One death is a tragedy

Most people have undoubtedly heard the famous quote attributed to Josef Stalin that one death is a tragedy and a million deaths are a statistic. As our country passes 100,000 reported deaths due to COVID-19 (the actual number is undoubtedly higher), we're seeing a horrible demonstration of how true that is. Yet while the saying undoubtedly goes to something universal in human nature, it also seems to me that we in America are collectively more apt to shrug off mass death than are people in many other countries.

Here in my home state of Ohio plans are continuing to go forward to reopen more and more parts of the economy. I am bewildered and dismayed by this. We instituted social distancing early enough here to prevent a massive surge of cases and we saved thousands of lives by doing this. But if we look at the daily death numbers (shown here with daily reported numbers in gray and a moving average to smooth out the daily reporting variability in black), we see...

The numbers reached a peak about a month ago. And they have essentially just remained at that peak ever since. On average a hair over 40 deaths each day. No real sign that that's changing.

So with the plan to continue reopening more and more of society despite no decline in deaths, it seems that we, for the time being, have just kind of... given up(?) on trying to bring those numbers down, and are just kind of... hoping(?) that they don't go up more?

If 40 people were to die every day over the course of a year, that would be 14,600 deaths. These are the top causes of death in Ohio for the year 2017, from the CDC:

Therefore COVID-19 would be the number three cause of death for the year, easily outpacing the current third place "accidents."

(If anyone is thinking "but we don't shut down society for heart disease and cancer" - those aren't infectious diseases. Plus, heart disease and cancer are very complicated issues and every year enormous resources are put into trying to help people stricken with them. COVID-19 is not an easy problem but it's, in theory, much simpler to solve because we're starting to get a decent understanding of how it spreads and how we can contain its spread.)

Think about that. An entirely new cause of death, jumping all the way to third on the list. Potentially 14,000+ deaths over the course of a year in Ohio alone, most of those people whose lives would be saved if we succeeded in containing the disease the way that countries like South Korea and New Zealand have. At that rate of death, odds are most of us will either know someone directly or know someone who knows someone who will die of this thing.

It's true, of course, that we can't shut down society indefinitely. The shutdown was supposed to buy time to implement solutions that would let us safely reopen. The problem is that a lot of people, most importantly those in charge at the federal level, have no real interest in doing what needs to be done to implement those solutions.

And now as we continue reopening, the guidance from our state government seems to be getting less and less evidence-based. I was dismayed to see that live music is being allowed to restart as long as performers have six feet distancing from all other people. Since we know that some of the worst spreading events can happen from people singing, there's no way that six feet distance would provide remotely adequate safety in an indoor setting.

I was also dismayed by an email I got from a spin studio at which I once attended a class, where they are reopening in a few weeks, stating that they are amending their mask policy so that masks won't be required in the bike room during class, and they believe this change falls within the state's guidelines ("that customers should 'wear face coverings based on activity'"). True, a spin class is not an ideal time to wear a mask, but based on reports of disease spread from intense fitness classes, I think that a spin class during this pandemic is probably just not safe, period.

I'm not putting the blame there primarily on the spin studio's owners. The state is forcing people to choose between further economic hardship and safety during a pandemic. It doesn't have to be this way. The government could give everyone who needs it enough economic assistance to get through the pandemic until things actually are under control - which is far from where we are right now.

And if you're wondering where we're going to get the money? Once things are better, we tax the wealthy like we did to get us out of the Great Depression and through World War II - the previous biggest crises we faced in the last 100 years. Right now the wealthiest of Americans, rather than having to make even the tiniest of sacrifices themselves, want to force ordinary Americans, disproportionately people of color, to work in unsafe conditions and to risk sickness and death. We shouldn't let them get away with it.

I have written before about how sickened I am by the way we, as a society, shrug off roughly 40,000 annual deaths each (nationally) from gun violence and traffic violence, when the death rates from those same causes are so much lower in other wealthy nations. Now it looks like the same thing is happening with COVID-19, but at a vastly higher level.

The damage from this is going to be with us for a long time. We have to all do our parts to mitigate that damage as much as we can. Keep social distancing as much as reasonably possible, and always wear masks when in places with a risk of disease spread. And we have to hold the people who are most responsible for this catastrophe accountable. Most especially at the ballot box this fall. And then, in the years to come, we have to always remember what happened and take steps to fortify our social safety nets and our relevant government agencies to make sure something like this doesn't happen again.

