27 March, 2020

Some good news

You know the nightmare scenarios I’ve been telling you about? If we treat this like the seasonal flu we could get over 800,000 dead people. Well, here is good news.
We are not going to get the nightmare scenarios. Why?
It is not that the modeling was wrong. Actually, the modeling has been fairly accurate. The modeling is precisely why Governor Kemp has not locked down all of Georgia, for example. The modeling, it turns out, has been right.
That includes all the modeling — including the part that showed if we changed our behavior we could avoid the nightmare scenarios.
Because you and I have changed our behaviors, we are seeing good news in the data. There is still a lot to be troubled by and there are still shortages and problems ahead. But for most of the country, we are turning the corner. It’s going to take a bit longer to see for sure, but the data is really encouraging.

24 March, 2020

How to Talk to Coronavirus Skeptics

In general, people use experts all the time, and most of us don’t spend a lot of time second-guessing experts on most issues. There are some definite exceptions to that. If we have reason to believe that people are dishonest or incompetent, then we may be skeptical. But, when it comes to science, the big exception has to do with what I’ve written about, which is implicatory denial. That is to say, we reject scientific findings because we don’t like their implications.

All of the major areas where we see resistance to scientific findings in contemporary life fall into this category. So if you ask yourself, Why do people reject the evidence of evolution? It’s not because evolutionary theory is a bad theory, or a weak theory scientifically, or that we don’t have good evidence for it. It’s because some people think that it implies that there’s no God, or that it implies that life is meaningless and has no purpose, or that it’s all just random and nihilistic. If we think about vaccinations, it’s a similar sort of thing. It’s not that the science of immunology is a bad science or a weak science. It’s not that the people who reject immunization really understand immunology and have an intellectual critique. It’s a matter of, if their children are autistic, they feel upset that their children have a quite devastating disease and modern medical science doesn’t have an explanation for it. So they feel upset and they want an explanation, and so they turn to something like vaccinations, and they say, “Well, that’s the cause.” And so on and so forth with climate change, et cetera.

That Discomfort You’re Feeling Is Grief

Finally, it’s a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.
One particularly troubling aspect of this pandemic is the open-endedness of it.
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the Spanish Flu. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

America’s coronavirus response failed because we didn’t understand the complexity of the problem.

In the United States and Europe, the die is mostly cast for the immediate future. But understanding our failures leading up to this moment isn’t an abstract exercise. Maybe we will muddle through the next few months, at great cost. But we will still need all the systemic thinking we can muster to anticipate the second and third order effects that will follow this crisis. And if we hope to blunt the impact of others like it, let’s not forget, again, that all of our lives are, together, embedded in highly complex systems.

23 March, 2020

Hold the line

First, we are in the very infancy of this epidemic’s trajectory. That means even with these measures we will see cases and deaths continue to rise globally, nationally, and in our own communities in the coming weeks. This may lead some people to think that the social distancing measures are not working. They are. They may feel futile. They aren’t. You will feel discouraged. You should. This is normal in chaos. But this is normal epidemic trajectory. Stay calm. This enemy that we are facing is very good at what it does; we are not failing. We need everyone to hold the line as the epidemic inevitably gets worse. This is not my opinion; this is the unforgiving math of epidemics for which I and my colleagues have dedicated our lives to understanding with great nuance, and this disease is no exception. I want to help the community brace for this impact. Stay strong and with solidarity knowing with absolute certainty that what you are doing is saving lives, even as people begin getting sick and dying. You may feel like giving in. Don’t.

The Virus Can Be Stopped, but Only With Harsh Steps, Experts Say

Just as generals take the lead in giving daily briefings in wartime — as Gen. Norman Schwarzkopf did during the Persian Gulf war — medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.
The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.
Instead, leaders must describe the looming crisis and the possible solutions in ways that will win the trust of Americans.
Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health. There is no time left to point fingers and assign blame.
“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,” said Adm. Tim Ziemer, who was the coordinator of the President’s Malaria Initiative from 2006 until early 2017 and led the pandemic response unit on the National Security Council before its disbanding.
“We need to focus on the enemy, and that’s the virus.”

22 March, 2020


We live disaggregated lives. We are disaggregated physically, many of us living far from family and home base. We are disaggregated sociologically, many of us shuttling between contexts that don’t touch one another, compartmentalized social and civic habits compounded now by online engagement. We are also disaggregated morally, the elites we once trusted to lead either offended by the idea that there could be a shared compass in pluralistic times, or themselves so corrupted in character and vision that it’s hopeless to defer in their direction.
And so we resort to an ancient survival mechanism activated when fear is kicked up and identities of all kinds are under siege: Find your team and defend it. It’s your only shot at significance and psychic sanity.

