On the latest episode of the podcast Social Distance, staff writer James Hamblin and executive producer Katherine Wells are joined by the public theologian Ekemini Uwan, who explains the idea of “radical acceptance.” Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. Katherine Wells: I want to talk to you about this idea you wrote about in your piece. It’s one thing to realize how the system works: This is how this country is working right now, these are the failures, these are the people being harmed. Once you do that, what is the next step? What does that look like? Ekemini Uwan: It looks like we begin to change our lives in service, not only to our loved ones, but also in service to our neighbors. Accepting reality would mean that I'm going to only go to the grocery store when I need to do that because I'm considering the needs of somebody else. What about the grocery-store clerk that's checking out my groceries? What does that mean to to look out for somebody that you do not know? That person is your neighbor. We are connected. And so what that person does impacts me. Wells: So radical acceptance is about action? Uwan: Yeah. Or even take another instance: We have over one 100,000 people who have died from COVID-19. We're gonna be barreling toward 200,000. My goodness. Think about the grief that comes with that. Even grief is an act of radical acceptance because accepting reality for what it is is hard. People are suffering. People are dealing with so many compounding issues. But denial just exacerbates our suffering. I think we see a lot of that on a macro level with the government. Wells: Yeah. It feels like we don't have a lot of good models for acceptance right now in the public. What I feel like I'm seeing is denial. A lot of it. Jim, what do you think? James Hamblin: Well, I think when a person in your life dies or when there's been a big natural disaster or an attack on a city and buildings are crumbled then there's this hard reality in front of you. We don't have the physical evidence in front of us and it's playing out on a time scale that makes it harder to grasp. In a situation like this one how do you know when you're at the point where you need to do radical acceptance? Uwan: Yeah, I think in some ways it was well forced upon us. This pandemic really caused people to really ask some serious existential questions, like, is this the end? At what point do we realize that losing over 100,000 people to a virus is not normal and it didn't have to be this way? That has not been the case in South Korea. That hasn't been the case in New Zealand. I think we really have got to reckon with this reality. Wells: Right. At least at the federal level, we're not having leaders model grief in a way that we're used to seeing. So it sounds like we have to do this for ourselves because there's not someone showing you how we come together. Hamblin: When I think of the role of religion in American life, it's especially involved at life transitions. Births and marriages and deaths—even for people who aren't regularly religious. I'm wondering if we maybe need something now to mark a transition, a national radical acceptance process. Uwan: Yes. America is long overdue for a truth commission, a reconciliation—or conciliation, let's say conciliation. Reconciliation implies that there was a time that we were together, or there was a time that we were unified, but there's not really ever been a time. Even with this whole COVID-19, We're all in this together: we're not. It's clear that we're not in this together. And that [conciliation] would be freeing not only to black and brown people, but to white people as well. There are real chains of bondage here and that's because of the foundation. I'd also say that we do need something to mark the lives lost, some sort of memorial. That's good for our souls. That's good for our mental health to be able to mark that and in some ways bring [us] closure. Something that marks a closure to the before so that we can move into this new future. Wells: Something that I want to make sure we make clear is that sometimes when you just hear the word acceptance, that can feel pretty close to complacency or inaction. Can you explain the difference between radical acceptance and complacency? Uwan: Yes. So you're seeing [the world] for what it is in this moment but it doesn't mean that you can't try to change the next moment. I think that's what we're seeing now with the protests. I think generation upon generation of black people in this country have always been working to change the next moment. We've never had the privilege of denying our reality. We've never had the privilege of denying white supremacy. We've never had the privilege of denying racism. It's so intrusive. It follows us into our homes. Breonna Taylor was shot eight times while she was asleep. Aiyana Stanley-Jones was killed years ago in Detroit in her sleep. Atatiana Jefferson. The list goes on and on. So, what do you do? You can't escape that reality. Hamblin: You mentioned South Korea. And I think about the difference in radical acceptance there versus here with regard to the virus. The last coronavirus hit South Korea hard and it did not hit us hard. We've been pretty much spared by a lot of recent outbreaks and we had this exceptionalism of, well, somehow America is going to be okay. Uwan: Well, I actually think that what we need as a nation is to confess and to reject American exceptionalism. And it's so pervasive. I even alluded to it in the piece. I thought it would blow over. I thought, you know, a month or two and we'd move on, that it would be like some of the other viruses. I didn't even realize that I had that American exceptionalism within me. That's not Okay. That's wrong. I should care that the virus is claiming lives in China and in Italy even if it never reaches American shores. It did but I should've cared even then. But that exceptionalism can harden us right to the humanity of other people and to the concerns of. None of us are really exempt from that. And it took this pandemic for me to even see how that ideology had crept into my own psyche. from https://ift.tt/2APyul9 Check out http://natthash.tumblr.com
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Supplements claiming to “boost your immune system” have gotten new attention during the pandemic. On the podcast Social Distance, the staff writer James Hamblin explains why these claims are mostly nonsense (and have been for years), and the executive producer Katherine Wells asks him about vitamins. Listen to their conversation here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. Katherine Wells: I just got a news alert: FDA withdraws approval of malaria drugs touted by Trump. Hydroxychloroquine, I assume, is what they’re talking about? James Hamblin: It had an emergency-use authorization, which is different from the long process that is required to prove that a drug helps. If there’s some plausible reason to think it might, it gets emergency use authorization. Here, we didn’t really have that, but we did have political pressure from the president, who had touted the drug as a miracle and actually encouraged people to try it at press conferences. Then suddenly it gets this emergency-use authorization. And a lot of people—a lot of doctors and patients—said: You know what? It can’t hurt. And it might help. They didn’t have evidence of that. But we have these sort of rose-colored glasses on. There’s an odd optimism in moments of fear, where you start to look at things that are implausible and that are not, in fact, risk-free. And suddenly it’s very easy to convince people: You know, why not try it? Why not do it? Wells: So we know that hydroxychloroquine is not going to somehow magically protect us, and now the FDA is saying no, but you have said many times that outcomes are highly correlated with people’s general health and immune systems. So we should be doing things to boost our immune system and make sure that we are as healthy as possible, right? Hamblin: Yeah. Actually, boosting the immune system is one of my pet peeves. Wells: Because you don’t like the word boost? Hamblin: Yeah, well, you don’t want to increase it unduly. We have talked about the cytokine storm, and that’s actually your immune system going way overboard. Wells: Right, and autoimmune disorders. Hamblin: Yes, exactly. Those are treated with immune-suppressing drugs, of which hydroxychloroquine is one. We’re talking about a sort of balance and equilibrium that we’re looking to achieve. Wells: I’ve been taking a multivitamin every day because I’m like: I don’t know. Couldn’t hurt. But you are a multivitamin skeptic for reasons that I don’t remember or understand. What’s wrong with taking a multivitamin? Isn’t that just good if you need it and not bad if you don’t? Hamblin: I think that’s generally true. It’s probably fine. Depending on if you’re taking a lot of other vitamins and supplements with it, there’s a potential with some vitamins that you can get too much, but most likely these vitamins are balanced such that you’re not going to have too much of anything. But what I’m interested in is that same fallacy I’m worried about with hydroxychloroquine: a false sense of protection. It’s been my experience that when I have taken multivitamins, I feel some sort of Maybe I don’t need to eat quite as well. A lot of people feel that you can maybe just, like, have a pizza and a multivitamin, and that means you’re full up on all the things you need. But it’s not the same. It doesn’t work. It would be amazing if you could replicate a healthy diet in one pill a day, but we’re so far from that. Wells: What is the point of a multivitamin then? Why does it not work? Hamblin: There is something to the actual structure of food. It contains fiber. It sends a signal to your gut simply by its volume. We have not been able to, in medical science, replicate the act of eating real food. When people have to have feeding tubes of different kinds of emergency nutrition, it’s never as sustainable as when you’re actually eating “real food.” Wells: Right, but there have been studies that show that people who wear safety gear are more reckless, and we still tell people, “Wear a seat belt and a helmet,” so why not take a multivitamin? Hamblin: If you can add a multivitamin and not change anything, then go for it. Whatever. I mean, you might waste your money. Wells: Is there really no science behind a vitamin being good for you? Hamblin: Not unless you have a deficiency in any of those areas. Wells: And do people generally have deficiencies? Does our modern diet mean you have some deficiencies? Hamblin: No, you need so little. And anything that you would be likely to get deficient in, we fortify. Even pastas and cereals, they’re fortified with vitamins in case you do just eat packaged foods all the time and never eat fresh produce. Wells: You’re telling me that, like, my Cheerios have a multivitamin in them? Hamblin: Oh, yeah. They’re loaded with vitamins. The reason there’s vitamin D in milk is because we add it to the milk. We found ways to make an ultra-processed diet that would avoid vitamin deficiencies. And that’s actually a problem for us. Wells: So our diet is already basically the equivalent of a multivitamin, where we’ve just randomly put vitamins in the crap we eat? Hamblin: That’s what fortification is. It’s one of those things that is sort of like oxygen. You are getting enough and getting more is not going to help you. The one outlier in the coronavirus-vitamin discussion is vitamin D. There’s almost nothing in our diet that gets us vitamin D. It shouldn’t even be called a vitamin, in my humble opinion. Wells: What is the definition of a vitamin? Hamblin: There is no definition. It’s derived from this marketing term, vital amines. We thought they all had an amine group on them and turns out they don’t. Wells: That’s what “vitamin” is?! Hamblin: Yeah. A great book on this is Vitamania, by Catherine Price. It goes into the whole supplement industry and how these ideas started. Wells: What are vitamins? Hamblin: It’s a random smattering of compounds. We call them “micronutrients,” as opposed to, say, macronutrients like fats, carbohydrates, and proteins. “Micro-” nutrients are these tinier ones, which you need, like, the amount of the head of a pin every month. Most of them occur in food. Vitamin D is one that doesn’t. You make it yourself being