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Health | The Atlantic
Health | The Atlantic
The Coronavirus Customer-Service Crisis
Early on Saturday, at the bakery a few blocks from my apartment, the barista didn’t quite have his new coffee-order spiel down. That morning, for fear of hastening the spread of the coronavirus, all the milks, sugars, and disposable lids had been moved behind the counter. He was nervous, he told me, because orders would take longer to dole out, and every request for “just a little sugar” or a particular type of milk had the potential to go wrong. He hoped people would be patient, but the rush had yet to come.At the neighborhood grocery, people were starting to get irritated that this store, like virtually every other in the city, had run out of disinfectant wipes. The women running the checkout lines were gloved for the first time, spraying down conveyor belts and debit-card keypads as thoroughly as they could before the next customer piled toilet paper and canned food into their lanes. The one who scanned my seltzer and pasta ingredients said that the onslaught of disaster-prepping customers had first descended last Wednesday and hadn’t let up since.The anxiety that accompanies hurricanes or floods—catastrophes that Americans are used to seeing on the news, if not in their own backyards—spikes intensely and dissipates quickly for most people. A novel respiratory infection such as COVID-19 is totally different. At first, a virus is an invisible disaster, working its way from person to person, weeks passing before the most severe symptoms emerge. By the time you understand how bad it is, it’s been bad for some time, which makes it difficult to prepare for. But as more of us have begun to understand that this new illness is far more sinister than the flu, the rhythm of everyday life has started to change in perceptible ways: honeymoons canceled, parties postponed, quarantine supplies sought. Often, the people executing these changes—and managing the underlying fear and panic—are overwhelmed and undertrained hourly workers or customer-service agents, who now form the de facto front line of pandemic response in the United States.[Read: The strongest evidence yet that America is botching coronavirus testing]A week and a half ago, at one of Brooklyn’s larger Targets, workers had prepared for what was coming: The endcaps of aisles were filled with bottle after bottle of rubbing alcohol and hundreds of tubs of Clorox wipes. The store had already been emptied of hand sanitizer, but customers milled around as if more might materialize at any second, stopping red-shirted employees to pump them for information.At the Break Room, a message board for Target employees, workers were starting to worry among themselves that the mood in their stores was about to get worse. Basic customer interactions had begun to go from polite to panicked. “Came across a guest with a broom trying to reach a canister of bleach wipes at the back of the top shelf,” wrote Redeye58. “She looked like she was about to climb the shelves when I stopped her.” (Target has not released details on how it plans to protect in-store workers; the company did not respond to a request for comment, but some posters at the Break Room have reported seeing more sanitizing products in employee areas.)[Read: You’re likely to get the coronavirus]At some stores, customers have started to inflict their anxieties on workers with no power to fix their problems. “They ask us more questions that we don’t have answers to, like when are we getting more of a product or how long will the line take,” said an employee at one Manhattan Trader Joe’s, who requested anonymity in order to avoid scrutiny from his employer. His store had been out of dried pasta, for example, for a week and a half. He echoed a sentiment shared across the employee forums and subreddits of many large retailers: “I just work here; I’ve got no idea what our distributor is doing.” He said that managers have suggested employees leave their register to wash their hands every five to 10 customers. They’re doing a “decent job” trying to support employees overall, he said, but employees can only do so much on their own. “I think [the company] could possibly be telling customers to just be more judicious when handling product and asking for our help,” he noted.Removing people from display shelves and explaining the finer points of retail to harried customers as they panic shop is stressful enough on its own. Doing so during a virus outbreak means risking exposure all day long. When stores are dealing with unending lines and impatient, nervous customers, workers can't always maintain a six-foot distance from people and clean their hands regularly. These basic safety measures would require clerks to leave registers and stop stockers from refilling rapidly depleted shelves. “We just fundamentally can’t wash our hands as often as needed, so it’s frustrating,” says another worker at a New York City-area Trader Joe’s store, who also asked that her name not be used to avoid the company’s scrutiny. “The sense of frustration and helplessness is growing. It’s making it really depressing to be at work.” She says that the company has asked employees not to wear gloves, because of customer complaints. Trader Joe’s has not responded to a request for comment on its in-store hygiene policies, but the company did announce last week that it would encourage sick workers to take time off by reimbursing them for missed shifts.[Read: The problem with telling sick workers to stay home]In some workplaces, that would count as a luxury. On a subreddit where Walmart store employees frequently discuss their jobs, a user posted a photo of George Patton, alongside a famous quote, altered to reflect how the company’s store managers might respond to workers who get sick and ask for days off: “May God have mercy upon my associates, because I won’t.” In the comments below the meme, other Walmart employees responded with more earnest anxiety. “I'm actually stressed about this. I have a family to support. So do a lot of my coworkers,” wrote Imaginary_Medium. “Several of my friends and family have health issues that affect their immune systems. Customers were climbing all over me and I wanted a hazmat suit.” (Walmart also didn’t respond to a request for comment, but a spokesperson told Business Insider that the company would monitor the situation and adjust policies as necessary.)For workers at gig-economy companies such as Uber and Instacart, the pressures are just as intense. Over the past week, Instacart has experienced demand spikes of up to 20 times its normal order volume in California and Washington, where community spread of the coronavirus has dominated news coverage. That sends the company’s shoppers back into crowded stores as quickly as possible after orders are completed, over and over again. Drivers who work with ride-share apps or Amazon’s Flex delivery service report being given little in the way of guidance or protection from above, beyond encouragement to sanitize their vehicles and their hands regularly. Workers at these companies are treated as independent contractors and don’t receive sick leave, health benefits, or job security.As the crisis deepens, a whole gamut of customer-service workers are being pulled into the fray. Canceled vacations, business travel, and conferences such as South by Southwest and Seattle’s Comic Con have left thousands of people trying to recoup money spent on flights and hotel rooms. Those people have flooded airlines and booking services in person, on social media, and on the phone, with wait times for assistance stretching to multiple hours and cancellation policies changing by the day.[Read: What will you do if you start coughing?]These roles can be thankless on a normal day—the Los Angeles Times once described customer-service agents as a “punching bag for airline passengers”—but when problems get complicated enough to push people away from companies’ websites or apps and onto the phone, things get really bad for those answering calls. “That customer is at a point where they’re pretty angry,” says Tiffany Apczynski, a vice president at Zendesk, which makes customer-service software. “They tried the other tools that don’t require them to pick up the phone, and this time they have to, so the problem has gotten really intense. It takes a toll on agents.” Research has consistently shown that the emotional labor often performed by people in customer-service jobs—the smiling through rudeness, the calming of nerves, the constant control of one’s own emotions—has what one widely cited study described as “uniformly negative effects on workers.” It has also been linked to an array of physical and mental-health problems, including depression and high blood pressure.A certain amount of interpersonal chaos is probably unavoidable while people are still calibrating their individual responses to a new kind of threat. But as COVID-19 hurtles toward “pandemic” status, without the U.S. government implementing widespread testing or social-distancing measures, businesses have been free to respond how they see fit. So far, that has meant many public-facing employees have been expected to absorb an inordinate amount of risk with little recourse or relief. The United States does not guarantee workers paid time off of any kind, and many in entry-level or service jobs can’t afford to miss work, or will lose their jobs if they do. Whether these workers have access to paid leave—or time to recuperate from being screamed at for 8 hours a day—depends on the company they work for and, often, the benevolence of those tasked with supervising them.Disasters, whether they’re mysterious illnesses, extreme weather, or the result of man’s cruelty, tend to illuminate the cracks in societies. Amid the panic shopping and refund seeking, the coronavirus has already started to illuminate a particular weakness of the U.S. in this crisis: Surviving a disaster in America is something people are expected to work out on a personal basis, with the employees in their local big-box store or the representative on the other end of the phone, whose time and energy is largely taken for granted until everyone needs it at once.
2020-03-11 16:44:31
2021-05-08T10:47:50.000000
1 y
theatlantic.com
The People Selling Hand Sanitizer for 10 Times Its Price
“I saw a little bit of an opportunity. Worst-case scenario, I have hand sanitizer for the next six years,” Anthony Del Zio, a 39-year-old Long Island man who owns an industrial-power-washing company, told me on the phone.Two weeks ago, Del Zio went to the drugstores near his house, as well as a Dollar Tree, and stocked up on hand sanitizer. At the time, there were no confirmed cases of COVID-19, the disease caused by the novel coronavirus, in New York State, but he had a hunch that his efforts would be worthwhile. As of yesterday, 173 cases have been confirmed in New York, a large share of the 1,015 nationwide. In response to the exploding case numbers, people all over the country have been preparing for worst-case scenarios of prolonged quarantine by panic-buying supplies such as food, toiletries, and other household staples—along with hand sanitizer and face masks, which they hope will protect them from the disease when they do venture out in public. But Del Zio was a little faster. He said his experience trading baseball cards on eBay taught him how to anticipate a financial win: “You learn supply and demand.”Del Zio is one of a wave of coronavirus price gougers, buying up basic supplies in the midst of the crisis and then upcharging people. Last week, he said, he found a bottle of Purell at Rite Aid for $7.99 and sold it on eBay for $138 the same day.[Read: What you can do right now about the coronavirus]eBay has since banned the sales of both face masks and hand sanitizer, saying that the prices on some listings may be so high as to be illegal. In emails to sellers, the company has also cited its “disaster and tragedy” policy, which prohibits attempting “to profit from human tragedy or suffering.” Amazon is still allowing third-party sales of hand sanitizer, although it told The Wall Street Journal that it is taking down listings that price gouge or make “deceptive claims.” Many sellers, for example, were writing that their products could “kill” the coronavirus, which is not an approved medical claim for hand sanitizer, though it does effectively reduce many types of germs. Facebook Marketplace announced a temporary ban on sales of medical face masks last week, though The Verge reported Monday that the site was still “littered” with listings—some asking for up to $1,000. Hand-sanitizer listings are still allowed, but with the same caveats as Amazon, and an added prohibition against implying a sense of urgency or limited supply.After eBay disallowed hand-sanitizer sales, Del Zio switched his operation over to Craigslist and Facebook Marketplace, where new listings are going up every hour. (Craigslist did not respond to a request for comment about whether it was considering any bans on sanitizer sales.) Del Zio said he doesn’t feel moral qualms about charging online buyers 17 times what he paid for a bottle of Purell because he doesn’t consider it to be an essential supply. “I’ve always washed my hands and used hand sanitizer wherever I went,” he said, but added that he doesn’t think sanitizer is going to protect anyone from the coronavirus—you touch your phone and your keys and the subway railings, and you can’t soak your hands in Germ-X all day long. In 2012, after Hurricane Sandy caused gas shortages and power outages on Long Island, Del Zio remembers neighbors paying $25 a gallon for gasoline for their generators. Now he said he knows people who fill up jugs of gasoline every time there’s a particularly gnarly-sounding forecast—both to prepare for their own needs and to sell at a markup. This kind of strategizing is just good sense in general, in his opinion. In any case, he gave some of the sanitizer away to his family and to friends of his elderly mother, who couldn’t get to the store themselves.Del Zio repeated some common misinformation about the novel coronavirus: “I know most of the cases are in China. I’m hearing stories that it’s from bats being boiled into soup. I don’t know how true that is.” (For the record, the virus is spreading faster outside China than within it. And the virus likely originated with bats, but not because they were boiled into soup.) He said he isn’t particularly worried about contracting COVID-19. “Me and my friends were concerned about the flu more than anything.” (There is not yet enough information to say exactly how the mortality rate of COVID-19 compares to that of the flu.)[Read: What happens if you get sick]Densely populated areas like New York have had trouble keeping hand sanitizer in stock for the past week, so the “For Sale” categories on local Craigslist pages have started to look like super-expensive sanitation-themed yard sales. In New York, single eight-ounce bottles of Purell are listed for as much as $25 apiece. A listing from Brooklyn advertises 78 bottles of industrial sanitizer for $750, while a California man is offering to ship 25 single-ounce bottles to New York for $150—which works out to $6 an ounce. “Fight the COVID-19 with easy [sic] and protect yourself and your love ones [sic],” a listing in Queens reads. It also suggests that the buyer use a contactless form of payment, as cash is a vector of disease.Russ, a 43-year-old IT specialist in Michigan, listed his stock of hand sanitizer on the Craigslist pages for six major cities. I agreed to identify him and others in this story by only his first name because it was the only way he would agree to explain his decision to price-gouge antibacterial gels. Russ offers to ship bottles and accepts cryptocurrency payments. (His area is not yet experiencing a shortage.) When he first heard there might be a demand in some cities, he told me in a phone call, he bought just five bottles and listed them on eBay for $15 each. They sold out within 30 minutes, so he bought 15 more bottles and upped the price to $20. He sold eight of them before eBay announced the ban on hand-sanitizer sales, so now he’s selling the rest of his stock on Craigslist for $25 each.“I know what you want to ask me. I weighed whether or not this was a moral thing,” he said. “My conclusion was: If I don’t do this, someone else is going to. That allowed me to do it.”Not everyone shares his assessment. Somebody on eBay messaged him and called him a “dick,” he said, in addition to informing him that God is watching. “I’m not trying to sell someone an eight-ounce bottle of hand sanitizer for $100, which I’ve seen. I’m not a bad person,” Russ said. He argued that the people who are going online to buy hand sanitizer are the same people who are buying out grocery stores, spending thousands of dollars on supplies. If he can make a little money off someone who’s willing to spend any amount to make herself feel safer, who really loses?Personally, Russ washes his hands and is now avoiding handshakes, but as for hand sanitizer, “you can buy a bottle of vodka and pour it on your hands and it will do the same thing.” (It won’t. Don’t buy a bottle of vodka and pour it on your hands.) “If hand sanitizer somehow became a miracle cure, I would give it away,” he said.[Read: 20 seconds to optimize hand wellness]I contacted half a dozen Craigslist hand-sanitizer sellers, and not all of them were so relaxed. David, a 35-year-old Brooklyn man, told me in a phone call that he had been buying face masks in early January specifically to sell on eBay, but that business dried up after his suppliers stopped being able to fulfill his orders. He’s “a little bit of a prepper,” he said, adding that he’d bought a second freezer so that he could stock up on food in case of a coronavirus lockdown.After the masks, he started buying as much hand sanitizer as he could: about 100 bottles. He’s not buying any more, he said, because he started to think it was immoral to even imply that hand sanitizer is something people need. “I don’t even know for sure how much it helps with the coronavirus.” (Using alcohol-based hand sanitizer is a good way to help prevent the spread of the virus, though washing your hands with soap is equally helpful.) He made only about $300 and said it wasn’t worth the effort.As the coronavirus continues to spread in the United States, Americans will have to consider the morality of stockpiling, price gouging, and even commuting to work. They’ll also have to consider how to avoid behaving stupidly.Sam, a doctoral student in Manhattan, was concerned about the possibility that he could “look like an ass who tried to take advantage of a crisis to profit.” He wound up with an excess of hand sanitizer because he panicked and bought 250 ounces of it on Amazon for $160 about a week ago. “Which is nuts since I make, like, 25K a year,” he explained over text. “I wish I hadn’t bought it in the first place.”[Read: The coronavirus is more than just a health crisis]He started selling the sanitizer on Craigslist just to make his money back, he said, and has sold about 210 ounces for $165; he plans to keep the remaining 40 ounces. “I am slightly embarrassed about buying so much, given the shortage,” he said. “It was a moment of anxiety.” He’s not worried about getting COVID-19, but he was startled by his own behavior, and what he’s witnessed from the people around him. It’s led him to the conclusion that “the atomized American soul is being laid bare.” Everyone is acting in their own best interest, he said, and the government is totally unequipped to deal with the crisis.“I am worried about living in a society that is completely unprepared for this,” he said.
2020-03-11 13:59:52
2021-05-08T10:47:50.000000
1 y
theatlantic.com
What Happens If You Get Sick
COVID-19 is not the flu. We have a vaccine for the flu. We have anti-viral medications designed to treat the flu. We have a sense of what to expect when we catch the flu, and when it’s necessary to seek medical attention. Doctors have experience treating the flu, and tests to help diagnose the flu, right there in the office, while you wait.Against the new disease, we have none of this. The coronavirus is new to our species. Once it breaks into one of our cells, the extent of its spread through the body seems to vary significantly and unpredictably. The experience can slowly progress from the familiar—cough, congestion, fever—to a life-threatening inflammatory response as the virus spreads down into the lungs, filling the airways with fluid. Survivors can have permanent scarring in the lungs. The virus can also spread into other organs, causing liver damage or gastrointestinal disease. These effects can play out over longer periods than in the flu, sometimes waxing and waning. Some patients have begun to feel better, then fallen critically ill. The disease can be fatal despite the optimal medical care.[Read: You’re likely to get the coronavirus]None of this is meant to cause panic. Panic is not useful. But as we all begin to comprehend the nature and extent of the new virus and its spread, questions should arise about what to do with those early, familiar symptoms. At what point should you ask for testing? When do you need to self-quarantine, and for how long? Who needs to be in a hospital, and who can ride things out at home? If you’re sick, should you bring your illness into a crowded clinic or emergency department, possibly shedding virus that infects others? Should you stay home, maybe using telemedicine, and risk infecting roommates or family members?The source of most panic is uncertainty. While much remains uncertain in the realm of virology and immunology, other sources of anxiety could be mitigated. Everyone could have clarity and certainty on those fundamental questions, or at least on the most immediately pressing: What should I do if I start to feel sick?In an ideal outbreak scenario, at the first signs of illness—or even after a concerning exposure—everyone would go get a quick test. It could assure them that they’re okay to go to work, or to go to a public gathering, or even to go home. If a test were positive, that person’s close contacts would be alerted of an anonymous exposure. They would be advised to come get tested. The process would be fast, easy, ubiquitous, and free.Given the nature and spread of this particular virus, though, this textbook public-health approach to tracking and containment has proven infeasible. Even if perfect tests were widely available, and everyone agreed to get tested as soon as possible whenever they felt sick, demand for screening and evaluation would overload existing doctors’ offices and hospitals.Emergency funds could theoretically be used to set up makeshift screening clinics in parking lots and public spaces. After being screened, some people could be escorted to a hospital for further treatment and evaluation. Others could be reassured that they were clear and go back to work. Still others could be advised to self-isolate at home until the illness passes, and to call, text, or return if symptoms escalated.A series of tents in a field adjacent to University Clinical Hospital in Wroclaw, Poland, now precede the entrance to the emergency department, March 4, 2020. (Agencja Gazeta/Krzysztof Cwik/Reuters)That level of monitoring and communication will prove vital to determining who needs hospital beds in the midst of a rapidly spreading, temperamental disease. Without it, to simply tell people to “stay at home if you’re sick” will be inadequate. Most cases of COVID-19 are reportedly “mild,” but that term can be misleading. As the World Health Organization adviser Bruce Aylward clarified last week, a “mild” case of COVID-19 is not equivalent to a mild cold. Expect it to be much worse: fever and coughing, sometimes pneumonia: anything short of requiring oxygen. “Severe” cases require supplemental oxygen, sometimes via a breathing tube and a ventilator. “Critical” cases involve “respiratory failure or multi-organ failure.”The disease can escalate unexpectedly, and even healthy young patients will need people checking in on them. They may be fine at home initially, but would need to know precisely what to watch out for, and when to seek care. [Read: What you can do right now about the coronavirus]People who do require medical supervision—but not hospital care—need a place to go and stay. This could include people with escalating symptoms or underlying risk factors. Even patients with a mild case will need places to self-isolate if they live with others who have not yet been infected, especially if those people are older or immune-compromised.China addressed this issue by mandating that sick people in Wuhan go into quarantine for two weeks, at one of the dozens of hastily adapted or constructed emergency facilities that look almost like military field hospitals. People are given food, beds, and medical monitoring. They can socialize with other sick people, and they can be transferred to a hospital if that became necessary.In the U.S. and most other countries, the process of removing oneself from society for two weeks is not so straightforward—or even possible, for many people. The Centers for Disease Control and Prevention has ordered some mandatory two-week quarantines, but so far only for a few hundred travelers. The contained have passed their days at military bases, of which the country has 15 with designated space for quarantines. The capacity for housing and feeding larger numbers of people is nowhere near what may be needed. In February the Pentagon “ramped up” the military bases in preparation to quarantine 1,000 people. Though mandatory quarantining at large scales would be infeasible (and legally treacherous), governments might at least offer facilities for people who have nowhere else to go when they get sick. To that end, Washington State’s public-health officials have already procured an Econolodge. Others could anticipate similar needs and secure local hotels, or retro-fit empty stadiums or dead malls, or even cruise ships at port. Ideally the accommodations would be nicer than military bases and would not feel punitive—or else people will not use them.Given the expanding global recommendations to avoid large gatherings and limit travel, such arrangements might also keep the hospitality industry from collapsing.[Read: We can still avoid the worst-case scenario]If all of this were happening, the United States might be able to avoid the sort of widespread shutdowns of cities, businesses, and institutions that are playing out in Italy, China, and elsewhere. But it is not happening. People who are sick are told only to go home. A shortage of tests means that many people are staying home who do not need to. Many others are going out because they can’t afford to stay home and miss work. Many don’t have health insurance, or fear the costs of being hospitalized. There is a strong financial incentive to conceal symptoms, to try to keep working and caring for children, and by consequence spreading the virus.As of last week, at Prohealth clinics in central Connecticut, patients who arrive with a fever and respiratory symptoms are instructed to wait in their car and call the clinic to announce their arrival. Then a doctor or nurse dons a full shield mask, a gown, and gloves and comes out to the parking lot. The patient is to roll down a window and be evaluated on the spot. If a flu test shows no sign of the flu, the patient is to wait in the car while the clinic contacts the state health department.Health officials are then faced with a challenge. What to do with this person, sick and alone in their car, and not allowed into their own doctor’s office? This is where a test for the coronavirus would be of use. Until this week, though, the state of Connecticut had received only one coronavirus testing kit from the CDC. Testing capacity is increasing now, in partnership with private labs. But as of last night, an ongoing Atlantic investigation could only confirm that 6,674 tests had been conducted nationally.This number is projected to increase quickly, but not instantly. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview with JAMA that aired on Monday: “The goal over the next week or two is to get to the point of having a million diagnostic tests ready for shipment.”A doctor prepares a test kit at a drive-in coronavirus check at a hospital in Germany. (Gross Gerau / Reuters)Expectations are tempered; a similar promise from Vice President Mike Pence of 1.5 million tests by the end of last week did not come to pass. But even when these tests eventually are available, some limitations will have to be realized. Among them, these are diagnostic tests, not screening tests—a distinction that should shape expectations about the role doctors will play in helping manage this viral disease.The difference comes down to a metric known as sensitivity of the test: how many people who have the virus will indeed test positive. No medical test is perfect. Some are too sensitive, meaning that the result may say you’re infected when you’re actually not. Others aren’t sensitive enough, meaning they don’t detect something that is actually there.The latter is the model for a diagnostic test. These tests can help to confirm that a sick person has the virus; but they can’t always tell you that a person does not. When people come into a clinic or hospital with severe flu-like symptoms, a positive test for the new coronavirus can seal the diagnosis. Screening mildly ill people for the presence of the virus is, however, a different challenge.“The problem in a scenario like this is false negatives,” says Albert Ko, the chair of epidemiology of microbial diseases at the Yale School of Public Health. If you wanted to use a test to, for example, help you decide whether an elementary-school teacher can go back to work without infecting his whole class, you really need a test that will almost never miss the virus.“The sensitivity can be less than 100 percent and still be very useful,” Ko says, in many cases. But as that number falls, so does the usefulness of any given result. In China, the sensitivity of tests has been reported to be as low as 30 to 60 percent—meaning roughly half of the people who actually had the virus had negative test results. Using repeated testing was found to increase the sensitivity to 71 percent. But that means a negative test still couldn’t fully reassure someone like the teacher that he definitely doesn’t have the virus. At that level of sensitivity, Ko says, “if you’re especially risk-averse, do you just say: ‘If you have a cold, stay home’?”“An inaccurate test—one prone to false positive or false negative results, can be worse than no test at all,” Ian Lipkin, an epidemiology professor at Columbia University, told me in an email. The CDC has not shared the exact sensitivity of the testing process it has been using. When Fauci was asked about it on Monday, he once again hedged. “If it’s positive, you absolutely can make a decision,” he said. If it’s not, that’s a judgment call. Usually a second test is recommended, and it depends on the patient’s symptoms, exposures, and how sick they appear to be.The tests involve other variables, too. Samples must be taken using a long cotton swab that goes into the back of the patient’s nose (or mouth, though this seems to be a less sensitive method). In either case, sometimes you just don’t get enough mucus on the swab. It can be hard to know if that was the cause of a negative test result when results come in from the lab a day later.[Read: The official coronavirus numbers are wrong, and everyone knows it]In attempt to increase sensitivity of the testing process, China not only swabbed people multiple times, but also added CT scans for an additional clue. The scans can sometimes help identify the unique patterns of lung damage caused by the virus, says Howard Forman, who practices radiology in the emergency department at Yale–New Haven Hospital. But scanning is a slow process to do at large scales, and it’s costly and involves exposure to radiation. “You would need dedicated scanners as well, so as not to contaminate other patients,” he told me. “So it becomes very difficult to use CT for high-level screening.” Given the number of variables, widespread screening test for the virus are not looming on the horizon as a way to obviate the urgent need for widespread social distancing.Some hope is being placed in biotech companies that are working to develop quick, mobile tests that could give results anywhere—be it at a doctor’s office or in a modified parking lot. “The goal would be to allow people to know if they have a cold or if they have the virus and need to self-quarantine, right there in the doctor’s office,” says William Brody, a radiologist and former president of Johns Hopkins University. He is currently working one such project with Hong Cai, a molecular biologist, at a small company called Mesa. The duo told me this is, at best, months away from being tested widely. Even then, its sensitivity will remain to be seen, and will likely be less than that of the current, slower tests. But she says her team is working as expeditiously as possible to solve the problem.In the absence o a quick, sensitive, ubiquitous screening test that can decisively rule out coronavirus infection—and send healthy people back out into the world to work and to live— we face unique challenges. The World Health Organization is lately signaling that a declaration of pandemic is imminent. Leaders point to dramatic shutdown and mass quarantine measures taken in China in laudatory terms—as evidence that lives can be saved, and this is how. Other countries are already following China’s example. Italy has banned weddings and funerals as the number of cases exploded in recent days. Japan has closed schools for a month. France has banned large public gatherings, and Iraq has banned even small ones. The United Nations has canceled all in-person meetings to address climate change.For now at least, it seems, minimizing damage will involve sweeping and imprecise action. To shut down a city, or a country, is to gamble that incurring disastrous economic consequences in the short term will prevent even more disastrous consequences in the longer term. In the nightmare scenario that everyone is trying to avoid, the disease spreads so quickly that a country’s health-care system is overwhelmed, and people go untreated amid panic and chaos.A pandemic is like a slow-motion hurricane that will hit the entire world. If the same amount of rain and wind is to hit us in any scenario, better to have it come over the course of a day than an hour. People will suffer either way, but spreading the damage out will allow as many people as possible to care for one another.Slowing the disease requires asking people to isolate themselves and, in most cases, stop working. Most of the world cannot shelter in place for long without income. When people are asked to survive alone—without the cultural, social, and financial inputs that typically keep us alive—new ways of attending to basic needs become immediately necessary. “For people who can’t afford time off work, we absolutely need to come up with out-of-the-box solutions right now,” Ko says.Among them is the idea that everyone receive cash, immediately. People need to feel able to skip work and still make rent and feed their family. They need cash without strings attached, and they need it now, not via a complex omnibus economic stimulus package next month. With each day that such bills are debated by skeptical senators, people will continue to go into their communities, out of a need to work, and spreading the disease simply because they have no other choice.Emergency cash transfers are already happening in Hong Kong, where citizens have received the equivalent of $1,282, in an effort to keep both the economy and people alive. In response to a month of nationwide school closures in Japan, the government is paying out $80 per worker per day to help cover child care or the costs of staying home to parent. Other government payments could be conditional on taking sick leave—a sort of emergency national sick-leave policy, whereby your employer might simply have to verify that you did indeed miss work for two weeks. Or, as with President George W. Bush’s $152 billion economic-stimulus bill in 2008, people could simply get a check in the mail.[Read: The problem with telling sick workers to stay home]“There’s precedent internationally for this idea,” says Natalie Foster, who studies economic policy at the nonprofit Economic Security Project. She says the cash could easily come in the form of earned-income tax credits. “We have an entire tax system that has been doing this for decades … We could expand and modernize it for this precarious moment.”“Unconditional or conditional cash transfers may be wise in a situation like this, where you’re asking people to stay home to protect themselves and others,” says Paul Farmer, a global-health professor at Harvard Medical School. “If people know there will be support, and other things like soup kitchens and nursing care at home, those would make a big difference overall in suffering involved with an illness like this. If people feel like Hey, we got you, they would be a lot less lonely and frightened. Pandemics bind us together, and often not in great ways. But sometimes in great ways.”
