Weekly COVID Update – Dec. 10, 2020

The Data

No one who has a scientific approach to the pandemic expected anything but this, but the numbers are stark. We are facing growth rates that dwarf anything we saw in the spring. This is especially tragic, since in a few days, we will likely start vaccinating Americans, using vaccines that have an incredible efficacy rate. The question is, will you take whatever measures are necessary to survive until you can get that vaccine? Will you protect those around you who are especially vulnerable? Yes, most people may be wearing masks and distancing. But all it takes is 30% of the population around you to be ignorant, careless, or just plain idiotic to thwart the efforts of everyone else.

We won’t have a national plan to defeat the pandemic, at least one with teeth, until January 20, 2021 at the earliest. If things keep going as they are, that will mean another 120,000 people will die before we even get started.

Unfortunately, it’s up to you to save yourself and hopefully your family and friends.

On July 1, for every 170 people in California, one of them had coronavirus. Today, it’s one out of every 27 people. You’ve probably got 5 times that many in your network of family and close friends.

With Apologies to the TL;DR Folks

Now that I’m posting weekly instead of daily, these posts tend to be a bit longer. Regular readers expect this and even thank me for it. I don’t even have an account on Twitter, so I never practiced expressing all my thoughts in 140 characters. So if that’s your expectation, sorry, but these posts are not for you!

Liberty and the Tragedy of the Commons

 In 1833, a British economist, William Forster Lloyd, coined the phrase “tragedy of the commons.” He was referring to shared resources ruined by people acting purely in their own self interest. It’s a ubiquitous phenomenon. We see it when national parks are defaced with names scratched into trees. On a micro scale, we see it when public sidewalks are unpassable because of dog feces not removed by owners.

On a macro scale, in the most tragic way, we are seeing in in our public health care system. There are 25 million people engaged in this resource, and without them, many of us would live short and miserable lives. These are the people who bring us into the hospital because our blood oxygen level is falling. They are the doctors and nurses who hold the hands of the dying as they say their last words to loved ones over a Zoom call. They are the people who clean up the blood and mucous of the departed. They are the epidemiologists desperately trying to stem the tide of this awful virus.

The health care system is one of the biggest, if not the biggest, public resource in America. Just as litter and graffiti deface a national park, selfishness, ignorance, and apathy have made a tragedy of this commons.

Thousands of healthcare workers have been living in hotels, because they’re afraid to expose their loved ones to COVID. If they’re sleeping at home, they have to remove all their clothing and disinfect themselves before hugging their loved ones. Many, if not most of them expect to see a few deaths a year. They do not expect to see dozens of deaths a week, every week, for months on end.

This tragedy of the commons is made 1,000 times worse by the people who prattle on about their “freedom,” who consider it an imposition to wear a mask or refrain from having parties with people they don’t live with. People doing this are exercising their privilege, knowing that if they get sick, healthcare workers will take care of them — not because they are “heroes” but because it’s their job.

Almost 3,000 of them have died doing that job. But there are other wounds that aren’t as visible as lungs gasping for air. Imagine if you had to do their job, seeing people die day after day, many of them telling you with their last gasp, “I thought it was just the flu.”

These are psychological wounds, as real as those suffered by soldiers. But these warriors too often don’t hear “thank you for your service.” Instead, they have to listen to indifference at best, and denial at worst.

Most of you wholeheartedly support what’s necessary to get this pandemic under control. Others write to me protesting that I want to take away their “freedom” of their “liberty.” And there is a third group of people who wear a mask “most of the time” and who socialize with friends indoors, but “they don’t have COVID.”

This is the time to reexamine your practices. Are you wearing a mask but letting your nose hang out? Are you going to make a “little exception” just for Christmas? If so, you will very likely contribute to the tragedy of the commons, just as surely as an anti-masker.

On the other hand, there are some activities that are important to us psychologically and that pose minimal risks. I’m relying on the document from California state government, updated Dec. 3, 2020. I realize that some local authorities may not have the same restrictions as this document outlines. But my outlook is this: the CA State document prevails.

In assessing the tragedy of the commons, there are not two equal sides morally. On one side is society, and its shared common needs and goals. On the other side are selfish, greedy, or ignorant individuals who pretend that “liberty” is a philosophy, when in fact it is a cheap phrase used to justify selfishness.

