A deeper dive into COVID data: what do those daily numbers actually mean? (Or: why growing hot spots are already worse than you know)

Every day we can go online and see a news report that today our state announced x new COVID cases, y new hospitalizations, and z new deaths. Have you ever wondered what those numbers actually mean?

Someone who was very new to all of this might think, oh, if those are the newly released numbers today, that means that yesterday there were x new cases, y new hospitalizations, and z new deaths.

Someone who has been following the numbers for a while would probably know by now that that's not quite true. They probably would have noticed that every week the number of daily deaths spikes in the middle of the week and plummets on the weekend. And they might know that this is because reporting slows down on the weekend and this creates a backlog that is cleared during the ensuing week.

Based on this knowledge, my general assumption was that most of the deaths reported on any given day were deaths that had occurred over the last few days, with some slowing down on the weekend and catching up during the week.

Turns out, it's more complicated than that!

Warning: this is going to be a very nerdy post full of graphs and number crunching, but if that sounds interesting to you, read on. The purpose of this post is largely educational, but if you don't feel like wading through the whole thing and want a take home message related to what's going on in the country right now, it's this: in places like Arizona, Texas, and several other southern states where numbers are now spiking, the real current numbers are likely already substantially higher than the reported numbers, and it might already be too late to avert disaster.

I've been following the numbers from covidtracking.com for quite some time. That site is the source for most visualizations of COVID daily numbers for the U.S. and its states that you'll see online. Every day the site updates and the number of newly reported cases, deaths, and (for many states) hospitalizations becomes available. What we are seeing there, and what is going into almost all the graphs that you might see, are the numbers by report date. Using the numbers from covidtracking.com, there's no way to see the actual dates on which those deaths, hospitalizations, or positive COVID tests occurred.

I recently started also looking at the numbers the state of Ohio provides on its COVID-19 dashboard. Here, the test date as well as (if applicable) hospitalization date and death date for each reported COVID case in Ohio are available. Here we can see on what dates all these events actually occurred, not just on what dates they were reported.

I've spent some time analyzing all these numbers and learned some things I found very interesting, so I wanted to share them with anyone else who'd like to learn more about this topic.

For the first set of graphs I looked at the numbers Ohio reported on each day of the one-week period from May 27 through June 2. This is a graph looking at all of the COVID cases Ohio reported during that week, by the case onset date (x-axis), with color coding indicating on which day of that week the cases were reported:

So, for example, new cases that occurred on May 26 were reported in large numbers on May 27, 28, and 29, and continued to be reported in decreasing numbers on May 30, 31, and June 1.

You can see from this graph that the bulk of the new cases reported between May 27 and June 2 happened relatively close in time to that week, but a quite substantial number of the cases occurred up to three weeks earlier, with smaller numbers going all the way back to March.

If you look closely, you might also notice that some of the colored bars are slightly negative, which would indicate that on the report date indicated by that color, the number of cases with that onset date was adjusted downward, presumably a result of corrections to make previously reported numbers more accurate.

Let's next look at the same graph but with hospitalizations:

It looks fairly similar to the new cases graph, although the peak at the right side is somewhat broader, indicating a tendency for there to be a bit more of a delay with the new hospitalization reporting than the new case reporting, at least over this time period.

And now the same graph for deaths:

Here the trends differ more from the other two graphs. The top of the peak is farther to the left, and the height of the peak relative to the height of the trailing bars toward its left is not as large, indicating that a greater proportion of deaths had reporting delays of more than a few days.

So those are examples of what the reporting delays can look like for cases, hospitalizations and deaths. Next let's look at the delays in a more quantitative manner. Here I used a longer period of time, from May 27 through June 10. For every case, hospitalization, or death reported in that time, I calculated the difference between reporting date and event date, and then I plotted the cumulative distributions of those values:

This graph shows, for any number of days from the day an event occurred, what fraction of events of that type are reported within that number of days. So for example, if you move right along the x-axis to 2 days, you can draw a line straight up and see that about 30% (0.3) of deaths are reported within two days of the death date, whereas for hospitalizations and cases it's more like 40%. Or say you want to see how many days it takes before half of a given event type are reported. Go up the y-axis to 0.5, then draw a line straight to the right and find that it takes 3 days for hospitalizations and cases but 5 days for deaths.

The distribution for deaths lags the distributions for cases and hospitalizations, meaning deaths tend to have longer delays, up to about 10 days or 75% reporting. Note that for all three types of event it takes about nine or ten days before you even get to three-quarters of full reporting! Beyond that point the trends reverse and it takes longer to pick up the most lagging cases and hospitalizations than the most lagging deaths; I'm not sure why that is. Also, the distributions for cases and hospitalizations are quite similar to each other.

You might wonder whether these distributions are affected by the day of the week on which the event occurred (or at least, I wondered that!).

The answer is yes. Here's a figure of the same thing except separated out by the day of week of each event (day of the event, not day the event was reported):

You can see that the delays are much more pronounced for deaths that occurred on a Tuesday, Wednesday, or Thursday, which makes sense with what I've already mentioned about reporting of deaths being slower on weekends. If a death isn't reported by Friday, there's a good chance it will take several additional days before it's reported. It takes a full seven days before there's even a 50% chance that a death occurring on a Wednesday will be reported.

Hospitalizations and new cases generally don't have as pronounced of a day-of-week effect on reporting delays. I did notice that for some reason, new cases occurring on Sundays apparently tend to have much longer delays.

So what does this all mean when it comes to interpreting the daily numbers that we see?

