Transplanting a Seattleite

I’ve been listening to a _lot_ of episodes of Maintenance Phase. Yesterday, among many other episodes, I listened to the one about the reality TV show The Biggest Loser. I used to watch this show, and while typing this, I searched this blog to read what I had to say about the show at the time. The podcast episode played various clips of the trainers being exceptionally awful (Old Skool Drill Seargent Style) to the participants. I had _hoped_ that they would find and discuss that bizarre episode where they visited the trainers’ houses and looked in their fridges and it turned out that Jillian’s fridge was completely empty except for bottle water and ice cream. (Spoiler: they did not.)

I stopped watching The Biggest Loser (and What Not to Wear and Clean House) many years ago, and for the most part, years before those shows stopped being produced. Listening to the podcast got me thinking about what those shows had in common and how my perspective on those shows has changed over the course of my life (and my kids’ lives). I’m a big believer in the idea that a lot of “gossip” (talking about absent third parties), especially the judgier aspects (whether that’s “positive” or “good” judgy, or “negative” or “bad” judgy, just all the judgy, all the Good for Her and Boo Hiss and etc.), is a way of talking about our values in the specific without directly pushing those values on a specific person who is there at the moment because that would be squirmy and awkward, whether we were saying nice things or not nice things. It’s probably not a great idea to tell people, Hey Don’t Ever Do That! And also, it won’t work, and I’m pragmatic enough to care.

Listening to the podcast, I realized that part of what happened with The Biggest Loser — and quite possibly with the other shows as well, especially What Not the Wear — was that the shows got more aggressive in their speech, more critical in their speech, and more normative in their speech. There was less celebration of the person’s own uniqueness and more cookie-cutter aesthetic. And a lot of the cookie-cutter aesthetic was not particularly appealing to me. The joy in those shows was getting to see in a parasocial way a really wide range of humanity in all their bumbling wackitude, and over time, the shows became harsher and harsher in their reshaping project and I wasn’t really there for that.

I didn’t quit being a JW because JW’s interpretation of the Lord’s Prayer is as a wish for the deity to come hurry up and kill everyone else so they can enjoy Paradise on Earth forever. The fundamental genocidal impulse baked into JW — and a lot of other literal, primitive, eschatology focused xtian groups — was clear to me, but that wasn’t why I left. I often say I _wish_ I had left for that reason, because the person I yearn to be is a person who is horrified by that genocidal impulse and sets a super clear boundary and so forth. But I’m really not that person. I mostly perceive that genocidal impulse as a manifestation of inchoate frustration and rage and disappointment and sadness that has transmuted into anger and things like that. It inspires in me a combination of eye roll and “there there” and a desire to go do something more fun, rather than revulsion.

So I must confront the fact that I watched The Biggest Loser and was not completely horrified by it right from the beginning. I’m not going to go back and rewatch things to see, well, was it really that bad in the beginning? I’m totally prepared to believe it was, at minimum, far worse than I had imagined at the time. I’m also very clear that at the time, I was still very much in the mindset of I Would Someday Once Again Be Smaller Than I Was at the Time, and I was still trying to figure out how to re-establish routines of eating and exercising that having two kids severely disrupted.

Anyway. I’m listening to an episode of Maintenance Phase now that is about eating disorders, and fat people having eating disorders and really severe physical symptoms (amenorrhea, vomiting blood, resting pulse below 30, stuff like that) and people who specialize in eating disorders denying them access to treatment because they are fat. Like, it _can’t_ be disordered eating, no matter what you are doing, and no matter what effect it is having on you, if you are not dangerously underweight. There’s a lovely guest on the show, and she’s articulating an alternate definition for eating disorder that does not rely upon the person’s size, or on the specific physical symptoms, but rather from a psychology perspective of, “How much does this interfere with your life?”

I don’t know _why_ I only just now heard that phrase for what it is. It is _all over_ the DSM. It _is_ an improvement over earlier, more clearly role adjustment phases of psychology, in that it focuses on the presenting client, and not the other people around them who want them to be other than they are. _But it still takes the existing environment of the client for granted_. If you are trying to follow bog standard eating practices for your culture, in your culture, like — in ours — 3 meals and a snack or two, composed of a protein, some fruit and/or veg, some more grain or potato component, with some kind of seasonings including some amount of sweet and some amount of fat and perhaps an alcoholic beverage if an adult or juice if a child — but you are surrounded by people who think that you should eat at most 2 meals a day, and the first one should not be until noon or ideally later, and who think that 1200 calories is too much and you should be aiming for 800 and the mile you walk twice a day is absolutely inadequate and you should be running, and aiming for a minimum of 3 and ideally five miles a day, etc. Well, trying to eat in that bog standard way is going to conflict a lot with the people around you. The picture I am painting here is one of a deeply fucked family environment and one more or less sensible person who is well adapted to a larger group in the culture around her. But it’s not _that_ hard to run through the many people you know in your life and realize just how much of a problem it is to define “hey, it’s a problem when this, but not that” based on “does it interfere with your life”. It’s _one step_ away from, “hey, your husband wants you to change and I’m here to make that happen for him, and that means you are going to have to be different than you are or want to be”. But it is not a meaningful distance down the path.