One hundred thousands deaths, and counting, are a statistic. But to all the people affected by those deaths, every single one is its own tragedy.

The other virus

I have a lot of things I want to say right now but it's been hard to find the right words to say them and even harder to figure out how to organize those words. What's going on in this country is absolutely infuriating and heartbreaking. At times I'm feeling like I'm losing my mind. We have passed 70,000 deaths from a deadly pandemic and there's no sign that things will be getting better any time soon and it's such a massive failure because there are things we could do to make it get better and there are a lot of people, including a lot of people in positions of power, who are doing nothing but stand in the way of doing those things that we should be doing. Which leads me to say that although COVID-19 is a deadly virus, there's an even deadlier virus that has been spreading in our society for the last few decades. A virus of insidious propaganda infecting the minds of a significant chunk of our country's population.

But let's first look at where we are with COVID-19 right now. Let's look at the current situation in my home state of Ohio, which is not so different from the current situation in a lot of other states. We are fortunate that we got advance warning and that we took preemptive action to stop a massive surge of cases from happening. Our Republican governor Mike DeWine listened to the Department of Health head he appointed, Amy Acton, a medical doctor who also has a Master's in Public Health, and took the lead nationally in shutting down large events like conventions and sports games before infections and deaths started to mount in the state. On March 23 a stay at home order was issued. So let's see what has happened since then. This is a graph I made using the daily COVID-19 hospitalization numbers reported by the state (obtained from covidtracking.com which aggregates all the states' data). There's a lot of variability in day to day numbers; for example, reported numbers on weekends tend to be lower and then there's a backlog that's made up for with higher numbers during the next week, so the black line is a moving average to better illustrate the underlying trend.

Numbers were steadily climbing. The stay at home order was put in place. Two weeks later the numbers fairly abruptly stopped rising. That time delay is pretty much exactly what we'd expect given what we know about this disease!

When I first looked at this graph early last week, it looked to me like we were on a gradual downward trend, but what it looks like now is that after an initial decline from the peak we've had almost three weeks in which the numbers have been basically flat. Suggesting that the measures we have collectively been taking over the course of the month of April to slow the spread of the disease have been enough to stop the number of infections from further growing - but not enough to make the number of infections decline toward zero.

Now there's a big push from some quarters to reopen society and we in Ohio are already going forward with the beginning stages of a plan to open things up. It's a careful and cautious plan. Some other states such as Georgia are going forward with much rasher reopening plans. But does it make sense to be reopening at all?

I'm not an expert in infectious diseases or public health. I don't know the specific details of how different interventions might affect transmission rate, and even people who do have expertise in these fields are still working furiously to try to better understand these details. But at a broad level there is a pretty simple concept here. The infectious model of disease spread has been known for a long time. If the number of infections is currently stable, and we make interventions that will, in aggregate, increase opportunities for the disease to spread, the number of infections is probably going to go up. We are currently still at a higher case load than we were when the stay at home order was enacted. If we went back to normal life right now, numbers would go up just as surely as they were in March. Even if we went back to something in between the way things are now and the way things were in normal life, numbers would go up, just at a slower rate. And then without further interventions to slow the spread they'd keep going up. And up and up and up. Because that's the way infectious diseases work. They'd keep going up until enough people had been infected to achieve herd immunity, but to get there we would first need an absolutely catastrophic death toll.

(I don't expect the numbers to actually go up and up and up. If they go up enough people will probably back off from reopening. We might have an extended period of alternating gradual inclines and declines. A sort of coronavirus limbo.)

The people of this country have made great sacrifices during this pandemic. Sacrifices to lives and health and economic well-being. We should, as a country, have been using the time bought by those sacrifices to come up with a plan, an evidence-based plan formulated by people with subject matter expertise in relevant fields, to get things under control long term. That basically hasn't happened at all.

Why? How did we get into this situation? What the fuck is going on?

On February 26, Donald Trump infamously said, "Again, when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done."