If you've read any of my posts about COVID you've seen graphs that look like this one:

The gray curve shows the number of deaths that were reported each day and shows the weekly oscillations I was talking about. You'll see trends like that on any COVID death graph that is showing the daily reported numbers with no smoothing. The black curve is a seven day moving average of the gray curve, which is another very common way of displaying COVID data. (Note: the dates for the black curve are the center dates of each seven-day period. Sometimes you might see the same sort of graph but with the dates being the end dates.) As each point is the average of seven days, it eliminates day-of-week effects and the weekly oscillations go away. You'll see this method of displaying the data on a lot of websites.

Similar graphs could be generated for cases and hospitalizations.

Now let's see what it looks like when we compare the numbers by their report date (which is the way they are almost always displayed) with the numbers by their event date.

First, new cases:

As I always do with the graph of daily cases for Ohio, I'll point out that the weird spike in mid-April is a result of a huge number of positive tests in prisons all being reported in a big bunch.

I will also point out, as usual, that reports of cases have to be put in the context of the total test numbers. If the cases are going up it might be because more testing is being done; you have to also pay attention to the percent positive. If cases and percent positive are both going up that's when you really know there's a problem. This is now happening in a number of states, mostly southern; it hasn't been happening in Ohio although the last few days unfortunately show signs we might be starting to head back in that direction...

You can see throughout the graph the delay between when positive tests happened and when they were reported. It does look like the delay was larger in March than it is now, which doesn't surprise me. But the delay still exists.

Next, hospitalizations:

And last, deaths:

So the theme of these three graphs is that when you're in a period of time where the numbers are going up, the average daily reported numbers are lower than the real daily average numbers. When you're in a period of time where the numbers are pretty flat, the two are about the same as each other. When you're in a period of time where the numbers are going down, the average daily reported numbers are higher than the real daily average numbers.

Another thing about these graphs is in all three, the numbers by event date (red) take a fairly sharp downward turn toward the end, but that's not real - that's from most of the numbers not having been reported yet. More on that in a moment.

Because with this pandemic the most rapid daily changes have always come from the growth phase, not the decline phase, the biggest deviation between the daily reported numbers and the real daily numbers always comes during times when the numbers are sharply rising. See, for example, around March 25-27 on the hospitalization graph. The real daily numbers were about twice the size of the numbers being reported at that time.

What does this mean in regard to what's going on today? There are a number of states, such as Arizona, Texas, Florida, and South Carolina, where numbers are currently going sharply up. Things are already looking bad but the reality is things are already worse than the numbers we're seeing!

And this doesn't take into account the delays from infection to onset of symptoms, from onset of symptoms to hospitalization, hospitalization to death, etc. I might explore those in another post. I think people are generally aware of these time lags and the fact that the numbers currently being reported reflect people who might have gotten infected a couple weeks ago. But the reporting delays explored in this post can create an even bigger time lag between "events on the ground" and when their effects really show up in the numbers we see.

This post is mainly about sharing some things I found interesting and trying to educate people, but if there's a big take home message, it's that if the numbers being reported are sharply rising, things are already worse than they look, so action needs to be taken ASAP. Fortunately in Ohio we did that in March early enough to avert disaster. In places like New York government officials waited too long and catastrophic death tolls were the result. Now, despite a much greater advance warning and much greater knowledge of the disease, it looks like the same mistakes might be in the process of being made in places like Arizona.

So that's the big takeaway, and now I also want to share some other analyses I found interesting.

The thing I mentioned about how the graphs of events by event date bend downward at the end but that's not real? So the graphs by report date have outdated numbers. And the graphs by event date have very incomplete numbers. Is there a way we can see what's really been going on, say, in the last week?

I took a stab at this by creating a function that takes the number of currently reported deaths or hospitalizations for each date along with how many days in the past each date was and returns an estimate of the "real" number of deaths or hospitalizations. The estimate is based on the cumulative distributions of reporting delays that I showed earlier.

So, for example, let's say that for a day five days in the past, there have currently been ten deaths reported. And say that the cumulative distribution shows that by day five, 50% of deaths for a given day are reported on average. Then the estimate for the "real" number of deaths for that day is doubled from ten to twenty. (The function is slightly more complicated because it uses the different distributions for each day of the week, which I found seemed to add a little accuracy.)

How do I know whether this method is effective? I can now look at the deaths that were reported by a date several weeks in the past, calculate the estimated daily deaths, and then compare them to what the numbers look like several weeks later, now that reporting is much closer to complete. I did find that the very most recent day has too much variability because the correction being made is very big, so I'm dropping the most recent day from the analysis, but other than that the results are pretty good. Let's take a look.

Here's a graph that shows the deaths by death date, both the most recent numbers and those that were reported by May 26, along with the estimated deaths from my calculations:

As you can see, the deaths that were reported by May 26 (gray curve) show the same downward bend at the end that we saw earlier in the graphs of the most recent numbers. The numbers for that same time range as of the most recent report (black) show that that downward bend was not real. The real numbers were basically flat at that time. But on May 26, using my estimation function, we would have seen that downward bend transformed into something that was basically flat (orange) and that turns out to be quite close to the more complete numbers that we now have for those dates.

The closer you get to the current date, the more uncertainty there is in these estimates, but all in all the method seems to work well. I also checked this with the function I made for hospitalizations as well as with the deaths/hospitalizations that were reported by a couple of other dates over the course of the last month, and I was quite pleased with how the results turned out.

Given the dual problems of the numbers by report date (what we usually see) being outdated, and the numbers by event date being very incomplete for more recent dates, this adjustment method seems like a decent way to better see what's really been going on recently. I'm not claiming that it provides any huge utility for informing decision making, but it does provide at least a little insight about the recent trends. Whether or not anyone else finds it useful, it was an interesting exercise for me to tackle!