I know it’s not cool to criticize when not having an alternative suggestion, so here is my alternative suggestion. Rather than saying, it’s not a problem if it isn’t interfering with your life AND it _is_ a problem if it _is_ interfering with your life, let’s just assume that if the person is asking the question, “Hey, is this a problem?” We should probably respond with, “What would be a satisfactory answer to that question _to you_?” AND think for ourselves, “What is a satisfactory answer to that question _to me_?” Find the shared bits, do those first, and then decide how much appetite remains to proceed along this or any related path. My hope is that would move everyone in a solution focused, “What Is It I Want?” direction, which is probably more helpful than debating the eating-disorder-ness in some sort of Platonic sense.

Obviously, don’t do this while someone is crashing. Do all the first-aid-y type stuff first. And if you are running a clinic for eating disorders and someone comes in and asks for treatment, your symptom checklist cannot be allowed to reduce down to a number on a scale.

Further! I would _expect_ that a lot of what would come up when the question, “What would be a satisfactory answer to that question _to you_?” would be a lot of rambling commentary about, I just want everyone to let me be me and yet these specific people in my life are giving me a bunch of shit about this list of things. That would help identify the context where conflict is occurring _and_ provide a basis for getting some color on that conflict. From there, a list of I Could Change This Thing I’m Doing and That Would Get Them to Back Off could be developed AND a list of What Do We Want to Ask of the Other Side / Can Those Relationships Be Wound Down in an Orderly Fashion. A lot of really painful conflict becomes more manageable when we have a timeline for when we won’t have to deal with those people as much / ever again. I know that sounds hard, but it’s probably a more productive choice than trying to adapt to the demands of mean people who are asking for impossible and undesirable things. If you are a member of a genocidal cult, your best path forward involves planning how you are going to leave. If you’ve got a lot of interpersonal conflict and family pressure that revolves around eating practices, that is not likely to be solved by focusing exclusively on your own eating practices. You are also going to need to have some kind of a strategy for navigating the relationship pressure as well.

Oh, yeah, a couple more observations.

If I watched Ruby and The Biggest Loser and perceived it as being much _less_ fat-bashing than I expected, but failed to notice the real problem with The Biggest Loser, part of which was the completely inappropriate and dangerous volume of exercise and the punitive nature of the exercise, but most of which was just how _everyone_ completely bought into the idea that being fat was Not OK, and I now listen to the podcast and I can hear just how much of a problem it is to just assume that Being Fat Is Not OK and relentlessly refuse to engage with the most basic and pervasive scientific evidence that, actually, being fat is definitely better for you than being underweight and probably also better for you than current definitions of “ideal weight”, where am I going in the future? I _feel_ like in the future, I’m going to listen to clips from The Biggest Loser and go, That’s a Criminal Threat, that’s Harassment, and the whole show is a hate crime.

Weirdly, that makes me feel very optimistic about the future, and our future increased capacity for compassion.

R. (Husband — there are so very many R’s in my life) and I have been back and forth many times for the last year plus over China’s efforts to prevent all community transmission of covid in its many variants. I, personally, have been incredibly impressed by their success at keeping case numbers, hospitalizations, deaths — all possible measures — so very, very low. The people of China can rightly be proud of how well they have worked together through an incredibly difficult process, and I believe the government in China can be proud at having succeeded in a task broadly understood to be impossible elsewhere in the world. It’s easy to point to New Zealand, or even Australia, however, they are much smaller, and have more favorable geography. And you can’t say, well, it’s a dictatorship, they can do anything, because there are plenty of dictatorships on this planet and none have accomplished anything nearly so impressive as China’s control over community transmission of covid in its many variants.

Alas, now we have this:

https://apnews.com/article/coronavirus-pandemic-business-health-beijing-xian-6767d4005dc16652da5c9ade29fd632a

The Winter Olympics are coming, and here is Omicron so very difficult to stop, and a city in seemingly endless lockdown, having all the usual and expected troubles replacing the usual mechanisms for food distribution with ones that create far few opportunities to transmit the virus. But this is so much worse. China has, in a short period of time, flipped first from a one child policy, to a two child policy for some, to a two child policy for all, to a please have three policy, to making it incredibly difficult to get a vasectomy and increasing fear among young people that other forms of birth control, such as the pill, will also be taken away or severely limited.

And now, a pregnant woman cannot get care in an emergency that results in miscarriage, because of efforts taken to prevent transmission of covid.

That’s not, “we’re running out of vegetables”. That’s a deep fissure. That one is going to be trouble.

When I was in college, I had a friend who was doing microbiology. She switched majors a few times, and ultimately wound up doing counseling. She was very, very smart, and quite fastidious. Despite being very, very smart, and quite fastidious, she wound up bringing home at least one of the things she was working on in the lab. It was a pretty boring thing! Like, rhinovirus level of boring. But she commented on it, and I think it was a motivator to _not_ orient towards doing bench science for a living. On some level, when you are culturing stuff and looking at it, there are risks.