out in the sun. And you don’t need a lot, just a few minutes. There is not evidence that laying out and tanning is good for you. That’s still a major cause of skin cancer. As long as you have some exposure, even just sitting near a window, that should be fine. But there are some serious researchers who believe that there are people who are in a gray area, who might not be getting enough vitamin D, especially when told to stay home. When you’re really limiting outdoor exposure, it could be good to take a supplement. Wells: So it’s not that vitamin D somehow fights off the coronavirus. It’s that if you don’t have enough vitamin D—and there could be a slightly elevated percentage of people who don’t have enough vitamin D, because we’re all staying inside a lot—then your immune system can get all wacky, and therefore you would want to take a supplement. What about vitamin C? At the beginning of this, I was taking a vitamin C supplement every day. Hamblin: Do you know why people think vitamin C helps with colds? Wells: I do not. Hamblin: So, Linus Pauling was a Nobel laureate, really respected. Albert Einstein said of Linus Pauling’s work: “It was too complicated for me.” This was back in the 1930s. Pauling did a lot of groundbreaking physics and became the world’s eminent scientist. And then, in his later years, he started getting really, really into vitamin C in a strange way. He took tons of it. He started becoming an evangelist for it, and it was strange because he really was as respected and credible as anyone could be in a scientific field. And people tested his theories that it would prevent cancer and all sorts of diseases, and it didn’t bear out. Vitamin-C supplements will not protect you and will not improve the course of respiratory illness. There is a smattering of bad evidence but no good evidence, and the only reason that people believe it in the first place is this historic fallacy that did not bear out from a person who ended up basically losing all of his credibility by the end of his life. Wells: What about orange juice? It’s completely marketed on vitamin C. Hamblin: And it’s just sugar. Juice is one of the worst things you can drink. We know that getting too much sugar is not good for you. And we know that consuming it in the form of an orange versus orange juice is simply better because we at least get some fiber in it. It moves through your system more slowly, absorbs it more slowly, whereas juice is just like Hook it into my veins. I don’t recommend drinking orange juice. Supplements are an enormous and almost unregulated industry. They are marketed as parts of all these foods in all these other industries, like orange juice, dairy, cereals, and all these things that, just because it says “Now with extra vitamin E,” you’re supposed to just believe that must be good. And despite the lack of evidence to support it, we also have this bias of thinking: Well, I think it’s good. And even if I’m wrong, it can’t hurt, right? And that bias is so strong when it comes to things like life and death. Anyone with any concern about their longevity or management of chronic illness is very susceptible to that reasoning and logic. And it’s very sad to see. With vitamins, and with hygiene-ritual products, it’s important to allocate the things that you believe are protecting you, or that you enjoy, and just make sure they really are things to protect you, or they really are things that add value and joy to your life. And if they’re not, then get rid of them. Wells: That’s really good advice. I think I’m going to keep taking the multivitamin every now and then just, you know, because it can’t hurt. But also, every time I take it, I’m gonna be like, I’m being had. Hamblin: You got me, multivitamin. Down you go. The vitamin-C supplements specifically. They’re allowed to say things like “Enhance immunity” or “Boost immunity.” They are not allowed to make specific medical claims, like saying “Prevents coronavirus infection.” But I’m already seeing that stuff pop up all over, you know. Wells: Wait, but “Boost immunity”—you’re saying that is false? Hamblin: Right, but they can make those claims. The supplement industry has an enormous lobby and has been basically unable to be regulated. They tried to regulate it back in the ’80s and there was a huge campaign in response. The lobby got to Ronald Reagan and was like, Don’t let the government take over your vitamins. And then Congress just let it go. There is a commercial that was funded by the vitamin industry with Mel Gibson. Government agents come into his house to take the vitamins out of his cabin. Wells: Oh my God. If Mel Gibson was involved, like, red flag. Hamblin: It’s sort of this wild west of compounds, where you can take anything to market right away. You’ve got to notify the FDA, and then you can start selling something and calling it vitamin D. Versus the pharmaceutical industry, where it’s a long, enormous, expensive process where you have to actually prove that it does what it says it does. Wells: That brings us back to where we started this conversation: the FDA actually preventing something peddled as a hopeful cure. But we’re still all drinking fizzy orange liquid. from https://ift.tt/3hEAE7O 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, My brother and his fiancée are planning to get married next week in California. I just assumed they would postpone it or have a small gathering, but as it turns out they’re going through with the 150-person wedding and local authorities are allowing it. I still don’t even feel comfortable going to a grocery store, so I can’t even imagine going to a large wedding and reception—even though everyone has been told they’ll have to wear masks. Oh, and they want my 3-year-old son to be in it. I feel like I could’ve said no, but that would’ve made me feel really bad and I didn’t want my relationship with his soon-to-be-wife to be affected going forward. Their decision is fully theirs to make, but it puts me and all other guests in a very awkward and potentially unsafe position. What do I do? Or say? Anonymous San Jose, California This is an unfortunate situation to be put in. You’re being forced to choose between feeling irresponsible and afraid, and feeling unkind and paranoid. At least one clear, universal lesson can be learned here: Don’t put people in this sort of position. Actually, two: Just because local officials haven’t forbidden something doesn’t make it safe. Legal can’t be mistaken for wise. In your specific case, I’m kind of in awe that this big wedding is happening right now. Cases of COVID-19 in California are surging. Having a reception seems especially feckless, because that part is specifically about interacting with other people. It’s easy to say that attendees will wear masks and socially distance, but that goes one of two ways: People adhere to the rules and the experience is awkward and sad, or they don’t and risk spreading the virus. When you bring together a lot of friends and family, the natural instinct to embrace and act like you did in the old days will be difficult to overcome. Not everyone in attendance will be on the same page about their willingness to socially distance. It’s not a setting where people could truly party. Having a wedding ceremony is a little different. For some, the whole ritual is hollow and trivial to begin with, so the pandemic is a perfect excuse to just elope. But for a huge number of people the marriage just won’t feel real without a ceremony of the sort that they’ve been imagining as long as they can remember: “the best day of my life.” The wedding-industrial complex paints a picture of a festive, elaborate, catered gathering as essential to any hope for marital bliss. [Read: The pandemic’s long-lasting effects on weddings] But that’s their problem, not yours. If you aren’t comfortable going to the wedding ceremony, you shouldn’t go. I wouldn’t feel comfortable. Having 150 people signals a lack of caution. Weddings can be selfish affairs, but having this event right now goes beyond selfish. Anyone who is inviting people to celebrate them in a mass (or even minor) gathering during this pandemic carries the burden of making extremely, deeply, abundantly clear to people that they don’t need to come. A new type of wedding invitation might help lay out the vibe: no more “We’d be thrilled for you to join us” or even “We request your presence” unless it is extremely clear that zero credit will be lost by guests who join virtually. Actually, I’m not even sure virtually should be a word anymore. Zooming into a wedding needs to be considered as real as being there in corporeal form. This probably should’ve been the case for a long time—I would’ve gone to way more weddings if I didn’t have to fly and book a hotel. Even a slight suggestion that people should be physically present will guilt people into traveling. Getting people to avoid mass gatherings is difficult enough; the least we can do is enable people who don’t even want to. The couple shouldn’t even want people there who feel uncomfortable. And at the same time, they shouldn’t want people there who are going to break the rules and make the marginally comfortable people suddenly feel like they made the wrong choice. The invitation should probably include some footnote about how such people will be asked to leave. [Read: A very unwelcome wedding guest] The weddings themselves also need a rethinking. Ceremonies can be as large as anyone wants, though only a small number of people (possibly even zero) should be physically present. If people do gather, don’t have everyone sing. If you have a preacher or the like, have them use a microphone rather than vocally projecting. The same goes for speeches or toasts at the … reception, which isn’t a word we should probably use, either. This is a moment to totally reimagine the traditional reception. The warm summer months will make it easier to find some way to bring together a group of people outside—you could have a buffet and a picnic where people could, hypothetically, enjoy themselves while still distancing. Once things move into a bar or restaurant, though, I think all bets are off. It’s probably too late to convince your brother of this, but he and his fiancée would do better to save the reception for later. I know a lot of people stand to lose some money by canceling events right now. If that’s the case with your brother, remember that Americans are not infrequently charged hundreds of thousands of dollars for getting a severe case of COVID-19. And that’s just from a financial toll. Once you start factoring in the cost of human life, the whole thing feels doomed. At some point, weddings will again be enthusiastic and loud and joyous and uninhibited. Couples who just do a little ceremony now might keep a big reception in their back pocket as something to look forward to once the pandemic is over. That reception might not be for a couple of years, but it will be worth the wait. Plus, it’ll be like you get two weddings. Two best days of your life. And then you can act overtly, righteously indignant if people don’t come. “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/3hwjTfb Check out http://natthash.tumblr.com On March 11, the NBA abruptly shut down its season after one of its players tested positive for COVID-19. Now, even though the pandemic isn’t behind us, the league has announced a plan to restart the season. Joel Anderson, Slate staff writer and co-host of the podcast Hang Up and Listen, joins to explain what's going on with the NBA. Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. James Hamblin: You have covered the NBA’s recent moves—the last game that was played in the NBA was March 11, as the WHO declared a pandemic? Joel Anderson: Yes. There was that surreal moment on March 11. Within a span of a few hours, the whole world changed. It was crazy. We found out Tom and Rita Hanks had tested positive or coronavirus, and flights from Europe to the U.S. were suspended. Then we saw that footage in Oklahoma City of all these players being frantically waved off the court because they were suspending a game which is something that, as a fan of the NBA, I had never seen that before in my life. Katherine Wells: I remember when the NBA was like, basketball is canceled—it was like, oh my God, this is a real thing. Anderson: Absolutely. It resonated that we were on the precipice of something bad. If the NBA is taking this seriously, if they're going to call off games and suspend the season then obviously this is something to reckoned with. Back in March, and even into April, there was real concern that the NBA wasn't going to come back. There were so many hurdles to clear, the testing capacity was a concern, and it wasn't clear that the players wanted to return. But it was inevitable as things started going along that we were going to get some basketball. The broadcast partners obviously wanted to do it. And then it became clear the testing capacity wouldn't be a problem, they were able to move forward. And so here we are. The NBA is going to open training camp July 9, as far as we know. Hamblin: They're doing that in their hometowns and then they're going to go on to Orlando? Anderson: No, the training camps are even going to take place in Orlando. They're going to start moving down that direction. They're trying to get people, you know, into a central location as soon as possible. So, even before training camps start, these teams are going to be down there, They're going to stagger their arrivals but they're going to do these training camps down there all together at the same time over the course of a few days. July 9 through July 11. Hamblin: Why Orlando? Anderson: It obviously helps that Disney is the league's biggest customer. Disney pays like $1.4 billion a year to broadcast games on ESPN and ABC. A lot of players already live down there. Orlando's sunny, family friendly and has no state income tax. And then think about this: Florida is run by a governor who's much more welcoming of business and getting things back to normal. They've already had a number of live sporting events there: NASCAR, UFC, WWE. In Florida right now, NASCAR is already planning to allow fans to attend races. Hamblin: Are there going to be fans at NBA games? Anderson: No. But as teams get eliminated, as we get deeper into the postseason, family members will be allowed. And supposedly there's going to be three [family members] per player. Hamblin: So, they're going to be playing to a mostly empty stadium. Is the energy going to feel similar? Is it going to be sort of like practice? Anderson: From what I understand, they're talking about possibly pumping in crowd noise. So there are a whole bunch of alternatives that they're bandying about right now. That's one of those things that are still to be determined. Hamblin: OK, what do we have here in terms of contingency for the inevitable —which is that people will get the virus and then they'll be rubbing their sweaty faces against the backs, shoulders, and potentially faces of other players. What's the plan when someone gets a positive test? Anderson: At a minimum we know that the league has made it clear that things are going to move along even if a couple of players come down with coronavirus. They're still ironing out details but we do know what happens is, if a player tests positive they'll have to quarantine. And if a player leaves the campus, they're going to also have to quarantine, too. It's just really hard to keep a bunch of young wealthy men locked in one bubble for months at a time. Hamblin: How long are they staying? Anderson: Fourteen of the 22 teams will be eliminated within fifty three days of arrival. So almost two months. Only four teams will be there after two months. So it's going to be a very compressed schedule. Hamblin: I come at things from a medical and health lens.My default from that perspective is, this is a bad idea. But I also fully understand that sports are an important part of the social fabric and bonding and community and culture and people need some semblances of things like that right now. So, do you think this is a good idea? Anderson: No. First of all, it's just going to require an unprecedented amount of work in a tight and uncertain timeframe to just stage these games. I think people think they want this, but I think it's going to change once they see it. It's not going to be a continuation of the season that was suspended. This is basically a whole new season. The idea that we're going to get any closure on anything that happened prior to March—that's just not possible because this is so weird. And also I think people are really eliding the health risk here. There's so much about this disease that we don't know. We don't know how it will affect players today. We don't know how it will affect them 20 years down the line. There are also coaches that are there that are elderly, for lack of a better term. My favorite team, the Houston Rockets, their coach is 69 years old. What happens if he gets coronavirus? What if he dies? That's a concern that I just think that people are pushing past right now. There's too much uncertainty to play games just for the sake of games. I just remember that where we were in March when the NBA calling off games was a big deal. It said something to society. It [said] they're willing to forfeit billions of dollars and all this attention for the greater good. Now, we're still in the middle of a pandemic and just like the NBA signaled that this was something to be reckoned with back in March it might be sending another signal to society by returning to court that we're telling ourselves that, oh, we're through this now, when that's not what's going on at all. from https://ift.tt/3fxq9l8 Check out http://natthash.tumblr.com When the coronavirus came to Boston, doctors at Brigham and Women’s Hospital noticed how silent certain floors became. Any patients who could be discharged were discharged. Anyone who could stay away stayed away. “The hospital had this eerie quiet,” says Jane deLima Thomas, the director of palliative care at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. But in the intensive-care units set up for COVID-19, machines beeped and whirred in room after room of the sickest patients. Those patients were sedated, intubated, and isolated. Many of them would die. Palliative care is about providing comfort—physical and emotional—to patients who are seriously ill, including those who may be close to death. Before the pandemic, deLima Thomas’s team worked with patients with kidney disease or cancer or heart failure, but this spring, they all switched to COVID-19. They embedded themselves in the ICUs. Palliative care is a field especially invested in the power of a hug, a steadying hand, and a smile. In other words, palliative care is made especially difficult by a virus that spreads through human contact. The first day the palliative-care doctors walked into the ICUs, Thomas says, “we felt like tourists.” They were dressed in business casual, while their ICU colleagues raced around in scrubs and masks. But the palliative-care team—which includes physicians, nurses, chaplains, and social workers—found ways to integrate themselves. In the early days of the pandemic, when protective gear was scarce, no visitors were allowed. Palliative caregivers, along with ICU nurses, held iPads cocooned in plastic bags so families could say goodbye on Zoom. They were sometimes the only one in the room when a patient died, otherwise alone. I interviewed several members of the Boston-based palliative-care team, and their stories, which have been condensed and edited for clarity, are below. Samantha Gelfand, FellowIn the ICU, the most immediate thing is the personal experience of walking down the hall. Nearly every patient’s room, the door is closed, and the patient is alone. And they’re often on their bellies for prone positioning. You can’t even see their faces often. Seeing anyone who is critically ill with a breathing tube, lots of monitors and beeping, it’s not easy. When we facilitate Zoom calls with family, I say, “Listen, it may be alarming to see that your loved one has tubes and tape and monitors on their head.” They may have soft wrist guards on their arms to stop them from trying to take out their own tubes. It doesn’t always work. I did a Zoom call with seven family members. The patient was a man in his 50s and he had seven kids, and they ranged from 18 to late 20s. I told the siblings what I could to prepare them, and still I’m holding the iPad and they start wailing. There’s a visceral experience of just devastation. As someone’s who lost my own parent, I think wailing is appropriate. I let them. I actually think holding the silence and bearing witness is the right thing to do first. It’s very uncomfortable to watch, but I think it’s misguided to try to hush or try to shorten it. How do you comfort someone on Zoom? It sucks. Our department has a reflection conference on Tuesday mornings. In COVID-19 times, we’re still doing this, but now we’re doing it by Zoom. One clinician will read the names of patients who died last week in our care. It’s very, very eerie to hear the list of names and have worked with probably half of them and not have seen their faces. Usually when we sit in that room and we remember the dead, we are remembering what it felt like to talk to them, what they looked like. And this, it’s like we’re remembering what it felt like to think about the patient or what their family members’ voices sound like. I really missed the times when I could think of a face the patient made or a comment that they said. It feels like a new way of grieving. Ricky Leiter, Attending PhysicianCOVID-19 doesn’t just affect individuals. It’s affecting families. I’ve had a couple cases where a married couple is in the ICU, next to each other. I was talking to a daughter whose parents were both intubated in the ICU. They were in their 70s to late 80s. Her father wasn’t doing well, and we were asking, “Should we try to resuscitate?” I remember her saying, “I can’t think about the hard stuff right now. This is all too much right now. I can’t do that.” And of course she couldn’t. How could she? Her parents were relatively healthy before they came in. It was the suddenness of all this. In my normal palliative-care practice, those are patients who have been sick for a while. They have been diagnosed with a serious and life-limiting illness. A lot of COVID-19 patients are otherwise pretty healthy; maybe they have high blood pressure. This is an entirely new universe. One of our fellows did five or six tough conversations like this with families in one day. I had a day like that early on. Our team walked back to our office, and everyone there asked what happened to us. We were so shell-shocked, and it felt like we were having the same conversations over and over. I don’t normally have six conversations where it’s the same disease, the same coronavirus. Reverend John Kearns, ChaplainMy brother died 30 years ago this September. It was a life-changing experience and really oriented me into the life of loss and grief. He died of AIDS, which seems so similar now with the fears surrounding an illness that wasn’t well understood. People then were afraid to touch him or hug him. My parents were very dedicated to his care. He died at home in our bedroom that we shared as brothers. It’s natural for people to take care of their loved one when someone’s sick. Being present for someone is part of what helps people get through it. They’re participating in some way. During this, the families have none of that participating. The first few weeks of COVID-19, we didn’t go inside the patients’ rooms. Now that we have more protective gear, they’ll let us go in, and the department has developed an iPad ministry to connect patients with family who can’t be at the bedside. Sometimes the family will email photographs and we’ll print them out and hang them in the room—photographs of the patients’ kids, wife, spouse, partner. Whether these sedated patients can see or hear is questionable, but the family gets to see, or the family gets to speak to them. I’ve spent as much as two hours in a patient’s room. I’ve gently wiped the forehead of a patient. I’ve led prayers with the family over the patient. And they will ask us to hold their loved one’s hand. Often there’s a hope to see there’s a response, whether it’s a simple squeeze of a hand, a blink, the movement of the head—anything that gives them hope that their loved one is going to make it. When the family wants to be seen by the patient, then you have to do the reverse camera and then hold it in such a way that they can see the patient’s face. You’re trying to orchestrate this intimate moment and sacred moment, and you’re fumbling with this iPad. Where is the