Now let's update the graphs I showed earlier comparing events by report day to events by event day to include these estimates. Here's the updated graph for deaths:

You can see that, as we have been in a period of declining deaths, the estimated deaths from my calculation (blue) are in between the deaths by date reported and the deaths by event date.

The hospitalization graph is more interesting:

We have also been in a period of declining hospitalizations. If you are looking at a graph of new hospitalizations by their report date, which is the graph you'd normally see, it looks like the curve is still trending downward. But in the estimated curve, it appears that the downward trend has recently leveled off and (although the most recent estimated numbers contain the most uncertainty) we may be starting to head back up.

This is concerning. I was worried about what would happen when bars and restaurants reopened. We didn't see an immediate effect from that, but we may be seeing one now. The numbers will have to be closely watched in the coming days. If this is the start of a real upward trend, it suggests we need to back off from reopening for the types of businesses (such as bars and indoor dining at restaurants) with the most transmission risk.

It also reinforces the importance of everyone being careful and of wearing masks, for which there is now a lot of compelling evidence of benefit in slowing disease spread.

One last interesting tidbit I found from this analysis. We know that in the reported numbers there's a strong day of week effect with higher numbers midweek and lower numbers on the weekend. Are there day of week effects in the actual numbers by event day?

First, cases:

The numbers are much lower on the weekend, especially on Sunday. This isn't surprising. If someone gets tested as a result of, say, a doctor's appointment, that would clearly happen less on the weekend. (Note: in making this particular graph I excluded the very high single day totals from prison testing, which would bump up the Thursday and Friday numbers if they were included.)

Next, hospitalizations:

Similar to cases but with a less pronounced decline on the weekend. Also Monday appears to have a slight bump compared to other weekdays. This all makes sense as well. People would be somewhat less likely to go get admitted at a hospital on the weekend, and then there's a bump on Monday to partly make up for people delaying going over the weekend.

The deaths graph is what surprised me:

Friday really stands out from the other days and I wonder why this is. Now, I don't know for sure that all of the death dates are completely accurate. Perhaps there is some tendency for the dates to occasionally be in error in a way that biases them toward Fridays.

If it is a real trend, I do have a somewhat morbid hypothesis for why it might exist. Perhaps when someone is clearly going to die soon, there's a little bit of a tendency - whether it be in the dying person, in the family, or in the hospital staff - to want to "get it out of the way" before the weekend.

Just a thought. And it might not be a real trend.

So that wraps up this deeper dive into Ohio's COVID data. I hope you found it interesting and informative. I may do some other posts like this exploring other aspects of the data. I've always really loved numbers and analyzing numbers and making charts and graphs ever since I was a child. Now, between posts like this and analysis I'm doing of things directly related to my research job, I spend a huge amount of my time thinking about and working with COVID-related numbers. It can be a distressing topic to spend so much time on, but I think doing all this helps me feel a little less powerless, because I'm actively working on things to try to make a difference.

Stay safe, everyone.

Privileged bubbles and trying to pop them

Recent events in the news:

A Black man jogging through a White neighborhood in Georgia was murdered in a modern day lynching; this happened months ago and the killers would have gotten off scot-free, with help from local authorities, if not for a video being made public.

A Black woman EMT in Louisville was shot and killed in her own home by police officers executing a no-knock warrant at the wrong address.

A White woman called the police and threatened the life of a Black man by falsely claiming that he was threatening her after he asked her to obey the rules and leash her dog in Central Park.

A police officer in Minneapolis murdered a Black man by kneeling on his neck for nine minutes while the victim offered no resistance.

All this in the midst of a global pandemic that here in the United States is both taking advantage of and putting a spotlight on existing systemic inequities as it disproportionately kills people of color.

And now, police are violently cracking down on protesters against racist police violence, just weeks after police exhibited remarkably peaceful restraint when faced with heavily armed White protesters who stormed state government buildings because they were angry they couldn't get haircuts.

Noticing a theme?

My Facebook feed is full of people expressing well justified outrage at these events. I'm not criticizing people for posting hashtags. I'm glad that so many people want to do something to make a difference. But what can we (and by "we" I specifically mean White people) do to actually make a lasting difference? Plenty of awareness has been raised about these issues by now. I'd guess that most everyone who is going to care about the issues already cares about them. People who still don't care, even now, aren't going to start caring because they saw another hashtag.

I'm absolutely not faulting people for posting statuses on Facebook to raise awareness, but that's the easy part. We also have to do things that aren't easy.

In this day and age, with a virulent racist occupying our nation's highest office and with white supremacists emboldened by this fact, it is not enough to be "not racist." (It has never been enough to be just "not racist," but I think that's become far more obvious over the course of the last decade and especially last few years than it was for most of my own lifetime.) We have to be actively anti-racist if we want to do something about the underlying racism that affects everything in our society. What are some things we can do to be actively anti-racist?

I've thought about this a lot in recent years, ever since Ferguson, really. I won't claim to be an expert. But I'd like to share some of my thoughts relating to my own life experiences.

"Who would really have it any other way?"

It's so easy for White people to live in a bubble. I know this very well from my own life. And White people, generally speaking, have no idea what it's like to actually experience racism. But we know that racism is bad, because we've been told that all our lives. And we've been told that racists are bad people. And we don't think that we ourselves, or our close friends and loved ones, are bad people. Therefore we must not be racist and we must not be contributing to the racism that is everywhere in our society.

Being told that something we did or said was racist, or contributed to racism, does not feel good. I know this. It hurts our feelings. But that doesn't mean it's not true. (Nor does it necessarily mean you're a bad person.) We have to stop being so sensitive to our own hurt feelings. We have to stop being such snowflakes. If the worst racism-related thing you can imagine happening to you is being called a racist... imagine what it's like to actually be a victim of racism.