2020-03-11 13:00:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
A Very Unwelcome Wedding Guest
Steven Zarnfaller’s elderly cousin couldn’t risk attending his wedding. Last week, Zarnfaller got a call from the 78-year-old, who has been like a mother to him. Given the news about the coronavirus, she told him, it was too dangerous for her to fly from New York to Oakland, California, for his April 5 ceremony. Since COVID-19, the disease caused by the coronavirus, appears to be especially deadly for the elderly, she had to avoid contracting the illness at the airport or on a plane.Zarnfaller decided that if someone that important to him couldn’t be there, the celebration wasn’t worth having. A few hours later, he and his fiancé canceled their 50-person wedding, sending out texts and emails to all their guests. Luckily, they hadn’t put down any nonrefundable deposits. But they still have to cancel their honeymoon. They had planned on going to Japan and Taiwan, two places that have had their own coronavirus outbreaks. “We had put a lot of work and effort into this amazing vacation,” Zarnfaller told me. “And now we have to basically start from scratch.”Wedding cancellations are just another way that the coronavirus outbreak is shaping American life. Along with scrapped conferences and quarantined cruises, private gatherings, including weddings, have become a logistical casualty of the disease. Already a time of intense jitters, wedding planning has only become more jittery thanks to a frightening virus that spreads quickly and forces people to stay in their homes.Weddings are an intensely intimate coronavirus disruption—both emotionally and financially. A canceled conference can have devastating effects on vendors, companies, and workers who rely on the event for income. Canceled weddings shake up families who thought they were planning the most significant day of their lives.Many of the suggested coronavirus precautions run counter to the very idea of weddings, which involve large groups of people, many of them elderly, convening in tightly enclosed spaces to dance with one another while eating food from shared trays. (Indeed, weddings are one of the types of gatherings currently banned in Italy.) Consider: Large segments of the American population are currently being told to avoid crowds. Older people—like young adults’ parents and relatives—really shouldn’t be flying. And with so many companies limiting nonessential travel, even people who aren’t at risk are wondering whether they should just avoid traveling if they can help it. All of this after several nonrefundable deposits to caterers, venues, and planners have been paid.[Read: America’s nursing homes are bracing for an outbreak]Interviews with wedding planners, brides, grooms, and insurance companies suggest that although for the most part the betrothed are not yet panicking, they are preparing. And they’re reading the fine print on their vendor contracts.Lauren Hagee, a public-affairs specialist in Washington, D.C., realized that the coronavirus might affect her May wedding when the shop where she bought her wedding dress in January warned her that she might not be able to get her dress in time because of “the news.” The coronavirus was then tearing through China, slowing down the factories that make wedding dresses. Hagee’s wedding, for which she’s already deposited about $10,000, is taking place in North Carolina, far from both her and her groom’s families. The couple hasn’t canceled anything yet, but “the real worry is that people are going to be getting very sick, and people are not going to want to travel at all,” she told me.For some weddings, guest counts are already going down because of worries about travel. And some brides- and grooms-to-be are asking for virtual rather than in-person meetings with their wedding planners. Lori Losee, the owner of a wedding-planning company called Elegant Affairs, in Lakewood, Washington, says she’s only had one client out of 25 raise the coronavirus question so far, and she’s advising clients not to panic—and not to cancel. Instead, she encourages them to consider putting on their wedding websites that if guests are sick, they should not come to the wedding. “Really think about what it means to cancel the wedding,” Losee told me. “You’re not going to get any deposits back from anything, because you’re going to be the one canceling.”Whether couples can get their money back depends on the vendor, says Rebecca Grant, a wedding planner in Seattle, the epicenter of the U.S. coronavirus outbreak. Grant will allow couples to transfer their wedding-planning funds to another date, as long as she’s available that day. “We as planners are trying to talk our couples off the ledge,” she told me. After all, it would be painful to call off a wedding months in advance only to find, in a month or two, that everything has returned to normal.Though this might be the recommendation from people whose livelihoods depend on weddings, public-health officials are not quite so sanguine. Nancy Messonnier, the director of the Centers for Disease Control’s National Center for Immunization and Respiratory Diseases, has warned that “disruption to everyday life might be severe.” Colleges and workplaces are shuttering to prevent the spread of the disease, and coronavirus cases in the U.S. are rising.Sarah, a bride near Seattle who did not want her last name used for privacy reasons, is following planners’ recommended protocol for her wedding in June. She said she’s prepared to either post a warning on her wedding website telling sick guests not to attend, or to simply retract her invitations and postpone the wedding to a later date, depending on the situation in a few months.Some couples might consider wedding-cancellation insurance, but finding coverage for coronavirus at this point would be difficult, says Steven Lauro, the vice president of Aon’s WedSafe Program, a wedding insurance provider, which provides wedding insurance. Even if you already have a policy, canceling simply because you fear you or your guests could get the coronavirus would likely not be covered. The fear of something happening, Lauro says, is not quite the same, in insurance terms, as a hurricane or an earthquake actually happening. Only if, say, flights were grounded to your wedding destination, or your venue canceled all events with no refunds, would your insurance kick in.Certain types of weddings, of course, have more need for a backup plan than others. Katja Schulz and her partner, who live in the U.K., were going to take a wedding cruise in July from Southampton to Norway. Except some countries, including the U.S., have now advised people not to take cruises because of how quickly the virus can spread in close quarters. Passengers aboard the Grand Princess cruise ship waited for days to disembark in Oakland, and they will be screened and potentially quarantined on military bases because of possible coronavirus exposure. Schulz and her fiancé are now debating whether to pay their next deposit for their spot on the cruise. “The question is, do we protect the $2,100 [we could avoid paying], or do we risk it all and hope that by then [the virus is] gone?” she says. Schulz says the cruise company told the couple in an email that it would understand if they want to cancel, though whether they’ll get back the money they’ve already spent is unclear.[Read: What you can do right now about the coronavirus]Two couples I spoke with are planning to marry this fall in Italy, which has seen more than 450 coronavirus deaths and which is completely on lockdown. Both couples, so far, are taking a wait-and-see approach. Solan Strickling and Adlin Cedeño hope that because so many of their wedding vendors are small, locally owned businesses, they’ll be up for negotiating on cancellation costs, if it comes to that. If the outbreak becomes so severe that the Summer Olympics are canceled, the couple told me they’d consider pulling the plug on their ceremony.The second couple is watching to see whether the quarantine measures that have spread across Italy last for several more months. “Many of our guests (including us!) already have travel booked, and changing the venue (which would likely also require a date change) would be a logistical nightmare,” Julia Ritz Toffoli told me in an email. “Not to mention the fact that we are very attached to our venue and would hate to have to plan a whole new wedding somewhere else.”For many, the uncertainty is the hardest part. Do you “continue planning like everything’s normal, and it’s going to be fine in May, which it very well could be?” Lauren Hagee asked. “Or do you start making your backup plan?”It’s a question that applies to many American families right now: Should they cancel their vacation or take the risk? Attend the event or forgo it? Should they be cautious, even if it’s painful? For those shelling out thousands of dollars for what’s supposed to be the most magical day of their lives, the question is even more pressing.
2020-03-10 20:43:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
The Voices of the Loneliness Epidemic
In January 2018, Theresa May, then the prime minister of the United Kingdom, made an unusual appointment: Tracey Crouch would serve as the world’s first minister for loneliness. The position, May said, would address the fact that, for an estimated 9 million U.K. citizens, “loneliness is the sad reality of modern life.” At the time, Alice Aedy, a British filmmaker in her 20s, was disconcerted by the news. “The idea of a minister for loneliness sounded very dystopian—almost Orwellian,” Aedy told me. “I thought it was a disturbing reflection of the times.” The loneliness epidemic—as many experts are calling it—is a veritable public-health crisis. Research has shown that loneliness and social isolation can be as damaging to physical health as smoking 15 cigarettes a day. A lack of social relationships is an enormous risk factor for death, increasing the likelihood of mortality by 26 percent. A major study found that, when compared with people with weak social ties, people who enjoyed meaningful relationships were 50 percent more likely to survive over time. John Cacioppo, a neuroscience professor at the University of Chicago and the world’s leading expert on loneliness, discovered the deleterious effects of social isolation at the cellular level. “We found that loneliness somehow penetrated the deepest recesses of the cell to alter the way genes were being expressed,” he writes in his book Loneliness: Human Nature and the Need for Social Connection. These are alarming findings, considering that nearly half of Americans report feeling lonely most of the time. The problem is especially acute among young adults ages 18 to 22—a conclusion that is consistent among surveys conducted in the U.K., New Zealand, Australia, and Japan. Why is Generation Z so lonely? It’s a question Aedy explores in her short documentary Disconnected, premiering on The Atlantic today. Following the announcement of Crouch’s appointment, Aedy set up a hotline for young people interested in contacting the new minister for loneliness. Within 24 hours, the mailbox was full. “Nothing could prepare us for how emotive the voicemails were,” Aedy said. “On the first night we received them, we stayed up until 3 a.m. listening, sometimes in tears.” Many callers ended their message by thanking the listener for the opportunity to share their feelings, which they said provided a sense of catharsis. A selection of these voicemails is heard in Disconnected. The testimonies are intimate and disarmingly honest. “It would have been difficult to get such revealing interviews in person or on camera,” Aedy said. It’s comforting to call an anonymous hotline, where “no one is there to respond or judge—as if you were stepping into a confession box.” One caller describes his experience of being alienated in a large city. “I sit in my flat and watch people walk by and think, How am I so alone in a place with so many people?” “Everyone else is having the time of their lives,” another caller says, “and you’re the anomaly.” Audio of the calls plays over haunting, atmospheric imagery of people navigating what appears to be a sci-fi dystopia. In fact, the 16-mm cinematography was shot in Lancashire, a “loneliness hot spot” in England. “There’s a lot going on in the voice messages,” Aedy explained, “so we didn’t want the visuals to be over-prescriptive. I wanted to reflect the mood I had personally experienced when listening to the voicemails.” As for the question she originally set out to answer, Aedy found that most of the anonymous callers referenced the strange dichotomy of feeling alone while surrounded by people. “This reinforced the notion that loneliness has little to do with being physically isolated, but more about a sense of disconnection from the people around you,” Aedy said. Cacioppo, the loneliness expert, believes that social media can create a profound sense of estrangement. In his book, he writes that internet communication is a kind of ersatz intimacy: “Surrogates can never make up completely for the absence of the real thing.” After making Disconnected, Aedy agrees. “The fundamental promise of the internet—better human connection—has failed,” she said. “While we may technically be more connected, I think we are actually more isolated from each other than we have ever been.”
2020-03-10 20:41:07
2021-05-08T10:47:50.000000
1 y
theatlantic.com
The Dangerous Delays in U.S. Coronavirus Testing Haven’t Stopped
Nearly two weeks after the new coronavirus was first found to be spreading among Americans, the United States remains dangerously limited in its capacity to test people for the illness, an ongoing investigation from The Atlantic has found.After surveying local data from across the country, we can only verify that 4,384 people have been tested for the coronavirus nationwide, as of Monday at 4 p.m. eastern time. These data are as comprehensive a compilation of official statistics as currently possible.The lack of testing means that it is almost impossible to know how many Americans are infected with the coronavirus and suffering from COVID-19, the disease it causes. While our analysis has tracked state and local announcements that more than 570 people in 36 states are infected, experts say that number is almost certainly too small to reflect the full extent of the disease’s spread in the U.S. Not enough Americans have been tested for officials to know how many people are ill, they say.[Read: The strongest evidence yet that America is botching coronavirus testing]When researchers have used statistical and genetic techniques to estimate the true size of the outbreak, they have concluded that thousands of Americans may have already been infected by the beginning of the month. Health officials have attributed 26 deaths to COVID-19 in the United States, as of today.The sluggish rollout of the tests has become a debilitating weakness in America’s response to the spread of the coronavirus. By this point in its outbreak, South Korea had tested more than 100,000 people for the disease, and it was testing roughly 15,000 people every day. The United Kingdom, where three people have died of COVID-19, has already tested more than 24,900 people.The Atlantic reached its new estimate through an ongoing collaboration with the data scientist Jeffrey Hammerbacher and a team of volunteers recruited for their experience with data collection, and after consulting data published by all 50 states and the District of Columbia. States vary widely in their reporting standards. All provide positive case reports. But many do not provide negative or pending case reports, which provide crucial context for both the progression of the virus and the government response to it.[Read: You’re likely to get the coronavirus]Our effort is necessary because the Centers for Disease Control and Prevention is not regularly providing data on the full scope of American testing. On its website, the federal agency now provides a number (1,707 as of Sunday) that reflects only the number of people tested at the CDC’s laboratory, even though state and private laboratories provide the bulk of testing. (The CDC did not immediately respond to a request for comment.)When the CDC has provided data, it has been slow and incomplete.On Saturday, Stephen Hahn, the commissioner of the Food and Drug Administration, told reporters that 5,861 specimens—not people—had been tested for the coronavirus by the end of the week. As a rule of thumb, it takes about two specimens to deliver results for a single patient, which would make this equivalent to about 2,900 people tested through Saturday.Last week, The Atlantic reported that it could only verify that 1,895 people had been tested for the coronavirus as of Friday morning.Testing capacity still varies enormously across the country. Many states, including some of the country’s most populous, are not reporting how many tests they have conducted overall. Texas, which now has 24 positive cases, has not posted on its website how many people it has tested overall. A spokesman for the state said it had tested 150 people as of last week, but “with private labs coming online now, I don’t think we’re going to have a definitive number for the entire state going forward.” Nevada has not reported any new data at all on its health-department website since March 3.Massachusetts, which has 41 presumptive cases, has not released its total number of people tested. Neither has Pennsylvania, which has 10 presumptive cases. Last week, a Pennsylvania official told us that the state could test only a dozen or so people a day, suggesting that it has a high rate of positives.[Read: The problem with telling sick workers to stay home]On Friday, California also stopped reporting how many tests it has conducted, switching to releasing only the number of positive cases. The California Department of Public Health told us that the state had tested 778 people as of Saturday, and that the state has 114 positive cases. It now has 15 labs doing tests across the state.North Carolina, which has two positive cases, and Indiana, which has two, have also never said how many overall tests they have conducted.LabCorp and Quest, two companies that run routine medical tests for doctors’ offices, have both announced that they can now test samples for COVID-19. The two companies can test a combined 2,500 patients a day, according to a tally assembled by Gottlieb, the former FDA commissioner, and published by the American Enterprise Institute.Altogether, the country can test a maximum of 7,840 people a day, according to Gottlieb’s preliminary tally. His count is another example of the kinds of data tabulation that a federal agency might usually take responsibility for.The testing situation is so bad that Marc Lipsitch, an epidemiology professor at Harvard, says that health officials and journalists should stop reporting the number of positive cases in the United States as “new cases.” Instead, he wrote by email, “they should refer to them as ‘newly discovered cases,’ in order to remove the impression that the number of cases reported has any bearing on the actual number.”The ponderous rollout of tests—and the stringent criteria that the CDC has imposed on them—has hamstrung doctors and injected anxiety into the lives of ordinary Americans. Are their symptoms pneumonia, the flu, or something worse?“I have no clue if we could have already or could be now spreading this to others,” a 38-year-old woman who lives near Austin, Texas, who asked not to be identified for privacy reasons, told us.After returning from Western Europe in late January, the woman and her husband came down with a mysterious illness, which sent them in and out of week-long fevers. She and her husband would wake up coughing in the middle of the night, their ribs aching so badly that they needed to vomit. She has tested negative for the flu, twice, and also tested negative for strep. She has been diagnosed with pneumonia.[Read: The official coronavirus numbers are wrong and everyone knows it]On her trip, she had frequently been in large, international crowds, where she could easily have been exposed to the coronavirus. But despite having all the symptoms, she has not been tested for it. When she called Austin’s public-health department to ask for guidance, she was told that unless she was hospitalized or had traveled to China, she could not be tested for COVID-19.“The woman who I talked to said, ‘There aren’t any cases here [in Travis County],’” she told us. “And I said, ‘There hasn’t been any testing, so how do you know?’”Without a firm answer about whether she has the virus, she has agonized over how to act responsibly. When is she overreacting? When is she being reckless? She and her husband have stayed home since they became ill, but their son and daughter, both younger than 5, attended school until her daughter ran a fever last week.“There’s no guidelines out there, even at the urgent care today,” she said. She now plans to keep both kids at home for the next two weeks.But that’s only one of many arenas where there is currently no firm guidance for people who think they may have the virus, but who cannot get tested for it.“Am I supposed to tell my team [at work]? Am I supposed to tell my kids’ school? Am I supposed to tell everyone I interacted with for the last four weeks?” she asked. “I don’t want to start a crisis, because I don’t know if I actually have this thing.”[Read: You already live in quarantine]Doctors have expressed similar frustration in getting patients tested. “The Georgia Department of Public Health has basically thrown up their hands when it comes to testing patients who do not require hospitalization,” Josh Hargraves, an emergency-room doctor in Georgia, told us. “On Friday we were told, ‘If the patient doesn’t have a travel history and doesn’t need to be admitted to the hospital, don’t bother calling; we’re not going to test.’” By Saturday evening, when Hargraves saw four prospective coronavirus patients, he managed to get one of them tested, but only after filling out onerous and unusual paperwork.“We’re still restricting usage and asking thoughtful, knowledgeable medical professionals to jump through hoops to get a test they know a patient needs,” Hargraves said.The outbreak is not at the same stage in every state. If public-health officials can quickly increase testing, it might be possible to have a much more comprehensive view before community transmission worsens.We know the virus is here and spreading in many places. Restrictive testing policies—especially ones focused on travel outside the United States—clearly don’t make sense anymore. There are sick people in this country whose doctors think they need testing and who still cannot be tested. Every day that this epidemic continues without adequate testing, the country’s ability to slow the outbreak will deteriorate.
2020-03-10 02:09:43
2021-05-08T10:47:50.000000
1 y
theatlantic.com
Reiki Can’t Possibly Work. So Why Does It?