Notes from the front lines (i.e., “the commons”)

For a more graphic look at this tragedy of the commons, from someone (special thanks to Redditor /u/cinemaphreak) with front-line experience.

  • Last spring we had 45 days to prepare for a possible bad “first wave” This is going to be on us in half that time.
  • “Pandemic Fatigue” has set in, made more dangerous by the complacency of months of low risk.
  • In the last 3 days multiple states are reporting that elective surgeries are postponed by hospitals. Very soon, it will almost certainly be all elective surgeries. Stage 1 & 2 cancer surgeries will have to be cancelled. Stage 3 will be forced to resort to chemo. A friend had stage 1 last spring and after the 2nd postponement his doctor urged chemo instead of waiting.
  • Hospitals being kept free of COVID patients to deal exclusively with heart attacks, organ failure, organ transplants and severe trauma are close to 100% capacity. Once they’re at maximum capacity, those will all become potential death sentences, since even if there’s bed/ICU space at locations with coronavirus patients the risk of post-op infection soars.
  • Non-COVID patients who get infected will have a very likely 20% fatality rate as their already compromised immune systems can’t deal with the post-op infection.
  • Once the hospitals hit capacity, all organ transplants will grind to a near halt (outside of clinics for the super wealthy) because of the immunosuppressing drugs would make many infections fatal. Those on waiting lists will have dramatically higher mortality rates as they wait for bed space to be opened up.
  • Masks are essential, but they are only one line of protection. “Essential” workers in settings where social distancing is impossible are at much higher risk, especially when such a high percentage of the population is contagious.
  • Once the situation becomes hopeless, front-line workers will walk off. A lot of the nursing staff are older and there was some drama last spring when they were basically being forced to endanger their lives without proper PPE.

Consistency

One very important point about “the commons.” You can’t get people to protect the commons if you don’t have a clear, simple message for the public to follow. We haven’t had any meaningful national leadership on the pandemic since it started. That left states to fend for themselves. Instead of having a clear, cohesive national plan, we have a patchwork of regulations, tiers, metrics, and exceptions that differ not just from state to state but county to county. This makes enforcement all but impossible and discourages even those who want to do the right thing.

I want to make it very clear that what I’m pointing out here is NOT a cause to recall the governor and install people who support Trump. It’s NOT a reason to give up following safety precautions. But we do need to let our elected leaders know that consistency is critical.

Here are just a few examples of what I’m talking about. Section IV of LA Mayor Garcetti’s Public Order bans travel by foot, getting together with people outside your household, etc. The Order is 12 pages long. I’ve read the entire thing twice, and I can’t figure out whether it’s OK to walk my dog around the block. One paragraph would lead me to believe that I can’t; another would make me think it’s OK, as long as I’m going to one of the 11 pages of business establishments that are exempt. But the state guidelines for Tier 1, or the Purple Tier, say it’s OK. In fact, Gov. Newsom encouraged people to exercise outside, as long as they weren’t congregating with people outside their household.

Wouldn’t it be great if there were one national system? Imagine if every city had different color traffic lights. In San Diego, red would mean go. In Orange County, orange would mean go. In LA, green would mean stop. Think there would be a few accidents? Well, that’s our national pandemic response – a crazy patchwork of regulations with so many exceptions it makes your head spin, and no federal financial support whatsoever to people and/or businesses who want to be safe. Ridiculous.

Think “American Exceptionalism” is a Great Thing?

Then read about life in countries that have controlled COVID.

LA Redditors: Help the LA Dept. of Public Health with COVID Data

I’m appealing to you to join Angelenos in Action, and not just you, but your friends, family, and neighbors too. It doesn’t take much effort on your part. Just do a once a week email or text telling them if you feel sick or not. If you feel sick, then there are a couple more yes/no questions about symptoms. That’s it!

Your data won’t be shared with anyone, so documentation, or lack of it, isn’t an issue.

How will this help? First, we know now that people can infect others when they have no symptoms. Typically, people might start with mild symptoms, but don’t get tested until they have more severe ones. This project can help communities get a better sense of when outbreaks are likely to occur.