The killing of George Floyd in Minneapolis, for me, unavoidably recalls memories of events that demonstrated to me just how hard it is for White people to recognize and confront racist sentiments expressed by people close to them. Floyd was quoted as saying "I can't breathe" while that police officer choked the life out of him with a knee to the neck.

The phrase "I can't breathe" entered the national consciousness after a similar incident almost six years ago when Eric Garner, another unarmed Black man, uttered the same words while the life was choked out of him by an NYPD cop.

A relative of mine wrote an infamous newspaper column about Eric Garner's death. The column began [content warning: extremely inflammatory sentiments about victims of racist police violence]:

Eric Garner and Michael Brown [the victim of the police shooting in Ferguson, Missouri] had much in common, not the least of which was this: On the last day of their lives, they made bad decisions. Epically bad decisions. 

Each broke the law — petty offenses, to be sure, but sufficient to attract the attention of the police. 

And then — tragically, stupidly, fatally, inexplicably — each fought the law. 

The law won, of course, as it almost always does.

On a family email list, an email thread about this column - or more specifically, online reactions to this column - came up. Family members were offended at the insults online commenters were slinging at my relative who wrote those words. Some family members did, yes, express disagreement with the column's sentiments. But no one said anything remotely to the effect of, "hey, that's pretty... racist?"

Another passage in the infamous column was this:

Second, and this speaks to the ubiquitous allegation that cops are treated “differently” than ordinary citizens in deadly-force cases: Indeed they are — and it is the law itself that confers the privilege. 

The law gives cops the benefit of every reasonable doubt in the good-faith performance of their duties — and who would really have it any other way?

I'd say that the overall sentiments in this column are pretty racist, and it would require a pretty narrow definition of what qualifies as "racism" to deny that - but this is something of a semantics issue. It's literally impossible to have lived in society and not have racial biases that affect our thinking, because we're constantly bombarded with messages that implant these biases in our brains. Whether these biases rise to the level of being "racist"? Does it matter that much?

Whether or not it's "racist," that statement - the law itself... confers the privilege... The law gives cops the benefit of every reasonable doubt... and who would really have it any other way? - in light of the things that keep happening to Black people at the hands of law enforcement - over, and over, and over - is probably one of the most blatant examples of being blinded by one's one privilege that I've ever seen. Like, maybe you can't imagine why anyone would really have it any other way... but maybe the people who have to constantly live in fear of what cops might do to them or to their loved ones, maybe they would have it another way?

(Because people's feelings get hurt so much by any hint that they're guilty of racism, other terms have been invented to try to illustrate the same concepts in different ways. Such as "white privilege." "White privilege" is basically just another way of saying that society is racist against non-White people. And it doesn't mean that White people's lives are easy, just that when White people's lives aren't easy, the color of their skin isn't one of the reasons for that. But again, as with "racism," people get their feelings hurt by the term "white privilege." Stop being such fragile snowflakes.)

Although this newspaper column is nearly six years old now, it came up not too long ago on the same family email list, in an unrelated topic, but before all the current craziness (that is, COVID and mass protests) in this country started. And in that recent thread, family members from different parts of the political spectrum all seemed to scoff at the idea that the relative who wrote that column was racist or was even "racially biased."

Because of course. Racists are bad people. My relative, a person I care about, is not a bad person. Ergo, my relative is not racist.

It doesn't really work that way.

I reiterate, it is impossible to live in society and not be racially biased. It is a question of whether we actively work to recognize and confront those biases.

Not unrelated to this line of discussion, the relative in question, in other emails, has also favorably cited the writings of Charles Murray, author of noted work of pseudo-scientific racism The Bell Curve. Specifically, an article was shared that in essence claimed that if different racial groups had equal opportunities in society, that wouldn't necessarily result in the different racial groups having the same outcomes - "the same mean income, the same mean educational attainment, the same proportions who become janitors and who become CEOs."

This is pretty much by definition a racist claim by Murray.

Think about how many times in the average Black person's life they must encounter an Amy Cooper (the Central Park dog leash lady) or a Derek Chauvin (the Minneapolis cop who murdered George Floyd), and that Amy Cooper or that Derek Chauvin has some ability to influence the course of events in that Black person's life - grades they get, job hirings, promotions, criminal charges, etc.

In the real world we inhabit, it is impossible to test Murray's hypothesis that, given equal opportunities, different races would not attain equivalent outcomes, because we are so incredibly far away from equal opportunities.

This all happened a long time ago. But for whatever reason, these incidents just have a way of sticking in my mind forever. Incidents where someone put forth racist ideas and no one in the family stood up and called it what it was. I myself would sometimes try to push back, but I wouldn't go so far as to say, "hey, that's racist."

And perhaps that wouldn't have accomplished anything anyway, because, again, of the whole White people being fragile snowflakes about accusations of racism thing.

But how often do conversations like this happen in White families all over the country, and no one tries to advance the anti-racist narrative, and impressionable people - impressionable children, especially - are watching and listening and having their world views shaped by such statements going unchallenged?

So one not easy thing we have to do is, when someone we know says something racially problematic, we have to be able to point that out, ideally in a way that will encourage others to listen and not just shut down (that part of it is even less easy). Another not easy thing we have to do is, when someone does point out that we have done or said something racially problematic or that we bear some responsibility for the racism that permeates society, we have to get over our hurt feelings and make a good faith effort to listen and learn. White people's feelings are not the important thing right now.