“When I started it, they all just called it that crap. Like, ‘Oh, they’re over there doing that crap.’ ” This nurse, whom I’ll call Jamie, was on the line from a Veterans Affairs medical center in the Northeast. She’d been struggling for a few minutes between the impulse to tout the program she’d piloted, which offers Reiki to vets as part of their medical care, and the impulse to “tread lightly,” because some of the doctors, nurses, and administrators she works with still think that Reiki is quackery or—you know.Reiki, a healing practice codified in the early 20th century in Japan, was until recently an unexpected offering for a VA medical center. In Japanese, rei roughly translates to “spiritual”; ki is commonly translated as “vital energy.” A session often looks more like mysticism than medicine: Healers silently place their hands on or over a person’s body to evoke a “universal life force.” A Reiki treatment can even, practitioners believe, be conducted from miles away.Reiki’s growing popularity in the U.S.—and its acceptance at some of the most respected American hospitals—has placed it at the nexus of large, uneasy shifts in American attitudes toward our own health care. Various non-Western practices have become popular complements to conventional medicine in the past few decades, chief among them yoga, meditation, and acupuncture, all of which have been the subject of rigorous scientific studies that have established and explained their effectiveness. Reiki is the latest entrant into the suite of common additional treatments. Its presence is particularly vexing to naysayers because Reiki delivers demonstrable salutary effects without a proven cause.Over the past two decades, a number of studies have shown that Reiki treatments help diminish the negative side effects of chemotherapy, improve surgical outcomes, regulate the autonomic nervous system, and dramatically alter people’s experience of physical and emotional pain associated with illness. But no conclusive, peer-reviewed study has explained its mechanisms, much less confirmed the existence of a healing energy that passes between bodies on command. Nevertheless, Reiki treatment, training, and education are now available at many esteemed hospitals in the United States, including Memorial Sloan Kettering, Cleveland Clinic, New York Presbyterian, the Yale Cancer Center, the Mayo Clinic, and Brigham and Women’s Hospital.When Jamie introduced Reiki at the VA center 10 years ago, she overrode the objections of some colleagues who thought it was pseudoscience and out of step with the general culture of the VA, where people are inclined to be suspicious of anything that might be described as “woo woo.” But she insisted that the VA—which also offers yoga, acupuncture, massage, clinical hypnosis, and tai chi—should explore any supplementary treatment for chronic pain and PTSD that doesn’t involve pharmaceuticals, especially narcotics. The veterans started coming, slowly, and the ones who came started coming back. Jamie didn’t promise anything other than that it might help them feel calm or help them with pain. The Reiki practitioner she hired was a local woman, somewhat hard-nosed, not inclined to offer anyone crystals. Soon after the program began, Jamie was getting calls from doctors and nurses: “Hey, is the lady here? Someone wants that crap.”The effects were startling, Jamie told me. Veterans who complained that their body had “forgotten how to sleep” came in for Reiki and were asleep on the table within minutes. Others reported that their pain declined from a 4 to a 2, or that they felt more peaceful. One patient, a man with a personality disorder who suffers from cancer and severe pain, tended to stop his normal routine of screaming and yelling at the staff when he came in for his Reiki sessions.Popular though her program has become, Jamie still hears from colleagues who dismiss the results of Reiki as either incomprehensible or attributable to the placebo effect. As we talked, a little noise of frustration came through the phone line. We take people seriously when they say they’re in terrible pain, even though we can’t measure that, she said. “Why do we have a problem accepting when somebody says, ‘I feel better; that helped’?”Carlotta ManaigoI first learned of Reiki six or seven years ago from a slim memoir by the writer Amy Fusselman. In 8: All True, Unbelievable, she describes receiving Reiki after years of psychotherapy and visits to doctors failed to ease what ailed her. “Doctors, in my experience, touch you with the desire to examine you, and then they use their brains to figure out what to do,” Fusselman writes.This is fine, but right then it wasn’t what I wanted. What I wanted was to lie there and not use my brain, and believe someone was trying to help me, also not with his or her brain. I understand how this sounds. But you have to remember that I had been trying to use my brain on my problems for twenty years … I was over my brain. I was over everybody’s brain.Reading this, I felt a prick of interest. I, too, was over my brain, which has always been as much the cause of my problems as the solution. What would it be like to admit the possibility of being made better by something that wasn’t pharmacological or physiotherapeutic or any of the many polysyllabic options readily available at my doctors’ offices? I believe, I suppose, in the spirit; and if I believe that people have a spirit as well as a body, then I might be willing to believe that feeling better or being well isn’t only a matter of adjusting the body.This notion felt mildly outré in 2013, though the idea had long anchored Western medicine, until it parted ways in the 19th century with the holistic approach of Chinese medicine and the Hindu system of Ayurveda. Roberta Bivins points out in her history of alternative medicine that for most of Western history, medical wisdom held that physical health relied on the balance of the four humors (blood, black bile, yellow bile, and phlegm). Those in turn were affected by emotions, weather, the position of the stars, and faith just as much as by diet, age, activity, and environment. Reiki’s healing touch also has precedent. In the fourth or fifth century b.c., a Greek physician, possibly Hippocrates, included the following observation in some notes on his profession:It is believed by experienced doctors that the heat which oozes out of the hand, on being applied to the sick, is highly salutary … It has often appeared, while I have been soothing my patients, as if there was a singular property in my hands to pull and draw away from the affected parts aches and diverse impurities … Thus it is known to some of the learned that health may be implanted in the sick by certain gestures, and by contact, as some diseases may be communicated from one to another.This passage is now part of what’s called the Hippocratic Corpus, a series of texts written by or closely linked to Hippocrates, commonly known as the father of Western medicine. The precepts laid down there form the foundations of the medical philosophies that shape our health care today.The Hippocratic Corpus also contains one of the earliest articulations of causal determinism, or the idea that all phenomena have a preexisting material cause. In the section titled “On the Sacred Disease,” the author insists that the illness we now recognize as epilepsy wasn’t a divine affliction at all, as it was believed to be at the time, but a physical ailment like any other, only with as-yet-mysterious causes. “Under a close examination spontaneity disappears,” the author writes, “for everything that occurs will be found to do so through something.”The text doesn’t explicitly juxtapose these two notions—healing energy and causal determinism—or attempt to resolve any friction that may exist between them. Instead, it suggests that both are true at once: Everything that happens has a natural cause, and some people have a radiating heat in their hands that has curative power.Even in the early and mid-19th century, physicians were still using humoral theory and competing with homeopaths and botanists for patients; surgeons were a crude last resort. This changed with the ascendancy of germ theory later in the century, when physicians—now focused on professionalizing their field—advanced a new, scientific medicine that they said was beyond dogma. It stood superior to its competitors because it was experimental and rational, requiring no faith—medicine as anti-mysticism.Since then, the Yale historian of medicine Naomi Rogers told me, what is often called orthodox medicine has staked out “quackery” as its enemy. People continued to go to homeopaths and other extramedical practitioners with their health problems, of course. But after the 19th century, those who put stock in health care that wasn’t based in hard science were deemed ignorant. Physicians are still frustrated by such resistance today, Rogers said, but now when patients insist on a course of action other than what the doctor recommends, they’re called noncompliant.The ranks of such patients have steadily grown, Bivins notes. Disillusionment with established medicine has been mounting for decades, fueled by the rising costs and more depersonalized care that have gone hand in hand with stunning technological advances and treatment breakthroughs. Eastern medicine and holistic healing models provided attractive alternatives to what critics in the late 1960s called the “medical industrial complex,” and by the new millennium extramedical “wellness” had become big business.By the time I signed up last May to learn Reiki at a wellness center in Brooklyn, where I live, a $4.2 trillion global wellness industry had already harnessed the collective American obsession with optimizing the experience of having a body. We were putting adaptogens in our coffee, collagen in our smoothies, jade eggs in our vaginas. We were microdosing, supplementing, biohacking, juicing, cleansing, and generally trying to make ourselves immaculate from the inside out. I also noticed that the yoga studios and “healing spaces” in Brooklyn had begun to incorporate new kinds of offerings: breath work, energy healing, and especially Reiki.The popularity of Reiki made sense as part of a backlash to the wellness explosion, which had lately come in for its share of debunking: It was a new form of consumption, critics argued, one that was more bound up with class, gender, anxiety, and late-stage capitalism than with actual health. Reiki takes only an hour or less; it entails no gear, no subscription, no purchases (other than the healer’s fee, which is often on a sliding scale according to income), no list of dietary strictures or dubious supplements. The practice could hardly be better pitched for the political and cultural mood: an anticonsumerist, egalitarian rite, available to everyone through mere breath and hands.[From July/August 2011: The triumph of New-Age medicine]Reiki looked like the culmination of a broader trend that Rogers told me had been on the rise over the past 40 years, a development she calls a “black box” attitude toward healing. We submit to a treatment, it works on us mysteriously (as if in a black box), and we feel better. Rogers noted that we are most comfortable relinquishing ourselves to methods we don’t understand when the authority figure recommending them seems to care about us. What’s more, we have been acclimated to this form of trust by orthodox medicine.Precision genetic medicine is inscrutable to laypeople, Rogers pointed out. Much of psychiatry resembles the black-box model too. So little is known, even by prescribing psychiatrists, about how and why psychotropic medications work in the brain. Yet the number of Americans who take SSRIs has been steadily rising over the past 30 years, despite a scientific consensus that the “serotonin imbalance” theory of depression is flawed—and despite a well-publicized controversy about whether the drugs are any more effective than placebos for most patients. Reiki is the perfect enactment of the black box, the healing gesture stripped to its essentials: a virtuous person sitting with you, intending your well-being in real time.Carlotta ManaigoI signed up for instruction in two of Reiki’s three training levels. The first enables you to do hands-on practice on yourself as well as friends and family (and pets); the second introduces the mental technique for practicing at a distance. (Master training equips you to teach and “initiate” others.) The studio was a warehouse space, with whitewashed brick walls and plywood floors, exposed piping, and brightly colored garlands hanging along the windows. The windowsills were strewn with crystals, shells, and small bottles of oil diffusing into the air.Once everyone had settled on seat cushions arranged in a large circle on the floor, the two women leading the training introduced the core belief: Reiki energy exists throughout the universe, and when the body is attuned to Reiki, it can act as a sort of lightning rod through which others can receive that energy. They told us to picture Reiki energy entering through the top of our head and exiting through our hands, suffusing us and whomever we touch with the intention to heal. The healer’s job is not to control the Reiki or to make decisions about healing. “We’re just the channel,” one of the masters said. “The healing is a contract between the person who needs to be healed and the higher power.” Reiki, they stressed, can never harm anyone. It should also be used only as a complement to conventional medicine, never as a replacement. “We are not doctors,” they said several times. “We cannot diagnose anyone with anything.”You can do Reiki on animals, they told us. “Cats are extra attuned to Reiki—cats almost do Reiki on their own. They can heal you.” No one questioned this. The same goes for plants, the masters suggested. Get two roses and give Reiki to one; that rose will live longer. A student raised her hand. “But you told us never to give Reiki without consent. How can you get consent from a flower or a tree?”“You can talk to a tree!” one of the masters said. “You should always ask the tree’s permission. Maybe it will tell you to Reiki the next tree.” I glanced around the room for raised eyebrows, but there were only more eager questions: Can you Reiki someone who has transitioned to the afterlife? Yes. Can you Reiki your food to make it healing? Yes, and you should.We were told that once the masters attuned us, our bodies and spirits would vibrate at a higher frequency than before, and we would stay on that higher frequency for the rest of our life. This would constitute a permanent transition in our physical and spiritual states. I was silently indignant: I do not believe in permanently alterable personal vibrations, whatever that means, and anyway I wanted mine left alone.The masters warned us that once they had opened us to Reiki energy, we should expect to feel a little emotionally drained and perhaps light-headed. They also suggested that many people experience drastic life changes after their first attunement. Major emotional issues come to the surface and require resolution; people suddenly lose their tolerance for alcohol or other drugs; friends, able to sense vibrations “on a different frequency,” distance themselves.And then, the moment for attunement having arrived, we were led in small groups to a narrow, darkened room. Before we passed through the doorway, one of the masters traced Reiki symbols in the air over each of us. “You guys,” said the other, making what I hoped was a joke, “we’re going to visit some other planets.” I can’t describe what happened next, because our eyes were closed while the masters performed silent rituals that aren’t explained to nonmasters.A few weeks later, I met with Pamela Miles, an international Reiki master and the leading expert on incorporating Reiki into medical care. Miles has been practicing Reiki since 1986. She has introduced programs into prestigious hospitals and taught Reiki at academic medical centers such as Harvard, Yale, and the National Institutes of Health. Miles has the soft voice, long hair, loose clothing, slow gestures, and easy smile characteristic of someone involved in healing arts. She also has the sharpness one sometimes observes in people who have devoted their life to a discipline—an exactitude and authority. When I told Miles about my training, she looked incredulous. “When they said you were going to have energy shooting through your head from the universe, were you scared?” This afternoon, she was patiently attempting to reeducate me.Miles falls on the conservative end of Reiki evangelists in that she’s careful not to make claims about its mechanisms or efficacy that can’t be supported in a scientific context. She does not, for example, subscribe to the belief that Reiki energy is a substance that can be given, received, or measured. No evidence of this has been confirmed, she pointed out. “Reiki is a spiritual practice,” she said. “That’s what it was to the founder, Mikao Usui. And all spiritual practices have healing by-products because spiritual practice restores balance, bringing us back to our center, and enhancing our awareness of our core selves.” When I asked her to explain what that meant practically, she chose her words carefully. “Through an unknown mechanism, when a Reiki practitioner places their hands—mindfully and with detachment—it evokes the healing response from deep within the system,” she said. “We really don’t know why this happens.”This agnosticism is not shared by all of Reiki’s powerful advocates in the United States. The array of psychologists, physicists, and physiologists on the boards of various national Reiki organizations I spoke with—many of whom are eager to develop a standardized method of training and accreditation—champion different forms of energy measurement. In conversations, I heard quantum physics invoked, as well as biophotons, sodium channels, and “magnetic stuckness,” and tools like EEGs and gamma-ray detectors. Ann Baldwin, a physiology professor at the University of Arizona and the editor in chief at the Center for Reiki Research, suggested that people who claim to have measured Reiki using energy-sensing machinery are instead measuring something else, such as heat—but she holds out hope that someday we may be able to measure Reiki.Research this for too long, and you start to sound vaguely stoned. Is Reiki real? Does it matter whether Reiki is real? And whose definition of real are we working with: Is it real according to the presiding scientific and medical framework, which tells us that phenomena need to be measurable to be taken seriously, or is it real in the looser, unquantifiable way of spiritual practice?[Read: The evolution of alternative medicine]There are those who will tell you that Reiki is absolutely real because people experience it to be real. It is real because we feel it, and feelings are produced in the body. Skeptics are quick to point to the placebo effect: The body’s capacity to heal itself after receiving only the simulated experience of medication or therapy is well documented. But precisely because that capacity is so well documented, reflexive dismissal of the placebo effect as “fake medicine” demands scrutiny—and is now receiving it. In late 2018, The New York Times Magazine reported on a group of scientists whose research suggests that responsiveness to placebos, rather than a mere trick of the mind, can be traced to a complex series of measurable physiological reactions in the body; certain genetic makeups in patients even correlate with greater placebo response. Ted Kaptchuk, a Harvard Medical School professor and one of the lead researchers, theorizes that the placebo effect is, in the words of the Times article, “a biological response to an act of caring; that somehow the encounter itself calls forth healing and that the more intense and focused it is, the more healing it evokes.”Carlotta ManaigoTo note that touch-based healing therapies, including Reiki, simulate the most archetypal care gestures is hardly a revelation. Several scientists I interviewed about their work on Reiki mentioned the way their mother would lay a hand on their head when they had a fever or kiss a scraped knee and make the pain go away. It is not hard to imagine that a hospital patient awaiting surgery or chemotherapy might feel relieved, in that hectic and stressful setting, to have someone place a hand gently and unhurriedly where the hurt or fear is with the intention of alleviating any suffering. That this increased calm might translate into lowered blood pressure or abated pain, anxiety, or bleeding—as has been observed in hospital patients who undergo Reiki—seems logical, too.The ailments that Reiki seems to treat most effectively are those that orthodox medicine struggles to manage: pain, anxiety, chronic disease, and the fear or discomfort of facing not only the suffering of illness but also the suffering of treatment. “What conventional medicine is excellent at is acute care. We can fix broken bones, we can unclog arteries, we can help somebody survive a significant trauma, and there are medicines for all sorts of symptoms,” Yufang Lin, an integrative-medicine specialist at Cleveland Clinic, told me. But medicine, she said, is less successful at recognizing the way that emotion, trauma, and subjective experience can drive physical health—and the way that they can affect recovery from acute medical care.Lifesaving surgery is miraculous but requires drugging the body, cutting it open, altering it, stitching it back together, and then asking it to heal. Chemotherapy causes the body to fall to pieces; it can damage the brain, wreck internal organs, and destroy nerve endings, sometimes permanently. Medicine is necessary, but it can also be brutal. Lin, like several of the physicians I spoke with, emphasized that healing is something that happens within the body, enabled rather than imposed by medicine. When we are traumatized, survival is the priority and our healing mechanisms are on lockdown, Miles observed. “We have to pull out of that stress state and get into a parasympathetic-dominant state before the body is able to self-heal and actively partner with conventional medicine.”Many physicians and scientists still believe that allowing Reiki to share space with medicine is at best silly and at worst dangerous. In 2014, David Gorski, a surgical oncologist, and Steven Novella, a neurologist, co-wrote an article calling for an end to clinical trials of Reiki and other forms of energy medicine. To assess approaches rooted in “prescientific thinking” with tools designed to evaluate “well-supported science- and evidence-based” treatments, they argued, degrades “the scientific basis of medicine.” It saps resources from research into valid therapies, and misleads patients.Other doctors and researchers have accepted the line of argument that Miles and many other Reiki advocates have put forward: The practice has no known negative side effects, and has been shown by various studies that pass evidentiary muster to help patients in a variety of ways when used as a complementary practice. Unlike the many FDA-approved medications that barely beat a placebo in studies and carry negative side effects, Reiki is cheap and safe to implement. Does its exact mechanism need to be understood for it to be accepted as a useful therapeutic option? For decades, experts weren’t precisely sure how acetaminophen (Tylenol) eases pain, but Americans still took billions of doses every year. Many medical treatments are adopted for their efficacy long before their mechanisms are known or understood. Why should this be different?In the Reiki training I attended, the moment came when we began to practice on one another for the first time. Taking turns, students would hop up on the table, and four or five others would cluster around. The masters told us to breathe deeply, gather our intention, and begin. After one or two minutes of uncertain silence, a woman a few tables away from me spoke up. “What are we supposed to be thinking?”I was relieved someone had asked. My entire reason for being in the class was to learn what a person is doing when practicing Reiki. But our teachers hadn’t said what, precisely, was supposed to transform the act of hovering our hands over one another into Reiki.“You don’t have to be thinking anything,” one master said. “You are just there to love them.”I thought to myself, more or less simultaneously, Oh brother and Of course. That we were simply there to be loving one another sounded like the worst stereotype of pseudo-spiritual babble. At the same time, this recalled the most cutting-edge, Harvard-stamped science I’d read in my research: Ted Kaptchuk’s finding that the placebo effect is a real, measurable, biological healing response to “an act of caring.” The question of what Reiki is introduces—or highlights—an elision between the spiritual and the scientific that has, as yet, no resolution.In 2002, two professors at the University of Texas Health Science Center, in Houston, gathered a group of people in order to document and study the qualitative experience of receiving a Reiki treatment. The study participants didn’t have any shared belief in Reiki or its possible results, or any particular need for healing; they simply received a session and then described what they felt.After treatment, the subjects spoke more slowly. They described their experience in the language of paradoxes. “In the normal state of awareness, especially in Western traditions, people tend to see disparate phenomena as distinct, discrete, and contradictory,” the authors of the study later wrote. “Most people resolve that disparity by denying or suppressing the existence of one of the poles.” But through Reiki, the subjects entered a liminal state, in which their thoughts seemed both like their own and not; time moved both very fast and very slowly; their bodies seemed no longer separate from the practitioner’s body, though they also remembered that their bodies were their own.At the end of my training, I did not feel invested with any new power, but I did feel raw and buzzy. Though plenty of things in my training had seemed flatly impossible to believe, I had spent lots of time on a table as a practice body for my classmates. I’d felt more relaxed and calm afterward, but did I feel healed? Healed of what? Healed by what? I’d spent even more time breathing deeply and placing hands on a stranger’s solar plexus, or the crown of her head, or the arch of her foot. In that time, I had sometimes felt nothing other than the comfort of human touch. Other times I had felt odd things: the sensation of magnetic attraction or repulsion between my hand and a rib cage, a burning heat that came and went suddenly. When I gently cupped my hands around a woman’s jaw, the tips of my right fingers buzzed as if from an electrical current, tickling me.I had spent two days in and out of the liminal state the UT study described, and I felt more sensitive to the world. I had also spent some meaningful time being touched kindly by strangers and touching them kindly, and thinking about what it might be like to feel well, to stop reporting to the doctor every year the same minor ailments: a tweaked shoulder, a tight jaw, general nervousness, scattered attention, my idiosyncratic imbalances and deficiencies. I didn’t personally “believe” in Reiki as a universal energy channeled through the hands, available to cats and plants and the dead. But I believed Yufang Lin and other physicians who attest that the body—helped by medicine and nutrition and all sorts of things—does the work of healing, and I believed Miles when she said that Reiki practice, through some unknown mechanism, may help the body to do it.Every once in a while, friends will hear that I’m Reiki-trained and ask whether I’ll “do it” on them. They usually ask whether it’s real, and I say I don’t know, but that at a minimum, I’ll have spent some time quietly and gently focusing on the idea of them being well. They usually answer that this sounds good.
2020-03-07 15:00:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
Exclusive: The Strongest Evidence Yet That America Is Botching Coronavirus Testing
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Updated at 4:10 p.m. E.T. on March 7, 2020.It’s one of the most urgent questions in the United States right now: How many people have actually been tested for the coronavirus?This number would give a sense of how widespread the disease is, and how forceful a response to it the United States is mustering. But for days, the Centers for Disease Control and Prevention has refused to publish such a count, despite public anxiety and criticism from Congress. On Monday, Stephen Hahn, the commissioner of the Food and Drug Administration, estimated that “by the end of this week, close to a million tests will be able to be performed” in the United States. On Wednesday, Vice President Mike Pence promised that “roughly 1.5 million tests” would be available this week.But the number of tests performed across the country has fallen far short of those projections, despite extraordinarily high demand, The Atlantic has found.[Read: You’re likely to get the coronavirus]“The CDC got this right with H1N1 and Zika, and produced huge quantities of test kits that went around the country,” Thomas Frieden, the director of the CDC from 2009 to 2017, told us. “I don’t know what went wrong this time.”Through interviews with dozens of public-health officials and a survey of local data from across the country, The Atlantic could only verify that 1,895 people have been tested for the coronavirus in the United States, about 10 percent of whom have tested positive. And while the American capacity to test for the coronavirus has ramped up significantly over the past few days, local officials can still test only several thousand people a day, not the tens or hundreds of thousands indicated by the White House’s promises.To arrive at our estimate, we contacted the public-health departments of all 50 states and the District of Columbia. We gathered data on websites, and we corresponded with dozens of state officials. All 50 states and D.C. have made some information available, though the quality and timeliness of the data varied widely. Some states have only committed to releasing their numbers once or three times a week. Most are focused on the number of confirmed cases; only a few have publicized the number of people they are capable of testing.[Read: The official coronavirus numbers are wrong, and everyone knows it]The Atlantic’s numbers reflect the best available portrait of the country’s testing capacity as of early this morning. These numbers provide an accurate baseline, but they are incomplete. Scattered on state websites, the data available are not useful to citizens or political leaders. State-based tallies lack the reliability of the CDC’s traditional—but now abandoned—method of reporting. Several states—including New Jersey, Texas, and Louisiana—have not shared on their official website the number of coronavirus tests they have conducted overall, meaning their number of positive results lacks crucial context. Louisiana’s governor has conducted press conferences noting the overall number of tests (5) and positive results (0).*The net effect of these choices is that the country’s true capacity for testing has not been made clear to its residents. This level of obfuscation is unexpected in the United States, which has long been a global leader in public-health transparency.The figures we gathered suggest that the American response to the coronavirus and the disease it causes, COVID-19, has been shockingly sluggish, especially compared with that of other developed countries. The CDC confirmed eight days ago that the virus was in community transmission in the United States—that it was infecting Americans who had neither traveled abroad nor were in contact with others who had. In South Korea, more than 66,650 people were tested within a week of its first case of community transmission, and it quickly became able to test 10,000 people a day. The United Kingdom, which has only 115 positive cases, has so far tested 18,083 people for the virus.Normally, the job of gathering these types of data in the U.S. would be left to epidemiologists at the CDC. The agency regularly collects and publishes positive and negative test results for several pathogens, including multiple types of the seasonal flu. But earlier this week, the agency announced that it would stop publishing negative results for the coronavirus, an extraordinary step that essentially keeps Americans from knowing how many people have been tested overall.[Read: What you can do right now about the coronavirus]“With more and more testing done at states, these numbers would not be representative of the testing being done nationally,” Nancy Messonnier, the chief CDC official for respiratory diseases, said at the time. “States are reporting results quickly, and in the event of a discrepancy between CDC and state case counts, the state case counts should always be considered more up to date.”Then, last night, the CDC resumed reporting the number of tests that the agency itself has completed, but did not include testing by state public-health departments or other laboratories. Asked to respond to our own tally and reporting, the CDC directed us to Messonnier’s statement from Tuesday.Our reporting found that disorder has followed the CDC’s decision not to publish state data. Messonnier’s statement itself implies that, as highly populous states like California increase their own testing, the number of people the CDC reports as having been tested and the actual number of people tested will become ever more divergent. The federal tally of positive cases is now also badly out of date: While the CDC is reporting 99 positive cases of the coronavirus in the United States, our data, and separate data from Johns Hopkins University, show that the true number is well above 200, including those on the Diamond Princess cruise ship.The White House declined to comment.The haphazard debut of the tests—and the ensuing absence of widespread data about the epidemic—has hamstrung doctors, politicians, and public-health officials as they try to act prudently during the most important week for the epidemic in the United States so far.Our reporting found that the capacity to test for the coronavirus varies dramatically—and sometimes dangerously—from state to state.California claims the highest testing capacity of any state, and has tested the most individuals so far. As of yesterday afternoon, it had tested 516 people, with 53 positive cases, a spokesperson for the Department of Health told us. The department now has the capacity to test 6,000 people every day, and it expects that capacity to expand to 7,400 people a day starting today, the spokesperson said.Washington State, the site of the country’s largest outbreak thus far, can test roughly 1,000 people a day. The state health department’s laboratory can test 100 people a day; the rest of the testing is being done at the University of Washington’s Virology Lab. Officials have found 70 positive cases in Washington so far, though a genetic study has estimated that there may be hundreds of untested people who have COVID-19 in the greater Seattle area.[Read: The problem with telling sick workers to stay home]Oregon, situated between the California and Washington hot spots, can test only about 40 people a day. Texas has 16 positive cases, according to media reports, but the health department’s website still lists only three cases. The Texas Tribune has reported that the state can test approximately 30 people a day.Other states can test even fewer. Hawaii can test fewer than 20 people a day, though it could double that number in an emergency, an official told us. Iowa has supplies to test about 500 patients a day. Arkansas, though not near a current known outbreak, is able to test only four or five patients a day.On the East Coast, testing capacity varies significantly. New York State has 22 positive cases, including several cases of community transmission in Manhattan and Brooklyn. It can test 100 to 200 people a day. Neighboring New Jersey and Connecticut have not shared any information about how many tests they have run, or about their daily testing capacity.Pennsylvania can test only about a dozen people a day, and Delaware can test about 50 people, our survey found. An official in Massachusetts, where two of 20 tests have come back positive, said that she did not know the Bay State’s daily capacity, but that its health department “currently [has] an adequate supply of test kits.”[Read: The gig economy has never been tested by a pandemic]These data come with an important caveat. Currently, most labs require two specimens to test one person. Single-specimen testing capability is being developed, but right now the top-line number of available tests should be cut in half. In other words, “1.5 million tests” should be able to test roughly 750,000 people. Some states, such as Colorado, told us how many specimens they could test a day (160), not how many patients (about 80). Other states shared the number of patients they could test, but not the number of specimens. In this story, we’ve standardized these numbers by dividing any specimen figure by two to give an estimate of the number of patients who can be tested.Our reporting found that three factors determine the number of people who are tested for the coronavirus.The first factor is the availability of tests. Until recently, very few physical tests were available, because of a mistake that the CDC made with a crucial component. The White House has pushed for and highlighted a massive increase in available tests, to perhaps 1 million in the next week. But labs have to be trained on how to set up and execute the relatively complex procedure.The second factor is that the CDC sets the parameters for state and local public-health staff regarding who should be tested. The agency’s guidelines were very strict for weeks, focusing on returning international travelers. Even as they have been loosened in the past few days, there are persistent reports that people—including a sick nurse who had cared for a coronavirus patient—have not been able to get tested.Finally, the more people who contract the illness, the greater the demand for testing. Some weeks ago, the number of cases in the United States was probably much, much smaller than today. The upshot is that there is likely to be an explosion of Americans tested for the coronavirus in the next week, led by California and Washington, each of which has a substantial number of cases and has shown signs that the virus is spreading.[Read: The coronavirus is a truly modern epidemic]Even in an emergency, laboratories cannot be spun up immediately. The University of Washington, which appears to have the country’s largest testing capacity outside of California—it can test up to 1,000 people a day—has been working on its own coronavirus test for several weeks.A week ago, the FDA eased some regulations on the types of coronavirus tests that can be used. This means that testing capacity will increase, but not overnight.It has not always been so challenging to get estimates of the number of Americans tested. Throughout February, the CDC published a regular tally of Americans who had been tested for the pathogen. Last Saturday, several days after the country’s first case of community transmission was confirmed, that figure was 472.Then the agency stopped updating the tally. It did not publish new numbers of how many Americans had been tested for the virus on Sunday or Monday, as public criticism of the sluggish response to the disease began to mount. On Tuesday, it announced that it would stop publishing the figure altogether.Our reporting has found that the CDC has not made good on Messonnier’s assurance that state numbers would be available and up to date. Many states are not reporting their results quickly: In our survey, we found that in some states, the most recently available numbers were days old.Since the CDC’s pullback, it has become extremely difficult to track the nation’s growing capacity to test for the coronavirus.There are material reasons for this. At first, the CDC did all the testing, so its results were easy to report. But as the outbreak grew, state public-health laboratories were brought into action. Each of them can do only so many tests, however, so university research laboratories have now joined the effort. Soon private laboratories such as LabCorp and Quest Diagnostics will begin testing people too. Both companies announced yesterday that doctors can now order tests. Still, no one is quite sure precisely when this new testing capability will start delivering results at scale.**The more entities involved, the more complex the data-gathering effort grows. State public-health departments should be tracking tests from university labs and eventually private labs, but in this time of crisis, they may not have the capacity to gather those data. For example, a Washington public-health official told us that the state could test up to 100 people, but as noted, the University of Washington has far higher throughput. That suggests a positive implication of our reporting: more capacity nationwide than our, or any, data reflect.[Read: Here’s who should be avoiding crowds right now]As more laboratories join in the effort, quality control will become more difficult. While each lab must have the FDA’s permission to operate, under an Emergency Use Authorization, a new FDA policy allows labs to immediately begin testing people, and requires that they submit their paperwork to the agency within the next 15 days.These types of measures are necessary because the United States’ response to the coronavirus is far behind the spread of the disease within its borders. Testing is the first and most important tool in understanding the epidemiology of a disease outbreak. In the United States, a series of failures has combined with the decentralized nature of our health-care system to handicap the nation’s ability to see the severity of the outbreak in hard numbers.Today, more than a week after the country’s first case of community transmission, the most significant finding about the coronavirus’s spread in the United States has come from an independent genetic study, not from field data collected by the government. And no state or city has banned large gatherings or implemented the type of aggressive “social distancing” policies employed to battle the virus in Italy, Hong Kong, and other affluent places. (After this story was published, Austin, Texas, cancelled this month’s SXSW festival.)If the true extent of the outbreak were known through testing, the American situation would look worse. But health-care officials and providers would be better positioned to combat the virus. Hard decisions require data. For now, state and local governments don’t have the information they need.* This story originally stated that Louisiana had not shared the number of coronavirus tests conducted overall; the governor had shared them during press conferences.**​​​​​​This story has been updated with new information about testing capabilities at LabCorp and Quest Diagnostics.