That was decades ago, sometime around 1991, give or take. We lived in a world that was soaked in fear of AIDS, and Laurie Garrett’s _The Coming Plague_ hit hard when it came out, as did Preston’s _The Hot Zone_. The first antivirals were available, but they had problems — they had bad side effects, they were crazy expensive and they were hard to access. It was also a world in which a lot of people were blaming the victim, and using moral frames for viral activity (yeah, because a virus is a capable moral agent, for sure!) and airbags in cars in the US were still a very new thing. The homicide rate was high. E Coli outbreaks were on the rise. Mad Cow and BSE were entering our vocabulary and a whole lot of us were learning a whole lot of things that were deeply terrifying, which sort of compensated for the reduction in terror of the end of the Cold War.

Also, in this rough time frame, Rand Paul’s father was running for office and running a creepy newsletter, and participating in a lot of nonsense about the possibility that AIDS was the result of US government researchers engaging in experimentation to create a deadly virus under the auspices of WHO.

This week, there was an entertainingly heated debate between Rand Paul and Dr. Fauci on the topic of whether the virus of our age might have been the result of gain-of-function experimentation. Fauci — correctly — wasn’t having any of that.

Gain of function is just a fancy term of art for the kind of thing that Rand Paul’s dad accused the US and WHO of doing to create AIDS — science taking some kind of material that is a problem on its own, and making it even worse, weaponizing it, whatever. Gain of function does _not_ include assessment of the existing capabilities of a virus. If you have something you isolated, and you infect a lab animal with it, to see what that does, that’s not gain of function. You have to tinker with it for it to qualify as gain of function. The research that Rand Paul is pointing to is _not_ gain of function research; it was about looking at viruses collected from bat guano and whatever in a cave, and assessing whether those viruses had the capacity, _in vitro_ of infecting human cells. They concluded that some of them could infect ACE2 cells. Which does, indeed, seem relevant. This was useful research. We needed to know this.

When Rand Paul and the other right wingers made their predictable accusations that It’s All Someone’s Fault and It Was On Purpose and It Was A UN / WHO / government Conspiracy, it was all about someone doing something on purpose to take a virus and make it worse. On purpose.

The research now being pointed to is research that basically found our problematic virus or its very close relative in the wild. I am prepared to believe that something along the lines of what happened to my college friend happened in conjunction with this or similar research. I am also prepared to believe that some animal in a live animal market caught that kind of virus from a bat, was then captured, brought to the market, exposed other animals and humans to the virus, and so forth. I am even prepared to believe that this has happened more than once in the past, and this is just the one where there was a lot of air travel and it got other places fast.

I do NOT want to see the kind of thing that happened to my friend in college with a rhinovirus-type-event turned into blame for the pandemic, because people LOOKED for guv-mint / UN conspiracy and couldn’t find it, so they downgraded it to “lab leak” and hoped everyone would notice that this isn’t actually gain of function, and it’s pretty boring, and it could just as easily happen with someone raising horses or whatever that happened to hang out under the wrong tree at the wrong time (Hendra). Ron Paul was wrong. Rand Paul is wrong.

https://www.washingtonpost.com/technology/2020/11/11/masks-qanon-target-melissa-rein-lively/

PR person (contractor? Freelancer? How is this not some shade of “influencer”?) apparently had a dissociative episode at a Target and wrecked a display of masks. But it wasn’t _that_ dissociative, because she took video and posted it on Instagram Live. *shrug* Anyway. Bad times followed, and she is now doing the apology tour. I have a couple issues with this article.

First — and this is probably the most and possibly the only important objection — “This story has been updated to include information about Lively’s racist language that came to The Post’s attention after publication.” This is not some nice person who got sucked into Qanon (if such a thing even ever happens — I am still unsure); this is someone posting n-word and anti-burqa stuff. _And then this was concealed in the apology tour._ Apology tours are fine, but just like BK, you are supposed to bring _all_ your bad in at once. If you do not bring in all the bad, and we find more later, we are going to wonder what else you’ve tried to bury.

Second — and indirectly related to the first — is her attack on cancel culture.

If you have _any_ understanding of cancel culture _at all_, you understand that what is being canceled is reprehensible behavior by people who do it so consistently and egregiously that the person has become a problem because it is clear that that behavior is part of their identity. Thus, the canceled ism includes canceling that person’s access to our collective attention. People who relentlessly abuse those without power need to have their power taken away from them. That is canceling.

Instead, this woman focuses on all the death threats and threats against her puppers and whatever. Which is def not fun stuff! But tons of people have to slog through that shit all the time, canceled or not canceled, it is part of being at the center of cultural conflict. She seems to think that _having brought that down on her own damn head_, she deserves some sympathy there, and wants to center herself as a hero for having the “courage” to fight back against that.

Reprehensible behavior needs to be pushed back on; people who persistently engage in it need to be pushed back on. Anyone wandering around, having behaved reprehensibly, saying, oh, gosh, I needed some therapy, I’m a nice person, I helped people, etc., has _missed the point_.

The apology tour should be OMG I am so sorry I did that and I am in therapy and I am getting better and I am taking steps not to wind up in that bad place again etc. And if she wants to go around and center Qanon as a problem, I am interested in hearing more about her experience and even her ideas about how to help wind down that hot spot of crazy. But attacking cancel culture is not the right approach here.

