Lauren Nichols has been sick with COVID-19 since March 10, shortly before Tom Hanks announced his diagnosis and the NBA temporarily canceled its season. She has lived through one month of hand tremors, three of fever, and four of night sweats. When we spoke on day 150, she was on her fifth month of gastrointestinal problems and severe morning nausea. She still has extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity to light and sounds, and brain fog. Even writing an email can be hard, she told me, “because the words I think I’m writing are not the words coming out.” She wakes up gasping for air twice a month. It still hurts to inhale. Tens of thousands of people, collectively known as “long-haulers,” have similar stories. I first wrote about them in early June. Since then, I’ve received hundreds of messages from people who have been suffering for months—alone, unheard, and pummeled by unrelenting and unpredictable symptoms. “It’s like every day, you reach your hand into a bucket of symptoms, throw some on the table, and say, ‘This is you for today,’” says David Putrino, a neuroscientist and a rehabilitation specialist at Mount Sinai Hospital who has cared for many long-haulers. Of the long-haulers Putrino has surveyed, most are women. Their average age is 44. Most were formerly fit and healthy. They look very different from the typical portrait of a COVID-19 patient—an elderly person with preexisting health problems. “It’s scary because in the states that are surging, we have all these young people going out thinking they’re invincible, and this could easily knock them out for months,” Putrino told me. And for some, months of illness could turn into years of disability. Our understanding of COVID-19 has accreted around the idea that it kills a few and is “mild” for the rest. That caricature was sketched before the new coronavirus even had a name; instead of shifting in the light of fresh data, it calcified. It affected the questions scientists sought to ask, the stories journalists sought to tell, and the patients doctors sought to treat. It excluded long-haulers from help and answers. Nichols’s initial symptoms were so unlike the official description of COVID-19 that her first doctor told her she had acid reflux and refused to get her tested. “Even if you did have COVID-19, you’re 32, you’re healthy, and you’re not going to die,” she remembers him saying. (She has since tested positive.) Long-haulers had to set up their own support groups. They had to start running their own research projects. They formed alliances with people who have similar illnesses, such as dysautonomia and myalgic encephalomyelitis, also known as chronic fatigue syndrome. A British group--LongCovidSOS—launched a campaign to push the government for recognition, research, and support. All of this effort started to have an effect. More journalists wrote stories about them. Some doctors began taking their illness seriously. Some researchers are developing treatment and rehabilitation programs. Representative Jamie Raskin of Maryland introduced a bill that would allow the National Institutes of Health to fund and coordinate more research into chronic illnesses that follow viral infections. It’s not enough, argues Nisreen Alwan, a public-health professor at the University of Southampton who has had COVID-19 since March 20. She says that experts and officials should stop referring to all nonhospitalized cases as “mild.” They should agree on a definition of recovery that goes beyond being discharged from the hospital or testing negative for the virus, and accounts for a patient’s quality of life. “We cannot fight what we do not measure,” Alwan says. “Death is not the only thing that counts. We must also count lives changed.” Only then will we truly know the full stakes of the pandemic. As many people still fantasize about returning to their previous lives, some are already staring at a future where that is no longer possible. A few formal studies have hinted at the lingering damage that COVID-19 can inflict. In an Italian study, 87 percent of hospitalized patients still had symptoms after two months; a British study found similar trends. A German study that included many patients who recovered at home found that 78 percent had heart abnormalities after two or three months. A team from the Centers for Disease Control and Prevention found that a third of 270 nonhospitalized patients hadn’t returned to their usual state of health after two weeks. (For comparison, roughly 90 percent of people who get the flu recover within that time frame.) These findings, though limited, are galling. They suggest that in the United States alone, which has more than 5 million confirmed COVID-19 cases, there are probably hundreds of thousands of long-haulers. These people are still paying the price for early pandemic failures. Many long-haulers couldn’t get tested when they first fell sick, because such tests were scarce. Others were denied tests because their symptoms didn’t conform to a list we now know was incomplete. False negatives are more common as time wears on; when many long-haulers finally got tested weeks or months into their illness, the results were negative. On average, long-haulers who tested negative experienced the same set of symptoms as those who tested positive, which suggests that they truly do have COVID-19. But their negative result still hangs over them, shutting them out of research and treatments. Several studies have found that most COVID-19 patients produce antibodies that recognize the new coronavirus, and that these molecules endure for months. Their presence should confirm whether a long-hauler was indeed infected. But there’s a catch: Most existing antibody studies focused on either hospitalized patients or those with mild symptoms and swift recoveries. By contrast, Putrino told me that in his survey of 1,400 long-haulers, two-thirds of those who have had antibody tests got negative results, even though their symptoms were consistent with COVID-19. Nichols, for example, tested negative for antibodies after twice testing positive for the coronavirus itself. “Just because you’re negative for antibodies doesn’t mean you didn’t have COVID-19,” Putrino said. Organizations and governments have been slow to recognize what long-haulers call “long COVID.” In July, the U.K. allocated $11 million (£8.4 million) for research into the long-term consequences of COVID-19, but “to be eligible, you have to have been admitted into hospital,” says Trisha Greenhalgh, a primary-health-care professor at the University of Oxford. “That makes no sense.” Meanwhile, the CDC’s website still does not mention this phenomenon, and its list of symptoms barely reflects the full range of neurological problems. As late as June 25, the agency’s deputy director for infectious diseases said “we don’t yet know” whether COVID-19 “could persist for more than a few months.” By then, thousands of long-haulers already did know, and had been talking about it. Without clear information from official sources, many long-haulers have found answers from one another. Support groups on Facebook have thousands of members. One Slack group, founded within a wellness organization called Body Politic, has almost doubled in size since June to more than 7,000 active participants from 25 countries. There are channels for discussing every organ system in the body. There are lists of sympathetic medical providers, and tips for convincing those who aren’t listening. Eerily, the group’s membership morphs as the pandemic spreads: “When Brazil had a huge spike, we had a massive influx of Brazilian patients,” said Nichols, who is an administrator. The Body Politic group has its own team of researchers, whose survey of 640 long-haulers remains the most illuminating study of the long COVID experience. More than any formally published study, it cataloged the full range of symptoms, and explored problems with stigma and testing. Many long-haulers start feeling better in their fourth or fifth month, but recovery is tentative, variable, and not guaranteed. Hannah Davis, an artist in New York City, still has fever, facial numbness, brain fog, and rapid heartbeats whenever she stands up, but she’s sleeping better, at least; at the end of July, she had her first relatively normal day since mid-March. Margot Gage, a social epidemiologist at Lamar University, has only now regained the ability to read without shooting pain, but still has debilitating headaches and fatigue. Hannah Wei, a product designer based in Ottawa who is a Body Politic researcher, has recovered from her neurological symptoms but not the scars the coronavirus left on her lungs. “Will I be living with this lasting damage, or will it eventually go away?” she says. “I don’t have the answers, and no one can tell me.” The physical toll of long COVID almost always comes with an equally debilitating comorbidity of disbelief. Employers have told long-haulers that they couldn’t possibly be sick for that long. Friends and family members accused them of being lazy. Doctors refused to believe they had COVID-19. “Every specialist I saw—cardiologist, rheumatologist, dermatologist, neurologist—was wedded to this idea that ‘mild’ COVID-19 infections last two weeks,” says Angela Meriquez Vázquez, a children’s activist in Los Angeles. “In one of my first ER visits, I was referred for a psychiatric evaluation, even though my symptoms were of heart attack and stroke.” This “medical gaslighting,” whereby physiological suffering is downplayed as a psychological problem such as stress or anxiety, is especially bad for women, and even worse for women of color. “Doctors not taking our conditions seriously is a common issue, and now we have COVID-19 on top of it,” says Gage, who is Black. When she sought medical help for her symptoms, doctors in two separate hospitals assumed she was having a drug overdose. Such gaslighting still occurs, but has been reduced by the recent spate of media attention. Davis was stunned when she met with a cardiologist who used the term long-hauler without needing an explanation. Vázquez burst into tears after her new primary-care provider instantly believed her. “I went into that appointment armed with my notebook, ready to do battle,” she says. “Just having a doctor who believed that my symptoms were directly related to COVID-19 was transformative.” Putrino, the Mount Sinai doctor, came to recognize long COVID on his own. Back in March, he realized that some patients who were referred to his hospital were in bad shape but weren’t sick enough to be admitted. His team created an app to keep track of these people remotely. By late May, they realized that “around 10 percent just weren’t getting better,” he told me. He has since started a program at Mount Sinai that’s dedicated to caring for long-haulers. But such programs are still scarce, creating large geographical deserts where long-haulers cannot find help. Putrino cannot see patients who live outside New York State. Igor Koralnik, a neurologist at Northwestern Medicine who runs a similar operation, was booked solid through April 2021; he has since brought extra staff members so he could accept more patients. Canadian long-haulers “have just one clinic, in Toronto, and that’s it,” Wei says. Putrino thinks that many long-haulers have symptoms that resemble dysautonomia. This is an umbrella term for disorders that disturb the autonomic nervous system, which controls bodily functions such as breathing, heart rate, blood pressure, and digestion. Damage to this system, whether inflicted by the virus itself or by an overly intense immune response, might explain why many long-haulers struggle for breath when their oxygen levels are normal, or have unsteady heartbeats when they aren’t feeling anxious. Things that were once automatic are now erratic. More than 90 percent of long-haulers also have “post-exertional malaise,” in which even mild bouts of physical or mental exertion can trigger a severe physiological crash. “We’re talking about walking up a flight of stairs and being out of commission for two days,” Putrino said. This is the defining symptom of myalgic encephalomyelitis, or chronic fatigue syndrome. For decades, people with ME/CFS have endured the same gendered gaslighting that long-haulers are now experiencing. They’re painfully familiar with both medical neglect and a perplexing portfolio of symptoms. These symptoms defeat intuitions that people have about work and rest, sickness and recovery. “You have to get away from this idea that you can do more each day, or that you can push through,” says Caroline Dalton of Sheffield Hallam University in England, who works for a COVID-19 rehabilitation program. Many long-haulers push themselves because they miss their lives, or need to return to work. But as her colleague Robert Copeland, a sport psychologist, explains, “managing your fatigue is now your full-time job.” The trick, then, is to slowly recondition a patient’s nervous system through careful exercises, without triggering a debilitating crash. On Putrino’s team, a strength and conditioning coach devises workouts to slowly get patients accustomed to a higher heart rate. A nutritionist fashions personalized meal plans to compensate for any dietary deficiencies. A neuropsychologist—Gudrun Lange, who has long worked with ME/CFS patients and is helping the group pro bono—uses relaxation and somatic-awareness techniques to help long-haulers who are unhealthily obsessing about their condition. Putrino insists on seeing and caring for all the long-haulers that he can. His colleagues at Mount Sinai’s newly launched center for post-COVID-19 care have to follow guidelines that permit them to admit only patients with positive tests. Anyone the center can’t admit is referred to Putrino’s team, which also keeps in touch with the Body Politic group to track patients who fall through the cracks. I asked him why he is so inclined to believe long-haulers when so many other medical professionals dismiss them. First, he said, “these people are telling us the same things over and over again.” But also, his wife has Ehlers-Danlos syndrome—a group of genetic disorders that affect the body’s connective tissues, and that commonly lead to dysautonomia. “I watched her go through the same thing: ‘You must have anxiety, or panic attacks, or every-excuse-under-the-sun,’” he told me. “Finally, after three years of searching, someone said, ‘Oh, you have dysautonomia and EDS.’ They put her on a treatment protocol, and she could live her life again.” “If you listen to the population you’re trying to help, they’ll tell you what’s wrong,” he said. Nichols is a few weeks away from meeting the CDC’s criteria for ME/CFS. She has post-exertional malaise. She has brain fog. On September 9, she’ll mark her sixth month of extreme fatigue. “Am I happy about it? No,” she said. “But I have to face reality. If this is what I have, this is what I have.” Lots of long-haulers are in the same boat. Many (but not all) cases of ME/CFS are triggered by viral infections, and new clusters have historically emerged after outbreaks. “When COVID-19 started to happen, I said to my husband, ‘Oh God, there’s going to be an avalanche of ME/CFS,’” Lange told me. Some long-haulers are skeptical—and even angry—about the ME/CFS connection. They won’t countenance the prospect of being chronically disabled. They don’t want to be labeled with a condition that has long been trivialized. Nichols sympathizes; she used to trivialize it herself. “I falsely thought it was just people being too tired—and I feel terrible about that,” she said. Her plan is to use her imminent diagnosis as fuel for advocacy, “as a way of paying back the ME community for my disbelief.” But COVID-19 is still a new disease, and ME/CFS is just one of several possible outcomes. Some long-haulers recover before the six-month threshold. Some don’t have post-exertional malaise. Some have lung damage and breathing problems that aren’t traditional ME/CFS symptoms. Some have symptoms that more closely fit with other chronic illnesses, including dysautonomia, fibromyalgia, or mast cell activation syndrome. Putrino doesn’t want to assign any labels. “Let’s just start helping them,” he said, while simultaneously collecting data that will eventually show how much long COVID overlaps with other known syndromes. (Several other teams are conducting similar studies.) Even when symptoms such as fatigue are shared, their biological roots might differ—and those differences matter. Exercise might be devastating for someone with ME/CFS, but might benefit a patient with something else. Many long-haulers, meanwhile, are treating any diagnosis as more of an anchor than an answer: It’s a starting point for understanding what’s happening to them. Vázquez, for example, was diagnosed with MCAS, and although it’s not a perfect match for her symptoms, “it’s close enough,” she says. No matter the exact diagnosis, the COVID-19 pandemic will almost certainly create a substantial wave of chronically disabled people. It might be hard to ignore this cohort because of the sheer number of them, the intense attention commanded by the pandemic, and the stories from celebrities such as the actor Alyssa Milano and the journalist Chris Cuomo. Then again, they might face the same neglect that people with ME/CFS have long endured. “We’ve been demanding for decades that people do something,” says Terri Wilder, an activist who has ME/CFS. “I’ve met with [NIH Director] Francis Collins. I’ve called Tony Fauci, and state senators. We still have no FDA-approved drugs, no systems of care. We only have 10 to 15 ME/CFS medical experts in the country. We all want our lives back, and we want this broken system fixed.” The uncertainty that long-haulers are experiencing results from that long-standing neglect. But so does the help they’re getting from people with chronic illnesses, who have already walked the same path. When the pandemic began, “it was like watching the roller coaster go up the hill, and only people like us knew that the track was broken,” says Alison Sbrana, who has ME/CFS and dysautonomia. She now spends her few productive weekly hours moderating the Body Politic support group. She has invited ME/CFS and dysautonomia specialists to give seminars, and has directed people to credible resources on aspects of disabled life, including care and benefits. That frontier, in which long-haulers attempt to access social support, “is about to be a shit show,” Sbrana says. Some want their employers to make accommodations, such as reduced hours or long-term sick leave, so they can keep working at a time when their medical bills