2020-03-06 18:40:15
2021-05-08T10:47:50.000000
1 y
theatlantic.com
You Already Live in Quarantine
Last Wednesday, I sat down in my office in midtown Atlanta to conduct a lunchtime writing seminar in Durham, North Carolina. I had considered flying in for the event, but my schedule was in flux, and the hassle of transit for a short meeting seemed excessive. At the suggestion of my hosts, I logged in to the videoconferencing program Zoom instead and led the event from my desk chair.[Read: You’re likely to get the coronavirus]I hadn’t avoided the trip out of concern about the coronavirus; my plans had been set before cases really began to crop up in the U.S. But over the next day, Zoom’s stock rose more than 10 percent, shored up on the perverse hope that global disruption might increase demand for remote meetings. In Italy, whole towns had been locked down, tens of thousands of people immobilized at home. Zoom was a diamond in the rough; lockdowns such as Italy’s and general global tumult caused by the uncertainty of pandemic drove most stocks down precipitously as cases of the disease known as COVID-19 ticked up in the United States and proliferated internationally.Ever in search of the upside of a downturn, financial analysts started looking for companies such as Zoom, whose business might remain stable or even thrive under mass-quarantine conditions. Netflix shares, for example, inched up last week while other tech issues reliant on disrupted Chinese supply chains, such as Apple, fell. The equity-research analyst J. C. O’Hara dubbed these “stay-at-home stocks,” adding Facebook, Amazon, the streaming-workout provider Peloton, and the workplace-chat platform Slack to the list. “What would people do if stuck inside all day?” O’Hara asked, consecrating quarantine as a market trend.[Read: What you can do right now about the coronavirus]The answer is far more familiar than the fearful conjecture forebodes. Many Americans would do the same thing they do now, mostly. Netflix has already fused us to our couches. For years, contemporary society has been bracing, and even longing, for quarantine.More than 100 cases of COVID-19 have been identified across 13 states, and the numbers have been quickly rising. Older people and health-care workers are at greater risk of danger from the virus, which also might have been spreading for weeks undetected in Washington State. Certain containment measures are already in place: Americans traveling from Italy and South Korea are being screened before boarding U.S.-bound flights. Public-health officials have started urging citizens to ponder self-quarantine in the event of illness, even though many workers don’t have the luxury of staying home sick anyway. Today, Los Angeles declared a health emergency.A number of organizations have also started preventative action. Twitter has banned noncritical business travel for its workers and “strongly encouraged” all its employees to work from home if they could. Amazon introduced restrictions on company visitors after two employees in Europe contracted the virus. Large trade shows and conferences have started pulling the plug, among them Facebook’s annual event for its platform developers.If conditions get truly bad, a serious public-health lockdown would indeed upend ordinary life. Barring that extreme, efforts such as the ones just mentioned extend a process that was under way long before a novel virus threatened to go pandemic. In a way, “quarantine” is just a raw, surprising name for the condition that computer technologies have brought about over the last two decades: making almost everything possible from the quiet isolation of a desk or a chair illuminated by an internet-connected laptop or tablet.[Read: A coronavirus quarantine in America could be a giant legal mess]As Twitter’s new policy emphasizes, Americans whose jobs involve pressing buttons on keyboards to create or manipulate symbols into ideas might not really need to go to the office to do so. A laptop and an internet connection are sufficient. Then, when it’s time for a break, DoorDash or Grubhub hastens lunch to the work desk, helping you avoid the coughs and foreign doorknobs of eating out. Later, Instacart or Amazon Prime Now drops groceries on stoops. TaskRabbit lets you schedule assistance with errands, and Washio will pick up and deliver your laundry. Nowadays doing something for real, with your own body, sometimes feels stranger than summoning it by smartphone.For an even broader demographic, entertainment has become shut-in, too. Cable and streaming have made cinema-going precious. Hanging out with friends is enjoyable, but Facebook, Instagram, Snapchat, Reddit, and others make socializing possible from anywhere.Against the backdrop of coronavirus uncertainty, the banal normalcy of this reality finally hit me over the weekend: I live this way by default now. I ordered wallpaper online, so I can redecorate my home without even leaving it. A week earlier, Best Buy had already delivered my new television, an irresponsibly huge apparatus I mounted on the wall. I fired it up and loaded in all my accounts: Netflix, Hulu, Disney+, Amazon Prime—enough content for a lifetime of excellent, let alone compromised, respiratory health.[Read: I prepared for everything, but not coronavirus on a cruise ship]From the next room, I’ve uploaded this story to Google Docs, where my editor and I have revised it by wire, across whole states. I didn’t meet, or even talk on the phone, with any of my colleagues at The Atlantic who were involved in the process. Like the employees of many media companies, we communicate with one another on Slack, one of O’Hara’s stay-at-home stocks. Together, from afar, we quietly tap away at stories, which you can then read on a screen in any setting you wish—from atop a Peloton saddle, perhaps, or while Netflix streams on the television.Not everyone gets to make that choice. As my colleague Alexis Madrigal noted last week, the gig workers who handle DoorDash or Amazon deliveries actually have to risk entry into the material world, putting them at far greater risk of contagion. Service-sector workers in retail, health-care, transit, teaching, and housekeeping have even less ability to choose when and where they do their jobs. From the beginning, the safety and security of service and flex workers has taken a back seat to that of the knowledge-economy elites who are their customers. A massive power imbalance is at work here.There’s peril for white-collar workers, too. Homeboundedness risks becoming an excuse for further belt-tightening, a version of disaster capitalism inspired by contagion rather than economic crisis. If remote learning, work, and leisure prove more profitable or more easily controlled than their in-person equivalents, employers with the means to make temporary shifts permanent might attempt to do so. Eventually, an unseen worker might be seen as an unnecessary one.Even so, the benefits of a life online have begun to outweigh the costs for some Americans. The flip side of quarantine’s threat is technology’s promise—we have been preparing for the end of in-person work for some time. As this week began, one of my Georgia Tech school chairs encouraged faculty to consider how we might conduct our classes remotely should the need arise. But that possibility is already daily practice. Canvas, an online courseware platform, powers our classes. We hold institutional licenses to videoconferencing services similar to Zoom. And we are invested in large-scale online education, including online degrees that enroll thousands of students all around the world. Never before in human history has it been so easy to do so much without going anywhere. Cinema box-office receipts fell sharply in 2019, as streaming entertainment became more plentiful and high quality. Apps and games and podcasts and digitally delivered matter of all kinds have followed suit. Now, absolutely drowning in it, the last thing anyone might worry about is getting bored at home.
2020-03-04 22:02:00
2021-05-08T10:47:50.000000
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theatlantic.com
Here’s Who Should Be Avoiding Crowds Right Now
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. In a time when a novel virus is still spreading quickly, a gathering of friends can now look more like a mob of disease vectors. Many of us are wondering, How many people is too many people to be around? The larger the crowd, after all, the greater the chance that someone in it will have the coronavirus.Tokyo has already canceled its marathon for all but professional runners. (More than 37,000 runners took part last year.) The March meeting of the American Physical Society in Denver has been canceled. (Organizers anticipated 10,000 attendees.) Workday canceled a sales conference in Orlando, and Google and Facebook have also scrapped multiple events. (Last year, one of these, F8, drew 5,000 attendees.) Seemingly overnight, the coronavirus has people rethinking concerts, vacations, and even getting to work on public transportation.[Read: The official coronavirus numbers are wrong, and everyone knows it]This is not an unreasonable conversation to be having with yourself about COVID-19, the disease caused by the virus. “There are people who are walking around who must have it, or have had it very recently, or are about to have it,” Helen Chu, an infectious-disease professor at the University of Washington, told me. For that reason, she added, canceling major public events, such as marathons and conferences, is a “wise choice.”A surprising number of people with a wide array of health conditions—including diagnoses as common as asthma—should be more cautious than usual. But most Americans shouldn’t necessarily be avoiding crowds and airplanes at this point, experts say. Instead, some risk assessment, both on an individual level and a societal level, is going to be required..[Read: You’re likely to get the coronavirus]Currently, the Centers for Disease Control and Prevention recommends that all Americans avoid nonessential travel to five countries: China, Italy, South Korea, Iran, and Venezuela. Some companies, including Twitter, have suspended all employee travel. But beyond that, there are weddings, conferences, vacations, and funerals to get to by plane. COVID-19 is transmitted through coughing or sneezing, so staying six feet away from people will help minimize the risk that someone else’s cough droplets will land on you. If you’re getting on a plane, however, that won’t be possible. And the closer you’re sitting to a fellow passenger who’s sick, the likelier you are to get COVID-19 from that person.On a more typical day, the average American city dweller might take a crowded train to a packed, open-plan office, then go to a bustling PTA meeting after work. According to Chu, people who already have a chronic illness or are at risk of getting one should avoid these types of crowds as much as possible. This includes people with cancer, people over the age of 65, and people with respiratory diseases such as chronic obstructive pulmonary disease, emphysema, or even asthma.People with asthma are not more likely to catch COVID-19, but they are more likely to fare poorly if they do. Asthma and similar health conditions cause the lungs to have trouble exchanging air, a situation that viruses such as the flu and the coronavirus exacerbate by filling the lungs with inflammatory cells, Chu said.[Read: What you can do right now about the coronavirus]There’s no hard cutoff for when a crowd becomes too risky for an asthmatic or elderly person. It’s not that, say, the opera is definitely off-limits but work meetings are guaranteed to be fine. Chu said she recommends that people who have asthma or a lung disease or are otherwise immunocompromised start thinking about telecommuting from work right about now.For everyone else, decisions depend on what Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, calls personal “risk preference.” That is, how worried are you about catching COVID-19? If you’re relatively young, healthy, and traveling to a place other than the five restricted countries relatively soon, you might decide that the risk of catching the disease is worth whatever it is you’re doing. Adalja told me that he has not canceled any of his public appearances. Two other experts told me that it’s still too premature for healthy people living in areas without a large number of cases to avoid gatherings or otherwise change their plans. Instead, says Henry Wu, the director of the Emory TravelWell Center, in Atlanta, the advice is the same as it has been for the rest of day-to-day life: They should just wash their hands often, cough into the crook of their elbow, and avoid touching their face.Of course, for some people, staying inside for a few weeks would be easier than going a single day without a good face-touch.
2020-03-04 14:00:00
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theatlantic.com
What You Can Do Right Now About the Coronavirus
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Over the past week, the number of confirmed cases of coronavirus infection in the U.S. has more than doubled. It’s become apparent that previous numbers were low, in part, because we weren’t testing people for it. We now know that there has been ongoing community spread, but to what extent is unclear.For now, most American schools and offices are open, and few public gatherings have been canceled. Life goes on for most people, but with more push alerts and uncertainty about what to do. Hopefully, the virus will hit various areas in waves, scattering disease over a longer period of time, so that people can be treated and society remains functional. A less preferable scenario would be that too many people in a given area are out of commission and in need of medical care. If this happens, cities and states may go into shutdown modes to block further viral spread, disrupting the economy and everyday life.[Read: The official coronavirus numbers are wrong, and everyone knows it]Everyone can help in the effort to prevent this from happening. Unlike many global-health issues that depend on orchestration at the highest levels of government, individual behaviors matter in an immediate sense. The demographic most likely to survive an infection—the young and healthy—may need to pay the closest attention to preventive measures. These are the people who will spread the disease while believing that they have only a cold. They can infect the elderly, or people who have chronic diseases or immune conditions, who are less likely to survive.A lot of advice is going around, both good and bad. I hope it’s helpful to compile some good information in one place. Much of what follows is not original—generally don’t trust health advice that no one else is giving—and please bear in mind that any guidance can and should change as the situation develops, and that local health departments and personal physicians may need to tailor recommendations for specific scenarios. That said, here are preventive measures that people are considering at the moment, and some notes that are worth your time and attention.Using hand sanitizerIt works. Use it often. Make sure it’s alcohol-based. There are some “natural” products designed to be less drying to your hands. These do not work.[Read: What is the right way to wash your hands?]Washing handsThis is always important, but especially now. Wash your hands for 20 seconds, regularly. Note that soap works ideally in combination with scrubbing and heat, but cold water works far better than nothing. You do not need antibacterial soap; the coronavirus is a virus, not a bacterium.Cleaning hand towelsWash them often, too.Shaking handsIt’s not a clearly threatening practice, and physical touch has its own value to consider, as do gestures of respect. But I’ve been an advocate of alternative forms of greetings such as fist bumps for years, and this outbreak doesn’t change that.Touching your faceAvoiding touching your face is a nice idea and would be very effective, but no one is going to stop touching their face.Using bathroomsHere’s an unproven suggestion from me that transcends this particular outbreak: All business and public spaces should turn their bathrooms’ doors around, so you push on the way out rather than the way in. If building codes or other safety codes prohibit this, install a foot pull. If none of this is possible, at least put the trash can for paper towels outside the door so everyone can use a paper towel to touch the handle.Disinfecting common surfacesThe crux of all the focus on hand-washing is that you’re unlikely to get the virus from someone coughing or sneezing directly into your face. You are much more likely to catch the virus by touching something that someone else touched after coughing into their hand. This can partly be prevented by disinfecting surfaces.The most commonly touched surfaces in homes and offices, especially shared spaces, are priority. Countertops, remote controls, and refrigerator handles should be disinfected regularly. That said, it’s very possible to become compulsive about this in ways that have their own risks. Any given surface is very unlikely to harbor a dangerous virus, so it’s possible to overdo this and waste a lot of time, resources, and concern. But if you’re the sort to typically only clean things that look visibly dirty, do consider the invisible.Cleaning phonesThis one warrants its own special note because phone screens may be the surface we touch the most. Other, similar coronaviruses are known to live on glass for up to four days. If you’ve been touching your phone with viral hands, then you do a beautiful job washing those hands, and then you touch your phone again, you may have just recontaminated yourself. I’m not suggesting constantly cleaning your phone. The Centers for Disease Control and Prevention currently recommends once a day, though I don’t see how—if it’s worth doing at all—that would be often enough. That said, I have never once cleaned my phone.Wearing masksMasks seem logical as preventive measures because the disease is spread by respiratory droplets, which can travel simply by breathing but mostly distribute in plumes from coughs or sneezes. If you were sick and had to leave home for some reason, ideally you would wear a surgical mask. But even this precaution is far from perfect—the wearable equivalent of sneezing into your elbow instead of right in someone’s face. You’re still infectious and should behave accordingly. The World Health Organization has published recommendations for when civilians should use masks. But stockpiling also deprives other people who might have needed to follow those guidelines.Stockpiling masksThis week the U.S. surgeon general, Jerome Adams, urged Americans to stop buying face masks. This is a matter of short supply, should worst-case scenarios play out. In an ideal world, people who live with other people would have masks on hand when someone in the house gets sick, and they could help prevent close-quarters spread. But this is not an ideal world, and masks are needed for the people who are at the highest risk. When doctors, nurses, and first responders cannot work, new crises present themselves.Stockpiling foodThis mainly applies to people in remote areas where the town’s one grocery store could close down. Closing the store would be preferable to having sick employees report to work. In these areas, it’s always advisable to have a short-term supply of food (for any natural disaster), and this would be fair to treat similarly. Elsewhere, supply chains could be threatened, requiring certain shippers or grocers to close temporarily and certain foods to become scarce in certain areas, but none of this is cause for stockpiling.Stockpiling prescription medicationsMost U.S. prescription medications are made in China, whose own outbreak has raised concerns about medication supply chains. As of now, supplies have not been disrupted, and China is reporting declines in the spread of the virus. As with food, though, anyone who has a vital prescription and lives in a place where access would be affected by the single shutdown of a local pharmacy or a public-transit system, for example, should always have a small supply for emergencies. Health-care providers should help ensure this.TravelingIt’s always advisable to avoid travel if you’re sick. But no stay home directive is sustainable for long periods, and urgent life events will overlap with this outbreak. So guidance about this will be targeted, and ideally informed by easy screening and testing that can advise people with the sniffles whether they are fine to get on a plane or should urgently self-quarantine.Staying homeThis is an extremely imperfect directive, as so many people’s jobs and other obligations make it impossible. But no single recommendation is perfect or universally applicable. And Americans have proved, flu season after flu season, that many workplaces are not accommodating enough of staying home. If workplaces are not accommodating, business may suffer even more in the long run, if more shutdown measures are taken.Seeking medical careThis may be the most crucial question: When do mild symptoms warrant attention? Most people are not accustomed to seeking care or testing when they have a mild cough or runny nose. My hope is that, in the coming days and weeks, local and federal officials share clear guidelines for exactly how and when to seek medical attention early in the disease’s course. China’s containment measures depended on early detection that isolated people at the beginning of their infectious stage. Then again, we can’t have everyone with a cough and sniffles rushing to doctors’ offices.South Korea, which has now identified some 5,000 cases, is pioneering drive-through screening clinics. The idea seems smart: There are no doorknobs to touch, no crowded waiting rooms with magazines that have been coughed on for months. Maybe most important, there is no paperwork to fill out and no cost. If an outbreak hits a major city, clinics and hospitals will likely be overrun with people who have cold and flu symptoms. Some of those people will need reassurance that they can go home and will be fine; others will need admission to a hospital; others may need an intermediate level of care, monitoring, and quarantine.Being conscientiousNo matter your position, there are people who stand to lose much more than you do if they get sick. No matter how worried you are, there are people who are more worried. Look out for them, and help make sure everyone takes these basic measures and doesn’t panic. Societies break down when people fear one another as simply bipedal distributors of infectious agents. See people as allies in this unique moment of uncertainty.
2020-03-03 21:34:00
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theatlantic.com
How to Think About the Plummeting Stock Market
Over the past week, stock markets around the world plunged as distressing news about the spread of the novel coronavirus continued to accumulate. In the United States, the three major stock indexes—the Dow Jones Industrial Average, the Nasdaq Composite, and the S&P 500—fell more than 10 percent below their recent peaks, a sharp decline that qualifies in Wall Street terminology as a market “correction.” One investor quoted in The Wall Street Journal called it a “bloodbath.”The global stock market is, theoretically, the distillation of how investors think everything that happens in the world will play out in the economy. Right now, judging by these drops, investors are much less optimistic than they were a week ago. But what they’re predicting is not only how bad the outbreak could be in terms of workers staying home sick, drops in consumer spending, or supply-chain disruptions; it’s also how bad people think it could be. Those might turn out to be two very different things.[Read: You’re likely to get the coronavirus]Public perception of a crisis can be extremely consequential in financial markets. “The notion of a pandemic is pretty scary to people, and they’re going to hunker down and be careful about how they live their lives” if bleak news continues to roll in, says Richard Sylla, a former professor at NYU’s Stern School of Business. They may, for instance, start to skip vacations or dine out less. Airlines and restaurants, in turn, might lose revenue or even limit service because of what they think their customers will do. All of this combined would carry negative consequences for the economy, regardless of how catastrophic the direct impact of the disease actually turns out to be. “What people are thinking, even if it’s wrong, maybe matters more on a day-to-day basis [in the stock market] than what the truth is,” Sylla said.What investors think the public is thinking is therefore crucial. Whether the costs of the outbreak turn out to be historically large or not, there is a risk that investors’ worries will snowball during this period of uncertainty, leading them to panic-sell and exacerbate any financial damage. “If in the next 20 years [the economy is] only going to be disrupted for three months, that suggests a very small impact on the market,” says Robert J. Shiller, a Nobel Prize–winning economist and the author of Narrative Economics: How Stories Go Viral and Drive Major Economic Events. But the situation could be much worse, and when investors think in “grandiose terms,” Shiller told me, that could “trigger other worrying.”Predicting the emotional reactions of the entire world population to coronavirus would be a bit easier if investors could turn to the market effects of previous pandemics for guidance. But history provides few indications of what might happen to the economy if the coronavirus and COVID-19, the disease it causes, continue to spread. “This is kind of a new thing,” Shiller said. “It’s too much to ask for the market to get it right.”The closest analogue is the global influenza outbreak of 1918 and ’19, which killed tens of millions of people. In 1918, the stock market actually did fine—the Dow rose a little. In the years after that, Sylla noted, “the stock market didn’t do much, and while its trend was flat, there were fluctuations within that—some ups and downs, just like we see now.”But drawing any conclusions from 100 years ago is difficult because, among other reasons, a lot of other stuff was happening then—namely, World War I. Because of that, says John Wald, a professor at the University of Texas at San Antonio’s College of Business, “it’s really hard to say whether [the 1918 pandemic] was priced correctly or not correctly” by the market.Perhaps a better parallel is the flu pandemic of 1957 and ’58, which originated in East Asia and killed at least 1 million people, including an estimated 116,000 in the U.S. In the second half of 1957, the Dow fell about 15 percent. “Other things happened over that time period” too, Wald notes, but “at least there was no world war.” More recent outbreaks, such as SARS and MERS, were more contained and didn’t wreak as much global economic havoc.Although the annual flu season is quite different from a pandemic, it does provide a good amount of data for economists to analyze. When Wald, along with the researchers Brian McTier and Yiuman Tse, examined trading records from 1998 to 2006, they found that in weeks when the flu was more widespread, stock-market returns were lower. They also found that when there was a higher incidence of the flu in the greater New York City area in particular, trading volume decreased, which is usually bad for the market. Here, the idea is that more professional investors might have gotten sick and executed fewer trades—which would not bode well if COVID-19 were to make its way to New York City.Sylla’s view of all this as a financial historian is pretty zen. “I wouldn’t pay much attention to the day-to-day reports of the newspapers—‘Here’s a good sign,’ ‘Here’s a bad sign,’” he said. In the short run, the stock market isn’t necessarily a good predictor of how bad the pandemic will get, in part because investors are working off the same scant information as everyone else. “What I would say history shows you is that a problem like this takes many months and maybe even a couple of years to play itself out,” he said. But, he went on, “Wall Street’s idea of history is the last 10 minutes.”