Even after weeks upon weeks of horrifically rising death tolls, he has persisted in this way of thinking. "I think what happens is it’s going to go away. This is going to go away," he claimed on April 28. Apparently others in the administration have also been putting forward this idea that the virus is just going to go away on its own in the coming months. It's essentially a form of magical thinking. It's ignoring all evidence and ignoring all the advice from experts in epidemiology and public health. I'd say it's even dismissing the idea that there is even such thing as subject matter expertise. Like they really seem to think that their predictions based on no evidence carry just as much weight as the predictions of people who have spent years studying these issues.

Look, it's not like everything scientists say is correct. All sorts of mistakes have been made using science. There's a famous Winston Churcill quote: "Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…" I'd say a similar thing about science: it's the worst method of understanding how the world works, except for all those other methods that been tried from time to time. It's impossible to ever get a perfect understanding of how anything works, but through proper application of the scientific method we can get increasingly less imperfect understandings, and we can do amazing things with those increasingly less imperfect understandings. The advances in human health, in identifying, stopping the spread of, and treating and curing various medical conditions, that science has given us over the last couple of centuries are truly astounding. And there are many other equally astounding achievements. We, as a country, put a man on the moon! Now we're letting this virus bring us to our knees?

Here in Ohio, the Republican governor had the wisdom to listen to Dr. Acton, a subject matter expert, to formulate a strategy to fight this pandemic. The Republican administration in Washington DC is utterly lacking that same wisdom. And even in Ohio, numerous Republican members of the state legislature are now trying to stop Dr. Acton from doing her job, some even going so far as to draw comparisons between Acton (who is Jewish) and Nazi Germany. At the same time, largely right-wing protesters are gathering at state houses and at public officials' residences, and resistance is growing, again largely among those on the right, to evidence-based approaches to containing the pandemic such as social distancing and mask wearing.

A recent Ipsos/Axios poll asked Americans whether they believed the actual number of deaths from COVID-19 was greater than, less than, or about the same as the officially reported number. These were the results:

(source)

This is not a question where the answer is a matter of opinion. It's a question where solid evidence exists in support of a correct, factual answer. The following image shows the number of deaths over the course of this year for three states with large COVID-19 outbreaks compared to the number of deaths in an average year, along with the number of officially recorded COVID-19 deaths:

(source)

It's impossible to ever know the exact numbers, but the gaps between the orange COVID-19 deaths and the dotted lines on each plot are reasonable approximations of the uncounted COVID-19 deaths. Therefore, the correct answer to the question in the above survey is very likely "more" and is definitely not "less." Notice that a majority of Democrats and a plurality of independents answered "more," whereas a plurality of Republicans gave the objectively wrong answer "less."

Why have questions of objective reality become such partisan issues? Why?

I won't get into the lengthy list of reasons why Trump's response to this crisis has been one of the worst failures of a president in American history, and yet surveys continue to show that a solid 40% of Americans approve of Trump's job performance. Most people I know, even many of those who have voted Republican for much of their lives, are all too aware at this point of how poor Trump's job performance is. Who are these 40% of Americans? What world are they inhabiting?

Sadly, this all goes back to the other virus I alluded to at the beginning of this post. In the 1990s, Fox News and other right-wing media sources began a concerted effort to convince their audiences that all other sources of news were "the liberal media" and could not be trusted. It was a great strategy to improve their profits, and also a great strategy for the very wealthy to get working and middle class voters to continue to vote against their own economic interests. This misinformation virus began to take hold in the '90s but has since grown into something even more insidious. I'm sure many of us have seen someone we know and care about fall under control of this virus over the years. The George W. Bush administration took great advantage of the right wing media machine, but there was a key difference - back then, I think that those in power were taking advantage of their propagandized voters but didn't actually believe themselves in a good deal of the propaganda; today, those in power have themselves become just as propagandized.

Many of today's GOP politicians are people who have spent so much time under the virus's influence that they're no more able to see reality than are their most devoted Fox News viewing voters. Trump himself is a Fox News junkie. Furthermore, many GOP politicians have become so cultish in their belief that it's not the government's job to help disadvantaged people that even if they can see the reality of the situation, they seem to be pathologically incapable of wanting to do the right things: providing sufficient economic relief so that people don't have to choose between their livelihoods and trying to stop the spread of a deadly virus, and mobilizing this country's vast resources in science, medicine, and industry to come up with plans to stop this pandemic in its tracks. As I said before, we went to the moon. We could certainly tackle this challenge if we had the will to do so.