21 March, 2020

How to Survive a Plague

These weeks of confinement can be seen also, it seems to me, as weeks of a national retreat, a chance to reset and rethink our lives, to ponder their fragility. I learned one thing in my 20s and 30s in the AIDS epidemic: Living in a plague is just an intensified way of living. It merely unveils the radical uncertainty of life that is already here, and puts it into far sharper focus. We will all die one day, and we will almost all get sick at some point in our lives; none of this makes sense on its own (especially the dying part). The trick, as the great religions teach us, is counterintuitive: not to seize control, but to gain some balance and even serenity in absorbing what you can’t.
There may be moments in this great public silence when we learn and relearn this lesson. Because we will need to relearn it, as I’m rediscovering in this surreal flashback to a way of living I once knew. Plague living is almost seasonal for humans. Like the spring which insists on arriving.
See you next Friday.

20 March, 2020

“They Ignored the Warning Signs”: A New York City ER Doctor Explains What She’s Up Against

What are you seeing on the ground in the ER right now?
It’s changing every day. A point I want to emphasize, though, is that the federal government set us up for failure. They should have paid attention to what the forecasters were saying months ago, but they ignored the warning signs and stuck their heads in the sand. The underreporting and under-testing has made us fundamentally unable to combat this effectively. The New York [state] government has been remarkable; [Governor Andrew] Cuomo has been doing a great job. But the lack of federal oversight means that there will be pockets of success and pockets of failure. It makes it that much harder for us to combat this on a global level. On the ground, I’m seeing health care professionals do their best to catch up. New York has the highest number of infections of all the states in America, and we’re going to see that number increase exponentially.
The testing criteria is changing day to day, but we are not able to test enough people—just a fraction of the patients we see are getting tested. People who live with their 85-year-old grandmother and are displaying symptoms are not getting tested. People who have symptoms [and] need a positive test in order to keep getting paid by their employers while they’re not working are not getting tested. Right now, we are saving the tests for people who are in critical condition.
We’re all wearing as much PPE [personal protective equipment] as possible, including goggles that were given to us by the hospital. But we don’t know how long the supplies are going to last.

18 March, 2020

Coronavirus Ravages 7 Members of a Single Family, Killing 2

Grace Fusco — mother of 11, grandmother of 27 — would sit in the same pew at church each Sunday, surrounded by nearly a dozen members of her sprawling Italian-American family. Sunday dinners drew an even larger crowd to her home in central New Jersey.

Now, her close-knit clan is united anew by unspeakable grief: Mrs. Fusco, 73, and four of her children are hospitalized with coronavirus. Two children who contracted the virus have died in the last week.

Mrs. Fusco’s eldest child, Rita Fusco-Jackson, 55, of Freehold, N.J., died Friday with the virus, a relative said. Her eldest son, Carmine Fusco, of Bath, Pa., died on Wednesday, said the relative, Roseann Paradiso Fodera.

Three of the four siblings who remain hospitalized are in critical condition, Ms. Paradiso Fodera said.

17 March, 2020

Don’t Feel Sorry for the Airlines

For American Airlines, the nation’s largest airline, the mid to late 2010s were what the Bible calls “years of plenty.”
In 2014, having reduced competition through mergers and raised billions of dollars in new baggage-fee revenue, American began reaching stunning levels of financial success. In 2015, it posted a $7.6 billion profit — compared, for example, to profits of about $500 million in 2007 and less than $250 million in 2006. It would continue to earn billions in profit annually for the rest of the decade. “I don’t think we’re ever going to lose money again,” the company’s chief executive, Doug Parker, said in 2017.
There are plenty of things American could have done with all that money. It could have stored up its cash reserves for a future crisis, knowing that airlines regularly cycle through booms and busts. It might have tried to decisively settle its continuing contract disputes with pilots, flight attendants and mechanics. It might have invested heavily in better service quality to try to repair its longstanding reputation as the worst of the major carriers.
Instead, American blew most of its cash on a stock buyback spree. From 2014 to 2020, in an attempt to increase its earnings per share, American spent more than $15 billion buying back its own stock. It managed, despite the risk of the proverbial rainy day, to shrink its cash reserves. At the same time it was blowing cash on buybacks, American also began to borrow heavily to finance the purchase of new planes and the retrofitting of old planes to pack in more seats. As early as 2017 analysts warned of a risk of default should the economy deteriorate, but American kept borrowing. It has now accumulated a debt of nearly $30 billion, nearly five times the company’s current market value.

16 March, 2020

Integrated Operations and Incident Command

This is what to do first, as your organization begins to work out plans and resources for reducing the slope of infection counts and raising the ceiling on health care capacity:
We believe the only successful working model for a response of this complexity among conditions this dynamic is to immediately instantiate an operations body with direct access to executive decision making.
The staff you recruit to work as incident lead in this operations body must be someone experienced with incident command, production operations, or emergency response at or near the executive level.
A successfully integrated operations body will have these features [...]