Sample coverage:

https://www.medscape.com/viewarticle/937387

I first saw this on the alexa device in my kitchen. Basically, the same kind of people who relentlessly bask in the sun tend to overdo on other things that are harmful to their body, and so if you are interested in further reducing skin damage / skin cancer due to sun exposure, ya gotta design your messaging accordingly.

Things I have learned:

(1) There is a journal called Investigational Dermatology. I mean, what’s not to love?

(2) The first thing I wanted to do with this information was craft a “Florida Man” or “Florida Woman” joke, in which the punch line or set up was, “The next time you are tempted to make a Florida Person joke, consider this.” Which, you know, self-referential / hypocritical / offensively moralizing, etc.

Things I have not learned, but would observe anyway: all my anecdata lines up with this result.

Journal article can be found here: https://www.jidonline.org/article/S0022-202X(20)32049-2/fulltext

At least as I post this, the full text is available with no paywall / credentialing required.

ETA:

OK, so, I have read it once (but not the methods and materials, because come on). I would observe that overall, this is a stupendously well-put together piece of reasoning with solid evidence in support. The twins study shows very strong heritability. They separated out sun-exposure-at-home (easy) from sun-exposure-from-travel, and addressed class issues inherent in the latter. They did recognize that kids do not get to pick where they travel; they did NOT adequately address spousal influence on travel choices, but, shrug.

Because this is a bunch of dermatologists (I mean, duh), there is a specialty-wide blind spot involving vitamin D. Because the risk of skin cancer goes up with exposure to sun, and because the sun does a lot of un-aesthetic things to skin, dermatologists are pretty anti-sun. They consistently ignore other body systems, their cancers, and how vitamin D modulates them (short form: if the dermatologists eliminated skin cancer by getting everyone to avoid the sun, total cancer and total morbidity and mortality from cancer would skyrocket because of the drop off in vitamin D). And because this is a bunch of dermatologists, their goal here is to figure out why all their advice about avoiding the sun is conspicuously Not Working. This is a theory about why it is not working (sunseekers are addicts, and our messaging did not take that into consideration, so we should).

It is quite difficult to imagine that taking the addictive nature of sunseeking into consideration in messaging about sun exposure is going to help. I mean, it is not like our other messaging around addictive stuff works particularly well! But I would further note that as with the cancer / vitamin D issue, it might be counter productive. That is, if a bunch of addicts suffer from executive function issues, and overconsumption of mind-altering substances and are also sunseekers, and you _stop them sunseeking_, what happens to the rest of the profile? I bet it does not get better! If a bunch of addicts are substituting from MJ or alcohol or nicotine or whatever to sun, you do not want to reverse that!

Finally, I am once again forced to wonder about why we are not including in this type of analysis any kind of detailed vitamin D status. (Probably not in the data sets! But maybe — NHS has a lot of stuff in it.) I _know_ that people who over-generate vitamin D from the sun avoid it like They Hate to Be Called Vampires. I also know that there are people who do bonkers things to get more sun. Are they doing that because there is something messed up with their ability to produce vitamin D? If we got them vitamin D in the right amounts at the right time, would they quit overdoing the sun exposure, the MJ, the alcohol, the nicotine, you name it?

I do not know if we are headed in the right direction, but this was a really interesting presentation, and I would encourage people to think pretty hard about the elements of it. We worry about a lot of food / vitamin / health behavior stuff, but I feel like the vitamin D thing is still poorly understood and what is understood is underappreciated.

WaPo coverage (sample — you can find lots of articles about this):

https://www.washingtonpost.com/health/2020/07/31/georgia-children-covid-outbreak/

The report can be found here:

https://www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm

I will henceforth refer to this camp as Camp C19.1.

In Georgia, tested everybody ahead of time.

“Camp A adhered to the measures in Georgia’s Executive Order* that allowed overnight camps to operate beginning on May 31, including requiring all trainees, staff members, and campers to provide documentation of a negative viral SARS-CoV-2 test ≤12 days before arriving.”

Please insert locking the barn door jokes here.

OK: masks on staffers yay, no masks on kids, boo, did not open windows and doors (yeah, see, the HVAC thing really does matter, and I get that Georgia in June is miserable beyond belief and that is why we need UVC in the HVAC). Daily vigorous singing and chanting. Yep. That’s summer camp, all right!

It is the timeline, however, that is absolutely astonishing:

“During June 17–20, an overnight camp in Georgia (camp A) held orientation for 138 trainees and 120 staff members; staff members remained for the first camp session, scheduled during June 21–27, and were joined by 363 campers and three senior staff members on June 21.”

I know, you are like, what is so astonishing about that?

“On June 23, a teenage staff member left camp A after developing chills the previous evening. The staff member was tested and reported a positive test result for SARS-CoV-2 the following day (June 24). Camp A officials began sending campers home on June 24 and closed the camp on June 27. On June 25, the Georgia Department of Public Health (DPH) was notified and initiated an investigation. DPH recommended that all attendees be tested and self-quarantine, and isolate if they had a positive test result.”

