Pandemic planning-The local edition

Advice from the Town of Fairfax. Don't already get their newsletter? Sign up here.

 Fairfaxers, you should know:

• "The Town has established a 1 to 1 volunteer matching service to support and protect people in need during this difficult time. Volunteers will help neighbors feel less nervous and alone during this time and check in on what support you may need over the coming weeks. If you would like to volunteer or you need some support, please click here for more information."
• Our local Chamber of Commerce is a good source of information in addition to the town's own COVID-focused website.
• The library is open virtually.
• Iron Springs is still selling beer: order via their website.
• The Scoop is delivering: order by phone at 415-453-3130.
• Good Earth is working on a delivery service and instituting measures to ensure social distancing in the store. Thank you Good Earth!
• At this point those parks and beaches that are still open have closed their parking lots, and current shelter-in-place orders require that you only walk or bike to get to open space.
• How's it going in California? Check out the SF Chron's map of infection.

Take a photo or two and send to Anne Mannes: she is asking for B&W photos showing how we all are dealing with shelter-in-place plus a couple of sentences for a project documenting Fairfax's response to this historic crisis.

Pandemic planning

We have a plan. This is it. You should have read it you fucking idiots.

The US government had a plan for dealing with the current crisis. In fact, the US government has a plan for almost any crisis. Unfortunately, the US government is currently in the hands of a pack of reprobates, so you're going to have to make your own plan. Here are some things to think about while doing so:

• The timeline is months, not weeks, and the weeks we've just been through aren't a very good guide for the ones to come. Don't freak out, but do overprepare.
• Understand that there is enough of everything for everyone, but that things may become (even more) unevenly and irregularly distributed. Don't hoard, but do stock up. Avoid panic buying: take inventory, put together a shopping list, and then get online or in line for some deliveries. If able to shop local, do so: those businesses are hurting. But call ahead to check stocking status and don't leave home without your sanitizer.
• Prepare for a scenario where all of the adults in the house are knocked out simultaneously for a week or more. Teach the children how to use a toilet plunger and make sure there's food available that they can prepare without setting the house on fire. I think that about covers that.
• Take care of parents and oldsters around you. They are surely not ready and, of course, are the ones in most danger.
• You're going to be spending a lot more time at home. Make it a place you want to be: clean up, repair, redecorate. Live alone? Maybe get a goldfish.
• Don't spend too much time at home! Get out at least twice a day, if only for a walk around the block, and whether or not you feel like it.
• Take lots of photos. You're going to see things you've never seen before.
• Music all the time, a moment of celebration daily.
• One day this will end and we will return to our normal commercial relationships...if we pay it forward and help the people we do business with now. Have a favorite restaurant? Buy a few meals' worth of gift certificates right away. Have a maid? Pay him for the duration even though he won't be doing your dusting.
• Last and least, try seeing this from the virus's point of view.

And call your mother, she worries.

SARS-CoV-2

From a virologist at Stanford studying / trying to solve coronavirus. Feel free to share.

As promised, this post is going to be much more in depth—and LONG. Feel free to skip the paragraphs and jump to the bullets, but I’d urge you to read completely if you have the time.

The main reason why I became a PhD virologist, having spent the last 13+ years studying RNA viruses like influenza, is precisely because of where we now find ourselves. The world has a short memory and we are woefully unprepared for a real pandemic. In my current job as a research scientist in the Glenn Laboratory at Stanford Medicine we are actively thinking about new virus targets, and designing and testing new antiviral drugs against SARS-CoV-2. I am thinking about this pandemic professionally and personally.

That said, I am not the last word on CoV-2. I beg that you all follow the reputable sources I’ll link to at the bottom of this post so you can stay up to date on the pandemic. Sadly, given this administration’s misinformation and censoring campaign, I can no longer recommend the CDC website for a complete accounting of the outbreak.