are mounting. Others cannot work, but are pressured to do so by bosses who don’t understand what long COVID is. “We keep seeing that people who don’t have a positive test result struggle to get paid time off work,” says Fiona Lowenstein, who founded Body Politic. Yet others “don’t want people to see them as complainers, push themselves, and then get sicker,” says Barbara Comerford, a New Jersey–based attorney who specializes in disability law and has represented many people with ME/CFS. If they lose their jobs, “they’re in really bad shape,” she adds. Other sources of disability benefits and care, including private insurance and Social Security, are notoriously hard to access. Long-haulers would need to provide a history of being unable to do substantial gainful employment, and ample medical documentation of their disability to prove that it’s expected to last at least a year. Many have neither. Being a long-hauler in August is very different from being one in February. The first wave, who were infected early in the year, endured months of solitude and confusion. While the national narrative shifted from physical distancing to reopenings, their realities were pinned in place by fever or fatigue. Many had no idea that others were going through the same ordeal. They wondered why they were still sick, or how long they’d be sick for. “We didn’t know what tomorrow would bring,” Nichols said. Long-hauler support groups act as windows in time. In the Body Politic community, “the earliest person we know got sick in January,” Davis says. “She posts from the future, two months ahead of everyone else.” Conversely, as veteran long-haulers watch new generations pass the same monthly milestones, some are struck by a strange sense of solidarity, validation, and jealousy. The newer long-haulers already know what to call themselves, have bustling communities to learn from, and have better access to tests and medical care. The older ones are battle-worn and weary. “There’s something about having got sick in March and April that’s a unique experience, almost like post-traumatic stress disorder,” Vázquez says. Throughout the pandemic, systemic failures have been portrayed as personal ones. Many people ignored catastrophic governmental choices that allowed the coronavirus to spread unchecked, and instead castigated individuals for going to beaches or wearing masks incorrectly. So, too, with recovery. The act of getting better is frequently framed as a battle between person and pathogen, ignoring everything else that sways the outcome of that conflict—the disregard from doctors and the sympathy from strangers, the choices of policy makers and the narratives of journalists. Nothing about COVID-19 exists in a social vacuum. If people are to recover, “you have to create the conditions in which they can recover,” Copeland, the sport psychologist from Sheffield Hallam, says. If those conditions don’t exist, they can be at least partly willed into existence. Here, too, the long-hauler story is a microcosm of the pandemic. In the U.S., citizens chose to physically distance themselves, take precautions, and wear masks long before leaders urged or ordered them to do so. Likewise, the long-haulers have taken matters into their own hands, pushing for respect, research, and support when none were offered. But such effort comes at a cost. Long-haulers are precariously perched on a physiological precipice—a difficult position from which to fight for their future. “A lot of people who don’t have the energy to educate the world are educating the world,” Nichols said. from https://ift.tt/31cuRjU Check out http://natthash.tumblr.com
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Our bodies run on predictable daily schedules. As morning approaches, our body temperature begins to rise, and our cortisol levels climb. Our heart rate and blood pressure spike upon awakening. By mid-morning, we tend to be at our most alert, while many components of athletic performance—including strength, coordination, and flexibility—peak in the afternoon. As darkness descends, the pineal gland dials up its release of melatonin; while we sleep, gastric-acid secretion surges. Similar 24-hour cycles, or circadian rhythms, govern nearly every cell, tissue, and organ in the human body, and almost all of its physiological functions. Hospitals, it turns out, have daily rhythms too, and they don’t always sync with our own. According to a recent Proceedings of the National Academy of Sciences study, conducted before hospitals were handling surges in coronavirus cases, hospital clinicians prescribe medications in predictable patterns, dispensing the majority in the morning. This schedule—what the researchers call a “systemic bias in the timing of medicine”—may be convenient for clinicians, but it’s not necessarily best for patients or consistent with their biological clock. Hospitals run all day and night, and in theory medications could be doled out whenever they’re needed. “Our findings challenge this notion,” the study’s authors write, “and reveal a potential operational barrier to best clinical care.” For busy doctors, time is a scarce resource—and hospitals are generally designed to deliver care as quickly and efficiently as possible. But the human body keeps its own time, so optimal care may be less of a race than a chronologically choreographed dance. [Read: The hospital is too damn loud] The research team, led by the pediatric otolaryngologist David Smith and the circadian biologist John Hogenesch, analyzed approximately 500,000 doses of a dozen drugs—including painkillers, antibiotics, and corticosteroids—given to inpatients at the Cincinnati Children’s Hospital Medical Center from 2010 to 2017. The researchers found that the times at which drugs were ordered and administered weren’t uniformly distributed—instead, there were “distinct morning-time surges and overnight lulls.” (The researchers, who are based at the Cincinnati hospital, declined an interview request.) Roughly a third of all orders were submitted in the four-hour period from 8 a.m. to noon. And most of those were concentrated between 8 and 10:30 a.m., when clinicians were conducting their morning rounds. The finding makes sense, says Garret FitzGerald, who directs the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania, and was not involved in the research. “Any of us that are physicians know that a lot of hospital behavior is driven by rounding times, and those rounding times are chosen for all sorts of reasons that don’t necessarily have any particular scientific basis,” he told me. That doesn’t make the synchrony between rounding and prescribing medically sound, however. Patients should get drugs when they need them, not just when it’s convenient for clinicians, and there’s no evidence to suggest that, say, infections or inflammation or pain are confined to the morning. (In fact, patient pain tends to worsen at night.) “A lot of the times the schedules that are in place have nothing to do with the biological requirements of the patient that may be driven by circadian rhythms,” says Michael Smolensky, a medical chronobiologist at the University of Texas at Austin. The flood of morning orders also seemed to create an operational bottleneck; the delay between when drugs were prescribed and when they were administered was longest for medications ordered in that 8-to-noon window, the researchers found. It’s not clear whether these delays affected patient outcomes, but it’s certainly conceivable that they could have. In addition to these potential problems, there's the fact that our bodies are not stable systems. Our own internal rhythms mean that time of day can influence how well a given drug works or how severe its side effects are. Many ailments wax and wane in predictable ways over the course of the day--cold and allergy symptoms tend to be worst in the morning, while heartburn often strikes overnight--as do blood flow, liver function, and other physiological processes that can affect drug metabolism. A compound that’s quickly eliminated from the body during the day can linger at night. “We know that giving drugs at different times of the day can often result in different blood levels of those drugs or different adverse effects,” FitzGerald said. Our responses to various drugs, he added, are “conditioned by the clock.” [Read: America’s rural hospitals are dangerously fragile] Many adults, for example, take a daily dose of aspirin to help stave off the blood clots that can cause heart attacks and strokes. These cardiovascular events are especially common in the early-morning hours, and some research suggests that aspirin is most likely to prevent them when taken before bed. The drug also seems to cause less damage to the lining of the stomach when ingested at night. “Treating at the wrong biological time may not get you the results you want,” Smolensky told me, “and it may potentially aggravate the medical condition even further.” Although these time-based effects have been documented for a wide variety of drugs, many medications “are taken without any thought about the concept of when,” Smolensky said. In fact, the Cincinnati researchers saw this play out at their hospital. Previous research has established that many blood-pressure medications are most effective when given at night. But at the Cincinnati Children’s Hospital Medical Center, almost twice as many doses of hydralazine, a drug commonly used to treat high blood pressure, were given during the day as at night. The researchers found no obvious clinical rationale for this timing—as a whole, patients’ blood pressures did not seem to be spiking significantly higher during the hours when the drug was most commonly ordered. And when the drug was dispensed at night, it prompted a bigger drop in blood pressure than when it was taken in the morning. “Paradoxically, patients were more responsive to therapy during the window of time (nighttime) when relatively few orders were placed,” the researchers write. In an ideal world, clinicians’ prescribing behavior would be calibrated to when different drugs work best. Antipsychotics, for instance, may cause fewer metabolic problems when they’re administered in the morning. The point is that there’s no optimal time that holds for all drugs—and no medical reason to front-load all medications in the morning. Unfortunately, correcting for this bias won’t be easy. Hospital staffing schedules are carefully designed, and rounding typically happens at the same time each morning for a reason. But simply making clinicians aware of the problem could prompt them to be a bit more thoughtful about when they’re ordering certain drugs. Hospital staff certainly have their hands full at the moment, but in the wake of this crisis, as they recover and retool, it may also be worth considering more serious changes, such as asking nurses to round more frequently or instituting regular nighttime check-ins. “Perhaps,” FitzGerald said, “we should get a little bit more sophisticated about the way that we give drugs according to time.” from https://ift.tt/3haOaiX Check out http://natthash.tumblr.com Is it just us, or are a lot of people buying cars right now? On the latest episode of the podcast Social Distance, James Hamblin asks staff writer Robinson Meyer about “COVID cars” and what they could mean for the future of cities. 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. Some highlights from their conversation: James Hamblin: Are people getting COVID cars? Robinson Meyer: It’s funny, I started looking into this because between June and August 1, I had friend groups where every person or every couple in them bought a car. And then I started looking for data. And I’ve come to think the answer is yes, not just because a ton of friends of mine have bought cars in the last few months, as well as I have also bought a car in the last few months-- Hamblin: Wait, you? Meyer: Yes, I got a car. I got a car because cars are kind of this ultimate form of PPE—and we can talk about whether that’s true—but they’re at least perceived as a form of PPE. But also just because, if you live in the city, there’s not a lot to do right now. What you can do right now is go to the beach or go hiking or go hang out outside. D.C. has a great public transit system, but it doesn’t have an amazing transit system to connect you with hikes that are an hour out of town. And always in the past, I’ve just rented a car if I want to go hiking. But renting a car feels a little dicey now because you don’t know who’s been in it in the past. I don’t know, you can tell me if this is an accurate concern or not, but I’m mindful that there could be ... they were sick and didn’t know it or something and virus could be in the HVAC or something ... it’s like basically a room that you’re borrowing from other people and you don’t know who else was in that room before you. Hamblin: Yeah, I think it’s a low likelihood, but not unreasonable. But certainly, when people are doing rideshares or riding in cars with, you know, people who are not in their bubble for any reason, that is not a good situation. Meyer: Yeah, so your view is that renting is low risk, but not reasonable. And ride-share is not the best? Hamblin: Surfaces are easily sanitized. Air should not be lingering from the person who was in there a few hours before. And I would always be driving with the windows open and fan on if you’re riding with anyone. I think the issue comes when you’re in a car with people outside your bubble and the windows are up and the air is not on, or the AC’s on and recirculating things, where you really are in extremely close quarters. Not just not social distancing, but you’re closer than you would be-- Meyer: Right, you’re like sharing a single scuba tank? Hamblin: Yes, exactly. I think that is not good. I guess the solution is that everyone wants to avoid having to catch a ride with people, having to do a ride share, having to take a cab ... so they’re getting their own freedom-mobiles. Is that right? Meyer: Yeah, that’s right. There are two data points here. The first is: back in the early summer, there was this interesting phenomenon where car sales on the whole were down, but car sales among 18 to 35-year-olds were up. Relatively young adults like you and me, who live in cities where we haven’t needed cars or where a car has just seemed like more expense than it’s worth, are suddenly deciding to get cars. The other data point is that people are buying a lot of used cars in a noticeable way. Carvana, which is this online-only, no-in-person national dealership, has basically said it’s inventory-constrained. In other words, it is not able to obtain used cars as fast as it’s selling them. I think some people are buying cars because they are afraid of contracting the virus. And I’ll be honest, that’s certainly a reason I bought a car. My parents live in New Jersey and during non-pandemic times, I would just take Amtrak to see them. But the idea of taking Amtrak, taking the metro or the subway during a pandemic, especially if one of the things that I’d be doing is visiting a potentially sick person already, that wasn’t that appealing to me. What’s your sense of how risky or low-risk taking public transit is? Hamblin: Well, that’s obviously a very broad term. We’ve talked a little bit on the show about airplanes, which at first seemed like very bad situations. The reason we don’t see outbreaks of things like flu on airplanes—and we haven’t seen outbreaks of coronavirus on airplanes—is because the airflow in there is really good. And actually, this mechanical engineer messaged me after we talked about this on the podcast and he’s been calling for opening the windows on subway cars and all that. I would feel very safe doing that. As it is, I don’t know what precautions are being taken in different places. I’m sure they vary. Flu season always kills tons of people. This is a great time to overhaul those systems and just make sure that they have the sort of—they don’t have to have airplane-level ventilation—but the kind of thing where you know you’re not sitting in stagnant air. That’s so important to restore faith in public transit. For the climate, it’s important. And for people not feeling like they need to all try to buy cars because what do people think is going to happen in New York and D.C. with all these cars? Where do they go? We already have 6,000 miles of road in New York City. My solution to the pandemic was to open those roads: open them to pedestrians and close them to cars. Because people need space to bike and run and hang out and get out of their apartments. And instead, people are buying cars and you’re going to need that road even more. Those parking spaces where we’ve also now located our restaurants are going to be even higher in higher demand. Do you see this changing the face of American cities? Meyer: I think this is one of the really great open questions about pandemic. Something I’ve been pretty disappointed about in D.C., that I think New Yorkers have also been disappointed about, is that a lot of the western cities, especially in the Pacific Northwest, have really taken this opportunity to reclaim the streets from cars. People need to social distance and they need to get outside. The way to do that is to pedestrian-ize streets. I’m curious about what’s going to happen to people like me who are reluctant car owners, or who have cars for very specific purposes, who also want cities to open the streets and also want cities to end on free parking so people have more space to walk around. Historically, car owners have kind of been this more monolithic block acting in their own interests, acting like they always want more parking. It’s actually really important during this time that cities and city planners and governments act forcefully to preserve all the benefits of being a pedestrian or cyclist or a scooter rider or an e-bike rider in the city because people are buying cars. And the tendency will be to revert to car-first planning and car-first decision making. And if cities don’t move forward during this time, then I think they’re going to wake up in 2021 or 2022, and they’ll have actually lost ground. People will just default to their cars a lot more. And cities like D.C. and New York will become less livable and more unhealthy places to live because people will be opting for cars. Hamblin: And we should mention, too, that not everyone that lives in cities can afford a car. Meyer: Yes, and we should also say that, certainly in cities like D.C. and New York, car ownership is like an important issue to a lot of different kinds of people. Studies show that if you don’t have