2020-02-28 18:00:09
2021-05-08T10:47:50.000000
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theatlantic.com
The Problem With Telling Sick Workers to Stay Home
As the coronavirus that has sickened tens of thousands in China spreads worldwide, it now seems like a virtual inevitability that millions of Americans are going to be infected with the flu-like illness known as COVID-19. Public-health officials in the United States have started preparing for what the Centers for Disease Control and Prevention is calling a “significant disruption” to daily life. Because more than 80 percent of cases are mild and many will show no symptoms at all, limiting the disease’s spread rests on the basics of prevention: Wash your hands well and frequently, cover your mouth when you cough, and stay home if you feel ill. But that last thing might prove to be among the biggest Achilles’ heels in efforts to stymie the spread of COVID-19. The culture of the American workplace puts everyone’s health at unnecessary risk.For all but the independently wealthy in America, the best-case scenario for getting sick is being a person with good health insurance, paid time off, and a reasonable boss who won’t penalize you for taking a few sick days or working from home. For millions of the country’s workers, such a scenario is a nearly inconceivable luxury. “With more than a third of Americans in jobs that offer no sick leave at all, many unfortunately cannot afford to take any days off when they are feeling sick,” Robyn Gershon, an epidemiology professor at the NYU School of Global Public Health, wrote in an email. “People who do not (or cannot) stay home when ill do present a risk to others.” On this count, the United States is a global anomaly, one of only a handful of countries that doesn’t guarantee its workers paid leave of any kind. These jobs are also the kind least likely to supply workers with health insurance, making it difficult for millions of people to get medical proof that they can’t go to work.They’re also concentrated in the service industry or gig economy, in which workers have contact, directly or indirectly, with large numbers of people. These are the workers who are stocking the shelves of America’s stores, preparing and serving food in its restaurants, driving its Ubers, and manning its checkout counters. Their jobs tend to fall outside the bounds of paid-leave laws, even in states or cities that have them. Gershon emphasizes that having what feels like a head cold or mild flu—which COVID-19 will feel like to most healthy people—often isn’t considered a good reason to miss a shift by those who hold these workers’ livelihood in their hands.[Read: You’ll likely get the coronavirus]Even if a person in one of these jobs is severely ill—coughing, sneezing, blowing her nose, and propelling droplets of virus-containing bodily fluids into the air and onto the surfaces around her—asking for time off means missing an hourly wage that might be necessary to pay rent or buy groceries. And even asking can be a risk in jobs with few labor protections, because in many states, there’s nothing to stop a company from firing you for being too much trouble. So workers with no good options end up going into work, interacting with customers, swiping the debit cards that go back into their wallets, making the sandwiches they eat for lunch, unpacking the boxes of cereal they take home for their kids, or driving them home from happy hour.Even for people who have paid sick leave, Gershon noted, the choices are often only marginally better; seven days of sick leave is the American average, but many people get as few as three or four. “Many are hesitant to use [sick days] for something they think is minor just in case they need the days later for something serious,” she wrote. “Parents or other caregivers are also hesitant to use them because their loved ones might need them to stay home and care for them if they become ill.”For workers with ample sick leave, getting it approved may still be difficult. America’s office culture often rewards those who appear to go above and beyond, even if that requires coughing on an endless stream of people. Some managers believe leadership means forcing their employees into the office at all costs, or at least making it clear that taking a sick day or working from home will be met with suspicion or contempt. In other places, employees bring their bug to work of their own volition, brown-nosing at the expense of their co-workers’ health.[Read: The gig economy has never been tested by a pandemic]Either way, the result is the same, especially in businesses that serve the public or offices with open plans and lots of communal spaces, which combine to form the majority of American workplaces. Even if your server at dinner isn’t sick, she might share a touch-screen workstation with a server who is. Everyone on your side of the office might be hale and healthy, but you might use a tiny phone booth to take a call right after someone whose throat is starting to feel a little sore. “Doorknobs, coffee makers, toilets, common-use refrigerators, sinks, phones, keyboards [can all] be a source of transmission if contaminated with the agent,” Gershon wrote. She advised that workers stay at least three to six feet away from anyone coughing or sneezing, but in office layouts that put desks directly next to one another with no partition in between—often to save money by giving workers less personal space—that can be impossible. No one knows how long COVID-19 can live on a dry surface, but in the case of SARS, another novel coronavirus, Gershon said it was found to survive for up to a week on inanimate objects.Work culture isn’t the only structure of American life that might make a COVID-19 outbreak worse than it has to be—the inaccessible, precarious, unpredictable nature of the country’s health-care system could also play an important role. But tasking the workers who make up so much of the infrastructure of daily American life, often for low wages and with few resources, with the lion’s share of prevention in an effort to save thousands of lives is bound to fail, maybe spectacularly. It will certainly exact a cost on them, both mentally and physically, that the country has given them no way to bear.
2020-02-28 17:35:32
2021-05-08T10:47:50.000000
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theatlantic.com
The Gig Economy Has Never Been Tested by a Pandemic
The shadow of the new coronavirus finally reached American shores this week, as markets jittered downward and new cases crept up. The scope of any outbreak here is not clear, but experts suspect that the virus will become widespread. While the disease, known as COVID-19, is a global phenomenon, the response to it is necessarily local, and divvied up among more than 2,600 local health departments in the U.S.Municipal governments have prepared plans and local officials are on high alert, but they have little experience dealing with a new infrastructural fact in a major disease outbreak: the gig economy. In Wuhan, China, where the COVID-19 outbreak originated, delivery drivers have played a major role in keeping the city going during containment efforts. In San Francisco, say, if people begin to shelter in place—or even simply shy away from heading out—it would seem likely that more people would order groceries or dinner rather than put themselves at risk.Gig-economy companies such as Uber, Lyft, and Instacart have two distinct features. One, they are particularly popular in large urban centers, where they play a now-crucial role in transportation and the delivery of local goods. Two, California’s recent legislation notwithstanding, the labor platforms don’t have employees as they have traditionally been understood. Uber drivers and Instacart delivery people receive financial incentives to work, but they are not compelled by a set work schedule.These two factors make for all sorts of possible disruptions to normal life if a large-scale disease outbreak were to strike an American city. What will people who have grown used to DoorDash delivery and Lyft rides do? How will the gig workers respond? What will the labor platforms do? What will local governments allow or attempt to compel?[Read: You’re likely to get the coronavirus]People’s actions will influence how the outbreak plays out, and these questions have never been answered in practice. There’s no this-worked-last-time playbook to run. The new coronavirus is novel not only in its biological configuration, but in how it will be linked to these new technological systems.County health officers do have experience preparing for disease outbreaks, with the closest analogue being the variant of H1N1 that arose in the spring of 2009. But back then, the whole set of technologies that underpin the gig economy was not around, Jennifer Vines, the health officer for Multnomah County, Oregon, told me. “We’re having to think differently,” she said. Her county is “just starting to map out a regional summit around these exact questions that would include transportation workers. We’re not going with doomsday, but what are the cascading effects?”For now, Vines and her team have issued basic guidance with fairly standard advice about washing hands, considering future child-care plans, and lightly stocking up on food. They’ve worked with schools, businesses, and some health clinics. Next will come guidance for cities, correctional institutions, long-term care facilities, and homeless shelters. Then they’ll try to convene other companies, including gig-economy outfits, though precisely what will come out of that meeting is unclear. Another thing that’s not clear: the extent to which the companies themselves have considered the issues of the disease outbreak deeply. I asked America’s most prominent delivery and ride-hailing services—Uber, Lyft, DoorDash, Postmates, Instacart, and Amazon—for comment about their disease-outbreak preparedness planning. Only Postmates and Instacart responded to me.“Community health and safety is paramount at Postmates, and we have shared precautionary [Centers for Disease Control and Prevention] guidance with those carrying out deliveries so that they are aware,” Postmates told me in a statement. “We will continue to encourage employees, merchants, consumers, and everyone to follow preventative measures such as washing hands and staying in if you are sick.”“We’re actively working with local and national authorities to monitor the situation as it unfolds,” Instacart said in a statement. “We’re adhering to recommendations from public-health officials to ensure we’re operating safely with minimal disruption to our service, while also taking the appropriate precautionary measures to keep teams, shoppers, and customers safe.”It’s possible to think through some of the basic scenarios that people will face if an outbreak becomes severe. The dilemmas are, in fact, all too easy to imagine in the absence of clear plans. Consider ride-hailing. If public transit comes to be seen as too risky because it’s so filled with people, Ubers and Lyfts could be considered the least risky option. Demand would surge.[Read: The servant economy]In many wealthy urban cores, Uber and Lyft drivers actually come from far outside the center of the metro area. If those drivers decide to quarantine themselves at home as demand goes up, the price of a ride could shoot very high. Conversely, if drivers flood into metro centers from outlying regions, they could become vectors spreading COVID-19 within cities and bringing it to outlying areas.Conflicting situations such as this pose hard choices for cities and companies alike. Uber and Lyft could limit price increases, or prevent drivers from entering certain areas. Or local public-health officers could determine that ride-hail drivers are a risk to public safety and tell the companies to stop operation within their jurisdictions. Would Uber and Lyft accept an exclusion zone? Would drivers and riders? Such restrictions could leave drivers with precarious finances unable to pay their bills.One silver lining could be that the tracking the companies do of their drivers and riders can make the work of epidemiologists easier, Vines noted. In recent years, during a measles outbreak, health officials were able to contact drivers who had been exposed to the disease by their riders. Still, it’s hard to find this comforting.Imagine another not-far-fetched scenario. If people see a public-health crisis unfolding, they might begin to make large orders on Amazon to stock up. But Amazon itself could easily suffer during an outbreak. Given the demanding labor policies of the retail behemoth and its subcontracted delivery companies, workers might be unlikely to want to miss shifts if they’re feeling a little under the weather. It could just be sniffles—but what if it’s COVID-19? An outbreak at one or more key facilities could cause the infrastructure that provides delivery services to falter just as demand surges. Suddenly, the convenience of having all the supplies you need to weather an outbreak arrive at your doorstep would disappear.For every little thing in modern life, a “servant economy” app exists. If schools are out, will demand at Care.com surge? If people don’t want to run out for dog food, will they turn to Chewy and Pet Plate? The dark side of hitting buttons on a phone and having things happen out there in the world is that other people—humans susceptible to viral infection—have to make all those things happen.No one knows yet how serious a COVID-19 outbreak will be in America, nor how disruptive it will prove for everyday life in any given place. But even if the virological properties of the disease are less nasty than early reporting implies, some Americans may witness a grim technological future that few imagined. Crossbreeding this disease with the nation’s platform economy might mean that the rich will shelter in place, safe and sound, while the poor troll through the streets, taking their chances for a necessary payday.
2020-02-28 15:35:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
The Opioid Epidemic Might Be Much Worse Than We Thought
It can be hard to comprehend the true scope of something as disastrous as the opioid epidemic. Perhaps that’s why it’s been compared with falling 747s and crashing cars. But in fact, knowing exactly how many people have perished is crucial to stopping the deaths.That’s why Elaine Hill and Andrew Boslett, economists at the University of Rochester, were so concerned when they found that many potential opioid deaths aren’t counted as such. In the fall of 2018, Hill and Boslett were studying how deaths from overdoses of opioids, such as heroin or OxyContin, were influenced by the decline of coal mining and the rise of shale gas fracking. But when they began looking at death records of Americans who had died of drug overdoses, they noticed that in more than 20 percent of the cases, the record said the type of drug could not be specified, perhaps because an autopsy had not been performed. In other words, the person had died of a drug overdose, but the death record didn’t say which drug.Hill and Boslett realized that such a high rate of unknowns wouldn’t work for the phenomenon they were trying to study. “Our lab wants to make as strong of a claim as possible, given evidence that maybe an economic shock … had an effect on drug-overdose rates,” Boslett says. “We want to know that the estimates we’re using on local drug-overdose rates are correct, or as correct as possible.”[Read: The true cause of the opioid epidemic]So the researchers set out to try to determine the real causes behind those unspecified drug overdoses. In the process, they uncovered something unsettling about how deaths are tracked in the U.S.: The way that a given county investigates deaths matters, and it could be dramatically shifting our nationwide estimates of the number of people who die of everything including opioids, childbirth, and the new coronavirus.Hill worked with Boslett and a doctoral candidate, Alina Denham, to come up with a model to estimate how many of those unspecified drug overdoses were caused by opioids. To do it, they set aside some of the death records in which the type of drug was known and created a model that would predict the drug, given other things that were known about that person: the county they lived in, their sex, where they died, other health conditions that contributed to the person’s death, and so on. For opioid deaths, that meant factoring in whether the person had other characteristics typically associated with opioid overdose, such as being addicted to opioids or having chronic pain. By applying the model to the “unspecified” overdose deaths, they were able to predict that 72 percent of those were actually from opioids.In fact, they estimate in a new study in the journal Addiction, there were more than 99,000 additional opioid deaths from 1999 to 2016 than had been previously documented, raising the national death toll by about 28 percent, to 453,300. What’s more, the discrepancies varied widely by state. In Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana, Hill and her team estimated that the number of deaths from opioid overdoses was actually double the previous estimates.Addiction“This paper is a very strong one,” says Atheendar Venkataramani, a health-policy professor at the University of Pennsylvania, who was not involved in the study. It suggests that “if you just follow the vital statistics alone, we’re probably underestimating the true number of opioid deaths.”Hill and her team suspect that’s because of differences in how counties across the U.S. investigate deaths. In essence, whether a given county uses a coroner or a medical examiner to investigate deaths matters. Medical examiners are doctors specially trained in pathology and forensics, but coroners can be general practitioners or even laypeople with no medical training. For coroners, “in many places, like the state of Pennsylvania, the only requirements are to be a legal adult with no felony convictions who has lived in the county for one year and to complete a basic training course,” Jordan Kisner wrote this week in The New York Times Magazine. Meanwhile, as Kisner pointed out, the United States has a dire shortage of medical examiners.Because of this low standard of training, Denham explains, “you would think [coroners] would not be able to identify opioid involvement in a death as well as a medical doctor trained in it would.” That inference seems to be held up by data: The states that had a lot of unclassified drug-overdose deaths, Hill and her colleagues found, tended to use coroners in their death investigations.[Read: The doctors whose patients are already dead]The undercounting of opioid deaths is important because “you need to know the scale of a problem to know how to intervene in the problem,” Venkataramani says. Dealing with a crisis like opioid addiction—or coronavirus, for that matter—requires lawmakers and public-health workers to make choices about where to direct precious funding and resources. If the severity of the opioid epidemic is underestimated, local public-health departments could be shortchanged, and even more lives could be lost. This is particularly important in the case of infectious diseases like coronavirus, where knowing the total number of deaths can help public-health officials estimate its lethality.Especially in the case of addiction, so much of illness happens outside the public eye that it’s sometimes only when someone dies that her neighbors or the government see exactly what she was going through. The tragedy of epidemics like opioid abuse is that nothing can be done to help the dead. But the dead can help others—if the things that killed them are accurately reported. Having a better grasp of just how many people are dying from various ailments is crucial for policy makers to help those who are still living.
2020-02-27 22:00:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
A Bold and Controversial Idea for Making Breast Milk
The inconvenient truth about breastfeeding is that breasts are, invariably, attached to a person. A person who could get too sick to breastfeed. A person who might have to go back to work within two weeks of giving birth, because U.S. law does not mandate paid leave. A person who might have no place to pump at work, despite a law that does actually mandate such a room. For understandable and frustrating reasons, many mothers who want to breastfeed—who have internalized years of hearing “Breast is best”—simply cannot.Enter: a bioreactor of lactating human breast cells.A small start-up called Biomilq recently announced it has managed to grow human mammary cells that make at least two of the most common components of breast milk: a protein called casein and a sugar called lactose. This is the first step, the company hopes, to making human milk outside the human body.Breast milk is of course far, far more complex than just casein and lactose. It is made up of at least hundreds of different components: a multitude of proteins, fats, and sugars, but also antibodies, hormones, and beneficial bacteria. Biomilq’s founders, Leila Strickland and Michelle Egger, say that they seek to eventually make milk that is “nutritionally” but not necessarily “immunologically” close to breast milk. Experts I spoke with said that mammary cells in a bioreactor simply could not replicate the full complexity and benefits of breast milk. One researcher laughed at the idea.Biomilq does seem to be onto something though, at least culturally. Since the postwar days of doctors pushing formula as the superior “scientific” option, the conventional and medical wisdom has swung in the opposite direction—to the point where women often feel guilty for being unable to breastfeed. “There’s just a feeling of failure: I can’t do this for my child. This is really important,” said Maryanne Perrin, a breast-milk researcher at the University of North Carolina at Greensboro, who has studied women trying to buy breast milk online for their children. “I heard a lot of anxiety in the voices and comments,” she added. In other words, there is definitely a demand for human breast milk.The idea for Biomilq, in fact, came out of Strickland’s own struggles to breastfeed as a new mom. Her son had trouble latching after he was born, and she wasn’t making enough milk. “During those months of life, my whole world revolved around whether or not my body would produce enough of this food,” she says. She wished for an option that was not formula. Strickland has a background in cell biology, so she naturally wondered: What about breast cells?In 2013, she began growing mammary cells in a tiny lab space in North Carolina, and in 2019, she met Egger, a student at Duke’s business school and a former food scientist at General Mills, who had worked on products such as Go-Gurt. They officially launched Biomilq late last year to make lab-grown human milk—or as they prefer to call it, “cultured breastmilk.” Another start-up based in Singapore, TurtleTree Labs, recently announced it is trying to re-create cow and human milk with cells as well.Human milk is currently available for sale, but it is not easy to buy. Officially, parents can go to a milk bank to buy donated breast milk that has been screened and pasteurized—but this requires a doctor’s prescription and can go for a hefty $4 or $5 an ounce to cover processing costs. (Milk banks also prioritize donor milk for sick or preterm infants in the hospital, for whom cow-based formula is particularly prone to causing a serious gut disease called necrotizing enterocolitis.) Unofficially, parents can go on Facebook or Craigslist or another online marketplace where women share or sell extra breast milk. These markets are cheaper and more convenient, but they’re also unregulated. Donors largely follow the honor system for disclosing medications and other health information. Meanwhile, formula is cheap, safe, and widely available in grocery stores. Biomilq promises to combine the “nutrition of breastmilk” with the “practicality of formula.”It’s hard to say, at this nascent stage, exactly how still-hypothetical breast milk made by cells in a bioreactor would compare with formula. The cultured human-milk proteins could be more suitable in a baby’s gut than dairy proteins, and sugars specific to human milk could help feed a baby’s new gut microbes.[Read: The ominous rise of toddler milk]But milk from cells in a bioreactor would still be missing some key components of true breast milk—for the simple reason that the components of breast milk don’t come from the breast alone. Natalie Shenker, a breast-milk researcher at Imperial College London, enumerated some examples: Antibodies, which transfer immunity against pathogens from mother to baby, come from the mother’s own immune cells in her blood. Hormones, which may shape the baby’s brain and behavior, from her endocrine system. Fats, which make up a substantial portion of the calories in milk, from her diet and own stored fatty tissue. (Biomilq suggests that these fats could be supplemented in cultured cells.) Beneficial bacteria that help populate the baby’s gut come from the mother’s own microbiome. The whole body is responsible for the production of what we call breast milk. The exact cocktail of protein, sugar, fats, antibodies, hormones, and bacteria in breast milk can change from day to day and even hour to hour. It can change in response to the baby’s needs. One hypothesis suggests that a sick baby can communicate via “retrograde milk flow”—more memorably termed “baby spit backwash”—to change the composition of breast milk to help the baby fight off disease. Breast milk is complex and dynamic. Perrin said she applauds any efforts to improve infant nutrition, but “to re-create breast milk in a test tube, I think we’re just so far away from that.”Growing enough mammary cells to make any milk at scale is also a huge technical challenge. These cells require expensive nutrients and are incredibly prone to contamination from bacteria. The recent interest in lab-grown meat has prompted a number of companies to work on these problems, but breast milk is likely to face higher scrutiny, deservedly so, because it is for babies. Shenker, who is familiar with the challenges of growing mammary cells from her own research, wondered whether re-creating milk was the best use of resources. Why go through the expensive, unproven process of growing cells to make milk in a bioreactor, she asked, when we already know how to get actual milk—nutritionally complete—from a donor? The problem is not a lack of breast milk on Earth, but a lack of access and distribution.[Read: The vindication of cheese, butter, and full-fat milk]When I contacted breast-milk researchers to ask about lab-grown breast milk, they ended up changing the topic to barriers faced by women who want to breastfeed. “A lot of moms aren’t getting the support they need,” said Meghan Azad, a breast-milk researcher at the University of Manitoba. Breastfeeding takes skill, which was lost for a generation when formula was dominant. It takes workplaces that give women the time and flexibility to breastfeed or pump. And it takes a culture that doesn’t shame women for breastfeeding in public. And although society makes it hard for women to breastfeed, it also tells them that “Breast is best.” The result is a nearly impossible set of expectations.The appeal of Biomilq is that it’s supposed to close the gap—that frustrating space between what mothers are expected to do and what most can realistically do. “We’re done making trade-offs between our baby’s health, our wellbeing, and the environment,” the company’s website proclaims. But it also puts the company in the position of both touting the benefits of breastfeeding … and telling women it’s okay not to breastfeed. Egger says Biomilq is not about replacing breastfeeding, but supplementing it. “If women can breastfeed even part of the time, they should be wholeheartedly supported in doing that,” she says. “We just see this as an opportunity for them to actually continue to enable that process and not having to feel guilt or shame or frustration.” She draws a particular contrast with formula companies, which have used aggressive tactics to get into hospitals and influence breastfeeding recommendations. Over the course of the 20th century, these standardized cans of formula often came to replace the highly personalized breast milk of mothers.The irony is that if human milk from cells, as a concept, really does take off one day, the more successful it is, the more likely it is to become formula 2.0: another practical, standardized, and commercial product. In fact, formula companies are already adding sugars called “human milk oligosaccharides” to their products, to sell formula that they can say is closer to breast milk.