So, ya got a symptomatic staffer on 22 (left on 23), and DPH is notified on 25. No way that is not 48 hours later than it should have happend, but there is a positive test result on 24, and the notification happens on 25.

Really.

And we are sticking to the kids do not get it / transmit it theory?

Enjoy this bit!

“A total of 597 Georgia residents attended camp A. Median camper age was 12 years (range = 6–19 years), and 53% (182 of 346) were female. The median age of staff members and trainees was 17 years (range = 14–59 years), and 59% (148 of 251) were female. Test results were available for 344 (58%) attendees; among these, 260 (76%) were positive. The overall attack rate was 44% (260 of 597), 51% among those aged 6–10 years, 44% among those aged 11–17 years, and 33% among those aged 18–21 years (Table). Attack rates increased with increasing length of time spent at the camp, with staff members having the highest attack rate (56%). During June 21–27, occupancy of the 31 cabins averaged 15 persons per cabin (range = 1–26); median cabin attack rate was 50% (range = 22%–70%) among 28 cabins that had one or more cases. Among 136 cases with available symptom data, 36 (26%) patients reported no symptoms; among 100 (74%) who reported symptoms, those most commonly reported were subjective or documented fever (65%), headache (61%), and sore throat (46%).”

Remember: in this report, _they still do not have tests on everyone_.

I would also like to note that when this camp occurred, (1) I _visited Georgia_ (stayed a night in Savannah and (2) available statistics at the time for various places around the country made the choice to get on those flights and spend time in Georgia and SC look pretty reasonable.

There are obviously a lot of things that people are planning on doing differently to reopen physical schools. (No singing, for one thing!) But it is still hard to get kids to wear masks (who am I kidding, it is not easy to get adults to wear masks) and the HVAC problem remains as yet unmitigated.

ETA:

Indiana school opened, had a case on its first day, plans on staying open until it hits about 20% absentee rate.

https://www.nytimes.com/2020/08/01/us/schools-reopening-indiana-coronavirus.html

And in Connect the Dots — which has done an amazing job getting its numbers down — teens are partying with predictable results.

https://www.nytimes.com/2020/07/31/nyregion/greenwich-ct-coronavirus-covid-parties.html

Look, writing about kids and social / emotional / mental health is, all by itself, no matter how it is done, deserving of a trigger warning. Everyone was (once) a child, which means that reading about the social, emotional and mental health of children reminds one of that childhood and that, all by itself, no matter the content, is hazardous.

So, Warning! Danger!

OK, so I have no idea if I am going to put together a real post about the reopening of schools and balancing social / emotional / mental health of kids vs. you know, killing them / their family / their friends / their teachers. But I am going to put together some links here and see what I think after a bit.

https://www.npr.org/2020/05/14/855641420/with-school-buildings-closed-children-s-mental-health-is-suffering

This is an NPR post from the middle of May. Remember, in the middle of May, things were super dire in the Northeast, and not bad at all in most of the rest of the country. Effective techniques were adopted in Seattle and the Bay area to keep their initial outbreaks from swamping their hospitals, however, which created a cohort of people who were talking and writing about the epidemic as Not That Bad / Manageable, while simultaneously seeing the massive impact on their lives of the measures taken to keep it from getting that bad.

This article quotes a couple of people who had not yet seen how bad it could get personally (Rand Paul, the pediatrician) to counter a quote from Fauci. Then there is a section in the middle about “Sarah” and her daughter “Phoebe”. Dad is mentioned as also having a job in tech, but while Mom has taken administrative leave, Dad is apparently working and the parents have thus seemingly adopted a Trad Gender approach to managing the abruptly worsened workload.

It is almost impossible to imagine that “Sarah”, the mother, is happy with this situation, and for a variety of reasons, we had not yet seen men / fathers really stepping up in a big way to take on their share of the suddenly worsened workload (I recognize that not all men / fathers did step up, and apparently I have SILs who know a lot of people getting divorced. Pretty sure those are not unconnected, however, it could just be that spending a lot of time together forced people to realize that they actually hate each other.

Anyway. Phoebe is

I FUCKING WARNED YOU SO DO NOT COMPLAIN ABOUT WHAT COMES NEXT, ALL RIGHT?

Engaging in death wish verbal expression, and also expressing some deeply problematic perceptions of family dynamics that may or may not have a basis in reality. Phoebe has just turned 5 and her birthday party was canceled. I have NO MORTAL CLUE what any of this has to do with school. Anyone who thinks that a return to school is going to help Phoebe with her Not Caring About Living or Dying suffers from a dangerous degree of magical thinking about the Powers of School.

I mean, on some level, by letting mom go back to work, and putting Phoebe in an environment full of other kids to play with and other adults to pay attention to her, _maybe_ Phoebe will become less depressed and thus less death-wish-y. Maybe. But she might actually have really significant other problems that were going to crop up even without a pandemic canceling her birthday party. And, you know, exposing some family issues that they could maybe use some help with.

OK, diving back in to get more linkage.

Upworthy provided a link to something I have seen circulating in many places

https://www.upworthy.com/school-reopening-kids-mental-health

This is really good amplification; hard to beat the rhetoric or framing. Thoughtful. From a person with current, relevant expertise.