15 March, 2020

From the Trenches …

Everyone I work with seems resigned to a sense of impending doom, and an expectation that we will all be infected in the weeks ahead, and that we have no alternative course of action without abandoning our patients.
Many coworkers live with their parents, immunocompromised family members, etc, and are terrified about what they will do when they get sick. Live in a call room? stay in a hotel? not go home for 2 months? We’re slowly changing our operations, adding staffing, infectious screeners, etc – but there is organizational resistance to make the big changes that are already necessary. Despite near-daily reports from Italy of WWII-era triage decisions, shortages of key equipment, PPE, etc – we are still operating as if we can add a couple shifts to the schedule and otherwise operate normally. We’re not isolating URI patients from other patients in the waiting room, nor keeping them out of the “clean” areas of the hospital. We still have zero ability to test anyone who isn’t critically ill. We’re still using PPE for individual patients, discarding it, then using a new set for every patient. This would obviously be appropriate under any other circumstances, however we have recently been told that we will run out of PPE, most likely masks, within several days. Colleagues in the NYC area report that in the last few days there has been a surge of ill ARDS/covid patients, including one facility which intubated 5 of these patients in a single 12 hour stretch. In addition they have been told only to wear masks if intubating because of shortages … Reports from China suggest Covid patients typically require ventilators for 2+ weeks before improving.

14 March, 2020

He has 17,700 bottles of hand sanitizer and nowhere to sell them

Now, while millions of people across the country search in vain for hand sanitizer to protect themselves from the spread of the coronavirus, Mr. Colvin is sitting on 17,700 bottles of the stuff with little idea where to sell them.
“It’s been a huge amount of whiplash,” he said. “From being in a situation where what I’ve got coming and going could potentially put my family in a really good place financially to ‘What the heck am I going to do with all of this?’”

11 March, 2020

When Women Run

One hundred years after women were granted the right to vote, the U.S. has more women in political office than ever before. Yet gender has been a major theme of the 2020 campaign, as candidates, voters and the media debate whether a woman can win the presidency. To better understand what it’s really like to try and win an election as a woman, we spoke to women from every state who have done it — 97 women in all.
These are their stories, in their words.

08 March, 2020

How Working-Class Life Is Killing Americans, in Charts

When the economists Anne Case and Angus Deaton first published their research on “deaths of despair” five years ago, they focused on middle-aged whites. So many white working-class Americans in their 40s and 50s were dying of suicide, alcoholism and drug abuse that the overall mortality rate for the age group was no longer falling – a rare and shocking pattern in a modern society.
But as Case and Deaton continued digging into the data, it became clear that the grim trends didn’t apply only to middle-aged whites. Up and down the age spectrum, deaths of despair have been surging for people without a four-year college degree:

Corona Panic


Here’s German psychologist Gerd Gigerenzer in his book Risk Savvy:

People aren’t stupid. The problem is that our educational system has an amazing blind spot concerning risk literacy. We teach our children the mathematics of certainty—geometry and trigonometry—but not the mathematics of uncertainty, statistical thinking. And we teach our children biology but not the psychology that shapes their fears and desires. Even experts, shockingly, are not trained how to communicate risks to the public in an understandable way.

07 March, 2020

Coronavirus isn't the Flu, and Politicians aren't the experts

I am a former politician who has worked in education for the last nearly twenty years, so I am not a medical expert. But, I had a baptism in virus, infection, and immune systems last year that gives me a unique perspective on the coronavirus debate as a wife and mother. I also was the Governor (acting Governor if you want) during 9-11, and my husband and I had just invested significant savings into a small business in 2008/9, so I also have some experience with fear-induced recessions from multiple perspectives. I've been reflecting on those personal and professional experiences as I've tried to give counsel to those making difficult coronavirus decisions. I have also had to make some hard coronavirus decisions recently. And, I've seen a lot of debate - particularly on parent-Facebook pages for colleges - around the decisions being made by college leaders on the coronavirus. For what it is worth, here are some thoughts & some personal feelings are thrown in:

06 March, 2020

The Telharmonium Was the Spotify of 1906


Rdio, however, was not the first service to allow American subscribers to stream music from their phones. That honor goes to the telharmonium, the first patent for which was granted in 1897. It was, essentially, a Victorian Spotify.

Invented by lawyer Thaddeus Cahill and initially known as the dynamophone, the telharmonium made use of telephone networks to transmit music from a central hub in midtown Manhattan to restaurants, hotels, and homes around the city. Subscribers could pick up their phone, ask the operator to connect them to the telharmonium, and the wires of their phone line would be linked with the wires emerging from the telharmonium station. The electrically generated tunes would then stream from their phone receiver, which was fitted with a large paper funnel to help pump up the volume. (The electric amplifier had not yet been invented.)

03 March, 2020

The Spy With No Name


In 1977, Johanna van Haarlem finally tracked down the son, Erwin, she had abandoned as a baby 33 years earlier. She immediately travelled to London to meet him. What followed, writes Jeff Maysh, is an unbelievable story of deception and heartbreak.