2020-02-27 17:30:51
2021-05-08T10:47:50.000000
1 y
theatlantic.com
The Opposite of Socialized Medicine
When the vaccine crackdown came, it was the doctors, of all people, who felt censored. It all started last year, when Adam Schiff, a Democratic representative from California, sent letters to Amazon and other tech giants expressing concern that the companies feature anti-vaccine videos and information on their platforms. Schiff cited a report by CNN that found that many searches on Amazon related to vaccines led to anti-vax content. The first listing, for instance, was a sponsored post for the book Vaccines on Trial, which is dedicated to “children who had to suffer due to adverse vaccine reactions.”Amazon removed anti-vaccine movies like Vaxxed: From Cover-Up to Catastrophe from its Prime streaming service, incensing advocates opposed to mandatory vaccines and leading to a lawsuit that was filed against Schiff a few weeks ago. The lawsuit came from a New York woman who wants more information about vaccines, alongside an organization that, on the surface, seems counterintuitive: a group of doctors called the Association of American Physicians and Surgeons.The lawsuit alleges that Schiff’s actions are tantamount to censorship. As a result of his letters, the suit says, Amazon kicked AAPS out of an affiliate network through which the organization had earned commissions. According to the group, searches on Facebook for AAPS vaccine articles instead yielded links to the World Health Organization, the National Institutes of Health, and the Centers for Disease Control and Prevention. One of the AAPS articles that was allegedly suppressed states, “Measles is a vexing problem, and more complete, forced vaccination will likely not solve it.” (Schiff’s office did not respond to a request for comment.)[Read: The new measles]The Association of American Physicians and Surgeons might sound like another boring doctors’ group politely debating telehealth legislation. But AAPS is a small yet vociferous interest group. Like Zelig with a stethoscope, it has popped up in nearly every major health-care debate for decades, including the Affordable Care Act and opioids, and it wields a surprising amount of influence. Senator Rand Paul of Kentucky was outed as a member in 2010. (A Paul spokesperson told me that while the senator is no longer a member, he is supportive of AAPS’s fight against Obamacare.) When Representative Tom Price of Georgia was nominated to lead President Donald Trump’s Department of Health and Human Services, several newspapers pointed out that he, too, was a member. (At the time, an HHS spokesperson said that not all doctors in a group believe the same thing.)Though AAPS often takes positions that are associated with conservative groups, it sometimes goes even further, pushing fringe views that most mainstream conservatives do not endorse, such as the belief that mandatory vaccination is “equivalent to human experimentation” and that Medicare is “evil.” Over the years, the group seems to have coalesced around an ethos of radical self-determination and a belief that mainstream science isn’t always trustworthy. It’s the most curious of medical organizations: a doctors’ interest group that seems more invested in the interests of doctors, rather than public health.At a time when doctors are facing scorching levels of burnout, health-care costs are soaring, and seemingly everyone is frustrated with the status quo, AAPS seems to have come up with an unusual answer: to turn back the clock. AAPS sees its vision as forward-looking and modern, but the group’s rhetoric recalls an era when a doctor would treat you for just a few bucks. No insurance deductible would need to be met first, and no intimidating vaccine schedule had been mandated from above.AAPS has been called the Tea Party’s favorite doctors, but it’s actually a more fitting health-care group for the Trump era. As Trump has contributed to sowing doubt about the scientific consensus, AAPS is seizing the moment. The group just wants to make health care great again—even if that means tearing it apart.AAPS was founded in 1943 in opposition to an early effort to provide universal health care to Americans. It first shot to fame half a century later, when it sued then–first lady Hillary Clinton to gain access to the records of her Task Force on National Health Care Reform. (Though the Clinton administration was initially ordered to pay AAPS’s lawyer fees and other costs, eventually a federal appeals court ruled in its favor.)Today, the group has moved beyond simply opposing health-care reform, with the apparent intent to throw sand in any and all government gears. It seems most invested in protecting doctors from regulations. “We believe in private medicine,” Jane Orient, AAPS’s longtime executive director and primary spokesperson, told me in a phone interview. “We have opposed attempts to intrude government and other third parties between the patients and the physicians.”[Read: When the religious doctor refuses to treat you]Orient said that AAPS’s membership consists of “under 5,000” of the country’s million or so doctors. She is a physician herself, based in Tucson and licensed by the Arizona Medical Board. According to AAPS’s tax forms, Orient makes $181,000 a year from the group, though she said in an email that much of this goes toward running the office, such as IT support and office supplies, and that her salary is $48,000. On Facebook, someone named Jane Orient from Tucson posts AAPS press releases on her feed, along with ads for radiation detectors, conspiracy theories about vaccines, and inspirational posts from Littlethings.com. Orient would not confirm whether this was her Facebook page.During our call, Orient was down on insurance companies, as well as electronic health records and anyone or anything that might tell a doctor what to do, ever. In 2005, Orient backed doctors who prescribe lots of opioids, telling a newspaper that doctors were being “imprisoned for prescribing in good faith with the intention of relieving pain.” (The opioid epidemic has claimed 700,000 American lives.) In 2007, AAPS sued the Texas Medical Board to stop it from relying on anonymous complaints to retaliate against doctors suspected of wrongdoing. (AAPS lost.) Later, AAPS became the first medical society to sue to overturn the Affordable Care Act, saying that it “spells the end of freedom in medicine as we know it.”During the 2018 election cycle, AAPS donated $16,000 to federal political candidates, all of them Republicans, according to the Center for Responsive Politics. Orient herself has consistently donated small amounts of money to candidates, almost exclusively Republicans, since 1998. But the group drifts from the Republican establishment in many ways. Orient said she opposes some traditionally conservative health-care policies, such as the Massachusetts predecessor to the Affordable Care Act devised by the conservative Heritage Foundation. Regarding Trump, Orient said he has been “a disappointment in some ways,” but that AAPS is “very glad for some of the things that he has done,” such as continuing to oppose Obamacare.Several mainstream conservatives I reached out to declined to speak with me about AAPS. When I finally got one right-leaning health wonk, Joe Antos, on the phone, he said he had been thinking of the wrong AAPS and did not know much about the group.Meanwhile, a media-relations representative at the American Medical Association, the main doctors’ group in America, mentioned that he'd expect the AAPS to accuse the AMA of having a ‘fascist’ relationship with the government. Orient told me that AAPS does not consider the AMA fascist, “although we certainly criticize many of their policies. We think it is important to define terms precisely and not to indulge in name-calling.”Perhaps the only thing Americans agree on when it comes to health care today is that something’s gotta give. Electronic records are a nightmare for many doctors, and patients hate fighting with insurers as much as doctors do. It’s natural to want to just nuke it all. AAPS presents an extreme vision of that: What would happen if the government didn’t make doctors do, well, anything? I’ve met with some doctors who see anti-vaccine patients and who also don’t accept insurance, and I was taken by how free, self-actualized, and otherwise perky they were. Many doctors might readily swap an overcrowded primary-care practice for a concierge gig like that.AAPS seems to have pushed this vision of the unfettered doctor too far, though. Over time, it has taken a puzzling turn toward unconventional medical views, as exemplified by its legal tangle with Schiff. To Orient, the government should not even dictate essential medications that protect public health. Asked whether vaccines increase the risk of autism, she said, “I think that the definitive research has not been done.” (The overwhelming scientific consensus is that vaccines do not cause autism.)In 2015, after measles broke out at Disneyland, AAPS put out a press release questioning the safety of vaccines. The group has suggested that women who have abortions are at a higher risk of breast cancer, though mainstream scientists say this is false. In 2008, an article on AAPS’s website suggested that President Barack Obama was covertly hypnotizing people with his speeches, and that this might explain why Jews voted for him. AAPS’s journal, the Journal of American Physicians and Surgeons, has published articles raising doubts that HIV causes AIDS and questioning the wisdom of urging people to quit smoking, according to the Louisville Courier Journal.Orient told me that the articles in the group’s journal don’t necessarily represent the official policy of AAPS. She called the story from the Louisville Courier Journal a “hit piece,” saying that the smoking article was arguing simply that “constantly telling [people] that nicotine is addictive might give them an excuse not to try” to quit. Regarding the abortion–breast cancer link, she said in an email that “there is a large and growing number of articles supporting this, although ‘mainstream’ American researchers deny it and focus on a small number of articles with negative findings.” She denied the suggestion about Jews and said that the entire AAPS article was referencing an article from another source.[Read: What the measles epidemic really says about America]Orient disagrees with the premise of this article, too. She said that AAPS cares most about patients, not doctors. Rather than being backwards-looking, she said, the group is “looking forward to a future in which there’s more innovation and more freedom, instead of one in which there’s tighter government control.” With such freedom, Orient told me, “we could have a thriving, innovative, friendly medical practice where when you call the doctor’s office on the phone, instead of saying, ‘What insurance do you have?’ the doctor’s office will say, ‘How can we help you?’”AAPS’s apparent yearning for patients to pay with cash and for doctors to do as they please has historical precedent. Medicare only arrived in 1966. Before that, the options for seniors were to, as PolitiFact notes, “spend their savings, rely on funding from their children … hope for charity from the hospitals or avoid care altogether.” In the early 1970s, only certain states had school vaccination laws—and their measles rates were 40 to 51 percent lower than in schools without such laws.There were indeed fewer rules and less paperwork back then. But the AAPS doesn’t seem to offer a solution for the fact that these days, a single “How can we help you?” from a doctor can result in a five-figure bill. In recent years, the group has focused on opposing calls for single-payer health care, and it even came out against surprise-billing legislation, which would protect patients from out-of-network hospital bills and has garnered bipartisan support in several states. (Orient dismissed these measures as “price controls imposed on physicians.”)In our conversation, Orient did say that physicians should strive to help people who can’t pay, that hospitals should charge more reasonable and transparent prices, and that patients are often able to reduce their hospital bills through negotiation. But in 2016, Orient wrote in an op-ed that some people might simply sell their belongings to pay their medical bills. “Consider this,” she wrote. “Would you rather buy a nice car and risk having to sell it to pay a bill, or pay the insurance company the same amount and never get to drive the car?” (Orient stands by this, writing in an email, “If you lived beyond your means and bought a car that you couldn’t afford, and did not provide for future medical costs, how much sympathy should you receive?”)Most health groups today have a specific idea for how to reform medical care, whether through single-payer health care or Netflix for doctors. The trouble with AAPS’s vision for America is that it exhibits a nostalgia for a past that never existed. Measles killed hundreds of Americans a year before the vaccine became available. Americans are drowning in medical debt that kindly doctors haven’t successfully eliminated, and selling our cars to pay for medical care would strike few people as the right answer. The idea that doctors always do right by patients, and that patients always have the money to pay, and that no one ever gets measles at Disneyland, is a tempting dream. The problem is, it’s just that.
2020-02-25 19:15:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
You’re Likely to Get the Coronavirus
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Updated at 7:43 p.m. on Feb. 25, 2020.In May 1997, a 3-year-old boy developed what at first seemed like the common cold. When his symptoms—sore throat, fever, and cough—persisted for six days, he was taken to the Queen Elizabeth Hospital in Hong Kong. There his cough worsened, and he began gasping for air. Despite intensive care, the boy died.Puzzled by his rapid deterioration, doctors sent a sample of the boy’s sputum to China’s Department of Health. But the standard testing protocol couldn’t fully identify the virus that had caused the disease. The chief virologist decided to ship some of the sample to colleagues in other countries.[Read: What you can do right now about the coronavirus]At the U.S. Centers for Disease Control and Prevention in Atlanta, the boy’s sputum sat for a month, waiting for its turn in a slow process of antibody-matching analysis. The results eventually confirmed that this was a variant of influenza, the virus that has killed more people than any in history. But this type had never before been seen in humans. It was H5N1, or “avian flu,” discovered two decades prior, but known only to infect birds.By then, it was August. Scientists sent distress signals around the world. The Chinese government swiftly killed 1.5 million chickens (over the protests of chicken farmers). Further cases were closely monitored and isolated. By the end of the year there were 18 known cases in humans. Six people died.This was seen as a successful global response, and the virus was not seen again for years. In part, containment was possible because the disease was so severe: Those who got it became manifestly, extremely ill. H5N1 has a fatality rate of about 60 percent—if you get it, you’re likely to die. Yet since 2003, the virus has killed only 455 people. The much “milder” flu viruses, by contrast, kill fewer than 0.1 percent of people they infect, on average, but are responsible for hundreds of thousands of deaths every year.[Read: The official coronavirus numbers are wrong, and everyone knows it]Severe illness caused by viruses such as H5N1 also means that infected people can be identified and isolated, or that they died quickly. They do not walk around feeling just a little under the weather, seeding the virus. The new coronavirus (known technically as SARS-CoV-2) that has been spreading around the world can cause a respiratory illness that can be severe. The disease (known as COVID-19) seems to have a fatality rate of less than 2 percent—exponentially lower than most outbreaks that make global news. The virus has raised alarm not despite that low fatality rate, but because of it.Coronaviruses are similar to influenza viruses in that they both contain single strands of RNA.* Four coronaviruses commonly infect humans, causing colds. These are believed to have evolved in humans to maximize their own spread—which means sickening, but not killing, people. By contrast, the two prior novel coronavirus outbreaks—SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome, named for where the first outbreak occurred)—were picked up from animals, as was H5N1. These diseases were highly fatal to humans. If there were mild or asymptomatic cases, they were extremely few. Had there been more of them, the disease would have spread widely. Ultimately, SARS and MERS each killed fewer than 1,000 people.COVID-19 is already reported to have killed more than twice that number. With its potent mix of characteristics, this virus is unlike most that capture popular attention: It is deadly, but not too deadly. It makes people sick, but not in predictable, uniquely identifiable ways. Last week, 14 Americans tested positive on a cruise ship in Japan despite feeling fine—the new virus may be most dangerous because, it seems, it may sometimes cause no symptoms at all.[Read: The new coronavirus is a truly modern epidemic]The world has responded with unprecedented speed and mobilization of resources. The new virus was identified extremely quickly. Its genome was sequenced by Chinese scientists and shared around the world within weeks. The global scientific community has shared genomic and clinical data at unprecedented rates. Work on a vaccine is well under way. The Chinese government enacted dramatic containment measures, and the World Health Organization declared an emergency of international concern. All of this happened in a fraction of the time it took to even identify H5N1 in 1997. And yet the outbreak continues to spread.The Harvard epidemiology professor Marc Lipsitch is exacting in his diction, even for an epidemiologist. Twice in our conversation he started to say something, then paused and said, “Actually, let me start again.” So it’s striking when one of the points he wanted to get exactly right was this: “I think the likely outcome is that it will ultimately not be containable.”Containment is the first step in responding to any outbreak. In the case of COVID-19, the possibility (however implausible) of preventing a pandemic seemed to play out in a matter of days. Starting in January, China began cordoning off progressively larger areas, radiating outward from the city of Wuhan and eventually encapsulating some 100 million people. People were barred from leaving home, and lectured by drones if they were caught outside. Nonetheless, the virus has now been found in 24 countries.Despite the apparent ineffectiveness of such measures—relative to their inordinate social and economic cost, at least—the crackdown continues to escalate. Under political pressure to “stop” the virus, last Thursday the Chinese government announced that officials in Hubei province would be going door-to-door, testing people for fevers and looking for signs of illness, then sending all potential cases to quarantine camps. But even with the ideal containment, the virus’s spread may have been inevitable. Testing people who are already extremely sick is an imperfect strategy if people can spread the virus without even feeling bad enough to stay home from work.Lipsitch predicts that within the coming year, some 40 to 70 percent of people around the world will be infected with the virus that causes COVID-19. But, he clarifies emphatically, this does not mean that all will have severe illnesses. “It’s likely that many will have mild disease, or may be asymptomatic,” he said. As with influenza, which is often life-threatening to people with chronic health conditions and of older age, most cases pass without medical care. (Overall, about 14 percent of people with influenza have no symptoms.)Lipsitch is far from alone in his belief that this virus will continue to spread widely. The emerging consensus among epidemiologists is that the most likely outcome of this outbreak is a new seasonal disease—a fifth “endemic” coronavirus. With the other four, people are not known to develop long-lasting immunity. If this one follows suit, and if the disease continues to be as severe as it is now, “cold and flu season” could become “cold and flu and COVID-19 season.”At this point, it is not even known how many people are infected. As of Sunday, there have been 35 confirmed cases in the U.S., according to the World Health Organization. But Lipsitch’s “very, very rough” estimate when we spoke a week ago (banking on “multiple assumptions piled on top of each other,” he said) was that 100 or 200 people in the U.S. were infected. That’s all it would take to seed the disease widely. The rate of spread would depend on how contagious the disease is in milder cases. On Friday, Chinese scientists reported in the medical journal JAMA an apparent case of asymptomatic spread of the virus, from a patient with a normal chest CT scan. The researchers concluded with stolid understatement that if this finding is not a bizarre abnormality, “the prevention of COVID-19 infection would prove challenging.”[Read: 20 seconds to optimize hand wellness]Even if Lipsitch’s estimates were off by orders of magnitude, they wouldn’t likely change the overall prognosis. “Two hundred cases of a flu-like illness during flu season—when you’re not testing for it—is very hard to detect,” Lipsitch said. “But it would be really good to know sooner rather than later whether that’s correct, or whether we’ve miscalculated something. The only way to do that is by testing.”Originally, doctors in the U.S. were advised not to test people unless they had been to China or had contact with someone who had been diagnosed with the disease. Within the past two weeks, the CDC said it would start screening people in five U.S. cities, in an effort to give some idea of how many cases are actually out there. But tests are still not widely available. As of Friday, the Association of Public Health Laboratories said that only California, Nebraska, and Illinois had the capacity to test people for the virus.With so little data, prognosis is difficult. But the concern that this virus is beyond containment—that it will be with us indefinitely—is nowhere more apparent than in the global race to find a vaccine, one of the clearest strategies for saving lives in the years to come.Over the past month, stock prices of a small pharmaceutical company named Inovio have more than doubled. In mid-January, it reportedly discovered a vaccine for the new coronavirus. This claim has been repeated in many news reports, even though it is technically inaccurate. Like other drugs, vaccines require a long testing process to see whether they indeed protect people from disease, and do so safely. What this company—and others—has done is copy a bit of the virus’s RNA that one day could prove to work as a vaccine. It’s a promising first step, but to call it a discovery is like announcing a new surgery after sharpening a scalpel.Though genetic sequencing is now extremely fast, making vaccines is as much art as science. It involves finding a viral sequence that will reliably cause a protective immune-system memory but not trigger an acute inflammatory response that would itself cause symptoms. (While the influenza vaccine cannot cause the flu, the CDC warns that it can cause “flu-like symptoms.”) Hitting this sweet spot requires testing, first in lab models and animals, and eventually in people. One does not simply ship a billion viral gene fragments around the world to be injected into everyone at the moment of discovery.Inovio is far from the only small biotech company venturing to create a sequence that strikes that balance. Others include Moderna, CureVac, and Novavax. Academic researchers are also on the case, at Imperial College London and other universities, as are federal scientists in several countries, including at the U.S. National Institutes of Health. Anthony Fauci, the head of the NIH’s National Institute of Allergy and Infectious Diseases, wrote in JAMA in January that the agency was working at historic speed to find a vaccine. During the SARS outbreak in 2003, researchers moved from obtaining the genomic sequence of the virus and into a phase 1 clinical trial of a vaccine in 20 months. Fauci wrote that his team has since compressed that timeline to just over three months for other viruses, and for the new coronavirus, “they hope to move even faster.”New models have sprung up in recent years, too, that promise to speed up vaccine development. One is the Coalition for Epidemic Preparedness (CEPI), which was launched in Norway in 2017 to finance and coordinate the development of new vaccines. Its founders include the governments of Norway and India, the Wellcome Trust, and the Bill & Melinda Gates Foundation. The group’s money is now flowing to Inovio and other small biotech start-ups, encouraging them to get into the risky business of vaccine development. The group’s CEO, Richard Hatchett, shares Fauci’s basic timeline vision—a COVID-19 vaccine ready for early phases of safety testing in April. If all goes well, by late summer testing could begin to see if the vaccine actually prevents disease.[Read: Coronavirus is devastating Chinese tourism]Overall, if all pieces fell into place, Hatchett guesses it would be 12 to 18 months before an initial product could be deemed safe and effective. That timeline represents “a vast acceleration compared with the history of vaccine development,” he told me. But it’s also unprecedentedly ambitious. “Even to propose such a timeline at this point must be regarded as hugely aspirational,” he added.Even if that idyllic year-long projection were realized, the novel product would still require manufacturing and distribution. “An important consideration is whether the underlying approach can then be scaled to produce millions or even billions of doses in coming years,” Hatchett said. Especially in an ongoing emergency, if borders closed and supply chains broke, distribution and production could prove difficult purely as a matter of logistics.Fauci’s initial optimism seemed to wane, too. Last week he said that the process of vaccine development was proving “very difficult and very frustrating.” For all the advances in basic science, the process cannot proceed to an actual vaccine without extensive clinical testing, which requires manufacturing many vaccines and meticulously monitoring outcomes in people. The process could ultimately cost hundreds of millions of dollars—money that the NIH, start-ups, and universities don’t have. Nor do they have the production facilities and technology to mass-manufacture and distribute a vaccine.Production of vaccines has long been contingent on investment from one of the handful of giant global pharmaceutical companies. At the Aspen Institute last week, Fauci lamented that none had yet to “step up” and commit to making the vaccine. “Companies that have the skill to be able to do it are not going to just sit around and have a warm facility, ready to go for when you need it,” he said. Even if they did, taking on a new product like this could mean massive losses, especially if the demand faded or if people, for complex reasons, chose not to use the product.Making vaccines is so difficult, cost intensive, and high risk that in the 1980s, when drug companies began to incur legal costs over alleged harms caused by vaccines, many opted to simply quit making them. To incentivize the pharmaceutical industry to keep producing these vital products, the U.S. government offered to indemnify anyone claiming to have been harmed by a vaccine. The arrangement continues to this day. Even still, drug companies have generally found it more profitable to invest in the daily-use drugs for chronic conditions. And coronaviruses could present a particular challenge in that at their core they, like influenza viruses, contain single strands of RNA. This viral class is likely to mutate, and vaccines may need to be in constant development, as with the flu.“If we’re putting all our hopes in a vaccine as being the answer, we’re in trouble,” Jason Schwartz, an assistant professor at Yale School of Public Health who studies vaccine policy, told me. The best-case scenario, as Schwartz sees it, is the one in which this vaccine development happens far too late to make a difference for the current outbreak. The real problem is that preparedness for this outbreak should have been happening for the past decade, ever since SARS. “Had we not set the SARS-vaccine-research program aside, we would have had a lot more of this foundational work that we could apply to this new, closely related virus, ” he said. But, as with Ebola, government funding and pharmaceutical-industry development evaporated once the sense of emergency lifted. “Some very early research ended up sitting on a shelf because that outbreak ended before a vaccine needed to be aggressively developed.”On Saturday, Politico reported that the White House is preparing to ask Congress for $1 billion in emergency funding for a coronavirus response. This request, if it materialized, would come in the same month in which President Donald Trump released a new budget proposal that would cut key elements of pandemic preparedness—funding for the CDC, the NIH, and foreign aid. [Read: It’s suddenly cold out. Am I going to get sick?]These long-term government investments matter because creating vaccines, antiviral medications, and other vital tools requires decades of serious investment, even when demand is low. Market-based economies often struggle to develop a product for which there is no immediate demand and to distribute products to the places they’re needed. CEPI has been touted as a promising model to incentivize vaccine development before an emergency begins, but the group also has skeptics. Last year, Doctors Without Borders wrote a scathing open letter, saying the model didn’t ensure equitable distribution or affordability. CEPI subsequently updated its policies to forefront equitable access, and Manuel Martin, a medical innovation and access adviser with Doctors Without Borders, told me last week that he’s now cautiously optimistic. “CEPI is absolutely promising, and we really hope that it will be successful in producing a novel vaccine,” he said. But he and his colleagues are “waiting to see how CEPI’s commitments play out in practice.”These considerations matter not simply as humanitarian benevolence, but also as effective policy. Getting vaccines and other resources to the places where they will be most helpful is essential to stop disease from spreading widely. During the 2009 H1N1 flu outbreak, for example, Mexico was hit hard. In Australia, which was not, the government prevented exports by its pharmaceutical industry until it filled the Australian government’s order for vaccines. The more the world enters lockdown and self-preservation mode, the more difficult it could be to soberly assess risk and effectively distribute tools, from vaccines and respirator masks to food and hand soap.Italy, Iran, and South Korea are now among the countries reporting quickly growing numbers of detected COVID-19 infections. Many countries have responded with containment attempts, despite the dubious efficacy and inherent harms of China’s historically unprecedented crackdown. Certain containment measures will be appropriate, but widely banning travel, closing down cities, and hoarding resources are not realistic solutions for an outbreak that lasts years. All of these measures come with risks of their own. Ultimately some pandemic responses will require opening borders, not closing them. At some point the expectation that any area will escape effects of COVID-19 must be abandoned: The disease must be seen as everyone’s problem. * This story originally stated that coronaviruses and influenza viruses are single strands of RNA; in fact, influenza viruses can contain multiple segments of single-strand RNA.
2020-02-24 17:39:12
2021-05-08T10:47:50.000000
1 y
theatlantic.com
Meat Trimmings Are a Health Food Now
For most Americans, meat sticks have one face: Macho Man Randy Savage. The pro wrestler fronted the Slim Jim brand for much of the 1990s, flipping tables and crashing through ceilings in television commercials to implore young men to snap into dried sausage rods. Over several decades of marketing, Slim Jim had fine-tuned itself for a certain type of bro: one who delighted in the purposefully trashy masculinity embodied by WWF icons in neon-fringed leather and the mystery-meat gas-station snacks they love. The processed protein cylinders long dominated the meat-snack market, netting hundreds of millions of dollars in sales in the ’90s for the packaged-foods behemoth Conagra.As the new millennium dawned, however, American tastes and the whims of pop culture started to shift. People began to worry about processed foods and search for different flavors and ingredients in their snacks. Savage’s tenure with Slim Jim ended, and the brand launched new campaigns—most notably, a series of late-2000s ads in which a man dressed as a meat stick implored people to eat him. Slim Jim even temporarily changed its slogan from “Snap into a Slim Jim” to “Made from stuff guys need.” But growing up is hard. By late 2010, sales of the sticks had dipped, and even as they rebounded in the years afterward, executives fretted over teenage boys aging out of their products.Five years later, I did a double take while walking through a Whole Foods in Brooklyn. Out of the corner of my eye, I had spotted a pile of narrow, long tubes in single-serving plastic shrink-wrap—Slim Jim packaging, but with the sophisticated shades of organic groceries instead of the garish colors of snacks fighting for attention in convenience stores. I stopped to marvel at the sticks, made by a company called Vermont Smoke & Cure, and to quietly scoff at their audacity. Who would buy a gentrified Slim Jim as health food?The answer turned out to be a lot of people. Over the past decade, the gospel of meat and spice has not only endured, but flourished into a shelf-stable-beef extravaganza. Slim Jim’s sales have nearly tripled since their 2010 dip, and new companies have sprung up to offer organic, grass-fed, or minimal-ingredient protein batons virtually everywhere: corner stores, airport newsstands, office snack deliveries, the ads slotted between Instagram Stories. To put a meat snack in every hand, snack purveyors have pulled off a trick that might have seemed impossible in the days of the Macho Man: They transformed surplus beef into health food.[Read: The capitalist way to make Americans stop eating meat]Despite my initial incredulity at the thought of gourmet Slim Jims, curiosity won out. I started buying fancy meat sticks and jerky in airports—flying is stressful enough without a tummy full of chocolate and Cheez-Its. I’ve never had a meat stick that I’d regard as delicious, exactly, but plenty of them taste perfectly fine. They occasionally show up in my office’s snack stash, and they’re a better bridge to a delayed lunch than a tiny packet of organic animal crackers. They seem like no less reasonable a thing to have floating around at the bottom of my tote bag than a protein bar flavored like birthday cake.To understand why dried sausage sticks are all the rage, you have to look past their most famous American purveyor and into the fitness-centric enclaves on Reddit, Facebook, and Instagram. There, carbohydrate-skeptical plans like the paleo diet, Whole30, and the ketogenic diet, often called “keto,” have found an audience of millions in the past decade—1.7 million people subscribe to the keto subreddit, and more than 4 million Instagram photos have been tagged with #whole30. These diets vary in their exact restrictions, but they all posit that Americans have been sold a bill of goods on “health food,” and that sugars, starches, and low-fat processed foods should mostly be abandoned in favor of minimally processed protein, fat, and vegetables. While the actual science behind these diets varies, they’ve helped mainstream concerns that are in fact supported by considerable evidence.Read: The Keto diet’s most controversial championIn 2012, Pete Maldonado was caught up in the first gusts of the internet’s low-carb whirlwind while exercising at a CrossFit gym. He began to dabble in paleo eating, which led him to a common realization for those who cut carbs: If you don’t have a full kitchen at your disposal and time to cook in it, avoiding them is basically impossible. Sugar shows up everywhere—even in conventional meat sticks and jerky, as a stabilizer—and particularly in the protein bars and powders marketed to people trying to build muscle. “There weren’t very many on-the-go convenient options, especially ones that were healthy,” Maldonado says. “They were candy bars for people who were into fitness.”Along with Rashid Ali, a fellow Florida-based CrossFitter, Maldonado founded the meat-stick brand Chomps. Its products are free of sugar and nitrates, which are common in conventional shelf-stabilized meat and verboten for many dieters. At first, Maldonado says, he and Ali expected to run Chomps as a side business while they worked day jobs. Things cruised along manageably for the first few years, as the company, like a lot of modern health-food brands, marketed itself directly to paleo and Whole30 adherents online. Then Uncrate, a popular website for men’s lifestyle recommendations, wrote an article about the Chomps sticks. “We got thousands and thousands of orders,” Maldonado says. “We realized that, wow, this isn’t a niche product. This is as general as it gets.”In 2016, Chomps got picked up by its first retail client, Trader Joe’s, and the company brought in $4 million in revenue. In 2020, Maldonado says, it is on pace to surpass $60 million in sales. Its clientele is mostly women in households that make more than $80,000 per year—exactly the people gas-station treats were never trying to attract, and people who might not want to bring a fistful of neon-encased meat whips to the office.Chomps is far from alone in its growth. Hershey bought the jerky upstart Krave in 2015 for more than $200 million, and food companies such as Chef’s Cut, Country Archer, and Stryve have also found a booming market for their sticks. As a genre, meat snacks—sticks, nuggets, jerky, and beyond—are expected by one industry analysis to become a $6 billion market in the United States by 2027. Much of those sales will continue to go to big brands like Slim Jim (whose parent company, Conagra, did not respond to a request for comment), but smaller companies can thrive in what the snack industry refers to as the “better for you” market, which traffics in “healthy” updates to old favorites. “The first thing consumers are going to look at might be the nutrition-facts label, but if it’s not that, it’s the ingredient list,” says David Walsh, a vice president of the industry trade group SNAC International. “The fewer the ingredients the better, and they want to understand all the ingredients as well.”This intense interest in ingredients isn’t just the result of changing ideas about health. Ideas are changing about snacks themselves. “Consumers are replacing meals with snacks, especially during the workday when they might not have time to run and grab a full meal,” says Chelsie Rae Lee, the chief revenue officer at SnackNation, a subscription service that delivers boxes full of miscellaneous snack foods to American companies (including The Atlantic). Indeed, Americans eat fewer traditional sit-down meals than previous generations did, so they need different kinds of snacks to take their place. Lee says that SnackNation’s meat sticks are so popular that the company launched what it’s calling the Marvelous Meat Lover’s Box, for offices that want to load up on protein.If you’ve read a lot about the popularity of plant-based proteins like Beyond Meat or the Impossible Burger, or about the growing anxiety over what America’s generous per capita meat consumption is doing to the planet or people’s bodies, it might seem counterintuitive that people intensely focused on their physical well-being and the provenance of their food would be fueling an explosion in bulk boxes of dried sausage. But an interest in fancy meat alternatives and in fancy portable meats are two sides of the same coin. Along with faux-burger technology, sales rates for protein-packed snacks made with chickpeas and beans have soared in recent years, but the vast majority of people seeking out those foods don’t seem intent on giving up meat; the rate of vegetarianism in the United States has been steady for decades. Instead, many Americans with disposable income are primarily concerned with making better, more informed choices about what they ingest. Someone who forgoes meat at dinnertime might also be someone who fishes a teriyaki-flavored free-range-turkey stick out of her purse for a mid-morning snack.By selling directly to consumers, small brands prepared to meet the baroque requirements of restrictive health regimens can build a following large enough to pry their way onto sought-after shelf space at major grocers. For most newer meat-stick brands, that means not just a limited ingredient list, but a good backstory of where their meat comes from and the life it lived. Maldonado was careful to emphasize that Chomps sources its beef, which comprises the trimmings from steaks and other retail cuts, from a sustainable, humane ranch in Tasmania. He found that American cattle were too mistreated.Even going to Australia and back for its beef sticks hasn’t been enough for Chomps to banish the ghost of Macho Man Randy Savage, though. The company’s products may contain only ingredients you can easily identify, but it’s hard to out-brand a burly man in neon leather selling ultra-processed treats. “This happens every time. I’ll get this sideways look when I’m explaining I’m making meat sticks, and then people are like, ‘Oh, do you mean like a healthy …,’” Maldonado laments. “And I’m like, ‘Yes, like a healthy Slim Jim.’”