This is a stunningly Say Nothing piece.

https://www.masslive.com/opinion/2020/07/the-case-for-reopening-schools-in-massachusetts-guest-viewpoint.html

Basically, a couple of medical types endorse DESE recommendations, while fully endorsing the Kids Do Not Get It Or Transmit It (much) frame.

I want to point to two particular paragraphs as really egregious:

”Children with emotional, psychological, or developmental disabilities often receive necessary services through schools. Because some of these services were put on hold, continued school closures have been especially detrimental to this group of vulnerable children.

The harms of remote learning have been felt most significantly by children already at risk. Children who rely on school lunch programs faced added food insecurity. Lack of access to technology and online resources significantly limited remote learning. We remain concerned with how school closures will exacerbate achievement disparities across income levels and ethnic and racial groups.”

We offer food and other services to kids through the public school system _because the kids are already there and it is easy_. Reopening the public school system in order to deliver food and other services is NOT easy. Actually it is breathtakingly short sighted and displays poor judgment.

Also, delivering services in this way (at schools, and only to people at schools — so, you know, if you are hungry or in need of social services of any sort but you are aged out of schools, fuck you anyway) is just another example of The Worthy Poor / Respectability Politics. Marginalized people do not want to get what they need while also being put at risk any more than anyone else does. Not a good look for liberals, no matter how Lady Bountiful they feel when they say it.

School Has Been Canceled!?!

ABRSD canceled school from Friday March 13-Friday March 20, with the understanding that the cancelation might go even longer. Other school districts and colleges and universities around the country and around the world had already canceled school, some of them for much longer. For example, school districts in Washington State, in Pierce, King and Snohomish Counties, canceled school through April. That is six weeks of No School! These cancelations happened because people are afraid that a disease called coronavirus (SARS CoV 2, or COVID 19, or several other names) will fill up our hospitals with people who have severe viral pneumonia and need oxygen and other medical technology to survive. If there are too many people in the hospital with those needs at the same time, the hospital will not be able to help everyone effectively.

How Does Canceling School Help Hospitals?

In general, viral disease can spread through touch. When a person with the virus touches another person, the virus can be transmitted. When a person with the virus touches an object, and another person touches the object, then the second person can pick up the virus from the object. When a person with the virus sneezes or coughs, viral particles go into the air and can land on surfaces, or other people, or be breathed in, and people can get sick that way, too.

The more people are crowded together, the faster the virus goes from person to person. By not touching each other, washing our hands often (in case we touched a virus on a surface), by avoiding touch our faces (where it is easy for a virus on our hand to go into our mouth or nose and thus make us sick), and by cleaning commonly touched surfaces (door handles, for example), we can slow this down. But the best way to slow transmission down is for people to have some distance from each other. At school, we are pretty close together a lot: on the playground at recess, in the halls and in the cafeteria at lunch. But also just sitting in the classroom, we are usually closer than 3 feet from other people. The recommended distance to keep from other people for effectively stopping transmission is 6 feet. That is very hard to do in a school.

By closing schools, the disease should spread more slowly. While young people mostly get very mild cases of this disease, they do not live by themselves. If a young person catches this disease at school and goes home, they might give it to a parent or other family member who gets very sick and needs to go to the hospital. If all young people catch this disease at school and go home, they might get a lot of their family members sick, and overwhelm the medical system.

How Long Will This Last?

We do not know.

Different people have different ideas about how long this will last. In China, the first case of the disease appeared in December of 2019, and while China is still monitoring very closely for more outbreaks, it looks like things in China were a lot better after about three months. They had to do many things to stop the disease, not just cancel school. They stopped almost all things in the city of Wuhan, and its province, Hubei, in order to keep the virus from spreading throughout China. It did spread, but other places were able to do things earlier to keep it from getting as bad in other cities and provinces. We are hoping that we can be more like those other cities and provinces, by canceling schools and doing more social distancing, earlier in this outbreak.

The virus is in other countries also. Italy is starting to do a lot of the things that China did in Hubei, to try to stop the virus. We do not know as much about what is going on in Iran, because it is much more difficult to learn about what is going on in Iran. Some smaller cities and countries, such as South Korea and Singapore, also had the virus, but they quickly identified through testing where the virus was, figured out who the virus might have gone to next, and carefully isolated those people early on.

[Why Do We Not Test People For the Virus in the United States?

We do not have enough tests. We tried to make a test back in December, when this first got started, but it turned out the tests we made did not work very well. We are trying to make better tests, but until we have lots of better tests, we cannot use the strategy that South Korea and Singapore used to identify who has the virus and who they might have given it to, to stop the spread of the disease.]

Because we cannot do things the way South Korea and Singapore did them, we cannot expect that the virus will be under control here as quickly as it was there. We should probably expect that things will take about as long to get under control here, as it took China to get things under control. That means about three or four months.

Flu and other diseases that affect breathing and make you cough (respiratory diseases) tend to be much worse in the winter (in our part of the world; rainy season in other parts of the world). We do not know exactly why this is true. Some people think that temperature or humidity make it easier or harder for the virus to live on surfaces for longer. Some people think that social distancing is naturally greater in summer than in winter (or the rainy season), and that is the reason. We do not know if this coronavirus will naturally get better in the summer. We hope that it will.