a car, and then you get access to a car, your earning potential does go up because now you can drive to a lot of jobs that you weren’t able to get to before. It’s important that the way we move forward in transportation basically makes it easier and easier to not own a car and makes it possible so that you have access to all the same number of jobs and that there are good jobs for you without a car, as you do with a car. The last 10 years congestion has gotten bad across the U.S., especially in the past three or four years. A lot of areas have really bad traffic that just did not have traffic before that. And we also know air pollution in some places is getting worse, especially from cars. A lot of the blame here seems to be on Uber and Lyft because all these ride sharing apps, instead of working on a taxi system, where basically taxis know where to go sit for rides. Uber and Lyft have moved to this system where cars are sorted by algorithm and there’s just a ton of cars without passengers on the road at any one time, driving basically from the end of one ride to the beginning of another. They have made congestion a lot worse. And something I do wonder ... I used Uber and Lyft a lot before the pandemic. And to some degree, the cost of owning a car is more, but not that much more than I might have spent on Uber and Lyft. I bought an old used car and I was spending a lot of money on Uber and Lyft. And if people, after the pandemic, switch a third or a half of their rides on Uber and Lyft to their own private vehicle—a private vehicle that when they are not driving, it is just sitting in a garage somewhere or sitting in a parking space somewhere—it could reduce congestion and improve overall outcomes because if that took some number of Uber and Lyfts off the road, we could actually see congestion decrease. Ride sharing apps are really bad for congestion. They’re not very good for pollution. They’re bad for their workers. But they’re nice and convenient, I guess, for some. But I do wonder, if a lot of folks who are buying cars now have basically used Uber and Lyft in lieu of a car ... if they started just using their own car, that could actually take some vehicles off the road. Hamblin: Well, you know, what would get cars off the road is if you didn’t allow them on the road because they were open to pedestrians. (both laugh) from https://ift.tt/3129a5P Check out http://natthash.tumblr.com At 8 a.m. Pacific time last Wednesday, I joined David Anderson’s 12th-grade government class at Live Oak High by clicking on a Zoom link. Because California suffered a surge in coronavirus cases this summer, students in Live Oak, a town about 50 miles north of Sacramento, will be learning virtually for the foreseeable future. Both Anderson and his students seemed nervous about how it would go. At 8:03, only eight of the 24 students had logged on, despite the fact that Anderson’s “classroom expectations” sheet requested that everyone “log in to class on time and prepared every day.” It might not have been the kids’ fault. Many students are poor in this rural chunk of the Sacramento Valley. The school ordered Wi-Fi hotspots for the students, but they won’t be available until August 22. In a class Anderson taught that afternoon, one boy’s video kept freezing from a slow connection. At the high point during the class I observed, 20 of 24 students had joined the Zoom session, which, Anderson told me later, is “better than expected.” Not all distance learning in rural areas is functioning even this smoothly, thanks to America’s notoriously unequal internet access. In the COVID-19 era, life has moved to the internet, but not everyone has it. As many districts start virtually this fall, some teachers say they’re fighting to ensure that all of their students can log into class each day. Their struggles are just one example of the consequences of America’s failure to get all of its citizens online before this uniquely internet-dependent time. [Adrienne LaFrance: ‘This push to open schools is guaranteed to fail’] Outside of Fresno, Rachel Cooper estimates that 20 percent of her eighth-grade students don’t have internet at home, and 20 percent have spotty internet. “It’s rough,” she says. Some kids are using their phones to log into class, but the screens are too small to do work on. Some kids’ internet cuts out in the middle of class, and others don’t log on at all. The school hasn’t been able to provide hotspots to all of its students yet, Cooper says. A Wi-Fi–equipped bus is supposed to drive around to areas where disconnected students live, but social distancing would require that students sit outside of it to do their work. “I’ve had several students already say that they were really nervous they were going to fall farther behind in a specific subject because they think distance learning is going to be really difficult,” Cooper told me. How did such an advanced country leave so many people technologically behind? Experts and former Federal Communications Commission officials describe a federal government that has neglected to treat broadband as a public utility, instead relying on the largely self-regulated internet industry to provide service wherever it wanted, for the price of its choosing. The United States government has historically not seen fast internet as something everyone should have, like it does water or even phone service, and the consequences are becoming frighteningly apparent. “I was responsible for this, and I failed,” Tom Wheeler, who served as chairman of the FCC under President Barack Obama, told me recently. [Read: There are other options besides opening schools] For starters, the FCC has failed to figure out where, exactly, the unconnected live, because the maps of broadband access the agency relies on are generated by internet providers and are extremely inaccurate. The FCC estimates that 19 million Americans don’t have a fast internet connection, but as CityLab’s Linda Poon has written, the true number may be more than double the official figure because of poor data gathering. According to the Pew Research Center, about 15 percent of all households with school-age children lack a high-speed internet connection. Some of these families live in areas that broadband providers don’t service, but others simply can’t afford the broadband that runs right outside their doorstep. In fact, some estimates suggest that the majority of people who don’t have internet actually live in cities and suburbs, not in rural areas. (In response to a request for comment, an FCC spokesperson said, “The Commission is working on a broad effort to collect more precise data from service providers so we can better identify where broadband gaps exist and vastly improve the maps we inherited from the previous Administration.”) In Cooper’s school district, for instance, there are some areas that internet providers haven’t hooked up, and others where getting internet would be too expensive for students’ families. “You pay $200, $300, and your internet’s still horrible,” she said. Even in normal times, this digital divide holds back the unconnected in innumerable ways. Broadband access tends to boost local economies, because many companies run on the internet and employers tend to take job applications only online. Many areas that lack internet also lack doctors, but telemedicine can’t reach places where few people have a connection strong enough for FaceTime. People without internet might have trouble accessing news and information, which has steadily migrated online. In areas where broadband exists, but not everyone can afford it, teachers still assign homework online, and only some students can complete it. [Read: These 8 basic steps will let us reopen schools] A lack of internet access can be a source of embarrassment, says Sharon Strover, a communications professor at the University of Texas at Austin. “Many people are acutely aware of their inability to quickly whip out a phone that can connect to the internet without thinking about how much it’s gonna cost.” In countries such as South Korea and Sweden, governments built out broadband infrastructure and opened it up to internet providers to use, much like the interstate highway system in the U.S., says Roberto Gallardo, the director of the Purdue Center for Regional Development. But the U.S. mostly left this up to the internet companies themselves, and parts of the country got overlooked. Typically, internet companies say there aren’t enough customers in certain areas for them to feel financially incentivized to go there. This occasionally leads to what advocates call “digital redlining,” in which wealthy areas get online, while lower-income neighborhoods don’t. Similar to residential redlining, this has a disparate racial impact: Black Americans are less likely than white Americans to have a broadband connection at home. “When I worked at the FCC, I fielded phone calls from consumers who would say, Why is broadband deployed two blocks from me, but when I call the provider, they say,‘It’s going to cost us tens of thousands of dollars to bring it to your neighborhood?’” says Chris Lewis, who worked on broadband access in the Obama administration and is now the president of Public Knowledge, an advocacy group for internet access. Meanwhile, in about two dozen states, it’s illegal or very difficult for cities to build out their own internet networks, in large part because of lobbying by internet companies. [Read: What happens when kids don’t have internet at home?] When the government does entice internet providers to go into underserved areas, the companies aren’t held accountable if they fail to connect all of the people they promised to. For instance, CenturyLink received $505 million a year for six years from the FCC to expand rural broadband. The company did not meet its targets, yet it was not sanctioned by the FCC, and it is still eligible for a new round of federal funding this October. (In response to a request for comment, CenturyLink said, “The FCC’s CAF II program rules provide flexibility to address real-world challenges that arise as rural networks are built out. CenturyLink is on track to achieve full deployment in all states well within the time period specified in the FCC’s rules.”) The reins on internet companies got even looser during the Trump administration. In 2017, the FCC gave up what little command it had over internet providers when it voted to repeal its net-neutrality regulations. Now “the FCC doesn’t have the legal authority to ensure that everyone is connected to broadband,” says Lewis, from Public Knowledge. (At the time, the agency defended its decision as “helping consumers and promoting competition.”) As a result, by some measures, the digital divide is growing even as the internet becomes more essential. In 2019, a quarter of adults earning less than $30,000 annually relied on their smartphones alone for internet access, up from 12 percent in 2013. Many of these individuals are forced to fill out job applications, school forms, and other paperwork on a five-inch screen. Several broadband advocates told me it’s too late in the pandemic to try to dig cables into every American’s yard. Instead, Public Knowledge and other groups support inserting a $50 internet-access subsidy into the next COVID-19 relief bill. But that package has stalled out in the Senate, so the future of the subsidy is uncertain. [Read: I run a tutoring company. I get dozens of calls a day about learning pods.] In the COVID-19 era, all of these failures have come crashing down on teachers who now rely on the internet to do their jobs. The charity site Donors Choose has filled up with teachers who are begging for Wi-Fi hotspots for their students. Strover, the UT-Austin professor, says one common solution for those who don’t have internet is to check out hotspots from public libraries. But during the pandemic, many libraries have been closed. Students who don’t have internet are offered paper schoolwork packets instead, but as one ESL teacher in rural North Carolina pointed out to me, “not everybody can just read the instructions and then learn it. Then you wouldn’t need a teacher, right?” (She asked to remain anonymous because she was concerned about her job.) To some teachers, internet access is another domain of the pandemic in which the government has failed to act, leaving everyday Americans scrambling for stopgap solutions. “It feels like a lot of times right now it’s my job as a teacher to find a way for [students] to connect to the internet,” Cooper told me. “And I don’t think that’s my job. Policy makers should have made it possible for students to connect.” from https://ift.tt/3471G3n Check out http://natthash.tumblr.com Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Michael Mina is a professor of epidemiology at Harvard, where he studies the diagnostic testing of infectious diseases. He has watched, with disgust and disbelief, as the United States has struggled for months to obtain enough tests to fight the coronavirus. In January, he assured a newspaper reporter that he had “absolute faith” in the ability of the Centers for Disease Control and Prevention to contain the virus. By early March, that conviction was in crisis. “The incompetence has really exceeded what anyone would expect,” he told The New York Times. His astonishment has only intensified since. Many Americans may understand that testing has failed in this country—that it has been inadequate, in one form or another, since February. What they may not understand is that it is failing, now. In each of the past two weeks, and for the first time since the pandemic began, the country performed fewer COVID-19 tests than it did in the week prior. The system is deteriorating. Testing is a non-optional problem. Tests permit us to do the most basic task in disease control: Identify the sick, and separate them from the well. When tests are abundant, they can dispel the fear of contagion that has quieted public life. “The only thing that makes a difference in the economy is public health, and the only thing that makes a difference in public health is testing,” Simon Johnson, the former chief economist of the International Monetary Fund, told us. Optimistic timelines suggest that vaccines won’t be widely available, in the hundreds of millions of doses, until May or June. There will be a transition period in which doctors and health-care workers are vaccinated, but teachers, letter carriers, and police officers are not. We will need better testing then. But we need it now, too. [Read: How the pandemic defeated America] Why has testing failed so completely? By the end of March, Mina had identified a culprit: “There’s little ability for a central command unit to pool all the resources from around the country,” he said at a Harvard event. “We have no way to centralize things in this country short of declaring martial law.” It took several more months for him to find a solution to this problem, which is to circumvent it altogether. In the past several weeks, he has become an evangelist for a total revolution in how the U.S. controls the pandemic. Instead of restructuring daily life around the American way of testing, he argues, the country should build testing into the American way of life. The wand that will accomplish this feat is a thin paper strip, no longer than a finger. It is a coronavirus test. Mina says that the U.S. should mass-produce these inexpensive and relatively insensitive tests—unlike other methods, they require only a saliva sample—in quantities of tens of millions a day. These tests, which can deliver a result in 15 minutes or less, should then become a ubiquitous part of daily life. Before anyone enters a school or an office, a movie theater or a Walmart, they must take one of these tests. Test negative, and you may enter the public space. Test positive, and you are sent home. In other words: Mina wants to test nearly everyone, nearly every day. The tests Mina describes already exist: They are sitting in the office of e25 Bio, a small start-up in Cambridge, Massachusetts; half a dozen other companies are working on similar products. But implementing his vision will require changing how we think about tests. These new tests are much less sensitive than the ones we run today, which means that regulations must be relaxed before they can be sold or used. Their closest analogue is rapid dengue-virus tests, used in India, which are manufactured in a quantity of 100 million a year. Mina envisions nearly as many rapid COVID-19 tests being manufactured a day. Only the federal government, acting as customer and controller, can accomplish such a feat. If it is an audacious plan, it has an audacious payoff. Mina claims that his plan could bring the virus to heel in the U.S. within three weeks. (Other epidemiologists aren’t as sure it would work—at least without serious downsides.) His plan, while costly, is one of the few commensurate in scale to the pandemic: Even if it costs billions of dollars to realize, the U.S. is already losing billions of dollars to the virus every day. More Americans are dying of the coronavirus every month, on average, than died in the deadliest month of World War II. Donald Trump has said that the U.S. is fighting a “war” against an “invisible enemy”; Mina simply asks that the country adopt a wartime economy. [George Packer: We are living in a failed state] We have been covering coronavirus testing since March. For most of that time, the story has been one of failure after failure. But in the past few weeks, something has changed. After months without federal leadership, a loose confederation of scientists, economists, doctors, financiers, philanthropists, and public-health officials has assembled to fill in that gap. They have reexamined every piece of the testing system and developed a new set of tactics to address the months-long testing shortage. Mina’s plan is the most aggressive of these ideas; other groups—such as the new nonprofit Testing for America, founded by private-sector experts who helped the White House in the spring—have advanced their own plans. Taken together, they compose a box of tools that could allow the country to fix its ramshackle house. The government has also done more in the past month to stimulate the creation of new kinds of tests than it has done in any period of the pandemic so far. The National Institutes of Health has awarded $248 million in grants to companies so that they can scale up alternate forms of COVID-19 testing as quickly as possible. The Centers for Medicare and Medicaid has begun to support the nascent testing market as well. This investment is belated and too