camera lens on these things? And at first, we were putting these iPads in plastic bags, like a Ziploc bag, to keep it from getting germs on it. So now it’s sliding around in this bag that’s a little too big. You also have the problem of fogging up your glasses and fogging up the shield. At times, it is hard to see the face of the person or to read something or to manipulate the iPad. There was a Muslim patient who was dying. We have a couple imams. One is actually out of the country; he has not been able to get home since COVID-19 started. The other imam wasn’t available. When the patient took a bad turn, I got called in by Ricky Leiter. As an interfaith chaplain, we also visit everyone. I had an iPad with 20 or so family members who were all over the globe. They were reciting prayers. At one point it reminded me of church bells. All those voices all over the world, coming together at the same time. Stephanie Brook Kiser, FellowI’ve had family members say to me, Just please go in person and tell them in person that I love them and promise me that they won’t die alone, that you’ll be there at the bedside. A patient I took care had been sick with COVID-19 and in the hospital for two or three weeks. He was 80 years old. His wife was just a few years younger. They had been together since they were teenagers. You can just tell in her voice that it was so hard for her to be apart from him. She said, “I can’t remember a time I’ve been apart from him for this long. I think this might be the first time since I’ve known him.” At the same time, she was living in fear in her home because she knew she had been exposed to him. Because of her age and other medical problems, she was at high risk to be at the same place he was: really sick in the ICU, with a breathing tube, not getting better at two weeks or three weeks. It was pretty clear medically, no matter what we were doing, he was continuing to get worse and worse and worse. We had a really difficult conversation over the phone about what his wishes would be, and it was clear to her and to their children that the biggest thing we could do was transition to focus on his comfort. We knew what that would mean is he would die pretty quickly. With the hospitals’ changing policy, if someone is actively dying, we can now allow for a family member too at the bedside. My experience in the ICU when that’s offered, more times than not family members actually say no, that they don’t actually want to come to the ICU. There’s a real infectious risk to them, and I’ve had a lot of family members say, “I don’t know that I want to see them again the way they are now. I want to remember them the way they were before.” The wife was in such distress and despair over the idea that she was so physically close in Boston but it wasn’t the right decision for her to come into the hospital. I spent a lot of time and I was even grasping at things: Can I arrange a Zoom call? Maybe I can record a video and send it to you guys? And the family was saying, We want to remember him in a different way. They said, We just want you to go to his bedside and hold his hand so that he knows he’s not alone. And I did that over the course of about 15 minutes. He died pretty quickly. I’ve been part of a lot of deaths of patients in palliative care. We don’t see a lot of death like this—without any family members present. We aren’t used to being that person at the bedside, trying our best to provide the comfort that a family member’s presence would provide and feeling inadequate in that at best. Afterwards I gathered his nurses and respiratory therapist and we talked. Everyone agreed it was unlike anything they had been part of. It was the first time I had touched him. And in the ICU, probably one of the only times I’ve physically touched the patient. Natasha Lever, Palliative-Care NurseI’ve been a nurse practitioner for seven years, and I was hired at Brigham to do heart-failure and palliative care. Literally the week after I started, COVID-19 happened. They had this whole very carefully planned out 12-week orientation, and I got a phone call from our director, Jane, and she said, “Either we’re going to keep you at home for the next few months or we’re just going to put you in the ICU.” I kind of got thrown into the deep end. I went into nursing because I love to be at the bedside and with patients. Not having families and loved ones at the bedside was probably the most difficult part of all of this. It felt so wrong to us that families were having to make decisions about withdrawing care when they haven’t seen their loved ones. I remember the one that hit me the most was a woman whose son had given her COVID-19. He had been quite ill himself, and he had recovered. The immense guilt that he felt was so profound. He kept saying—he’d obviously been watching the news—“Please, don’t throw her in a body bag if she dies.” He kept talking about how they had been so excited they were going to move into a house together and he was going to buy his first house. He had plans for her and just wanted her home so badly. She passed away and it was very difficult. That was one of my first cases. And this was week two of my job as a palliative-care practitioner. I remember the first day I was in the ICU, it was completely chaos. It was very loud, lots of people. Almost this adrenaline rush you felt. A couple of weeks in, things sort of settled down. Now the ICU numbers are down. I had a really strange feeling when they were closing down the COVID-19 ICUs. I walked down the hallway and it was dark and all the rooms were empty and clean and there was no one there. Two weeks ago, this was one of the most busy, chaotic places in the hospital and there was just this silence. No alarms, and no people. It was almost as though, Is this a dream, did that really happen? Now I have just started doing the orientation that I was supposed to be doing. I’m going back to the hospital. I’m extremely excited to be at the bedside. I have never been so excited to talk to a patient in real life. from https://ift.tt/2AxuPbT Check out http://natthash.tumblr.com It took only a couple of weeks after the first coronavirus lockdowns in the United States for news reports to bear out what people in the hardest-hit cities immediately saw with their own eyes: When the going got tough, many residents—and especially the wealthy--got out. The outflux was most pronounced in New York City, where an estimated 5 percent of the population vacated the premises for some period of time, according to a New York Times analysis of cellphone location data. Some of the earliest leavers headed to their more spacious vacation homes, while others went to hunker down with their extended family in the suburbs. In Brooklyn, where I live, it was hard to miss the people packing up their cars in late March and much of April; they were often the only people outside who weren’t carrying sacks of groceries or delivering other people’s Amazon orders. Soon, some people began to predict doom for America’s biggest cities. No city seemed to have a coherent plan to make cramped, confined public transit safe for commuters. Bars and restaurants wouldn’t be back to normal for months, maybe years, and some would close permanently. School reopenings were stuck in limbo. The people who left for the safety of the suburbs would stay out, some posited, and other high earners would follow them. Over the past few weeks, as protesters have been met with tear gas and rubber bullets in cities across the country, some who had predicted an exodus grew more resolute. Even The New York Times asked if New York City was still worth it. [Tom Vanderbilt: The pandemic shows what cars have done to cities] These visions of an urban ice age have been buttressed by another recent prediction: that office work will no longer require physically going into an office. Employers that had resisted remote work have been forced to figure out the kinks, and now they’re under pressure to keep that option available even as states begin to reopen. Google, Facebook, and Twitter have extended work-from-home directives for their staffs into 2021 or made the option permanent, fueling the fantasy that former apartment dwellers in expensive cities will soon be able to take conference calls while far away, from a lounge chair next to their very own pool. As coronavirus case counts begin to tick back up across the country and the specter of a second spike in infections looms, people in major American cities who can afford to may be tempted to pack up their apartment and get out. But fleeing cities is a bigger gamble than many white-collar workers might realize. Those who panic-move could soon find that the future of work and cities is far different from what they expected. When we talk about people leaving America’s biggest cities right now, people largely means the rich. In The New York Times’ analysis of cellphone location data, 420,000 people fled New York City for some period of time from March 1 to May 1. Those who left were heavily concentrated in the city’s wealthiest zip codes, especially those in Manhattan. A similar phenomenon was found in the city’s trash-collection patterns, in which the amount of garbage dropped most sharply where rich people had vanished. That snapshot of movement reflects long-standing trends in who is able to move from place to place in the U.S. “The ability to move is really concentrated among the higher-earning people,” says Samantha Friedman, the head of the Center for Social and Demographic Analysis at the State University of New York at Albany. Poorer people change dwellings much more frequently than their affluent counterparts, she told me, but their moves are almost always within the same area; they tend to bounce between rentals and the homes of friends or relatives. The middle- and high-income people who could leave the city this year can be divided into two basic groups. First, there are the panic-movers, who hadn’t previously considered leaving before the pandemic hit. In one private Facebook group for panic-movers that I snooped around in for several weeks, the few thousand members looked for advice on how to persuade their New York–loving spouses to leave or asked for recommendations of small towns that are, somehow, very similar to the country’s biggest, densest city. [Molly Jong-Fast: The New New York Will Be Better] The second group of movers makes for less exciting trend stories: people who are taking part in normal attrition, of which New York City has plenty--tens of thousands of its residents move away every year. The city is expensive and cramped, and lots of people plan their exit to coincide with the predictable needs of their family or career, or just because they want something different. The pandemic may have accelerated these movers’ timelines by a few months or a year, but the decision to leave was already made. By all indications, this second group of movers is far larger than those who have abruptly decided to flee. “There was this movement already of people starting to move out of the high-cost cities like San Francisco, New York, and Washington, D.C.,” Derek Hyra, a demographer at American University and the head of the school’s Metropolitan Policy Center, told me. Cities such as Atlanta, Georgia; Austin, Texas; and Nashville, Tennessee have picked up significant population gains because of their relatively affordable real-estate markets, Hyra said, ripe for house flipping and gentrification. May was a historically bad month for the high-end Manhattan rental market, but there’s little reason to believe that the months ahead will be worse. While new leases in the borough dropped by more than 60 percent last month, the number of apartments that came on the market spiked by just 34 percent compared to last year. Some current vacancies might be held from the public until brokers are able to show them to prospective tenants in person again, but there’s also a simpler explanation: People decided that moving during a pandemic would be a big hassle and renewed their leases at greater rates than in a normal year. In the past few months, anecdotal evidence emerged that some landlords were taking advantage of tenants’ strong desire to stay put by jacking up their rent, a trend hardly in line with the narrative of a mass exodus. Disasters may inspire plenty of people to fire up Zillow in a fit of anxiety, but for most people a lot more than