If we think it will take about three or four months to get coronavirus under control in the United States, that means we think it will be much better in June. If we think that summer will help get the coronavirus under control in the United States, that means we think it will be much better in June.

Obviously, we hope that school will be able to start sooner than summer! And we also are worried that just like the flu gets worse in the fall, this or a similar virus might come around again next fall or winter. What changes can we make longer term to help us avoid having to cancel school in the future?

Managing Future Outbreaks of Viral Disease

We can think about how to rearrange our society to have greater social distance built into it naturally. More people could work from home. More schools could have tele-learning all the time, or as an option.

We need to make sure that we get better at testing. The scientists and doctors who develop the tests, and the companies that make the tests, need to have enough money all of the time to be ready to create an effective test quickly when there is a new disease. Also, we need to listen carefully when scientists and doctors say that a new disease is spreading, and not try to stop them talking about it.

We can do things to reduce the amount of work the health care system has to do during an outbreak. Right now, if you have a mental health crisis, or you have broken your arm, or you have a fever, or you cut your hand while chopping vegetables, you all go to the same place: the hospital emergency room. If we could separate some of these things out during a disease outbreak, we could better use our resources and not overwhelm our system. In China and other places affected by an earlier coronavirus called SARS, they set up fever clinics just for people who had a fever to go to get tested. They carefully protected the health care workers who did the testing to make sure they did not get sick. South Korea has drive up fever clinics; people do not even get out of their cars. This also helps to ensure social distancing between the people with fevers, so if a person has a fever from the flu, and another person has coronavirus, you do not give the flu person the coronavirus and the coronavirus person the flu, thus taking two sick people and making them even sicker.

In Conclusion

School has been canceled, right now, here in Acton, for a week and a day. It might be longer. We do not know when we will go back to school yet. We are staying home, and avoiding large groups of people, to reduce the spread of coronavirus. We want to make sure that the people who do get sick can get good care at our hospitals, and that can only happen if there are not too many of them at the same time. Staying home from school, and not helping spread coronavirus, is how we can help prevent other people from dying of this disease. We probably will not get sick, and if we get sick, we probably will not get very sick. But other people might, and we care about them, too.

Would it not be absolutely awesome to read a scholarly article on that topic? I would love that! If you find some, please share with me!

In the meantime, let us cast our minds back to back in the Days of Yore, before we quit going to hospitals and checking into them for days or weeks at a time for things like having a baby or an appendectomy or pneumonia or whatever. Now, of course, we go to an outpatient doctor’s office, unless we are Super Modern, in which case maybe we use an app like roman or whatever the hell that thing is with the ads with the reddit guy who married the tennis star in them. If we do find ourselves at the hospital, we often never properly speaking check in — there is not an emergency room, there is an emergency department with multiple rooms, each with their own single bed, etc.

Of course, poor people in underserved areas must make do with existing hospitals and systems from the Days of Yore. But for most of us, for a few decades now, the question is about whether you get a semi-private room, or a private room — and even if you get stuck with semi-private, there will be a substantial curtain and probably no one at all in the other half of the room. Wards just do not even happen.

Notice I have not mentioned specialized isolation units.

So we all worry a lot about handwashing (you should wash your hands! Thoroughly. Especially before you eat. Do not touch your face! Stop shaking hands. Etc.). And that is a worthy thing to do! But there are fucking hard limits on the benefits of handwashing if you are in a bed, and a few feet away — less than 6, say — there is someone else. And there is no wall, no curtain, just you in a bed and them in a bed. Also, whenever they have visitors — and if they are not infectious, they will have visitors, because being in a hospital is worrisome for everyone so people come by with treats and flowers and books and charging cords and better food than the hospital serves or at least something more to the liking of the person who is stuck in that bed next to yours.

If you are in a hospital, and you have something contagious, and you are housed in such a large room with lots of people, bedridden, or a visitor of the bedridden, you are a Super Spreader.

Turns out the easiest way to make sure that does not happen is to Not Have Large Rooms With Lots of People In Them. So we do not do that any more.

But people who are not lucky enough to live in a country with the most fucking expensive health care on the planet DO often find themselves in hospitals, in wards. And thus encounter Super Spreaders.

These are cultural factors. These are things that really turn out to matter. Also, did I mention that we barely let anyone into the hospital and then we send them home as quickly as humanly possible? There is a really good reason for that. Diseases transmit really slowly from a person home alone to other people also home alone.

ETA: Really, stay out of the hospital. The 2015 South Korea MERS outbreak involved private or semi-private rooms, more than 6 feet apart, and like, 36 people on the same floor as the traveler caught it. Stay out of hospitals if you possibly can manage it. And think hard about places where a lot of people are sharing a ventilation system.

In general, my attitude about pandemics is strongly informed by how much I loved reading Albert Camus' _The Plague_ as a young person. So, you know, just keep that in the back of your head and assume I am always going to be a lot less prone to panic than pretty much anyone else who has noticed that a pandemic is in progress.