meager—by comparison, the government has spent more than $8 billion on vaccine development—but it is significant. If the new proposals make anything clear, it’s that it is in our power to have an abundance of tests within months—and to return life to normal, or something close to it, even before a vaccine is found. There is a way out of the pandemic. Today, if you go to the doctor with a dry cough and fever, and get swabbed for COVID-19, you will probably receive a test that was not designed for an out-of-control pandemic. It’s called a “reverse-transcription polymerase chain reaction” test, or PCR, test, and it is one of the miracles of medicine. The PCR technique has allowed us to probe the genomes of the Earth: Its invention, in 1983, cleared the way for the Human Genome Project, the early diagnosis of certain cancers, and the study of ancient DNA. It works, in essence, like a zoom-and-enhance feature on a computer: Using a specific mix of chemicals, called “reagents,” and a special machine, called a “thermal cycler,” the PCR process duplicates a certain strand of genetic material hundreds of millions of times. When used to test for COVID-19, the PCR technique looks for a specific sequence of amino acids that is unique to the coronavirus, a snippet of RNA that exists nowhere else. Whenever the PCR machine—as designed and sold, for instance, by the multinational firm Roche—encounters that strand, it makes a copy of both that sequence and a fluorescent dye. If, after multiplying both the strand and the dye hundreds of millions of times, the Roche machine detects a certain amount of the dye, its software interprets the specimen as a positive. To have a “confirmed case of COVID-19” is to have a PCR machine detect the dye in a sample and report it to a technician. Tested time and time again, the PCR technique performs stunningly well: The best-in-class PCR tests can reliably detect, in just a few hours, as few as 100 copies of viral RNA in a milliliter of spit or snot. The PCR test has anchored the American response to the pandemic. In CDC guidelines written by a council of state epidemiologists, a positive PCR result is the only way to confirm a case of COVID-19. And the Food and Drug Administration, which regulates all COVID-19 tests used in the U.S., judges every other type of test against PCR. Of the more than 62 million COVID-19 tests conducted in the U.S. since March, the overwhelming majority have been PCR. [Read: There’s one big reason the U.S. economy can’t reopen] However, a small but growing pile of clinical evidence—and a sky-scraping stack of real-world accounts—has revealed glaring issues with PCR tests. From a public-health perspective, the most important questions that a test can answer are: Is this person infected and contagious now? and If he’s not contagious, might he be soon? But these are not questions that even a positive PCR result can address. And especially as they’re conducted in the U.S. today, PCR tests do not tell us what we need to know to stop the virus. Imagine that, at this instant, you are exposed to and infected with the coronavirus. You now have COVID-19—it is day zero—but it is impossible for you or anyone else to know it. In the following days, the virus will silently propagate in your body, hijacking your cells and making millions of copies of itself. Around day three of your infection, there might be enough of the virus in your nasal passages and saliva that a sample of either would test positive via PCR. Soon, your respiratory system will be so crowded with the virus that you will become contagious, spraying the virus into the air whenever you talk or yell. But you likely will not think yourself sick until around day five, when you start to develop symptoms, such as a fever, dry cough, or lost sense of smell. For the next few days, you will be at your most infectious. And here is the first problem with PCR. To cut off a chain of transmission, public-health workers have to move faster than the virus. If they can test you early—around day three of your infection, for instance—and get a result back in a day or two, they may be able to isolate you before you infect too many people. But right now, the U.S. is not delivering PCR results anywhere close to that fast. Brett Giroir, the federal coronavirus-testing czar, admitted to Congress last month that even a three-day turnaround time is “not a benchmark we can achieve today.” As an outbreak raged in Arizona this summer, some PCR results took 14 days or more to come back. That’s worse than useless—“I would not call that a test,” Johnson, the economist, told us—because most bouts of COVID-19 last 14 days or fewer. “The majority of all U.S. tests are completely garbage, wasted,” Bill Gates, who has helped fund COVID-19 testing, recently said. After your symptoms start around day five, you might remain symptomatic for several days to several months. But some recent studies suggest that by day 14 or so—nine days after your symptoms began—you are no longer infectious, even if you are still symptomatic. By then, there is no longer live virus in your upper respiratory system. But because millions of dead virus particles line your mouth and nasal cavity, and because they contain strands of intact RNA, and because the PCR technique is very sensitive, you will still test positive on a PCR test. For weeks, in fact, you may test positive via PCR, even after your symptoms abate. And here is PCR’s second problem: By this point in your illness, a positive PCR test does not mean what you might expect. It does not mean that you are infectious, nor does it necessarily mean that there is live SARS-CoV-2 virus in your body. It does not make sense to trace any contacts you’ve had in the past five days, because you did not infect them. Nor does it make sense for you to stay home from work. But our country’s public-health infrastructure cannot easily distinguish between a day-two positive and a day-35 positive. The final issue with PCR tests is simple: There aren’t enough of them. The U.S. now runs more than 700,000 COVID-19 tests a day. On its own terms, this is a stupendous leap, a nearly 800-fold increase since early March. But we may be maxing out the world’s PCR capacity; supply chains are straining and snapping. For months, it has been difficult for labs to get the expensive chemical reagents that allow for RNA duplication. Earlier this summer, there was a global run on the tips of pipettes—the disposable plastic basters used to move liquid between vials. Sometimes the bottleneck is PCR machines themselves: As infections surged in Arizona last month, and people lined up to be tested, the number of tests far exceeded the machines’ capacity to run them. When tests dwindle, the entire medical system suffers. In Arizona, many doctors’ offices were short-staffed at the peak of the outbreak, because any doctor exposed to the virus needed to test negative before returning to work, and the system simply couldn’t handle the volume of tests. “We’ve had people out seven to 10 days” waiting for a negative result, Catherine Gioannetti, the medical director of health and safety for Arizona Community Physicians, told us. “It’s essentially a broken system, because we don’t have results in a timely fashion.” If labs don’t have the capacity to turn around doctors’ tests, which are often fast-tracked, they definitely do not have the capacity to test contagious people who are wholly asymptomatic. These silent spreaders may remain infectious for weeks but never develop any symptoms. They are the virus’s “secret power,” one testing executive told us, and they account for 20 to 40 percent of all infections. Some evidence suggests that they may be more infectious than symptomatic people, carrying higher viral loads for longer. The challenge is clear: We need an enormous number of tests. The American population at large—and not just feverish, coughing people—has to be screened. Let’s say, for instance, that you wanted to test everyone in the U.S. once a week. That’s 45 million tests a day. How can we get there? In the immediate future, the only way to increase testing is to squeeze more tests out of the existing PCR system. Our best bet to do so fast is through a technique called “pooling,” which could get a few hundred thousand more tests out of the system every day. Pooling is straightforward: Instead of testing each sample individually, laboratories combine some samples, then test that “pooled” sample as one. The technique was invented by Robert Dorfman, a Harvard statistician, to test American soldiers for syphilis during World War II. Today it is commonly used by public-health labs to test for HIV. It works as follows: A lab technician mixes 50 HIV samples together, then tests this pool. If the result is negative, then none of the patients has HIV—and the researcher has evaluated 50 samples with the same materials it takes to run one test. But if the pooled sample is positive, a new phase starts. The technician pools the same specimens again, this time into smaller groups of 10, and retests them. When one of these smaller pools is positive, she tests each individual sample in it. By the end of the process, she has tested 50 people for HIV, but used only a dozen or so tests. This approach saves her hundreds of tests over the course of a day. Pooling is a great first step to maximizing our test supply, Jon Kolstad, an economist at UC Berkeley, told us. This is in part because regulators and public-health officials are already familiar with it. The FDA has told Quest Diagnostics, LabCorp, and BioReference, three major commercial laboratories, that they can start pooling a handful of coronavirus samples at a time. In some parts of New England that haven’t seen much of the virus, pooling could triple or even quadruple the number of tests available, a team at the University of Nebraska has found. But pooling is only a stopgap. It works best for diseases that are relatively rare, such as HIV and syphilis. If a disease is too common, then the work of pooling—the laborious mixing and remixing of samples—is more work than it’s worth. (About twice as many Americans have been infected with the coronavirus as have contracted HIV since 1981.) In Arizona and some southern states burning with COVID-19, traditional pooling would not be worth the effort, the same Nebraska team found. Kolstad and Johnson, the MIT economist, are experimenting with ways to increase the efficiency of pooling. By grouping samples more deliberately, they can create larger pools of people with similar risks. A group of office workers might be at lower risk than a group of meatpackers who work close together, and even within a meatpacking plant, workers on one side of the plant might be at greater risk than those on the other. And because pooling saves money, companies and colleges and schools could run more tests. This would create a virtuous cycle. Each day, a person has a certain chance of being infected that varies with the prevalence of the disease in a community. Test every day, and there is simply less time between tests in which a person could have been infected. This makes it possible to build larger pools of people who are likely negative. Starting up these systems would require clearing logistical and regulatory hurdles—a positive coronavirus sample is a low-level biohazard, and the FDA regulates it as such. Dina Greene, who directs lab testing for Kaiser Permanente in Washington State, says that contamination problems are already difficult for labs to manage, and would be more so if labs have to manually mix together samples. Kolstad has been thinking through this problem. His team is experimenting with a different technique, which one might call “intermediate pooling.” Instead of having labs make pools on the back end, Kolstad proposes deploying trained nurses in mobile pooling labs in retrofitted vans. It would work well for nursing homes, he says: The nurses might arrive at a certain time every day, test every employee, pool the samples in the van, and then drop them off at a nearby clinical lab. (Because the FDA regulates pooling in clinical labs more strictly than in this type of “surveillance testing,” it may also be easier to obtain FDA approval for this plan.) Kolstad and his team are trying out this technique with a network of nursing homes in the Boston area, and delivering the pooled tests to a nearly complete, fully automated COVID-19 testing facility run by Gingko Bioworks, a $4 billion start-up in Cambridge that is pitching another method to scale up U.S. testing, one that could vastly increase the pace of processing. Since its founding in 2009, Ginkgo Bioworks has specialized in synthesizing new kinds of bacteria for use in industrial processes. Its engineers spin new forms of DNA using genetic-sequencing machines made by Illumina, a large and publicly traded biotechnology company. But in the spring, as viral testing buckled, Ginkgo’s engineers realized that their Illumina machines could be put to another use: Instead of creating genes, they could identify existing ones—and do so much faster than a PCR machine can. Unlike PCR machines, which can analyze at most hundreds of individual samples per run, sequencing machines can read thousands of samples simultaneously. A high-end PCR machine, operated by a round-the-clock staff, can run up to 1,000 samples a day; a single Illumina machine can read more than 3,000 samples in half that time. Ginkgo has sharpened that advantage by building its fully automated factory in Boston, centered on Illumina machines, which it says could test about 250,000 samples a day. It aims to open the facility by mid-October; in two months more, another three could go up and Ginkgo could be testing 1 million samples each day. The company has designed its supply chain to withstand high demand. It has rejected some reagents, for instance, because it doesn’t trust that there will be enough of them; it uses saliva samples, not swabbed nose or throat samples, because it does not think there are enough swabs in the world to meet demand. The genetic-sequencing supply chain is already built for such scale because other automated factories—doing noninvasive neonatal testing, for example—already use Illumina machines. Both Ginkgo and an Illumina-backed start-up, Helix, have received NIH grants to rapidly scale up their testing. If the technique receives FDA approval, as many expect, the two companies could as much as triple the country’s testing capacity. “In three months, I think we could be at between 1 and 3 million additional tests per day in this country, without any problem at all,” John Stuelpnagel, a bioscience entrepreneur and one of the founders of Illumina, told us. The approach has its challenges. Any samples must be shipped to one of Ginkgo’s or Helix’s centralized testing locations, which imposes a huge logistical obstacle to scaling up. The incumbent testing companies—Quest and LabCorp—have achieved dominance because of their ability to collect samples from places where they’re tested. But in Ginkgo’s full vision, 1 million tests will cover far more than 1 million people. The key to this approach is “front-end pooling.” Imagine that every day, when kids arrive in their classroom, they briefly remove their mask and spit into a bag. (It is a perfect plan for second graders.) The bag would then be shipped to the nearest Ginkgo factory, which could test the pooled sample and deliver a single result for the classroom by the next morning. “If you pool together one classroom, and test that classroom together, then if you get a positive, you can send the whole classroom home,” Blythe Adamson, an economist and epidemiologist at the nonprofit Testing for America, told us. “For children, it protects their privacy—we don’t know which student” tested positive. Front-end pooling could also drive costs down, partly by saving on materials. “Do 10 people spit in one bag? That’s one-tenth the cost,” Jason Kelly, Ginkgo’s chief executive, told us. “It’s logistically simpler, because one bag shows up, not 10, so there’s 10 times less unboxing, 10 times less robotic movement.” The challenge, he said, is chiefly one of industrial design, not molecular biology: There is no FDA-approved device, at present, that will let 10 kids safely spit into one vial. We should have federally backed development and fast regulatory approval for that kind of device, Kelly said. The Ginkgo sequencing approach and front-end pooling have never been tried before, because they make sense only in a pandemic. Only at the scale of tens of thousands of tests do Ginkgo tests start to cost less than PCR, Adamson said. But at that scale, their cost drops quickly in comparison—possibly down to $20, Stuelpnagel said, if not $10, compared with more than $100 for a PCR test. “You’d never do [any of this] for HIV,” Kelly said. “It’s only in a pandemic you go, ‘Oh my God, we’re undertesting by a factor of 10.’” But what if testing needs to scale up not 10 times, but 20, or 50, or 100 times? That’s where another type of test—an antigen test—comes in. At the same time that Ginkgo and other next-gen sequencing tests should come online, antigen tests will be scaling up. Unlike a PCR or a Ginkgo-style test, an antigen test does not identify any of the virus’s genetic material. Instead, it looks for an antigen, a slightly redundant name for any chemical that’s recognized by the test. Antigen tests aren’t as sensitive as genetic tests, but what they sacrifice in accuracy, they make up in speed, cost, and convenience. Most important, an antigen test can be conducted quickly at a “point of care” location, such as a doctor’s office, nursing home, or hospital. Two of the most anticipated such tests are already on the market. Manufactured by two companies, Quidel and Becton, Dickinson, they look for an antigen called “nucleocapsid,” which is plentiful in the SARS-CoV-2 virus. The companies say they will be making a combined 14 million tests a month by the end of September; for comparison, the U.S. completed 23 million total tests in July. This scale alone will make this type of test an important factor in fall testing. Hospitals and doctors told us they are eager to get their hands on antigen tests, in part because they’re worried about dealing with COVID-19 during the coming flu season. In years past, if a patient had a cough and a runny nose in December, she would likely be diagnosed with the flu, even if she tested negative on a rapid flu test. “But now we can’t presume [patients] have the flu,” because they might have COVID-19, says Natasha Bhuyan, the West Coast medical director for One Medical, a chain of primary-care