How could a political party that has become so fundamentally opposed to doing things that would benefit any but the wealthiest of their constituents continue to maintain power? There are a lot of factors, but a very big one that can't be ignored is, again, that virus of misinformation. Propaganda is effective.

Let me be clear that there are certainly also moderates and liberals who are living in distorted realities. There are certainly also numerous problems with the Democratic party and with its response to the pandemic. And I think there's a tendency among people in general to not take something like this seriously enough if it hasn't affected them personally. But to try to claim that this problem is not an asymmetric one that is much larger on the right is to deny reality just as much as trying to claim that COVID-19 deaths are being over-reported.

We've been building to a moment like this for a long time. The disinformation virus has infected the minds of enough voters to keep an increasingly plutocratic and amoral GOP in power. The virus has strengthened its hold over those voters' minds to the point where they are increasingly living in a different reality made up of "alternative facts" (to quote Kellyanne Conway's January 2017 defense of the Trump administration's lies about inauguration crowd sizes - a preview, it now seems, of everything that has come since). The virus has infected not only the voters, but the politicians who represent them. With a president now under control of the misinformation virus, whose world view is warped by media sources who are themselves intentionally presenting a warped world view to be more favorable to that president, there is now a vicious feedback cycle at play. Those who are fully under control of this virus are spiraling farther and farther away from reality. And now with all this having been set up over the course of the last three decades, a perfect storm of a crisis hits. For us to tackle this crisis in an ideal manner, it would require that our public servants and the public at large would all buy into evidence-based, expertise-guided solutions. It would not be a simple task. A pandemic like this one is a very rare event. It would take a great commitment of effort and resources. But it could certainly be done.

It's pretty simple if you think about it. With the level of social distancing and other measures we've taken so far, we've gotten the cases to be pretty flat. And we all know that there are plenty of people, both in positions of power and in everyday life, who aren't taking this as seriously as they should. If all those people could just be doing a little better job, cases wouldn't be flat, they'd be declining. And then with the extra time bought by cases declining, we could devote the great resources of our country to building up a massive testing program so that everyone can get tested. And then we could mostly reopen society and keep things under control with a fraction of the current death toll until a vaccine becomes available. This is all very plausible. Other countries are accomplishing it much more successfully than we are. But it looks like the other deadly virus of propaganda and misinformation is preventing us as a country from stopping the deadly virus that causes COVID-19.

One of the worst parts is that, whereas COVID-19 is a crisis that has solutions that are, at least in theory, fairly clear, the crisis of the misinformation virus is one that I don't really have a clue how we're going to solve. Studies have shown that when people strongly believe in something untrue, if you present them with evidence that contradicts their erroneous belief, it tends to just make them believe it more strongly.

Why am I even writing all this? It's not going to change the mind of anyone who disagrees. I guess I hope that it might encourage people who don't disagree but haven't thought about these issues as much to think about them more, to think about what we can all do to overcome this problem. Think about whether there are people in your lives who might have a low-level infection from this misinformation virus and could still be cured. Think also, if you've ever been a Republican voter in the past, about what the party has become, how infected it has become with this horrible disease, and how this isn't just a Trump problem, it's a much bigger problem that we're going to continue to have to deal with long after Trump is gone.

And I'm also writing it because all these thoughts are swirling around in my mind and causing me distress and writing them down and putting them out in the world helps me process and helps me going forward to not have as much of my mental capacity taken up by these distressing thoughts.

Just a little over five years ago now I sat in a hospital room and watched as my wife, at 36 years old, died because her lungs stopped working. I will vividly remember that horrible night for the rest of my life. I don't want other people to suffer that same fate if it can be avoided. There are a lot of people unnecessarily suffering that same fate right now, and the whole experience is made that much worse by the limits on hospital visitations that are required to help contain a deadly pandemic. I work in scientific research because I want to try to discover things that could save people's lives and improve their health and well-being. My motivations for speaking out on and combating misinformation about COVID-19 are the same. It's infuriating and depressing beyond words that so many people all the way up to the president of this country have had their minds so warped that they would brush off all that death and ignore experts' guidance on how to stop it. I don't know what we can do about it but we have to do better.