that is needed to actually start filling up moving boxes. In the three weeks I spent reading posts in the panic-movers Facebook group, many of the people posting revealed themselves not to be actual panic-movers. They had long been plotting their exit to suburban school districts or smaller cities where child care and housing are more affordable. These affluent adults approaching middle age are leaving dense, expensive cities for the same reason many of them flocked there in the first place: not in reaction to the pandemic, but in reaction to the changing circumstances of their own lives. “There has to be a very good reason to move in this kind of environment, and I’m skeptical it’s just going to be related to this virus,” Friedman says. “When a person gets married and they have children, that often prompts a need for a move.” Amber van Moessner counts her family among the group that was already looking to leave. In 2018, she took a job that she describes as “90 percent remote” with the expectation that she and her husband would need to leave the city if they wanted to raise a family. “After we had a baby—tale as old as time—we started thinking about how sustainable our life was here,” she told me. “Back in November, we started looking at real-estate upstate and [the pandemic] has really expedited our interest in leaving, because we’re just trapped in our two-bedroom apartment with our now-13-month-old son.” For many people in both categories of movers, predictions for their own futures hinge on the same hope: that several months of remote work during the pandemic will have forced America’s white-collar employers to loosen their work-from-home policies for good. Now that companies have systems in place to accommodate employees who have dispersed around the country, why would they revert to the old normal? But the work-from-home “revolution” is already off to an uneven start, with many people returning to offices at the behest of their employers in states that have more fully reopened. There’s reason to believe that will continue. “Everything is determined by the employers,” Peter Cappelli, a management professor and the director of the Center for Human Resources at the Wharton School of the University of Pennsylvania, told me. “The idea that, Hey, maybe we should move from San Francisco or Brooklyn to someplace rural and I’ll keep working there, I don’t see that as a smart bet, to be honest.” [Read: The pandemic will cleave America in two] People whose employers are amenable to fully remote work might still see consequences if they stay out of the office. Some employers could use remote work as an opportunity to tighten budgets beyond just their office leases, especially if the economy stays in a recession for a while. Facebook, among the first big companies to make working from home a permanent option, has already made clear that it will cut workers’ pay if they relocate from the Bay Area to less expensive places—a cost-cutting tactic common among employers whose workers retain their jobs when they move to less expensive areas. Early changes to remote-work policies from Facebook and across Silicon Valley are an indication that plenty of employers will be considering their options when it comes to the future of their workforces. Tech companies are highly influential in America’s white-collar corporate culture, and they’ve helped mainstream casual dress codes and open floor plans in the past 15 years. But Cappelli is skeptical that simply trying remote work will be enough to push most companies in that direction permanently. “We went through this idea about 20 years ago when hoteling became popular,” he recalled. Hoteling means that workers don’t have permanent workspaces in their offices, but instead wheel out their belongings from storage when they need to come in for a day or two. If you’re unfamiliar with the term, it’s because almost all of the companies that tried it have since abandoned it. Modern tools such as Zoom and Slack go a long way toward making remote work less isolating than it might be otherwise, but their existence alone didn’t do much to spur a new wave of work-from-home optimism before the pandemic arrived, and their predecessors—Skype, anyone?—weren’t enough to stop employers from concentrating jobs in big cities in the aftermath of the Great Recession. “There were all these predictions that teleworking technology would lead to an exodus of people from the cities, and actually it led to a recentralization in certain cities,” such as San Francisco, Los Angeles, and New York, Hyra, the demographer, told me. Even if bosses let employees keep working from home, it wasn’t merely jobs that drove mostly white, young college graduates into cities during the 2010s. It was the tastes of those people themselves, who were pursuing the things that Millennials are now stereotyped as loving: dining out, craft cocktails, live music, dating without settling down into married life. “A big part of wanting to be in cities is wanting to be around other people, a diversity of ideas, a diversity of amenities, different types of food, restaurants and entertainment, racial and ethnic diversity,” Hyra explained. America had raised a generation of young people who, on average, valued the things urbanity had to offer. There’s not much evidence that the pandemic has changed the tastes of otherwise enthusiastic city dwellers. And even if moving seems like an effective strategy to stay safe, it’s not exactly clear that it will look that way in hindsight. No one really knows how the pandemic will progress over the next year, in big cities or elsewhere. New York City’s outbreak now seems to be under far better control than those in many popular migratory destinations in the Sun Belt, which could change the calculus for panic-movers. The year is not yet half over, and the first five months weren’t particularly friendly to those with the temerity to predict the future; “may you live in interesting times” is a curse for a reason. For those of us who have stuck around, New York City still likes to remind us what it has to offer. Diversity and community are terms euphemized to the point of meaninglessness, but they take on a new valence when people come together in the face of historic adversity. The panic-movers might have seen their favorite restaurant close up in March and decided to flee to the suburbs, choosing a route that has helped isolate millions of Americans from the friendship and support they might receive in more tight-knit places. The people who stayed behind assembled robust mutual-aid networks to deliver free groceries and supplies to their vulnerable neighbors. Last weekend, while sitting on one of the benches that line Eastern Parkway in my Brooklyn neighborhood, it was hard to imagine a barren future. The whole borough seemed to be heading to protest, equipped with signs, hand sanitizer, and enough masks to go around. As I walked back to my apartment, along streets filled with cyclists and sidewalks lined with people waiting to pick up takeout, I saw something that had felt impossible in the siren-ridden weeks of early April: a family, gathered around their car, emptying it instead of packing it up. from https://ift.tt/3htO9Hq Check out http://natthash.tumblr.com On the latest episode of Social Distance, staff writer James Hamblin and executive producer Katherine Wells answer questions from listeners. Listen to the episode here: Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published. What follows is an edited and condensed transcript of their conversation. James Hamblin: This question comes from Tyler Richter in Springfield, Missouri. He says, "As churches open up their doors, are they risking the safety of their congregants by singing together? Our church announced, prior to this past Sunday, that we would not be singing out of an abundance of caution. However, when we arrived we were told if we were to sing, we should do so at a very quiet volume and most people were either mouthing the words or barely producing any sound when they sang." Katherine Wells: It seems like such a surreal scene. Hamblin: Yeah, it's kind of eerie, right? Part of the worship experience tends to be the exultation and singing loudly and joyously, and that seems to be a very risky part of this. Globally, when you look at the number of people who practice some form of religion that congregates and does some sort of either singing or chanting or praising, yelling out exclaiming things—this is potentially a huge driver of transmission. It's also something people are going to be quick to deem essential, as our president has. So, it's a legitimate question of how do you do this as safely as possible? Wells: Like, how does church work now? For instance. Hamblin: Yeah and there's still a lot to be understood here but basically you have all this mucus in your nasal pharynx and that's where the virus is hanging out and replicating. If you sneeze it comes out in these big droplets and those are going to fall to the ground pretty quickly. If someone is six feet away none of those will hit you and it's okay. But there's some that will be projected into the air because they're so tiny, they're considered aerosolized — so they can just float and linger for a long time. That happens in coughing. It's this process of force. The forcible ejection creates the aerosolization in a way that when you're breathing real calmly and quietly it's just going to produce less [viral] material. Singing, especially when you're doing it loudly and passionately, is much closer to coughing than it is to just sitting quietly. Wells: I remember at the beginning of this, there was a choir that sang together and everybody got sick and several people died, I think. Right? Hamblin: That was a case where there was one person who had some flu-like symptoms and attended and spread the virus to 53 out of 61 people who were at that choir practice. We were talking with Alexis [Madrigal] on Monday about super spreading and this is exactly how outbreaks really pick up the pace quickly is when you have not just someone spreading it to maybe a family member or a coworker but one person infecting 53 people. Then the same thing has been observed elsewhere: in Amsterdam, 102 out of 130 members of a choir got infected. In Austria, 43 out of 44. A lot of people in a small space projecting a lot and usually not having good airflow because part of this is you're supposed to be in a chamber where the sound will resonate in certain ways. It's not the same when it's done outdoors. Wells: So should people have church services outdoors? Hamblin: This is the kind of thing where I'm going to be really hesitant to adjudicate exactly at what point it becomes okay. What Tyler said is that in his church they've started to transition to not just singing quietly but having about a fourth as many people in the congregation come [to services]. I think the more masks you can wear, the more airflow you can have, the more outdoors it can be—as in, if you could leave all doors and windows open and there's this free flow. All of those factors are going to help and none are going to make it risk-free. Wells: Okay, next question. This week, this whole thing blew up about asymptomatic transmission. And it's something we've talked about before. But we've got a question about this from Lauren. She says, "can you guys please unpack the WHO kerfuffle on asymptomatic transmission?" Do you understand this kerfuffle? Hamblin: Yes. On Monday, there was a comment from an official at the World Health Organization. The official said that asymptomatic spread is "very rare." And that got picked up. Wells: And we should just say asymptomatic spread is the idea that someone can be showing no symptoms at all and feel totally fine and that they could still be spreading. Hamblin: Yes and that would also include people who never go on to get symptoms. Some people who are asymptomatic later test positive and never really felt anything. There are also people who are in an asymptomatic phase which, with any viral illness, precedes the symptomatic phase. In many diseases, people are shedding the virus as it's replicating and they're able to spread that before their immune system ramps up and they start to have all these symptoms of the disease. Wells: So you may not know you have it, but you could be contagious. Hamblin: Right. We know that people in asymptomatic phases are