clinics. An antigen test seems to offer a way out of this dilemma. The tests cost less than half as much as standard PCR tests, and they don’t need to be sent away to a lab. They can deliver a result in 15 minutes. But this approach has downsides. While the tests work well enough, successfully identifying most people with high viral loads, they have sometimes delivered false positives. Last week, Ohio Governor Mike DeWine tested positive on the Quidel test, leading him to cancel a meeting with President Trump. But later that day, he tested negative, three times, when analyzed by PCR. And while these tests will be useful, they have their own supply-chain drawbacks. Both companies’ tests can be interpreted only with a proprietary reader, and while many clinics and offices already have these readers on hand, neither company is prepared to mass-produce them at the same scale as the tests. (Quidel now makes 2,000 of its readers a month, but is aiming to scale to 7,000 a month by September, a spokesperson told us.) Because both tests look for nucleocapsid, which exists only inside the coronavirus, they need a way to sever the virus’s outer membrane. This requires more reagents. For many technicians, these drawbacks aren’t worth the benefits. “Most people who are real lab experts are steering away from all that stuff because they can’t justify it,” Greene, the Kaiser lab director, said. The readers are a particular sticking point for Michael Mina, the Harvard epidemiologist. He calls the BD and Quidel systems “Nespresso tests,” because, just as a Nespresso pod can transform into coffee only through a Nespresso brewer, they can deliver results only when their readers are at hand. “What I want is the instant coffee of tests,” he told us. What if there was an antigen test that could be made in huge numbers and didn’t require a specialized reader? What if it worked more like a pregnancy test—a procedure you can do at home, and not only at a doctor’s office? Such tests exist—and have existed since April—and they are made by e25 Bio, a 12-person company in Cambridge. An e25 test is a paper strip, a few inches long and less than an inch wide. It needs only some spit, a saline solution, and a small cup—and it can deliver a result in 15 minutes. Like a pregnancy test, the strip has a faint line across its lower third. If you expose the strip to a sample and it fills in with color, then the test is positive. It does not require a machine, a reagent, or a doctor to work. Its unusual quality is that it does not look for the same antigen as other tests. Instead of identifying nucleocapsid, the e25 test is keyed to something on the outside of the virus. It reacts to the presence of the coronavirus’s distinctive spike protein, the structure on the virus’s “skin” that allows it to hook onto and enter human cells. “I think we’re the only company in North America that has developed a spike antigen test,” Bobby Brooke Herrera, e25’s co-founder and chief executive, told us. This has several advantages. It means, first, that the e25 test does not have to rupture the virus, which is why it doesn’t need reagents. And it means, second, that the e25 test is actually looking for something more relevant than the virus’s genetic material. The spike protein is the coronavirus’s most important structure—it plays a large part in determining the virus’s infectiousness, and it’s what both antibodies and many vaccine prototypes target—and its presence is a good proxy for the health of the virus generally. “We’ve developed our test to detect live viruses, or, in other words, spike protein,” Herrera said. Working with two manufacturers, e25 thinks that it could make 4 million tests a month as soon as it receives FDA approval. Within six weeks of approval, it could make 20 million to 40 million tests a month. In short, e25 could single-handedly add as many as 1.2 million tests a day to the national total. But FDA approval has not yet arrived, because the FDA compares every test to PCR, and no antigen test, however advanced, can stand up to the accuracy and sensitivity of the PCR technique. “The FDA, early on in the outbreak, said we had to follow a rubric of 80 percent sensitivity compared to PCR. How they got that number, I’m uncertain, but my best guess is it came from influenza epidemics in the past,” Herrera said. This requirement has made antigen tests worse, Herrera argues, because it causes manufacturers to prioritize sensitivity at the cost of speed or convenience. It’s why other antigen tests use readers, or centrifuges, or look for nucleocapsid, he contends. By slightly weakening those guidelines, to 60 or 70 percent sensitivity, the FDA could let cheaper at-home tests come to market. The models that e25 uses show that even an at-home test that caught 50 percent of positives and 90 percent of negatives could detect outbreaks and reduce COVID-19 transmission. Recall the coronavirus’s infection clock—how, from day zero of an infection to day five, the amount of the virus in your system exponentially increases; how it begins to ebb with the onset of symptoms; how, by day 14 or so, the PCR test is likely detecting only the refuse RNA of dead virus. While antigen tests need the equivalent of 100,000 viral strands per milliliter, a typical PCR test can detect a positive from as little as 1,000 strands per milliliter. There is only about a day at the beginning of an infection when the two tests would give different results—when there are more than 1,000 viral strands per milliliter of your saliva or snot but fewer than 100,000, according to Dan Larremore, a mathematician at the University of Colorado at Boulder. During that period—approximately day two or day three of an infection—antigen tests are truly inferior to PCR tests. Yet the opposite is true as COVID-19 fades: There are potentially weeks at the end of an infection when there is enough viral RNA to clear the threshold for a positive PCR test but not enough to set off an antigen test. During that period, antigen tests, such as e25’s, outperform PCR tests, Mina argues, because they identify only people who are still contagious. So why, he asks, are they judged against PCR tests—and kept off the market—for failing to find the virus when there is no intact virus to find? Antigen tests are not better than PCR tests in every instance. When someone at a hospital presents with severe COVID-19-like symptoms, for example, health-care workers cannot risk a false negative: They will need a PCR test. Some experts worry that at-home tests will have a much lower accuracy rate than advertised. Laboratory tests are conducted by professionals on machines they are familiar with, but amateurs will conduct at-home tests, which risks introducing errors not captured by official ratings or even imagined by regulators. At a national scale, this could mean that someone might have COVID-19, fail to realize it, and infect other people. “What’s concerning is the salami slicing of sensitivity. A percent here, a percent there, and pretty soon you’re talking real people,” Alex Greninger, a laboratory-medicine professor at the University of Washington, told us. Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told us that it’s not yet clear whether people who receive a positive result on an at-home test will report that information to health authorities and choose to self-isolate. But given that they are cheaper than PCR tests, have a faster turnaround time, and can be conducted at home, these paper tests do seem different, in a useful way. In some cases, they answer a more helpful question than PCR tests. There is good evidence to infer that a high viral load, which is what antigen tests detect, is correlated with infectiousness. The more virus in your body, the more contagious you are. In that light, paper antigen tests aren’t SARS-CoV-2 tests at all, not like PCR tests are. They are rapid, cheap COVID-19 contagiousness tests. That shift in thinking, Mina argues, should undergird a shift in our national strategy. Mina wants to coat the country in COVID-19 contagiousness tests. To understand the scale of his vision, start with the closest American analogue, the ubiquitous, paper-based, inexpensive at-home pregnancy test. Americans use 20 million of those each year. This is not sufficient for Mina’s plan. “Ideally, we’re making way more than 20 million [paper tests] a day,” Mina said. Entering a grocery store? Take a test first. Getting on a flight? There’s a test station at the gate. Going to work? Free coffee is provided with your mandatory test. He began pitching the idea as a moonshot in July, but it quickly took hold. By the end of the month, Howard Bauchner, the editor in chief of The Journal of the American Medical Association, gushed on a podcast that ubiquitous tests were “the best way we can get back to a semblance of working society.” The idea has gained other advocates. Last month, a panel of experts convened by the Rockefeller Foundation called for the U.S. to do 3.5 million rapid antigen tests a day, or 25 million a week—five times more than the number of PCR tests they recommended. The researchers compiled a list of 12 rapid tests in development, including e25’s, and called for an aggressive government-led effort to support them. (The Rockefeller Foundation has also provided funding to the COVID Tracking Project at The Atlantic.) “These sort of tests are on the horizon, but getting them into the hands of everyone who needs them—schools, employers, health providers, public essential workers, vulnerable communities—will require the muscle that only the federal government can provide,” the experts wrote. The muscle, specifically, of a wartime economy. The experts called for the White House to invoke the Defense Production Act, a Truman-era law that allows the federal government to compel companies to mass-produce goods in moments of national crisis. (Manufacturers are compensated for their effort at a fair price.) Only naked federal authority could push production fast enough to make enough tests in time to curb the virus, they wrote. Herrera, the e25 executive, has been waiting for months for the government to invoke such power. There is essentially no resource constraint on the raw materials that make up antigen tests, but there is a profound limit to available productive capacity. “Being able to manufacture these products,” Herrera said, “is where the bottleneck lies.” And after it has the tests, Herrera believes, the company will need help sending them where they’re most needed. If testing companies are to save the world, they need federal support to do it. And here is the tragedy—and the promise—of Mina’s moonshot: To fix testing, the federal government must do exactly what it has declined to do so far. Why is testing still a problem? Partly because the CDC and the FDA bickered in February and delayed by weeks the initial rollout of COVID-19 tests. Partly because infections continued to grow in the spring and summer, further boosting the number of tests needed to track the virus. But those reasons alone still do not explain the fundamental issue: Why has the U.S. never, not since the pandemic began, had enough tests? The answer is because the Trump administration has addressed the lack of testing as if it is a nuisance, not a national-security threat. In March and April, the White House encouraged as many different PCR companies to sell COVID-19 tests as possible, declining to endorse any one option. While this idea allowed for competition in theory, it was a nightmare in practice. It effectively forced major labs to invest in several different types of PCR machines at the same time, and to be ready to switch among them as needed, lest a reagent run short. Today, the government cannot use the Defense Production Act to remedy the shortage of PCR machines or reagents—because the private labs running the tests are too invested in too many different machines. Because of its trust in PCR, and its assumption that the pandemic would quickly abate, the administration also failed to encourage companies with alternative testing technologies to develop their products. Many companies that could have started work in April waited on the sidelines, because it wasn’t clear whether investing in COVID-19 testing would make sense, Sri Kosaraju, a member of the Testing for America governing council and a former director at JP Morgan, told us. The Trump administration hoped that the free market would right this imbalance. But firms had no incentive to invest in testing, or assurance that their investments would pay off. Consider the high costs of building an automated testing factory, as Ginkgo is doing, said Stuelpnagel, the Illumina co-founder. A company would typically amortize the costs of that investment over three to five years. But that calculation breaks down in the pandemic. “There’s no way that we’re doing high-throughput COVID testing five years from now. And I hope there’s not COVID testing being done three years from now that would require this scale of lab,” he said. Companies aren’t built to deal with that level of uncertainty, or to serve a market that would dramatically shrink, or disappear altogether, if their product did its job. Even if the experimentation would benefit the public, it doesn’t make sense for individual businesses to take on those risks. So nothing happened—for months. Only in the past few weeks has the federal government begun to address these concerns. The NIH grants awarded to Ginkgo, Helix, Quidel, and others were aimed, in part, at providing capital that would let businesses scale up quickly. And the Centers for Medicare and Medicaid has started to ensure that demand will exist for an experimental test: It has promised to buy Quidel or BD tests for every nursing home in the country. But even if those companies succeed in delivering what they’ve promised, life will not go back to normal. An extra 1 million tests a day will allow us to ramp up contact-tracing operations and slow down the virus, but they will not change the texture of daily life in the pandemic, especially if there is another resurgence of the virus in the winter. For that, Mina’s moonshot is required. It will require much more than the $200 million the federal government has invested in testing technology so far, and it will require the full might of the federal government, with its unique ability to coerce manufacturing capacity. But its costs are not astronomical. If every paper test costs $1, as Mina hopes, and every American takes a test once a week, then his plan will cost about $1.5 billion a month. Congress has already authorized at least $7 billion to fix testing that the Trump administration had declined, for months, to spend. And even if Mina’s plan cost $300 million each day, the annual expense would amount to a fraction—about 3 percent—of the more than $3 trillion Congress has already spent dealing with the economic fallout of the pandemic. Yet the plan wouldn’t merely mitigate the harm of the pandemic. It could end it. To escape the pandemic in this way, the U.S. must make hundreds of millions of contagiousness tests—tests that are not perfect, but just good enough. Mass-producing a cheap thing fast is, as it happens, something the United States is very good at, and something this country has done before. During the Second World War, the U.S. realized that the most effective way of shipping goods to Europe was not to use the fastest ship, but to use cheap “Liberty ships,” which were easy to mass-produce. The Allies “created this model of a ship that was kind of cheap, not as fast as they could make it, and not as good as they could make it,” Mark Wilson, a historian at the University of North Carolina at Charlotte, told us. “They were building cheap—one might say disposable—ships. They weren’t very good. But they just wanted to out-volume their opponents.” We must out-volume the virus, and what will matter is not the strength of any one individual ship, but the strength of the system it is part of. When the FDA regulates tests, though, it looks at the sensitivity and specificity of a single test—how well the test identifies illness in an individual—not at how the test is part of a testing regimen meant to protect society. For this reason, Mina proposes that the FDA make room for the CDC or the NIH to oversee the use of contagiousness tests. “I think the CDC could potentially create a certification process really simply. They are the public-health agency, and could say, ‘We will evaluate different manufacturers. None of these will be fully regulated by law, but here are the ones you should or should not choose.’” Paper tests do have downsides. Testing tens of millions of people each day would be an unprecedented biotechnical intervention in the country, and it might have unpredictable, nasty side effects. Mina’s plan is “being pushed without really thinking through the operational consequences,” Nuzzo said on a recent press call. Brett Giroir, the federal testing czar, has worried that a deluge of positive paper tests could lead asymptomatic people to swamp the rest of the medical system. “You do not beat the virus by shotgun testing everybody, all the time,” he said on the same call. Paper tests are based on an inference about human behavior. For example, if people knew that every paper test would catch only seven or eight infections out of every 10 (compared with PCR, which would catch all 10), would they keep taking them? Would the country’s testing system split in two, delivering PCR tests for the rich and cheap paper tests for the poor? Each way of testing for the virus is not only a technology or a medical device. Each is its own hypothesis about public health, human behavior, and market forces. So here is what May 2021 could look like: Vaccines are rolling out. You haven’t gotten your dose yet, but you are no longer social distancing. When your daughter walks into her classroom, she briefly removes her mask and spits into a plastic bag; so do all the other children and the teacher. The bag is then driven across three states and delivered to the nearest Ginkgo processing facility. When you arrive at work, you spit into a plastic cup, then step outside to drink coffee. In 15 minutes, you get a text: You passed your daily screen and may proceed into the office. You still wear your mask at your desk, and you try to avoid common areas, but local infection levels are down in the single digits. That night, you and your family meet your parents at a restaurant, and before you proceed inside, you all take another contagiousness test. It’s normal, now, to see the little cups of saliva and saline solution, each holding a strip