There are many qualified public health officers/scientists/ physicians and journalists out there compiling/publishing/ analyzing the data I will present below. Some of us disagree with each other. Most of us do not. Keep in mind that the growing pandemic is a moving target for analysis. There is a din of noise surrounding the CoV-2 outbreak, and I have held back for this long since I didn’t want to add to it. Given the disastrous response from our government and the lack of consistently accurate information being given to the public—I feel compelled to weigh in.

First, the good news: while devastating, this pandemic is more akin to a dress rehearsal awaiting the big show—that show being a virus that is both highly infectious and highly lethal, like a super-transmissible avian flu. Thankfully, SARS-CoV-2 is not that virus. But that doesn’t mean it won’t be destructive nor that it won’t have far-reaching consequences.

The U.S. had a chance (months, in fact, of chances) to get in front of this crisis but squandered it. What could have been managed—or at least mitigated—is now truly snowballing. From not making test kits early enough to a total paucity of testing, the inadequacy of med supply stock piles, the 2018 dismantling of pandemic preparedness funds/agency, and finally to the absolutely abhorrent misinformation machine and total ineptitude that is our own president and the administration that protects his interests over ours, we are now in a worsening crisis of at least part of our own doing. But we’re here now, so what’s actually happening out there and what does it mean?

I’ve now had multiple iterations of the same conversation with many people wanting to know what’s real vs not regarding the CoV-2 pandemic. Here’s my bullet points:

• SARS-CoV-2 is the official virus name. COVID-19 is the name of the disease it causes.(e.g. how HIV causes AIDS)
• CoV-2 is predicted to eventually infect most of the world’s population within the year, and therefore has a high probability to seasonally recur. Best guess in the pub health community is 60-80% of the population will be infected, meaning ~4B eventual infections.
• Case fatality likely to be ~ 0.7%, probably closer to 0.5% and no more than 1%. The current fatality numbers being reported are skewed high and premature. We don’t have an accurate picture of the denominator, ie how many people are actually infected. Right now, the bulk of people getting tested are those that have more severe disease. Countries that are testing widely, like S. Korea, are catching many more positive cases that show little-to-no symptoms. Currently S. Korea’s fatality rate is around 0.7%. This likely represents the upper end of what we can expect. Italy’s fatality rate is higher, despite broad testing, but they are also burdened with an older population that has high comorbidities. Same with numbers coming from cruise ships. Most scientists believe actual fatalities to be below 1%. Note: that is still 10x worse than seasonal flu.
• Taken together, the first two points mean that within the year if we do not take more drastic measures now, we can be looking at ~40M deaths. This is not an alarmist number, but a real one. Fatalities will decline rapidly once herd immunity takes place (ie, once most people develop immunity) and successful antiviral interventions come about, including a vaccine, but these won’t be available for the current wave nor the next wave.
• The soonest we’ll likely see a vaccine ready for distribution is 1.5 years from now.Importantly, this means we’ll have at least one additional CoV-2 wave before we have a vaccine/prevention strategy. Some say they can get vaccines out within the year, but given the labor-intensive manufacturing, safety and efficacy testing, production, distribution, etc, I think 18mo or even longer is a safer bet.
• CoV-2 is not like the flu. There are some similarities in terms of transmission method, overlapping of symptoms, and the potential to turn into a seasonal occurrence, but these two viruses are very different.
• 0.6%-1% fatality is still multiple orders of magnitude larger than flu’s (~0.1%). We have antiviral drugs and vaccines to help manage influenza; we currently have none for CoV-2.
• If CoV-2 becomes seasonal, we’ll have the additive effect of flu’s yearly morbidity and mortality plus CoV-2. Our healthcare system as it stands now, is not equipped to handle this.
• There’s quite a bit we don’t know about CoV-2, which makes it dangerous. We don’t know if you can build a lasting immune memory to the virus or if you can be reinfected (some scientists are now saying they believe this to be true, but it remains to be shown); if the virus will mutate to a more/less aggressive form; if it’s able to infect other species in addition to humans; why it spares children but is so lethal to elderly, and if this can change; how immuno-protective the vaccines will be, and whether they’ll need to be redesigned yearly like flu vaccines; etc.
• This is also NOT like the 1918 flu pandemic.There we didn't have many of the basic medical interventions, much less antibiotics etc, that we have today. And the 1918 pandemic was much deadlier (~3%).
• Those most at-risk for COVID-19 should take social distancing to the extreme now (persons 60 yrs above and persons with comorbidities). This means no travel, avoiding public spaces, avoiding physical interactions, no gym or exercise classes, extra diligence on hand washing, etc. This applies both to folks in the current outbreak hotspots like the Bay Area and Seattle, as well as to all the at-risk folks in the U.S. and elsewhere.
• Persons under 20 years old, particularly kids and infants, are uniquely resistant to the disease. There are lots of hypotheses why this is the case, but as it stands now, no healthy adolescent or child has died or even had severe disease due to CoV-2. They are, however, still getting infected. Because kids are messy, touch all sorts of things, and congregate with lots of other kids/parents/grandparents, they make for great virus vectors to transmit the disease. This is why closing down schools is so important.
• The “80% will experience mild disease” is a misnomer. Imagine the worst flu of your life, but you recover without med assistance: welcome to "mild disease." Medically, mild cases are any that you recover from at home. It’s true that some demographics, like healthy adults and esp young kids, are likely to experience few to no symptoms at all, but I also wouldn’t count on just getting the sniffles or a mild fever either.
• Everyone should employ at least some form of social distancing for the foreseeable future.Because we don’t have vaccines/therapeutics to help stop the disease, the best thing we can do is limit its spread by not giving it new hosts for transmission. We do this by limiting our exposure to other people. It’s a pain in the ass. Your life is going to change dramatically. Schools will and should close. Public events should be cancelled. Everyone where possible should work from home. Social distancing is an industry killer, but right now, it’s the only tangible and proven means of mitigating the public health impact. We do not want to be in Italy’s position of rationing access to ICU care because there are more patients in acute crisis than beds/resources available. Social distancing gives the healthcare system more time to “flatten the curve”
• Finally, for every # of people infected you hear reported in your area, you can safely multiply that number by 10x to 40x to get the real picture. In the bay area we have 200+ confirmed cases--best guess is we're actually closer to 5,000 or more.