contagious. We don't know the exact number of how many cases are spread by people who are completely asymptomatic the whole time versus people who go on to develop symptoms later versus people who are experiencing symptoms and are also contagious but the statement from the World Health Organization was revoked and [they] clarified that we don't know the exact percentage. I'm not sure why they said it was very rare and I think it was just a point of confusion. Wells: So, prior to this week it was known that it was possible to not have symptoms and be contagious but we didn't know exactly how [often that happened]. On Monday, a WHO official said, basically, don't worry about it—seems very rare. And then they were like—never mind, just go back to before where we don't really know. Hamblin: Right that was sort of a blip in the news cycle that shouldn't have happened. Someone misspoke and a tiny fragment of a comment was taken out of context. Wells: Got it. So if anyone saw that and took from it the conclusion that hey, if I feel fine I'm probably not contagious, therefore, I don't need to wear a mask or I don't have to be as careful because I'm not feeling symptoms so I couldn't possibly be contagious — that is incorrect. That was a mistake. You could totally be contagious and not feeling [any symptoms]. Hamblin: Yeah, the reason that was a kerfuffle is because it's a dangerous misstatement. It's really important that people recognize that you can be asymptomatic and still spreading [the virus]. It would be much easier and more straightforward if we could say, as long as you don't have a cough then you're fine or if you don't have a fever, then you're not contagious. There are diseases where we can say just stay home unless you're feeling sick. But this is not one of them. from https://ift.tt/3fq1GOn Check out http://natthash.tumblr.com There is a unique quality to this day-by-day pandemic sadness, this quarantine depression that with the protests is edging into despair. I’m not referring to those adults who seemed, in the early, pre-protest days, to be inexplicably thriving. “I’ve never been so busy!” one friend, a computer consultant, giddily enthused. “With time zones from London to Tokyo to Denver, I’m on Zoom call after Zoom call!” Then there were the professional couples suddenly toiling in their backyard like farmers, growing lettuce so swollen that they could feed brontosauruses and posting explanatory video tours on Facebook: “For our rainwater. See? This is called a ‘swale.’” Privileged to work from home, I’m luckier than most. That’s what my peers and I have kept murmuring: “We’re lucky.” But the words crumble in our mouths because, not being astronauts who have actually trained for this human-lab-rat experiment, our effort to keep things in perspective goes only so far. We have no goals, no purpose. Short of banging pans at night, we can’t help essential workers. We’re 60ish, so our street protests would be at odds with public health. And my two teens? Quarantined at their dad’s. One is home from college, while the other has been watching a once-magical senior year destroyed—the musical canceled days before opening, no prom, no graduation. High school’s one grim activity: “Come clean out your lockers.” Said my teen, “To hell with my stuff. Burn it.” Meanwhile, my formerly natty partner, Charlie, has grown a scraggly mall-Santa beard as he sits in bed all day amid an ever-expanding litter box of newspapers. News alerts chime as he plots the course of the pandemic and its destruction on a hand-drawn wall map in the bedroom. It’s like getting a doctorate in the coronavirus from a deranged Civil War reenactor. Now protest cities are sprouting across another global map, as he sits on the phone arguing with several generations of family, the younger ones saying defund the police, the older ones saying defund your college tuitions. All is emotion, tears, a madhouse. For my own sanity, even before this most recent turn, I needed an escape—but where? As I cast about for options, a girlfriend recommended that I try “Yoga With Adriene.” I’m not a yogic person by nature. With creaky hips and a monkey mind, I don’t have the patience. In fact, I’d just deleted another online yoga “opportunity” that required a $150, 12-pack commitment and featured an 8:30 p.m. class called “Sleep Like a Baby.” I definitely don’t have a problem sinking into unconsciousness by day’s end. (A rare grace note to our current existence is being able to wear a mask while filling your grocery cart with an embarrassing amount of alcohol.) However, Yoga With Adriene turned out to have a very low bar for entry. It’s free and on YouTube. Among Adriene’s offerings is a 30-day beginners’ series called “Home.” It dropped—presciently—in January 2020. Was our yogini picking up some special global vibrations? Yoga With Adriene is ridiculously easy to find—start typing yoga into YouTube’s search bar and pop! There’s our girl. That is perhaps because, as I’d eventually learn, Yoga With Adriene has been “discovered” by seemingly every American who is not doing something important during the pandemic, and perhaps a few who are. Even before COVID-19 warped our world, Adriene was YouTube’s top yoga channel, with about 6 million subscribers. In the past two months, almost 1 million new people have signed up; there were 1.8 million views on April 13 alone. “Home” begins comfortably with “Day 0: Welcome.” Fade up on a homey bachelorette loft bathed in Crate and Barrel’s golden midday light. To gently upswelling music, we see Adriene—a youthful, Clinique-fresh-faced brunette—gazing out her window, sipping her morning coffee. The music ends, and here is Adriene, in virginal braids, sitting on a pillow in a T-shirt and leggings, petting her napping dog, Benji. In a lilting alto, she suggests we slip into comfy clothing and offers that this series “is designed for us to come together, as we are. We may be coming to this program wanting to trim and tone the body—you will!” Then, more softly: “You may be coming to this program to heal something that’s been aching you. Maybe you will.” We do three breaths together, and … namaste. That’s it. Six minutes has felt like three. I immediately click onto “Day 1: Recognize.” What I end up recognizing, while attempting a half-lotus and gazing down onto my prayer hands, is that my thighs are so pudgy, I’d popped a seam in my legging—quite a feat for fabric that’s ostensibly elastic. But by “Day 5: Soften,” I’ve forgiven myself and simply changed into larger, airier (pajama) pants. “Home” will turn out to be the double-espresso-with-8-ounces-of-whipped-cream-topped-with-bacon yoga, but I don’t know that yet. [Read: Why your yoga class is so white] Before COVID-19, I considered my writing and teaching schedule to be relatively sedentary, but almost three months of quarantine has blown the lid off something that a whole lot of 21st-century Americans have taken for granted: the incredibly high level of stimulation in our lives. I know now that I’m just a quivering, hormonal meat bag that had been glued together with twice-weekly trips to Equinox—and not just for the exercise, but for the psychological and sensory boost. To make the popular Tuesday and Thursday 8:30 a.m. spin classes, you had to reserve a bike on your Equinox app 26 hours ahead of time, not 24. Accordingly, at 6:32 a.m on Mondays and Wednesdays, I’d watch as the ghostly circles representing bikes filled up. Twelve, 23, 34 … Scoring the last bike, I felt as doped up as Lance Armstrong in the Tour de France. The morning of, I’d drink coffee, inhale the newspaper, do the crossword (timed) and the KenKen (also timed), before jumping into my car and directing my steely focus toward nabbing one of the prime electric-car parking slots at the “studio.” (Electric cars, yes! We win at parking!) On our assigned saddles, we manic-depressive, middle-aged spinners (Lycra bike pants the color of venomous snakes, titanium water bottles) jostled elbows while whoop-whooping to Duran Duran: Her name is Rio and she dances on the sand! [Read: I joined a stationary-biker gang] Clearly, no such endorphins are released by a socially distanced walk around the block. Or by that cautious weekly visit to the grocery store, even if you do manage to nab a roll of paper towels. So now, in these strange, cramped, partly safe and partly not end times, there’s a caged energy that can turn into bouts of muted—or not so muted—panic. One morning, the resting rate of my hammering heart, typically about 74 beats a minute, registered 115, and that was on lavender-chamomile tea. Which is why I’ve become addicted to Adriene Mishler. She herself is a kind of drug. When I see her, I experience actual wavelets of serotonin. I’ll admit that there are things about this yogini I might have found annoying pre-pandemic. She is young (35), white, skinny, and—yes—Texan. An only child and a theater kid, she’s as cheerfully anodyne as a summer-camp counselor. In downward dog, when our T-shirts fall forward over our chins, Adriene calls this, without irony, a “love cave.” But who cares when I’m so in need of tender ministrations? Adriene is there anytime I need her, like a friendly pocket deity. I have only to flip open my laptop: “Hello, friend,” Adriene purrs. “Hello, my darlings.” And then, as opposed to issuing burdensome commands like “Warrior one!” “or “Tree pose—now,” she utters four magical words: “Let’s start sitting down,” or, even better, “Let’s start lying down.” (Even on mornings when I can barely get out of bed, entering Adriene’s world is like stepping into a warm bath, as if she were saying, “Let’s start with a gentle cry,” or “Let’s get a small—but not too small; choose what feels right—bowl of Häagen-Dazs.”) It’s not that the yoga is always easy. Yes, on “Day 8: Gratitude,” we lay on the floor and hugged a pillow, and I’m ashamed to say I wept a little. (My girlfriend reported with unabashed enthusiasm: “I did Day 8 three times!”) But that had been preceded two days earlier by “Day 6: Ignite,” when we actually did a few sun salutations, planks, boat poses. This is the flow of “Home,” the slap and reward, slap and reward. Part of the allure is Adriene’s voice, pitched slightly lower than you would expect. If it were an aromatherapy candle, it would be ylang-ylang eucalyptus with a light charcoal rasp, like an exfoliant. Adriene may be Elizabeth Holmes–ing it, but who I am to judge? And then there’s the virtual mirroring. Instead of seeing your own lumpy self reflected back at you, you see only Adriene, lovely Adriene. And if you don’t feel like doing a low lunge today, just sit down, enjoy your coffee, and watch Adriene do it for you. Later, maybe, you’ll join her in down dog. Or just leave that to Benji, a dog so catatonic, I wonder if he is on medication. But again, whatever. He is our emotional-support animal, and I am calmed. Yoga With Adriene’s origin story is fairly humble. In 2009, Mishler, an aspiring actor, befriended the director Chris Sharpe on the set of his low-budget horror movie, The Spider Babies (never released). Sharpe persuaded Mishler, who declined to be interviewed for this story, to pivot toward a YouTube yoga series. It ran weekly for almost two years before gaining any traction. How to account for Yoga With Adriene’s subsequent success? For one thing, Sharpe and Mishler became masters of YouTube’s search-word algorithms—the breakout title being “Yoga for Weight Loss.” Tricky, because yoga doesn’t typically spur weight loss. But that’s a topic for another day. How about we all just drop into cow pose now? In a 2019 South by Southwest talk called “Giving to Grow and Receive,” the two yoga entrepreneurs attributed the size of their following to the fact that 90 percent of the content is free—only a small subset of subscriptions comes with a fee. But the deceptively simple-looking videos are the magic. “Adriene is thoroughly professionally trained as an actor,” Sharpe told me on the phone. “So we did a few videos, and they were more actor-y and performance-y. I had to lose a lot of the bells and whistles that I thought would be cool. It was a matter of taking a lot of stuff away, to create this very small, intimate experience. “I consider Mister Rogers one of the spirit guides of what we’re doing, from the production to everything else. Because the mic’s actually taped to her chest, sometimes, during those quiet moments, it actually