Let me be very clear, this is not just a problem among conservative White people. This is a problem among numerous liberal White people as well. For another example from the dreaded family email list, a fairly liberal family member shared a statement by a fringe group of conservative African-American pastors decrying the Supreme Court's 2013 decision that the anti-gay Defense of Marriage Act was unconstitutional. The statement was, "We are devastated that the Supreme Court succumbed to political pressure by voting to weaken the sacred institution. They neglected our most precious children who need a mother and a father united in marriage for healthy development."

This liberal family member strongly disagreed with the Black pastors and expressed that they did not even know how to respond without being labeled racist. Basically, they felt that it was hypocritical for a Black person to say this because of the high rate of Black children being raised by single parents.

Obviously I do not agree with the Black pastors' stance on gay marriage. But saying that they're hypocrites because they're Black? Yes, yes that would, in fact, be racist.

And again no one else in the family seemed to have a problem with this.

Again, a long time ago. Again, something that stuck in my mind. That's just the way my brain works.

The point is not to demonize specific people in my extended family, it's to illustrate how pervasive these attitudes are, and how casually accepted they are, even among people who harbor no conscious animosity toward other races and who would absolutely never think of themselves as racist.

I don't want to just call out other people here. I'm not going to pretend I'm immune to this stuff.

Bubbles

I grew up in a total white privilege bubble. In school I learned about the Civil Rights movement and the message that came across was that, although there might still be racist individuals out there, and those individuals were bad for being racist, racism as a structural, societal issue had largely been solved in the 1960s.

I was in such a bubble that I actually believed this to be true until at least several years into my adult life.

(The most ironic part was probably learning about school integration in a classroom that was at least 95% White and no one ever pointing out that disconnect.)

I remember when I was in college, thinking that if affirmative action was used for school admissions, it should be focused only on economic status, not on race, because I thought disadvantages Black students faced in modern society were due to Blacks tending to be poorer as a result of racism in the past, but not because of racism that still existed in the present. And that low income White students were just as disadvantaged as low income Black students.

This seems completely crazy to me now. But when I was in college, I actually believed this.

(And just in case it's not clear - I am not saying that low income Whites face no disadvantages. Just that Blacks, of any income level, face many other obstacles that Whites don't face.)

I also remember making enormous use of "ironic racism" for the purpose of Internet humor when I was in my mid 20s. I thought I was just being absurd because I thought that people generally didn't believe those things anymore, for real, in modern society.

Talk about being in a bubble!

Truth is, I can only think of two Black people who I knew in person over the entire first eighteen years of my life. Both were people I went to school with and got along with but neither was a close friend. I had literally not the slightest comprehension of what it was like to be a Black person in America, because no one ever tried to tell me.

This is a map showing the block-by-block racial demographics of where I lived when I was growing up (from justicemap.org which uses Census data):

Purple indicates Whites are the most common race. The darkest shade of purple indicates greater than 90% White. I lived in one of the purplest of purple regions on this map.

Where I live now looks very different.

On this map, purple again indicates Whites are most common, red indicates Blacks are most common, and the deeper purple or red indicates a larger percentage of that particular race. I live right at a transition point between plurality White and plurality Black. I didn't choose where I live based on the racial demographics, I just happened to find a place I liked in this location.

So here's the thing. When I was younger, if I had been passing through this neighborhood and seen the people who lived here, there would have been a little voice in my head saying, in essence, "A lot of Black people live here so it's probably not a very good neighborhood."

No one in my life ever tried to instill racist values in me. Not remotely. But when you grow up around all White people, and don't really know any Black people, and most of the Black people you see in the media are either pro athletes (who are obviously very rare to encounter in everyday life) or people accused of crimes, that's just what happens to your brain.

(It's also worth pointing out the inherent privilege in these "good neighborhood" assessments. Most White people would see a neighborhood like the one in which Ahmaud Arbery was murdered for jogging while Black as a good neighborhood.)

So as I said before, it's not a question of whether or not someone is racially biased, because it's impossible to live in society and not be racially biased. It's a question of whether you recognize that those biases exist in your brain and then make an effort to actively confront those biases.

I'm not looking for a pat on the back, like "oh what a great guy you are for overcoming your biases." I mean honestly the biases are still there and it's a constant process of confronting them, and it's not easy to do, but it's also not nearly as hard as it must be to be a person who is constantly on the receiving end of those biases. So I think the least I can do as a decent human being is try to recognize and confront those biases and I hope other people can do the same.

School integration (or lack thereof)

If we zoom out from those maps I showed to the metro area level, we see two areas that are both quite segregated, Cleveland (second map below) even more than Columbus.

This is pretty typical of American cities. Why? There's a long, racist, history there that I won't get into (but look into redlining if you aren't familiar with the term).

Oh, one of the upshots of this clustering of Black Americans into inner city areas is that they are exposed to higher levels of pollution (thanks, urban freeways!), which has all sorts of negative health effects on both the brain and body. One of these is higher rates of asthma. Eric Garner's daughter Erica, who became an outspoken activist after her father was killed by the NYPD, tragically died at the age of 27 after an asthma-induced heart attack. Erica Garner was a victim of our racist society just as much as her father. It's also very likely the case that her health conditions were exacerbated by the stress of living in a world full of people making derogatory and deliberately inflammatory statements about her and her deceased father.

That said, I mainly bring up this segregation because it goes to one of the other important but not easy things that my life experiences have convinced me White people need to do.

Everyone wants what's best for their children. A big part of that, society tells all of us, is making sure our children go to a really good school. I have no doubt that most people, when thinking about where they are going to raise their children (a very big decision, to be sure), look up the ratings of the schools that their children would potentially attend.