And despite all of the above, if you suspect you're sick with CoV or someone you know is, I still don't know how to help instruct you on where you can get tested or even if you can get access to testing at this point. That's seriously fucked up. The U.S. is so far behind the world in this respect, it's reprehensible. So yeah, SOCIAL DISTANCING people.

The above is a lot to take in. I want to stress that it’s not time to panic. Most of us will get through this unscathed, but inconvenienced. CoV-2 will likely recur and we will see this virus again and again. Let’s get our shit together during this first pass, so we save ourselves and our resources for the next round.

My CoV information go-tos:

1. Johns Hopkins Center for Systems Science and Engineering, global map with current cases presented in a dashboard format: https://gisanddata.maps.arcgis.com/…/opsdashboa…/index.html…
2. Daily COVID-19 reports published by the WHO: https://www.who.int/…/novel-coronavirus-2…/situation-reports
3. The European Centers for Disease Control and Prevention: https://www.ecdc.europa.eu/en/novel-coronavirus-china
4. New England Journal of Medicine and The Lancet are great for more about the virus and disease itself.

Finally, The Washington Post, The New York Times, and The Atlantic are all doing solid work on the reporting front.

Stay safe and stay sane, friends,
Rachel
--
Rachel Hagey Saluti, PhD
Research Scientist
J. Glenn Laboratory
Stanford University School of Medicine
(512) 797-2596 || rhagey@stanford.edu

DUDE, WHAT IS THE DEAL WITH REPUBLICANS?