of color-changing paper, sitting on tables near the entrance of every public place. And before you fall asleep, you get a text message from the school district. Nobody in your daughter’s class tested positive this morning—instruction can happen in person tomorrow. There is no technical obstacle to that vision. There is only a dearth of political will. “The lack of testing is a motivation problem,” Stuelpnagel said. “It’s going to take a lot of effort, but it should take a lot of effort, and we should be willing to take that effort.” Mina is frustrated that the answer is so close, and so doable, but not yet something the government is considering. “Let’s make the all-star team of people in this field, pay them whatever they need to be paid, put billions of dollars in, and get a working test in a month that could be truly scalable. Take it out of the free-market, capitalistic world and say: ‘This is a national emergency’—which,” he said, “it is.” from https://ift.tt/2PSzBVg Check out http://natthash.tumblr.com This week, the bottom fell out of college football. The future of the fall season had been wavering for more than a month as the coronavirus continued to burn through much of the United States, and on Tuesday, the Big 10, the conference that comprises the Midwest’s major football programs, was the first to topple. It canceled its fall season, and a few hours later, the Pac-12, which represents major programs on the West Coast, made the same call. Forgive me for trying to put these cancellations in their bizarrely complicated context. The Big 10 and Pac-12 are two of the five regional conferences that make up college football’s top tier as the Power 5, which together play for the sport’s most prestigious, but certainly not its only, national championship. (Central Florida fans, please don’t email me.) The schools of the SEC, Big 12, and ACC, which cover the Southeast, Great Plains, and East Coast, respectively, are moving ahead with football for now, game schedules redrawn. The reasoning behind the Big 10’s and Pac-12’s decisions to shut things down is both obvious and inscrutable. Both conferences cited ongoing concerns about COVID-19’s impact on athletes’ health. But they haven’t explained what has changed since last week, when the Big 10 released a new, supposedly coronavirus-proof schedule. (When reached for comment, the Pac-12 referred to its previous public statement on the matter. The Big 10 did not respond.) The three remaining leagues presumably have the same information as the Big 10 and Pac-12, yet they have come to different conclusions, plunging the sport into an unprecedented upheaval. “Evaluations are on-going and will continue into the foreseeable future,” Bob Burda, a spokesman for the Big 12, told me via email. “If at any time our scientists and doctors conclude that our institutions cannot provide a safe and appropriate environment for our participants, we will change course.” If some conferences manage to play, they’ll tap into television deals worth hundreds of millions of dollars, gaining an advantage in recruiting high-school players and luring stars away from suspended leagues. (The SEC and ACC did not respond to requests for comment.) In nonpandemic times, top-tier college football’s decentralized chaos is actually part of the sport’s charm. The Power 5 is only the tip of an iceberg that includes hundreds of teams organized into multiple conference tiers, as well as those that refuse to align with a conference at all. This general lawlessness gives the sport an idiosyncratic regionalism: College football is barely noticed in some states, and inspires a near-pentecostal fervor in others. Whereas professional football is shellacked with benign corporate marketability, in college football, a touchdown celebration that mimics a urinating dog can play a role in removing Confederate iconography from Mississippi’s state flag. This decentralization has also allowed college football’s leaders to maintain a dangerous status quo. In exchange for a long shot at fame and riches in the NFL, college students play for free in a system often criticized as unfair and damaging, many of them for schools that collect an annual revenue of tens or hundreds of millions of dollars. Schools and conferences operate within this structure with relative independence and impunity, and with little requirement to safeguard the future health and safety of their players. Conference leaders tend to argue that they can’t do anything to change this system, because of how college sports’ governing body, the National Collegiate Athletic Association, or NCAA, adheres to the principle of amateurism. NCAA regulation prohibits universities from paying students or granting them education-disrupting protections. But the NCAA itself exists only because the leagues consent to be regulated by it. If conference commissioners and the leaders of football’s most powerful programs wanted something else, they almost certainly could have it. Now, given months to prepare for competition, college football has buckled under the weight of its own nonsense. Hands tied by the NCAA, colleges can’t provide athletes with the bubble-style protections and benefits that have made some pro sports a pandemic success. The pandemic has exposed the outrageous hypocrisy of amateurism. College football is unraveling before our eyes. The concept of amateurism has been around since college football’s beginning, in the late 1800s, but college football has never had the type of purity that the term implies. In the sport’s early decades, as the historian Taylor Branch has detailed in The Atlantic, players were usually hired to play and barely, if at all, disguised as regular college students. They frequently died of injuries sustained during games. In the early 1900s, the NCAA was founded to assure fans that the game was committed to cleaning itself up, but the organization lacked meaningful power until the 1950s. During that era, it took control of college football by consolidating the sport’s TV rights and inventing the concept of the “student-athlete”—the idealistic notion that players were simply exceptional young adults, playing for the love of the game—which helped schools defeat liability claims from players who had been catastrophically injured or killed while playing. The NCAA’s role in modern football is primarily to regulate what athletes can do and receive while enrolled in school. It sets limits on the frequency and conditions of practice, and restricts “improper benefits,” including paychecks and cash bonuses. The NCAA asserts that this oversight is necessary because amateurism is what makes college football special. Paying players, the NCAA’s defenders argue, would open a Pandora’s box of corruption and destroy the game’s parity, consolidating success at a few well-funded programs. It’s difficult to maintain any pretense of the parity, though, when the University of Alabama has won four out of the sport’s past 10 national championships, and Clemson University, its frequent opponent in playoff games, has won two of the others. (An NCAA spokesperson referred me to its protocols for playing in the pandemic, but did not comment further on other topics.) Usually, the economic component of the NCAA’s amateurism enforcement is the subject of the widest public scrutiny. Ensuring that athletes aren’t compensated often means punishing players for things such as accepting gifts or signing autographs sold by memorabilia dealers. These rules get absurdly granular: For years, schools could give athletes bagels, but not free cream cheese for their bagels. Once, three players at the University of Oklahoma were required to donate several dollars each to charity for eating too much pasta. Over time, that level of micromanagement has become more and more out of step with fans’ attitudes toward players. Recent polls have shown that people largely have come around to the idea that, at the very least, players have a right to profit from their name and likeness. According to Nathan Kalman-Lamb, a lecturer at Duke University whose work focuses on sports, race, and labor relations, these economic concerns sometimes overshadow a more dire problem of amateurism, however. “The most serious ramifications for college players relate to health and safety, a situation only exacerbated during the pandemic,” he wrote via email. “They are not governed by occupational health and safety provisions, nor do they have employer-provided health insurance.” As summer workouts continue for some football players, many teams have declined to release information about how many coronavirus cases they have on their roster. At Colorado State University, coaches have reportedly pressured players to lie about symptoms or threatened them with reduced playing time if they quarantine according to safety standards. At Florida State University, a group of wide receivers went public this morning with allegations that the football program was not adhering to testing protocols or being transparent with players. (Both CSU and FSU have denied the accusations and asserted that their programs are safe for players.) With early indications that at least 10 players in the Big 10 have developed COVID-19-linked myocarditis, a rare heart condition that can lead to cardiac arrest and premature death, many university administrators seem worried about their institutions’ long-term liability in subjecting athletes to that risk. To move forward with playing while keeping athletes safe, colleges do have a model in American sports they could follow: the NBA bubble. Professional basketball’s restricted conditions—rules for athletes about housing, movement, and socialization in exchange for fair pay and constant testing for the coronavirus—have yielded the safest results of any league playing in the U.S. so far. But the NCAA policies on amateurism that football programs have so often benefited from have now painted colleges into a legal corner. In football-roster outbreaks at schools such as Kansas State and LSU, infections have been mostly traced back to players’ lives as regular college students, socializing at bars and house parties. As more students return to campuses in the coming weeks, universities could, in theory, restrict players from taking part in those elements of campus life—not to mention attending classes, as is required for them to continue playing. But a barrage of lawsuits about pay and liability have put the NCAA on the defensive. Any special treatment players receive—removing them from conventional college housing, giving them special clearance to do classes online, restricting their access to bars and parties—is potential ammunition in court. It’s also potential ammunition for students, staff, and faculty: If their university admits it can’t keep football players safe in regular campus conditions, why is everyone else being forced into them? And so, football players keep playing, with “no meaningful protections from harm,” according to Kalman-Lamb. In the past, college football players have tried to unify to improve their conditions, most recently in 2014, when players at Northwestern University formally requested labor-union representation. But the effort was shot down the next year by the National Labor Review Board. That has left players without a formal way to lobby for fair treatment, as their professional counterparts have done in order to set the conditions of league “bubbles.” Kalman-Lamb noted that players can also be exposed to a long-term health risk when a pandemic isn’t threatening their safety. Usually, the biggest long-term health concern for football players is chronic traumatic encephalopathy, or CTE, a debilitating degenerative brain disease that’s caused by repetitive collisions and found in many retired football players. The NCAA has been widely accused of downplaying or obscuring the severity of the condition and its link to football. (In response to concerns about CTE, the NCAA has redrawn football’s rules to penalize players for some types of helmet-to-helmet collisions, and it funds research into concussions.) The safest thing for all involved in college athletics would be to uniformly cancel sports—to cancel in-person college itself—until transmission of the coronavirus can be brought under significantly better control almost everywhere in the country. Until then, players will be at risk. But if conferences are intent on playing, Power 5 universities could reject the dangers of amateurism by, at the very least, paying players a fair wage and providing expanded health benefits for their perilous and near-limitlessly profitable work. The math on how this could be done has been run innumerable times over the years. As critics often point out, schools use myriad accounting tricks to make the legal argument that their athletic departments don’t have much money on hand at all—among them, pouring the profits into facilities upgrades like weight-room DJ booths and indoor waterfalls in locker rooms. To get an expanded benefits system fully up and running for all college athletes would require some time and logistical heavy lifting, but if they wanted to, schools could start doing so right now. For their part, many players seem to realize that their status as amateurs is endangering both their safety and the viability of the football season. In the past two weeks, large groups of players in the Big 10 and Pac-12 have released lists of safety and compensation demands, threatening not to play if an agreement couldn’t be reached. “We want to play the game we love and have given so much of ourselves to, but we want to do it in a safe way,” Elisha Guidry, a defensive back at UCLA, wrote in a letter signed by 13 players from the Pac-12. “Every player that puts on these pads to play this game is a person with their own family, own friends, own passions, and own purpose that is greater than football.” Kalman-Lamb and his two co-hosts on the End of Sport podcast have argued that by canceling the season, those two conferences have effectively punted the necessity of dealing with a nascent labor movement to the spring, at the earliest. If pandemic conditions have improved by then, coaches, conference commissioners, and university presidents might regain more power in setting the terms of any negotiations. Even before college football’s house of cards started to fall this week, though, there was some early indication that athletes would not be deterred. Following player demands from the Big 10 and Pac-12, on Sunday night, some of the game’s most prominent players from other conferences, including the Clemson University quarterback Trevor Lawrence and the Ohio State University quarterback Justin Fields, tweeted out a message of support—both for finding a way to have a season, and for the right of players to form an association that would be able to negotiate playing conditions on their behalf. There was no explicit backlash among the sport’s leadership—some coaches and athletic directors eventually tweeted in support of the players’ demands, which were not as lengthy or detailed as those set forth by the Big 10 or Pac-12 groups. College football was giddy, unexpected chaos again, as it always has been. The players want to play. Now they wait and see if those in power will bother to listen. from https://ift.tt/2CoMyD2 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, I’m an attorney and I’ve been working from home. Yesterday I had to visit several courthouses to pick up files. At the security checks at the entrance, they had some kind of infrared camera to check people’s temperature. At one courthouse, I came in through the employee garage and someone stopped me and put a thermometer to my forehead. I live in Miami, my car’s AC is broken, and I had been stuck in traffic and was soaked in sweat. Yet my temperature apparently was 97 degrees, and I was waved inside. Are these temperature checks just “security theater”? How effective are they? Megan Miami, Florida Yes, what you’re describing is theater. As logical as mass temperature checks may seem, the practice hasn’t clearly been shown to help contain the coronavirus. The practice is sort of like spraying down the sides of buildings, showering football players in hand sanitizer, or deep cleaning an office carpet. These things might make us feel safer, but they may not keep us safe if they actually cause us to let our guard down. Fever screens seem part of America’s ongoing failure to learn an abiding lesson of modern medicine: Screening tests often backfire. They have value only in specific contexts. Doctors have repeatedly seen this play out with lifesaving tests like mammograms, CT scans, and colonoscopies, which can lead to unnecessary biopsies and surgeries when overused. Body temperature is a vital sign that is monitored continually in hospitals, where it can be an invaluable window into how a patient is faring. But screening groups of people for the coronavirus is a different matter, and that is what’s happening now. Employers around the United States are attempting to order daily temperature checks to determine who is allowed to enter an office and do their job. As you noticed, access to courts may be based on this test. Fever screens have even been implicated in many plans to open schools: New York City’s Department of Education announced last week that kids would be randomly screened before being allowed to enter school buildings, despite the fact that kids with the virus rarely develop fevers. [Read: Hygiene theater is a huge waste of time] Temperature checks were first deployed in January amid China’s “throw everything at the wall and show the world we’ve got this locked down” attempt to stop the virus. News reports showed people being ordered out of their car at tollbooths to have infrared thermometer guns placed against their forehead. For a period in February, the Chinese government required some 11 million people to report temperatures to the government daily. By late February, though, researchers had begun reporting that the tactic wasn’t an effective screening tool for this new disease. Unlike Ebola and some other infectious diseases, this coronavirus is contagious before symptoms appear. Many infected people never develop any symptoms at all. While a fever is one of the most common symptoms for people who do get sick, it’s still far from universal among those infected. In June, a study at an Australian hospital found that a minority of patients admitted with the virus had a fever. The researchers concluded that “using fever as a screening tool for COVID-19 may provide a false sense of security.” But what’s the harm? In this moment, that’s