picks up her heartbeat.” Aha! I realize Adriene is indeed Mister Rogers–like. With the soothing voice, the cozy living room, the comfortable togs, she exists in a small, glowing snow globe, out of time, where everything is always okay. This, then, is the apex of online wellness for our moment—a production not from Oprah, Deepak Chopra, or some Pilates-touting supermodel, but from a couple of nice kids from Austin who channeled America’s favorite G-rated neighbor. Now that we’re cut off from our physical worlds, however chaotic, the voluntary slowing of our own heart rates is a lifeline. “Breathe in a lotta love?” Adriene croons. Then: “Breathe out a lotta love.” Normally I’d find all of this absurd. But steeped daily in stories of personal and global loss, nothing looks the same anymore. I’ve taken to sleeping on my back in Savasana—corpse pose—with a pillow on my chest, thinking: “Breathe in a lotta love?” (Forgive myself that I’ve failed to help so many.) “Breathe out a lotta love.” (Send hope that all who are suffering will find happier times.) The small things often stand in for the large, and my ragged, bearded husband and I keep finding ourselves having circular arguments about food. His pandemic go-tos are bratwurst with sauerkraut and shrimp gumbo, which I can no longer bear. My culinary crutch is throwing chicken thighs into the Crock-Pot with “herbs” from my “garden,” whose planters I routinely run over with my car. One day, I was counting on some chicken for lunch but discovered that he’d fashioned it all into goopy enchiladas. Me (weepy): “Why?” Charlie: “I hate wasting food!” Me: “So use the yucky bratwurst from five days ago!” But then, thinking of Adriene, who gently invites us to skip even child’s pose if we’re not feeling it, I heard myself saying: “God, we’re just so depressed right now. We don’t have to hit any marks at all. Let’s just give ourselves a hug.” Cornily, we did. from https://ift.tt/2AXZEWS Check out http://natthash.tumblr.com Throughout the summer of 2012, Tylor Morgan would call his sister Lacey at night and beg her to come over and sit with him. It wasn’t obvious why Tylor felt so depressed. Growing up in Pocatello, Idaho, Lacey and Tylor had a fairly happy childhood. Tylor was shy, with lily-white hair and blue eyes. He retreated to the background while their charismatic older brother, Mark, drew the limelight. Their parents had divorced and remarried, but the siblings stayed close. Recitals were attended and mountains explored. Tylor was “pretty much a normal kid,” Lacey, who is now 26, told me. Tylor graduated high school in 2007, right before the Great Recession. But even that initially seemed okay; he liked to work. As a young man, he managed stores and fast-food restaurants around Pocatello. In his free time, he would tinker with his pickup truck or ride motorcycles. The only troubling thing Lacey noticed was that Tylor had been drinking a lot. Occasionally, he would get drunk and tell Lacey that he was in pain, and he wanted it to stop. The air felt heavier around him. He would get upset about girls, or not having a good enough job, or not making enough money. The exact problem wasn’t always clear. A few times, Lacey sat with him in the hospital, where he was staying the night because his blood-alcohol level was teetering on deadly. Then, that May, Mark died at 25 in what was ruled a suicide. His brother’s death left Tylor awash in guilt and horror. The brothers had argued the night of Mark’s death, and Tylor blamed himself. One night three months later, Tylor called Lacey again and asked her to come over. Lacey couldn’t go that night—she can’t remember precisely why—but she promised to see him in the morning. “I need you to just wait until tomorrow,” she told him. Minutes after they hung up, Tylor called the police and reported a suicide at his house. Then he picked up his gun and pulled the trigger. He was 23. Tylor’s and Mark’s deaths became two of a growing number of suicides among Millennials. Though they might seem in the prime of their life, recent research shows that Millennials—people born from roughly 1981 to 1996—are more likely to die prematurely from suicide and drug overdoses than previous generations were. Perhaps that’s to be expected, given the turmoil Millennials have faced in recent years. After scrambling up a slippery career ladder during the Great Recession, Millennials were slammed with the opioid epidemic. Billions of narcotic pills were shipped to parts of the U.S. where people had few opportunities, but plenty of pain. Now even more challenges loom over young people. Many Millennials who had their careers crippled by the 2008 recession are being flung into yet another economic downturn, just as they’re supposed to be hitting their career peak. Because of social-distancing restrictions meant to reduce the spread of the coronavirus, young people who hoped to find a partner haven’t been able to date in person for months. And still more outbreaks of COVID-19, the disease caused by the coronavirus, might occur this year. As David Grusky, the director of the Stanford Center on Poverty and Inequality, put it to me, Millennials are “the bad-luck cohort.” Interviews with more than a dozen experts on suicide and mental health reveal that Millennials are financially and generally stressed, and it’s driving some of them to extremes. Older Millennials snapped into adulthood after 9/11, fought in two wars, entered the job market during a recession, and are now weathering a global pandemic in overpriced one-bedroom apartments. They’ve experienced slower economic growth than any other generation in U.S. history, according to a Washington Post analysis. And having been clobbered by the last recession, they’re about to get clobbered again. In a report published last year by the Stanford Center on Poverty and Inequality, economists Mark Duggan and Jackie Li found that mortality rates for people from ages 25 to 34 had risen by more than 20 percent since 2008. “That is, mortality rates among millennials ages 20 to 34 were substantially higher in 2016 than among their counterparts from Generation X when they were [their age] exactly 16 years earlier,” they write. The main contributors to the increase have been suicides and drug overdoses, and the increase was highest among white people. Another report from the Trust for America’s Health last year found that drug-related deaths among people ages 18 to 34 more than doubled from 2007 to 2017, while alcohol-related deaths rose by 69 percent and suicides by 35 percent. This tendency toward premature death has been especially pronounced among Millennials who, like Tylor, never earned a college degree. In 2017, white people without a bachelor’s degree born in 1980 were four times more likely to die by suicide than those with a college degree, as Princeton economists Anne Case and Angus Deaton write in their new book, Deaths of Despair and the Future of Capitalism. Among those without college degrees, the later you were born, the more likely you are at any given age to live in pain, binge-drink, have poor health, and die from suicide or a drug overdose. White people in their 20s and 30s are dying from alcoholic liver disease, a condition that normally takes decades of hard drinking to develop. To be sure, the rise in Millennial suicides is set against a broader backdrop of despair: Rates of suicide are going up for all Americans, including Gen Z, the generation after Millennials. People ages 45 to 64 still have the highest overall risk of suicide. For Millennials, the reason behind this uptick appears to be that young people with less education face more financial strain than previous generations did. The good jobs that used to be available to people without college degrees have slowly evaporated. “Jobs are a source of meaning in our lives,” says Cheryl Fulton, a professor in the counseling program at Texas State University. “So if you don't have a job or are underemployed, you’re not deriving that satisfaction that comes from the meaning and purpose a job provides.” Rising health-care costs have encouraged employers to reduce headcounts and have eaten into employees’ salaries, Case and Deaton write. In addition, the decline in manufacturing jobs and the rise of the gig economy have driven non-college-educated young people’s wages into the ground. Millennials without a college degree are earning far less in early adulthood than previous generations did, according to another report in the Stanford series. The median salary for a 25-year-old man with a high-school degree or less is $29,000 a year, which is about $2,600 less than what Gen Xers earned at that age and nearly $10,000 less than Baby Boomers. In 1970, more than 90 percent of 30-year-olds were earning more than their parents were at the same age; in 2010, only half of 30-year-olds were. Millennials have, on average, no housing wealth. Therapists who treat Millennials told me that many of their clients feel frustrated and embarrassed that they aren’t able to afford “adult things” such as houses and vacations, either because they don’t earn enough or because they are handcuffed to enormous student loans. Marriage can alleviate loneliness and ease financial strain, but Millennials are getting married later than previous generations. “They feel that they shouldn’t be in this situation,” says Gail Saltz, a psychiatrist who works at Weill-Cornell Medical College. That can cause shame, and shame is “one of the bigger drivers of suicide.” The difference between what we have and what others have can prompt the bone-deep shame that leads to suicidal ideation, says Jonathan Singer, an associate professor of social work at Loyola University Chicago and the president of the American Association of Suicidology. People might start to feel like a burden or, if they’re unable to land a job, like they have no way of building a social network. More so than in other cultures, Americans tend to intertwine their jobs with their identity. “In the United States, if somebody is unemployed, we see that as an indication of bad character,” Singer told me. Yet Millennials are the first generation to have come of age with Facebook and Twitter—compelled to compare themselves with others but not jaded enough to know how empty these comparisons can be. Gen Z actually has a more healthily skeptical view toward social media, says Kate Comtois, a professor who focuses on suicide prevention at the University of Washington. These platforms had already ripened by the time Gen Z became teens, and perhaps as a result, they see social media’s downsides more clearly. Millennials, by contrast, were the first to reveal their life to an online audience, and some felt stung by the reception. As Lacey, Tylor’s sister, put it to me, “We have our blooper reel in our head, and everyone else’s highlight reel in the palm of our hands.” Lacking the money they need and the idyllic life they crave, Millennials experience extremely high levels of anxiety and perfectionism, several therapists told me. “They have almost double the rate of anxiety disorders compared to Baby Boomers,” says Nadine Kaslow, a psychiatrist and suicide-prevention expert at Emory University School of Medicine, who estimates that at least a third of her clients are Millennials. “The anxiety, depression, perfectionism, and substance use all increase their risk for suicidal thoughts.” The nature of these substances, for that matter, blurs the line between overdoses and suicides. Some people use depressants such as alcohol to take the edge off their anxiety, then wind up depressed. And some suicides are simply drug overdoses in disguise—someone who doesn’t care much about living might get less and less careful about not overdosing. The competing crises of 2020 are likely to make all of this worse. One study found that graduating into a recession has long-term, negative effects on life expectancy into middle age. People who entered the labor market in the recession of the early ’80s suffered higher rates of lung cancer, liver disease, and drug overdoses later in life. For Millennials who entered the labor market from 2008 to 2010, “all kinds of expectations they had about how they’re going to move right into the next job blew up,” Comtois told me. As the economy folds in on itself, the gains that older Millennials have made in the past 10 years may be erased entirely. A recent survey found that 31 