Again, from Sapolsky's Behave:

Starting with Theodor Adorno in the 1950s, people have suggested that lower intelligence predicts adherence to conservative ideology. Some but not all studies since then have supported this conclusion. More consistent has been a link between lower intelligence and a subtype of conservatism, namely right-wing authoritarianism (RWA, a fondness for hierarchy). One particularly thorough demonstration of this involved more than fifteen thousand subjects in the UK and United States; importantly, the links among low IQ, RWA, and intergroup prejudice were there after controlling for education and socioeconomic status. The standard, convincing explanation for the link is that RWA provides simple answers, ideal for people with poor abstract reasoning skills.

To summarize: on the average, rightists are made more anxious by ambiguity and have a stronger need for closure, dislike novelty, are more comforted by structure and hierarchy, more readily perceive circumstances as threatening, and are more parochial in their empathy.

The differing views of novelty certainly explain the liberal view that with correct reforms, our best days are ahead of us in a novel future, whereas conservatives view our best days as behind us, in familiar circumstances that should be returned to, to make things great again.

Republicans report three times as many nightmares as do Democrats, particularly ones involving loss of personal power. As the saying goes, a conservative is a liberal who has been mugged.

 Well now, there you have it.

DUDE, WHY DO THE RICH SUCK SO MUCH?

Second set of excerpts from Sapolsky's eye-opening Behave:

Why have stratified cultures dominated the planet, generally replacing more egalitarian ones? For population biologist Peter Turchin, the answer is that stratified cultures are ideally suited to being conquerors—they come with chains of command. Both empirical and theoretical work suggests that in addition, in unstable environments stratified societies are “better able to survive resource shortages [than egalitarian cultures] by sequestering mortality in the lower classes.” In other words, when times are tough, the unequal access to wealth becomes the unequal distribution of misery and death.

Almost by definition, you can’t have a society with both dramatic income inequality and plentiful social capital. Or translated from social science–ese, marked inequality makes people crummier to one another.

The frequency of “air rage”—a passenger majorly, disruptively, dangerously losing it over something on a flight—has been increasing. Turns out there’s a substantial predictor of it: if the plane has a first-class section, there’s almost a fourfold increase in the odds of a coach passenger having air rage. Force coach passengers to walk through first class when boarding, and you more than double the chances further. Nothing like starting a flight by being reminded of where you fit into the class hierarchy. And completing the parallel with violent crime, when air rage is boosted in coach by reminders of inequality, the result is not a crazed coach passenger sprinting into first class to shout Marxist slogans. It’s the guy being awful to the old woman sitting next to him, or to the flight attendant.

When humans invented material inequality, they came up with a way of subjugating the low ranking like nothing ever before seen in the primate world.

…people who dislike a particular out-group on economic grounds are likelier than chance to dislike another group on historical grounds, another on cultural, and so on. Much the same is true here—social, economic, environmental, and international political orientations tend to come in a package. This consistency explains the humor behind a New Yorker cartoon (pointed out by the political psychologist John Jost) showing a woman modeling a dress for her husband and asking, “Does this dress make me look Republican?” Another example concerns the bioethicist Leon Kass, who not only has had influential conservative stances on human cloning, finding the possibility “repugnant,” but also finds it repugnant when people display the “catlike activity” of licking ice cream cones in public. More to come on his issues, including with licking ice cream cones. What this internal consistency suggests is that political ideology is merely one manifestation of broader, underlying ideology—as we’ll see, this helps explain conservatives being more likely than liberals to have cleaning supplies in their bedrooms.

 

Categorical boundaries to the extension of empathy also run along socioeconomic lines, but in an asymmetrical manner. What does that mean? That when it comes to empathy and compassion, rich people tend to suck.

Across the socioeconomic spectrum, on the average, the wealthier people are, the less empathy they report for people in distress and the less compassionately they act. Moreover, wealthier people are less adept at recognizing other people’s emotions and in experimental settings are greedier and more likely to cheat or steal.

And, finally, a third set on conservatives here.

DUDE, WHERE’S MY FRONTAL CORTEX?

Long read, so very worth it.

