more “natural” to some people, Maria Chao, the associate director of research at the University of California San Francisco’s Osher Center for Integrative Medicine, told me. People tend to be drawn to such organic-seeming cures because they see illness as a violation of the natural, healthy state of the world, according to Alan Levinovitz, a religion professor at James Madison University and the author of the recent book Natural, about people’s faith in nature. “Naturalness represents that which is good, and that which will return us to health,” Levinovitz told me. [Read: The best hopes for a coronavirus drug] Simmering a pair of silver wires and drinking the resulting mixture also serves as a kind of ritual, and rituals can help us feel better about things when little else can. (Just think of all the “morning ritual” literature out there.) “It’s about symbolic empowerment,” Levinovitz said. “These are rituals that people can do when they’ve lost confidence in an establishment.” And why wouldn’t they have lost confidence in conventional medicine? Pharmaceutical companies actually did lie about the addictive nature of prescription opioids. People get rushed to hospitals, only to face confounding, towering bills later. Less nefariously, but still significantly, some public-health experts were telling us not to wear masks as recently as a month ago. The internet brims with misinformation, such as the kind Keane, the blogger, stumbled on, about what can and cannot kill the coronavirus. None of this means that unscrupulous silver scammers shouldn’t go unpunished, or that even more people should consider taking colloidal silver for COVID-19. But it should, perhaps, help us understand why people believe in something dubious at a time when there isn’t much to believe in. At one point in our interview about colloidal silver, Chao, a professor who has multiple advanced degrees from Columbia University, admitted that while she doesn't know when she would ever actually take silver, “I have a bottle of it in my medicine cabinet.” from https://ift.tt/3hSYjBs Check out http://natthash.tumblr.com You go out to a bar with friends this week, and you’re planning to visit your elderly relatives in a few days. You feel healthy, and you even get a COVID-19 test out of caution. The result comes back negative. Is it safe to go? Not exactly, experts say. How well COVID-19 tests work in people who feel healthy is still a key unknown of the pandemic. The test may overlook the small but growing amounts of virus in someone who has not yet developed symptoms, who could still go on to spread COVID-19 without knowing it. So as Americans weigh the risks of attending protests, rallies, birthday parties, dinners, and all the social gatherings that make up normal life, they will have to contend with the uncertainty that a negative test result does not rule out infection. “If they go do a risky contact, they can’t get a ‘Get out of jail free’ card. They can’t just get tested and feel fine,” says A. Marm Kilpatrick, a disease ecologist at UC Santa Cruz. [Read: America is giving up on the pandemic] Understanding false negatives from COVID-19 tests is especially important because people who do not yet know that they’re sick play a major role in the spread of COVID-19. A study based on data in and around China suggests that 44 percent of transmission comes from presymptomatic cases. The United States has not isolated people who say they feel sick as aggressively as China has, so it likely has a higher proportion of symptomatic transmission, says Benjamin Cowling, an epidemiologist at the University of Hong Kong, who co-authored the study. But China’s experience makes clear that simply isolating people once they are sick is not enough. “We can’t ignore presymptomatic transmission,” Cowling says. “Even if you manage to stop some of the transmission from going on by doing isolation cases, you still will have this presymptomatic transmission, which keeps the epidemic going.” It’s still unclear how good COVID-19 tests are at finding these presymptomatic cases, but the timing of the test matters. As soon as the coronavirus finds its way into a new host, it hijacks cells to copy itself. The amount of virus builds over this time, peaking at or right before symptom onset, which can take two to 14 days but usually takes an average of five or six. Accordingly, public-health authorities have advised getting tested about four days after exposure. [Read: The protests will spread the coronavirus] This is a reasonable recommendation, given the knowns, but surprisingly little data exists on how early COVID-19 tests can detect infection before symptom onset. One model using COVID-19 cases from seven previously published studies suggests that the false-negative rate is 100 percent on day one of exposure, which falls to 38 percent on day five (when symptoms on average appear) and then a minimum of 20 percent on day eight. But in combing the literature, the researchers behind this model found only one case where a patient was tested before feeling sick—as part of a cluster at a chalet in the French Alps. Moreover, the model doesn’t address a whole other set of people who never develop symptoms at all. “It gave no information about people who are permanently asymptomatic,” Justin Lessler, an epidemiologist at Johns Hopkins University who co-authored that study, told me. More data is likely to come soon. On Tuesday, the Food and Drug Administration released recommendations for labs and manufacturers that want to validate COVID-19 tests in people who don’t have symptoms. (Currently, no tests are FDA-authorized for screening asymptomatic people.) Testing large numbers of asymptomatic people--such as by pooling samples—to identify potential silent carriers will also be an essential part of the reopening strategy for schools and businesses. [Read: COVID-19 can last for several months] For individuals, however, the FDA cautions that negative results do not rule out infection. It asks that asymptomatic tests include this statement: “Negative results must be considered in the context of an individual’s recent exposures, history, presence of clinical signs and symptoms consistent with COVID-19.” And this, in the face of imperfect COVID-19 tests, is key to interpreting a negative result. It depends on your probability of having COVID-19 in the first place. Consider again the decision to visit elderly relatives after a negative test. “If you have symptoms or you work in a place where you’re at high risk for exposure, then even with a negative test, you might want to think really hard about it,” Steven Woloshin, a co-director of the Center for Medicine and Media at the Dartmouth Institute, explained to me. “If you’re at low risk because you live in some remote area, you’re practicing social distancing, you always wear a mask, and you feel fine,” a negative test is probably a true negative. So even with widespread testing, social distancing and masks will continue to be important for controlling the spread of COVID-19. from https://ift.tt/3emsLSr Check out http://natthash.tumblr.com |
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