a question we need to take seriously—with regard to tests, hygiene practices, or anything else we might be doing to try to stay safe. Anything with the potential to benefit our health also has the potential to undermine it. If people are reassured by a fever check and compromise on the basics—wearing a mask, distancing, hand-washing—they put themselves and others at risk. This test has no ability to reassure people, but a real ability to mislead. A useful test is both sensitive and specific. If you haven’t encountered these terms yet, they can seem esoteric, but we should all know them. A test is considered sensitive if it catches most (and ideally all) cases. A test is specific if it doesn’t misidentify too many cases—that is, if it doesn’t catch too many more than all. Temperature checks for coronavirus infections don’t seem to be sensitive or specific. An elevated body temperature can be caused by many factors other than COVID-19—or illness at all. Some people will see an elevation after exercise or during anxiety. When you’re sweating, your body is working to expel heat through the skin. I’m surprised you registered at 97 degrees. But I still couldn’t comfortably say you aren’t spreading the virus. Your temperature also may not have been 97 degrees. Infrared scanners are imperfect compared with measuring temperature under the tongue or in the rectum. When they’re pointed at your forehead, they’re pretty reliable. But when scanning a crowd, as some public-transit agencies and school districts have started to do, the accuracy fades. Such technology is well suited to detect the presence of humans, as in disasters or military scenarios, but subtle variations and mild fevers are likely to be lost in the crowd. Discerning those is especially difficult because, as you note, people’s normal body temperatures vary on their own. What may constitute an early elevation in one person could be a normal temperature for another. [Read: Why some people get sicker than others] The irony that all of this is happening in a courthouse is probably not lost on you. The state collecting medical information about people raises all sorts of legal issues, only heightened now that the outcome of an inaccurate test could deny access to basic services like courts or schools. Because scanning people for a fever is typically considered a medical test, the act also typically requires consent. And consent or no, employers aren’t normally allowed to demand medical tests of employees. When the pandemic hit the U.S, the Equal Employment Opportunity Commission developed emergency precautions that specifically allow employers to monitor employees’ body temperature. But not everyone agrees that this is sound legal policy. As the American Civil Liberties Union argued in response to fever screening in May, privacy is always valued relative to the value of the intervention. Some privacy may need to be sacrificed during a crisis, but we must be deliberate about how and where those compromises are made: for tests that will deliver actionable information proven to help protect the population. Temperature checks may be useful in specific circumstances, as opposed to mass fishing expeditions. But people who are found to have a fever are likely being told what they already know. When fevers do come on, people typically already feel ill. They’re likely to also have a cough, shortness of breath, or other symptoms. They should have had access to a proper test that would tell them if they had the virus. They should have been able to seek medical attention. They should have been able to isolate at home. The real spirit of mass temperature checks, as they’re currently being used, is punitive. If, amid the many false positives and false negatives, fever screening does successfully catch a few sick people who went out anyway, then this may be a symptom of a societal ill. Feverish people are not likely venturing out because they have a death wish or want to infect others; they’re likely doing it because they can’t afford to stay home, or they need to pick up their kids, or they don’t have sick leave. The solution to this isn’t to pour more resources into infrared cameras in an attempt to detect and detain these people. It’s to put those resources into taking care of them in the first place. “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/3fQkZQW Check out http://natthash.tumblr.com Twenty years ago, Erin Brockovich was released, and the brash, unvarnished legal assistant turned activist at the heart of the film—memorably portrayed by Julia Roberts in micro-miniskirts and vertiginous high heels—had the surreal experience of becoming a household name almost overnight. “Let me be the first to tell you that life takes an interesting turn when your name becomes a verb,” the real Erin Brockovich writes in the introduction to her new book, Superman’s Not Coming. “To ‘Erin Brockovich something’ has become synonymous with investigating and then advocating for a cause without giving up.” The first case that Erin Brockovich Erin Brockoviched—the subject of the movie—was her 1990s battle with Pacific Gas & Electric. The power company had contaminated the groundwater in the small desert town of Hinkley, California, with chromium‑6, a highly toxic chemical used in industrial processes. In 1991, Brockovich, then a file clerk at the San Fernando Valley law firm Masry & Vititoe, happened upon suspicious medical records while sorting through a box of files for a pro bono real-estate case. She drove out to the Mojave Desert to investigate. The water was green. She saw frogs with two heads. Residents were suffering from nosebleeds, miscarriages, and cancers. She persuaded Ed Masry to take the case, and in 1996 they won a $333 million settlement for 650 plaintiffs, at the time the largest toxic tort settlement in American history. (Brockovich herself received a $2.5 million bonus.) Brockovich, 60, is magnetic, fast-talking, and very funny, not unlike her character in the movie, a portrayal she calls “about 97 percent accurate.” On the early-May afternoon when we first speak via Zoom, she is in her home office in Agoura Hills, California, a sunny room with shelves full of framed photographs of her now-adult kids. She lives alone (she and her third husband divorced in 2015), save for her three small dogs, one of whom, a Pomeranian named Wiley, is yapping in the background. She tells me she has been working on an ABC drama based on her life, Rebel; she will executive produce and Katey Sagal will star. Erin Brockovich grossed $256 million worldwide, a success only partly attributable to Julia Roberts’s charismatic performance, for which she won the Best Actress Oscar. The movie made its namesake into a kind of American folk hero, à la Davy Crockett or Mother Jones. (Every time her name floated up on my phone, it was like Annie Oakley had texted me.) Like most folk heroes, her appeal is a populist one. Audiences could see themselves in this struggling, twice-divorced single mom who wasn’t a doctor, a lawyer, or a scientist, and believe that they too might fight injustice. To “Erin Brockovich something,” then, means not only to investigate an issue, but to be a regular person who takes on a corporate giant polluting the environment. The notion feels especially urgent now, as the Trump administration’s Environmental Protection Agency fails to regulate toxic chemicals and industry lobbyists wield undue power. After the movie’s release, Brockovich, who was already at work on another contaminated-groundwater case—this one in the Latino farming community of Kettleman City, California—was deluged with emails and letters. “I put my finger in the dike,” she tells me, “and I thought I might help stop its flow. I had no idea.” In 2005, she left the law firm to start her own company, Erin Brockovich Consulting, which she runs out of her home; she advises people on environmental-contamination issues, consults with law firms, and is a regular on the keynote-speaker circuit. [Read: The trouble with America’s water] She continues to receive thousands of emails every month. “A mother writes me and says, ‘I’m concerned. I live down in Florida. My daughter was diagnosed with a glioblastoma. I have heard reports that we had a solvent chemical in our water. Do you know anything about it?’ ” she says, describing a typical email. The following week, another email from another mother. A few of these, and she searches her inbox for the town’s name: “I’m like, ‘Holy shit. Ten people from that same community have reached out to me.’ This happened to me over and over again.” Brockovich is dyslexic and has a photographic memory; she prefers to see things laid out visually, so she started plotting the email inquiries on a map. One day, she looked at her map and counted 300 dots scattered around the country. She decided to make her work accessible to more people, so she digitized it and put it up on her website. Here, people can self-report health effects of environmental pollution, and find others reporting the same issue. “I looked at it today and there’s 13,000 dots on it,” Brockovich says. “It’s like, ‘What the fuck? What’s going on?’ ” IN LATE 2015, the country began asking similar questions as reports of exceedingly high lead levels in the water in Flint, Michigan, began to circulate. In April 2014, an emergency manager had made the disastrous cost-cutting decision to stop supplying Flint with water from the Detroit system and make the Flint River its temporary source while the city built its own pipeline. The Flint River had long been a dumping ground for industry; it also contains significant amounts of bacteria and organic matter, thus requiring high levels of chlorine and ferric chloride to clean it. But Flint had an antiquated system of lead pipes, which the disinfectants corroded, causing lead to leach into the water supply of 95,000 people. Shortly after the switch, Flint residents—54 percent of whom are Black, and 40 percent of whom live below the poverty line—started complaining about their foul-smelling and discolored water, plus a host of strange new health issues, including rashes, hair loss, and diarrhea. Eventually, they began emailing Brockovich, sending her photos of their brown, yellow, or orange water. She forwarded a few emails to Bob Bowcock, the water-quality expert she works with. Bowcock says that Brockovich has “this ridiculous sixth sense about her” and that “nine times out of 10” her hunches are borne out by his research. In late January 2015, almost a year before President Barack Obama would declare a state of emergency in Flint, Brockovich posted about the “Dangerous Undrinkable Drinking Water” on her public Facebook page. When a water issue arises, Brockovich and Bowcock usually travel to the city or town in question. “My role is to quarterback all the experts and pull all the science together,” Bowcock says. “Her part is to rally the troops and get the town organized and conduct the town-hall meeting.” But at the time, Brockovich was in Australia for work, so in mid-February, Bowcock got on a plane to Flint himself. There, he found levels of chlorine that exceeded those of a swimming pool. Bowcock drew up a plan for Flint’s mayor, the water municipality, and the Flint city council. “We actually wrote a whole water protocol,” Brockovich says, “and the city told us to fuck off.” Flint’s issues grew out of a tangle of bureaucratic incompetence, bad decisions, and racism, but the city is hardly unique. A 2017 study by the Natural Resources Defense Council (NRDC) found that “contaminants that may harm human health” were present in the tap water of every state in the nation—often in poor communities and communities of color, which are targeted as sites for industrial plants and landfills. In 2015, community water systems had more than 80,000 reported violations of the Safe Drinking Water Act, the 1974 law that regulates roughly 100 contaminants. More than 18 million Americans got their drinking water from systems that had violated federal lead regulations, according to a 2016 NRDC report. Brockovich’s book—at once a master class on water for the layperson and an exhortation to work for improvements in our own communities—takes readers on a tour of struggling locales around the country. At Camp Lejeune, for instance, the Marine Corps base in Jacksonville, North Carolina, residents were exposed via drinking water to numerous contaminants, among them TCE, an industrial solvent that can cause birth defects and childhood cancers. Brockovich writes that so many babies died there in the ’60s and ’70s that a nearby cemetery had a section called “Baby Heaven.” Reading the book, one acquires a dispiriting sense of why water issues are so widespread and entrenched. The most obvious reason is that you can’t see the majority of chemicals, so unless you have your water tested, you likely won’t know a contaminant is there. But water problems are also fairly technical, requiring a grasp of chemical and legal terms. “Water’s not an easy discussion; it’s not sound bites,” Brockovich says. “It’s a story.” She explains that “no two bodies of water on this planet have the same fingerprint,” which means that each has its own particular problems. Then there are the structural issues. Our country’s infrastructure is antiquated—some water mains are 50 to 100 years old. Of the approximately 40,000 chemicals on the market, less than 1 percent have been tested for human safety. Science is often manipulated by companies that put profit over public health. In sum, industry pollution goes largely unsupervised and laws remain unenforced. The U.S. also lacks a national disease database where people can report their issues and connect the dots between illness clusters and environmental hazards. In 2013, Brockovich joined Trevor Schaefer, a young man from Idaho who had been diagnosed with brain cancer at the age of 13, to testify on Capitol Hill about the importance of documenting and tracking cancer clusters. Three years later, President Obama signed “Trevor’s Law” as part of the newly strengthened Toxic Substances Control Act, but the current administration has failed to implement it. Brockovich hopes her crowdsourced digitized map will act as a de facto disease database. “She’s a pioneer in environmental investigations and with uncovering pollution sources,” Schaefer, now 30, says. “She’s been so successful in exposing it.” As Brockovich herself often says, her path was not an obvious one. The youngest in a family of four children growing up in Lawrence, Kansas, a university town 45 minutes west of Kansas City, Brockovich was placed in special-education classes for her dyslexia. Her parents—her mother, B. J. O’Neal-Pattee, was an editor of the University of Kansas alumni magazine; her father, Frank Pattee, was a mechanical engineer who worked as a regional manager for the U.S. Department of Transportation—taught her to believe in herself and gave her a solid moral foundation that emphasized honesty and “stick-to-itiveness,” as her mother called it. Those lessons, she says, didn’t sink in until she worked on the Hinkley case. In 1978, Brockovich graduated from high school and enrolled in Kansas State University. She spent her first semester staying out all night and skipping classes, and when her father saw her report card, he made her drop out. She transferred to Wade College in Dallas, graduated with an associate’s degree in fashion merchandising and interior design, then took a job as a manager at a Kmart store in Los Angeles, but she hated the work and resigned after three months. She dabbled in the world of professional beauty pageants and was crowned Miss Pacific Coast in 1981. The following year, she met and married her first husband, a house painter, with whom she had her son and her first daughter. Their five-year marriage was volatile, and Brockovich suffered debilitating panic attacks. When her husband got a job in the food industry that moved the family to Reno, Nevada, Brockovich was hired by a brokerage firm there; one of the brokers was a man named Steve Brockovich, who would become her second husband and the father of her younger daughter. That marriage was tumultuous, too—her self-esteem took such a dive that she had to be hospitalized for anorexia—and lasted only a year, leaving her broke, pregnant, and shatteringly lonely. Around that time, Brockovich got in a car accident that herniated two disks in her spine. But the misfortune proved fortuitous. Not long after, she met a biker named Jorge; he introduced her to Jim Vititoe, who represented her in a lawsuit against the other driver. She lost, but she persuaded Vititoe to hire her. The rest is, well, a movie. Brockovich and I speak for the last time in early June; the country is aflame with protests about police brutality against Black people, and the pandemic shows no signs of abating. When I ask how she is, Brockovich tells me she is deeply sad about the murder of George Floyd. But, as is her way, she sidesteps any concrete discussion of politics. Her dad was a Republican, and her book emphasizes that it was Richard Nixon who started the EPA. Yet she also worked with former Democratic Senator Barbara Boxer on Trevor’s Law, a bipartisan bill, and she has been critical of Trump’s EPA on social media. “I never get into the politics of it. I’ll pull my hair out,” she says. “There’s plenty of blame to go around everywhere.” She believes that water is not a partisan issue but a human right: “It doesn’t matter what side of the aisle you’re on, the color of your skin, what’s in your bank account.” If Brockovich does have a discernible politics, it’s her populism, her belief in people, her utter faith that they—we—can take matters into our own hands. “People think when I speak to a community that I’m coming in with an agenda, but my only role is to empower the people,” she writes. In her discussion of Hannibal, Missouri, where local women got ammonia banned as a disinfectant, she includes a quote often attributed to Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Doesn’t she ever get demoralized? After all, Hinkley is almost a ghost town now because the groundwater contamination spread, and California currently has no legal limit for chromium-6. Seven years ago, she says, she did feel burned out—“It’s just too much; it doesn’t stop”—but then she stood in the delivery room and watched as her first granddaughter was born and thought, “What will this world be like for her if I don’t continue to fight? What legacy are we going to leave?” And she felt reinvigorated. This article appears in the September 2020 print edition with the headline “The Relentless Erin