Earlier this heating season, there was a fair amount of loose talk about how it was going to be a bad flu year. I briefly considered getting a flu shot for me and/or my children, however, you are not supposed to get vaccines when you are already sick, and T. had been sick, on and off, since October (a couple rounds of diagnosed strep, lots of antibiotics, nebulizer treatments, etc.). I just could not work up the energy to care enough to go get shots for any of us. A. also was ill (much more briefly), and the rest of us had some kind of persistent respiratory and head cold thing going which was deeply annoying but not incapacitating.

We are all (mostly) better (finally). And now, there is quite a lot of loose talk about the coronovirus outbreak in China. I noticed when I started hearing about middle aged women buying surgical masks and N95 respirators, and then I started looking for news articles and apparently a lot of people have decided to hoard stuff in case the awful makes it here, and the people who actually need the masks to stay safe while treating people in the affected areas can just go fuck right off. I mean, I assume that is what mask buyers are thinking, and if you are buying and hoarding masks in the US and you do not have a compromised immune system yourself or live with and/or care for someone who does, or have a certification as an EMT, first responder, nurse, doctor, midwife, wtf, well, YES I did actually assert bad motive and reprehensible character to you as a person. And I meant it.

Obviously, if you always stock masks, the way everyone stocks TP and food and so forth, that is fine, and if you use them at a certain rate, maybe you could ration yourself a bit until the global need comes back down but you do you -- I am not asserting you are a problem. I am specifically being hostile to people who never normally own masks but are now going out and stocking them by the box.

OK, now that we are through the Do Not Do This part of the exercise, I will proceed to what I said in the subject line.

How bad will this one be?

My sister was a bit concerned, until she got a look at the demographics of the deaths. Once she saw it was predominantly older (and male), she relaxed. She figures that it is disproportionately hard on people who have lungs which are already damaged, such as by smoking. You can look at Chinese smoking demographics; the match looks pretty good actually.

Some years, the flu kills a lot of people. Other years, the flu kills a lot more people. The range is from low end 10s of thousands; the high end is hundreds of thousands. However, a lot of people who have looked hard at what happened in the really bad one (1918) have concluded that it would not have been nearly so bad if people had not been eating aspirin by the handful (oh, it was being prescribed that way by doctors, so, you know, shared blame. And people did not really Get Reye Syndrome until the 1960s, which probably goes a ways to explaining some other bad years).

Quarantining is no longer used for the flu, because ... insert laughter here. I mean, what is the fucking point. By the time you realize that there is a problem, there are a lot too many people wandering around spreading it, and (see hostile remarks about the mask buyers above) enough of those people will evade attempts to control their movements to render a quarantine absolutely pointless. (I have already mentioned Albert Camus.)

I am interested to see the results China gets from their quarantine decisions. We will all learn a lot from these efforts. I mean, if it works, at all, then it will be an indication that at least some stuff moves slowly enough to stop or meaningfully slow, and at least some countries have enough control over their citizenry to make it work. But that is learning that will occur in the future -- we should have an answer to that question around August or so.

In the meantime, attempts to figure out the mortality rate are absolutely pointless. We will not know until the sample population antibody studies are done how many people had this thing and completely failed to notice that they had it. There have been numerous past epidemics which made people look a bit foolish, when estimated mortality went from ... very high percentages to difficult to measure low percentages.

This is so unsatisfying! Obviously, if you are a scientist specializing in the development of new vaccines, this is an exciting time to be alive, potential funding sources are opening up all around to help you pursue your vitally important but generally underappreciated efforts. Of course, it is frustrating, because many people would LOOOOOVE to test your new ideas, and government regulators are peskily getting in the way and insisting on making sure the thing is safe before determining whether it is effective. For the rest of us, it is a great opportunity to flaunt our excellent handwashing habits, and

OK THIS PART I MEAN SO PAY ATTENTION GET LOTS OF SLEEP NOW IS NOT THE TIME TO EXHAUST YOURSELF

generally good habits of self care.

Watch the death count. It will accelerate for weeks until it gets to a total count of at least tens of thousands. That many people die IN THE US every year from the flu. If it starts to approach a hundred thousand dead, and is still accelerating, THAT is a really excellent time to panic, stockpile food and water, and stay home. Cancel vacations at that point matter where they are. Etc. But read that sentence carefully. It has to still be accelerating when it nears or hits 100K to justify panic. People will look at climbing deaths and tell you to panic, when it is decelerating. If you do not remember what these words mean, ask whichever of your kids knows enough to explain to you the difference between the first derivative and the second derivative.

But as long as it it NOT accelerating as it passes a hundred thousand deaths, we are still looking at a typical bad year for the flu type situation, NOT viral End Of the World.

If we do not get anywhere near a hundred thousand, it was not a serious problem at all, and you will all forget it happened unless you are unlucky enough to have been close to one of the victims.

Obviously, it is sad that so many people have gotten sick, and some of them have died. Equally, it is sad that there will be more deaths. Every year, more people die. Because there are more people to die. That perspective can be hard to sustain, but is worth hanging onto, while everyone around you enjoys the hell out of panicking about Viral Armageddon.