Ohio school district report cards show that the Grandview Heights school district, where I grew up, gets an A grade. The Cleveland Heights-University Heights school district, where I currently live, gets a D grade.

"I would be a bad parent if I sent my kids to a D-rated school!" a lot of people undoubtedly think.

What those people may or may not know is that these school ratings are largely proxies for the socioeconomic statuses of the students who attend the schools, and do not really tell us anything independent of that about the quality of the schools.

The school funding system in the state of Ohio, where school districts are funded by local property taxes so that wealthier districts have better funded schools, has been declared unconstitutional multiple times going back to 1997, and yet still nothing has been done to fix this problem.

Furthermore, because Black people face numerous structural obstacles at every step of life as a result of living in a deeply racist society, Black students, on average, are more likely to struggle in school. Therefore a majority Black district will tend to get lower ratings regardless of how good the teachers in those schools are.

At Grandview Heights High School, by the most recent report, the student population is 91% White (non-Hispanic). At Cleveland Heights High School, it's 76% Black, 15% White.

This is interesting when compared to the overall demographics of the cities. Grandview Heights is 93% non-Hispanic White. Cleveland Heights is 46% White, 42% Black. The former's school demographics match the city demographics. The latter's are drastically different.

This is because in Cleveland Heights a much larger percentage of students, especially White students, attend private schools.

So the pattern is: White parents who live in a racially diverse area tend to either (a) move to a not diverse suburb (like the one where I grew up) or (b) send their kids to private school (like the schools a lot of White kids in my current city of residence attend), either way so they can ensure their kids go to a high-rated school.

(Cleveland Heights, by the way, is one of the most liberal cities in the entire country. Out-and-out, virulent racists are extremely rare here. So this is definitely an example of what I mean when I say these problems that contribute to a structurally racist society are present among White people of all political stripes.)

"Separate but equal" was ruled unconstitutional in 1954. The Supreme Court correctly ruled that there could not be equality under segregation. Yet today, school segregation in much of this country is almost as bad as ever.

This is definitely one of those things that's not easy, because society bombards parents with messages that they have to make sure their kids have the best possible path to success and they have to make sure their kids go to the best schools and they would be irresponsible parents if they didn't. And one part of solving this is that we have to demand equitable school funding. But I also contend that any time a well-to-do White family living in a racially diverse metropolitan area makes a decision to send their children to largely segregated schools - public or private - that decision contributes, in its own tiny way, to the vast racial divide that is tearing our country apart.

Now this does not mean that White parents who make these decisions are racists or bad people. Okay, some are, but most aren't. They're just doing what society tells them they have to do to be good parents. But as this ongoing pandemic is also illustrating, we have to think beyond our own selfish interests and think more about society at large. Everyone doing what they think is in their own best interests creates a disaster for society.

I expect this is uncomfortable for some people to think about because I know that lots and lots of the people I know come from families who made the decision, or are people who made the decision themselves, to enroll children in largely segregated schools because that's what society told them was what they had to do for their children. But we have to confront this issue. This is part of what I mean by doing things that aren't easy.

And I don't mean that all well-to-do White parents have an absolute moral obligation to send their kids somewhere like Cleveland Heights for school. There are a lot of factors that go into a decision like that. I'm just saying promoting diversity and equity in society should be one of those factors. I'm saying that what we do have an obligation to do, at the very least, is to reject the notion that being a good parent means making sure your kid goes to a "highly rated" school, when we know that those school ratings reflect the socioeconomic statuses of the student bodies and little else.

If I had gone to a school like Cleveland Heights instead of Grandview Heights, would I have any less success in life? I really doubt it. I think my ability to be successful comes a lot more from the resources and nourishing home environment my parents provided me than it comes from what school I attended. (Underprivileged children, of any racial background, would undoubtedly have much more to gain from attending exceptionally well funded schools that someone like me.) I also know that friends of mine who attended Cleveland Heights, both White and Black, seem to have gotten good educations and turned out just fine.

And if I had attended such a school, it would have helped me to not be in such a ridiculous white privilege bubble for the first two-plus decades of my life.

I think everyone benefits from getting to know people from diverse backgrounds, as well as from having adequately funded schools. Right now, poor kids who would have the most to gain from really well funded schools are mostly trapped in underfunded schools with other poor kids, and therefore have neither adequate school funding nor diversity. Rich kids who have far more resources at home and could get by more easily with slightly less well funded schools but would really benefit from more exposure to diversity are often in really well funded but also not diverse schools. Some places like Cleveland Heights do genuinely have a lot of socioeconomic diversity, but I suspect the increasing reliance on school ratings by parents who have the most ability to choose where to send their kids to school is making it harder to maintain that socioeconomic diversity in their student bodies.

I want to again emphasize the point that it's not enough, it's never enough, to be not racist, we have to be anti-racist. Let's imagine that, somehow, tomorrow, suddenly everyone in the whole world stopped having any racist motivations whatsoever, but everything else was the same. Black students would still tend to be in less well funded schools, as a result of our country's racist past. Financially comfortable White parents, taking a totally "race neutral" approach but still following the paradigm that they have to send their kids to the top rated schools, would continue to move to mostly White suburbs and/or send their children to private schools. Black parents, having on average less financial resources because, again, of the effects of past racism, would generally find it much harder to make those same decisions about where to enroll their own children. Despite no one being racist anymore, racial segregation and inequity would continue for generations if not into perpetuity!

That's one of the reasons why we can't, can't ever, settle for just being not racist. We have to do more.

Going forward

With the chaos engulfing our country now as cops nationwide choose to violently crack down on protesters rather than accept the possibility of being held accountable for their actions, and the president encourages that police violence, and an increasingly authoritarian and white nationalist Republican Party seems hellbent on dismantling our democracy, I fear everything I discuss in this post is insignificant next to the urgency of this moment. Things seem to have gotten so much worse even in the time since I began composing these words.