Brockovich.” from https://ift.tt/31DYJ7H Check out http://natthash.tumblr.com America has botched its coronavirus response in so, so many ways since the pandemic began. Even in a country that stands apart from the world for its horrific failures, there have been as many leadership bungles as there are states: Some failed to heed early warnings. Others refused to learn the lessons of outbreaks that came before theirs. Still others played politics instead of following science. And then there’s Georgia. Georgia’s response to the pandemic has not been going well. It was bad from the beginning: Back in early April, weeks after other states took initial precautions, Georgia dawdled toward a shutdown while its coronavirus cases surged. Still, less than a month later, the state chose to be among the first in the nation to reopen, bringing back businesses known to accelerate the virus’s spread, such as restaurants and gyms, even though new infections had never made a significant or sustained decline. In June, the state welcomed back bars. What happened next was predictable, and was predicted: Case counts came roaring back. More people got sick and died. Many of these deaths were preventable. The state now has the sixth-highest number of coronavirus cases in the United States, behind five states with significantly larger populations. Lots of states—such as Florida, California, and New York—have mishandled the pandemic since it hit in March. But when you look closely at Georgia, you see a state with a leader unique among his peers. First-term Republican Governor Brian Kemp presided over a late shutdown so short that his reopening drew a public rebuke from President Donald Trump, who has frequently opposed shutdowns altogether. Kemp’s administration has repeatedly been accused of manipulating data to downplay the severity of the outbreak. He has sparred publicly with the state’s mayors and sued to stop them from implementing safety restrictions or even speaking to the press. To understand the course that Georgia has plotted through the pandemic, you have to understand Kemp’s failures. Those same failures, and the trajectory of the state governed by them, also represent a microcosm of America under Trump. The governor has demonstrated a willingness to defer to the president instead of his own constituents, sacrifice Georgians’ safety to snipe at his political foes, and shore up his own power at the expense of democracy. In short, Kemp is a wannabe authoritarian, and millions of Georgians have suffered as a result, with no end in sight. Kemp has emulated strongmen since he entered state government. In 2018, as Georgia’s secretary of state, Kemp administered his own election by a thin, contested margin, despite calls to resign the office before running for governor. In his previous role, Kemp systematically purged more than 1 million voters from the state’s rolls, disproportionately disenfranchising Georgians of color. More than half a million of those voter registrations were voided in July 2017 alone, months into Kemp’s campaign for governor. Kemp’s office did not respond to a request for an interview, but in the past, he has repeatedly denied that these actions amounted to voter suppression. In Georgia, and around the world, it has become clear that a novel virus doesn’t respond to the anti-scientific, expertise-shirking preferences of modern authoritarianism. When Kemp announced the closure of the state’s nonessential businesses on April 2, he said it was because he had learned something game-changing about the virus: that it is transmissible before an infected person develops symptoms. In reality, that had been a widely accepted belief for weeks, one that had helped encourage earlier lockdowns around the country. And unlike other states that were slow to shut down, Georgia already had a raging outbreak of nearly 5,000 identified cases. In southwest Georgia in late February, a funeral in the small, majority-Black town of Albany set off a chain of infection that sickened hundreds of people and left the local hospital system overburdened and overpaying for low-quality protective gear. [Read: Georgia’s experiment in human sacrifice] If a slow shutdown had been Kemp’s only major fumble, he’d be in broad and ideologically varied company both nationally and internationally. Instead, he has continued to double down on the state’s approach to the virus in ways that mirror not just Trump, but authoritarian leaders overseeing poorly controlled outbreaks all over the world, such as Brazil’s Jair Bolsonaro and India’s Narendra Modi. He has also taken a more hard-line stance than most of his Republican peers. GOP governors in Alabama, Mississippi, and Texas have implemented statewide mask rules in response to worsening outbreaks, and others who haven’t, such as Ron DeSantis in Florida and Doug Ducey in Arizona, have still allowed cities and counties to enforce their own local requirements. Not only has Kemp repeatedly refused to require masks in Georgia, but the state’s current pandemic emergency order was written with an explicit restriction to prevent local leaders from implementing their own mask rules. Kemp’s administration has gone so far as to sue Atlanta Mayor Keisha Lance Bottoms over the city’s mask mandate and its plan to roll back the city’s reopening to its earliest stage, closing bars and restricting restaurants to takeout. When Bottoms fought the lawsuit, Kemp sought to stop her from speaking to the press. Other cities in the state, such as Savannah and Athens, also passed their own mandates but escaped inclusion in the lawsuit, which has pushed some to question whether the governor was trying to punish Bottoms for her support of Joe Biden. A Kemp spokesperson told The Washington Post that the lawsuit was primarily about the new restrictions on businesses in Bottoms’s order, which weren’t present in other municipalities’ mask mandates, but as the paper pointed out, masks were listed as the first issue in the complaint. “One has to ask about the political aspect of a conservative southern governor and a strong supporter of the president having a very public legal action against the Atlanta mayor, who’s been a vocal supporter of Joe Biden,” Harry Heiman, a professor at the Georgia State University School of Public Health, told me. Kemp backed down from the lawsuit last week, and Atlanta’s local mandate remains in effect. None of Kemp’s actions has been popular among the state’s residents. According to findings released last week by the Atlanta-based market-research platform 1Q, 73 percent of Georgians surveyed believe that cities should be able to enforce their own mask mandates, and 70 percent disagree with Kemp’s refusal to institute a mandate statewide. In recent months, his overall approval rating has taken a hit. In May, Kemp was the only governor whose coronavirus response was less popular than the president’s among his own constituents. A recent poll pegged Kemp’s approval rating at 43 percent, down from more than 59 percent in January. Kemp, like Trump, has recently started to encourage mask usage while still aggressively opposing any kind of enforceable mask rule. The problem with that approach, according to public-health experts, is that it sows confusion, making it more difficult for people to feel confident in their safety. The state’s own messaging has at times been misleading in other ways. On its Department of Public Health website, the state spent months backdating cases to a patient’s first symptoms, which meant that the most recent two weeks of the graph always looked as if the pandemic was in marked decline. The state has also released misleading graphics that it later insisted were honest errors in data rendering, such as a bar graph of case counts with the dates out of chronological order, again depicting a nonexistent downward slope. In mid-July, two nearly identical maps of Georgia’s coronavirus outbreak began circulating on Twitter, depicting the state’s outbreaks on July 2 and July 17, over which time cases increased significantly. Both maps show only three of the state’s 159 counties shaded in red, marking the most dire spread of the disease. As case counts exploded, the state had raised the number of cases required for a county to change color. Once local media took notice, the state redesigned its map. The public health department’s website also now allows users to sort new coronavirus cases by date of diagnosis, the method used almost exclusively in other government and media visualizations of the pandemic. [Read: Keisha Lance Bottoms: Atlanta isn’t ready to reopen—and neither is Georgia] Then there is the matter of reopening schools. The state’s accelerated reopening spiked cases just in time for the South’s typically early school calendar to begin, leaving educators, parents, and students to fend for themselves as Kemp urges the resumption of in-person instruction in order to protect kids from non-coronavirus threats such as malnutrition and abuse. But if Kemp’s concerns lie with the safety of the state’s children and the importance of getting them back in the classroom, why didn’t he do more to stop the spread of the virus? Why, instead, did he prioritize sending low-wage workers back to their jobs in bars, restaurants, nail salons, and gyms? Some of Georgia’s school districts opened this week, and already the system is buckling under the weight of infection: Yesterday, we learned that the state’s outbreak had claimed its youngest victim yet, an otherwise healthy 7-year-old boy. One Cherokee County elementary-school class has already had to be quarantined after a second grader received a positive test result on the first day of school. Earlier this week, a photo from inside North Paulding High School in exurban Atlanta showed a crowded hallway with few teenagers wearing masks. An outbreak has already sickened members of the school’s football team, and students say they fear expulsion if they don’t show up. Two students were suspended for distributing photos of the school’s lax safety measures; at least one of those students has been reinstated following a public outcry over her right to free speech. Georgia’s public universities, which are preparing for students to come back over the next couple of weeks, provide a bleak view of how the state is managing the dangers that a return to regular life presents for Georgians. For much of this summer, the University System of Georgia refused pleas from faculty and staff to require students to wear masks to class, or to allow individual colleges to make their own mask rules, before eventually relenting and requiring masks. At the University of Georgia, freshmen will still be required to live in cramped on-campus housing, much of which assigns two students to one privacy-free room, even if their classes are remote. For students who attend instruction in person, photos have begun to circulate on social media of the safety measures that await them: a small plexiglass divider loosely affixed to the front of a teacher’s classroom desk, or every other urinal in a public bathroom marked off with painter’s tape. With the majority of students yet to return, UGA already has the third-largest campus outbreak in the country, and Athens, the town where the school is located, ran out of intensive-care beds last week. [Read: ‘This push to reopen schools is guaranteed to fail’] Despite all his mistakes, it’s not too late for Kemp to wrangle the pandemic, said Heiman, the Georgia State professor. He told me that a statewide mask mandate; closing bars, gyms, and indoor dining; and clear, consistent messaging from state leadership about pandemic safety can work quickly to limit transmission of the virus, just as such measures have in New York, following that state’s catastrophic outbreak. Once transmission is low, more businesses can be safely reopened, testing supplies and personal protective equipment can be stockpiled, school buildings can be altered for better ventilation, and life can return to something closer to normalcy while Georgians wait for treatments and vaccines to come along. In order to do that, though, Kemp would have to do something authoritarians hate: admit he was wrong, and change his mind based on evidence, the advice of experts, and the will of the people. The same is true for the country as a whole. America is a few decisions away from a much different future. Instead, like the authoritarian he’s shown himself to be, Kemp seems intent on maintaining the disastrous course his administration has plotted so far, at the expense of the people of Georgia. “It’s truly unbelievable,” Heiman said. “It will be a case study for decades to come of what an utter collapse of political and public-health leadership looks like.” from https://ift.tt/2DN6Oys Check out http://natthash.tumblr.com News of scientific developments now reaches a much wider audience in this pandemic. But not all science news is created equal, and the difference between a meaningful study and a meaningless one is often distinguished only through terms many Americans aren’t familiar with. (What exactly is a “double-blind” study and why does that matter?) On this episode of the podcast Social Distance, James Hamblin explains to Katherine Wells how a scientific study works and how to read scientific news. Hamblin also explains how this kind of public interest in early science is changing the discipline itself They’re also joined by staff writer Ed Yong to discuss how American healthcare needs to change to beat the coronavirus. Read his new cover story here. 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. Here is a sample of their conversation with Ed Yong, edited for length and clarity: Katherine Wells: I’ve been trying to follow studies about treatments and about the vaccine. It feels like we’re all hanging on every tiny medical development, but it feels like the reason we’re doing that is because we’ve accepted that the coronavirus is now basically endemic in the US. We’re so far past containing it that we’re having to pin our hopes on miracle drugs or a sort of miracle medical solution to what began as a social problem. Ed Yong: The only thing I would push back gently on is that this is a recent thing. I think it’s actually our default posture. I think that people do gravitate towards these biomedical solutions. There’s this sort of techno-utopian view that more research and some kind of highfalutin development is going to address problems. But in many ways, these advances are kind of sticking customs that don’t address the foundational rot that has allowed lots of marginalized groups from black people to indigenous people to disabled and elderly and poor people to be disproportionately hit. That can be solved through social interventions: things like universal healthcare, things like sick pay for all. It’s not rocket science. Those are measures that you could put in and that wouldn’t have to wait for something biomedical. But we look for that silver bullet because I think it’s almost easier. It absolves us of responsibility for looking deeply at the systemic underpinnings of these crises and trying to actually fix them. I write about this in the big piece: this miniscule fraction, 2.5 percent of America’s health-care spending is on public health. What we’re doing is we’re spending huge amounts of money to treat people who are already sick and almost no money on preventing them from falling sick in the first place, which, when you think about it, is ludicrous. The entire point of health care is to maintain health for as long as possible. And the best way to do that is through prevention. That’s what public health is. It is the world of things like sanitation, of vaccination, of testing and tracing and isolating. Wells: But sanitation and prevention is boring. And like getting in a crisis and then having to solve it and the hero comes to save the day with some sort of innovation is exciting. Yong: I mean, yes, I actually think that’s true. Public-health people lament this all the time: public health is distinctly not sexy. And it’s especially not that when it works. I think it’s the problem. When public health works, all that you see is the miracle of a normal, healthy day. It’s only when it doesn’t work, when everything goes to pot, that you realize just what you are missing. It’s really hard to internalize that. People take their health for granted. I don’t think it’s a stretch to say that so much of our fiction involve stories of like people doing stupid things and a hero comes in and saves the day. Just stop people from doing the stupid things in the first place. Wells: But then you’re being a buzzkill. James Hamblin: Nanny state ... socialists ... taking away my soda ... Yong: … strapping a seatbelt on you whilst pulling that cigarette out of your mouth. Hamblin: These are the things I was thinking about when I was sitting in a radiology reading room, reading C.T. scans and MRIs. I just felt like I really wasn’t helping with the problems. And then I stopped doing that, and I went and studied public health and got into writing about this stuff. And I feel like it quickly becomes political. It’s hard to advocate for these things without sounding like it’s aligning with certain political incentives, even if your actual incentive is really just to keep people healthy. Yong: I think a lot of this does boil down to your values and how you see the world. Now, I would argue that acting in the collective good and looking after other people who are not you is a moral choice. And I think that the extreme opposite of that: this sort of rugged individualism, this neoliberal attitude of every person for themselves, if you get sick, it’s your own fault, is not only wrong, but counterproductive. It creates a lot of the conditions that allow this virus to spread. Other people can feel free to disagree with that, but I think that is the right analysis given this problem. That being said, let’s remember that, in the main, people have taken public-health actions that they were totally unfamiliar with, like social distancing and wearing a mask, to a degree that I really did not anticipate. These things are not universal, but there’s certainly much more common place given that they did not really exist in this country before this year. Now, imagine what people could have done and what people might be doing if these measures hadn’t been so highly politicized. If the president hadn’t turned them into yet another front on this ridiculous culture war. I think we would be in a much better place. from https://ift.tt/2PAMUcY Check out http://natthash.tumblr.com |
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