percent of people ages 18 to 34 lost their jobs or were put on a temporary leave because of the pandemic, compared with 22 percent of those ages 35 to 49 and 15 percent of those ages 50 to 64. The recent protests against systemic racism and police abuses are yet another example of the frustrations faced by young people, especially black Millennials. In recent weeks, there’s been an outpouring of examples of unequal treatment of people of color in prestige industries such as journalism and publishing. Though racism itself can harm public health and life expectancy, the protests and police tactics used during them are also likely to spread the coronavirus. That could mean more deaths from COVID-19 in coming months, or another economy-crushing shutdown. Every person I spoke with was concerned that suicides among Millennials and other groups might rise further in the coming years. Diana Anzaldua, a therapist in Austin, Texas, says she’s heard more of her Millennial clients talking about suicidal ideation recently. The social connections that buoyed us have been stripped away because of pandemic-related social-distancing measures. One study projected that the pandemic could lead to 75,000 additional deaths from drugs, alcohol, and suicide. Most gun deaths are suicides, and there’s been an uptick in gun purchases during the pandemic. What does suicidal ideation look like? Some researchers theorize that it’s a feeling of defeat and humiliation followed by a sense of entrapment—of no exit. Some people say they’re thinking about hurting themselves, or that they feel utterly alone. Others are more explicit: “I just want this to be over.” When someone says, “I’m thinking this is how I would do it,” the alarms clang in therapists’ heads. These alarming trends don’t mean we should give up on Millennials—or on anyone else who is contemplating hurting themselves. Suicide prevention can be, in fact, extremely effective. Admitting that you struggle with depression can still summon more stigma than help, but Millennials, at least, are more open to talking about mental health than previous generations were. In fact, in part because the quarantine struggle has been a shared experience, some early reports have suggested that suicides have not increased so far during the pandemic. People see that others are depressed and lonely, making defeat feel more like a temporary problem than a permanent condition. The pandemic is a shared burden, not an individual one. One of the best ways to prevent suicide is to make people feel less alone by assuring them that someone cares about them. It doesn’t even have to be a special someone. Some studies found that suicidal people were less likely to act on their thoughts if the hospital where they had sought treatment mailed them a simple form letter, as Jason Cherkis reported for HuffPost. Just because someone is suicidal doesn’t mean they’re hopeless. Lacey felt guilty for a long time after Tylor’s death, but was also unsure exactly how much guilt she should feel. If Tylor had said, “Hey, if you don't come over, I'm going to kill myself,” she would have rushed to his side. Ultimately, she has come to the conclusion that, given how many times he had alluded to suicide, he would have likely harmed himself at another time. Lacey credits Tylor’s death with changing her perspective on life. She no longer goes weeks without speaking to her family members after an argument, “because we know what it’s like to one second have them, and one second not,” she says. Even though she’s in only her mid-20s, she’s been a foster mom to 10 kids and adopted a baby girl. When I asked how to describe her in this article, Lacey said, “A mom, foster mom, and adoptive mom.” She knows the quote about making lemonade out of lemons is a stretch. But, she said, even after the worst tragedies, you can make something resembling lemonade, approaching lemonade. Even if you don’t have lemonade, you’ll have something. from https://ift.tt/2UA4Y9K 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]. As we gradually reopen businesses, education, churches, etc., some questions arise. Is it safe for my friends who are music educators to teach choir in public schools, even with social-distancing practices in place? As churches open their doors, are they risking the safety of their congregants by singing together? Our church announced prior to this past Sunday that we would not be singing out of an abundance of caution. However, when we arrived we were told that if we were to sing, we should do so at a very quiet volume. Most people were either mouthing the words or barely producing sound when they sang. Tyler Richter A very general rule for minimizing the spread of any respiratory virus: Silence is safer than whispering. Whispering is safer than talking. Talking is safer than singing. In the context of so much being shut down, the question of singing may sound trivial. But it’s not at all. Given that a huge portion of the world population regularly attends religious services, and that many services involve group singing, navigating this question is crucial for the year to come. Thousands of lives may hang on how it is done. As the United States reopens, continued spread of the virus among some people—such as family members, roommates, or possibly co-workers—will be inevitable. What we can most hope to prevent are the “super-spreading” scenarios in which one person infects dozens of others. Choirs have repeatedly proved to be grounds for such events in the coronavirus pandemic. The most infamous case was in Washington State, where one person attended a choir practice in early March while experiencing flu-like symptoms. Three weeks later, two fellow singers were dead. A subsequent study found that the “act of singing” contributed to 53 of the 61 choir members eventually testing positive. Around the same time, 102 of 130 members of an Amsterdam choir developed COVID-19 after a performance, and four people associated with the choir died. In Austria, 43 of 44 participants in a choir seminar tested positive. Similar super-spread choir outbreaks have been reported in South Korea and Germany. These events took place just before shutdowns went into effect. They will happen again, when shutdowns end. With so much evidence now compiled, the simple answer to your question—don’t sing in groups—could seem obvious. In some places, leaders see it that way. Some parts of Germany, for example, have outlawed singing in churches. No law like that is forthcoming in the U.S., where churches are effectively exempt from much of the legal system. So decisions will largely be left up to local officials, individual congregations, and congregants. [Read: The pastors already planning to rebel against future shutdowns] The problem is, Americans don’t even have clear, uniform guidance for making such decisions, in part because the virus has become so politicized in the U.S. On May 22, the Centers for Disease Control and Prevention posted a warning on its website that deemed singing hazardous and recommended that congregations “consider suspending or at least decreasing use of choir/musical ensembles and congregant singing, chanting or reciting.” The next day, the agency deleted it after President Donald Trump deemed religious institutions “essential” and called on governors to reopen them. (The Washington Post reported that the White House instructed the CDC to delete the choir warning; neither the White House nor the CDC responded when I asked for comment.) The government’s abdication of its duty to provide basic information on managing coronavirus risk is especially dangerous because, in addition to the documented super-spreading events, there’s clear physiologic reason to be concerned about singing—or chanting, yelling, wailing, or even wassailing. Doing so in proximity to other people, especially when airflow in a space is limited, is a pandemic nightmare scenario. When you sing, microscopic particles burst forth from your mouth in a fountain of mist. Large droplets fall quickly to the ground, but the rush of air also creates an aerosolized mixture of everything that’s lingering in the mucus membrane of your pharynx. This is exactly where the coronavirus attaches and replicates, which it can do before a person feels any symptoms. Once aerosolized, those tiny mucus particles can linger in the air for an hour or more and float farther than six feet. A normal exhale creates a little bit of aerosol output, but a cough or sneeze puts out a ton. Singing similarly puts force behind the excretion, shooting it out like a geyser. (The goal of singing, if I recall from my music education, is to “project.”) The exact danger of aerosolized virus remains unclear, but since choir rehearsals have proved so clearly risky, the safe default assumption at the moment is that these floating particles can get you sick. And while six feet is a typically cited safe distance to prevent viral transmission, you could assume that a sick person singing on the other side of a large room could infect you if you spend enough time listening. Given the void of health recommendations from federal agencies on the subject of singing, musical organizations are stepping in and providing patchwork guidance. Last month, the National Association of Teachers of Singing, the American Choral Directors Association, Chorus America, the Barbershop Harmony Society, and the Performing Arts Medical Association hosted a joint webinar for choir directors, music educators, and performers on how dangerous group singing is in a pandemic. During the session, Donald Milton, an environmental-health professor at the University of Maryland, advised the groups not to gather again to sing in person until a vaccine or treatment for COVID-19 becomes widely available, even if that takes years. This is the expert consensus, unfortunately. But the dangers don’t erase the fact that singing is integral to all sorts of cultural traditions, religious and otherwise, and a fundamental way of bonding, communicating, and expressing emotion. These things have value to human health that’s not as easy to measure as viral RNA, yet still demands to be taken seriously. [Read: Why the coronavirus is so confusing] Like so many things, experts can’t offer a simple, permanent No or Yes, do it exactly like you always used to on the subject of pandemic singing. There may be some hope in the middle ground, where the risk is not zero, as it would be if everyone sang over Zoom in isolation chambers, but is still lower than traditional choral scenarios. Some groups have developed choral hacks like remote performances, or proposed amplifying clergy with microphones so they don’t have to project more than necessary. Churches that have the means could even, theoretically, be equipped with negative ventilation, which sucks air out of the space, like what hospital rooms have. Windows can be opened, crowds thinned, masks worn, and singing kept to a bare minimum. People can be rigorously tested (theoretically) to make sure that carriers of the virus come nowhere near the church. All of this, done together, would decrease the risks of super-spreading events. A cheaper option is using nature to take services and rehearsals fully outdoors. This will be only a temporary fix in most places, because winter will bring its own challenges. And singing in the open air will fundamentally alter the effect: Sound waves will disperse instead of reverberating through an acoustically designed chamber. Whatever is lost in that experience for the congregation, there might be solace in remembering that the virus is dispersing into that air, as well. It’s not a zero-risk scenario, but we have every reason to believe it is safer than the old way. [Read: How communal singing disappeared from American life] As with everything in this fragile moment of reopening, the answer is going to be that the safest thing would be to never gather in groups for the foreseeable future. Short of that, the more preventive work that can be done, the better. Much of that work will seriously detract from the traditional worship experience. It’s a moment for creativity and openness to carrying on the spirit of the endeavor in new ways that, by their conscientiousness, will carry special significance. “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/30wXqIH Check out http://natthash.tumblr.com |
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