The most important thing for the remainder of this year is ensuring Trump and the complicit Republicans in Congress are removed from power. If that doesn't happen, there's a very real possibility all will be lost.

After that, I hope and pray we will all have the opportunity to come together and rebuild our country into a truly more perfect union. The suggestions I'm making are not quick fixes for anything. They're things we'll have to make a consistent effort on for probably the rest of our lives.

I'm not an expert on these issues. I'm just someone who has thought about them a lot and who is hopefully less naive than he was as a young man who had lived his whole life in a bubble, and who likes sharing his thoughts with the world. I've only touched on aspects of the race issue that I can directly relate to my own life experiences. There are other, exceedingly important, elements, that I haven't explored. Police reform seems like the most pressing issue at this moment and I haven't really touched on it, but this is already a long post. And although the problems with police forces are the most blatant right now, if we want lasting change we need to address so much more than that.

The message that I want all White people to hear and process is this - "racism," "racial bias," call it whatever you want, but it's something we all have in our brains, something that affects how we all view the world, whether or not we want to admit it. We've all been told that racism is bad, so it can be uncomfortable to admit these things about ourselves. But we can't prioritize our own comfort over other people's lives. We have to directly confront these biases both in ourselves and in the people around us.

When someone we consider a friend or loved one says something that illustrates racial bias, we can't just let it slide for the sake of avoiding conflict. I get it. I'm generally a conflict-averse person. One thing I've had to work on in therapy is recognizing that avoiding talking about uncomfortable issues to avoid conflict tends to lead to bigger problems in the long run. This is true for societal issues just as much as for personal issues. Maybe the Trumpists' ongoing looting of our country and everything we took for granted is the price we White people are paying for our failure to directly address these issues for so long.

Of course, vulnerable communities and people of color are paying much worse prices for our failures.

When I was a kid, not only did I not really know any Black people, but the people around me didn't really talk about race in any meaningful sense. It seems like people thought, "Well, MLK said we shouldn't judge people by the color of their skin, so if we just tell everyone to not judge people by the color of their skin, it will all work out. No need for any more in depth or uncomfortable conversations about the many ways MLK's dream isn't being realized in society."

It's obvious now that approach didn't work.

I will strongly credit my parents for raising me with good values, even if those values weren't race-conscious. I learned to recognize the fact that my family was very fortunate, that there were a lot of people in the world who didn't have nearly the same good fortune, and that people who are very fortunate have a responsibility to help people who are less fortunate. I didn't learn that rampant racism in society is one of the reasons some people are much less fortunate, but once I became educated as an adult on these issues, my passion about them naturally grew from the values I'd been instilled with as a child.

We have to recognize now that part of instilling our children with a complete set of good values is teaching them about racial justice. And how to be anti-racist instead of just not racist.

We have to reject widely held beliefs that help perpetuate structural racism even in the absence of active racist intent, such as the commonly held beliefs about schooling that have resulted in segregation getting worse, not better, in certain parts of this country over the last few decades.

And we have to do so many other things. This is nowhere close to being a comprehensive list. My heart hurts at what is happening in this country. Writing this is my little attempt at making a difference. I hope it can make a small difference. I vow to do more in the months and years ahead to try to continue to make those small differences. If we all do something every day to make just a little tiny difference, that can add up to enormous change.

But only if we don't settle for doing the easy things.

Any of us who has been settling for doing just the easy things, we have to recognize that time is over.

We have to do the hard things too if we're going to save our country.

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.

The cost

Having been married to a really amazing person who was diagnosed with stage 4 lung cancer at the age of 34 and tragically succumbed to the disease at the age of 36 has, I think, given me a perspective on the COVID-19 pandemic that most people my age don't have.

For a related example, during my early adult years, I didn't bother getting an annual flu shot. I'll be fine even if I do get the flu, so what's the point? I thought. I know this is a very common attitude.

After Cara became ill with lung cancer, she passionately advocated for everyone to get their flu shots. Obviously, I did get mine, and I've continued to ever since, because now I understand - the reason it's important for young, healthy people to get their flu shots isn't to protect those young, healthy people from the flu; it's to decrease the chances that someone like Cara, who had compromised lung function and at certain points during her various treatments a compromised immune system, would get the flu. Getting a flu shot is such an easy thing to do but something with such enormous benefits if everyone does it. (Yes, flu shots aren't perfect and sometimes there are outbreaks of a strain that the shot didn't cover - that doesn't mean that flu season wouldn't have been much worse without the flu shots.) But before it was made personal, the importance of getting those shots never got through to me. So now I try to remind all the people out there who are lucky enough to not yet have had it made personal.

Now we're facing a historic outbreak of a viral respiratory infection that is far more deadly than the flu, and there's no shot we can get to protect ourselves and our vulnerable loved ones. So we have to do other things to protect all the vulnerable people out there - be diligent about washing our hands, don't touch our faces (these are things that would help against flu outbreaks too, and hopefully that's a lesson that society will learn going forward), and most important right now, social distancing.

It's simple math and biology. When an infectious disease is spreading in a population and we don't know who all has it, the more contacts there are between people, the more likely it is that the disease will spread. And with this particular disease, unless strong containment measures are taken, exponential, uncontrollable growth is inevitable, and it will result in our health care system being overwhelmed. There's a tendency for people to think "it can't happen here" but it can and it will. Look at places like Italy and Spain where the body counts are piling up and doctors are having to triage patients like during wartime. People who have severe symptoms and are too old are simply not given life-saving treatment because the resources just don't exist. It's already starting to be like that in New York City, and without serious intervention it will eventually be like that Everywhere. In. The. Country.