Second, we know that vulnerable communities are getting hit the hardest by COVID. The information you share will help the LA DPH see trends that can give them better insight into how COVID-19 impacts specific communities and geographic areas. This can help them prioritize our public health response by helping them understand the health of LA County in real time.

Hundreds of you have been giving me upvotes and awards, and believe me, I appreciate it immensely. But this week, I’m asking you for a special favor. Don’t just click on the up arrow. Click here to learn more about the program, and click here to join!

Want to learn more about COVID and virology?

Redditors alerted me to a terrific YouTube series. I have to confess, I don’t understand most of what these guys are saying, but what little I do comprehend has really opened up my world, and it might do the same for you.

  1. YouTube: Prof. Vincent Racaniello – Virology 2020. Racaniello is Higgins Professor in the Department of Microbiology and Immunology at Columbia University’s College of Physicians and Surgeons. He is a co-author of a textbook on virology, Principles of Virology. His slides are absolutely fantastic, and every lecture astounds me with the cleverness and strange beauty of viruses, despite the havoc they have wrought in our lives.
  2. YouTube & podcast: This Week in Virology. Racaniello and his panel cover all the topics that come up during the week, focusing on COVID-19.

If you believe you’re an expert in this field, watch these videos. If you understand every word, then you probably are. If you’re like me, and half of what they’re saying goes over your head, you can thank them for saving you from the Dunning-Kruger effect.


Stay safe and healthy, everyone. See you next week!

4 comments on “Weekly COVID Update – Dec. 10, 2020

  1. Zorgi,

    As usual, you’re right on target with your analysis and commentary. Your discussion of Mayor Garcetti’s 12 page public health order and its confounding lack of clarity sent me searching for this: https://www.reddit.com/r/coolguides/comments/fmlg1y/communication_101_as_a_ux_researcher_i_study_how/?utm_source=reddit-android
    The need for clarity is even more pronounced when people are distracted, stressed and scared. It’s pointless in these conditions to use vague phrasing or novel terminology. The message simply will not get through and be remembered.

    It’s also been demonstrated that our brains operate differently (and far less efficiently) when we are stressed:
    The Brain’s Response to Stress – How Our Brains May Be Altered During the COVID-19 Pandemic: https://www.youtube.com/watch?v=TsQUeNuvIDY&feature=emb_logo
    Stress thwarts our ability to plan ahead by disrupting how we use memory: https://www.sciencedaily.com/releases/2020/04/200403115103.htm

    Combine vaguely worded, contradictory messages and stress-induced brain fog and the end result is non-compliance, defensiveness, and hostility: “How do you expect me to know what to do? I can’t understand it and it changes all the time anyway. F*ck you!”

    1. Thanks, Rebecca. As bad as some of the local messaging is, I don’t completely blame the politicians. Yes, I would like them to be a lot more clear. But we also have to take into account the lack of a national plan. If we had a cohesive national plan, part of that would be regulations, and part would be messaging and getting compliance. I don’t expect Garcetti to be an expert in all this, so it stands to reason he’s going to do some counter-productive things in an effort to get the pandemic under control. I certainly wouldn’t want to be in his position. And what’s compounding the whole thing is that McConnel has basically said f**k you to the whole country by not allowing a second relief bill to even come to the floor. This makes the job of local politicians almost impossible, since it forces them into the false choice between public health and the economy. On the bright side, there are only 3,628,800 seconds until Trump is gone!

      1. Zorgi,

        My comment about clarity was in reference to the nuts-and-bolts aspects of creating an easy-to-undertand document. I actually wasn’t considering anything beyond that. Garcetti’s office employs staff whose job it is to communicate with the public; my point was that these folks have been hired to provide information that is clear and unambiguious. If they can’t do that, and if they can’t coordinate their message so it is congruent with other state agencies, then they need to do better.
        I’ve spent over 20 years in higher education, not just teaching students but also writing and evaluating everything from course syllabi up through program assessments. I learned very early on–primarily because I worked for a program director who could not write clear instructions for any of our assessments–to have others (students or colleagues) read and review anything before it was finalized and distributed. Kinda like editorial beta-testing: If the smaller, hand-picked group struggled to understand the document, I knew I had to go back and rework it.

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