2020-02-21 14:00:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
Corporate Buzzwords Are How Workers Pretend to Be Adults
If there’s anything corporate America has a knack for, it’s inventing new, positive words that polish up old, negative ones. Silicon Valley has recast the chaotic-sounding “break things” and “disruption” as good things. An anxious cash grab is now a “monetization strategy,” and if you mess up and need to start over, just call it a “pivot” and press on. It’s the Uber for BS, you might say.Cloying marketing-speak, of course, isn’t limited to the tech world. As a health reporter, much of my work involves wending my way through turgid academic studies, which are full of awkward turns of phrase such as salience and overweight (used as a noun, as in “the prevalence of overweight”). Even more tedious is reading some of the reports put out by nonprofit organizations, which always seem to want to arm “stakeholders” with tools for their “tool boxes.” I wish journalists were immune, given that we fancy ourselves to be plainspoken, but sadly common in our world is talk of “deep dives” and “impactful long form.” (Use of the word impactful is strongly discouraged by The Atlantic’s copy desk. As is the use of many other words.)Not quite a cliché, not quite a term of art, a buzzword is a profound-seeming phrase devised by someone important to make something sound better than it is. Typically, the buzzword develops a shibboleth status in a given field—“we’re all about Big Data”—to the point where everyone is saying it and everyone feels as if they must say it. Meanwhile, with each repetition and slide deck, the term grows more hackneyed, and many of its speakers grow more nauseated at its mention. Does anyone actually say disrupt with a straight face anymore?When I recently asked on Twitter about everyone’s least favorite buzzwords, people really mind-shared some good ones. Capacity grates, as does at-risk when describing people, along with the delightfully redundant root cause. The “optics” of “growth hacking” do little to “value-add,” as well. But the strange thing is, these folks are from the fields in which those words are used. Like everyone’s loud tipsy uncle, the buzzwords people know best tend to be the ones that irritate them most. That so many people continue to use these words anyway speaks to one of the most powerful quirks of office life—and the power dynamics that make it so difficult to change.According to Gretchen McCulloch, the author of Because Internet, buzzwords were born from the artifice of the office itself. At work, people are paid to do things they wouldn’t otherwise do in their leisure time. They don’t dress at the office the way they do at home; they don’t act at the office the way they do outside of it; and they don’t talk about drilling down and rightsizing around their friends. Buzzwords mark the boundary of work life, broadcasting “I’m working!” in much the same way an Ann Taylor getup does. They allow workers to relate to one another—the much-decried “synergy” is an important part of a lot of people’s jobs, after all.[Read: Is it weird to wear leggings at work?]Frankly, buzzwords also help save time. You can command a co-worker to “get their ducks in a row” and have them basically know what you mean. In this way, speaking in business jargon is a way of showing that you fit in with the office, the Copenhagen Business School professor Mary Yoko Brannen told me. One of the most important elements of culture is language.From a more cynical perspective, buzzwords are useful when office workers need to dress up their otherwise pointless tasks with fancier phrases—you know, for the optics. Coal miners and doctors and tennis instructors have specific jargon they use to get their points across, but “all-purpose business language is the language you use when you aren’t really doing anything,” says the anthropologist David Graeber, the author of Bullshit Jobs. Similarly, buzzwords can provide a PR-friendly gloss on whatever “pain points” you’re trying to cover up, as in the case of doctors who say they are “happy to provide you with the paperwork to submit to your insurance company.” (In English, this means they don’t take insurance.)Given its ubiquity, we might expect workers to stop worrying and embrace the buzzword. What’s so wrong with a little thought-leading? The reason buzzwords are so annoying, McCulloch says, is that language is inherently a reflection of the people who speak it and the circumstances in which it’s used. Terms such as circling back and touching base are inseparable from that one annoying work task you’re just trying to get someone to respond to. “If you find corporate buzzwords annoying, it’s probably because you find work annoying,” McCulloch says.The fact that buzzwords are a joke even to many of the people who rely on them suggests that work, and its language, is a kind of pretense. And speaking the language of work reminds people that they’re pretending. Graeber remembers the first time he and all his high-school friends shook hands, as kind of a gag. It became a recurring joke, as in “Oh, this is what adults do.” “I think people in these offices are permanently caught at that moment,” he says. We’re forever “closing the loop” on things because of a vague notion that this is what adults do.[Read: Office talk visualized]Few people enjoy faking it in this way, though. I recently unearthed an email from college in which I told a friend exactly what I needed from her and why her recent actions had been bothering me, and it was as if it were written by a different person. These days, I’d be more likely to feign a weekend stomach bug and reschedule drinks until I was feeling less mad. “Sorry to resched!” I might say.Buzzwords are a reminder, in a way, of a time in life when it was acceptable to speak more plainly and say what you really meant. The realization that you’re rarely doing much of either anymore can be depressing. As the sociologist Erving Goffman wrote in The Presentation of Self in Everyday Life, “To the degree that the individual maintains a show before others that he himself does not believe, he can come to experience a special kind of alienation from self.”Blue-sky scenario, you would ditch the wheelhouses and start speaking more straightforwardly. But McCulloch warns that doing so may brand you as an iconoclast—something that’s more fraught for women and people of color, who already face greater barriers to acceptance in the workplace. For many workers, it can be risky to tell your boss that you’re going to “come up with really random, insane ideas to see if you like any of them,” rather than that you plan to “think outside the box.” So rather than disrupting the status quo, you may just want to leverage your ability to speak Corporate in order to bring more to the table. At least until you become the boss.
2020-02-19 17:19:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
A Photographer Has Spent 20 Years Documenting Stillbirths
Since 1997, Todd Hochberg has been going to hospitals to photograph families after the death of a baby. These requests come at all times of day and night—more often at night, it seems, when it is a stillbirth. If he can, Hochberg will be there for the birth itself, and then in the emotional hours after as parents see and hold and even bathe their dead child while saying goodbye.For parents, these photographs document one of the worst days of their life. But they also represent the few cherished memories they will ever have of their child. Hospitals used to whisk stillborn babies away from their parents, but they now recognize the importance of memories in grieving. Many offer photography, along with mementos such as footprints and locks of hair. Organizations such as Now I Lay Me Down to Sleep also have a network of volunteer photographers around the country.Stillbirth affects about one in 100 pregnancies in the United States, which means that about 24,000 babies are stillborn in the U.S. every year. The cause is often unknown. Hochberg has photographed 500 to 600 families, including those whose infant died shortly after birth as well as those who lost an older child. He presents each family with an album with dozens of photos, sometimes as many as 130.In the early 2000s, Hochberg left a corporate photography job to pursue what he calls “bereavement photography” full-time. He doesn’t charge the families. Some of the hospitals he works with have found grants to fund his work. Otherwise, he relies on donations. “It’s nowhere near what I made as a corporate photographer,” he says. “It’s certainly my life’s work at this point. I don’t see myself doing anything else.”A transcript of our conversation follows. It has been condensed and lightly edited for clarity.Sarah Zhang: There’s a lot of discomfort around death and dead bodies in our culture. You’ve been photographing families with their dead children for more than 20 years now. Has it changed how you feel about death?Todd Hochberg: For certain. My first experience with a stillbirth, I was there in the room when Mom delivered. It was like the first time I had witnessed an open surgery with a lot of blood—the odors of the chemicals as well as the blood and wound. This very small and very premature baby had somewhat translucent skin. And it was a bit disarming, but I caught myself. I took some breaths and I went with it. My fear and my anxiety vanished when I saw that baby in Mom’s arms, as she cuddled and was connecting with this baby outside the womb.A hospital chaplain visits as Roslyn cradles Anya. Two-and-a-half-year-old sister, Kira, anddad, Matt, sit beside them. Roslyn experienced a placental abruption after a car accident. (Courtesy of Todd Hochberg)Zhang: How did you get into bereavement photography?Hochberg: I had been working in health care as a medical photographer and corporate photographer for a large health-care system in Chicago. The hospital needed pictures of surgical procedures as well as for evidentiary purposes. And I was looking for something a little more meaningful in my work. I made a friend who was a chaplain who worked with these families whose babies died at birth or shortly thereafter. And I had been a collector of antique Victorian photographs, these memorial images in Victorian times with children. I’d go to flea markets and antique shows and they spoke to me somehow.Zhang: I’ve seen these Victorian photographs periodically go viral on social media, and they’re usually described as “creepy” and “unsettling.” What spoke to you in these photographs?Hochberg: The grief was very present for me. They were largely portraits of parents holding their babies. My intention, when I thought of doing this work, was to do a portrait. What I discovered was something very different: I wanted to tell the story of these babies and their parents and their experience.[Read: Why American babies die] Zhang: When I’ve talked with parents who have had a stillbirth, they talk about how they just have so few memories. The blanket, the hat their child wore—these small things really come to mean a lot. Do you see your photographs as helping these families document the few memories they do have?Hochberg: They have so little. The photographs are one more thing to help them bond and grieve more completely. They affirm their baby’s life, validate the feelings they’ve had. There could be many years of hopes and dreams for this baby’s existence, and to not have evidence—I use the term touchstones. The photographs become touchstones for a family’s own experience and their own feelings.I’ve been in touch with families from upwards of 20 years hence. When they have an anniversary, they’ll send me an email telling me how much these pictures are still helpful to them. And the siblings of these babies are upwards of 20 years old or 15 years old. They still look at them.Cody and Ethan hold Avery skin to skin, moments after his birth in the delivery room. (Courtesy of Todd Hochberg)Zhang: How do you approach photographing these babies, especially cases when they are very premature?Hochberg: I don’t shy away from the reality of what’s there. And I don’t retouch anything, meaning take away scar tissue or what have you. But I will photograph in such a way, for some of the pictures at least, that is kinder to the anomalies or the difficult presentation. I photograph in black-and-white. That makes softer the discoloration that often happens. There could be skin peeling or maceration. But I’ll photograph in such a manner to be kinder. I’m there to photograph the story and the family’s connection.I have a particular photograph that speaks to that, where the mother is holding this baby in the palm of her hand. Very young. It had spina bifida. I’m photographing at an angle below her. I’m on my knees, which I often do because I’m interested in seeing parents’ faces. There’s more intimacy in that. She holds this baby very close to her face, and she’s examining and tentatively looking over this baby. Her love and her grief are so present. I always try to photograph the babies in the context of being held, as opposed to lying in the bed or the warmer.Zhang: Is there a particular photograph or family that has stuck with you?Hochberg: I remember parents who had twins and one was stillborn. They knew he wasn’t going to survive delivery. It was a twin-to-twin transfusion. The other twin was in the NICU and Mom was in recovery. Dad decided he’s going to carry this stillborn baby to visit his twin in the NICU. He wanted his two sons together.A nurse caregiver looks on as Cody holds Avery to her chest. (Courtesy of Todd Hochberg)Zhang: What do parents usually do with your photographs? Do they keep them private or share them?Hochberg: It varies. I’ve been in people’s homes a few months later, and I’ve seen some of my images hanging on the wall and on the mantle. I have families, proud moms who post on their Facebook pages. Some will keep them very private and just share between themselves. Parents might want to have them in their home but might not want to look at them for a couple years, a month. In one case, it was two years, and I got a call or an email from a mom that said she’s finally ready to see them.[Read: What good is thinking about death?]Zhang: On your website, you write that “these photographs may be difficult for some people to view.” Have you had people who were angry or upset by your photographs? Why did you feel it was necessary to say this to viewers?Hochberg: I was aware early on, it wasn’t very present in the culture. Everywhere I went, if I talked about it to people and friends, there is this aghastness. Their faces turn red. And then they listen to me and I describe the benefits to parents. It’s not a voyeuristic thing. There isn’t one person I’ve talked to who hasn’t said, “Oh, yeah, my mother had that baby” or “my cousin’s uncle” or “My best friend’s sister had a stillbirth.” There’s all these stories that come out when people start talking.Dana and her daughters, Chloe and Kate, hold Henry. Henry died of a rare condition called bilateral renal agenesis, in which he was born without kidneys. (Courtesy of Todd Hochberg)Zhang: It sounds like the photographs have two different purposes. One is for the parents themselves. But as parents have shared them and your work has gained more attention, they have also opened up a conversation about stillbirth. Was the second purpose always on your mind, or was it something that you noticed later?Hochberg: I noticed it the second year I was doing the work. The chaplain I mentioned was a mentor to me, along with a nurse bereavement coordinator at the same hospital. They felt like, Other caregivers need to see what you’re doing. It wasn’t my idea. My intent then became, yes, help these parents first, but then also indirectly, through making these pictures for parents, by them showing their pictures to their friends and their neighbors and family members. It helped to change things a little bit …Do you want to hear a quote from a parent?Zhang: What is the quote?Hochberg: This is one of the families I’ve photographed: You have brought our son Jeremiah to life, giving him personality and a role of his own. In each record of our brief time together, you’ve captured the beauty of our son, his thick hair, his soft face and hands, his cuddly body. You’ve captured every nuance of emotion we experienced, things we didn’t even realize we were feeling. You have allowed us to experience it all again, every twist of the gut, every heartache, every proud moment, and especially the love. We value each feeling. You have validated our role in the experience by enabling us to share with our family and friends an important part of ourselves, a tale which could not be told adequately with words or even tears. You’ve captured the transformation that took place in our lives and hearts that night. We are not the same people we were before we met Jeremiah.
2020-02-18 16:00:00
2021-05-08T10:47:50.000000
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theatlantic.com
An Ode to Cold Showers
Luci GutiérrezHere’s what used to happen.I’d wake up, smoldering and sighing, reel out of bed and into the kitchen, and put the kettle on. Then I’d think: Well, now what? Time would go granular, like in a Jack Reacher novel, but less exciting. Five minutes at least until the kettle boils. Make a decision. Crack the laptop, read the news. Or stare murkily out the window. Unload the dishwasher? Oh dear. Is this life, this sour weight, this baggage of consciousness? What’s that smell? It’s futility, rising in fumes around me. And all this before 7 a.m.Here’s what happens now.I wake up, smoldering and sighing, reel out of bed and into the kitchen, and put the kettle on. And then I have a cold shower.I don’t want to go overboard here, reader. Life-changing, neurosis-canceling, enlightenment at the twist of a tap—I don’t want to make these claims for the early-morning cold shower. But if like me you have a sluggish seam of depression in your nature, and a somewhat cramped brain, and a powerful need, throughout the day, for quasi-electrical interventions of one sort or another, reboots and renewals—or if you just want to wake up a little faster—can I most devoutly recommend that you give it a shot?Do it first thing. As soon as you get up. Don’t torture yourself with postponement. And don’t muck around with hot-to-cold transitions, temperature tweakings, etc. Fling wide the plastic curtain, crank the tap to its coldest, take a breath, and step right in. Not grimly or penitentially, but with slapstick defiance: Holy Mother of God! Cowabunga! Here I go! (If it’s too early in the day for slapstick defiance, try a head-shake of weary amazement.)The water hits, and biology asserts itself. You are not a tired balloon of cerebral activity; you are a body, and you are being challenged. You gulp air; your pulse thumps. Your brain, meanwhile, your lovely, furry old brain, goes glacier-blue with shock. Thought is abolished. Personality is abolished. You’re a nameless mammal under a ravening jet of cold water. It’s a kind of accelerated mindfulness, really: In two seconds, you’re at the sweet spot between nonentity and total presence. It’s the cold behind the cold; the beautiful, immobile zero; a flame of numbness bending you to its will. Also—this is important—you can still lather up in a cold shower, and get all your washing done: hair, body, everything.Then you get out, and you’re different. Things have happened to your neurotransmitters that may be associated, say the scientists, with elevated mood and increased alertness. You’re wide awake, at any rate. Your epidermis is cool and seal-like. Your nervous system is jangling—but melodically, like tiny bells. And from the kitchen, you can hear the kettle starting to whistle.
2020-02-17 14:00:00
2021-05-08T10:47:50.000000
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theatlantic.com
The Neglected Consequences of Foot-Binding
For several hundred years, millions of Chinese girls had their bodies painfully misshapen to conform to a prevailing social expectation. Intact feet, girls were told, would damage their marriage prospects. To achieve a more suitable size and shape, young girls’ feet were crushed repeatedly over years. Each excruciating procedure forced the girls to learn to walk anew, rereading the ground from an unfamiliar position and through unimaginable pain.The tiny “lotus foot” in its delicate silken shoe was seen as one of the most attractive qualities in a prospective bride; the smaller the foot, the more sexually pleasing the girl was. More recent studies have shown that foot-binding was likely practiced not purely for the sake of marriage, but also to keep girls at home and engaged in handicrafts, such as spinning cotton, in order to contribute to their family’s income. The end result, no matter the motivation, was severe physical impairment. Yet despite foot-binding’s brutality, and hundreds of anthropological studies addressing it, the long-term medical consequences of the practice have been largely neglected. Examining the debilitating, lifelong physical effects that foot-binding had on Chinese girls can be crucial for understanding the lengths to which societies will go to restrict women’s freedom.“Bound Feet in China,” a 1937 article in The Journal of Bone and Joint Surgery, gives one of the few detailed physical descriptions of foot-binding currently available, but still couches the cruelty of the process in metaphor and largely ignores the lasting health consequences. “The four outer toes are flexed upon the sole and are held in that position,” the authors wrote. “The metatarsals are pressed together as the bandages are applied. In spite of the pain after each kneading, the girl is forced to walk, in order to help re-establish circulation.” In plain English, that means that all of a girl’s toes except the first were crushed toward the bottom of her foot and bound with cloth strips. The process could start when she was as young as 3 years old, though 5 was more common, and was repeated for two or three years—her toes routinely rebroken and bound again more tightly.In many cases the intense pain of foot-binding was exacerbated by infection (which sometimes led to gangrene), hindered circulation, and weakened bones and ligaments. A girl’s feet typically remained bound with bandages and strips of either silk or cotton, depending on what her family could afford, for the rest of her life.Humans took millions of years to evolve into bipedal walkers, relying on several points of the foot shifting weight and balance as we take each step. Foot-binding reduced these points to only the big toe and heel bone; the arch was shoved up to make the foot shorter, and the other toes were bent under the ball. In many cases the arch was broken completely. Girls whose feet were bound would never again be able to walk fluidly, severely limiting their ability to move through the world.Many cultural accounts of foot-binding have been written, especially from a feminist perspective, and many academic studies mention the process. But for one of the only medical descriptions of foot-binding’s long-term consequences, we have to turn to Steve Cummings, an epidemiologist and professor emeritus at the University of California at San Francisco.Cummings went to Beijing in 1991 to study why older Chinese women had 80 percent fewer hip fractures than American women of the same age range. He and a team of researchers randomly selected neighborhoods from each of Beijing’s central districts, then visited every house that they knew had a woman over the age of 50. They invited more than 300 women to a lab at Peking Union Medical College Hospital, where participants performed a series of regular motions (e.g., standing from a chair with their arms crossed, squatting) along with tests for grip strength and gait speed.The second participant in the hip-fracture study “came in with two canes and her foot wrapped up oddly,” Cummings told me. “I thought it was just curious.” By that time, he had been living in Beijing for two or three months, and he and his family had traveled extensively through the city and around the country. During those travels, he had never once seen a woman with her feet in the same condition as those of the second study participant.[Read: The peculiar history of foot-binding in China]Soon after, another woman came in with a crutch and an odd kind of shoe. When Cummings asked about the woman’s feet, his colleagues—many of them female doctors in their late 50s—told him that they had been bound. “I assumed it was fairly rare,” he said.Then more women with bound feet started coming in. What Cummings realized—the reason he hadn’t seen these women elsewhere in China—was that for the most part they physically couldn’t go out. The women he met spent much of their life in or very close to their home, their disability preventing them from venturing farther out. He was seeing them in the lab only because transportation to the hospital was provided.The women he’d met with bound feet, Cummings eventually wrote in a report on the cohort, were much more likely to have fallen in the previous year than women without, had lower bone density in their hips and lower spines, and had greater trouble getting up from a chair without assistance. Although the consequences for millions of Chinese women living with what he calls a “forced disability” were profound, Cummings’s study was initially turned down by journals like The Lancet and The New England Journal of Medicine. Both told him that because foot-binding was essentially extinct, it wasn’t a current medical problem. He finally sent his report to the American Journal of Public Health in 1996 with a note to explain that although foot-binding is no longer practiced, “the study has enormous implications for how we treat women.”Cummings’s hip-fracture study had a nearly unheard-of 95 percent participation rate, and about 15 percent of the women he studied had bound feet. That amounted to millions of women stuck at home, unable to engage in everyday activities such as grocery shopping, because they had such difficulty walking—never mind squatting while waiting for the bus or carrying shopping bags while managing canes and crutches. In his study, Cummings concluded that older Chinese women were less prone to hip fractures than American women in part because the former squatted much more often, which builds bone density and strengthens hips. Older Chinese women with bound feet, though, had a completely different story. “The way these women avoided injury,” he said, “was by not doing anything.”Further clinical study of foot-binding is nearly impossible; the women who were girls when it was outlawed are dying out. Jo Farrell, a Hong Kong–based photographer and cultural anthropologist, spent several years putting together a small art book of China’s last “lotus feet” women, titled Living History: Bound Feet Women of China. She found 50 women to photograph, all in their 80s or older, three of whom died before the book was published in 2015. They had a wider range of mobility than the women Cummings met in Beijing—among them were women who worked in fields, raised children, fixed chimneys, and went bowling—but descriptions of their childhood binding were no less horrifying.Foot-binding is one phenomenon in the long history of societies controlling women’s physical movement—along with their rights as citizens and their legal status as human beings—as a tenet of civilized existence. In her book Wanderlust: A History of Walking, Rebecca Solnit details laws and practices going back centuries that limited women’s free movement. In certain periods in France, for example, women were arrested if they were found walking on certain streets at certain times.But women have been bent in more literal ways too. Foot-binding was one. Corsets were another; only rarely do we remember that Victorian women’s hourglass shape came at the expense of their lungs and rib cages. In Japan, most workplaces still require women to wear high heels, even while they’re job hunting. In response to a petition for that requirement to be abolished, Japan’s minister of health and welfare defended it as “occupationally necessary,” despite the strain that high heels put on backs, knees, and foot bones, as well as the risk of vertebral slippage.[Read: What high heels can teach about gendered ‘truths’]Like recent research that makes visible the long-lasting brain damage inflicted by childhood abuse or PTSD, examining the medical consequences of corsets, high heels, and foot-binding in detail forces us to look their effects in the face. Brain scans that show the effects of trauma, or peer-reviewed research on the epigenetic effects of living through a war or genocide, are evidence that survivors’ accounts of abiding damage aren’t imagined. The restrictions of foot-binding and other physical constraints imposed on girls and women are obvious; the damage is real. “A male counterpart,” Cummings said of foot-binding, “is impossible to imagine—both because impairment of male function of any sort was not imaginable and because, had anything like that occurred, it would have been written about at the time, probably with outrage.”With the unavoidable conclusions provided by modern, in-depth medical research, societies now have the knowledge necessary to avoid the mistakes they made in the past. Whether they have the will, though, is less certain. Foot-binding, as a practice, is extinct, but as Cummings pointed out repeatedly, what it says about how we are willing to treat women, and the damage we will inflict and accept to maintain control over their movement and their freedom, is anything but settled.