I've been thinking a lot about that twenty month period of time between Cara's diagnosis with lung cancer and her death, and what that time would have been like if it had happened against the backdrop of the raging COVID-19 pandemic.

Three months after Cara's initial hospitalization, her first treatment failed, her condition dramatically worsened, and we spent Thanksgiving in the ICU leading up to a surgery to create a window in Cara's pericardium and drain the fluid that was accumulating in the space around her heart. Imagine if that had happened while ICUs were overwhelmed with COVID-19 patients and there were no available beds. Stage 4 lung cancer is incurable; although some people now live a long time with the disease thanks to new treatments, the expected prognosis is still, ultimately, death. Someone with a terminal illness would not and could not be a top priority for an ICU bed in such a situation. Chances are Cara would have been dead. It would all have been over just three months after her diagnosis. Those additional seventeen months that have so many memories that I cherish so much (because that Thanksgiving in the ICU my honest assessment of the situation was that she likely did not have a whole lot more time left) would never have happened. And that's what will happen to so many people if the pandemic spreads unchecked. So many people will die premature deaths of COVID-19 and of so many other things, deaths that could have been prevented if the health care system wasn't so overwhelmed.

After the Thanksgiving in the ICU, Cara started a new treatment and her condition improved greatly. She never again returned to the ICU until the week before her death. But imagine also how different those seventeen precious extra months would have been if COVID-19 had cropped up during them. Cara would have had to live in constant fear of contracting the illness. She couldn't have continued working. She wouldn't have been able to hang out with her friends. The two of us couldn't have done so many great things that we did together. We couldn't have gone out and done pretty much anything other than go for walks. And walks are wonderful and I'm sure a lot of us are gaining newfound appreciation for them right now, but there are so many other things, so many wonderful social activities - for humans are social creatures, after all - that we and especially Cara would have had to miss. She would have been essentially trapped in our home for most of every day to reduce her risk of getting the infection and knowing Cara, I know how awful that would have been for her. And if I happened to find myself in any situation where there was a fear I might have contracted the virus, I'd have had to physically separate myself from Cara, and it's hard to imagine how hard that would have been for both of us, the whole time knowing that she had a life-threatening disease and every moment we had together was precious.

The spring after Cara's diagnosis, I successfully defended my dissertation after many long years of graduate school. Cara was so proud of me and so excited that she got to walk across the stage with me as I received my diploma.

Imagine if that had happened against the backdrop of COVID-19. The dissertation defense would have been virtual. There'd have been no going out to celebrate with family. The graduation ceremony wouldn't have happened. Cara wouldn't have gotten to walk across the stage with me. So many happy memories would never have been created.

In early March of 2015, Cara and I took a trip to Miami Beach together.

Obviously, that trip would not have happened during a COVID-19 pandemic. It was really great that we got to take that trip because it had been a very cold winter and that was really hard for Cara. We had no idea at the time she only had a month and a half to live. Because of that the memories are extra special to me.

When Cara did go, in a room on the Cleveland Clinic's palliative care floor, her mother and I were with her, and one or the other or both of us had spent a great deal of the time with her during those last few days. Right now at the Clinic there are no visitors to hospital patients with certain very limited exceptions. So for most of that time, at least until it became clear that the end was imminent, Cara would have been scared and alone in her hospital room. Or if the hospital system had become overwhelmed, maybe she wouldn't have even been able to receive proper end of life care.

And of course after Cara died, there was a funeral. When someone we love dies, it's such an important part of the grieving process to be able to get together with others who loved that person and to share memories and hugs and tears. Right now, that couldn't happen. There would probably be a video chat memorial service. There are probably going to be a whole lot of those in the weeks and months to come. And we would be thankful for having the technology to allow us to do that, but we would also be missing out on an essential part of the human experience by not being able to get together in person to say our goodbyes, to grieve, and to celebrate the lives of our lost loved ones.

Because being physically together with people we care about is such an important part of the human experience, it's hard right now to remove so much of that contact from our lives. But understand - the hypothetical scenarios I envisioned in this post, of what Cara's life with and death from cancer might have been like under the specter of COVID-19, those are reality right now for so many people. That's part of the cost of all this. And although we cannot control the fact that this virus exists and has spread to our country, we, collectively, have a great deal of power to control how bad it gets. If we let it get really bad, if a large percentage of the population ignores social distancing, the scenarios I imagined in this post multiplied by millions could be the ultimate cost. That is a really horrible thing to imagine. But it's not imaginary. It's already real in places like Italy. It's already starting to become real here.

Every time someone ignores social distancing, they potentially add to that cost. Every time someone decides to get together with a group of friends because they think this can't hurt them. Every time people go and play basketball at the park (playing basketball is something I really miss right now, but I understand why I can't do it!). Every time a business owner decides their business is essential when it isn't really essential and keeps their employees coming into contact with each other and with other people. Most especially every time someone in a position of government authority makes a decision to not enact strict social distancing measures when all the evidence and all the experts say it's imperative we do that right now. Every time someone does one of those things, it's potentially adding another name to what will be a very long list of people who had to suffer alone in a hospital without their loved ones visiting them, to die not because there was nothing that could be done to save them but because there weren't enough resources to do it, and then to not have a funeral to give their loved ones some comfort at such a horrible time.

That's the cost. Please do everything you can to minimize that cost. Please. I know most of my friends are already taking this seriously, but if you aren't, please, please do. And if you know other people who aren't taking it seriously, please, please pass along this message to them. It could be one of the most important things you'll ever do in your life.