I was struck by this passage encountered one late night in Sapolsky's brilliant Behave:

Chapter 6 discusses experiments where a subject plays a game with two other people and is manipulated into feeling that she is being left out. This activates her amygdala, periaqueductal gray (that ancient brain region that helps process physical pain), anterior cingulate, and insula, an anatomical picture of anger, anxiety, pain, disgust, sadness. Soon afterward her PFC activates as rationalizations kick in—“This is just a stupid game; I have friends; my dog loves me.” And the amygdala et al. quiet down. And what if you do the same to someone whose frontal cortex is not fully functional? The amygdala is increasingly activated; the person feels increasingly distressed. What neurological disease is involved? None. This is a typical teenager.

"Oh, that's why, he's literally brain damaged," I thought to myself. Such terrific explanatory power, I could hardly wait to get to chapter 6 which, it turns out, is titled "ADOLESCENCE; OR, DUDE, WHERE’S MY FRONTAL CORTEX?" I found that so very helpful in explaining why you-know-who acts you-know-how that I'm sharing these many additional quotes with you, my parents of teenager readers:

…the frontal cortex makes you do the harder thing when it’s the right thing to do…. The frontal cortex is the last brain region to fully mature, with the most evolutionarily recent subparts the very last. Amazingly, it’s not fully online until people are in their midtwenties. You’d better bet this factoid will be relevant to the chapter about adolescence.

All this takes energy, and when it is working hard, the frontal cortex has an extremely high metabolic rate and rates of activation of genes related to energy production. Willpower is more than just a metaphor; self-control is a finite resource.

Is resisting lying a demanding task for your frontal cortex, or is it effortless habit? As we’ll see, honesty often comes more easily thanks to automaticity.

If by adolescence limbic, autonomic, and endocrine systems are going full blast while the frontal cortex is still working out the assembly instructions, we’ve just explained why adolescents are so frustrating, great, asinine, impulsive, inspiring, destructive, self-destructive, selfless, selfish, impossible, and world changing.

Older teenagers experience emotions more intensely than do children or adults…. For example, they are more reactive to faces expressing strong emotions.

So adolescents take more risks and stink at risk assessment. But it’s not just that teenagers are more willing to take risks. After all, adolescents and adults don’t equally desire to do something risky and the adults simply don’t do it because of their frontal cortical maturity. There is an age difference in the sensations sought—adolescents are tempted to bungee jump; adults are tempted to cheat on their low-salt diet.

Novelty craving permeates adolescence; it is when we usually develop our stable tastes in music, food, and fashion, with openness to novelty declining thereafter.

This suggests that in adolescents strong rewards produce exaggerated dopaminergic signaling, and nice sensible rewards for prudent actions feel lousy.

…adolescents are more social and more complexly social than children or adults [and thus feel a] frantic need to belong.

Rejection hurts adolescents more, producing that stronger need to fit in.

An open mind is a prerequisite for an open heart, and the adolescent hunger for new experiences makes possible walking miles in lots of other people’s shoes.

Obviously, the adolescent years are not just about organizing bake sales to fight global warming. Late adolescence and early adulthood are when violence peaks, whether premeditated or impulsive murder, Victorian fisticuffs or handguns, solitary or organized (in or out of a uniform), focused on a stranger or on an intimate partner. And then rates plummet. As has been said, the greatest crime-fighting tool is a thirtieth birthday.

An oft-repeated fact about adolescents is how “emotional intelligence” and “social intelligence” predict adult success and happiness better than do IQ or SAT scores. It’s all about social memory, emotional perspective taking, impulse control, empathy, ability to work with others, self-regulation.

Heavy childhood exposure to media violence predicts higher levels of aggression in young adults of both sexes (“aggression” ranging from behavior in an experimental setting to violent criminality)…. The link between exposure to childhood media violence and increased adult aggression is stronger than the link between lead exposure and IQ, calcium intake and bone mass, or asbestos and laryngeal cancer.

Very helpful. And if you want a similarly telling explanation for why the rich (right) seem so puzzlingly unconcerned for the poor, here's a bunch more quotes.