2020-02-14 14:30:00
2021-05-08T10:47:50.000000
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theatlantic.com
Two Couples Tried a Group Marriage. It Didn’t Work.
It was 1969, and 8-year-old Amy Grappell thought her house was haunted. She’d seen shadows pass her bedroom door in the dark of night. Once, she was sure she’d heard a ghost; the stairs creaked as if the specter were walking in the hallway. Amy mustered some courage and got out of bed. A strange man was coming out of her mother’s bedroom. Was he real? Their eyes met. “Are you sleeping with my mother?” the child asked. She meant sleeping in the literal sense—Amy didn’t know what sex was, but the whole thing seemed like a betrayal all the same. When Amy asked her mother about the man, she was told that she’d been imagining things. “I began to doubt my own sense of reality, which led to a profound sense of instability,” Grappell told me. It turned out that Amy’s parents, Paul and Deanna, had entered into a group marriage with another married couple, Eleanor and Robert, who lived in their suburban Long Island town. “The men would tiptoe out of their houses after us kids were asleep to switch wives,” Grappell said. “To keep up appearances, the right car had to be at the right house in the morning.” It was the era of free love, and the couples were struggling with the monotony of marriage. “Their individual marriages were failing, but they found that, together, they were happy,” Grappell said. The couples thought they had found an alternative to divorce—“a brave new world that would pave the way for how couples would live in the future.” The four-way affair proved so satisfying, in fact, that the couples agreed to make it official. They entered into a domestic-living experiment that they called the “quadrangle.” “It allowed them to fulfill their emotional and sexual needs while maintaining their marriages and social status,” Amy said. The new arrangement proved destabilizing for the couples’ kids. For Amy, it was especially deleterious. “When the other family moved into our home, it was like an invasion,” Grappell said. She felt neglected. “My feelings of abandonment and desperation were the enemy of their utopia.” The psychological effects haunted her for years. Ultimately, Amy found an unconventional way to process the trauma. “I had always wanted to tell this story, but wasn’t sure how,” she said. She decided to make a short documentary that would force her to talk openly with her parents. “I don’t think I had any idea how difficult it would be,” she said. “It was like walking through a minefield of the past for all of us.” The result, Quadrangle, features separate interviews with Paul and Deanna, who have been estranged for many years. An inspired editing choice has them appearing side by side on the screen, forming a diptych of converging and diverging sentiments. There’s a certain voyeuristic excitement to watching the story of the unconventional relationship unfold through individual memory. But underneath is a palpable darkness—the invisible force of the kids’ suffering, and the eventual dissolution of the relationships. “My parents strived to create a utopian version of family, but in the end, ego trumped idealism, and the relationships unraveled,” Amy said. Both couples divorced and married their foursome partners. Amy revealed that the trauma she suffered growing up as a child of a group marriage has made her more conventional in her romantic relationships. She is now married, but “not having a functional family model myself, I chose not to have kids, though I wanted them.” Amy Grappell is working on an upcoming memoir about her experience.
2020-02-13 20:21:40
2021-05-08T10:47:50.000000
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theatlantic.com
The Coronavirus Is a Data Time Bomb
So far, less than 0.0008 percent of the humans on Earth have been diagnosed with the disease caused by the coronavirus known as COVID-19. But thanks to the circulation of disease and capital, the whole world has been affected.Chinese manufacturing cities such as Wuhan, the epicenter of the outbreak, are intimately entangled with the supply chains of the entire world. That means that both the disease and the containment measures enacted to control it (take, for example, the quarantine still in place for 70 million people) will have a dramatic effect on businesses across disparate industries.Any company—including Apple and Walmart—that brings things in from China has to worry about production and distribution slowdowns. That’s partly because supply chains are less linear than they sound. Production networks often have complex interrelationships that go back and forth across borders. An American retailer might contract with only one Chinese company, but that entity in turn might act like a general contractor, pulling in components from many sources or farming out work to a changing list of factories. In 2018, for instance, more than 1,000 facilities were involved in some way with the making of Apple products.Meanwhile, exporters—such as Brazilian ranchers and Chilean winemakers—are facing a massive drop in Chinese demand. Inside China, the economic decline is expanding beyond the manufacturing sectors; even a media company said it was laying off 500 workers because of the epidemic.[Read: A historic quarantine]What makes this all so strange is that a mosaic of facts is known about the economic consequences of the coronavirus, but the arrival of those consequences outside China will be delayed, and their magnitude is uncertain. It doesn’t help that experts inside and outside China have questioned the reliability of the country’s official statistics for years. And local reporting provides reasons to doubt coronavirus numbers as well.What Target executives are worried about today will actually show up for shoppers in April. You might think that financial markets, at least, would be “pricing in” the problems, but share prices are at record highs. The coronavirus has likely already dealt many of its economic blows—and now those disruptions will trickle through the networks that connect China to the rest of the global economy.Some of the effects will be material: There might be fewer items on store shelves, some prices might rise, product development could slow down. But some of the impact, and an additional source of lag, will come from the data describing the reality of the past two months, much of which has yet to be tabulated. Companies and governments need statistics to understand what’s happening in the world. The U.S. government, for example, maintains a complex data-gathering operation: the Bureau of Economic Analysis, the Bureau of Labor Statistics, certain survey programs of the Census, the National Agricultural Statistics Service, the Economic Research Service, and many others. The data that these organizations publish take time to reflect on-the-ground commerce. Under normal conditions, this may not be significant. But when the economy suffers a globe-altering shock, statistical windows on the world can be dangerously out of step with reality.For now, the data points that can be marshaled to make sense of the macroeconomic picture are not good. Chinese oil demand was down 20 percent earlier this month, “probably the largest demand shock the oil market has suffered since the global financial crisis of 2008 to 2009, and the most sudden since the Sept. 11 attacks,” as Bloomberg put it. With some huge Chinese cities under varying versions of lockdown, the total number of cars and trucks on the road has fallen. Factories are not running at full capacity either. Pollution near Shanghai, a reliable and hard-to-fake indicator of economic activity, has plummeted, according to Morgan Stanley. Container ships are sailing with smaller than normal cargo loads. Prices for bulk carriers that move iron ore and coal have collapsed. One analyst told the Financial Times that the coronavirus “will have a bigger impact on the global tech supply chain than SARS and creates more uncertainty than the U.S.-China trade war.”That very trade war led some companies to move their supply chains to other Asian countries, but China remains the beating heart of manufacturing and assembly for the world’s goods. “Suddenly, all supply chains seem vulnerable because so many Chinese supply chains within supply chains within supply chains rely on each other for parts and raw materials,” Rosemary Coates, a supply-chain consultant, wrote in the trade journal Logistics Management. “That tiny valve that is inside a motor that you are sourcing for your U.S.-made product is made in China. So are the rare earth elements you require to manufacture magnets and electronics.” The impacts may also vary widely from province to province and even factory to factory based on how local governments regulate their regions, CNBC’s Beijing bureau chief, Eunice Yoon, noted.[Read: How to misinform yourself about the coronavirus]The slow industrial march out of China has also left some industries, like toy making, with depleted inventories. Companies that spent last year building new production networks in other Asian countries are more resilient in the long term, but at this particular moment, they may not have enough product to sell.Less predictable secondary effects have cropped up too. As Indonesia’s president called for stimulus spending to guard against an economic slowdown, the price of Indonesian garlic went up 70 percent, apparently because Chinese consumers were buying up the folk cure in bulk. Even small ripples must have some effect: In Australia, where students from China could not return to class after the summer holiday, universities pushed back their start dates, which hurt the businesses around them. The question is whether all those small problems and complications will add up to anything more serious than annoyance.Then, consider the political ramifications of the economic slowdown. What if the coronavirus crisis slows China’s economic growth enough to destabilize the Communist Party’s control? Bill Bishop, a longtime China analyst, wrote that the outbreak is the closest thing “to an existential crisis for Xi [Jinping] and the Party that I think we have seen since 1989.”The coronavirus is a remarkable probe for the complex relationships that hold up today’s economy. In our world, information flows much more quickly than goods. That means we can glimpse a major world event, in tweets and videos from the quarantine zone, weeks before its impact will be quantified. It is an uneasy and strange position, like knowing an earthquake has struck but not knowing whether a tsunami is on the way. One upshot for Americans is likely, though: Even if the worst of the outbreak is over—and it might not be—bad economic news may well be in our future.Or if tens of millions of Chinese workers can be sidelined, and the American economy can plow through it all without a hitch, then it might be time to revise how deep the “Chimerica” connection really is.
2020-02-13 17:58:19
2021-05-08T10:47:50.000000
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theatlantic.com
The Doctors Who Bill You While You’re Unconscious
Let’s say you need to get minor surgery, such as repairing some torn knee cartilage. If you have insurance, you would probably call the hospital or your insurer ahead of time to be sure that the hospital was “in network” with your insurance. If you’re extra savvy, you might double-check that the surgeon who will be operating on you is in-network, too.I should be good, you might think. You reason that you won’t face any unexpected charges beyond your insurance’s co-pay, because the point of an insurance network is to funnel you to doctors and hospitals that your insurance will cover. But in fact, it’s more complicated than that. Americans often get staggering bills from providers they didn’t realize would participate in their surgery.Many health-care horror stories begin with the receipt of this kind of “surprise bill”—a bill, often in the thousands of dollars, that a patient wasn’t expecting, and which often reflects the difference between what the provider believes it should be paid for the service and what the insurer actually paid them. These bills can accrue interest and end up on your credit report. Debt collectors can hound you to pay in unusual ways, and even garnish your wages. You often can negotiate with the hospital to reduce your payment, but that process takes time and skills that not everyone has.A growing body of research suggests that this nightmare scenario is fairly common for Americans. And now, a new study published in the Journal of the American Medical Association has found that surprise bills might be even more common than previously estimated: They happen about a fifth of the time that a patient has an elective surgery at an in-network hospital with an in-network surgeon. Having a surprise out-of-network bill raised the total bill by an average of $14,083. The dollars racked up while many patients were unconscious, and an out-of-network specialist simply walked into the room.For the study, the authors looked at 347,356 people nationwide who were insured with a major private insurer. (The authors declined to name the company.) By reviewing bills from seven common elective procedures undergone from 2012 to 2017, including the aforementioned knee-cartilage procedure and hysterectomies, they found that the surprise bills came most often from anesthesiologists, who put patients to sleep before procedures, and surgical assistants, who do everything from aid in an operation to check on the patient afterward. Though the hospital might be in-network, these specialists might not work for the hospital, but simply treat patients there. The out-of-network surgical assistants charged more, at $3,633 on average, than did the anesthesiologists, at $1,219.To the University of Michigan researcher Karan Chhabra, the lead author of the study, the most surprising thing is that surgeons can often choose their own assistants, but not their anesthesiologists. So why might surgeons pick out-of-network surgical assistants? “My hope is that it’s an accident,” Chhabra told me. “[Doctors] don’t always talk about which insurance everyone accepts.” Of course, most doctors are acting in good faith, but, he added, “my concern is that in some cases it might be happening intentionally to sort of exploit patients.” For example, surgeons might be teaming up with out-of-network assistants, and vice versa, to get more money from patients.Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told me that though this study highlighted anesthesiologists and surgical assistants, surprise bills can also come from out-of-network pathologists, who analyze tissue and blood samples, or radiologists, who examine X-rays and MRIs. No matter who the surprise bills come from, “you don’t pick these people. You don’t know them,” Pollitz said. “You learn their name when the bill comes.”The results in the new JAMA study are similar to, though slightly higher than, findings from the Kaiser Family Foundation. The health-care nonprofit recently found that about 18 percent of emergency visits and 16 percent of inpatient admissions result in surprise out-of-network bills. People who go to the hospital with a heart attack are especially vulnerable to surprise bills, it found.The surprise bills were also more likely to come if there were surgical complications, perhaps because as the procedure grows more complex, more people get involved in treating it. The risk of getting a surprise bill was higher on Affordable Care Act exchange plans compared with other plans, possibly because Obamacare plans have so-called narrow networks, with fewer participating doctors to keep costs down. There was also some variation among the states: Alaska had the highest rate of surprise bills, at 46 percent, and Nebraska had the lowest, at 3 percent.JAMAIt’s hard to know what’s behind the variation in surprise billing among the states. It could have something to do with the number of physicians in an area or the percentage of them that take a given insurance plan, Chhabra said. It could also have to do with venture-capital companies investing in physician practices, Pollitz said, and reasoning that “if you don’t accept many or any insurance networks … you can bill whatever you want.”The data gave Chhabra a bleak impression of the U.S. health-care system. “It’s way too hard for a well-intentioned patient to come out unscathed,” he told me. “The way we set the system up is really putting patients last.”Legislation is making its way through Congress that would put a stop to these bills. For care at an in-network hospital, the legislation would make it so that out-of-network doctors would have to be covered, and patients would pay the amount they would regularly pay for in-network care. President Donald Trump has expressed support for this measure, but doctors’ groups are still quarreling with insurers over how much exactly they would get paid under this proposal.The new study was accompanied by an editorial by Karen Joynt Maddox, an assistant professor at Washington University School of Medicine, and Edward Livingston, the deputy editor of JAMA, calling on surgeons to “speak out” against surprise billing, and for Congress to pass the surprise-billing legislation. In the meantime, the next time you get surgery, it might be worth asking ahead of time if every provider who treats you will be in-network. It might not prevent a giant bill—but at least you won’t be surprised.
2020-02-11 18:01:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
How Your Laptop Ruined Your Life
The New York City subway is a terrible place for productivity. During the morning commute, the crowds force many people to stand, one hand occupied by a pole for balance, so getting any real work done is often impossible. Riders can use their phones to browse their inboxes or draft a couple of emails, but internet access in the city’s tunnels is spotty. When you look around, people mostly are reading books, scrolling through their music libraries, playing colorful phone games, or just staring into space, disconnected.Occasionally, though, someone violates the morning subway’s slacking-off sanctity. Earlier this week, a woman managed to find a seat next to me on the train, took out her laptop, and started plugging away at a spreadsheet. The sight filled me with dread, as it does every time I spot a fellow commuter writing code or finessing a PowerPoint presentation while I listen to podcasts. I suddenly became much more aware of the hard, thin edge of my own work computer, digging into my thigh through my tote bag.It’s a common existential crisis among American office workers that virtually nowhere is now safe from the pull of their jobs. This inescapability is usually attributed to the proliferation of smartphones, with their push notifications signaling the arrival of emails and other workplace messages. The first iPhone, released in 2007, helped make social media omnipresent and pave the way for hyper-connected professional lives. Now, on-call retail workers and law-firm partners alike often feel as though they never really clock out.But that blame is often applied solely to the wrong piece of take-home technology. If staying home with a cold still requires a full day of work or you can’t find a seat at your local coffee shop on a Tuesday afternoon, iPhones are not responsible for ruining your life. The novelty and early popularity of smartphones seem to have distracted America from how quickly its laptops were also dissolving much of the boundary between work and home.You could be forgiven for not picking up on every important thing that happened in America in 2008. The economy and housing markets cratered that year, evaporating 2.6 million jobs and pushing more than 3 million homes into foreclosure. Barack Obama was elected as the country’s first black president, after an especially bitter race. Millions of people were super-into the Twilight series of young-adult vampire-romance novels. There was a lot going on.But 2008 was also a crucial period in the construction of the tech-addled world Americans now live in. The first iPhones sold 10 million units. Google launched its first Android phone, setting up the key rivalry that still animates the American smartphone market more than a decade later. As those world-changing devices made their way into the hands of millions of curious people, another mobile gadget quietly rose to the top of its market. Some disagreement exists over whether 2007 or 2008 was the first year that laptops outsold desktops in the general market, but 2008 was the first year that American employers bought more laptops than desktops.[Read: Three theories for why you have no time]Amid the economic upheaval, there was optimism about how laptops might improve things. They were cheaper, lighter, and more powerful than they’d ever been, which meant more types of office workers could use them. The rapid availability of wireless internet meant more people could unshackle themselves from their rigid office life and daily commute. “Laptops and U.S. consumers are in the honeymoon stage,” the Los Angeles Times explained then. “Users can connect their laptops to external monitors, keyboards and mice while seated at a desk, then eject them and work from a coffeehouse, library, airplane or living room.”At work, receiving a laptop became a status symbol. It showed that you were a person worth investing in at a regular company, or that you had found a way into the booming, then-mysterious tech industry. When I got my first office job in 2008, only upper management had laptops. The devices separated the important people from those of us who were subject to their decisions.As laptops have kept improving, and Wi-Fi has continued to reach ever further into the crevices of American life, however, the reality of laptops’ potential stopped looking quite so rosy. Instead of liberating white-collar and “knowledge” workers from their office, laptops turned many people’s whole life into an office. Smartphones might require you to read an after-hours email or check in on the office-communication platform Slack before you started your commute, but portable computers gave workers 24-hour access to the sophisticated, expensive applications—Salesforce CRM, Oracle ERP, Adobe Photoshop—that made their full range of duties possible.According to a recent study, Americans with college degrees and beyond—the ones most likely to start a new job and immediately be handed a laptop—spend 10 percent more time working now than they did in 1980. Those extra hours have been deeply felt: “Screen time” has become a thoroughly modern boogeyman, and to escape it, people are often advised to avoid bringing their phones to the dinner table, to stop scrolling through social media before bed, and to stay away from their email app before they’ve taken their morning shower.But those habits won’t fix Americans’ relationship with work when their entire job comes home with them every night. More than the smartphone, laptops ended “work hours” as a concept. An office used to be a thing you went to for a certain number of hours a day; now, work is an entire plane of existence. When people fret about work invading all hours of life, what they’re really worried about isn’t the email that lets you know something needs to be done, but the expectation that they’ll start a task immediately, or continue working after they commute home. Things that might have been handled at 9 a.m. the next morning have suddenly become 9 p.m. problems. [Read: Give up on work-life balance]For young people who have never experienced professional life any other way, being constantly available and ready to put in another hour or to solve another problem is often seen as a reputational requirement, which shoves personal interests, hobbies, and goals to the periphery of people’s life and burns them out. It makes it hard to focus on cooking dinner or getting a good night’s sleep. People take their laptop on their vacations, just in case. At many companies, laptop culture creates the expectation that a real sick day is only available to the seriously hobbled; otherwise, you and your head cold better be working from home.Laptops, of course, aren’t all bad. They remove a barrier for those who want to write, create art, make music, or develop a new skill. Laptops can be portals of procrastination, leading to hours of Bojack Horseman or YouTube makeup tutorials. Because they’re still pretty unwieldy, they don’t lend themselves to the same kind of mindless check-ins that can make smartphones so stressful. I’ve never seen anyone nearly get hit by a car because they couldn’t look up from a computer.Even at work, laptops do deliver some of the perks with which they were sold. For people who would rather freelance than go into an employer’s office, they really do provide the flexibility that gave people so much optimism more than a decade ago. For jobs that have always required long hours, they might mean fewer nights chained to an office desk. You can wait at home for the plumber on a Tuesday without sacrificing a day of vacation time. In real emergencies, they can be invaluable.But laptops’ biggest sin might be granting employers the convenience to treat any little hiccup like an emergency, no matter how inconsequential. Their employees don’t have much of a choice but to pull out their computers and get to work.
2020-02-10 17:06:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com
20 Seconds to Optimize Hand Wellness
It’s a familiar situation in a public restroom: You’re on your way in, and someone else is leaving without washing their hands. They see you, and wheel around toward the sink. They start whistling, as if to seem casual, and then give their hands a quick spritz with water.Even among people who will never see each other again, there’s a compulsion to perform a tiny baptism of the fingertips: Not enough scrubbing or soap to actually remove a virus, just enough to signal civility. Accordingly many Americans’ standard of what constitutes a washing of the hands is abysmal. Studies have put the average hand-washing time at about six seconds, less than half of what is recommended by global-health guidelines. Only around 5 percent of us regularly wash long and thoroughly enough.Our failures feel newly relevant as, for the past month, panic has gripped parts of the world over how to stop the spread of a deadly strain of coronavirus—a variant of the common-cold virus. So far, the virus is known to have killed at least 500 people and infected some 25,000 more, primarily in China, where the outbreak began. In response to the crisis, the country has enacted a historically unprecedented quarantine. Streets in the urban heart of Wuhan are seen empty, and people caught outside are berated by drones.The U.S. government dipped its toe into similar waters on Sunday, ordering a mandatory two-week quarantine of all travelers inbound from Hubei province. Two-thirds of Americans feel that the virus is a “real threat,” according to an NPR poll released yesterday, and a sense of need for forcible action is pervasive. Scientists at the National Institutes of Health have mobilized to work on an emergency vaccine. Face masks have sold out in many places, despite little evidence that they are helpful outside of specific situations.Amid so much concern and resource allocation, many people remain dismissive of the most widely accepted, simple advice to slow the spread of most viruses. The Centers for Disease Control and Prevention and other agencies around the world have one clear, concise, definitive recommendation: Wash your hands for at least 20 seconds.Last week on The Daily Show, Trevor Noah captured the standard response to that advice when he joked, “Wash your hands? Scientists always warn us about some new, weird death virus, and then when we say, ‘What’s the plan?,’ they’re like, ‘Uh, wash your hands.’” The audience laughed. “That’s not a plan!”Hand-washing does seem extremely obvious—which may be the problem. Those of us who have lived our entire lives removed from epidemics of cholera and other deadly hygiene-related outbreaks haven’t witnessed the power of hand-washing and take it for granted. But it may be the single most important thing any given person can do to help stop and prevent outbreaks.Respiratory infections are diseases we very often give to ourselves. People are told to cover their coughs and sneezes, but studies show a vast majority don’t wash their hands after doing so. Someone carrying the pathogenic microbes might shake your hand, or touch a doorknob or desk that you later touch. Once you pick them up, if you touch your face, the circle is complete.It’s impossible to know exactly how much people have changed their hand-washing habits since the outbreak first made headlines a month ago; comprehensive studies have not yet been published. But America’s general history of focusing less on evidence-based preventive behaviors than on billable treatments does not bode well, nor does our health-care system’s tendency to prize newer, marketable products over the cheap and obvious ones.To get some vague sense of whether the long-standing 20-second guideline is suddenly resonating widely, I asked people on Twitter whether their hand-washing length has changed in recent weeks. A few people told me that they’re becoming more conscious of others’ behavior—and that they’re especially grossed out when witnessing the three-second spritzes or performative soapless washes. But no one said Yes, I’ve started to actually wash my hands properly. I never really used to do it. While that’s likely not something people are eager to admit, suboptimal standards seem common even among those who you’d think would be most meticulous. “Sometimes researchers who work in labs with viruses don't take that much caution in washing their hands,” Robert Lawrence, a biochemist and science writer, told me.Following outbreaks always makes me conscious of my own habits, and those of everyone around me, too. I haven’t noticed any changes in the bathrooms I frequent. Subtle shifts could be happening, but I assumed that our HR department wouldn’t let me put a video camera in our office restroom to get a proper sample size.What would make people want to change? At what point does “I’m really freaked out by this virus” become “I’m so freaked out by this virus that I’m going to regularly wash my hands for at least 20 full seconds”? Even if you have zero fear of the flu or coronavirus, or death at all, there is good reason to spend 20 seconds. Guys have said to me: I didn’t pee on my hands, so why should I wash them? To which I say: Man, the point isn’t to get pee off of your hands. The act is, truly, a selfless one. Hand-washing could help prevent the millions of cases of cold, flu, and gastrointestinal disease that spread around the world each year. In the U.S., we apparently believe we’re too important to spare 20 seconds to play our part in not contaminating others.Instead of shaming hand-hygiene negligence, it may be more productive to celebrate hygienic awakenings. Part of the solution is developing a routine that everyone enjoys and looks forward to. If washing our hands feels like penance, we will never keep it up. One way is to kill time by singing. This is, no joke, one of the official CDC recommendations: “Need a timer? Hum the ‘Happy Birthday’ song from beginning to end twice.”Since humming that song as you loom over a sink makes you sound unhinged anyway, you might as well sing. If “Happy Birthday” isn’t feasible because of the melodic range, feel free to try a cooler song I made up: “I’m washing these hands, oh yes I am, yes I am,” to the tune of “The Wheels on the Bus.” You’ll know you’ve sung long enough when the person next to you has sung “Happy Birthday” twice. Then you’re supposed to dry your hands, which I find can be done just by putting your arms out to your sides and spinning around a few times.
2020-02-06 15:31:00
2021-05-08T10:47:50.000000
1 y
theatlantic.com